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When David Fajgenbaum nearly died of Castleman disease for the fifth time, he decided to take fate into his own hands. Using his medical training, he searched for an existing drug that might save his life—and found one. Now his organization, Every Cure, is scaling the same approach to uncover hidden treatments for other diseases with no known cure. David and Claudia discussed: How Every Cure is using AI to test 75 million possible disease-drug combinations The perverse incentives that keep generic drug repurposing in the shadowsWhy the hardest part of innovation isn't discovery, it's getting proven treatments into clinical practiceRepurposing existing drugs makes so much sense. But as David points out, there's no market for it:“Once a drug is generic.. the price is going to plummet… And even if you were to double the sales of your drug because you found a new disease area, now you've gone from 1% to 2% of what you got before… So there's no incentive whatsoever for our system to find a new use for a generic drug. Zero incentive.”Relevant LinksLearn more about Every CureRead David's book Chasing My Cure: A Doctor's Race to Turn Hope Into ActionWatch David's TEDTalk Listen to David's Podcast interview with Adam GrantGet info on the Dada2 FoundationWatch a video on Matt Might's story About Our GuestDavid Fajgenbaum, MD, MBA, MSc, is co-Founder & President of Every Cure and a physician-scientist at the University of Pennsylvania, where he is one of the youngest faculty members ever to receive tenure at Penn Medicine. He is also the national bestselling author of Chasing My Cure: A Doctor's Race to Turn Hope Into Action, which is being adapted into a film by Forrest Gump producer Wendy Finerman. During medical school, Fajgenbaum discovered a treatment that saved his own life and founded the Castleman Disease Collaborative Network. He has advanced 13 more repurposed treatments for cancers and rare diseases and co-founded Every Cure to unlock more hidden cures from existing medicines which has received over $100M from ARPA-H and TED's Audacious Project. He also serves on the Board of Directors for the Reagan-Udall Foundation for the FDA. One of the youngest recipients of multiple top NIH and FDA grants, Fajgenbaum has authored over 100 scientific papers in leading journals, including The New England Journal of...

Listen up - because your healthcare costs are about to increase! ACA tax credits are set to expire by the end of 2025, and millions are at risk of becoming uninsured. Learn about how our system leaves so many behind on how we got here, from Dr. Ricardo Nuila, author of “The People's Hospital: Hope and Peril in American Medicine.” He shared with the PT team about the Texas healthcare system, Medicaid, and more on living in the state with the highest uninsured rate in the country. Dr. Nuila works as an internal medicine doctor and hospitalist in his hometown of Houston, is an associate professor of medicine at Baylor College of Medicine, and has written for Texas Monthly, VQR, The New York Times Sunday Review, The Atlantic.com, and The New England Journal of Medicine. Learn more about Dr. Ricardo Nuila at https://www.ricardonuila.com.Thanks for listening! Learn more about Progress Texas and how you can support our ongoing work at https://progresstexas.org/.

Welcome to Ozempic Weightloss Unlocked. Today, we are diving into the latest news and updates on Ozempic, a drug reshaping how we think about weight loss, health, and lifestyle.In the past year, millions of people have turned to Ozempic, part of a group of medications called GLP-1 receptor agonists. Originally created to manage blood sugar for people with type 2 diabetes, Ozempic's appetite-suppressing effects have made it a sought-after tool for weight management. According to the Pennington Biomedical Research Center, these medications were developed from a compound first found in the saliva of the Gila monster lizard. It is amazing to think that a hormone from a desert reptile is now changing lives in clinics around the world.One of the most important updates is accessibility. The White House recently announced a deal with drug makers Eli Lilly and Novo Nordisk to cut prices for Ozempic and related drugs. The average monthly cost, once more than one thousand dollars, could now be as low as fifty to three hundred fifty dollars a month, depending on your insurance. Kim Fisher of the UC Davis Innovation Institute for Food and Health says around one in eight adults in the United States—about forty-one million people—have already used GLP-1 drugs. Lower prices open the door for many more people to take advantage of these treatments.For listeners looking for alternatives to injections, there is more good news. Novo Nordisk recently released results from a study on an oral pill version of Ozempic's sister drug, Wegovy. The New England Journal of Medicine reports that this once-daily pill resulted in an average weight loss of sixteen point six percent—almost identical to the weekly injection. While the pill is not yet approved by the Food and Drug Administration, it may become a game-changer for those seeking a needle-free option. Novo Nordisk says they hope to set a new benchmark for oral weight loss medications pending approval.If you are wondering whether these drugs only affect the scale, the answer is no. According to research from UC Davis and the University of California San Diego, GLP-1 drugs not only promote weight loss, but may also offer broader health benefits. Some of the latest studies show that these medications can lower cardiovascular risk, benefit blood pressure, and even reduce the risk of major events like heart attacks and stroke.Researchers at UC San Diego found that GLP-1 use among people with colon cancer was tied to much lower death rates—fifteen point five percent for those on the drugs, versus thirty-seven point one percent for those who were not. While the exact reasons are still being studied, experts believe these medications reduce inflammation, improve insulin sensitivity, and might even directly inhibit the growth of cancer cells.The way GLP-1 drugs work is by mimicking a natural hormone produced in your gut after eating. They help your body feel full longer, lower blood sugar, and curb cravings—especially for sweets and fatty foods. Patients often report that the constant mental chatter about food is quieter, making it easier to stick to healthy habits.With all the benefits, it is important to mention common side effects. Many users experience nausea, vomiting, or diarrhea, particularly when starting or increasing doses. Doctors recommend pairing treatment with a nutrient-dense diet, regular exercise, and enough protein to help preserve muscle mass.Experts are also discussing the need for ongoing research into the long-term effects and best practices for managing side effects. As these drugs become more widely used, scientists are working to make sure weight loss translates into lasting improvements for health and well-being.That is all for today's episode of Ozempic Weightloss Unlocked. Thank you for tuning in. To stay up to date on the next wave of news and breakthroughs, remember to subscribe. This has been a quiet please production, for more check out quiet please dot ai. Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI

Send us a message with this link, we would love to hear from you. Standard message rates may apply.We discuss a clear, practical guide to menopause, explaining what it is, why it happens, and how to manage the most common symptoms with everyday steps and evidence-based options. We set up next week's deep dive on hormone therap. • Defining menopause and typical timing• Why estrogen declines and bodywide effects• Common symptoms across sleep, mood, and metabolism• Hot flashes and night sweats frequency and duration• Vaginal and urinary symptoms that mimic UTIs• Bone density loss and changing heart risk• Lifestyle tactics that actually help• When to ask about hormonal and non-hormonal treatments• Teaser for hormone therapy update next weekSend us an email at yourcheckuppod@gmail.comReferences1. Menopause-Biology, Consequences, Supportive Care, and Therapeutic Options. Davis SR, Pinkerton J, Santoro N, Simoncini T. Cell. 2023;186(19):4038-4058. doi:10.1016/j.cell.2023.08.016.2. The Menopause Transition: Signs, Symptoms, and Management Options. Santoro N, Roeca C, Peters BA, Neal-Perry G. The Journal of Clinical Endocrinology and Metabolism. 2021;106(1):1-15. doi:10.1210/clinem/dgaa764.3. Management of Menopausal Symptoms: A Review. Crandall CJ, Mehta JM, Manson JE. JAMA. 2023;329(5):405-420. doi:10.1001/jama.2022.24140.4. Menopause. Davis SR, Lambrinoudaki I, Lumsden M, et al. Nature Reviews. Disease Primers. 2015;1:15004. doi:10.1038/nrdp.2015.4.5. Menopause: Physiology, Definitions, and Symptoms. Gatenby C, Simpson P. Best Practice & Research. Clinical Endocrinology & Metabolism. 2024;38(1):101855. doi:10.1016/j.beem.2023.101855.6. Reproductive Aging in Biological Females: Mechanisms and Immediate Consequences. Muhammad YA. Frontiers in Endocrinology. 2025;16:1658592. doi:10.3389/fendo.2025.1658592.7. Treating Menopause - MHT and Beyond. Davis SR, Baber RJ. Nature Reviews. Endocrinology. 2022;18(8):490-502. doi:10.1038/s41574-022-00685-4.8. Management of Perimenopausal and Menopausal Symptoms. Duralde ER, Sobel TH, Manson JE. BMJ (Clinical Research Ed.). 2023;382:e072612. doi:10.1136/bmj-2022-072612.9. Hormone Therapy for Postmenopausal Women. Pinkerton JV. The New England Journal of Medicine. 2020;382(5):446-455. doi:10.1056/NEJMcp1714787.10. An Empowerment Model for Managing Menopause. Hickey M, LaCroix AZ, Doust J, et al. Lancet (London, England). 2024;403(10430):947-957. doi:10.1016/S0140-6736(23)02799-X.11. Menopause. Carter AE, Merriam S. The Medical Clinics of North America. 2023;107(2):199-212. doi:10.1016/j.mcna.2022.10.003.Support the showSubscribe to Our Newsletter! Production and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

Broadcast from KSQD, Santa Cruz on 11-13-2025: Dr. Dawn discusses a New England Journal of Medicine study examining radiation exposure from medical imaging in over 4 million children showing increased hematological cancer risk. Head and brain CTs deliver highest bone marrow doses, with under-1-year-olds receiving 20 milligrays compared to background radiation of 1 milligray yearly. The study found 3,000 cancers in 4 million children over roughly 10 years, with relative risk increasing 1.6-fold per CT scan. However, methodological flaws include combining US and Canadian cohorts with different data quality, potential reverse causation where imaging detected pre-existing cancers, and arbitrary 6-month latency assumptions are significant flaws in this study.. Despite small absolute risk increases given low baseline cancer rates, she encourages parents to question necessity of repeat scans and request alternatives like MRI when appropriate. She reports on cutting-edge CRISPR therapy using lipid nanoparticles to deliver molecular scissors targeting the ANGPTL3 gene controlling LDL cholesterol production. Recent setbacks in several other CRISPR trials raise issues for unexplained liver toxicity. Concerns include off-target gene editing effects and partially repaired DNA creating mutated proteins triggering autoimmune reactions. Dr. Dawn emphasizes restricting gene therapy to life-threatening genetic diseases with no alternatives until safety improves. Stanford scientists used AI model Evo trained on 9 trillion gene samples to design 300 new bacteriophages from scratch, with 16 phages successfully killing E. coli bacteria. AI tools now predict protein structures, design custom drugs, create antivenoms, invent antibiotics, and break down PFAS forever chemicals. The research represents evolution through computation and requires guardrails on AI's ability to manipulate biological structures. An emailer shares the Rosencare model where hotel chain owner Harris Rosen created self-insured health coverage featuring direct provider contracting, imaging facilities charging one-third to one-half traditional costs, transparent pharmacy benefit management, and zero or $5 primary care copays. Employees receive proactive screening for colonoscopies, mammograms, cholesterol, diabetes, and hypertension during clinic visits. Ninety percent of medicines including insulin cost nothing, with remaining drugs $0-25, and hospital admissions cost flat $750. The model saved $600 million while providing superior preventive care by eliminating insurance middlemen and focusing on early chronic disease detection when 75-85% of costs originate. Dr. Dawn explains abdominophrenic dyssynergia causing bloating unrelated to gas or food. The diaphragm descends and abdominal wall muscles relax, pushing organs forward after meals. CT scans showed lettuce-related bloating involved no intestinal gas changes but demonstrated this abnormal muscle reflex. Randomized trials showed biofeedback training with chest-lifting and abdominal wall contracting exercises before and after eating for four weeks improved symptoms 66%. She warns that constant bloating in postmenopausal women unrelated to eating requires ovarian cancer screening. She discusses how genes drive personality using dopamine receptor gene DRD4 polymorphisms as an example. The 7-repeat variant present in 48% of Americans creates receptors binding dopamine poorly, associating with ADHD, pathological gambling, alcoholism, drug dependence, and bulimia, plus personality traits of novelty-seeking, impulsiveness, and optimism. The 2-repeat DRD4 variant common in Asia correlates with lower anger and higher forgiveness. DRD2 variations enhance the memory of negative outcomes, creating pessimistic bias and avoidance behavior. She presents the KETO trial showing "lean mass hyper-responder phenotype" where very low-carbohydrate dieters averaging age 55 maintained LDL cholesterol of 272 for five years but showed identical coronary artery calcium scores and plaque burden as matched controls with LDL under 150. Despite extreme LDL elevation, the very low insulin levels from carbohydrate restriction prevent LDL oxidation, the inflammatory "loading" process enabling arterial damage. She concludes with unusual cancer symptom where recurrent pain in specific body locations after alcohol consumption, lasting 1-2 days, occurs in 5% of Hodgkin lymphoma patients and in other cancers when alcohol induced blood vessel dilation and inflammatory chemical release in cancer-containing lymph nodes causes pain after drinking.

