Hey guys! I had the pleasure of sitting down with Menno Henselmans for a discussion on mastering your physique. Menno Henselmans is a former business consultant turned international public speaker, scientific researcher and educator. His works have been published in over a dozen languages and his website was ranked the #1 fitness website by The Huffington Post.Menno Henselmans IntroCardio vs Weight liftingThe Best WorkoutWorking Out the Whole Body or Isolating Muscle Groups?Men vs Women and Workouts?Ideal Repetitions for Men and Women?How to Best Lose Fat?Dietary Fat for Preventing Muscle Loss?Benefits of Fat ConsumptionCarbs before Working OutThe Nocebo EffectWomen and Diet (and Fat)Risks of UndereatingRisks of Diet Cycle with Undereating and Bingeing Weekly Intake of CaloriesHow Much Should We Eat?Keto vs. CarnivoreThe Importance of HabitsMenno's New Book: The Science of Self-Control____RESOURCESMenno Henselman's Newsletter: https://mennohenselmans.com/subscribe/Coaching Program: https://mennohenselmans.com/online-pt-course/The Science of Self-Control book: https://mennohenselmans.com/book-the-science-of-self-control/Instagram: https://www.instagram.com/menno.henselmans/Facebook: https://www.facebook.com/MennoHenselmans____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER: _____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
PCP Episode 289 – Michael Owen's Morning Workout ➤Full PCP Episode Playlist – https://goo.gl/mduhGw ➤iTunes – http://bit.ly/PCPApplePodcast ➤Google Play – http://bit.ly/PCPGooglePlay ➤Spotify – http://bit.ly/PCPSpotify ➤All PCP mp3s: http://www.theprocrastinatorspodcast.com/ Support the PCP on Patreon conglomerate empire society! Join the PCP Minecraft Server: PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY PCP SHIRTS & MERCH! https://gumroad.com/theprocrastinators (radcon behind the scenes) … Continue reading "Michael Owen's Morning Workout – The Pro Crastinators Podcast, Episode 289"
The 2 worlds collide! The PCP crew is joined by the illustrious PIF crew (Pod In Full). Clyde/Mark is joined by the other original PIF host (Esco, AJ Milla, and Budoo) to discuss the life and times of Shawn Carter (aka Jay-Z) hot off the heels of his rock and roll hall of fame induction. *** Find us on all social media @popcultparent Email us at firstname.lastname@example.org Don't forget to Rate us, Review, and Subscribe! Join the Cult! *** All movies, tv clips, and music used in this podcast are the property of their copyright holders. They are used for the purpose of review and infringement is not intended.
Hey guys, here's episode 6 of community Q&As! How to handle the holidays as a CarnivoreWhat does Judy eat in a day?Should I add fat when I'm overweight? Lunchbox recipe share! (Carnivore Tortilla!)Gout, purines and carnivore Lunchboxes: Is Spam, okay?Celery powder and uncured meatBenefits of topical magnesium spray and leg crampsHow much magnesiumHydrochloric acid gives me heartburn, why? (try MegaGuard)Carnivore Cure group program details#Carnivore75Hard free programBest fat to useGallbladder and CarnivoreDo you eat lamb? Omega 3sKeto bashing with Carnivores. Thoughts?____RESOURCESMegaGuard: https://nutritionwithjudy.com/shopping/supplements/gut-health/megaguard/Magnesium: https://nutritionwithjudy.com/diy-organic-magnesium-spray/NwJ gut healing kit: https://nutritionwithjudy.com/shopping/supplements/gut-health/gut-healing-kit/CATG post – Keto dangerous: https://cutting-against-the-grain.buzzsprout.com/1848841/9393276-real-talk-fear-sellsNwJ Carnivore Bloodwork: https://nutritionwithjudy.com/shopping/health-tests/complete-wellness-panel/NwJ newsletter: https://nutritionwithjudy.com/join-nutrition-with-judys-newsletter/NwJ Stress Episode: https://www.youtube.com/watch?v=H2khQXeuof0&tHoney and Fruit Q&A: https://www.youtube.com/watch?v=sAAg1MgfF7EOmega 3 Testing: https://nutritionwithjudy.com/shopping/health-tests/omega-3-omega-6-fatty-acid-test/Sole Water RecipeFree Carnivore75Hard Program____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER_____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
"I left my primary care practice earlier this year to focus on life coaching. Why did I leave? Because I wanted to do more and make a bigger impact. I remember how eager I was to complete medical training as I approached the light at the end of the tunnel. I thought I could finally relax and enjoy life as an attending after all the delayed gratification from becoming a doctor. All I ever wanted was to help people feel better and live a life of ease myself. However, I was disappointed and frustrated by our broken health care system and how care coordination could impact patient outcomes negatively. Working as a PCP in the pandemic didn't make it any easier. I saw so many patients suffer and felt helpless that I couldn't do more. I wanted to offer healing on a deeper level by examining the root cause in order to change things for good and care for the person as a whole. But I was feeling stuck. I was afraid to leave my stable job. Medicine was all I knew. What else could I do?" Cindy Tsai is an internal medicine physician and can be reached on Twitter @cindytsaimd. She shares her story and discusses her KevinMD article, "Should you stay or leave medicine?" (https://www.kevinmd.com/blog/2021/09/should-you-stay-or-leave-medicine.html)
PCP Episode 288 – Pikmin Bloom, Inflation & The General ➤Full PCP Episode Playlist – https://goo.gl/mduhGw ➤iTunes – http://bit.ly/PCPApplePodcast ➤Google Play – http://bit.ly/PCPGooglePlay ➤Spotify – http://bit.ly/PCPSpotify ➤All PCP mp3s: http://www.theprocrastinatorspodcast.com/ Support the PCP on Patreon conglomerate empire society! Join the PCP Minecraft Server: PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY PCP SHIRTS & MERCH! https://gumroad.com/theprocrastinators (radcon behind … Continue reading "Pikmin Bloom, Inflation & The General – The Pro Crastinators Podcast, Episode 288"
Ryan Staley is the Founder & CEO of Whale Boss — consultancy that helps founders and revenue leaders implement seven and eight-figure sales operating systems. He joined us on this episode of the Predictable Revenue Podcast to break down the strategies founders and start-ups need to adopt to amplify revenue. Highlights include: What are the most important metrics for start-ups (2:00), three core operating systems for start-ups (3:30), creating exponential growth through PCP (4:29), the three core operating systems for start-up revenue leaders (7:35), the whale scale operating system (9:22), the exponential extension engine (10:13), the referral operating system (13:30), the four-step referral framework (17:38). -------------------- Are you looking to create repeatable, scalable, and predictable revenue? We can help! ► https://bit.ly/predictablerevenuecoaching
An interview with Dr. Leslie Fecher from the University of Michigan Health System, author on “Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.” She reviews considerations for the use of steroids to manage immune-related adverse events in patients treated with immune checkpoint inhibitor therapy in the final episode of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines TRANSCRIPT SPEAKER 1: 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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today we're continuing our series on the management of immune related adverse events. I am joined by Dr. Leslie Fecher from the University of Michigan Health System in Ann Arbor, Michigan, author on "Management of Immune Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy. ASCO Guideline Update" and "Management of Immune Related Adverse Events in Patients Treated with Chimeric Antigen Receptor T Cell Therapy, ASCO Guideline." And today we're focusing on considerations for the use of steroids to manage immune related adverse events in patients treated with immune checkpoint inhibitor therapy. Thank you for being here, Dr. Fecher. LESLIE FECHER: Thank you, Brittany, for this invitation. BRITTANY HARVEY: Great. Then I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with a publication of the guidelines in the Journal of Clinical Oncology. Dr. Fecher, do you have any relevant disclosures that are related to these guidelines? LESLIE FECHER: The details of my disclosures are included in the manuscript, but I'd just like to note that I have received research funding, specifically in the form of clinical trial funding, from companies that do manufacture these immunotherapies. BRITTANY HARVEY: Thank you. Then getting into the content, so steroids are valuable agents in the management of immunotherapy related adverse events. So first, what should clinicians consider pretreatment with steroids? LESLIE FECHER: So I think one of the first things is obviously going back to the traditional history and physical exam, and making sure you understand any preexisting comorbid conditions, such as diabetes, high blood pressure, preexisting cataracts or glaucoma, infections, osteopenia or osteoporosis. It's always good to try and optimize things before getting started on steroids. Additionally, it's typically considered very reasonable to check hepatitis B and C serologies prior to starting immunotherapy treatment. And also consideration of assessment for tuberculosis, if there are specific risk factors, understanding if somebody already carries a diagnosis of HIV, and Understanding the status of that in advanced would be relevant. BRITTANY HARVEY: Those are important considerations. Then in addition to that, how should opportunistic infections be prevented? LESLIE FECHER: So one of the most common infections that we tend to try and prevent is pneumocystis jirovecii pneumonia, or PJP, previously known as PCP pneumonia. And this is one of the more common things that we recommend prevention for. So in patients who have received the equivalent of prednisone dosing of 20 milligrams per day for four or more weeks, or greater than 30 milligrams per day for three weeks or more, that's when it would reasonably be indicated. There are obviously specific institutional guidelines for the preferred regimen, but I think that's important to consider. The role of viral prophylaxis as well as antifungal prophylaxis is a bit less clear, but is something to be considered, especially depending on the duration of the steroid course. And whether or not in the setting of herpes zoster, for example, if the patient has had issues with zoster in the past. BRITTANY HARVEY: OK. and then the use of these steroids is to treat immunotherapy related adverse events. But what are the key recommendations for monitoring both the short term and long term adverse effects from steroids? LESLIE FECHER: So I think being aware of the side effects as well as making sure that the patients and the family members or loved ones that are helping them are aware of them as well. From a short term standpoint, typically we recommend things such as GI prophylaxis, with either a proton pump inhibitor or a histamine 2 antagonist, to reduce or prevent gastric ulcers or duodenal ulcers or gastritis. Given some of the long term effects, such as bone loss as well as steroid myopathies, we encourage exercise as well as physical therapy in some circumstances. But really one of the most important things is to make sure that you're