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9 episodes with Overdiagnosis
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2 episodes with Overdiagnosis
3 episodes with Overdiagnosis
6 episodes with Overdiagnosis
2 episodes with Overdiagnosis
2 episodes with Overdiagnosis
2 episodes with Overdiagnosis
Preview: Conversation with Dr. Ronald Dworkin re the modern trend of overdiagnosis and overmedicalization. More later. 1961
1/2: #M.D: OVERDIAGNOSIS. OVERMEDICALIZATION RONALD DWORKIN, CIVITAS INSTITUTE 1931
2/2: #M.D: OVERDIAGNOSIS. OVERMEDICALIZATION. RONALD DWORKIN, CIVITAS INSTITUTE 1960
Questions, suggestions, or feedback? Send us a message!Our guest today is Suzanne O'Sullivan, the author of the book The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far. Suzanne is a neurologist, clinical neurophysiologist, and writer. She has been a consultant since 2004 and has been at The National Hospital for Neurology and The Epilepsy Society since 2011. Her specialist interests are in epilepsy and in improving services for people who suffer with functional neurological disorders.Suzanne qualified in medicine in 1991 from Trinity College Dublin. In addition to academic publications in her field, she is an author of award-winning non-fiction books, each focusing on her medical casework.Her 2016 book, It's All in Your Head: True Stories of Imaginary Illness, won the Wellcome Book Prize, and the Royal Society of Biology's General Book Prize, for "for an accessible, engaging and informative life sciences book written for a non-specialist audience". Her book, The Sleeping Beauties: And Other Stories of Mystery Illness, was shortlisted for the 2021 Royal Society Science Book Prize.We talk about:Is there an epidemic of overdiagnosisExtending the definitions of disordersThe rise of ADHD and Autism diagnosisThe impact of this on either end of the spectrumHas this had a positive or negative effect on mental healthMedicalising natural mood swings and differencesIllness as identityCancer screening and proactive surgeryLet's analyseWeb: www.whereshallwemeet.xyzTwitter: @whrshallwemeetInstagram: @whrshallwemeet
Dr. Suzanne O'Sullivan is a neurologist and award-winning author. In her latest book, The Age of Diagnosis, she tackles the growing crisis of overdiagnosis—how modern medicine's obsession with labels may be doing more harm than good. Drawing from her front-line experience during the COVID-19 pandemic, O'Sullivan reflects on how uncertainty, fear, and the urge to explain the unexplainable shaped her thinking and deepened her understanding of what it truly means to be “sick.”
The UK's chancellor has announced a £5bn cut to benefits, much of which will be borne by those on long-term disability allowance. Gerry McCartney, professor of wellbeing economy at Glasgow University explains about why these cuts will not only hurt the most vulnerable, but will be counterproductive to the government's wish to get people back to work. Also, Suzanne O'Sullivan, consultant neurologist and author, joins us to talk about her new book "Age of Diagnosis". The book used clinical cases to explore the issues of medicalisation, and Suzanne explains why overdiagnosis doesn't mean that care isn't needed. Reading list; UK welfare reforms threaten health of the most vulnerable Guardian edited extract from "The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far"
Join us for the Vet Vault's own conference in the snow: Vets On Tour Wānaka, New Zealand, 10-15 August 2025!Have you ever felt pressured, as a vet, to do more 'stuff' - diagnostics, procedures, and sell more, even when you can't quite see the clinical justification for it? In this episode we welcome Dr. Brennen McKenzie-veterinarian, researcher, creator of the SkeptVet blog, author of Placebos for Pets? The Truth About Alternative Medicine in Animals, and all-round lover of science-based thinking. And who better to help us draw the line between solid science and revenue-driven decision making than someone who is known for their scepticism? Dr. McKenzie brings real-world wisdom and refreshing honesty to the debate. Together we explore the often-unspoken pressures of profit-driven care, commission-based pay, and what happens when business incentives conflict with good science. Brennen shares lessons from two decades in practice on how to use Spectrum of care reasoning to make clinical decisions that respect science, client resources, and the needs of your employer. A must-listen for any vet who's ever questioned the system—and their place in it.Find out more about Brennen's current work in longevity at loyal.com.Join our community of Vet Vault Nerds to lift your clinical game and get your groove back with our up-to-date, easy-to-consume clinical episodes at vvn.supercast.com.Get help with your tricky cases in our Specialist Support Space.Visit thevetvault.com for show notes and resources related to this episode.Subscribe to our weekly newsletter here for Hubert's favourite clinical and non-clinical learnings from the week.Episode Topics and Timestamps08:11 The Shift to Profit Driven Veterinary Practice09:46 A Guide to Evidence-Based Decision Making12:00 Client Communication and Financial Constraints17:31 Spectrum of Care: A New Approach32:15 Overdiagnosis and Screening: A Critical Look39:09 Cognitive Psychology in Veterinary Decision Making42:45 The Power of Checklists in Medical Practice43:18 Balancing Autonomy and Systematic Decision Making45:52 Clinical Audits: Improving Practice Through Data48:36 Intuitive vs. Algorithmic Thinking in Veterinary Medicine51:37 The Pitfalls of Anecdotal Evidence in Veterinary Practice01:07:40 Communicating with Clients About Unproven Therapies01:18:17 Pass Along Question and The One Bit of Advice
Guest: Dr Suzanne O'Sullivan
In today's Spring Statement Labour are having to make cuts - and welfare has been hit hard. Last week the health secretary Wes Streeting said that too many people were being written off work due to overdiagnosis. A statement which received considerable backlash.But what do we really mean by overdiagnosis? And how is it affecting public health?Hannah Barnes is joined by neurologist and author Suzanne O'Sullivan about her increasing fears of overdiagnosis and the impact it can have on both physical and mental health; what she thinks about those comments from Wes Streeting (and the reaction to them); and the relationship between public policy and health.This conversation was recorded in partnership with the Cambridge Literary Festival.If you'd like to register for tickets for the upcoming festival from 23-27 April please follow the link: cambridgeliteraryfestival.com Hosted on Acast. See acast.com/privacy for more information.
COFFEE MOANING the PODCAST ON APPLE PODCASTS: https://podcasts.apple.com/gb/podcast/coffee-moaning/id1689250679ON SPOTIFY: https://open.spotify.com/show/3p6z4A1RbhidO0pnOGGZl2?si=IqwD7REzTwWdwsbn2gzWCg&nd=1HOW TO STAY MARRIED (SO FAR) the PODCASTON SPOTIFY: https://open.spotify.com/show/57MT4cv2c3i06ryQlIpUXc?si=1b5ed24f40c54ebaON APPLE PODCASTS: https://podcasts.apple.com/gb/podcast/how-to-stay-married-so-far/id1294257563 Hosted on Acast. See acast.com/privacy for more information.
BUFFALO, NY – March 12, 2025 – A new #editorial was #published in Oncotarget, Volume 16, on March 10, 2025, titled “COMETgazing – interesting insights, lessons for clinical practice and a call for more precision using the biomarkerSCOPE.” Dr. Mangesh A. Thorat, affiliated with Queen Mary University of London, Homerton University Hospital, and King's College London, discusses new findings suggesting that some women diagnosed with early-stage breast cancer may not need immediate surgery. The editorial is based on results from the COMET trial, which studied women with low- to intermediate-grade ductal carcinoma in situ (DCIS). The findings raise questions about the necessity of surgery and highlight the importance of more precise screening methods for DCIS, ensuring that only those who truly need treatment receive it. Breast cancer screening programs are designed to detect cancer early, but this editorial reinforces the concern that some detected cancers may never become a real threat. The COMET trial compared two strategies for treating breast cancer: standard treatment, which includes surgery and possible additional therapy, versus active monitoring, where patients are closely observed without immediate intervention. The results indicate that many of the invasive cancers diagnosed in the monitoring group were likely present from the start rather than developing from DCIS over time. Dr. Thorat points out that these invasive cancers were often slightly larger, but they did not appear to be aggressive. These findings challenge the assumption that immediate treatment is necessary for all cases of DCIS. Researchers estimate that at least half of the invasive breast cancers in this study either take years to progress or may never progress at all. “The planned long-term follow-up of the trial may shed more light on the median length of lead-time and the proportion of IBCs regressing as well as DCIS progression under different lead-time assumptions.” Current methods for evaluating DCIS rely heavily on histological grading, which has limitations. Dr. Thorat emphasizes the need for more precise tools to determine which DCIS cases require treatment. His previous research suggests that biomarkers, such as multi-clonal estrogen receptor (ER) expression and tumor-infiltrating lymphocytes (TILs), may help predict which DCIS cases are truly at risk of becoming invasive. The editorial also highlights that many women prefer to avoid surgery when possible. In a related study, only 52% of patients in the standard care group followed through with it, indicating that more individuals are willing to consider alternatives to surgery. This fact underscores the importance of developing accurate biomarkers to guide treatment decisions and ensure that patients receive appropriate care without unnecessary interventions. As researchers continue to follow patients from the COMET trial, they hope to learn more about how invasive breast cancers behave over time. Finally, Dr. Thorat encourages clinicians and scientists to rethink breast cancer treatment and develop better ways to identify which patients truly need surgery—and which do not. DOI - https://doi.org/10.18632/oncotarget.28698 Correspondence to - Mangesh A. Thorat - m.thorat@qmul.ac.uk To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM
The Real Truth About Health Free 17 Day Live Online Conference Podcast
Dr. Pamela A. Popper provides valuable insights on how to effectively navigate the healthcare system. Learn practical tips to become a more informed and empowered healthcare consumer. #HealthcareGuide #PatientEmpowerment #HealthNavigation