Søren Thorgaard Skou (PT, MSc, PhD) has vast experience within the field of osteoarthritis and other chronic conditions and has been the principal investigator of several high-quality randomized controlled trials on surgical and non-surgical treatment, one of which was published in The New England Journal of Medicine (impact factor of 79.26), the highest ranked of all general medical journals. Currently, he is the principal investigator of a randomized, controlled trial of meniscal surgery vs. exercise therapy and education for young people with a meniscal tear (DREAM) and a 5-year EU-funded project (MOBILIZE, grant agreement No 801790) with the overall aim of improving health in people with more than one chronic condition (i.e. multimorbidity) through personalized exercise therapy and education. Furthermore, he is the co-lead of Exercise First, a research program funded by Region Zealand aimed at developing, testing and implementing initaitives that support that the individual patient received the right prevention and treatment at the right time and to increase self-management using e-health.  He is one of the main architects and leader of the implementation of the highly successful treatment program Good Life With osteoArthritis in Denmark (GLA:D) for patients with knee and hip osteoarthritis. Furthermore, he is a recipient of a prestigious ERC Starting Grant from the European Research Council, and a postdoc grant and a Sapere Aude Research Talent Award from the Independent Research Fund Denmark.  --- Follow Professor Søren Skou on Twitter https://twitter.com/STSkou He is affiliated with both University of Southern Denmark and the research unit PROgrez at Slagelse Hospital, Denmark (@PROgrezDK) _____________________ This podcast episode is sponsored by Fibion Inc. | Better Sleep, Sedentary Behaviour and Physical Activity Research with Less Hassle --- Collect, store and manage SB and PA data easily and remotely - Discover ground-breaking Fibion SENS --- SB and PA measurements, analysis, and feedback made easy.  Learn more about Fibion Research --- Learn more about Fibion Sleep and Fibion Circadian Rhythm Solutions. --- Fibion Kids - Activity tracking designed for children. --- Collect self-report physical activity data easily and cost-effectively with Mimove. --- Explore our Wearables,  Experience sampling method (ESM), Sleep,  Heart rate variability (HRV), Sedentary Behavior and Physical Activity article collections for insights on related articles. --- Refer to our article "Physical Activity and Sedentary Behavior Measurements" for an exploration of active and sedentary lifestyle assessment methods. --- Learn about actigraphy in our guide: Exploring Actigraphy in Scientific Research: A Comprehensive Guide. --- Gain foundational ESM insights with "Introduction to Experience Sampling Method (ESM)" for a comprehensive overview. --- Explore accelerometer use in health research with our article "Measuring Physical Activity and Sedentary Behavior with Accelerometers ". --- For an introduction to the fundamental aspects of HRV, consider revisiting our Ultimate Guide to Heart Rate Variability. --- Follow the podcast on Twitter https://twitter.com/PA_Researcher Follow host Dr Olli Tikkanen on Twitter https://twitter.com/ollitikkanen Follow Fibion on Twitter https://twitter.com/fibion https://www.youtube.com/@PA_Researcher

Welcome to Ozempic Weightloss Unlocked, where we decode the latest breakthroughs, news, and hidden truths about one of the world's most talked-about weight loss drugs. Today, the buzz is about change—how new research, fresh delivery methods, and evolving regulations are reshaping the Ozempic story. Let us start with what is most recent. There is a big development: needles may no longer be necessary. According to reporting in Popular Mechanics and new data published in The New England Journal of Medicine, Novo Nordisk, the maker of Ozempic and Wegovy, has released results for a daily oral version of semaglutide, the active ingredient in Ozempic. In their clinical trial, this pill matched the weight loss produced by the weekly injection, with an average of 16.6 percent reduction in body weight. About a third of participants lost more than 20 percent. While side effects like nausea and vomiting were reported at higher rates than placebo, this new pill could make using these drugs more accessible than ever.Access is also the hot topic in pricing. Until this year, monthly Ozempic prescriptions could cost up to $1,350 without insurance support. But after new negotiations, many users will soon pay $50 to $350 per month, depending on dosage and coverage. Lower prices are expected to make these drugs far more widely available.So, how well does Ozempic stack up in its primary role? Ozempic was first approved to treat type two diabetes, with weight loss as a major secondary effect. Harper Clinic Utah reports that, in clinical trials, people using Ozempic lost on average between 10 and 15 percent of their body weight over a little more than a year. But real world success depends on how consistently people use it and whether they also improve their diet and exercise habits.Now a common question—how does Ozempic compare to newer weight loss options like Zepbound and Wegovy? The main distinction is the active ingredient. Ozempic uses semaglutide, which triggers the body to release the hormone GLP-1, helping you feel fuller and slow digestion. Zepbound uses tirzepatide, which mimics both GLP-1 and a second hormone called GIP, and results from major trials suggest it can lead to more dramatic weight loss—up to 21 percent of body weight in some studies. However, Ozempic remains covered by insurance for diabetes, while Zepbound is less often covered.Beyond weight, a new area of research is exploring how Ozempic could affect long-term health conditions. According to ScienceDaily, a recent large-scale analysis found that when people stop using prescription weight loss drugs like Ozempic, they tend to regain much of their lost weight, underscoring the need for ongoing treatment or lifestyle change. But these medicines may do much more than affect weight. Recent studies at University of California San Diego found that people with colon cancer who were on GLP-1 drugs were less than half as likely to die within five years. Another new UVA study, covered by Fox News and ScienceDaily, points to dramatically lower death rates in cancer patients who use GLP-1 drugs like Ozempic—potentially because they lower inflammation and improve metabolic health.There is also new investigation about Ozempic's possible use in treating long COVID. According to research covered by ClickOnDetroit, anecdotal reports suggest that some people taking GLP-1 drugs for weight loss also experienced improvement in their post-COVID symptoms, and new clinical trials are underway.Despite these major advances, affordability and access remain challenges. The latest KFF Health Tracking Poll says that about one in eight adults in the United States are now taking a GLP-1 medication like Ozempic, Wegovy, or Zepbound. But half of those surveyed still find the drugs financially out of reach, even as prices are starting to come down.What does all this mean for lifestyle and health? The current scientific consensus is clear: these drugs do not replace needed changes in eating habits and physical activity. As physicians emphasize, Ozempic works best as part of a treatment plan that includes real lifestyle change.As you can see, Ozempic and drugs like it are not just a story about slimming down—they are opening doors to better health, new medical research, and greater access for millions. Thank you for tuning in to Ozempic Weightloss Unlocked. Make sure to subscribe so you do not miss the next episode covering the evolving science and your questions about Ozempic and weight loss. This has been a quiet please production, for more check out quiet please dot ai. Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI

In the past week, breakthrough developments surrounding Ozempic and its use for weight loss have dominated health news, reflecting sweeping changes in both medical access and public perception. According to Popular Mechanics, Novo Nordisk, the pharmaceutical giant behind Ozempic and the similar injectable Wegovy, has just revealed the results of a major 71-week clinical study evaluating an oral pill form of semaglutide, the active ingredient in both Ozempic and Wegovy. This study, published in The New England Journal of Medicine, found that the daily pill achieved nearly the same results as the weekly injection, with participants losing an average of 16.6 percent of their body weight, far surpassing the 2.7 percent weight loss seen in the placebo group. About one third of those taking the pill lost more than 20 percent of their starting weight, signaling not just statistical significance but profound clinical impact. The trial also reported side effects consistent with earlier injectable versions, including increased incidences of nausea and vomiting, though these were not severe enough to derail the optimism surrounding the pill's future.Compounding these scientific advancements, the White House this week announced successful negotiations with both Eli Lilly and Novo Nordisk to dramatically reduce the cost of GLP-1 receptor agonists—the drug class of Ozempic, Wegovy, and Zepbound—which many insurance providers had previously excluded or charged full price for. Now, eligible patients may see their out-of-pocket costs plummet from over one thousand dollars per month to a much more accessible fifty to three hundred fifty dollars depending on dosage and coverage. According to comments from Kim Fisher at the UC Davis Innovation Institute for Food and Health, these price adjustments are expected to drive a swift increase in demand and medication use, with around one in eight adult Americans having already tried some form of GLP-1 therapy.Despite the popularity and transformative outcomes touted by both consumers and medical professionals, Ozempic and related drugs are not without controversy. While these medications have reshaped the landscape for obesity and diabetes treatment, as UC Davis reports, emerging evidence indicates a need for caution and individualized care. Some patients experience notable gastrointestinal effects such as nausea and diarrhea, largely because GLP-1 drugs alter how the gut processes food and signal fullness to the brain. In addition, while fat loss can be dramatic, experts highlight that up to one quarter of the total weight lost may be from lean muscle, underscoring the importance of physical activity and adequate protein to preserve strength. Another concern echoed this week involves bone health, as rapid weight loss and restricted nutrition may inadvertently reduce bone density, especially in older adults and postmenopausal women. Leading researchers emphasize that a successful and safe weight loss journey with Ozempic demands precision nutrition, attentive exercise regimens, and regular monitoring to minimize health risks and maximize wellbeing.The intersection of celebrity culture with the Ozempic phenomenon also drew fresh attention over the past week, especially regarding Oprah Winfrey's evolving relationship with the drug. Oprah, who has long shared her struggles with weight publicly, admitted in recent interviews that she initially resisted taking Ozempic, saying she felt it was the easy way out and preferred to focus on lifestyle change. According to AOL, she reflected on her internal conflict about using medical intervention for weight loss, underscoring how the rise of drugs like Ozempic has forced a cultural reckoning over what constitutes effort, discipline, and legitimacy in personal health. While some celebrity peers openly dismiss rumors or deny any use of weight loss drugs, Oprah's decision to speak candidly about her hesitation and subsequent experiences gives voice to a wider conversation happening both in Hollywood and across the nation. As more public figures reveal their choices, the stigma of using medication to address chronic weight struggles may begin to dissipate, helping others seek support without shame.In summary, the past week has marked a pivotal moment in the ongoing Ozempic story. The introduction of a highly effective oral pill, substantial price cuts via government negotiation, and ongoing public debate about safety, efficacy, and cultural perceptions have all contributed to growing momentum. Now, as clinicians and patients alike look ahead to a future where advanced weight management tools are both more accessible and potentially safer to use, the importance of personalized guidance and health literacy has never been clearer.Thanks for listening, please subscribe, and remember—this episode was brought to you by Quiet Please podcast networks. For more content like this, please go to Quiet Please dot Ai.Some great Deals https://amzn.to/49SJ3QsFor more check out http://www.quietplease.aiThis content was created in partnership and with the help of Artificial Intelligence AI

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

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

Søren Thorgaard Skou (PT, MSc, PhD) has vast experience within the field of osteoarthritis and other chronic conditions and has been the principal investigator of several high-quality randomized controlled trials on surgical and non-surgical treatment, one of which was published in The New England Journal of Medicine (impact factor of 79.26), the highest ranked of all general medical journals. Currently, he is the principal investigator of a randomized, controlled trial of meniscal surgery vs. exercise therapy and education for young people with a meniscal tear (DREAM) and a 5-year EU-funded project (MOBILIZE, grant agreement No 801790) with the overall aim of improving health in people with more than one chronic condition (i.e. multimorbidity) through personalized exercise therapy and education. Furthermore, he is the co-lead of Exercise First, a research program funded by Region Zealand aimed at developing, testing and implementing initaitives that support that the individual patient received the right prevention and treatment at the right time and to increase self-management using e-health.  He is one of the main architects and leader of the implementation of the highly successful treatment program Good Life With osteoArthritis in Denmark (GLA:D) for patients with knee and hip osteoarthritis. Furthermore, he is a recipient of a prestigious ERC Starting Grant from the European Research Council, and a postdoc grant and a Sapere Aude Research Talent Award from the Independent Research Fund Denmark.  --- Follow Professor Søren Skou on Twitter https://twitter.com/STSkou He is affiliated with both University of Southern Denmark and the research unit PROgrez at Slagelse Hospital, Denmark (@PROgrezDK) _____________________ This podcast episode is sponsored by Fibion Inc. | Better Sleep, Sedentary Behaviour and Physical Activity Research with Less Hassle --- Collect, store and manage SB and PA data easily and remotely - Discover ground-breaking Fibion SENS --- SB and PA measurements, analysis, and feedback made easy.  Learn more about Fibion Research --- Learn more about Fibion Sleep and Fibion Circadian Rhythm Solutions. --- Fibion Kids - Activity tracking designed for children. --- Collect self-report physical activity data easily and cost-effectively with Mimove. --- Explore our Wearables,  Experience sampling method (ESM), Sleep,  Heart rate variability (HRV), Sedentary Behavior and Physical Activity article collections for insights on related articles. --- Refer to our article "Physical Activity and Sedentary Behavior Measurements" for an exploration of active and sedentary lifestyle assessment methods. --- Learn about actigraphy in our guide: Exploring Actigraphy in Scientific Research: A Comprehensive Guide. --- Gain foundational ESM insights with "Introduction to Experience Sampling Method (ESM)" for a comprehensive overview. --- Explore accelerometer use in health research with our article "Measuring Physical Activity and Sedentary Behavior with Accelerometers ". --- For an introduction to the fundamental aspects of HRV, consider revisiting our Ultimate Guide to Heart Rate Variability. --- Follow the podcast on Twitter https://twitter.com/PA_Researcher Follow host Dr Olli Tikkanen on Twitter https://twitter.com/ollitikkanen Follow Fibion on Twitter https://twitter.com/fibion https://www.youtube.com/@PA_Researcher