constantly both assessing and eliciting from the patient and family members for any other side effects. So often, common acute short term side effects can be increased risk of infection. So making sure you're asking about it. They may not have the typical manifestations of infection, such as fevers or chills. Insomnia or difficulty with anxiety, irritability, skin changes for sure, or high blood pressure. And then obviously being aware that laboratory evaluation for glucose intolerance is important as well. BRITTANY HARVEY: Definitely. Those are important points for clinicians, patients, and caregivers. So then we've had some of the other authors on this guideline talk about tapering steroids. So what are those recommendations on how clinicians should taper steroids? LESLIE FECHER: So tapering is an art in and of itself in my opinion, and there's lots of different ways to do it. Some general concepts are you want to really try and understand what the side effect is that you are managing, because that will require frequent reassessment. And so when we talk about reassessing patients during the treatment of their toxicities, the management of the toxicities, in my opinion, is almost as important as the management of the immunotherapy itself. And so patients still need to be seen, still need to be assessed, still need blood work done. And so reassessment for the toxicity that you're managing, given that we can see rebounding of symptoms. So for example, if they were getting treated for diarrhea or colitis, having a really good understanding of what their baseline bowel movements were, how bad they got, and then a constant reassessment and making sure that the patient, as well as the family, knows that this should not come back again, if you will, in the midst of the taper. I think the other things to be aware of is that I tend to always reassess before giving the next decrease in dose of the steroids rather than having an automatic decrease. Because again, patients sometimes will follow those, even if their symptoms recur. So ensuring that there's that, again, reassessment. When we're on oral steroids, some of the general concepts we say is that the course should be at least usually about four weeks total, sometimes as long as six weeks or even longer, depending on the toxicity. And we think about, on average, decreasing from a prednisone or prednisolone amount roughly 10 milligrams every three to seven days, depending on the side effect that you're managing. The longer the taper, the slower you might need to go, depending at the end. And also being aware of the risk of adrenal insufficiency towards the end of a long steroid course is also an important thing to assess for. BRITTANY HARVEY: Great. I appreciate you reviewing those considerations. So then in your view, Dr. Fecher, how will these recommendations for the use of steroids in the management of immune related adverse effects impact both clinicians and patients? LESLIE FECHER: I think it will bring ongoing awareness to the physician and their team, as well as the patient and their team. I think that this is obviously really important that everybody is involved and aware. And I use the term engagement from a patient and family member standpoint. It's really critical to have an understanding of the side effects, have an understanding of the prednisone management. And explaining that not only to the physician team and nurses and other people involved in their care, but when patients call in, that they know to look out for rebounding of their symptoms and to report them immediately, as that can impact steroid tapering. I think, again, the awareness and engagement is going to ensure that patients get the best care and best results. BRITTANY HARVEY: Absolutely, and thanks for highlighting both that awareness and engagement. So thank you so much for your work on these guidelines, and for taking the time to speak with me today, Dr. Fecher. LESLIE FECHER: Thank you so much, Brittany. I appreciate your time. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/supportive care guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app, available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode.
Hey guys! I had the pleasure of sitting down with Dr. Stephanie Seneff for a discussion on the dangers of glyphosate. Stephanie Seneff is a senior research scientist at MIT, where she has had continuous affiliation for more than five decades. After receiving four degrees from MIT (B.S.. in Biophysics, M.S., E.E., and Ph.D. in Electrical Engineering and Computer Science), she has conducted research in packet-switched networks, computational modeling of the human auditory system, natural language processing, spoken dialogue systems, and second language learning. Currently a Senior Research Scientist (MIT's highest research rank) at the Computer Science and Artificial Intelligence Laboratory, she has supervised 21 Master's and 14 Ph.D. students. For over a decade, since 2008, she has directed her attention towards the role of nutrition and environmental toxicants on human disease, with a special emphasis on the herbicide glyphosate and the mineral sulfur.All about Dr. Stephanie Seneff Why GlyphosateKids and GlyphosatePUFAs/GlyphosateWhy Meat-Only can be PowerfulGut and GlyphosateShort Chain Fatty Acid Profile Better on Carnivore?Why did We Think Glyphosate is Safe?Why Honey May not be Ideal (even organic)What Plant-Based Foods to Eat Grain Fed Meats or Organic Plants Mental Health and GlyphosateThyroid and Hormones with GlyphosateVitamin A ToxicityOmega 6 Solutions (Sulfur)Low Sulfur DietThe Importance of SunlightGlyphosate StoriesChemical and Pharmaceutical Companies, Monsanto and BayerDangers of Herbicides Where to find Dr. Seneff and her book, Toxic Legacy – How the Weedkiller Glyphosate is Destroying our Health and the Environment ____RESOURCESDr. Stephanie Seneff: https://stephanieseneff.net/Book: https://stephanieseneff.net/book/Twitter: https://twitter.com/stephanieseneffFacebook: https://www.facebook.com/stephanie.seneff.5LinkedIn: https://www.linkedin.com/in/stephanie-seneff-9a04958/____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER: _____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
PCP Episode 287 – Hausu & Samus ➤Full PCP Episode Playlist – https://goo.gl/mduhGw ➤iTunes – http://bit.ly/PCPApplePodcast ➤Google Play – http://bit.ly/PCPGooglePlay ➤Spotify – http://bit.ly/PCPSpotify ➤All PCP mp3s: https://goo.gl/WVbIw6 Support the PCP on Patreon conglomerate empire society! Join the PCP Minecraft Server: PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY PCP SHIRTS & MERCH! https://gumroad.com/theprocrastinators (radcon behind the scenes) TPC … Continue reading "Hausu & Samus – The Pro Crastinators Podcast, Episode 287"
In this episode, Founder of the Concussion Corner Academy®, Jessica Schwartz, talks about the nature of concussion treatment. Today, Jessica talks about her concussion experience and how it has shaped her work leading up to the Concussion Corner Academy®, the reality of long-term concussion symptoms, and some of the top concussion myths. Is it ever too late to have your concussion symptoms treated? Hear about treatment barriers, some of the surprising statistics in concussion and TBI research, and the importance of education, all on today's episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “When you're young, make sure you have extended disability on yourself.” “There's no evidence-based, agreed upon international definition of concussion or traumatic brain injury.” “There's been zero phase 3 trials on TBI and concussion in over 30 years.” “Up to 30% of folks now have persistent symptoms of concussion.” “If we can teach one, we can serve many.” “2012 was the first year the International Consensus Statement discussed the cervical spine in terms of examination treatment.” “2015 was the first academic year in which there was a formal training for both TBI and concussion if you were a neurology resident.” “2017 was the first year on the International Consensus Statement that we identified concussion as a rehabilitative injury.” “The injury of concussion is an injury of loss. It's a loss of your ‘I am.'” “Join Twitter.” More about Jessica Schwartz Jessica Schwartz PT, DPT, CSCS is an award-winning Physical Therapist, a national spokeswoman for the American Physical Therapy Association, host of the Concussion Corner Podcast, founder of the Concussion Corner Academy®, and a post-concussion syndrome survivor, advocate, and concussion educator. After spending a full year in rehabilitation, experiencing the profound dichotomy of being both doctor and patient, Dr. Schwartz identified the gaps in concussion treatment and management in the global healthcare community. Her role has been to identify the cognitive blind spots and facilitate collective competence for healthcare providers, physicians to athletic trainers, focusing on comprehensive targeted physical examinations, rehabilitative teams, and concussion care management. Suggested Keywords Healthy, Wealthy, Smart, Concussion, Research, Statistics, Physiotherapy, Neurology, Concussion Corner, Myths, Healthcare, Rehabilitation, Injury, Loss, To learn more, follow Jessica at: Website to Join the Program: The Concussion Corner Academy® Facebook: Concussion Corner Twitter: @ConcussionCornr Instagram: @ConcussionCorner LinkedIn: Jessica Schwartz YouTube: Concussion Corner LinkTree: https://linktr.ee/ConcussionCorner Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read the full transcript here: 00:02 Hey Jess, welcome to the podcast. Finally, I'm so excited to have you on. 00:07 Thank you so much for having me. I can't believe we haven't done this yet. 00:10 I know it's like absolutely insane. And just so people know Jessica and I both live in New York City, and we actually see each other quite a bit. And this is the first time I've had you on the podcast. But I'm really excited to have you on today because we're going to be talking about concussion, persistent post concussion symptoms, and you'll talk a little bit more about that name changed in the bulk of the interview. But before we get into some common myths around concussions, I would love for you to let the listeners know a little bit more about why you decided to really specialize in this niche within medicine and rehabilitation. 