In this interview, Brooke Siem, who is the author of a memoir on antidepressant withdrawal, May Cause Side Effects, interviews Gretchen LeFever Watson, PhD. Gretchen is a developmental and clinical psychologist with postdoctoral training in pediatric psychology. She has served as a professor in multiple disciplines at universities and medical schools in the United States and abroad and as the patient safety director for a large healthcare system. She secured millions in federal funding to study the epidemiology of psychiatric drug use and to develop community-based strategies that reduce reliance on psychiatric labels and medications—strategies that also improved educational outcomes. In 2008, BMJ recognized her as one of 100 international scientists journalists could count on for unbiased reviews of health research. Dr. Watson is an academic affiliate at the University of South Carolina and the author of the Amazon bestseller Your Patient Safety Survival Guide: How to Protect Yourself and Others from Medical Errors. She lives in Virginia Beach and loves to windsurf. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. https://www.madinamerica.com/donate/ To find the Mad in America podcast on your preferred podcast player, click here: https://pod.link/1212789850 © Mad in America 2025. Produced by James Moore https://www.jmaudio.org
Today, we dive into a thought-provoking discussion with Dr. Jennifer Simmons, a breast cancer surgeon turned functional medicine oncologist, who is redefining breast cancer diagnosis, treatment, and screening. Use Jenn's code: Drjenn20 for 20% of the Auria test. What We Discuss: Critique of Mammograms and Below-Average Efficacy ... 03:15 Canadian Breast Cancer Screening Trial Findings ... 06:50 Concerns with Overdiagnosis in Mammograms ... 08:25 Consequences of Unnecessary Breast Cancer Treatments ... 11:40 Absence of Predictive Tests for Cancer Aggressiveness ... 15:10 Debunking the Myth of Early Detection's Efficacy ... 18:00 Dense Breast Tissue and Mammogram Limitations ... 21:30 Risks Associated with Mammogram Radiation ... 24:10 Importance of Lymphatic System Health ... 29:00 Alternative Approaches to Monitoring Breast Health ... 32:20 Holistic Benefits of Rebounding, Dry Skin Brushing ... 35:45 Criticism of Restrictive Bras and Advice on Usage ... 38:10 Bioidentical Hormone Replacement Therapy (HRT) Insights ... 41:20 Misconceptions About Estrogen and Breast Cancer ... 45:05 Introduction to the Mitolux Device ... 51:50 Dietary and Physical Recommendations for Optimal Health ... 54:20 History and Long-term Impact of Breast Health ... 1:09:05 Pharmaceutical Dependencies and Lifestyle Impact ... 1:12:20 Arguments Against Over-treatment of DCIS ... 1:15:30 Innovative Breast Cancer Screening Tests: AURIA and QT Scan ... 1:18:50 Challenges with Current Breast Cancer Treatments ... 1:22:10 Ethical Considerations in Breast Cancer Treatment ... 1:25:45 Made Possible By Our Amazing Sponsor: SiPhox - SiPhox Health offers at-home blood testing solutions, providing custom supplements based on your personalized blood work. Visit http://SiPhoxhealth.com/nat and use code LONGEVITY to save on your test. Manukora - Looking to boost your immunity and gut health with nature's finest? Manukora Honey, sourced from New Zealand, brings you high-quality honey rich in health benefits. Visit this link http://manukora.pxf.io/kO0rJN to enjoy a special discount with the code LONGEVITY. Wizard Sciences - Ready to upgrade your brain game? Unlock your cognitive potential with Neural Rx. Use code NAT15 at checkout to get 15% off your purchase. Don't wait—start the year with a sharper, more focused mind. Visit Wizardsciences.com Nat's Links: YouTube Channel Join My Membership Community Sign up for My Newsletter Instagram Facebook Group
The Real Truth About Health Free 17 Day Live Online Conference Podcast
Dr. Pamela A. Popper provides valuable insights on how to effectively navigate the healthcare system. Learn practical tips to become a more informed and empowered healthcare consumer. #HealthcareGuide #PatientEmpowerment #HealthNavigation
Allen Frances shares his approach to chronic depression.CME: Take the CME Post-Test for this EpisodePublished On: 01/06/2025Duration: 16 minutes, 47 secondsChris Aiken, Allen Frances, and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Leading glaucoma experts Drs. Jamie Brandt and Pradeep Ramulu join host Dr. Andrew Pouw to talk about the burden of overdiagnosis and overtreatment of mild glaucoma, and mitigation strategies both in the clinic and at the policy desk. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.
About My Guest: Dr. Jenn Simmons is a breast cancer surgeon turned Integrative oncologist on a mission to change how we diagnose, treat, and screen for breast cancer. Her best selling book, the smart woman's guide to breast cancer, is changing the narrative around breast cancer and will undoubtedly change the lives of millions of women worried about or affected by a breast cancer diagnosis. She is opening the first perfection imaging center, which accurately screens for breast cancer using revolutionary new technology without pain, compression, or radiation. No more mammograms ladies ! Social Handles: Website Facebook YouTube Dr Simmons' Podcast Summary: In this episode of Back to the Basics, Dr. Cassie Smith hosts Dr. Jenn Simmons, a former breast cancer surgeon turned integrative oncologist, to discuss the shortcomings of traditional breast cancer screening and the potential of safe, alternative therapies. Dr. Simmons sheds light on how mammograms may not save lives as commonly believed, often leading to overdiagnosis and unnecessary treatments that compromise patients' quality of life. She shares insights from studies and patient cases, explaining how breast cancer growth is unpredictable and why current screening methods fail to identify which cancers need intervention. The conversation highlights Dr. Simmons' advocacy for more effective and less invasive breast cancer screening methods, such as QT scanning, which provides better results without the pain and radiation associated with mammograms. They also explore the life-changing benefits of bioidentical hormone therapy for breast cancer survivors, debunking the myth that hormone replacement fuels cancer recurrence. Dr. Simmons emphasizes the importance of personalized, holistic care to help survivors regain their vitality, reduce post-treatment complications, and improve their long-term health outcomes. Timestamps: 01:12 - Guest Introduction: Dr. Jenn Simmons 02:50 - The Problem with Traditional Breast Cancer Screening 05:00 - Overdiagnosis and Its Emotional Impact 07:45 - Alternative Breast Cancer Screening 10:12 - Bioidentical Hormone Therapy After Breast Cancer 14:20 - Addressing Post-Treatment Symptoms 18:50 - Holistic Oncology: Personalized Care 25:15 - Hormone Therapy Myths 40:00 - Future of Breast Cancer Care 55:00 - Bioidentical Hormones in Cancer Recovery 1:10:00 - Wrapping Up: Empowering Women 1:15:00 - Closing Remarks Connect with Modern Endocrine: Check out the website Follow Cassie on Instagram Follow Cassie on Facebook Follow Cassie on YouTube Follow Cassie on TikTok Sign up for Modern Endocrine's newsletter Disclaimer
In today's episode of Keeping Abreast with Dr. Jenn, Dr. Jenn takes a deep dive into breast cancer screening, uncovering the hidden risks of routine mammograms and exploring safer alternatives. With a mission to empower women to make more informed decisions, Dr. Jenn discusses overdiagnosis, overtreatment, and the emotional toll these can take. She introduces innovative technologies like the QT scan and AURIA test, which offer more accurate, non-invasive options for breast cancer detection. This episode is a must-listen for anyone navigating their breast health journey and seeking to move beyond traditional screening methods.In this episode, you'll:Learn the potential risks of repeated radiation exposure from mammograms.Understand the emotional and psychological effects of overdiagnosis and overtreatment.Discover the benefits of cutting-edge, non-invasive technologies like the QT scan and AURIA test.Explore tailored strategies for high-risk individuals and better breast health monitoring.Gain insight into the importance of self-breast examinations and recognizing bodily changes.Hear real-life stories of unnecessary mastectomies and how they could have been avoided.Episode Timeline:00:01 Introduction to Breast Health Awareness Month01:00 The Importance of Screening Programs04:13 Mammograms: Benefits and Drawbacks09:46 How Mammograms Influence Treatment Decisions15:09 Overdiagnosis and Overtreatment in Breast Cancer20:01 Alternatives to Traditional Screening Methods29:46 Introducing Innovative Technologies: QT Scan & AURIA Test50:14 Conclusion and Recommendations for Breast HealthTo talk to a member of Dr. Jenn's team and learn more about working privately with RHMD, visit: https://jennsimmons.simplero.com/page/377266?kuid=327aca17-5135-44cf-9210-c0b77a56e26d&kref=vOKy0sAiorrKTo get your copy of Dr. Jenn's book, The Smart Woman's Guide to Breast Cancer, visit: https://tinyurl.com/SmartWomansBreastCancerGuideTo purchase the auria breast cancer screening test go here https://auria.care/ and use the code DRJENN20 for 20% Off.Connect with Dr. Jenn:Website: https://www.realhealthmd.com/Facebook: https://www.facebook.com/DrJennSimmonsInstagram: https://www.instagram.com/drjennsimmons/YouTube: https://www.youtube.com/@dr.jennsimmons