When treating head and neck cancer, how can you tell the difference between true disease progression and pseudoprogression? In this episode of the BackTable Podcast, we discuss the practical implementation of the KEYNOTE-689 trial published in the New England Journal of Medicine, which demonstrated the benefit of adding neoadjuvant and adjuvant immunotherapy to standard head and neck cancer care. Our tumor board panel includes Dr. Mihir Patel, a head and neck surgeon from UNC Chapel Hill, Dr. Siddharth Sheth, a head and neck medical oncologist from UNC, Dr. Jennifer Johnson, a professor of medical oncology and otolaryngology at Sidney Kimmel Comprehensive Cancer Center, and Dr. Adam Luginbuhl, a head and neck surgical oncologist at Thomas Jefferson University. --- SYNPOSIS The doctors address the trial's practical implications, patient selection, case management, dealing with tumor progression, and the integration of multidisciplinary care. They also emphasize the importance of communication, real-world application of trial protocols, and the potential benefits and challenges of such therapies. --- TIMESTAMPS 00:00 - Introduction03:18 - Discussing the New Indication for Immunotherapy11:42 - Challenges and Practical Implementation22:48 - Managing Tumor Progression: A Case Study28:07 - Exploring Treatment Options: Surgery vs. Chemotherapy36:46 - Operational Challenges and Future Directions43:58 - Concluding Thoughts and Future Directions --- RESOURCES Keynote 689https://www.nejm.org/doi/full/10.1056/NEJMoa2415434

A new study in rural western Uganda finds that treating baby-carrying cloths, or lesu, with an insecticide with modest repellent effect significantly reduces malaria infections in young children. Transcript In many parts of sub-Saharan Africa, mothers carry their young children on their backs in colorful cotton wraps called lesu. Could treating these cloths with insecticide reduce malaria transmission? A study published in the New England Journal of Medicine explored this question in rural western Uganda, where malaria is transmitted year-round. Researchers enrolled 400 mothers with children aged six to 18 months. Using a blinded randomized placebo-controlled trial design, half received lesu treated with permethrin, a commonly-used insecticide. The other half received untreated cloths. All participants also received  insecticide-treated bed nets. Every two weeks for 24 weeks, the mothers and children visited local health centers to check for fever and undergo malaria testing. The results were striking: children carried in permethrin-treated lesu represented 66% fewer malaria cases – 0.73 cases per 100 people compared with 2.13 in the control group. The findings suggest that insecticide-treated lesu – much like treated bed nets – could offer an effective new tool particuarly against outdoor biting for a highly vulnerable population - children under 5 years of age - in sub-Saharan Africa. Source Permethrin-Treated Baby Wraps for the Prevention of Malaria [NEJM] About The Podcast The Johns Hopkins Malaria Minute podcast is produced by the Johns Hopkins Malaria Research Institute to highlight impactful malaria research and to share it with the global community.

Medical imaging, like X-rays and CT scans, are routine, non-invasive and painless tools used by doctors to make diagnoses. But a recent study of about 4 million children published in the New England Journal of Medicine suggests that the radiation exposure from imaging could pose a risk for pediatric cancer. John Yang speaks with Dr. Rebecca Smith-Bindman, the study’s lead author, to learn more. PBS News is supported by - https://www.pbs.org/newshour/about/funders. Hosted on Acast. See acast.com/privacy

Medical imaging, like X-rays and CT scans, are routine, non-invasive and painless tools used by doctors to make diagnoses. But a recent study of about 4 million children published in the New England Journal of Medicine suggests that the radiation exposure from imaging could pose a risk for pediatric cancer. John Yang speaks with Dr. Rebecca Smith-Bindman, the study’s lead author, to learn more. PBS News is supported by - https://www.pbs.org/newshour/about/funders. Hosted on Acast. See acast.com/privacy

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

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

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

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

A New England Journal of Medicine study showed a novel chemotherapy regimen, trastuzumab deruxtecan combined with pertuzumab, outperformed the current standard in treating HER2-positive advanced breast cancer, demonstrating better efficacy and tolerability with fewer traditional chemotherapy-related side effects. A JAMA Oncology study by Uppsala University revealed a modest increase in breast cancer risk with hormonal contraceptive use among over two million Swedish women, emphasizing the need for balanced counseling regarding risks and benefits. The REPAIR trial in Denmark, published in the British Medical Journal, demonstrated that a short course of antibiotics significantly reduced clinically important wound complications after vaginal delivery in women with episiotomies or second-degree tears, highlighting its potential benefit in postpartum care.

Vidcast:  https://www.instagram.com/p/DQdnYr9jZwV/An exciting, ground-breaking clinical study now shows that children born with a defective gene coding for a vital inner ear protein can have that gene  repaired and hearing restored. This phenomenally successful preliminary clinical trial was recently published in the New England Journal of Medicine.Genetic bioengineers at New York's Regeneron Pharmaceuticals loaded a normal copy of the otoferlin gene into a dual adeno-associated virus acting as a Trojan horse.  Twelve children, born without the ability to synthesize otoferlin protein, received the gene injection, dubbed DB-OTO therapy, into their inner ears at 3 clinical centers: Harvard's Mass. Eye and Ear Infirmary, UC San Diego's Children's Hospital, and University College London.  Otoferlin is necessary for the inner ear's ability to convert sound vibrations into electrical impulses.  At 24 weeks post-injection, 9 of the 12 children, 75%, regained measurable hearing.  Three, 25%, developed near normal hearing.  The gene therapy was well-tolerated without any significant side effects.This gene therapy, with further refinement and after larger clinical trials, may be a one-and-done treatment for one common form of congenital deafness. Cochlear implants will continue to be essential therapy for other types of genetic and acquired severe hearing losses pending development of other genetic and/or chemical cochlear modifications.https://www.nejm.org/doi/full/10.1056/NEJMoa2400521#deafness #children #congenital #otoferlin #dboto 

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

In this episode, Dr. Brendan McCarthy, Chief Medical Officer of Protea Medical Center, dives deep into estrone, one of the three key estrogens, and explains why understanding it is crucial for women's health. Learn about: The differences between estradiol, estriol, and estrone How estrone levels shift during perimenopause and menopause Why oral estrogen can dramatically increase estrone The impact of lifestyle factors like diet, body fat, stress, alcohol, and sedentary behavior on estrogen balance Practical tips to support healthy estrogen metabolism naturally Dr. McCarthy breaks down complex biochemistry in a clear, actionable way so you can take charge of your hormonal health.   Citations: 1. Bulun, Serdar E., et al. “Aromatase and Estrogen Biosynthesis in Adipose Tissue.” Endocrine Reviews, vol. 23, no. 3, 2002, pp. 305–342. 2. Labrie, Fernand, et al. “Importance of the Intracrinology of Estrogen Synthesis in Peripheral Tissues in Postmenopausal Women.” Journal of Steroid Biochemistry and Molecular Biology, vol. 118, nos. 4–5, 2010, pp. 273–279. 3. Sasano, Hironobu, and Toshihiko Harada. “Differential Expression of Aromatase and 17β-Hydroxysteroid Dehydrogenase Isoenzymes in Human Tissues.” Journal of Steroid Biochemistry and Molecular Biology, vol. 86, no. 3–5, 2003, pp. 327–333. 4. Yager, James D., and Nancy E. Davidson. “Estrogen Carcinogenesis in Breast Cancer.” New England Journal of Medicine, vol. 354, no. 3, 2006, pp. 270–282. 5. Cavalieri, Ercole L., and Eleanor G. Rogan. “Depurinating Estrogen-DNA Adducts, Mechanisms of Formation, and Prevention.” Clinical Cancer Research, vol. 16, no. 3, 2010, pp. 596–602. 6. Suba, Zsuzsanna. “Circulating Estrogens and Estrogen Metabolism in Obese Women.” Journal of Clinical Endocrinology and Metabolism, vol. 98, no. 11, 2013, pp. 4336–4344. 7. Simpson, Evan R., and Konstanze C. Pike. “Aromatase Expression in Adipose Tissue: Relationship to Obesity and Insulin Resistance.” Endocrinology, vol. 156, no. 9, 2015, pp. 3422–3435. 8. Key, Timothy J., et al. “Circulating Sex Hormones and Breast Cancer Risk Factors in Postmenopausal Women: Reanalysis of 13 Studies.” British Journal of Cancer, vol. 105, no. 5, 2011, pp. 709–722. 9. Stanczyk, Frank Z., et al. “Oral, Transdermal and Injectable Hormone Therapy: Pharmacokinetics and Effects on Estrone/Estradiol Ratios.” Menopause, vol. 24, no. 9, 2017, pp. 1080–1090. 10. Santen, Richard J., et al. “Estrogen Bioidentical Hormone Therapy: Route of Administration and Risk.” Journal of Clinical Endocrinology and Metabolism, vol. 105, no. 7, 2020, pp. 2062–2074. 11. Zeleniuch-Jacquotte, Anne, et al. “Postmenopausal Levels of Estrone, Estradiol, and Estrone Sulfate and Breast Cancer Risk.” Cancer Epidemiology, Biomarkers & Prevention, vol. 23, no. 8, 2014, pp. 1531–1539. 12. Dall, Gabriella V., and Christine L. Clarke. “Local Estrogen Biosynthesis and Signaling in Breast Cancer Progression.” Steroids, vol. 78, no. 7, 2013, pp. 639–646. 13. Heald, Anthony H., et al. “Relationships Between Serum Estrone, Insulin Resistance, and Adiposity in Postmenopausal Women.” Clinical Endocrinology, vol. 67, no. 3, 2007, pp. 340–345. 14. Kuiper, George G. J. M., et al. “Estrogen Receptor β Selectivity of Estriol and Implications for Tissue-Specific Effects.” PNAS, vol. 94, no. 17, 1997, pp. 9105–9110. 15. Michnovicz, Joseph J., et al. “Dietary Indoles and Estrogen Metabolism: Effects of Cruciferous Vegetable Intake.” Journal of Nutrition, vol. 134, no. 12, 2004, pp. 3479S–   Dr. Brendan McCarthy is the founder and Chief Medical Officer of Protea Medical Center in Arizona. With over two decades of experience, he's helped thousands of patients navigate hormonal imbalances using bioidentical HRT, nutrition, and root-cause medicine. He's also taught and mentored other physicians on integrative approaches to hormone therapy, weight loss, fertility, and more. If you're ready to take your health seriously, this podcast is a great place to start.  

In this episode of Thinking Thoracic, host Dr. Erin Gillaspie talks with Dr. Robert Lentz and Dr. Fabien Maldonado about the groundbreaking VERITAS trial, which is reshaping how clinicians diagnose lung cancer. Published in the New England Journal of Medicine, the VERITAS trial compared navigational bronchoscopy with CT-guided biopsy in a rigorous, randomized design, bringing much-needed evidence to interventional pulmonology. The discussion explores how the study was conceived, why robust device trials are vital to patient outcomes, and what the findings mean for the future of minimally invasive lung diagnostics.