00:52 Awesome. Well, I thank you for the softball pitch care know. For those that don't know, Karen used to play softball on Central Park quite a bit. But yeah, no, I mean, I thank you so much for having me on. First. I've been listening to healthy, wealthy smart forever. So just thank you again. And yeah, I mean, gosh, I think back to I was a we were one of the first six residents actually, we were the first six residents in orthopedics at NYU in 2010. When I finished up grad school and all that jazz, and we I had it, I got the dream job, right, got the dream job. I had to leave New York City for it, which sounds crazy. But I think a lot of folks can connect to that, you know, working in, you know, the old adage, Jay, we used to call mills and things like that are seeing three or four patients plus per hour. And I was like, this isn't why I went into physical therapy. This is not why I wanted to do this. And I found this great clinic out in New Jersey during residency and we saw one to two patients per hour. And we had a support staff and they were emotionally intelligent. They were physical therapy owned, and they let us grow. And keep that like use of excitement, right? I don't know about you. But I'm hopped up on caffeine and too little sleep as we launched a new business this week. But it was great. And it really it fed my soul. It was wonderful colleagues and we ended up I ended up starting kind of in the opposite end of things, a civilian prosthetics program. So I was, you know, volunteering and showing up at the Manhattan VA, which has a wonderful prosthetics program. And then we also launched a breast cancer program and be launched a concussion program. So that was kind of like my first entree into concussion about 1011 years ago. And we were the only really only office in New Jersey with that type of rehabilitative practice at approaching concussion. And so very Dunning Kruger ask, it was like, you know, you don't know what you don't know until you kind of are made self aware of it. I got hit by a car. So I was hit by a car in October 3 of 2013. And right before then, oh, actually, it wasn't even right before then care. I'm sorry about that. But it was two years before it was our last day of residency. We saw that there was a conference at NYU at the hospital. And it was on concussion and it was NY us first concussion conference. Now this was 2011. So my best friend from Italy Beatrice, you know, hi, BIA. She's in Lucca. She's a great physio, if you're out in Italy listening in. And we were like, What do you want to go and it was our first weekend off for residency. I mean, we were exhausted, excited. And we're like, let's do it. So we went to this conference, I fell in love with it. And so we were at least aware of what this program was at NYU. Fast forward two years from there. And I was actually hit by a car here in Manhattan. So that's really where it's my life's work and passion is to become because I actually live with persistent symptoms. So and went through quite a recovery. So that's kind of how it all kind of came together and coalesced. 03:49 And when you suffered a concussion, and this was in 2013 It did you did you have kind of the self awareness at that time to think, well, you know, I've been learning a lot about concussions, I think I can I can kind of help myself here and did that then really propel you to learn more and to dive in even more. 04:19 So when I was hit, I was hit by an unlicensed driver from behind and my airbags did not go off. I was in my Toyota Prius you may have even been in that car at some point. And I didn't think anything of it but I knew I when I said the story is I I got out of the car. I want to get out of the car. I got hit so hard. I was stoplight at a red light wasn't looking behind me because we were stopped. And it was the traditional traffic right care like we're just inching forward. And I was probably on that block of 12 Street between Fifth and Sixth Avenue for about two or three light cycles because of traffic. So I just got Walt from behind and so the New Yorker in May right so born and raised New Yorker You know, unbuckle the seatbelt and get out of the car to give this guy the business. And I was just so dizzy care. And I held onto the top of the hood of my roof of the car and I was like, I gotta sit down. Fast forward. I thought this was quote unquote, just going to be a concussion. And at that time, we really thought concussions were pretty much resolved spontaneously within seven to 10 days based off of the literature from 2002. From Brolio and McCrea at all from the NCAA study. But we don't have that's false. And we have so much updated information we can chat about if you'd like. So I thought it was just going to be seven to 10 days. I went back to work for for a week, I thought, you know, I would just be sore, kind of like a whiplash or like a Dom's. And now, I just kept D compensating and then from there went from 10 to 14 hours of rehab a week for 14 months. 05:53 And how did you continue to work and continue to function during all this time? 05:58 I did not. So I went off of I went out of work, mind you, I was just promoted to junior partner the week I got hit. So I remember I was like directing a prosthetics program, we had all these other programs, I just became junior partner, which would have been a profit share with a company and I loved my job, I would still send people back to that clinic, those four clinics in New Jersey in northern New Jersey. So essentially what happened was, it was a conversation that went on for months. So I was on short term disability for six months. And I say this to all physical therapists, physicians, OTs, PTs, whoever's listening to this, when you're young, make sure you have extended disability on yourself, because our bodies are so fragile at the end of the day. And again, I was an athlete, I was a cyclist I was training for, for a century bike ride and life changes in the blink of an eye. And I was underinsured with a $50,000 policy policies for car insurance to go up to 300,000 to 3 million for certain policies. And it would have been an extra $12 a month. But again, you're a new grad, you're just out of residency, just out of DPT school and you know, you're thinking about student loans and just being out of school. And so you don't really plan that far. So that's a whole other conversation we can have on another podcast. So I was on short term disability and we all know the legality of and we all have our own cognitive biases about this, right? So when people are involved in litigation, we know that their care tends to go a little bit longer. So I just I knew that. And I didn't want to, I almost didn't want to set myself up for failure, right? I just wanted to be a good soldier, show up for therapies, neuro psychology, vision therapy, talk therapy, vestibular therapy, regular musculoskeletal for the whiplash therapy, and just be a good soldier and show up as a good patient, just thinking that I would get better and slightly different than a musculoskeletal injury. The difference is with with brain injury is that there are cognitive and behavioral impairments that differentiate those from brain injury from musculoskeletal injury and rehab. On top of that, add the environmental aspect, and that's a whole other aspect of the injury. So there's no finite, you know, six to eight weeks of tissue healing or things like that, when it comes to brain brain injury, that it's a very gray area. So I was on disability for six months. And then that ended and that was petrifying. So two weeks before disability ended. I wanted to burn it down. That's when I got angry. And I think that's when I really went through that whole grief cycle, because I just kept showing up to therapy thinking I was going to get better, and then I did not. So went back after 14 months, I had the no fault car insurance, which helped pay some bills back home with mom at the time. And that was it. So after that, when I went back to work, I actually realized I had a vision handicap with overhead LED lights. So I still live with persistent symptoms, I still live with neuro fatigue, I still have an ocular motor disorder. But we learn how to manage and cope and I have wonderful support systems and definitely a grit that a lot of people don't have as well, I think I'm missing a chromosome there somewhere. 09:03 And you know, and this was eight years ago. So I think it's important for the people listening to understand that, you know, when one is diagnosed with a concussion, it's not just like you said over and seven to 10 days or maybe a week or a month or even a year, and that there are symptoms that can persist. And I think that's a great segue into what are some common myths around concussions. So I asked Jessica give me like maybe your top three common myths that surround concussion and and post concussion. So Jessica, I'll throw it over to you. So what would be Myth number one that is circulating out in whether it be layman's world or even the medical world? Well, 09:53 um, I was actually I'm going to give you something that we didn't speak about. I'll kind of combine one of them with three but One of them, actually two that we didn't speak, I'll surprise you as well. But there's actually no evidence based definition agreed upon international definition of concussion or traumatic brain injury. And that kind of will segue a little bit into two is that there's actually been zero phase three clinical trials on TBI concussion in over 30 years. So, when we're talking about research, I mean, talk about ground floor ground level, I mean, we were in the basement 10 years ago, just not having any idea what we were looking at. So I even I try to tell people like when we're talking about this, and looking at the literature, the medical legal literature got ahold of this injury 50 plus years ago, and it's been in the trapped with closed head injury and medical legal literature, but really not until 22,004. And on how we've been talking about this as a rehabilitative injury, and things like that. So, you know, historically, when we don't know what to do with someone in medicine, we tend to send them down to trajectories, we send them, we allude that they're milling, lingering, or looking for a secondary gain, or we tell them that's all in their head, and it can't be real, right. So that's what's kind of happening with these patients that we know up to 30% of folks now have persistent symptoms of concussion, they don't just spontaneously. You know, in even two weeks, we even actually, because we didn't really know what we're looking for right care. So we didn't have an agreed upon definition. So how can you know what you're looking at unless you know where you're looking for. So that's so very important to connect to is that a lot of the mismanagement of concussion was so much more prevalent in a well cared for patient. 11:38 That's wild. And so before 2004, basically, if you had persistent persistent symptoms after a concussion, it was like, good luck. 11:50 Yeah, you were allude that you're faking it. You were looking at this, that it was a psychological injury. Yeah. You know, and 11:57 that, that in and of itself is crazy making? 12:00 Yes, well, that's the whole thing and the chicken or the egg, right. And you can't deny psychological conversations when it comes to the brains like Hello. However, you know, it's really the chicken or the egg, you have these somatic things that we have the ability today in 2021, in a well versed clinician to validate the patient's symptom profile by doing targeted, comprehensive physical examinations as it pertains to concussion. So we actually the best thing that we can do for a patient like this, and I'm sure you've had all the chronic pain people on your podcast and things like that is validate their symptom profile. Listen, you're not crazy for seeing words coming up off the page. No, you didn't drop some LSD or an illegal drug. You have an ocelot Xia? You know, but the difference between the moderate and severe TBI is is that these folks have the self awareness to know that something's not right. But they do not have this objective language to express the what or how they feel with brain injury. So what do we do all day care? And how are you feeling? What's your pain level? What's your number? How are you feeling? But brain injury folks do not have the subjective language to express that so when they go to the mall and our fear avoidant of that, or they go to the supermarket, and they are don't like to be in a complex visual sensory environment, because the colors may blur, and things like that, that is then looked at as a fear avoidant behavior. And that's been sent to psychological counseling for decades. So how can we as physios how do we get these guys first and gals? So not to Detroit too much to keep you on track. But those are two. The first two is that there have been there are over 43 working definitions of concussion. One of them is evidence based. And to that there are zero phase three clinical trials in over 30 years for TBI concussion. 