In this solo episode of Keeping Abreast with Dr. Jenn, I challenge the conventional approach to breast cancer detection, introducing the groundbreaking QT Imaging Technology and ARIA test, which provide safer, more accurate alternatives to traditional mammography. Whether you're navigating dense breast tissue concerns or looking for proactive health strategies, this episode is packed with essential information. We explore the critical differences between screening and diagnostic exams, the hidden dangers of environmental toxins contributing to rising cancer rates, and practical detox methods to protect your health. Learn how to avoid overdiagnosis and overtreatment, and why personalized, non-invasive care is key—especially post-mastectomy. Tune in to discover how to take charge of your breast health with cutting-edge advancements in cancer prevention and early detection.In this episode, you'll learn:The key differences between screening and diagnostic breast exams and how they impact breast cancer detection.How QT Imaging Technology and the ARIA test are revolutionizing breast cancer screening with safer, more accurate alternatives to traditional mammograms.Which breast health symptoms—like lumps, skin changes, and nipple discharge—require a diagnostic study.Essential radiation protection strategies and how environmental detoxification can help safeguard your health.Why dense breast tissue requires special attention and what it means for early cancer detection.The risks of overdiagnosis and overtreatment, and how to avoid unnecessary procedures.Why personalized care is crucial for post-mastectomy recovery and long-term breast health.Episode Timeline:00:05 Welcome and Episode Introduction01:02 Screening vs. Diagnostic Populations: Understanding the Differences03:15 Introduction to QT Imaging Technology and the ARIA Test06:30 Key Symptoms That Warrant a Diagnostic Study10:18 Radiation Protection Tips and Environmental Detox for Health12:45 Post-Mastectomy Self-Examination and Personalized Care15:22 Risks of Overdiagnosis and Overtreatment22:15 Environmental Toxins and Effective Detoxification Strategies25:51 3D Mammograms and Radiation Risks for Dense Breasts34:22 The Importance of Annual Testing and Risk Stratification for Early Detection36:45 Screening vs. Diagnostic: When Each Type of Exam is Needed39:52 The Future of Breast Cancer Screening: Advancements and What's Next55:11 Understanding Dense Breasts and Their ImplicationsTo talk to a member of Dr. Jenn's team and learn more about working privately with RHMD, visit: https://jennsimmons.simplero.com/page/377266?kuid=327aca17-5135-44cf-9210-c0b77a56e26d&kref=vOKy0sAiorrKTo get your copy of Dr. Jenn's book, The Smart Woman's Guide to Breast Cancer, visit: https://tinyurl.com/SmartWomansBreastCancerGuideJoin the Facebook group: Facebook: https://www.facebook.com/groups/keepingabreastwdrjennConnect with Dr. Jenn:Website: https://www.realhealthmd.com/Facebook: https://www.facebook.com/DrJennSimmonsInstagram: https://www.instagram.com/drjennsimmons/YouTube: https://www.youtube.com/@dr.jennsimmons
In this JCO Precision Oncology Article Insights episode, Mitchell Elliot summarizes an editorial: “A Targeted Methylation–Based Multicancer Early Detection Blood Test Preferentially Detects High-Grade Prostate Cancer While Minimizing Overdiagnosis of Indolent Disease” by Dr. Brandon A. Mahal, et al. published on August 29, 2024. TRANSCRIPT Mitchell Elliott: Hello and welcome to JCO Precision Oncology Article Insights. My name is Mitchell Elliott, a JCO Editorial Fellow. Today, I'll be discussing the article, “A Targeted Methylation–Based Multicancer Early Detection Blood Test Preferentially Detects High-Grade Prostate Cancer While Minimizing Overdiagnosis of Indolent Disease,” by Mahal et al. Cancer overdiagnosis, particularly of low-risk conditions that are unlikely to cause harm, is a common issue in screening tests. In prostate cancer screening, overdiagnosis affects 23% to 42% of cases, often due to the prevalence of low-grade cancers and the low specificity of the prostate specific antigen or PSA tests. Data from previous studies have highlighted that men with low grade prostate cancer often die with prostate cancer and not of prostate cancer. Over diagnosis can lead to unnecessary treatments, increased patient anxiety, side effects, and excessive healthcare costs. Multicancer early detection, or MCED tests offer a new approach by detecting multiple cancer types from a single blood sample with low false positive rates, typically less than 2%, and they also have the ability to predict the cancer type from this one test. The GRAIL Galleri test, based on methylation patterns of circulating tumor DNA, showed high accuracy detecting over 50 cancer types, including prostate cancer, in the circulating cell free genome atlas or CCGA in PATHFINDER studies. This type of MCED test paradigm is being developed for use alongside traditional screening methods in adults over the age of 50. This study evaluated this particular MCED test ability to detect both indolent and aggressive prostate cancer, aiming to assess its potential to contribute to over diagnosis. This cohort was part of the circulating cell free genome atlas or CCGA study, a multicenter case control study with three phases to validate this particular MCED test. The CCGA enrolled 15,254 participants, of which 8,584 had cancer and 6,670 did not. Enrollment was carried out in 142 North American sites between 2016 and 2019. Eligibility for cancer cases required a confirmed diagnosis or high suspicion with planned biopsy or surgery within six weeks of enrollment. This study evaluated 420 recently diagnosed men with prostate cancer from substudy 3, the independent clinical validation arm. The PATHFINDER study was a prospective cohort study of 6,662 adults over the age of 50 enrolled from seven US health networks between December 2019 and December 2020. Participants underwent testing with the GRAIL Galleri test, with results shared with physicians and participants. The test indicated the presence or absence of a cancer signal and predicted the cancer signal of origin if detected. This study's prostate cancer cohort included 18 men diagnosed through MCED testing or PSA screening, excluding two with recurrent disease. PSA testing was not collected in this particular study. Detectability by the Gleason group, clinical stage, association of detection status with tumor methylation fraction, and overall survival were assessed in these studies. The results are broken down by each substudy evaluated. Substudy three of the CCGA enrolled a clinically relevant patient population. The median age of the men enrolled were 65. Ethnic diversity was not represented, however, in this cohort, with only 15% of participants reporting as non-white, non-Hispanic. It is important to note that only 8.4% of patients included in the study self-identified as black non-Hispanic, a particular group of participants with a higher incidence in more aggressive prostate cancer. The overall MCED test sensitivity for prostate cancer detection was low in 11.2% or 47 out of 420 patients included in this cohort. The cancer signal of origin prediction accuracy was 91.5% with 43 of 47 patients having prostate cancer predicted. The test did not detect any low-grade tumors. It detected 3 of 157 favorable or intermediate grade tumors as well as 4 of 78 unfavorable intermediate grade tumors, and finally 36 of 113 high grade tumors, typically, Gleason score 4 and 5. Detection increase was staged with only 3.2% or 3 of 95 of stage one disease detected with the MCED test, while 14.9% or 7 of 47 with stage 3 and 81.5% 22 out of 27 patients with stage four disease. Compared with expected overall survival estimated from the United States SEER database, non-detected cancer cases had roughly three times better overall survival with a hazard ratio of 0.263 with a 95% interval of 0.1 to 0.5 with a p value of less than 0.05, and detected case that had similar survival, the hazard ratio of 0.672 with a 95% interval crossing one and a p value of 0.2 when adjusted for age, Gleason grade, and clinical stage. This suggests that patients identified to be ctDNA positive at diagnosis have an overall worse outcome than those who are ctDNA negative, a consistent phenomenon with previous studies using the same or different tumor informed and diagnostic ctDNA assays. Next, the authors evaluated the outcomes in the PATHFINDER cohort of 18 participants. The characteristics of patients enrolled were similar to the previous cohort. Only one case was detected, which was between Gleason group 3 and 5, and had either stage 3 or stage 4 disease not defined in the manuscript. Because only a single case of prostate cancer was identified in PATHFINDER via this test, cancer signal of origin, predicted accuracy, tumor methylation fraction, and survival outcomes were not calculated. In summary, this test preferentially detected high grade and advanced stage prostate cancers, identifying 93% of Gleason grade 3 to 5 and 67% of stages 3 and 4 cases, while notably did not detect Gleason grade 1, having only 1.9% of Gleason grade 2 detected and 4.2% of stage 1 and stage 2 cancers overall. Importantly, around one third of the detected cases in substudy three of the CCGA, involved non metastatic disease, including stage 1 to stage 3 were Gleason grade 3 to 5, which are potentially curable. Prostate cancers that were not detected via this test had better survival rates after adjusting for age, grade and stage in the SEER database. This suggested that MCED testing is unlikely to contribute to the overdiagnosis of indolent prostate cancers. Additionally, a positive cancer signal with a predicted prostate origin strongly indicates the presence of aggressive disease, warranting immediate diagnostic investigation. One limitation of the study is the lack of representative inclusion of patients from diverse ethnic backgrounds. Overdiagnosis of prostate cancer due to PSA levels disproportionately affects black men, and the generalizability of these findings in the study is limited by the fact that over 85% of the study cohort was self-reported as white non-Hispanic. Further data is required to understand the biology of cancer in this community and limit the bias of molecular screening tests so they are effective regardless of ethnicity. Thank you for listening to JCO Precision Oncology Article Insights. This was a summary on “A Targeted Methylation–Based Multicancer Early Detection Blood Test Preferentially Detects High-Grade Prostate Cancer While Minimizing Overdiagnosis of Indolent Disease.” Please follow and subscribe on your favorite streaming platforms. For more podcasts from ASCO, visit www.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.
David Liew talks to rheumatologist Nicola Cook about the utility of common investigations for suspected inflammatory arthritis in adults. They discuss the notion of pretest probability and how this is used to determine the utility of testing, and the role of specific tests. Nicola also talks about the potential harm of overinvestigation. Read the full article by Nicola and her co-author, Rachelle Buchbinder, in Australian Prescriber.
In this episode, we discuss the frequency of Pap smears for twin pregnancies as well as the need for using twin-based growth data for the diagnosis of fetal growth restriction in twins. We will poke the fire of controversy of the use of the terms "fetal growth restriction" and "small for gestational age" and discover how the terms might harm pregnancies. Next, we discuss the new AAP guidelines for diagnosis of tongue ties. Finally, we answer a listener question about pushy doctors, paying for unnecessary tests, and the disconnect many gynecologists have with guideline and evidence based care. 00:00:02 Ultrasound Use in Twin Pregnancies00:14:06 Twin Growth and Fetal Growth Restriction 00:20:00 Fetal Growth Assessment in Twin Pregnancies00:29:10 Overdiagnosis of Tongue Tie in Infants00:38:05Breastfeeding and Tongue Tie Recommendations00:45:43 Controversy Surrounding Pelvic Exams00:58:21 Unnecessary Physical Exams and IUD PreferencesFollow us on Instagram @thinkingaboutobgyn.