Après le cerveau, les géants de la tech s'attaquent désormais… à l'œil. Tandis qu'Elon Musk tente de soigner des pathologies neurologiques grâce à Neuralink, un ancien partenaire du milliardaire, Max Hodak, s'est lancé un défi tout aussi ambitieux : redonner la vue aux personnes atteintes de DMLA, la dégénérescence maculaire liée à l'âge, principale cause de cécité dans le monde. Et les premiers résultats sont spectaculaires.Une étude publiée dans le New England Journal of Medicine dévoile les conclusions d'un essai clinique mené sur 38 patients âgés de plus de 60 ans, tous atteints de DMLA avancée aux deux yeux. Chez 32 d'entre eux, l'implant a pu être testé sur une durée d'un an : 26 participants ont retrouvé une vision partielle, soit un taux de réussite de plus de 80 %. L'image perçue reste floue et en noir et blanc, mais elle permet de distinguer les formes et les mouvements — un bond de géant pour des patients auparavant aveugles.L'appareil en question est une minuscule puce de 2 millimètres sur 2, composée de micropanneaux photovoltaïques. Inséré chirurgicalement dans la rétine, il remplace les cellules mortes responsables de la cécité. Associé à des lunettes connectées, l'implant capte les images de l'environnement grâce à un faisceau de lumière infrarouge, puis les transforme en signaux électriques transmis au nerf optique. Le cerveau reconstitue alors une image — une prouesse qui imite le fonctionnement naturel de l'œil humain.Ce dispositif révolutionnaire a été mis au point par Science Corporation, la start-up fondée par Max Hodak après son départ de Neuralink. L'entreprise s'est appuyée sur les travaux de la société française Pixium Vision, pionnière dans les implants rétiniens, dont elle a racheté la technologie en 2024. Un mariage entre biologie et microélectronique qui ouvre la voie à une nouvelle génération de prothèses sensorielles. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

Today we're thrilled to get to know Travis Zack, Chief Medical Officer of OpenEvidence. OpenEvidence is the world's leading medical information platform and the fastest growing applications for physicians in history. Over 40% of US clinicians leverage OpenEvidence for evidence based practice support that is directly embedded into their workflows.Through an array of strategic content partnerships (including the American Medical Association, The New England Journal of Medicine, The Journal of the American Medical Association, and all eleven JAMA specialty journals—such as JAMA Oncology and JAMA Neurology) OpenEvidence gives clinicians the power to search once, skip the scavenger hunt, and surface the science in seconds. Most recently, OpenEvidence has raised $200M in its Series C from Top Investors like Sequoia, GV Thrive, Kleiner Perkins and others!In this episode, we discuss how OpenEvidence is transforming access to medical evidence, the company's rapid growth and adoption by clinicians, its business model and journal partnerships, and the future roadmap for AI-powered clinical decision support.

Autism isn't new, but our understanding of it has changed dramatically. It's now recognized as a broad neurodevelopmental spectrum that shapes how millions of people perceive, process, and interact with the world. In this episode, we explore what autism is AND isn't, from its earliest signs in infancy to its deep genetic roots, and why misinformation about it continues to spread. We speak with three remarkable experts leading the field in early detection, genetics, and public education: DR. AMI KLIN, PhD, Director of the Marcus Autism Center at Emory University and a pioneer in early autism research, whose work shows autism can be identified in babies as young as two months old. DR. JOSEPH BUXBAUM, PhD, Director of the Seaver Autism Center at Mount Sinai and a global leader in autism genetics, uncovering hundreds of genes linked to the condition. DR. ANDREA LOVE, immunologist, microbiologist, and founder of ImmunoLogic, known for her clear, evidence-based communication about vaccines, immunity, and autism myths. Together, we discuss: • What autism really is, and how the definitions have evolved • How it develops in infancy (and why early diagnosis can be so critical) • The powerful genetic evidence behind autism • The persistence of vaccine myths, and how misinformation spreads • How technology like eye-tracking can detect autism early • The rise of “profound autism” and what it means for families • The future of genetics-based treatments and therapy Whether you're autistic yourself, a parent navigating a new diagnosis, or simply seeking understanding, we're thrilled to share this extensive, in-depth episode with you. This is... Your Brain On Autism. SUPPORTED BY: the 2026 NEURO World Retreat. A 5-day journey through science, nature, and community, on the California coastline: https://www.neuroworldretreat.com/ ‘Your Brain On' is hosted by neurologists, scientists, and public health advocates Ayesha and Dean Sherzai. ‘Your Brain On... Autism' • SEASON 6 • EPISODE 1 LINKS Dr. Ami Klin at Emory University: https://ctsn.emory.edu/faculty/klin-ami.html Dr. Ami Klin at Marcus Autism Center: https://www.marcus.org/about-marcus-autism-center/meet-our-leadership/ami-klin  Dr. Joseph Buxbaum at Mount Sinai: https://profiles.icahn.mssm.edu/joseph-d-buxbaum  Dr. Andrea Love's website: https://www.immunologic.org/ Dr. Andrea Love on Instagram: https://www.instagram.com/dr.andrealove  REFERENCES Autism Spectrum Disorder: A Review. JAMA, 2023. https://jamanetwork.com/journals/jama/article-abstract/2800182  Is There a Bias Towards Males in the Diagnosis of Autism? A Systematic Review and Meta-Analysis. https://link.springer.com/article/10.1007/s11065-023-09630-2  Acetaminophen Use During Pregnancy and Children's Risk of Autism, ADHD, and Intellectual Disability. https://pubmed.ncbi.nlm.nih.gov/38592388/  Eye-Tracking–Based Measurement of Social Visual Engagement Compared With Expert Clinical Diagnosis of Autism. https://jamanetwork.com/journals/jama/fullarticle/2808996  Rare coding variation provides insight into the genetic architecture and phenotypic context of autism. https://www.nature.com/articles/s41588-022-01104-0  Rare coding variation illuminates the allelic architecture, risk genes, cellular expression patterns, and phenotypic context of autism. https://www.medrxiv.org/content/10.1101/2021.12.20.21267194v1  Andrew Wakefield and the fabricated history of the alleged vaccine-autism link. https://geneticliteracyproject.org/2024/04/29/andrew-wakefield-and-the-fabricated-history-of-the-alleged-vaccine-autism-link/ VACCINES & AUTISM 1. Major Cohort Studies Hviid et al., 2019 – Annals of Internal Medicine A nationwide study of 657,461 Danish children found no increased risk of autism in vaccinated children compared to unvaccinated peers — even among those with risk factors such as a sibling with autism. Ann Intern Med. 2019;170(8):513–520 Madsen et al., 2002 – New England Journal of Medicine In 537,303 Danish children, researchers found no difference in autism rates between vaccinated and unvaccinated groups, and no relationship with age, timing, or date of vaccination. NEJM. 2002;347:1477–1482 Jain et al., 2015 – Journal of the American Medical Association (JAMA) A U.S. cohort of 95,727 children — including those with siblings with autism — showed no link between MMR vaccination and autism risk, even in genetically predisposed children. JAMA. 2015;313(15):1534–1540 Madsen et al., 2003 – JAMA A study of 467,450 Danish children found no relationship between thimerosal-containing vaccines and autism. JAMA. 2003;290(13):1763–1766 DeStefano et al., 2022 – Vaccine A retrospective cohort of over 500,000 U.S. children with ASD found no increase in adverse events or worsening of autism-related symptoms following vaccination. Vaccine. 2022;40(16):2391–2398 2. Population-Level Epidemiologic Evidence Taylor et al., 1999 – The Lancet One of the earliest large epidemiological studies found autism prevalence was the same in vaccinated and unvaccinated children, and the age of onset was unrelated to the timing of MMR vaccination. Read: Lancet. 1999;353(9169):2026–2029 Institute of Medicine (U.S.) Immunization Safety Review, 2011 A global review of studies from the U.S., Denmark, Sweden, and the U.K. concluded there is no causal relationship between vaccination status and autism, and no plausible biological mechanism linking vaccines (including thimerosal) to ASD. Read: National Academies Press / PubMed 20669467 3. Systematic Reviews and Meta-Analyses Taylor et al., 2014 – Vaccine A comprehensive meta-analysis of 10 studies including over 1.2 million children found no association between vaccination and autism or ASD. Vaccine. 2014;32(29):3623–3629 Maglione et al., 2014 – Pediatrics Review of 67 high-quality studies covering the full U.S. immunization schedule concluded that vaccines are safe, adverse events are rare, and there is no link to autism, type 1 diabetes, or other chronic conditions. Pediatrics. 2014;134(2):325–337 Parker et al., 2004 – Pediatrics Systematic review of 10 primary studies examining thimerosal exposure found no relationship between vaccines and ASD. Authors noted that studies showing an association were methodologically flawed or biased, while robust studies consistently showed safety. Pediatrics. 2004;113(6):1904–1910 Offit & Hackett, 2003 – Clinical Infectious Diseases Review of immunology and epidemiology concluded that claims that vaccines “overwhelm” or “damage” the immune system are not biologically plausible based on how the immune system actually functions. Clin Infect Dis. 2003;46(9):1450–1456

Sasha K. Shillcutt, MD, MS, FASE is a tenured and endowed Professor and the Vice Chair of Strategy in the Department of Anesthesiology at the University of Nebraska Medical Center. She is a double-boarded cardiac anesthesiologist and is also CEO & Founder of Brave Enough, a community of thousands of women in healthcare where she teaches women how to advance through courses, coaching, and events. She leads conferences and retreats for professional women and is a certified coach for women leaders. Sasha is a well-published researcher in anesthesiology and gender equity, best-selling author, and international speaker. She speaks frequently to executives and leaders on the topics of professional resilience and wellbeing. Her TEDx talk titled Resilience: The Art of Failing Forward has been viewed by thousands of people. Her writing has been published in both the New England Journal of Medicine and JAMA. Her first book, Between Grit and Grace: How to be Feminine and Formidable, has sold thousands of copies and her second book, Brave Boundaries, is an international best seller. Her podcast, The Brave Enough Show, has over 315K downloads & she has coached hundreds of women leaders to thrive. Some of the topics we discussed were: Setting boundaries at work, in business, or entrepreneurshipSetting and keeping boundaries that serve you Common mistakes people make when setting up boundaries and how to avoid themHow to navigate situations where people are unhappy with the boundaries you setRecommendations for people on their journey of learning better boundariesHow to approach situations where you feel someone is setting an unreasonable boundaryBoundaries and time management And more!Learn more about me or schedule a FREE coaching call:https://www.joyfulsuccessliving.com/ Join the Voices of Women Physicians Facebook Group:https://www.facebook.com/groups/190596326343825/ Connect with Dr. Shilcutt: WEBSITE INSTAGRAM FACEBOOK TWITTER LINKEDIN 

A pivotal European clinical trial of a new electronic eye implant has seen remarkable results.  The study, published in the New England Journal of Medicine, showed 84% of participants were able to read letters, numbers and words using prosthetic vision through an eye that had previously lost its sight due to the untreatable progressive eye condition, geographic atrophy with dry age-related macular degeneration (AMD).  RNIB Connect Radio's Toby Davey was joined by Mahi Muqit, senior vitreoretinal consultant at Moorfields Eye Hospital and the Institute of Ophthalmology at University College London who lead the UK arm of the trial to explain more about the results of the study and the technology used too. There is more information about this new pioneering eye device on the following pages of the Moorfields Eye Hospital website which also includes a link to register on the Moorfields research portal, ROAM which will give you access to current and future research - https://www.moorfields.nhs.uk/about-us/news-and-blogs/news/pioneering-eye-device-restores-reading-vision-to-blind-eyes (Image shows the RNIB Connect Radio logo. On a white background ‘RNIB' written in bold black capital letters and underlined with a bold pink line. Underneath the line: ‘Connect Radio' is written in black in a smaller font)

Die Themen in den Wissensnachrichten: +++ Technische Lösung bei unheilbarer Augenkrankheit +++ Erstmals Stechmücken in Island entdeckt +++ Bestimmte Gene könnten anfällig machen für Cannabis-Konsum +++**********Weiterführende Quellen zu dieser Folge:Subretinal Photovoltaic Implant to Restore Vision in Geographic Atrophy Due to AMD, New England Journal of Medicine, 20.10.2025Mosquitoes arrive in Iceland, RUV, 20.10.2025Genome-wide association studies of lifetime and frequency of cannabis use in 131,895 individuals, Molecular Psychiatry, 13.10.2025Invariant HVC size in female canaries singing under testosterone: Unlocking function through neural differentiation, not growth, PNAS, 20.10.2025Oomycetes manipulate plant innate immunity through galacturonide oxidases, Nature Communications, 20.10.2025Alle Quellen findet ihr hier.**********Ihr könnt uns auch auf diesen Kanälen folgen: TikTok und Instagram .