13:42 Wow. Wow. Wow, those are two biggies. Two big myth. 13:46 I would think so then I'll combine the last three because there are points. So the third one is, you know, I really, I'm really into education care. And I really believe that if we can teach one we can serve many, okay. And that's just what I've been privy to. And this implicit trust in the last, like eight to 10 years with this injury, that I've been invited to all different conferences for emergency physician athletic training, PT, you name it, because we all need to be on the same page here. So folks really need to I always say that we need to have a really humble approach when we come here because and I say this with kindness and I but I say this very firmly, is that with concussion, we have infinite ports of access to entry to care. Okay, you can go to the urgent care the emergency department, you could even be at your OB GYN appointment and you might have had this fall and a ski injury over the weekend and in your annual or biannual you know OBGYN appointment if you're a woman. And you know, you could have had you could have pre presented with signs and symptoms of concussion and not be aware of it. So I see that because there's infinite ports of entry on like cancer or unlike cardiology, you have a heart attack, where do you go care and you go to the emergency room, right? And then you see the cardiologist just right or you get diagnosed with cancer or your PCP or you start losing weight, you have some red flag showing up. Where do you go? Yeah, young colleges right to the oncologist, right. So that's a, that's a defined pathway. With concussion, we don't have a defined pathway. And that's not necessarily a bad thing. However, it's where a lot of this mismanagement has come up over the last few years and decades, and that's where patients start to suffer. And that's where it healthcare, we've actually imparted something that's called AI atherogenic suffering, which is where actually the health care system where your doctor is actually part of a way of suffering on a patient. So I bring that to our attention with these three quick facts. I'll say them quickly, and then we can chat about them. Go for one 2012. That's the number you got to know. 2012 was the first year the international consensus statement discuss the cervical spine in terms of examination treatment, that whole stick that connects the central nervous system to the peripheral nervous system and runs the autonomics up and down, right 2012. We just started talking about the cervical spine internationally. 2015 was the first academic year in which there was a formal training for both TBI and concussion, if you are a neurology resident. So if you were a brain physician in 2015, that was their first formal didactic year, they had training in concussion and brain injury. So just let that settle in there for a second because that's, that's just wow. Again, this is a place to build up, not tear down, but that was taking place within the behavioral neurology section of the American Academy of Neurology. And the third one was that 2017 was the first year on the international consensus statement that we actually identified the concussion as a rehabilitative injury. 2017. So, like, what? So if you think about it, as physical therapists, congratulations, happy 100 years care. We just had our centennial, right. So we were rehabilitation aids, literally in the trenches 100 years ago, like now, and we were treating what we were treating brain injury, what are we doing in the ICUs for treating brain injury? We're getting them up, we're getting them moving. But what do we prescribe when we don't know what to do with someone and healthcare rest? So we now know that that's not the ideal thing to do beyond the first 72 hours, but yeah, 2012, cervical spine 2015, brain physician started learning how concussion and 2017 was we call the rehabilitative so that's my third. 17:29 Wow, that's, it just seems like that cannot be possible. 17:33 Yeah. And, and it seems like that and because we know better, right? But imagine then being, you know, having deficits and having trouble thinking and processing, and what's our most valuable resource attention, but then you can't process. So it's, it's so horrible when you're a patient, and you have to negotiate the system, if you go through a no fault, or you go through a worker's comp, and there's all these other aspects, you know, of that of, of the injury. So I always say, sorry, I always say is that concussion as an injury of loss of it, I am, so you have to really pay attention to where your patients are in space and time when you when you meet them. 18:10 And it all seems to me like just not having a clear pathway. To me sounds like barriers to treatment, and barriers to to improvement. And then my question, I just one quick question. It. If you if the patient doesn't quite know who to go to, they don't know that they're they they have a concussion? Because some people like oh, you know, he got his bell rang, or whatever. And they don't even go to see a doctor, but they're having some symptoms, but they're not quite sure who to go to? Is it that the longer your symptoms go on, the less likely you are to recover? 18:50 So there's a yes or no answer to that. I don't want to say it depends. But the good news is, is that we have folks five and 10 years out who may have not sought treatment, like the patient you just alluded to, or sought treatment, then kind of plateaued, the brain wasn't ready yet. And that's totally fine. And we've got to tell patients that No, hey, maybe we need to take three to six months and just kind of let this settle. Let's reset, regroup, and then let's come back. Because the brain just may not be ready. You cannot force this. This is not about grit and resilience, in terms of being sore and pushing through. You've got to listen to the brain and I talked about it with like the knee effusion principle. You know, we have residency in orthopedic so I talk ortho all the time, although I love the neuro, neuro world these days as well. But you know, it's like the knee effusion principle, right? You do too much the knee fuses, we want to give it if it doesn't come down in two days, we did too much. Let's cut in half, right. So it's the same thing with concussion except the difference that is super frustrating to both patients and clinicians that aren't in the know is that you can have delayed symptom onset. So you can do something within the therapy office or they can do something like for example, have a vestibular migraine, where they feel good while they're walking outside and they feel okay walking But as soon as they stop their body like isn't really caught up to them yet. And then they get this distributor migraine within 20 to 60 minutes, and then they feel like garbage. But then they don't know what even to associate with. And that right there, Karen will make you feel crazy. So so it's very important to have somebody in the know, but you said something right before that question about barriers? And you're absolutely right, there are barriers, but I'll do you one better is that we're not only have barriers to accessing quality care for concussion, we also have i atherogenic, suffering, where they come and I, as a provider may not know enough about concussion to look at this from 360. So we have providers that don't know, they may be maybe in 2021, we'll be able to pull up the international consensus statement. But that's only for sport, and it's very limited. So it doesn't go through the nuance of the suffering and the delayed symptom onset and things like that. It's very white paper esque, right? So we actually then cause harm by quote unquote, just treating the neck, not looking at the vestibular system, not looking at sleep, not looking at the ocular motor system, not looking at is the the migrant or aspect of it, not, you know, all these other things and aspects that make concussion concussion. So from a symptom profile standpoint, so if you feel typically I should say, 21:15 yeah, and, and, you know, like you said earlier, you're all about education, and getting people to therapists, and whether you're a physical therapist, occupational therapist, you've been a personal trainer, physician, really understanding the ins and outs of concussion. And so I'm going to, I'm going to plug your educational entity that is that is launching, and it's concussion, corner Academy. And so now, I really like that you're coming at this from the patient and the provider standpoint. So talk a little bit more about concussion, quarter Academy, and what separates it from other educational programs. Because, you know, as you know, there's a lot out there in the world, right? So how, what, what is it about this that makes it different, and that you're really proud of as you should be? 22:08 Oh, I appreciate that care. And, golly, I mean, talk about like, your life's work, right? And I really, I just get goosebumps thinking about this. And I'm like, wow, this is this is really just a dream. And I'll be very honest with you, this is a we're in a pandemic, still, some people may not want to admit that. But we're, we're still in a pandemic. And we all kind of went through something, right, especially in New York City, we really went through it initially in the acute phase of this pandemic. And I did, I lost a good chunk of my practice, and I had to really sit with myself and I said, Gosh, just what do you want to keep doing? You know, what do you want to do with your life, I had patients no less than four years, some 11 years as patients. And I was like, I'm not doing this again, I just don't have the energy. And that was from just a like a, like, almost like a burnout aspect. I just couldn't imagine re building up my my practice again, I have no problem seeing patients, if they call me but I have no desire to market. Now. I was like, Well, my ideal life based off of my symptoms and persistent symptoms. You know, I really work every other day. So yeah, I can push through every five days and do a regular work week if needed, but I don't feel well. And then I'm not pleasant. And it's just, you know, I just know my limits. So with the neuro fatigue and the stuff that I live with, I said, Well, what's, uh, what's, what's something I can do? Well, if I could work remotely, that was kind of it. And I said, How can I help the concussion community? So