In this powerful episode the Radically Genuine Podcast welcomes back Dr. Kristin Reihman, a medical director at the Family Hope Center, author, renowned expert in the treatment of Lyme disease and Founding Board Member of the Conscious Clinician Collective.Dr. Reihman shares her insights on the overdiagnosis of ADHD and explores alternative methods for addressing brain health. We discuss the importance of diet, exercise, and brain-stimulating programs in brain development and function. This conversation explores the limitations of traditional ADHD diagnoses, the power of neuroplasticity, and answers so many questions that our audience asks about “ADHD”.Timestamps and Key Points:Introduction [00:01 - 02:20]- Introduction to the episode and addressing the temporary heating issue in the studio.- Mention of weekly Substack articles and the recent post about attention spans and social media.- Introduction of today's guest, Dr. Kristin Reihman, who responded to an article and shared insights on ADHD treatment without medication.Main Discussion [02:20 - 20:30]:- Views on the overdiagnosis of ADHD and the need for a more nuanced understanding of neurodiversity.- Introduction of Dr. Kristin Reihman, her background, and her work at the Family Hope Center.- Discussion on the approach to ADHD and brain health, emphasizing the importance of diet, exercise, and brain-stimulating programs.- Explanation of the integrated neurological chart used at the Family Hope Center to assess brain function in various domains.- Challenges of diagnosing brain issues in infants and the importance of early interventions.- Examples of natural reflexes and brain development in newborns.- The role of environmental factors and physical activity in brain development.- Explanation of brain injuries and their impact on development, highlighting the differences between static and cumulative brain injuries.Addressing ADHD [20:30 - 36:00]:- Discussion on the paradigm shift needed in understanding and treating ADHD, focusing on healing the brain rather than labeling it.- The current medical system's reliance on labels and medication.- Approach at the Family Hope Center for different types of brain injuries and the personalized programs created for children.- Process of neurological assessment and measuring progress through the integrated chart.- Specific exercises and programs used to stimulate brain development, including crawling and creeping exercises.- Importance of holistic approaches, including diet, sleep, and environmental factors, in brain health.Alternative Perspectives [36:00 - 52:00]:- Limitations of traditional ADHD diagnoses and the importance of understanding the root causes.- Impact of neuroplasticity and how active interventions can change brain function.- Personal anecdotes about brain injuries and recovery through neuroplasticity.- Role of grounding and nature in brain health and personal recommendations.- Need for more specialists in the field of brain health and the potential for broader application of these methods.Challenges and Solutions [52:00 - 62:00]:- Challenges in the current medical system regarding ADHD diagnoses and treatment.- Parenting challenges and cultural shifts affecting children's development.- Importance of hope and the potential for healing without medication.Closing Thoughts [62:00 - 64:45]:- Summary of key takeaways about brain health, the influence of environment and experiences, and the need for a shift in understanding ADHD.- Encouragement to explore alternative methods for brain health and to seek holistic approaches for themselves and their children.- Conclusion and appreciation for the guest's insights.Key Quotes:Dr. Roger McFillin: "Our understanding of the brain is still evolving and ever-growing. Notions of abnormal development may actually represent natural variations in neurological functioning."Dr. Roger McFillin: "The key is recognizing this is a skill to be developed, not a disorder to be medicated. By understanding and working with our brain's natural tendencies rather than against them, we can enhance our focus."Dr. Kristin Reihman: "We help people understand where the glitches are so they can actually rewire them and get to the place where they don't need medication. They don't lose their neurodiversity and brilliance just because it's easier to function in the world."Dr. Kristin Reihman: "If the brain gets the signal to grow, heal, and organize at the midbrain, it will continue that process on the way up. It's really a bottoms-up approach that focuses on resetting the stage for the brain to work properly."Dr. Kristin Reihman: "The Family Hope Center uses an integrated neurological chart to measure a variety of brain functions. We chart people's abilities and plug in a program to stimulate growth in specific areas, helping to smooth out the road from the ground up."Note: This podcast episode is designed solely for informational and educational purposes, without endorsing or promoting any specific medical treatments. We strongly advise consulting with a qualified healthcare professional before making any medical decisions or taking any actions.*If you are in crisis or believe you have an emergency, please contact your doctor or dial 911. If you are contemplating suicide, call 1-800-273-TALK to speak with a trained and skilled counselor.RADICALLY GENUINE PODCASTDr. Roger McFillin / Radically Genuine WebsiteYouTube @RadicallyGenuineDr. Roger McFillin (@DrMcFillin) / XSubstack | Radically Genuine | Dr. Roger McFillinInstagram @radicallygenuineContact Radically GenuineConscious Clinician CollectivePLEASE SUPPORT OUR PARTNERS15% Off Pure Spectrum CBD (Code: RadicallyGenuine)—-----------FREE DOWNLOAD! 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Host Miriam Carey Brown interviews, Erin Coppin, a medical practitioner and mother of children with ADHD. Erin discusses her journey from initial suspicions to formal diagnosis, highlighting the challenges and revelations along the way. She emphasizes the importance of understanding the distinct differences in behavior and brain function between children with ADHD and their neurotypical peers. Miriam and Erin also touch on the importance of early intervention, to help children with ADHD succeed. This episode is part of a series aimed at shedding light on ADHD, breaking down misconceptions, and offering practical advice for parents.
Host: Brian P. McDonough, MD, FAAFP Guest: Nima Nabavizadeh, MD Guest: Tomasz Beer, MD, FACP While multi-cancer early detection (MCED) testing has the potential to significantly impact the way we approach cancer screening, it's important to be aware of the risks associated with it, like overdiagnosis. That's why Drs. Nima Nabavizadeh and Tom Beer join Dr. Brian McDonough to discuss the advantages and drawbacks of MCED testing and how we can mitigate the risk of overdiagnosis. Dr. Nabavizadeh is an Associate Professor in the Department of Radiation Medicine in the School of Medicine at OHSU in Portland, Oregon, and Dr. Beer is the Chief Medical Officer for Multi-Cancer Early Detection at Exact Sciences Corporation.
Nick and Whitney are back and we have questions on feeling guilty for inheritating a family member's millions, whether you can be overdiagnosed by assessments, and how to resolve intrusive memory trauma. If you are an Apple user please rate us!If you are a Spotify user, please rate us! Submit a question to the show!Help us reach #1 on Goodpods!Listen ad-free, get the show a day early and enjoy the pre-show hang out on the same app you're using RIGHT NOW at www.Patreon.com/Therapy where you can also access our vast library of deep dives, interviews, skill shares, reviews and rants as well as our live discord chat!Interested in Nick's mental health approach to fitness? Check out www.MentalFitPersonalTraining.comCheck out Dr. Jim's book "Dadvice: 50 Fatherly Life Lessons" at www.DadviceBook.comGrab some swag at our store, www.PodTherapyBaitShop.comPlay Jim's Neurotic Bingo at home while you listen to the show, or don't, I'm not your supervisor.Submit questions to:www.PodTherapy.netPodTherapyGuys@gmail.comFollow us on Social Media:FacebookInstagramTwitterResources:Suicide Prevention Lifeline - 1-800-273-8255.Veterans Crisis Line - 1-800-273-8255.Substance Abuse & Mental Health Services Administration (SAMHSA) National Helpline - (1-800-662-HELP (4357)OK2Talk Helpline Teen Helpline - 1 (800) 273-TALKU.S. Mental Health Resources Hotline - 211
In this episode, Dr. Shawn Tassone discusses the recent recommendations from the United States Preventive Services Task Force (USPSTF) regarding mammography guidelines. The USPSTF recommends biennial screening mammography for women aged 40 to 74, with a B recommendation. Dr. Tassone explains the incidence and mortality rates of breast cancer, particularly among non-Hispanic white and non-Hispanic black women. He also addresses the potential harms of mammography, such as false positive results and overdiagnosis. Dr. Tassone discusses thermography as an alternative to mammography and emphasizes the importance of individualized screening based on risk factors. Episode Highlights The USPSTF recommends biennial screening mammography for women aged 40 to 74, with a B recommendation. Breast cancer is the second most common cancer and cause of death among women in the US. Mammography has potential harms, including false positive results and overdiagnosis. Thermography is not currently considered an alternative to mammography. Screening should be individualized based on risk factors. Resources Dr. Shawn Tassone's Practice | Tassone Advanced Gynecology Dr. Shawn Tassone's Book | The Hormone Balance Bible Dr. Shawn Tassone's Integrative Hormonal Mapping System | Hormone Archetype Quiz Medical Disclaimer This podcast and website represent the opinions of Dr. Shawn Tassone and his guests. The content here should not be taken as medical advice and is for informational purposes only. Because each person is so unique, please consult your healthcare professional for any medical questions.
The Overdiagnosis Of America: "Un-Doctor-Inate" With The "Un-Doctor"#mentalhealth #overdiagnosis #mindset #alternativehealing #theundoctor Dr. Fred Moss is a mental health advocate/psychiatrist serving in many capacities: keynote speaker, psychiatry expert witness, podcaster, mental health coach, and teacher. A desire to help people be real and heard has been the driving force leading him to multiple settings and roles as a psychiatrist over the years and compelling him to continually look for better, more effective ways to provide the highest quality care to align people with their most authentic self to deliver into an eagerly awaiting world. He is the amazing creator of Welcome To Humanity, The True Voice Course, Healing the Healer, and Global Madness.Website: https://drfred360.com/Instagram: https://www.instagram.com/drfredmoss/Facebook: https://www.facebook.com/drfredmossmdLinkedin: https://www.linkedin.com/in/drfredmoss/X: https://twitter.com/drfredmossYoutube: https://www.youtube.com/@UChWsIz7slIB-Y1sfHorXDGA Thanks for tuning in, please be sure to click that subscribe button and give this a thumbs up!!Email: thevibesbroadcast@gmail.comInstagram: https://www.instagram.com/listen_to_the_vibes_/Facebook: https://www.facebook.com/thevibesbroadcastnetworkLinktree: https://linktr.ee/the_vibes_broadcastTikTok: https://vm.tiktok.com/ZMeuTVRv2/Twitter: https://twitter.com/TheVibesBrdcstTruth: https://truthsocial.com/@KoyoteMonstrosityMonstrosity has celebrity guests, deep paranormal discussions, and comedy gold.Listen on: Apple Podcasts SpotifyFor all our social media and other links, go to: Linktree: https://linktr.ee/the_vibes_broadcastPlease subscribe, like, and share!
Have you ever found yourself lost in a sea of distractions, struggling to maintain focus? Or wondered about the intricate workings of attention in our brains? How do we understand the fine line between neurodivergence and clinical severity in the context of attention disorders?Today, Dr. Scott sits down with Dr. Sasha Hamdani, a board-certified psychiatrist, best-selling author, and entrepreneur. Dr. Hamdani brings a wealth of knowledge and personal insight into the complexities of attention and its nuances. From the evolution of ADHD diagnosis to the pioneering creation of the Focus Genie app, we explore the multifaceted nature of attention, including its various types and the challenges it presents in our daily lives.Join us as they discuss the critical aspects of attention: its definition, the ability to focus, regulate, and transition between topics, and the intriguing relationship between ADHD, generational stress, and trauma. Dr. Hamdani shares her expertise on the capacity for attention, how it varies among individuals, and the potential impacts of overdiagnosis and underdiagnosis in ADHD.This conversation promises to enlighten and challenge your understanding of attention, providing a deeper appreciation of our brain's complexity and the many shades of normal when it comes to attention-related challenges. Whether you're grappling with focus issues yourself, know someone who does, or are simply curious about the inner workings of the human mind, this episode is not to be missed.Topics We Break DownHow a deep understanding of what it means to pay and tend to attention can influence our relationship with it.The intricate science of the brain and what makes it unique among the body's other organs. Appreciating the value of both inclusivity and diagnosis in the context of neurodivergence.How behavioral and lifestyle changes can support focus and brain function.Overdiagnosis, underdiagnosis, and access to care.The influence of traumatic experiences on the brain.What self-care, tracking, and problem-solving might look like for people with ADHD.How differentiating between four kinds of attention can help us identify our strengths and weaknesses.