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog You will learn: What holds up new treatments for diseases and conditions How long the FDA sits on a known safe medical medication before it is released to the public. Why safe and effective drugs are NOT approved by the FDA Why doctors are forced to use medications off label How you can help During my 44 years of medical practice, I have encountered conditions for which there is no approved medication or surgical treatment available as recognized by the American College of OBGYN or the FDA. This situation can present challenges both for physicians managing these patients and for individuals seeking relief from their symptoms. This issue is not often addressed on Dr Oz, in the news, or at medical conferences. For many conditions, physicians wait for the development of approved medications or treatments, and in the meantime may inform patients that there is currently no treatment or cure available. Some doctors may attribute a patient's concerns to aging, stating that it is a universal experience. While this may be accurate, such explanations may not provide comfort to patients seeking solutions to their symptoms. This lack of helpful guidance can discourage individuals from seeking medical care when they feel their concerns are not acknowledged. This seems to result from insurance companies prioritizing cost savings by minimizing patient care.  Every year insurance companies decrease what they pay doctors for their services, while their expenses go up, and the Government requires more and more work behind the scenes like HIPPA, OSHA, and Clia requirements that costs more to deliver the same service.  If you have a problem with the time your doctor spends with you then blame the insurance companies whose profits rise every year…Soon doctors will do what I do and only take cash.  The practice of medicine is not working in a free market. While insurance limits the prescriptions of medication to those meds that are FDA Approved, the FDA and medical specialty colleges often delay approval of new, low-risk treatments for up to 20 years after their effectiveness is demonstrated. This lengthy process should be reconsidered to treat people who are ill and suffering, now. There is plenty of research in the medical journals that explain the safety of new and effective treatments that can save peoples' lives that are not FDA approved yet. The FDA is not interested in expediting the release of medication/ devices quickly to those people who need help now. They drag out the testing of a medicine that has been effective for years and may or may not approve it. On the flip side they have approved many drugs that later are found to have severe side effects, and they just change the warnings on the medication inserts. They don't take them off the market except in severe cases. Drugs that have worked treating patients successfully are being used but are not FDA approved. These “grandfathered drugs” don't need to go through the testing that new drugs go through because they work with few well-known risks. I use many if these medications because they are inexpensive for my patients and are often more effective than new meds for the same problem. One of the drugs that the FDA has not had to approve is Armour Thyroid, a natural thyroid replacement. My experience with treatments not approved by the FDA Armour Thyroid: Armour Thyroid (AT) has been prescribed by doctors to replace thyroid hormones for about 100 years. It is natural, made from Pig thyroid. It only comes from “medical Pigs” that are raised for medical purposes.  We use medical pigs for skin grafts, and other parts of the pig to treat human diseases like heart valve replacements.  Armour Thyroid is composed of the four thyroid hormones that humans make: T4, T3, T2, T1. The synthetic thyroid replacement, Synthroid/levothyroxine is only T4.  The active form of thyroid is T3, and it requires an enzyme to convert T4 into T3. If a person can't convert T4 into active T3 then nothing improves except the blood levels of T4, and TSH. The majority of women cannot convert T4 into T3. Therefore, if they take Synthroid or levothyroxine and their doctor only checks their TSH level and not the level of free T3 and free T4 to see if the Thyroid is working, then women are told that they are healed, yet they know they are not because none of their low thyroid symptoms are resolved. When this happens, doctors tell female patients that it is all in their heads and dismiss us when we tell them we are not cured with this synthetic T4 medication. Yet Synthroid is a chemical, and AT is natural from medical pigs, so the FDA is trying to Bann the only drug that has successfully treated millions of women. PS. Synthroid was not tested on women like many other drugs that were passed through the FDA before 2014! If you think this is a small problem, think again. Thyroid hormones are vital to human life, and the thyroid gland requires Iodine in the diet. The Midwest US has no Iodine in the soil or water. Therefore, this area is overburdened with hypothyroidism. I have been on AT for 50 years without complication and I have prescribed it thousands of times ever since I went into private practice.  AT works to relieve the symptoms of hypothyroidism for women and men, and it works better for women that the “new” drug Synthroid/levothyroxine, which is FDA approved. You ask how could the FDA approve a drug that doesn't successfully treat women? It is because Synthroid was not tested on women!  Until 2014 the FDA did not test women in the required drug trials.  AT works for us (women), Levothyroxine does not. Now the FDA wants to ban AT. It is not approved because it was around for decades before they started testing medications like they do now, and the history of successful treatment should stand on its own merit! Example 2: Bio-Identical Hormones BIH:  BIHs had not been approved by the FDA until recently and there was no announcement that they are now approved for women who have hormone deficiency symptoms or postmenopausal symptoms. Most doctors and women who have been afraid of the only hormones that can help them, bioidentical hormones, haven't yet been told that NOW, FINALLY the medical colleges and the FDA finally have quietly approved BI hormones.  There are no pure estradiol and pure testosterone pellets that are made by a drug company for women. My patients get their estradiol and testosterone pellets from a compounding pharmacy.  I have been prescribing BIH since 1985 without FDA approval because the oral estrogen formulations that were available at pharmacies caused weight gain and put women at high risk for blood clots. Non-oral BI hormones have fewer risks than FDA approved estrogens.  I waited more than 45 years for the FDA to approve BI hormones for treatment of women.  All those women in the last 45 years who were taking FDA approved estradiol and those who couldn't tolerate them have been harmed by FDA goals of never approving compounded or bio-identical hormones.  The delay has harmed 50% of American women. Example #3 Devices for Weight Loss I was involved in the discovery and testing of a unique device that stimulated acupuncture points with a TENS-unit-type patch connected to your cell phone for easy adjustment of your hunger or “fullness”. The FDA requires testing to approve any new device so the group of investors I was part of had to invest thousands of dollars for a device we already knew worked. The FDA told the investigators of all new devices who they should test, who they can't have in the study, and how long the testing should take. I found their parameters for the study of this device to be unrealistic. The women in our test group could not be taking hormones of any kind (birth control, ERT, HRT), and could not be on antidepressants, could not have diabetes or insulin resistance or be on any drug that assisted in weight loss. These women subjects had to be a certain BMI (level of obesity) and had to be tested repeatedly with weight and body composition measurements None of my patients who needed weight loss could participate.  Most GYN patients are on some medication or supplement, so the FDA made this study of our device so narrow that REAL WOMEN weren't tested! Sadly, we lost many women in the control group from the study because they were NOT losing weight while the ones on the device were obviously dropping pounds, so we had trouble maintaining test subjects. The testing phase of this simple device took 7 years! Our device works and no one will ever know about it or be able to use this non-medicinal weight loss device because when the FDA rejects your device you will be breaking the law if you produce and sell it directly to the public. It has no side effects or dangers..it just controls the amount you eat with stimulation of an acupuncture point. There are many ways to change this situation, and it takes years and billions of dollars to change the whole system of bringing treatments to patients quickly.  I'm afraid I won't see a revolution of the way we bring medicines and devices to market during my lifetime. Currently there is a 17-year delay between proving a drug or device works for a particular illness or condition and when it becomes available to doctors and patients. So what do we do in the meantime?  I seek treatments for patients who are unresponsive to traditional medicine by reading journals like Life Extension, that inform doctors and patients alike about new effective solutions for common medical complaints and diseases that the FDA has ignored or stymied with endless drug trials.  Life Extension Magazine highlights studies on new medications for diseases without an FDA approved solution and publicizes diagnostic tests often overlooked by mainstream publications because they are not yet FDA approved. The medical journals I read (New England Journal of Medicine, JAMA, Menopause, Metabolism and Endocrinology, Journal of Age management, to name a few) offer treatments for orphan diseases or even common problems that haven't been blessed by the FDA. It takes an average of 17 years from the culmination of research on a new drug, test or device until it is approved for use by the public! At the end of this Blog, I will give you a link to make your voice heard by signing a petition to shorten the approval of new treatments and medications from the average of 17 years to 3 years! My patients don't have time to wait for relief, and that may be the case for you as well. If you want to do something to help, please click this link and let the FDA know how you feel. Please sign a Petition to enact an amendment to the FOOD, DRUG and COSMETIC ACT, by going to: https://age-reversal.net/fda/

Sasha K. Shillcutt, MD, MS, FASE is a tenured and endowed Professor and the Vice Chair of Strategy in the Department of Anesthesiology at the University of Nebraska Medical Center. She is a double-boarded cardiac anesthesiologist and is also CEO & Founder of Brave Enough, a community of thousands of women in healthcare where she teaches women how to advance through courses, coaching, and events. She leads conferences and retreats for professional women and is a certified coach for women leaders. Sasha is a well-published researcher in anesthesiology and gender equity, best-selling author, and international speaker. She speaks frequently to executives and leaders on the topics of professional resilience and wellbeing. Her TEDx talk titled Resilience: The Art of Failing Forward has been viewed by thousands of people. Her writing has been published in both the New England Journal of Medicine and JAMA. Her first book, Between Grit and Grace: How to be Feminine and Formidable, has sold thousands of copies and her second book, Brave Boundaries, is an international best seller. Her podcast, The Brave Enough Show, has over 315K downloads & she has coached hundreds of women leaders to thrive. Some of the topics we discussed were: Setting boundaries at workUnderstanding your pain points Setting up boundaries outside of the homeSetting boundaries with your phoneSetting boundaries with yourselfSetting boundaries for phones with teenagersDealing with situations where your boundaries are not being respectedSetting boundaries with the people you loveModeling setting healthy boundaries for your kids And more! Learn more about me or schedule a FREE coaching call:https://www.joyfulsuccessliving.com/ Join the Voices of Women Physicians Facebook Group:https://www.facebook.com/groups/190596326343825/ Connect with Dr. Shilcutt: WEBSITE INSTAGRAM FACEBOOK TWITTER LINKEDIN 

Send us a textIn this episode, we cover the anatomy and functions of the menisci, the mechanisms behind various types of meniscal tears, and clinical assessment techniques. We also discuss when to opt for conservative care versus surgical treatment, and reviews special tests and imaging standards like MRIs. Tune in to enhance your understanding of knee meniscal injuries and improve your clinical practice.00:00 Introduction to Bets Snacks Podcast00:23 Overview of Knee Meniscal Tears00:54 Anatomy and Function of the Menisci03:03 Types of Meniscal Tears05:58 Clinical Assessment Techniques08:15 Imaging and Diagnosis09:04 Conservative vs. Surgical Treatment12:03 Conclusion and Additional ResourcesBeamer BS, Walley KC, Okajima S, et al. (2017). Meniscal Repair vs Partial Meniscectomy: A Comparative Analysis of Clinical Outcomes. Arthroscopy, 33(9), 1635–1643.Englund M, Guermazi A, Gale D, et al. (2008). Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons. New England Journal of Medicine, 359(11), 1108–1115.Logerstedt DS, Scalzitti D, Risberg MA, et al. (2010). Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions. Journal of Orthopaedic & Sports Physical Therapy (JOSPT) Clinical Practice Guidelines, 40(6), A1–A35.LaPrade RF, Geeslin AG, Everett CR, et al. (2015). Diagnosis and Treatment of Meniscal Injuries: A Review. Sports Health, 7(2), 147–154.Stensrud S, Risberg MA, Roos EM. (2012). Effect of Exercise Therapy on Meniscal Tear Outcomes in Middle-Aged Adults: A Randomized Controlled Trial. British Medical Journal (BMJ), 344:e533.Go to PT Final Exam using this link to access great studying options to conquer the NPTE!Support the showStay Connected! Make sure to hit follow now so you don't miss an episode! Got questions? Email me at ptsnackspodcast@gmail.com or leave feedback HERE. You can also join the email list HERE Need CEUs Fast?Time and resources short? Medbridge has you covered: Get over $100 off a subscription with code PTSNACKSPODCAST: Medbridge Students: Save $75 off a student subscription with code PTSNACKSPODCASTSTUDENT—a full year of unlimited access for less! Prepping for the NPTE? Get all the study tools you need to master it at PT Final Exam. Use code PTSnacks at checkout to get a discount! Want to Support the Show?Help me keep creating free content by: Sharing the podcast with someone who'd benefit. Contributing directly via the link...