we decided, and my partner is a graphic designer and in to animation and editing and all of this stuff. We said, how can we make this beautiful, and deliver it? Because the user experience was so important to us? And then how can we deliver it internationally to where it's accessible? So we're, we formed the academy, and essentially, the goal has always been to promote healing, decrease suffering, increase support, and deliver it with kindness to this mismanage patient population, but we need to have access. So I have a tremendous faculty. We're launching we are we have a nonprofit partnership. We have the faculty are actually the people on the international consensus statement. They're the people treating the the boots on the ground, their clinician scientists, and they get it, they get concussions, and they're vested in concussion. So it's going to be a 12 week online course for our first cohort. It's fixed. It's from January 16 to April 10. It's going to be two hours per week one posted for you and one live on Sunday mornings at 10am. Eastern which will allow for our European friends and our California friends as well on the West Coast. And it's going to be 24 hours of CEU activity for for for physical therapists and athletic trainers. As long as we have 10, ot speech pathologists, neuropsychologist, psychologists, social workers, we can see you them as well, but it's the first round so it's kind of a lot of investment here. So I'm just going with PT and 80 to start unless we have 10 of the others. And we're going to have a nonprofit partnership, but the the beauty of it all is already I'm actually going to have, we're going to be doing research on our students. So we're actually going to be looking to change outcomes based off of evidence based practice and education. So we're going to be able to study our students, and then link up with our nonprofits as well to support them because it's really an underfunded sector of research where cancer gets billions and trillions and and TBI and concussion tend to get hundreds of millions. So we're really going to try and support the folks you know, who are boots on the ground. 25:29 I love it. It sounds so great. Where can people find more information about it? 25:34 Sure. It's going to be it? Well, it's already at it's at concussion corner.org.org. If you follow the podcast, we tried to give things away just like you do with healthy, wealthy smart. So we've had the concussion corner podcast is 2018. I hosted the Super Bowl concussion are moderated, I should say, the Super Bowl concussion conference in Minneapolis and we launched it then it's been around in over 50 countries, it's been so well received, we have a lovely community. So we're going into education, and how can we have a supportive community with open office hours and open office hours and things like that, that will what will provide our students with, with eventually a rehabilitation video database, where that's going to be searchable for folks as well. So they can search, you know, cervical spine examination intervention, what's the referral process look like. So it'll be a robust program, but we're going to be beta in January with I just want to point out, we're going to have a referral program. And, again, I'm a person and have one right, so we're not going to have an early bird special, like we're used to at conferences. But the whole thing is to spread this word of mouth. So instead of taking $100 off, we're going to give a $75 referral. If you have seven to eight people that you refer your whole tuition is paid for Plus, you get your 24 hours of CEU. So we want to really just want this to be word of mouth, from from like grassroots, let's build it by conversation and internal marketing and get people in who are invested in wanting to learn about this injury. 27:02 Awesome, awesome. And of course, we'll have a link to it in the show notes here at podcast at healthy, wealthy, smart calm for anyone who wants to learn more about the program and about the modules and how it's set up. Or you want to just get some more information. Or if you're ready, you heard this and you're like, I see people with concussion all the time. I'm not 100% comfortable, I need to learn more, or this is something I want to learn more about, I think now you have the perfect opportunity to learn. So we'll have a link there in the podcast notes for anyone who is ready to pull the trigger and join Jessica in January. So now just is there anything that you really want the listeners to take away from this conversation around concussion and rehab of concussion? 27:58 Yeah, so I'm sure there's, there's so many things off the top of my head, really connecting to that concussion is a rehabilitative injury. And if we can connect to that the injury of concussion is an injury of loss. It's a loss of your I Am your I am funny, I am husband, I am wife, I am Doctor, I am surgeon, you're I am. So if we are sensitive to that and connect to that concussion is an event, it's not an event there, it has to be a mechanism of injury, don't get me wrong, but it's not an event, it's an actual process. And we have this neuro metabolic cascade. And then we tend to have this loss of function in our in our environment. So that is really what I want folks to connect to. Because we have to make sure we're meeting our patients where they are and their moments of recovery. So that's really the big thing to connect to is that folks tend to really connect to the event of the concussion, you know, the post traumatic amnesia, the domestic event, the loss of consciousness, and less than 10% of those folks, but they're not connecting to where those folks are in their trajectory. And how many folks have they seen before you on average, people see six to 10 providers before they walk into my door. Okay, connect to that. Do they trust healthcare providers before they've talked to you? Did they have physical therapy in a hospital gym that wasn't really, neurologically sensitive to their needs, their smell, their sound, their lights, things like that. So connect to your patients in a different way. I can guarantee you if you're a new grad, this is going to this is going to get you excited. And if you're a little more seasoned, like Karen and myself and you're feeling a little burnt out, this is a great way to look at your patients 360 We're looking at autonomics we're looking at neurology, vestibular ocular motor. The physiological aspect of its sleep, nutrition, neuro endocrine, let's talk about sexual dysfunction and concussion. That's a whole other podcast. But it really is something that you can hear my passion about, or these patients are being mismanaged much more probably than they're being well cared for. And we can change that and there's no reason that we can't change that for next day. Not Knowledge Translation in the clinic, so I challenge your listeners to that care. 30:03 Amazing, amazing. And now I have one more question to ask. And it's one that I asked everyone. And that's knowing where you are now, in your life and in your career, what advice would you give to your younger self, let's say, you know, straight out of straight out of Ithaca physical therapy school. 30:21 Um, let's see here, straight. So I've honestly joined Twitter, I have had so many, I've had so many positive experiences, the 99 that I've had positive and the one negative, you know, and you really have to conduct yourself in a certain way, of course, but I joined Twitter, I've had so many amazing opportunities. I was invited to the Super Bowl, I was asked to be one of our spokeswoman like you for American Physical Therapy Association, I've been invited to speak at conferences and, and just network with people who I would never have access or touch points to. And I really think it was the most powerful thing I've done for my education, besides, you know, maybe a residency postdoc, really. So I really do and we wouldn't have met the same way either. So I think it's been great. 31:05 All right. Well, that I think that might be the first time I've gotten that. What advice would you give to your younger self is to join, join Twitter and join social media. So thank you for that. And like you said, you have to make it your own, and you have to approach it, approach it in the right way. So I think that's great advice. And now, again, people can go to concussion corner.org. To find out more. And of course, like I said, we'll have all the links at podcast at healthy, wealthy, smart, calm. So a big thank you, Jessica, for coming on the program busting some concussion myths. So thank you so much. 31:42 Oh, thank you so much for having me and to all your listeners. Thanks so much for your time and attention. I really appreciate it. 31:47 Of course and everyone thanks so much for listening, have a great couple of days and stay healthy, wealthy and smart
Hey guys! I had the pleasure of sitting down with Dr. Philip Ovadia for a discussion on metabolic health. Dr. Philip Ovadia is a board-certified Cardiac Surgeon and founder of Ovadia Heart Health. His mission is to optimize the public's metabolic health and help people stay off his operating table. As a heart surgeon who used to be morbidly obese, Dr. Ovadia has seen firsthand the failures of mainstream diets and medicine. He realized that what helped him lose over 100 pounds was the same solution that could have prevented most of the thousands of open heart surgeries he has performed—metabolic health.In Stay off My Operating Table: A Heart Surgeon's Metabolic Health Guide to Lose Weight, Prevent Disease, and Feel Your Best Every Day, Dr. Ovadia shares the complete metabolic health system to prevent disease.Dr. Ovadia grew up in New York and graduated from the accelerated Pre-Med/Med program at the Pennsylvania State University and Jefferson Medical College. This was followed by a residency in General Surgery at the University of Medicine and Dentistry at New Jersey and a Fellowship in Cardiothoracic Surgery at Tufts – New England Medical School.All about Dr. Philip Ovadia- 12 myths about metabolic health- 5 markers to define metabolic health- 7 principles of metabolic health- Sleep- Ideal diet for metabolic health?- Heart disease at younger ages- Where can people find Dr. Ovadia_____RESOURCES- Dr. Ovadia at www.OvadiaHeartHealth.com- Twitter: https://twitter.com/ifixhearts- Book: Stay off my Operating Table – A Heart Surgeon's Metabolic Health - Guide to Lose Weight, Prevent Disease and Feel Your Best Everyday: https://amzn.to/3AUXjFj____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER: _____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
The challenges of standup comedy were nothing compared to the obstacles Felipe Esparza faced throughout his childhood. His family was caught crossing the border and sent back to Mexico. When he finally made it to America, he found himself living with an abusive father in a Los Angeles neighborhood being decimated by crack and PCP. And as Felipe tells Marc, even when he was getting good standup gigs, he couldn't escape his past. They also talk about Felipe's vegan journey, the big comedy lesson he learned from the library, and the difference between doing his act in English and in Spanish. See omnystudio.com/listener for privacy information.