Dr Meg Jay is back. Dr Meg Jay is a clinical psychologist, best-selling author and TED talk phenomenon. Her new book "The Twenty Something Treatment" is a lifeline for a demographic who are struggling most with over diagnosis and over prescription. Dive into the intricacies of the twentysomething experience with Dr. Meg Jay as she unpacks vital topics on mental health, relationships, and personal growth in this engaging podcast episode. From the impact of societal causes on young minds to the challenges of navigating love and intimacy, Dr. Jay offers practical insights and strategies for thriving in the tumultuous journey of adulthood. Join me as I explore key questions surrounding identity, purpose, and emotional maturity, providing listeners with invaluable guidance for navigating life's complexities. Send this to a 20-something year old or someone who is close to one! If you enjoyed this follow me on Instagram and get in touch: www.instagram.com/developmentbydavid Buy Dr Meg Jays New Book: https://www.amazon.co.uk/Twentysomething-Treatment-Revolutionary-Remedy-Uncertain/dp/1668012294
I am always curious about how others continually improve, and Dr. Thomas Brenn gives good insights on this. Learning in whatever way works for you, getting exposure to new things in ways that you can remember, discovering true mentorship...it's definitely a fun journey. Dr. Thomas Brenn MD PhD received both his doctorate degrees in Germany. He completed postdoctoral fellowships in Genetics and Pathology at Stanford University, residency training at the Brigham and Women's Hospital, and dermatopathology and soft tissue pathology fellowships with Dr. Phillip McKee and Dr. Christopher Fletcher. He has worked in the United Kingdom, Canada, as well as the US and is currently based at the University of Michigan.
Dr. Robyn Roth (AKA @theboobiedocs on Instagram) debunks myths about mammograms and emphasizes the importance of early detection. The discussion covers the impact of breast density on imaging and the need for additional tests. This conversation covers various topics related to breast cancer, including risk factors, genetic testing, high-risk clinics, family planning, lifestyle modifications, overdiagnosis, caregiving, finding purpose, the biopsy experience, researching doctors, and self-advocacy during exams. The breast cancer risk calculator: https://ibis-risk-calculator.magview.com Verify information on social media, especially when it comes to health-related topics. Mammograms play a crucial role in early breast cancer detection and can save lives. Breast density can affect the accuracy of mammograms, and additional imaging may be necessary. Mammograms involve a low dose of radiation that is comparable to other everyday exposures. Knowing your breast cancer risk is important for determining appropriate screening and prevention strategies. Family planning decisions may be influenced by genetic testing results and breast cancer risk. Lifestyle modifications, such as maintaining a healthy weight, exercising, and minimizing stress, can help reduce breast cancer risk. Overdiagnosis and over treatment are important considerations in breast cancer management. Connect with Robyn here: https://www.instagram.com/theboobiedocs Her Podcast Show: The Girlfriend's Guide to Breast Cancer, Breast Health, & Beyond _______________________________________________________________________________ The BLUEPRINT from Results to Rising details HERE Join the RESET & RISE Community HERE EMAIL ME: coachjennyd@gmail.com FAVORITE TEA: Pique Tea: https://www.piquetea.com/?rfsn=5818415.d1d969a&utm_source=affiliate
In this episode, Daniel Belkin and Mitch Belkin interview Marc Gosselin, MD about his journey to radiology, being a radiology program director, dealing with burnout, transitioning from academics to private practice, and overdiagnosis in radiology. They discuss in situ thrombosis versus pulmonary emboli, whether medical evidence should have an expiration date, and why physicians should admit fault when they are wrong.Who is Marc Gosselin?Dr. Marc Gosselin is the head of cardiopulmonary imaging at Vision radiology, a retired full professor at Oregon Health and Science University. Previously, Dr. Gosselin was a program director of the University of Utah's radiology program.References:Clinical Features of Pulmonary Embolism (1961)Sensible Medicine: Why statins do not cause diabetesSupport the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon
This week, Kate, Mark, Gary and Henry will discuss a possible new agent for acne, analgesia in adults with renal colic, breast cancer overdiagnosis in older women, and the importance of BP cuff size. Plus a Dickensian quiz.
Dr Mark Sherwood joins this episode of Battlefront: Frontline with Dustin Faulkner.Some of the topics discussed during this show include:Biden Regime and Pro-Hamas Gen Z are Foreshadowing Jew and Christian PersecutionTexas Propositions on 2023 Ballot Will Expand Overreach, Taxation, and Corporate FascismMental Illness is OverdiagnosedFollow BBN on twitter: @dloydfaulk @bf_frontlineOn GETTR, FrankSocial, Truth Social, Gab : @BFBroadcastingOn Telegram: https://t.me/BFBroadcastingOn Rumble: BFBroadcastingSupport independent media:- Visit https://sherwood.tv/battlefront and discover the new Kingdom Fuel, Kingdom Kandy, and Kingdom Cup. Also, choose preventative health plans from the Functional Medical Institute.- New items are arriving like the MyPillow 2.0 and MyMattress Topper 2.0. Save up to 66% now with the code: Battle. Visit https://mypillow.com/battle and https://mystore.com or call (800) 559-7535.- Prepare your food supply with mRNA Vaccine free and organic Texas freeze-dried beef at https://freedomfirstbeef.com and use the code BATTLE for 10% off.- They stole your privacy through technology. Take it back at https://4freedommobile.com Use the code BATTLE and Let Freedom Ring.- Visit https://micronicsilver.net and save 10% with the code BATTLE. Get products like the amazing Silvizone Skin Cream and enjoy the benefits of younger looking skin and inflammation relief. What benefits will you experience personally?⁃ I drink the coffee of PATRIOTS and every time I take a sip of that coffee...mmm...It tastes like FREEDOM. Use code BATTLE for 10% off at https://freedomfirstcoffee.com.Protect yourself from free radicals in your bloodstream with the new Z-Shield with powerful cleansing ingredients including turmeric. Visit https://zstacklife.com/?ref=BATTLEFRONT and use the code Battlefront for 5% off.Sources:https://therightscoop.com/ugly-pro-hamas-mob-harasses-jewish-student-at-harvard-video/https://thefederalist.com/2023/11/02/the-pro-hamas-left-is-warming-up-for-real-violence/https://farmandranchfreedom.org/texas-proposition-1-right-to-farm-or-right-to-harm/https://www.thegatewaypundit.com/2023/10/new-police-report-reveals-what-voices-were-telling/https://thefederalist.com/2023/11/02/why-does-gen-z-protest-everything-but-terrorism/
Ray Moynihan is an accomplished health journalist and author who has won several awards for his work. He is also an academic at Bond University and a documentary filmmaker. Moynihan's research and writing focus on the healthcare industry, with an emphasis on how diseases are created, branded, and marketed to unsuspecting people. He is known for his use of sharp humor, which can be seen in his mock documentary about a fictional illness called 'Motivational Deficiency Disorder.' He is also a founding member of the international conference Preventing Overdiagnosis and hosts the podcast The Recommended Dose. Today, we will be discussing something that the speaker refers to as "an assault on being human" - the labeling of everyday life struggles as disorders and how patient advocacy groups, doctors, medical journalists, and respected academics are often manipulated by a powerful, corporatized healthcare system. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. Mad in America podcasts and reports are made possible, in part, by a grant from the Thomas Jobe Fund. To find the Mad in America podcast on your preferred podcast player, click here
Discussion of ADHD is EVERYWHERE in the news and social media. Often we hear patients, friends, and family members stating “I saw a post on FB/Instagram/Twitter/TikTok about ADHD that resonated with me, should I get tested?” While many people experience periods of inattention, unfocused motor activity, and impulsivity, those with ADHD experience these symptoms to a much greater degree, and these behaviors can often interfere with their social lives, working lives, and general mental health. Depending on your age and many other social factors, screening and evaluation for ADHD may have passed you over during your young, formative years. Thankfully, meaningful research exists to provide helpful data on how to diagnose and manage this condition!So let's learn more, shall we? Thankfully we have a wonderful expert guest in the field of Neuropsychology to educate us today. Welcome, Leslie Guidotti Breting, Ph.D., ABPPDr. Leslie Guidotti Breting is a board-certified, clinical neuropsychologist and director of Neuropsychology at NorthShore University Health System where she has practiced since 2010. She serves at a national level on the Board of Directors for the American Board of Clinical Neuropsychology and is the Chair of the Student Affairs Committee for the American Academy of Clinical Neuropsychology. She has been engaged in clinical research, publishing extensively on the topics of ADHD, epilepsy, mTBI, and concussion. She conducts neuropsychological evaluations for adults, including those concerned about ADHD. She has also evaluated professional and collegiate athletes for therapeutic use exemption for stimulants related to treatment for ADHD.The key moments in this episode include:00:01:15 - Prevalence of ADHD, 00:02:39 - Increase in ADHD Diagnosis Rates? 00:05:07 - What is a Neuropsychologist? 00:16:20 - Genetics and Heritability of ADHD 00:17:22 - Screening for ADHD 00:19:08 - Overdiagnosis of ADHD? 00:21:45 - Diagnosing ADHD in Young Children 00:23:17 - Challenges in Diagnosing ADHD 00:31:26 - ADHD and Autism Spectrum Disorder Co-Occurrence 00:32:10 - Symptoms of ADHD in Adults00:35:23 - Pathophysiology of ADHD 00:36:50 - Executive Functioning and ADHD00:49:19 - Medication and Treatment Options00:58:16 - "Growing out" of ADHD 01:02:29 - Algorithm of Probability for ADHD Diagnosis - new research01:03:03 - No Blood TestsRESOURCES FOR TODAY'S EPISODE:CHADD- Children and Adults with ADHD website.American Academy of Child and Adult Psychiatry ADHD Resource Center. Find a board-certified Clinical Neuropsychologist through the American Academy of Clinical Neuropsychology website.Dr. Leslie Guidotti-Breting's professional NorthShore University page. For more episodes, limited edition merch, or to become a Friend of Your Doctor Friends (and more), follow this link! This includes the famous "Advice from the last generation of doctors that inhaled lead" shirt that Julie wears in this episode :)Also, CHECK OUT AMAZING HEALTH PODCASTS on
In this month's Talk Evidence, Helen and Juan are reporting from Preventing Overdiagnosis - the conference that raises issues of diagnostic accuracy, and asks if starting the process of medicalisation is always the right thing to do for patients. In this episode, they talk about home testing, sustainability and screening. They're also joined by two guests to talk about the overdiagnosis of obesity - when that label is stigmatising and there seem to be few successful treatments that medicine can offer, and the need to educate students in the concepts of overdiagnosis and too much medicine, to create a culture change in medicine. Links; The Preventing Overdiagnosis conference The BMJ EBM papers on choosing wisely.