Today on Perspectives, we're talking about the future of healthcare and what it means to be a better ancestor. A special article in the New England Journal of Medicine Catalyst introduces the Better Ancestor Framework—a bold new approach to transforming a healthcare system that too often has been shaped by structural racism, and instead reimagining one rooted in healing, trust, and justice for all. The article's three authors driving this work are Dr. Somava Saha, Executive Director of WE in the World, Kellie Easton, President and CEO of Action4Equity, and Kenneth Reid, Chief Operating Officer at Action4Equity. My guest on the show today is Dr. Saha. Together, they're asking a powerful question: What kind of healthcare system do we want to leave behind for future generations? During this conversation, we'll explore their new Better Ancestor Framework, the cultural wisdom that inspired it, and how it's already helping communities across the country build a fairer, more humane healthcare system.

JCO PO author Dr. Asaf Maoz at Dana-Farber Cancer Institute shares insights into article, “Causes of Death Among Individuals with Lynch Syndrome in the Immunotherapy Era.” Host Dr. Rafeh Naqash and Dr. Maoz discuss the causes of death in individuals with LS and the evolving role of immunotherapy. TRANSCRIPT Dr. Rafeh Naqash: Hello, and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCOPO articles. I'm your host, Dr. Rafeh Naqash, podcast editor for JCO Precision Oncology and Associate Professor Medicine, at the OU Health Stephenson Cancer Center. Today, I'm super thrilled to be joined by Dr. Asaf Maoz, Medical Oncologist at Dana-Farber Cancer Institute, Brigham and Women's Hospital, and faculty at the Harvard Medical School, and also lead author on the JCO Precision Oncology article entitled "Causes of Death Among Individuals with Lynch Syndrome in the Immunotherapy Era." This publication will be a concurrent publication with an oral presentation at the annual CGA meeting. At the time of this recording, our guest's disclosures will be linked in the transcript. Asaf, I'm excited to welcome you on this podcast. Thank you for joining us today. Dr. Asaf Maoz: Thank you so much for highlighting our paper. Dr. Rafeh Naqash: Absolutely. And I was just talking to you that we met several years back when you were a trainee, and it looks like you've worked a lot in this field now, and it's very exciting to see that you consider JCOPO as a relevant home for some of your work. And the topic that you have published on is of significant interest to trainees from a precision medicine standpoint, to oncologists in general, covers a lot of aspects of immunotherapy. So, I'm really excited to talk to you about all of this. Dr. Asaf Maoz: Me too, me too. And yeah, I think JCOPO has great content in the area of cancer genetics and has done a lot to disseminate the knowledge in that area. Dr. Rafeh Naqash: Wonderful. So, let's get started and start off, given that we have hosts of different kinds of individuals who listen to this podcast, especially when driving from home to work or back, for the sake of making everything simple, can we start by asking you what is Lynch syndrome? How is it diagnosed? What are some of the main things to consider when you're trying to talk an individual where you suspect Lynch syndrome? Dr. Asaf Maoz: Lynch syndrome is an inherited predisposition to cancer, and it is common. So, we used to think that, or there's a general notion in the medical community that it is a rare condition, but we actually know now from multiple studies, including studies that look at the general population and do genetic testing regardless of any clinical phenotype, that Lynch syndrome is found in about 1 in 300 people in the general population. If you think about it in the United States, that means that there are over a million people living with Lynch syndrome in the United States. Unfortunately, most individuals with Lynch syndrome don't know they have Lynch syndrome at the current time, and that's where a lot of the efforts in the community are being made to help detect more individuals who have Lynch syndrome. Lynch syndrome is caused by pathogenic germline variants in mismatch repair genes, MLH1, MSH2, MSH6, or PMS2, or as a result of pathogenic variants in EPCAM that cause silencing of the MSH2 gene. Dr. Rafeh Naqash: Excellent. Thank you for that explanation. Now, one of the other things I also realized, similar to BRCA germline mutations, where you require a second hit for individuals with Lynch syndrome to have mismatch repair deficient cancers, you also require a second hit to have that second hit result in an MSI-high cancer. Could you help us understand the difference of these two concepts where generally Lynch syndrome is thought of to be cancers that are mismatch repair deficient, but that's not necessarily true for all cases as we see in your paper. Can you tease this out for us a little bit more? Dr. Asaf Maoz: Of course, of course. So, the germline defect is in one of the mismatch repair genes, and these genes are responsible for DNA mismatch repair, as their name implies. Now, in a normal cell, we think that one working copy is generally enough to maintain the mismatch repair machinery intact. What happens in tumors, as you alluded to, is that there is a second hit in the same mismatch repair gene that has the pathogenic germline variant, and that causes the mismatch repair machinery not to work anymore. And so what happens is that there is formation of mutations in the cancer cell that are not present in other cells in the body. And we know that there are specific types of mutations that are associated with defects in mismatch repair mechanisms, and those are associated a lot of times with frameshift mutations. And we have termed them ‘microsatellites'. So there are areas in the genome that have repeats, for example, you know, if you have AAAA or GAGA, and those areas are particularly susceptible to mutations when the mismatch repair machinery is not working. And so we can measure that with DNA microsatellite instability testing. But we can also get a sense of whether the mismatch repair machinery is functioning by looking at protein expression on the surface of cancer cells and by doing immunohistochemistry. More recently, we're also able to infer whether the mismatch repair machinery is working by doing next-generation sequencing and looking at many, many microsatellites and whether they have this DNA instability in the microsatellites. Dr. Rafeh Naqash: Excellent explanation. As a segue to what you just mentioned, and this reminds me of some work that one of my good friends, collaborators, Amin Nassar, whom you also know, I believe, had done a year and a half back, was published in Cancer Cell as a brief report, I believe, where the concept was that when you look at these mismatch repair deficient cancers, there is a difference between NGS testing, IHC testing, and maybe to some extent, PCR testing, where you can have discordances. Have you seen that in your clinical experience? What are some of your thoughts there? And if a trainee were to ask, what would be the gold standard to test individuals where you suspect mismatch repair deficient-related Lynch syndrome cancers? How would you test those individuals? Dr. Asaf Maoz: We do sometimes see discordance, you know, from large series, the concordance rate is very high, and in most series it's over 95%. And so from a practical perspective, if we're thinking about the recommendation to screen all colorectal cancer and all endometrial cancer for mismatch repair deficiency, I think either PCR-based testing or immunohistochemistry is acceptable because the concordance rate is very high. There are rare cases where it is not concordant, doing multiple of the tests makes sense at that time. If you think about the difference between the tests, the immunohistochemistry looks at protein expression, which is a surrogate for whether there is mismatch repair deficiency or not, right? Because ultimately, the mismatch repair deficiency is manifested in the mutations. So if the PCR does not show microsatellite instability and now NGS does not show microsatellite instability, the IHC may be a false positive. At the end of the day, the functional analysis of whether there are actually unstable microsatellites either by PCR or by NGS is what I would consider more informative. But IHC again is an excellent test and concordant with those results in over 95% of cases. Now there is also an issue of sampling. It's possible that there's heterogeneity within the tumor. We published a case in JCOPO about heterogeneity of the mismatch repair status, and that was both by immunohistochemistry, but also by PCR. So there are some caveats and interpreting these tests does require some expertise, and I'm always happy to chat with trainees or whoever has an interesting or challenging case. Dr. Rafeh Naqash: Thanks again for that very easy to understand explanation. Now going to management strategies, could you elaborate a little bit upon the neo-adjuvant data currently, or the metastatic data which I think more people are familiar with for immunotherapy in individuals with MSI-high cancers? Dr. Asaf Maoz: Yeah, that's an excellent question and obviously a very broad topic. Individuals with Lynch syndrome typically develop tumors that are mismatch repair deficient or microsatellite unstable. And we have seen over the last 15 years or so that these tumors, because they have a lot of mutations and because these mutations are very immunogenic, we have seen that they respond very well to immunotherapy. And this has been shown across disease sites and has been shown across disease settings. And for that reason, immunotherapy was approved for MSI-high or mismatch repair deficient cancer regardless of the anatomic site. It was the first tissue-agnostic approval by the FDA in 2017. And so there are exciting studies both in the metastatic setting where we see individuals who respond to immunotherapy for many years, and one could wonder whether their cancer is going to come back or not. And also in the earlier setting, for example, the Cercek et al. study in the New England Journal from Sloan Kettering, where they showed that neoadjuvant immunotherapy can cause durable responses for rectal cancer that is mismatch repair deficient. And in that series, the patients did not require surgery or radiation, which is standard of care for rectal cancer otherwise. And there's also exciting data in the adjuvant space, as was presented in ASCO by Dr. Sinicrope, the ATOMIC study, and many more efforts to bring immunotherapy into the treatment landscape for individuals with MSI-high cancer, including individuals with Lynch syndrome. Dr. Rafeh Naqash: A lot of activity, especially in the neo-adjuvant and adjuvant space over the last two years or so. Now going to the actual reason why we are here is your study. Could you tell us why you looked at this idea of patients who had Lynch syndrome and died, and the reasons for their death? What was the thought that triggered this project? Dr. Asaf Maoz: As we were talking about, we now know that immunotherapy really has changed the treatment landscape for individuals with Lynch syndrome, and that most cancers that individuals with Lynch syndrome do have this mismatch repair deficiency. But we also know that individuals with Lynch syndrome can develop tumors that do not have mismatch repair deficiency, and we call them mismatch repair proficient or microsatellite stable. And there was a series from Memorial Sloan Kettering showing that in colorectal cancer, about 10% of the tumors that individuals with Lynch syndrome developed did not have mismatch repair deficiency. In addition to that, we anecdotally saw that some of our patients with Lynch syndrome died of causes that were not mismatch repair deficient tumors. We wanted to see how that has changed since immunotherapy was approved in a tissue-agnostic manner, meaning that we could look at this regardless of where the cancer started, because we would anticipate that if the tumor was mismatch repair deficient, the patient would be able to access immunotherapy as standard of care. Dr. Rafeh Naqash: Thank you. And then you looked at different aspects of correlations with regards to individuals that had an MSI-high cancer with Lynch syndrome or an MSS cancer with Lynch syndrome. Could you elaborate on some of the important findings that you identified as well as some of the unusual findings that perhaps we did not know about, even though the sample size is limited, but what were some of the unique things that you did identify through this project? Dr. Asaf Maoz: The first question was what cause is leading to death in individuals with Lynch syndrome? And we had 54 patients that we identified that had died since the approval of immunotherapy in 2017, 44 of which died of cancer-related causes. And when we looked at cancer-related causes of death, we wanted to know how many of those were due to mismatch repair deficient tumors versus mismatch repair proficient tumors or MS-stable tumors. And we found, somewhat surprisingly, that 43% of patients in our cohort actually died of tumors that were microsatellite stable or mismatch repair proficient, meaning of tumors that are not typically associated with Lynch syndrome. This is not entirely surprising as a cause of death because we know that immunotherapy does not typically work for tumors that are microsatellite stable. And so in the metastatic setting, there are much less cases of durable remissions with treatment. But it was helpful to have that figure as an important benchmark. There are previous studies about causes of death in Lynch syndrome, and particularly from the Prospective Lynch Syndrome Database in Europe. Those have provided really important information about cause of death by cancer site, but they typically don't have mismatch repair status and are more difficult to interpret in that regard. They also don't include a large number of individuals who have PMS2 Lynch syndrome, which is the most common, but least penetrant form of Lynch syndrome. Dr. Rafeh Naqash: As far as the subtype of pathogenic germline variants is concerned, did you notice anything unusual? And I've always had this question, and you may know more about this data, is: In the bigger context of immunotherapy, does the type of the pathogenic germline variant for Lynch syndrome associated MSI-high cancers, does that impact or have an association with the kind of outcomes, how soon a cancer progresses or how many exceptional responders perhaps with MSI-high cancers actually have a certain specific pathogenic germline variant? Dr. Asaf Maoz: That's an excellent question, and certainly we need more data in that space. We know that the type of germline mutation, or the gene in which there is a germline pathogenic variant, determines to a large degree the cancer risk, right? So we know that individuals who have germline pathogenic variants in MLH1 or MSH2 have a much higher colorectal cancer risk than, for example, PMS2. We know that for PMS2, the risks are more limited to colorectal and endometrial, and may be lower risk of other cancers. We also know that, you know, the spectrum of disease may change based on the pathogenic germline variants. For example, individuals who have MSH2 associated Lynch syndrome have more risk of additional cancers in other organs like the urinary tract and other less common Lynch-associated tumors. The question about response to therapy is one where we have much less information. There are studies that are trying to assess this, but I don't think the answer is there yet. Some of the non-clinical data looks at how many mutations there are based on the pathogenic variant and what the nature of those mutations are, whether they're more frameshift or others. But I think we still need more clinical data to understand whether the response to immunotherapy differs. It's also complicated by the fact that the immunotherapy landscape is changing, especially in the metastatic setting, now with the approval of combination ipilimumab and nivolumab for first-line treatment of colorectal cancer that is microsatellite unstable. But in our study, we did find that, as you would expect, there is an enrichment in MS-stable cancers among those with PMS2 Lynch syndrome. Again, our denominator is those who died, right? So this is not the best way to look at the question whether this is overall true, that is more addressed by the study that Sloan Kettering published. But we do see, as we would anticipate, that there are more microsatellite stable cancers among those with PMS2 Lynch syndrome that died. Dr. Rafeh Naqash: A lot to uncover there for sure. This study and perhaps some of the other work that you're doing is slowly advancing our understanding of some of these concepts. So I'd like to shift gears to a couple of provocative questions that I generally like to ask. The first is, in your opinion, and you may or may not have data to back this up, which is okay, and that's why we're having a conversation about it. In your opinion, do you think the type or the quality of the neoantigen is different based on the pathogenic germline variant and a Lynch syndrome associated MSI-high cancer? Dr. Asaf Maoz: I think there are some data out there that, you know, I can't cite off the top of my mind, but there are some data out there that suggest that that may be the case. I think the key question is the quality, right? I think that whether these differences that are found on a molecular level also translate to a clinical difference in response is something that is unknown at this moment. Some people hypothesize that if the tumor has less neoantigens, there's less of a response to immunotherapy. But I think we really need to be careful before making those assertions on a clinical level. I do think it's a really important question that needs to be answered, among others because, you know, in the colorectal space, for example, where we have both the option of doing ipilimumab with nivolumab and the option of doing pembrolizumab, we don't really know which patients need the CTLA-4 blockade versus which patients can receive PD-1 blockade alone and avoid the potential excess toxicity of the CTLA-4 blockade. There are a lot of interesting questions there that still need to be answered. And of course, individuals with Lynch syndrome are just a fraction of those individuals who have MSI-high cancer. So there's also the question about whether non-Lynch syndrome associated MSI-high cancer responds differently to immunotherapy than Lynch syndrome associated MSI-high cancer. A lot of very interesting questions in the field for sure. Dr. Rafeh Naqash: Absolutely. My second question is more about trying to understand the role of ctDNA, MRD monitoring in individuals with Lynch syndrome. If somebody has a germline, you know, Lynch syndrome MSI-high cancer, when you do a tumor-informed ctDNA assessment, what do you capture generally there? Because, and this question stems from a discussion I've had with somebody regarding EGFR lung cancer, since I treat individuals with lung cancer, and the concept generally is that even if the tissue showed EGFR, but for MRD monitoring, when you do a barcoded sequence of different tumor specific mutations, it's not actually the EGFR that they track in the blood when they do ctDNA assessment. But from a Lynch syndrome standpoint, if you have a germline, right, which is the first hit, and then you have the somatic in the tumor, which is the second hit, are you aware or have you tried to look into this where what is exactly being followed if one had to follow MRD in a Lynch syndrome MSI-high colorectal cancer? Dr. Asaf Maoz: I think a lot of the MRD assays are proprietary, and so we don't receive information about what the mutations that are being tracked are. In general, the idea is to track mutations that we would not expect to disappear as part of resistant mechanisms. We want these to be truncal mutations. We want these to be mutations in which resistance is not expected to result in reversion mutations. But what specifically is being tracked is something that I don't know because these assays, the tumor-informed ones, are proprietary, and we don't get the results regarding specific mutations. When it's circulating tumor DNA that is not necessarily tumor-informed, we do get those results, but that is less so about the specific selection of mutations. Dr. Rafeh Naqash: Thank you for clarifying that question to some extent, of course, as you said, we don't know a lot, and we don't know what we don't know. That's the most important thing that I've learned in the process of understanding precision medicine and genomics, and it's a very fast-paced evolving field. Last question related to your project, what is the next step? Are you planning any next steps as a bigger multicenter study or validation of some sort? Dr. Asaf Maoz: There are two big questions that this study raises. One, is this true across multiple other sites, right? Because this is a single center study, and we really need additional centers to look at their data and validate whether they are also seeing that a substantial portion of deaths in individuals with Lynch syndrome are attributable to mismatch repair proficient cancer. The other question is whether we can look at specifically MSI-high cancer versus MS-stable cancer and understand what the mortality rate for each of those are. From a clinical perspective, it's important to counsel individuals with Lynch syndrome about general cancer screening outside of mismatch repair deficient tumors and to understand that there is also a risk of mismatch repair proficient tumors and that treatment for those tumors would be different. There's a lot of work to be done in the future. Another major area of need is to see whether tumors that are microsatellite stable can be sensitized to immunotherapy, and that is beyond the Lynch syndrome field, but that is something that certainly would benefit these individuals with Lynch syndrome who develop mismatch repair proficient cancer. Dr. Rafeh Naqash: That's very interesting to hear, and we'll look forward to seeing some of those developments shape in the next few years. Now, I'd like to spend a minute, minute and a half on you specifically as a researcher, clinician, scientist. Could you briefly highlight - because I remember meeting you several years back as a trainee, with your interest in genomics, computational research - could you briefly tell us what led you to hereditary cancer syndromes based on your research and work? What are some of the things that you learned along the way that other early career investigators can perhaps take lessons from? Dr. Asaf Maoz: Big questions there, thanks for asking. I got interested in the field of hereditary cancer syndromes when I came to the United States and started doing lab research in Stephen Gruber's lab at the time at USC. He's now at City of Hope. And my interest was originally looking at immunotherapy and immunology, but I went to the case conferences where we were learning about individuals with hereditary cancer, and those were kind of earlier days where we were still trying to figure out how to test and what the implications for these individuals would be. And through fellowship, I was also very interested in that, and I did my senior fellowship years with Dr. Yurgelun here at Dana-Farber, who is the director of the Lynch Syndrome Center. And I I think it's the combination between being able to treat individuals based on precision medicine and what the germline mutation is, but also the ability to prevent cancer and to develop strategies to intercept cancer early that is really appealing to me in this field. It's also a great field to be in because it's a small field. If you come to the CGA-IGC meeting, you'll be able to interact with everyone. Everyone is super collaborative, super nice, and I really recommend it to trainees. The CGA-IGC annual meeting is really a great opportunity to learn more and experience some of the advancement specifically in the GI hereditary space. Lessons for trainees. I think there are a lot of lessons that I could think about, but I think finding strong and supportive mentors is one of the things that has helped me most. I think that just having close relationship with your mentor, having frequent discussions and honest discussions about what is feasible, what is going to make a difference for your patients and your research and what you want to focus on is really important. And so I think if I had to choose one thing, I would say choose a mentor that you trust, that you feel you have a good relationship with, and that has the availability to support you. Dr. Rafeh Naqash: Thank you so much for those insightful comments, and thank you for sharing with us your journey, your project, and some of your interesting thoughts on this concept of hereditary cancers. Hopefully, we'll see more of this work being published in JCOPO through your lab or work from others. Dr. Asaf Maoz: Thank you so much. I appreciate the opportunity to be here. Dr. Rafeh Naqash: Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at ASCO.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Today, I'm joined by Dr. Lisa Shah, Chief Medical Officer at Twin Health.   Replacing population averages with personal biomarkers, Twin Health leverages digital twin technology to address root causes of metabolic conditions like obesity and diabetes.   In this episode, we discuss how machine learning is transforming disease management.   We also cover:   Building a GLP-1 off-ramp Balancing AI with human support Achieving a 71% diabetes reversal rate   Subscribe to the podcast → insider.fitt.co/podcast  Subscribe to our newsletter → insider.fitt.co/subscribe  Follow us on LinkedIn → linkedin.com/company/fittinsider    Twin Health's Website: www.twinhealth.com  Dr. Lisa Shah's LinkedIn: https://www.linkedin.com/in/lisa-shah-4a297b19/ Twin Health's Facebook: https://www.facebook.com/twinhealthusa/ Twin Health's Instagram: https://www.instagram.com/twinhealthusa Twin Health's LinkedIn: https://www.linkedin.com/company/twinhealth/   -   The Fitt Insider Podcast is brought to you by EGYM. Visit EGYM.com  to learn more about its smart workout solutions for fitness and health facilities.   Fitt Talent: https://talent.fitt.co/  Consulting: https://consulting.fitt.co/  Investments: https://capital.fitt.co/    Chapters: (00:00) Introduction (02:00) Digital twin technology explained and healthcare applications (04:15) Why digital twin technology is finally possible now (08:30) Turning 3K daily data points into actionable guidance (11:15) Balancing digital twin AI with human care team support (15:00) Clinical outcomes and New England Journal of Medicine study (19:15) Root cause solutions vs symptom management (21:15) Scaling from employer benefits to consumer prevention (24:00) Value-based care approach vs. direct-to-consumer model (27:15) Digital twin complexity across multiple health systems (31:00) Building trust through real-time feedback loops (33:00) Agentic AI applications in healthcare delivery (37:42) Future roadmap (40:15) Conclusion  