Tell us a story. Smoke some PCP laced weed. Save a girl from being raped. Kill a drug dealer and try to avoid getting your shit pushed in, because King Kong ain't got shit on us. It is our pleasure to recommend to you this week, Antoine Fuqua's American crime thriller, Training Day (2001). Clips From: Training Day --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/watchthisordie/message Support this podcast: https://anchor.fm/watchthisordie/support
DaftPina: The Master Manipulator: PCP Episode 286 – Daftpina, AetherionArt, Antoons (ft. Reborn Pyro & adv1ll) ➤Full PCP Episode Playlist – https://goo.gl/mduhGw ➤iTunes – http://bit.ly/PCPApplePodcast ➤Google Play – http://bit.ly/PCPGooglePlay ➤Spotify – http://bit.ly/PCPSpotify ➤All PCP mp3s: https://goo.gl/WVbIw6 Support the PCP on Patreon conglomerate empire society! Join the PCP Minecraft Server: PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY PCP … Continue reading "Daftpina, AetherionArt, Antoons (ft. Reborn Pyro & adv1ll) – The Pro Crastinators Podcast, Episode 286"
Sins Of Omission: The AZT Scandal By Celia Farber Spin Nov. 1989 On a cold January day in 1987, inside one of the brightly-lit meeting rooms of the monstrous FDA building, a panel of 11 top Aids doctors pondered a very difficult decision. They had been asked by the FDA to consider giving lightning-quick approval to a highly toxic drug about which there was very little information. Clinically called Zidovudine, but nicknamed AZT after its components, the drug was said to have shown a dramatic effect on the survival of Aids patients. The study that had brought the panel together had set the medical community abuzz. It was the first flicker of hope - people were dying much faster on the placebo than on the drug. But there were tremendous concerns about the new drug. It had actually been developed a quarter of a century earlier as a cancer chemotherapy, but was shelved and forgotten because it was so toxic, very expensive to produce, and totally ineffective against cancer. Powerful, but unspecific, the drug was not selective in its cell destruction. Drug companies around the world were sifting through hundreds of compounds in the race to find a cure, or at least a treatment, for Aids. Burroughs Wellcome, a subsidiary of Wellcome, a British drug company, emerged as the winner. By chance, they sent the failed cancer drug, then known as Compound S, to the National Cancer Institute along with many others to see if it could slay the Aids dragon, HIV. In the test tube at least, it did. At the meeting, there was a lot of uncertainty and discomfort with AZT. The doctors who had been consulted knew that the study was flawed and that the long-range effects were completely unknown. But the public was almost literally baying at the door. Understandably, there was immense pressure on the FDA to approve AZT even more quickly than they had approved thalidomide in the mid-60s, which ended up causing drastic birth defects. Everybody was worried about this one. To approve it, said Ellen Cooper, an FDA director, would represent a "significant and potentially dangerous departure from our normal toxicology requirements." Just before approving the drug, one doctor on the panel, Calvin Kunin, summed up their dilemma. "On the one hand," he said, "to deny a drug which decreases mortality in a population such as this would be inappropriate. On the other hand, to use this drug widely, for areas where efficacy has not been demonstrated, with a potentially toxic agent, might be disastrous." "We do not know what will happen a year from now," said panel chairman Dr. Itzhak Brook. "The data is just too premature, and the statistics are not really well done. The drug could actually be detrimental." A little later, he said he was also "struck by the facts that AZT does not stop deaths. Even those who were switched to AZT still kept dying." "I agree with you," answered another panel member, "There are so many unknowns. Once a drug is approved there is no telling how it could be abused. There's no going back." Burroughs Wellcome reassured the panel that they would provide detailed two-year follow-up data, and that they would not let the drug get out of its intended parameters: as a stopgap measure for very sick patients. Dr. Brook was not won over by the promise. "If we approve it today, there will not be much data. There will be a promise of data," he predicted, "but then the production of data will be hampered." Brook's vote was the only one cast against approval. 'There was not enough data, not enough follow-up," Brook recalls. "Many of the questions we asked the company were answered by, 'We have not analyzed the data yet,' or 'We do not know.' I felt that there was some promising data, but I was very worried about the price being paid for it. The side effects were so very severe. It was chemotherapy. Patients were going to need blood transfusions. That's very serious. "The committee was tending to agree with me," says Brook, "that we should wait a little bit, be more cautious. But once the FDA realized we were intending to reject it, they applied political pressure. At about 4 p.m., the head of the FDA's Center for Drugs and Biologics asked permission to speak, which is extremely unusual. Usually they leave us alone. But he said to us, 'Look, if you approve the drug, we can assure you that we will work together with Burroughs Wellcome and make sure the drug is given to the right people.' It was like saying 'please do it.'" Brad Stone, FDA press officer, was at that meeting. He says he doesn't recall that particular speech, but that there is nothing 'unusual" about FDA officials making such speeches at advisory meetings. "The people in that meeting approved the drug because the data the company had produced proved it was prolonging life. Sure it was toxic, but they concluded that the benefits clearly outweighed the risks." The meeting ended. AZT, which several members of the panel still felt uncomfortable with and feared could be a time bomb, was approved. Flash forward: August 17, 1989. Newspapers across America banner-headlined that AZT had been "proven to be effective in HIV antibody-positive, asymptomatic and early ARC patients," even through one of the panel's main concerns was that the drug should only be used in a last-case scenario for critically-ill AIDS patients, due to the drug's extreme toxicity. Dr. Anthony Fauci, head of the National Institutes of Health (NIH), was now pushing to expand prescription. The FDA's traditional concern had been thrown to the wind. Already the drug had spread to 60 countries and an estimated 20.000 people. Not only had no new evidence allayed the initial concerns of the panel, but the follow-up data, as Dr. Brook predicted, had fallen by the waysite. The beneficial effects of the drug had been proven to be temporary. The toxicity, however stayed the same. The majority of those in the AIDS afflicted and medical communities held the drug up as the first breakthrough on AIDS. For better or worse, AZT had been approved faster than any drug in FDA history, and activists considered it a victory. The price paid for the victory, however, was that almost all government drug trials, from then on, focused on AZT - while over 100 other promising drugs were left uninvestigated. Burroughs Wellcome stock went through the roof when the announcement was made. At a price of $8,000 per patient per year (not including blood work and transfusions), AZT is the most expensive drug ever marketed. Burroughs Wellcome's gross profits for next year are estimated at $230 million. Stock market analysts predict that Burroughs Wellcome may be selling as much as $2 billion worth of AZT, under the brand name Retrovir, each year by the mid-1990s - matching Burroughs Wellcome's total sales for all its products last year. AZT is the only antiretroviral drug that has received FDA approval for treatment of AIDS since the epidemic began 10 years ago, and the decision to approve it was based on a single study that has long been declared invalid. The study was intended to be a "double-blind placebo-controlled study," the only kind of study that can effectively prove whether or not a drug works. In such a study, neither patient nor doctor is supposed to know if the patient is getting the drug or a placebo. In the case of AZT, the study became unblinded on all sides, after just a few weeks. Both sides of the contributed to the unblinding. It became obvious to doctors who was getting what because AZT causes such severe side effects that AIDS per se does not. Furthermore, a routine blood count known as CMV, which clearly shows who is on the drug and who is not, wasn't whited out in the reports. Both of these facts were accepted and confirmed by both the FDA and Burroughs Wellcome, who conducted the study. Many of the patients who were in the trial admitted that they had analyzed their capsules to find out whether they were getting the drug. If they weren't, some bought the drug on the underground market. Also, the pills were supposed to be indistinguishable by taste, but they were not. Although this was corrected early on, the damage was already done. There were also reports that patients were pooling pills out solidarity to each other. The study was so severely flawed that its conclusions must be considered, by the most basic scientific standards, unproven. The most serious problem with the original study, however, is that it was never completed. Seventeen weeks in the study, when more patients had died in the placebo group, the study was stopped short, and all subjects were put on AZT, no scientific study can ever be conducted to prove unequivocally whether AZT does prolong life. Dr. Brook, who voted against approval, warned at the time that AZT, being the only drug available for doctors to prescribe to AIDS patients, would probably have a runaway effect. Approving it prematurely, he said, would be like "letting the genie out of the bottle." Brook pointed out that since the drug is a form of chemotherapy, it should only be prescribed by doctors who have experience with chemotherapeutic drugs. Because of the most severe toxic effects of AZT - cell depletion of the bone marrow - patients would need frequent blood