- "The Results of a New 15-Year Study on Breast Cancer Reveals an OVERDIAGNOSIS and UNNECESSARY TREATMENT of Older Women for the Disease" - RICK ELDRIDGE: Never Give Up in Select Theaters September 1st - "Target Experiences First DROP in Retail Sales in SIX YEARS - 'Woke' Ideology and Marketing Appear to Be the Blame" - RACHEL JOY BARIBEAU: Relentless Joy: Finding Freedom, Passion, and Happiness (Even When You Have to Fight for It)
Mark discusses living with and managing type 2 diabetes. He also shares how being both Black and gay has influenced his interactions with the healthcare system and offers his insights into the larger issue of healthcare disparity in the United States.Thrive Alabama WebsiteSupporting Articles:1) Maternal Mortality Rates in the United States, 20212) Racial Bias in the Treatment and Management of Pain3) Paying for PrEP4) US Government Lawsuit Against Gilead5) Legal Battle Over ACA PrEP Coverage6) Prediabetes: Opportunity or Overdiagnosis?7) Cancer Facts for Lesbian & Bisexual Women8) HPV Vaccine: What Age is Too Late?9) Tuskegee Syphilis Study10) AMA Opinion: Physician Exercise of Conscience11) Women & PrEP12) HIV Testing, Prevention, & Care for Transgender People13) The Private Sector & Universal Health Coverage Support the showWant to get in touch? Email any time at thekppod@gmail.com.
The Real Truth About Health Free 17 Day Live Online Conference Podcast
How Do We Know If Information Shared In Top Health Journals Is Something We Can Trust? Ian Harris, MD• https://med.unsw.edu.au/our-people/ian-harris • Book - Hippocrasy: How doctors are betraying their oath #IanHarris #Surgery #Placebo #OverDiagnosis Dr Ian Harris is a practicing orthopedic surgeon, university professor and an acclaimed author of several books including Hippocrasy: How doctors are betraying their oath. In Hippocrasy, Dr Harris, along with his colleague Dr Rachelle Buchbinder argue that the benefits of medical treatments are often wildly overstated, and the harms understated. These Two world-leading doctors reveal the true state of modern medicine and how doctors are letting their patients down. That overtreatment and overdiagnosis are rife. And the medical system is not fit for purpose: designed to deliver health care not health. This powerful exposé reveals the tests, drugs, and treatments that provide little or no benefit for patients and the inherent problem of a medical system based on treating rather than preventing illness. The book also provides tips to empower patients—do I really need this treatment? What are the risks? Are there simpler, safer options? What happens if I do nothing? Plus solutions to help restructure how medicine is delivered to help doctors live up to their Hippocratic Oath. Professor Ian Harris is an orthopedic surgeon who works at Liverpool, St George, St George Private and Sutherland Hospitals in Sydney. His academic affiliation is with UNSW, South Western Sydney Clinical School at Liverpool Hospital, in Sydney. In addition to approximately 200 peer-reviewed publications, he also wrote Surgery, The Ultimate Placebo - an eye-opening evaluation of commonly performed surgical operations that have been tested and shown to be no more effective (and arguably worse) than placebo, or that have never even been tested. He suggests we treat new surgical procedures like new drugs, and only pay for those that are part of a trial to find out if they really work. To Contact Dr Harris go to Email: ianharris@unsw.edu.au Disclaimer:Medical and Health information changes constantly. Therefore, the information provided in this podcast should not be considered current, complete, or exhaustive. Reliance on any information provided in this podcast is solely at your own risk. The Real Truth About Health does not recommend or endorse any specific tests, products, procedures, or opinions referenced in the following podcasts, nor does it exercise any authority or editorial control over that material. The Real Truth About Health provides a forum for discussion of public health issues. The views and opinions of our panelists do not necessarily reflect those of The Real Truth About Health and are provided by those panelists in their individual capacities. The Real Truth About Health has not reviewed or evaluated those statements or claims.
The Real Truth About Health Free 17 Day Live Online Conference Podcast
Study Shows Kids Who Had Their Cavities Filled With bis-GMA Become More Moody, Aggressive, And Generally Less Well Adjusted Ian Harris, MD• https://med.unsw.edu.au/our-people/ian-harris • Book - Hippocrasy: How doctors are betraying their oath #IanHarris #Surgery #Placebo #OverDiagnosis Dr Ian Harris is a practicing orthopedic surgeon, university professor and an acclaimed author of several books including Hippocrasy: How doctors are betraying their oath. In Hippocrasy, Dr Harris, along with his colleague Dr Rachelle Buchbinder argue that the benefits of medical treatments are often wildly overstated, and the harms understated. These Two world-leading doctors reveal the true state of modern medicine and how doctors are letting their patients down. That overtreatment and overdiagnosis are rife. And the medical system is not fit for purpose: designed to deliver health care not health. This powerful exposé reveals the tests, drugs, and treatments that provide little or no benefit for patients and the inherent problem of a medical system based on treating rather than preventing illness. The book also provides tips to empower patients—do I really need this treatment? What are the risks? Are there simpler, safer options? What happens if I do nothing? Plus solutions to help restructure how medicine is delivered to help doctors live up to their Hippocratic Oath. Professor Ian Harris is an orthopedic surgeon who works at Liverpool, St George, St George Private and Sutherland Hospitals in Sydney. His academic affiliation is with UNSW, South Western Sydney Clinical School at Liverpool Hospital, in Sydney. In addition to approximately 200 peer-reviewed publications, he also wrote Surgery, The Ultimate Placebo - an eye-opening evaluation of commonly performed surgical operations that have been tested and shown to be no more effective (and arguably worse) than placebo, or that have never even been tested. He suggests we treat new surgical procedures like new drugs, and only pay for those that are part of a trial to find out if they really work. To Contact Dr Harris go to Email: ianharris@unsw.edu.au Disclaimer:Medical and Health information changes constantly. Therefore, the information provided in this podcast should not be considered current, complete, or exhaustive. Reliance on any information provided in this podcast is solely at your own risk. The Real Truth About Health does not recommend or endorse any specific tests, products, procedures, or opinions referenced in the following podcasts, nor does it exercise any authority or editorial control over that material. The Real Truth About Health provides a forum for discussion of public health issues. The views and opinions of our panelists do not necessarily reflect those of The Real Truth About Health and are provided by those panelists in their individual capacities. The Real Truth About Health has not reviewed or evaluated those statements or claims.
Listen in as Tim talks about flexibility, bread, overdiagnosis and shame. Dr. Timothy McCalmont is Professor Emeritus of the Departments of Pathology and Dermatology, University of California, San Francisco. He was Co-Director of the UCSF Dermatopathology Service for 25 years as well as the Editor of the Journal of Cutaneous Pathology. His BS in Biochemistry and MD are from Iowa State University, he attended medical school at the University of Iowa College of Medicine, and his residency in anatomic pathology was completed at Wake Forest University Medical Center. He subsequently started residency training in dermatology at UCSF, where he did his dermatopathology fellowship training as well. He is internationally renowned for his diagnostic skills that span the breadth of dermatopathology. Dr. McCalmont is currently a dermatopathology consultant in the private sector at Golden State Dermatology Associates, active on Twitter @mccalmo, and on KiKo.
Get ready for your weekly dose of cocktails and conversation with the ladies of Herspiration Happy Hour! Tonight at 7pm EST, tune in for an exciting new episode and join the ladies as they discuss one of today's hot-button topics - Mental Health. Tune in to hear the ladies debating whether the push for mental health is doing more harm than good and whether recent mental health initiatives have impacted individuals, their families, and society (i.e gentle parenting, Overdiagnosis and pathologizing normal emotional experiences, glamorizing or trivializing mental health struggles, etc). Grab your favorite drink and join in! Remember, you can be a part of the show and interact in the chat with the host.Connect with the host on IG:@iamdrpgurley@thegirlfriendtherapist@thebluephoenixheals@dianaricharsonphillipusCatch up on past episodes on Apple Podcast, iHeartRadio, Pandora, Amazon Music, Spotify, Google Podcast, and many other platforms.#podcast #season6 #empoweringwomen #goaldiggers #ladybosstribe #inspiration #womanceo #empowerher #savvybusinessowner #womensupportingwomen #thisgirlmeansbusiness #motivation #womenempowermentSupport the show
Overdiagnosis of nonalcoholic fatty liver disease (1:50), galactorrhea (5:20), testicular torsion (9:40), medication abortion (12:40), anxiety disorders in children and adolescents (14:40), platelet-rich plasma injections (19:50), and a new feature, hot takes in family medicine (22:50).