Sasha K. Shillcutt, MD, MS, FASE is a tenured and endowed Professor and the Vice Chair of Strategy in the Department of Anesthesiology at the University of Nebraska Medical Center. She is a double-boarded cardiac anesthesiologist and is also CEO & Founder of Brave Enough, a community of thousands of women in healthcare where she teaches women how to advance through courses, coaching, and events. She leads conferences and retreats for professional women and is a certified coach for women leaders. Sasha is a well-published researcher in anesthesiology and gender equity, best-selling author, and international speaker. She speaks frequently to executives and leaders on the topics of professional resilience and wellbeing. Her TEDx talk titled Resilience: The Art of Failing Forward has been viewed by thousands of people. Her writing has been published in both the New England Journal of Medicine and JAMA. Her first book, Between Grit and Grace: How to be Feminine and Formidable, has sold thousands of copies and her second book, Brave Boundaries, is an international best seller. Her podcast, The Brave Enough Show, has over 315K downloads & she has coached hundreds of women leaders to thrive. Some of the topics we discussed were:Taking care of everybody else without leaving room for yourselfPrioritizing your well-being by setting aside time just for youHow to set up boundariesWhat boundaries really areSetting up boundaries in your personal life (like with your partner, children, parents, siblings, friends, etc.)Communicating your boundaries with othersSetting up boundaries at workAnd more!Learn more about me or schedule a FREE coaching call:https://www.joyfulsuccessliving.com/Join the Voices of Women Physicians Facebook Group:https://www.facebook.com/groups/190596326343825/ Connect with Dr. Shilcutt: WEBSITEINSTAGRAMFACEBOOKTWITTERLINKEDIN 

For decades, clinical trial recruitment has been the biggest challenge in the industry. Christine Senn, senior vice president of Site-Sponsor Innovation at Advarra, offers insights into why the struggle continues, such as delays in getting regulations updated after a quarter of a century, and how to overcome the deadlock in clinical trial recruitment that is tied to current obsolete marketing guidelines. Also, host Deborah Borfitz shares the latest on beta blockers, low dose aspirin lowering the risk of recurring colorectal cancer, repurposing drugs for breast cancer relapse prevention, remote participation research on why athletes and military members face higher ALS risk, and the first agentic AI platform for life sciences from Medable. Show Notes News Roundup Rethinking beta blockers Press release on the Mount Sinai website Subgroup analysis study in the European Heart Journal Aspirin lowers risk of colorectal cancer recurrence Study in The New England Journal of Medicine  CLEVER study to prevent breast cancer relapse Study in Nature Medicine News release on Penn Medicine website   Champion Insights ALS initiative News release on Answer ALS website Medable's Agent Studio Press release on the Medable website Disseminating research findings Systematic review in PLOS Medicine  Guest Christine Senn, Ph.D., senior vice president of site-sponsor innovation at Advarra The Scope of Things podcast explores clinical research and its possibilities, promise, and pitfalls. Clinical Research News senior writer, Deborah Borfitz, welcomes guests who are visionaries closest to the topics, but who can still see past their piece of the puzzle. Focusing on game-changing trends and out-of-the-box operational approaches in the clinical research field, the Scope of Things podcast is your no-nonsense, insider's look at clinical research today.