transfusions. As it happened, AZT was rampantly prescribed as soon as it was released, way beyond its purported parameters. The worst-case scenario had come true: Doctors interviewed by the New York Times later in 1987 revealed that they were already giving AZT to healthy people who had tested positive for antibodies to HIV. The FDA's function is to weigh a drug's efficacy against its potential hazards. The equation is simple and obvious: A drug must unquestionably repair more than it damages, otherwise the drug itself may cause more harm than the disease it is supposed to fight. Exactly what many doctors and scientists fear is happening with AZT. AZT was singled out among hundreds of compounds when Dr. Sam Broder, the head of the National Cancer Institutes (NCI), found that it "inhibited HIV viral replication in vitro." AIDS is considered a condition of immune suppression caused by the HIV virus replicating and eating its way into T-4 cells, which are essential to the immune system. HIV is a retrovirus which contains an enzyme called reverse transcriptase that converts viral RNA to DNA. AZT was thought to work by interrupting this DNA synthesis, thus stopping further replication of the virus. While it was always known that the drug was exceedingly toxic, the first study concluded that 'the risk/benefits ratio was in favour of the patient." In the study that won FDA approval for AZT, the one fact that swayed the panel of judges was that the AZT group outlived the placebo group by what appeared to be a landslide. The ace card of the study, the one that cancelled out the issue of the drug's enormous toxicity, was that 19 persons had died in the placebo group and only one in the AZT group. The AZT recipients were also showing a lower incidence of opportunistic infections. While the data staggered the panel that approved the drug, other scientists insisted that it meant nothing - because it was so shabbily gathered, and because of the unblinding. Shortly after the study was stopped, the death rate accelerated in the AZT group. "There was no great difference after a while," says Dr. Brook, "between the treated and the untreated group." "That study was so sloppily done that it really didn't mean much," says Dr. Joseph Sonnabend, a leading New York City AIDS doctor. Dr. Harvey Bialy, scientific editor of the journal Biotechnology, is stunned by the low quality of science surrounding AIDS research. When asked if he had seen any evidence of the claims made for AZT, that it "prolongs life" in AIDS patients, Bialy said, "No. I have not seen a published study that is rigorously done, analyzed and objectively reported." Bialy, who is also a molecular biologist, is horrified by the widespread use of AZT, not just because it is toxic, but because, he insists, the claims its widespread use are based upon are false. "I can't see how this drug could be doing anything other than making people very sick," he says. The scientific facts about AZT and AIDS are indeed astonishing. Most ironically, the drug has been found to accelerate the very process it was said to prevent: the loss of T-4 cells. "Undeniably, AZT kills T-4 cells [white blood cells vital to the immune system]" says Bialy. "No one can argue with that. AZT is a chain-terminating nucleotide, which means that it stops DNA replication. It seeks out any cell that is engaged in DNA replication and kills it. The place where most of this replication is taking place is the bone marrow. That's why the most common and severe side effect of the drug is bone marrow toxicity. That is why they [patients] need blood transfusions." AZT has been aggressively and repeatedly marketed as a drug that prolongs survival in AIDS patients because it stops the HIV virus from replicating and spreading to healthy cells. But, says Bialy: "There is no good evidence that HIV actively replicates in a person with AIDS, and if there's isn't much HIV replication in a person with AIDS, and if there isn't much HIV replication to stop, it's mostly killing healthy cells." University of California at Berkeley scientist Dr. Peter Duesberg drew the same conclusion in a paper published in the Proceedings, the journal of the National Academy of Sciences. Duesberg, whose paper addressed his contention that HIV is not a sufficient cause for AIDS, wrote: "Even if HIV were to cause AIDS, it would hardly be legitimate target for AZT therapy, because in 70 to 100 percent of antibody positive persons, proviral DNA is not detectable... and its biosynthesis has never been observed." As a chemotherapeutic drug, explained Duesberg, explained Duesberg, AZT "kills dividing blood cells and other cells," and is thus "directly immunosuppressive." "The cell is almost a million-fold bigger target than the virus, so the cell will be much, much more sensitive," says Duesberg. "Only very few cells, about one in 10,000 are actively making the virus containing DNA, so you must kill incredibly large numbers of cells to inhibit the virus. This kind of treatment could only theoretically help if you have a massive infection, which is not the case with AIDS. Meanwhile, they're giving this drug that ends up killing millions of lymphocytes [white blood cells]. It's beyond me how that could possibly be beneficial." "It doesn't really kill them," Burroughs Wellcome scientists Sandra Lehrman argues. "You don't necessarily have to destroy the cell, you can just change the function of it. Furthermore, while the early data said that the only very few cells were infected, new data says that there may be more cells infected. We have more sensitive detection techniques now." "Changes their function? From what - functioning to not functioning? Another example of mediocre science," says Bialy. "The 'sensitive detection technique' to which Dr. Lehrman refers, PCR, is a notoriously unreliable one upon which to base quantitative conclusions." When specific questions about the alleged mechanisms of AZT are asked, the answers are long, contradictory, and riddled with unknowns. Every scientific point raised about the drug is eventually answered with the blanket response, "The drug is not perfect, but it's all we have right now." About the depletion of T-4 cells and other white cells, Lehrman says, "We don't know why T-4 cells go up at first, and then go down. That is one of the drug mechanisms that we are trying to understand." When promoters of AZT are pressed on key scientific points, whether at the NIH, FDA, Burroughs Wellcome or an AIDS organization, they often become angry. The idea that the drug is "doing something," even though this is invariably followed with irritable admissions that there are "mechanisms about the drug and disease we don't understand," is desperately clung to. It is as if, in the eye of the AIDS storm, the official, government-agency sanctioned position is immunized against critique. Skepticism and challenge, so essential to scientific endeavour, is not welcome in the AZT debate, where it is arguably needed more than anywhere else. The toxic effects of AZT, particularly bone marrow suppression and anemia, are so severe that up to 50 percent of all AIDS and ARC patients cannot tolerate it and have to be taken off it. In the approval letter that Burroughs Wellcome sent to the FDA, all of 50 additional side effects of AZT, aside from the most common ones, were listed. These included: loss of mental acuity, muscle spasms, rectal bleeding and tremors. Anemia one of AZT's common side effects, is the depletion of red blood cells, and according to Duesberg, "Red blood cells are the one thing you cannot do without. Without red cells, you cannot pick up oxygen." Fred, a person with AIDS, was put on AZT and suffered such severe anemia from the drug he had to be taken off it. In an interview in the AIDS handbook Surviving and Thriving With AIDS, he described what anemia feels like to the editor Michael Callen: "I live in a studio and my bathroom is a mere five-step walk from my be. I would just lie there for two hours; I couldn't get up to take those five steps. When I was taken to the hospital, I had to have someone come over to dress me. It's that kind of severe fatigue... The quality of my life was pitiful... I've never felt so bad... I stopped the AZT and the mental confusion, the headaches, the pains in the neck, the nausea, all disappeared within a 24-hour period." "I feel very good at this point," Fred went on. "I feel like the quality of my life was a disaster two weeks ago. And it really was causing a great amount of fear in me, to the point where I was taking sleeping pills to calm down. I was so worried. I would totally lose track of what I was saying in the middle of a sentence. I would lose my directions on the street." "Many AIDS patients are anemic even before they receive the drug." Says Burroughs Wellcome's Dr. Lehrman, "because HIV itself can infect the bone marrow and cause anemia." This argument betrays a bizarre reasoning. If AIDS patients are already burdened with the problems such as immune suppression, bone marrow toxicity and anemia, is compounding these problems an improvement? "Yes AZT is a form of chemotherapy." Says the man who invented the compound a quarter-century ago, Jerome Horowitz. "It is cytotoxic, and as such, it causes bone marrow toxicity and anemia. There are problems with the drug. It's not perfect. But I don't think anybody would agree that AZT is of no use. People can holler from now until doomsday that it is toxic, but you have to go with the results." The results, finally and ironically, are what damns AZT. Several studies on the clinical effects of AZT - including the one that Burroughs Wellcome's approval was based on - have drawn the same conclusion: that AZT is effective for a few months, but that its effect drops of sharply after that. Even the original AZT study showed that T-4 cells went up for a while and then plummeted. HIV levels went down, and then came back up. This fact was well-known when the advisory panel voted for approval. As panel member Dr. Stanley Lemon said in the meeting, "I am left with the nagging thought after seeing several of these slides, that after 16 to 24 weeks - 12 to 16 weeks, I guess - the effect seems to be declining." A follow-up meeting, two years