About MikeBesides his duties as The Duckbill Group's CEO, Mike is the author of O'Reilly's Practical Monitoring, and previously wrote the Monitoring Weekly newsletter and hosted the Real World DevOps podcast. He was previously a DevOps Engineer for companies such as Taos Consulting, Peak Hosting, Oak Ridge National Laboratory, and many more. Mike is originally from Knoxville, TN (Go Vols!) and currently resides in Portland, OR.Links Referenced: Twitter: https://twitter.com/Mike_Julian mikejulian.com: https://mikejulian.com TranscriptAnnouncer: Hello, and welcome to Screaming in the Cloud with your host, Chief Cloud Economist at The Duckbill Group, Corey Quinn. This weekly show features conversations with people doing interesting work in the world of cloud, thoughtful commentary on the state of the technical world, and ridiculous titles for which Corey refuses to apologize. This is Screaming in the Cloud.Corey: This episode is brought to us in part by our friends at Datadog. Datadog is a SaaS monitoring and security platform that enables full-stack observability for modern infrastructure and applications at every scale. Datadog enables teams to see everything: dashboarding, alerting, application performance monitoring, infrastructure monitoring, UX monitoring, security monitoring, dog logos, and log management, in one tightly integrated platform. With 600-plus out-of-the-box integrations with technologies including all major cloud providers, databases, and web servers, Datadog allows you to aggregate all your data into one platform for seamless correlation, allowing teams to troubleshoot and collaborate together in one place, preventing downtime and enhancing performance and reliability. Get started with a free 14-day trial by visiting datadoghq.com/screaminginthecloud, and get a free t-shirt after installing the agent.Corey: Forget everything you know about SSH and try Tailscale. Imagine if you didn't need to manage PKI or rotate SSH keys every time someone leaves. That'd be pretty sweet, wouldn't it? With Tailscale SSH, you can do exactly that. Tailscale gives each server and user device a node key to connect to its VPN, and it uses the same node key to authorize and authenticate SSH.Basically you're SSHing the same way you manage access to your app. What's the benefit here? Built in key rotation permissions is code connectivity between any two devices, reduce latency and there's a lot more, but there's a time limit here. You can also ask users to reauthenticate for that extra bit of security. Sounds expensive?Nope, I wish it were. tail scales. Completely free for personal use on up to 20 devices. To learn more, visit snark.cloud/tailscale. Again, that's snark.cloud/tailscaleCorey: Welcome to Screaming in the Cloud, I'm Corey Quinn and I'm having something of a crisis of faith based upon a recent conversation I've had with my returning yet again guest, Mike Julian, my business partner and CEO of The Duckbill Group. Welcome back, Mike.Mike: Hi, everyone.Corey: So, the revelation that had surfaced unexpectedly was, based upon a repeated talking point where I am a terrible employee slash expensive to manage, et cetera, et cetera, and you pointed out that you've been managing me for four years or so now, at which point I did a spit take, made all the more impressive by the fact that I wasn't drinking anything at the time, and realized, “Oh, my God, you're right, but I haven't had any of the usual problems slash friction with you that I have with basically every boss I've ever had in my entire career.” So, I'm spiraling. Let's talk about that.Mike: My recollection of that conversation is slightly different than yours. Mine is that you called me and said, “Mike, I just realized that you're my boss.” And I'm like, “How do you feel about that?” He's like, “I'm not really sure.”Corey: And I'm still not entirely sure how I feel if I'm being fully honest with you. Just because it's such a weird thing to have to deal with. Because historically, I always view a managerial relationship as starting from a place of a power imbalance. And that is the one element that is missing from our relationship. We each own half the company, we can fire each other, but it takes the form of tearing the company apart, and that isn't something that we're really set up to entertain.Mike: And you know, I actually think it's deeper than that because you owning the other half of the company is not really… it's not really power in itself. Like, yeah, it is, but you could easily own half the company and have no power. Because, like, really when we talk about power, we're talking about political power, influence, and I think the reason that there is no power imbalance is because each of us does something in the company that is just as important as the other. And they're both equally valuable to the company and we both recognize the other's contributions, as that, as being equally valuable to the company. It's less to do about how much we own and more about the work that we do.Corey: Oh, of course. The ownership starts and stops entirely with the fact that neither one of us can force the other out. So it's, as opposed to well, I own 51% of the company, so when I'm tired of your bullshit, you're leaving. And that is a dynamic that's never entered into it. I'm also going to add one more thing onto what you just said, which is, both of us would sooner tear off our own skin than do the other's job.Mike: Yeah. God, I would hate to do your job, but I know you'd hate to do mine.Corey: You look at my calendar on a busy meeting day and you have a minor panic attack just looking at it where, “Oh, my God, talking to that many people.” And you are going away for a while and you come back with a whole analytical model where your first love language feels like it's spreadsheets on some days, and I look at this and it's like, “Yeah, I know what some of those numbers mean.” And it just drives me up a wall, the idea of building out a plan and an execution thing and then delegating a lot of it to other people, it does not work for my worldview in so many different ways. It's the reason I think that you and I get along. That and our shared values.Mike: I remember the first time that you and I did a consulting engagement together. We went on a multi-day trip. And at the end of, like, three days of nonstop conversations, you made a comment, it was like, “Cool. So, what are we going to do that again?” Like, you were excited by it. I can tell you're energized. And I was just thinking, “Please for love of God, I want to die right now.”Corey: One of the weirdest parts about all of it, though, is neither one of us is in a scenario where what we do for a living and how we go about it works without the other.Mike: Right. Yeah, like, this is one of the interesting things about the company we have built is that it would not work with just you or just me; it's us being co-founders is what makes it successful.Corey: The thing that I do not understand and I don't think I ever will is the idea of co-founder speed dating, where you basically go to some big networking mixer event, pick some rando off the street, and congratulations, that's your business partner. Have fun. It is not that much of an exaggeration to say that co-founding a company with someone else is like a marriage. You are creating a legal entity that without very specific controls and guidelines, you are opening yourself up to massive liability issues if the other person decides to screw you over. That is part of the reason that the values match was so important for us.Mike: Yeah, it is surprising to me how similar being co-founders and business partners is to being married. I did not expect how close those two things were. You and I spend an incredible amount of time just on the relationship for each of us, which I never expected, but makes sense in hindsight.Corey: That's I think part of it makes the whole you managing me type of relationship work is because not only can you not, “Fire me,” quote-unquote, but I can't quit without—Mike: [laugh].Corey: Leaving behind a giant pile of effort with nothing to show for it over the last four years. So, it's one of those conversation styles where we go into the conversation knowing, regardless of how heated it gets or how annoyed we are with each other, that we are not going to blow the company up because one of us is salty that week.Mike: Right. Yeah, I remember from the legal perspective, when we put together a partnership agreement, our attorneys were telling us that we really needed to have someone at the 51% owner, and we were both adamant that no, that doesn't work for us. And finally, the way that we handled it is if you and I could not handle a dispute, then the only remedy left was to shut the entire thing down. And that would be an automatic trigger. We've never ever, ever even got close to that point.But like, I like that's the structure because it really means that if you and I can't agree on something and it's a substantial thing, then there's no business, which really kind of sets the stage for how important the conversations that we have are. And of course, you and I, we're close, we have a great relationship, so that's never come up. But I do like that it's still there.Corey: I like the fact that there's always going to be an option to get out. It's not a suicide pact, for lack of a better term. But it's also something that neither one of us would ever entertain lightly. And credit where due, there have been countless conversations where you and I were diametrically opposed; we each talk through it, and one or the other of us will just do a complete one-eighty our position where, “Okay, you convinced me,” and that's it. What's so odd about that is because we don't have too many examples of that in public society, it just seems like there's now this entire focus on, “Oh, if you make an observation or a point, that's wrong, you've got to double down on it.” Why would you do that? That makes zero sense. When you've considered something of a different angle and change your mind, why waste more time on it?Mike: I think there's other interesting ones, too, where you and I have come at something from a different angle and one of us will realize that we just actually don't care as much as we thought we did. And we'll just back down because it's not the hill we want to die on.Corey: Which brings us to a good point. What hill do we want to die on?Mike: Hmm. I think we've only got a handful. I mean, as it should; like, there should not be there should not be many of them.Corey: No, no because most things can change, in the fullness of time. Just because it's not something we believe is right for the business right now does not mean it never will be.Mike: Yeah. I think all of them really come down to questions of values, which is why you and I worked so well together, in that we don't have a lot of common interests, we're at completely different stages in our lives, but we have very tightly aligned values. Which means that when we go into a discussion about something, we know where the other stands right away, like, we could generally make a pretty good guess about it. And there's often very little question about how some values discussion is going to go. Like, do we take on a certain client that is, I don't know, they build landmines? Is that a thing that we're going to do? Of course not. Like—Corey: I should clarify, we're talking here about physical landmines; not whatever disastrous failure mode your SaaS application has.Mike: [laugh]. Yeah.Corey: We know what those are.Mike: Yeah, and like, that sort of thing, you and I would never even pose the question to each other. We would just make the decision. And maybe we tell each other later because and, like, “Hey, haha, look what happened,” but there will never be a discussion around it because it just—our values are so tightly aligned that it wouldn't be necessary.Corey: Whenever we're talking to someone that's in a new sector or a company that has a different expression, we always like to throw it past each other just to double-check, you don't have a problem with—insert any random thing here; the breadth of our customer base just astounds me—and very rarely as either one of us thrown a flag on something just because we do have this affinity for saying[ yes and making money.Mike: Yeah. But you actually wanted to talk about the terribleness of managing you.Corey: Yeah. I am very curious as to what your experience has been.Mike: [laugh].Corey: And before we dive into it, I want to call out a couple of things that make me a little atypical for your typical problem employee. I am ADHD personified. My particular expression of that means that my energy level is very different at different times of day, there are times where I will get nothing done for a day or two, and then in four hours, get three weeks of work done. It is hard to predict and it's hard to schedule around and it's never clear exactly what that energy level is going to be at any given point in time. That's the starting point of this nonsense. Now, take it away.Mike: Yeah. What most people know about Corey is what everyone sees on Twitter, which is what I would call the high highs. Everyone sees you as your most energetic, or at least perceived as the most energetic. If they see you in person at a conference, it's the same sort of thing. What people don't see are your lows, which are really, really low lows.And it's not a matter of, like, you don't get anything done. Like, you know, we can handle that; it's that you disappear. And it may be for a couple hours, it may be for a couple of days, and we just don't really know what's going on. That's really hard. But then, in your high highs, they're really high, but they're also really unpredictable.So, what that means is that because you have ADHD, like, the way that your brain thinks, the way your brain works, is that you don't control what you're going to focus on, and you never know what you're going to focus on. It may be exactly what you should be focusing on, which is a huge win for everyone involved, but sometimes you focus on stuff that doesn't matter to anyone except you. Sometimes really interesting stuff comes out of that, but oftentimes it doesn't. So, helping build a structure to work around those sorts of things and to also support those sorts of things, has been one of the biggest challenges that I've had. And most of my job is really about building a support structure for you and enabling you to do your best work.So, that's been really interesting and really challenging because I do not think that way. Like, if I need to focus on something, I just say, “Great. I'm just going to focus on this thing,” and I'll focus on it until I'm done. But you don't work that way, and you couldn't conceivably work that way, ever. So, it's always been hard because I say things like, “Hey, Corey, I need you to go write this series of emails.” And you'll write them when your brain decides that wants to write them, which might be never.Corey: That's part of the problem. I've also found that if I have an idea floating around too long, it'll linger for years and I'll never write anything about it, whereas there are times when I have—the inspiration strikes, I write a one- to 2000-word blog post every