Send us a message with this link, we would love to hear from you. Standard message rates may apply. We unpack myths, the new stepwise approach, and why return to school should come before return to play.• what a concussion is• common and delayed symptoms including mood and sleep changes• immediate sideline steps• why “cocooning” is outdated and how light activity helps• individualized recovery timelines and risk of returning too soon• return-to-learn before return-to-play with simple accommodations• a staircase model for activity and symptom thresholds• helmets vs brain movement and the role of honest reporting• practical tips for coaches, parents, and student athletesCheck out our website, send us an email, share this with a friend or young student athlete who is playing some sports and might get a concussionReferencesBroglio SP, Register-Mihalik JK, Guskiewicz KM, et al. National Athletic Trainers' Association Bridge Statement: Management of Sport-Related Concussion. Journal of Athletic Training. 2024;59(3):225-242. doi:10.4085/1062-6050-0046.22.Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. Lumba-Brown A, Yeates KO, Sarmiento K, et al. JAMA Pediatrics. 2018;172(11):e182853. doi:10.1001/jamapediatrics.2018.2853.Feiss R, Lutz M, Reiche E, Moody J, Pangelinan M. A Systematic Review of the Effectiveness of Concussion Education Programs for Coaches and Parents of Youth Athletes. International Journal of Environmental Research and Public Health. 2020;17(8):E2665. doi:10.3390/ijerph17082665.Gereige RS, Gross T, Jastaniah E. Individual Medical Emergencies Occurring at School. Pediatrics. 2022;150(1):e2022057987. doi:10.1542/peds.2022-057987.Giza CC, Kutcher JS, Ashwal S, et al. Summary of Evidence-Based Guideline Update: Evaluation and Management of Concussion in Sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250-2257. doi:10.1212/WNL.0b013e31828d57dd.Halstead ME. What's New With Pediatric Sport Concussions? Pediatrics. 2024;153(1):e2023063881. doi:10.1542/peds.2023-063881.Halstead ME, Walter KD, Moffatt K. Sport-Related Concussion in Children and Adolescents. Pediatrics. 2018;142(6):e20183074. doi:10.1542/peds.2018-3074.Leddy JJ. Sport-Related Concussion. The New England Journal of Medicine. 2025;392(5):483-493. doi:10.1056/NEJMcp2400691.McCrea M, Broglio S, McAllister T, et al. Return to Play and Risk of Repeat Concussion in Collegiate Football Players: Comparative Analysis From the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017). British Journal of Sports Medicine. 2020;54(2):102-109. doi:10.1136/bjsports-2019-100579.Scorza KA, Cole W. Current Concepts in Concussion: Initial Evaluation and Management. American Family Physician. 2019;99(7):426-434.Shirley E, Hudspeth LJ, Maynard JR. Managing Sports-Related Concussions From Time of Injury Through Return to Play. The Journal of the American Academy of Orthopaedic Surgeons. 2018;26(13):e279-e286. doi:10.5435/JAAOS-D-16-00684.Zhou H, Ledsky R, Sarmiento K, et al. Parent-Child Communication About ConcussSupport the showSubscribe to Our Newsletter! Production and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

Is your smartwatch just a fun gadget, or a serious medical device?  In this episode, Jonathan Wolf is joined by Dr. Malcolm Findlay, a leading consultant cardiologist, to explore the powerful health data available on your wrist. They decode the most misunderstood metric, Heart Rate Variability (HRV), and reveal how your wearable can provide clinical-grade insights into your heart's health. Dr. Findlay explains the counter-intuitive science behind HRV — why more ‘wobble' in your heartbeat is a sign of good health — and breaks down the two opposing nervous systems that control it. He shares the latest on how these devices can accurately detect serious conditions like atrial fibrillation and why he, as a cardiologist, trusts the ECG function on a consumer smartwatch to make diagnoses. For listeners who track their own data, this episode is a practical guide to what your numbers actually mean. Dr. Findlay explains how to interpret your personal HRV trends, what constitutes a significant change, and when you should use the ECG feature. He also debunks common myths about heart rate zones, revealing the level of exercise intensity that truly benefits your long-term health. The episode concludes with an empowering look at how this technology is shifting control into our own hands. Can a simple alert from your watch really help prevent a catastrophic event like a stroke? Discover which metrics matter most and how to use them to guide your wellness journey.

In this episode of Quah (Q & A), Sal, Adam & Justin coach four Pump Heads via Zoom. Mind Pump Fit Tip: 6 Ways to Destroy Your Testosterone. (2:38) Classic bad dad mistake. (26:56) The dangers of daily plastic exposure for kids. (29:45) Net positive or negative with these GLP-1 weight-loss drugs. (35:13) The more you know. (38:40) Shout out to @mdmotivator on Instagram. (42:01) Stay hydrated out there! (44:06) Billionaire chat.  (46:01) The grass-fed market is exploding! (51:23) #ListenerLive question #1 – Do you have any go-to methods or overlooked strategies for improving grip strength in the general population clients? (53:24) #ListenerLive question #2 – I am starting to get bored in the gym and want a new workout routine to switch things up.  Can you point me in the direction of something that would challenge me and still be fun for me to do? (1:03:37) #ListenerLive question #3 – I'd love to follow up on your first round of advice and get your guidance on breaking through this plateau so I actually look different next year. (1:12:18) #ListenerLive question #4 – Any advice on how I should train when I've been dealing with a chronic injury? (1:23:01) Related Links/Products Mentioned Ask a question to Mind Pump, live! Email: live@mindpumpmedia.com Get your free Sample Pack with any “drink mix” purchase! Find your favorite LMNT flavor or share it with a friend. Try LMNT risk-free. If you don't like it, give it away to a salty friend and we'll give you your money back, no questions asked! Visit DrinkLMNT.com/MindPump Visit Butcher Box for this month's exclusive Mind Pump offer!  ** Available for a limited time, a curated box pre-filled with Mind Pump's favorite cuts — no guesswork! Butcher Box members who sign up through Mind Pump will receive: $20 OFF their first box, Free chicken breast, ground beef, OR salmon in every box for a whole year! ** Flash Sale: MAPS Performance 50% off! ** Code ATHLETE50 at checkout. ** Mind Pump Store The Link Between Sleep and Testosterone Effect of partial and total sleep deprivation on serum testosterone in healthy males: a systematic review and meta-analysis Examining the effects of calorie restriction on testosterone concentrations in men: a systematic review and meta-analysis Mind Pump #2690: The NEW DIET Everyone Is Using For Fat Loss How a sedentary lifestyle reduces testosterone levels in men Correlation between serum zinc and testosterone Cortisol and testosterone dynamics following exhaustive endurance exercise Childhood plastic exposure could be fueling obesity, infertility, and asthma Lilly's oral GLP-1, orforglipron, demonstrated meaningful weight loss and cardiometabolic improvements in complete ATTAIN-1 results published in The New England Journal of Medicine Ozempic's hidden pregnancy risk few women know about A Runner Shattered the Stroller Mile World Record Baby strollers for Rolls-Royce Cullinan In Memoriam: The 31 Billionaires Who Died Over The Past Year Visit Luminose by Entera for an exclusive offer for Mind Pump listeners! ** Promo code MPM at checkout for 10% off their order or 10% off their first month of a subscribe-and-save. ** Mind Pump #2659: Eight Ways to Build a Crushing Grip & Strong Forearms & More (Listener Live Coaching) MAPS Prime Pro Webinar Trainer Bonus Series Episode 3: Assessments That Sell Training Mind Pump Podcast – YouTube Mind Pump Free Resources People Mentioned

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

Multiple food allergies are a daily stressor for millions of families. From avoiding social events to fearing accidental exposures, it can feel like living in a constant state of alert. Until recently, there were no FDA-approved treatments that targeted more than one allergen at a time. In this episode, we break down the study: “Omalizumab for the Treatment of Multiple Food Allergies,” published in 2024 in the New England Journal of Medicine. Known as the OUtMATCH trial, it's the first large-scale study to show that omalizumab (Xolair), a biologic already used for asthma and hives, may help people with multiple food allergies by raising the threshold for reactions. We explain how omalizumab works by blocking IgE, the antibody that triggers allergic reactions, and how the study measured changes in reaction thresholds (the amount of an allergen a person can ingest before reacting). We also explore the trial design, results, safety profile, and what all of this means for the day-to-day management of food allergies. What we cover in our episode about OUtMATCH trial How omalizumab works to prevent allergic reactions: Learn how blocking IgE increases the amount of allergen needed to trigger symptoms, offering protection from small, accidental exposures. Who qualified for the OUtMATCH trial and why: Find out which patients were included and how eligibility impacted outcomes. What success looked like in this study: Understand how researchers defined protection across multiple allergens. Why not everyone responded the same to omalizumab: Explore the variability in results and what it means for clinical care. What else the study found beyond food challenges: Hear about safety findings, quality of life data, and the open-label extension.

Stress isn't just something to “manage” — it's a signal, a teacher, and often, an invitation to look deeper at our health, our choices, and our lives. In this solo episode, Darin reframes stress not as an enemy, but as a dashboard light pointing toward misalignments in our nervous system, environment, relationships, and purpose. Drawing on science, practical tools, and personal insight, Darin reveals how layered stress silently drains our vitality — and how to transform it into an ally for growth, healing, and deeper contentment. Whether it's hidden trauma, toxic environments, unresolved conflict, or the modern distractions constantly pulling at our attention, Darin lays out a roadmap to stop the leaks and reclaim the energy already within you. This episode is a powerful reminder: stress isn't the end of the story — it's the beginning of awareness, safety, and a super life.     What You'll Learn in This Episode [00:00] Introduction to the Super Life podcast [03:27] Why stress might not be your enemy [04:17] Stress as an ally: the signals it gives us about misalignment [04:32] The dashboard light metaphor: how stress reveals hidden issues [05:28] The illusion of “no choice” and the infinite possibilities always available [06:12] Global stress statistics and why most people underestimate their stress load [07:23] Hidden stress revealed through heart rate variability and physiology [08:23] Layered stress: how sleep, exercise, and poor choices compound each other [09:25] Safety vs. calm — why your nervous system craves safety first [10:15] Trauma and the unconscious mind: how old wounds drive our stress response [11:54] Inner narratives and negative self-talk as hidden stress multipliers [12:22] The role of community and your social field in stress and resilience [13:53] Relationships, honesty, and how your circle shapes your energy [14:55] Why boundaries around media and politics are vital for mental clarity [17:42] Finding micro-purpose when life feels overwhelming [18:52] Environmental layers of stress — light, air, and clutter [19:15] The existential layer: stress from living without service or purpose [20:12] Stress as a risk amplifier — how it undermines healing and health [20:55] The deeper truth of safety, connection, and higher power [23:00] Practical tools: breathing, grounding, nature, and conscious choices [24:01] Trauma reframed: not a problem, but a protector at the time [25:25] Lessons from Peter Levine and wild animals: releasing trauma physically [26:04] Questions to ask trauma: “What are you protecting me from?” [26:56] Stress as a multiplier of aging, disease, and poor outcomes [29:20] Why stress isn't a single cause — it's layered and chronic [30:18] Anti-stress strategies: circadian rhythm, nature, and gratitude [31:49] Energy leaks to avoid: clutter, poor food, scrolling, bad boundaries [32:22] What matters most: service, contribution, and alignment [33:28] Final toolkit: breathwork, movement, nature, sleep, and gratitude [34:38] The deeper invitation: step into sovereignty and live your SuperLife     Thank You to Our Sponsors: Manna Vitality: Go to mannavitality.com/  or use code DARIN20 for 20% off your order. Bite Toothpaste: Go to trybite.com/DARIN20 or use code DARIN20 for 20% off your first order.     Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences Check out my podcast with Dr. Amy Abbington     Key Takeaway “Stress is not the enemy. It's a dashboard light — a teacher showing you where you're out of alignment. When you reframe stress, you reclaim your energy and create space for healing, safety, and the joy of living a super life.”     Bibliography (selected, peer-reviewed) Sources: Gallup Global Emotions (2024); Gallup U.S. polling (2024); APA Stress in America (2023); Natarajan et al., Lancet Digital Health (2020); Orini et al., UK Biobank (2023); Martinez et al. (2022); Leiden University (2025). Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med.1991;325(9):606–612. New England Journal of Medicine Cohen S, et al. 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