week that goes out, and there are times it takes me hours and there are times I bust out the entire thing in first draft form in 20 minutes or less. Like, if it's Domino's, like, there's not going to be a refund on it. So, it's kind of wild and I wish I could harness that somehow I don't know how, but… that's one of the biggest challenges.Mike: I wish I could too, but it's one of the things that you learn to get used to. And with that, because we've worked together for so long, I've gotten to be able to tell in what state of mind you are. Like, are you in a state where if I put something in front of you, you're going to go after it hard, and like, great things are going to happen, or are you more likely to ignore that I said anything? And I can generally tell within the first sentence or so of bringing something up. But that also means that I have other—I have to be careful with how I structure requests that I have for you.In some cases, I come with a punch list of, like, here's six things I need to get through and I'm going to sit on this call while we go through them. In other cases, I have to drip them out one at a time over the span of a week just because that's how your mind is those days. That makes it really difficult because that's not how most people are managed and it's not how most people expect to manage. So, coming up with different ways to do that has been one of the trickiest things I've done.Corey: Let's move on a little bit other than managing my energy levels because that does not sound like a particularly difficult employee to manage. “Okay, great. We've got to build some buffer room into the schedule in case he winds up not delivering for a few days. Okay, we can live with that.” But oh, working with me gets so much worse.Mike: [laugh]. It absolutely does.Corey: This is my performance review. Please hit me with it.Mike: Yeah. The other major concern that has been challenging to work through that makes you really frustrating to work with, is you hate conflict. Actually, I don't actually—let me clarify that further. You avoid conflict, except your definition of conflict is more broad than most. Because when most people think of conflicts, like, “Oh, I have to go have this really hard conversation, it's going to be uncomfortable, and, like—”Corey: “Time to go fire Steven.”Mike: Right, or things like, “I have to have our performance conversation with someone.” Like, everyone hates those, but, like, there's good ways and bad ways to them, like, it's uncomfortable even at the best of times. But with you, it's more than that, it's much more broad. You avoid giving direction because you perceive giving direction as potential for conflict, and because you're so conflict-avoidant, you don't give direction to people.Which means that if someone does something you don't like, you don't say anything and then it leaves everyone on the team to say, like, “I really wish Corey would be more explicit about what he wants. I wish he was more vocal about the direction he wanted to go.” Like, “Please tell us something more.” But you're so conflict-avoidant that you don't, and no amount of begging or we're asking for it has really changed that, so we end up with these two things where you're doing most of the work yourself because you don't want to direct other people to do it.Corey: I will push back slightly on one element of that, which is when I have a strong opinion about something, I am not at all hesitant about articulating that. I mean, this is not—like, my Twitter is not performance art; it's very much what I believe. The challenge is that for so much of what we talk about internally on a day-to-day basis, I don't really have a strong opinion. And what I've always shied away from is the idea of telling people how to do their jobs. So, I want to be very clear that I'm not doing that, except when it's important.Because we've all been in environments in the corporate world where the president of the company wanders past or your grand-boss walks into the room and asks an idle question, or, “Maybe we should do this,” and it never feels like it's really just idle pondering. It's, “Welp, new strategic priority just dropped from on high.”Mike: Right.Corey: And every senior manager has a story about screwing that one up. And I have led us down that path once or twice previously. So—Mike: That's true.Corey: When I don't have a strong opinion, I think what I need to get better at is saying, “I don't give a shit,” but when I frame it like that it causes different problems.Mike: Yeah. Yeah, that's very true. I still don't completely agree with your disagreement there, but I understand your perspective. [laugh].Corey: Oh, he's not like you can fire me, so it doesn't really matter. I kid. I kid.Mike: Right. Yeah. So, I think those are the two major areas that make you a real challenge to manage and a challenge to direct. But one of the reasons why I think we've been successful at it, or at least I'll say I've been successful at managing you, is I do so with such a gentle touch that you don't realize that I'm doing anything, and I have all these different—Corey: Well, it did take me four years to realize what was going on.Mike: Yeah, like, I have all these different ways of getting you to do things, and you don't realize I'm doing them. And, like, I've shared many of them here for you for the first time. And that's really is what has worked out well. Like, a lot of the ways that I manage you, you don't realize are management.Corey: Managing shards. Maintenance windows. Overprovisioning. ElastiCache bills. I know, I know. It's a spooky season and you're already shaking. It's time for caching to be simpler. Momento Serverless Cache lets you forget the backend to focus on good code and great user experiences. With true autoscaling and a pay-per-use pricing model, it makes caching easy. No matter your cloud provider, get going for free at gomomento.co/screaming That's GO M-O-M-E-N-T-O dot co slash screamingCorey: What advice would you have for someone for whom a lot of these stories are resonating? Because, “Hey, I have a direct report is driving me to distraction and a lot sounds like what you're describing.” What do you wish you'd known sooner about how to coax performance out of me, for lack of a better phrasing?Mike: When we first started really working together, I knew what ADHD was, but I knew it from a high school paper that I did on ADHD, and it's um—oh, what was it—“The Overdiagnosis of ADHD,” which was a thing when you and I were at high school. That's all I knew is just that ADHD was suspected to be grossly overdiagnosed and that most people didn't have it. What I have learned is that yeah, that might have been true—maybe; I don't know—but for people that do have any ADHD, it's a real thing. Like, it does have some pretty substantial impact.And I wish I had known more about how that manifests, and particularly how it manifests in different people. And I wish I'd known more earlier on about the coping mechanisms that different people create for themselves and how they manage and how they—[sigh], I'm struggling to come up with the right word here, but many people who are neurodivergent in some way create coping mechanisms and ways to shift themselves to appear more neurotypical. And I wish I had understood that better. Particularly, I wish I had understood that better for you when we first started because I've kind of learned about it over time. And I spent so much time trying to get you to work the way that I work rather than understand that you work different. Had I spent more time to understand how you work and what your coping mechanisms were, the earlier years of Duckbill would have been so much smoother.Corey: And again, having this conversation has been extraordinarily helpful. On my side of it, one of the things that was absolutely transformative and caused a massive reduction in our interpersonal conflict was the very simple tool of, it's not necessarily a problem when I drop something on the floor and don't get to it, as long as I throw a hand up and say, “I'm dropping this thing,” and so someone else can catch it as we go. I don't know how much of this is ADHD speaking versus how much of it is just my own brokenness in some ways, but I feel like everyone has this neverending list of backlog tasks that they'll get to someday that generally doesn't ever seem to happen. More often than not, I wind up every few months, just looking at my ever-growing list, reset to zero and we'll start over. And every once in a while, I'll be really industrious and knock a thing or two off the list. But so many that don't necessarily matter or need to be me doing them, but it drives people to distraction when something hits my email inbox, it just dies there, for example.Mike: Yeah. One of the systems that we set up here is that if there's something that Corey does not immediately want to do, I have you send it to someone else. And generally it's to me and then I become a router for you. But making that more explicit and making that easier for you—I'm just like, “If this is not something that you're going to immediately take care of yourself, forward it to me.” And that was huge. But then other things, like when you take time off, no one knows you're taking time off. And it's an—the easiest thing is no one cares that you're taking time off; just, you know, tell us you're doing it.Corey: Yeah, there's a difference between, “I'm taking three days off,” and your case, the answer is generally, “Oh, thank God. He's finally using some of that vacation.”Mike: [laugh].Corey: The problem is there's a world of difference between, “Oh, I'm going to take these three days off,” and just not showing up that day. That tends to cause problems for people.Mike: Yeah. They're just waving a hand in the air and saying, “Hey, this is happening,” that's great. But not waving it, not saying anything at all, that's where the pain really comes from.Corey: When you take a look across your experience managing people, which to my understanding your first outing with it was at this company—Mike: Yeah.Corey: What about managing me is the least surprising and the most surprising that you've picked up during that pattern? Because again, the story has always been, “Oh, yeah, you're a terrible manager because you've never done it before,” but I look back and you're clearly the best manager I've ever had, if for no other reason than neither one of us can rage-quit. But there's a lot of artistry to how you've handled a lot of challenges that I present to you.Mike: I'm the best manager you've had because I haven't fired you. [laugh].Corey: And also, some of the best ones I have had fired me. That doesn't necessarily disqualify someone.Mike: Yeah. I want to say, I am by no means experienced as a manager. As you mentioned, this is my first outing into doing management. As my coach tells me, I'm getting better every day. I am not terrible [laugh].The—let's see—most surprising; least surprising. I don't think I have anything for least surprising. I think most surprising is how easy it is for you to accept feedback and how quickly you do something about it, how quickly you take action on that feedback. I did not expect that, given all your other proclivities for not liking managers, not liking to be managed, for someone to give feedback to you and you say, “Yep, that sounds good,” and then do it, like, that was incredibly surprising.Corey: It's one of those areas where if you're not embracing or at least paying significant attention to how you are being perceived, maybe that's a problem, maybe it's not, let's be very clear. However, there's also a lot of propensity there to just assume, “Oh, I'm right and screw everyone else.” You can do an awful lot of harm that way. And that is something I've had to become incredibly aware of, especially during the pandemic, as the size of my audience at this point more than quadrupled from the start of the pandemic. These are a bunch of people now who have never met me in person, they have no context on what I do.And I tend to view the world the way you might expect a dog to behave, who caught a car that he has absolutely no idea how to drive, and he's sort of winging it as he goes. Like, step one, let's not kill people. Step two, eh, we'll figure that out later. Like, step one is the most important.Mike: Mm-hm. Yeah.Corey: And feedback is hard to get, past a certain point. I often lament from time to time that it's become more challenging for me to weed out who the jerks are because when you're perceived to have a large platform and more or less have no problem calling large companies and powerful folk to account, everyone's nice to you. And well, “Really? He's terrible and shitty to women. That's odd. He's always been super nice to me.” Is not the glowing defense that so many people seem to think that it is. It's I have learned to listen a lot more clearly the more I speak.Mike: That's a challenge for me as well because, as we've mentioned, my first foray into management. As we've had more people in the company, that has gotten more of a challenge of I have to watch what I say because my word carries weight on its own, by virtue of my position. And you have the same problem, except yours is much more about your weight in public, rather than your weight internally.Corey: I see it as different sides of the same coin. I take it as a personal bit of a badge of honor that almost every person I meet, including the people who've worked here, have come away, very surprised by just how true to life my personality on Twitter is to how actually am when I interact with humans. You're right, they don't see the low sides, but I also try not to take that out on the staff either.Mike: [laugh]. Right.Corey: We do the best of what we have, I think, and it's gratifying to know that I can still learn new tricks.Mike: Yeah. And I'm not firing anytime soon.Corey: That's right. Thank you again for giving me the shotgun performance review. It's always appreciated. If people want to learn more, where can they find you, to get their own performance preview, perhaps?Mike: Yeah, you can find me on Twitter at @Mike_Julian. Or you can sign up for our newsletter, where I'm talking about my upcoming book on consulting at mikejulian.com.Corey: And we will put links to that into the show notes. Thanks again, sir.Mike: Thank you.Corey: Mike Julian, CEO of The Duckbill Group, my business partner, and apparently my boss. I'm Cloud Economist Corey Quinn, and this is Screaming in the Cloud. If you've enjoyed this podcast, please leave a five-star review on your podcast platform of choice, whereas if you've hated this podcast, please leave a five-star review on your podcast platform of choice along with an angry comment that demonstrates the absolute worst way to respond to a negative performance evaluation.Corey: If your AWS bill keeps rising and your blood pressure is doing the same, then you need The Duckbill Group. We help companies fix their AWS bill by making it smaller and less horrifying. The Duckbill Group works for you, not AWS. We tailor recommendations to your business and we get to the point. Visit duckbillgroup.com to get started.Announcer: This has been a HumblePod production. Stay humble.
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