after the original Burroughs Wellcome study, was scheduled to discuss the long range effects of AZT, and the survival statistics. As one doctor present at that meeting in May 1988 recall, "They hadn't followed up the study. Anything that looked beneficial was gone within half a year. All they had were some survival statistics averaging 44 weeks. The p24 didn't pan out and there was no persistent improvement in the T-4 cells." HIV levels in the blood are measured by an antigen called p24. Burroughs Wellcome made the claim that AZT lowered this level, that is, lowered the amount of HIV in the blood. At the first FDA meeting, Burroughs Wellcome emphasized how the drug had "lowered" the p24 levels; at the follow-up meeting, they didn't mention it. As that meeting was winding down, Dr. Michael Lange, head of the AIDS program at St. Luke's-Roosevelt Hospital in New York, spoke up about this. "The claim of AZT is made on the fact that it is supposed to have an antiviral effect," he said to Burroughs Wellcome, "and on this we have seen no data at all... Since there is a report in the Lancet [a leading British medical journal] that after 20 weeks or so, in many patients p24 came back, do you have any data on that?" They didn't. "What counts is the bottom line," one of the scientists representing Burroughs Wellcome summed up, "the survival, the neurologic function, the absence of progression and the quality of life, all of which are better. Whether you call it better because of some antiviral effect, or some other antibacterial effect, they are still better." Dr. Lange suggested that the drug may be effective the same way a simple anti-inflammatory, such as aspirin, is effective. An inexpensive, nontoxic drug called Indomecithin, he pointed out, might serve the same function, without the devastating side effects. One leading AIDS researcher, who was part of the FDA approval process, says today: "Does AZT do anything? Yes, it does. But the evidence that it does something against HIV is really not there." "There have always been drugs that we use without knowing exactly how they work," says Nobel Prize winner Walter Gilbert. "The really important thing to look at is the clinical effect. Is the drug helping or isn't it?" "I'm living proof that AZT works," says one person with ARC on AZT. "I've been on it for two years now, and I'm certainly healthier than I was two years ago. It's not a cure-all, it's not a perfect drug, but it is effective. It's slowing down the progression of the disease." "Sometimes I feel like swallowing Drano," says another. "I mean, sometimes I have problems swallowing. I just don't like the idea of taking something that foreign to my body. But every six hours, I've got to swallow it. Until something better comes along, this is what is available to me." "I am absolutely convinced that people enjoy a better quality of life and survive longer who do not take AZT," says Gene Fedorko, President of Health Education AIDS Liaison (HEAL). "I think it's horrible the way people are bullied by their doctors to take the drug. We get people coming to us shaking and crying because their doctors said they'll die if they don't take AZT. That is an absolute lie." Fedorko has drawn his conclusion from years of listening to the stories of people struggling to survive AIDS at HEAL's weekly support group. "I wouldn't take AZT if you paid me," says Michael Callen, cofounder of New York City's PWA coalition, Community Research Initiative, and editor of several AIDS journals. Callen has survived AIDS for over seven years without the help of AZT. "I've gotten the shit kicked out me for saying this, but I think using AZT is like aiming a thermonuclear warhead at a mosquito. The overwhelming majority of long-term survivors I've known have chosen not to take AZT." The last surviving patient from the original AZT trial, according to Burroughs Wellcome, died recently. When he died, he had been on AZT for three and one-half years. He was the longest surviving AZT recipient. The longest surviving AIDS patient overall, not on AZT, has lived for eight and one-half years. An informal study of long-term survivors of AIDS followed 24 long-term survivors, all of whom had survived AIDS more than six years. Only one of them had recently begun taking AZT. In the early days, AZT was said to extend lives. In actual fact, there is simply no solid evidence that AZT prolongs life. "I think AZT does prolong life in most people," says Dr. Bruce Montgomery of the State University of New York City at Stony Brook, who is completing a study on AZT. "There are not very many long-tern survivors, and we really don't know why they survive. It could be luck. But most people are not so lucky." "AZT does seem to help many patients," says Dr. Bernard Bahari, a New York City AIDS physician and researcher, "but it's very hard to determine whether it actually prolongs life." "Many of the patients I see choose not to take AZT," says Dr. Don Abrams of San Francisco General Hospital. "I've been impressed that survival and lifespan are increasing for all people with AIDS. I think it has a lot to do with aerosolized Pentamidine [a drug that treats pneumocystis carinii pneumonia]. There's also the so-called plague effect, the fact that people get stronger and stronger when a disease hits a population. The patients I see today are not as fragile as the early patients were." "Whether you live or die with AIDS is a function of how well your doctor treats you, not of AZT," says Dr. Joseph Sonnabend, one of New York's City's first and most reputable AIDS doctor, whose patients include many long-term survivors, although he has never prescribed AZT. Sonnabend was one of the first to make the simple observation that AIDS patients should be treated for their diseases, not just for their HIV infection. Several studies have concluded that AZT has no effect on the two most common opportunistic AIDS infections, Pneumocystic Carinii Pneumonia (PCP) and Kaposi's Sarcoma (KS). The overwhelming majority of AIDS patients die of PCP, for which there has been an effective treatment for decades. This year, the FDA finally approved aerosolized Pentamidine for AIDS. A recent Memorial Sloan Kettering study concluded the following: By 15 months, 80% of people on AZT not receiving Pentamidine had a recurring episode. "All those deaths in the AZT study were treatable," Sonnabend says. "They weren't deaths from AIDS, they were deaths from treatable conditions. They didn't even do autopsies for that study. What kind of faith can one have in these people?" "If there's any resistance to AZT in the general public at all, it's within the gay community of New York," says the doctor close to the FDA approval, who asked to remain anonymous. "The rest of the country has been brainwashed into thinking this drug really does that much. The data has all been manipulated by people who have a lot vested in AZT." "If AIDS were not the popular disease that it is - the money-making and career-making machine - these people could not get away with that kind of shoddy science," says Bialy. "In all of my years in science I have never seen anything this atrocious." When asked if he thought it was at all possible that people have been killed as a result of AZT poisoning rather then AIDS he answered: "It's more than possible." August 17, 1989: The government has announced that 1.4 million healthy, HIV antibody-positive Americans could "benefit" from taking AZT, even though they show no symptoms of disease. New studies have "proven" that AZT is effective in stopping the progression of AIDS in asymptomatic and early ARC cases. Dr. Fauci, the head of NIH, proudly announced that a trial that has been going on for "two years" had "clearly shown" that early intervention will keep AIDS at bay. Anyone who has antibodies to HIV and less than 500 T-4 cells should start taking AZT at once, he said. That is approximately 650,000 people. 1.4 million Americans are assumed HIV antibody-positive, and eventually all of them may need to take AZT so they don't get sick, Fauci contended. The leading newspapers didn't seem to think it unusual that there was no existing copy of the study, but rather a breezy two-pages press release from the NIH. When SPIN called the NIH asking for a copy of the study, we were told that it was "still being written." We asked a few questions about the numbers. According to the press release, 3,200 early AARC and asymptomatic patients were devided into two groups, one AZT and one placebo, and followed for two years. The two groups were distinguished by T-4 cell counts; one group had less than 500, the other more than 500. These two were then divided into three groups each: high-dose AZT, low-dose AZT, and placebo. In the group with more than 500 T-4 cells, AZT had no effect. In the other group, it was concluded that low-dose AZT was the most effective, followed by high-dose. All in all, 36 out of 900 developed AIDS in the two AZT groups combined, and 38 out of 450 in the placebo group. "HIV-positive patients are twice as likely to get AIDS if they don't take AZT," the press declared. However, the figures are vastly misleading. When we asked how many patients were actually enrolled for a full two years, the NIH said they did not know, but that the average time of participation was one year, not two. "It's terribly dishonest the way they portrayed those numbers," says Dr. Sonnabend. "If there were 60 people in the trial those numbers would mean something, but if you calculate what the percentage is out of 3,200, the difference becomes minute between the two groups. It's nothing. It's hit or miss, and they make it look like it's terribly significant." The study boasted that AZT is much more effective and less toxic at one-third the dosage than has been used for three years. That's the good news. The bad news is that thousands have already been walloped with 1,500 milligrams of AZT and possibly even died of toxic poisoning - and now we're hearing that one third of the dose would have done? With all that remains so uncertain about the effects of AZT, it seems criminal to advocate expanding its usage to healthy people, particularly since only a minuscule percentage of the HIV-infected population have actually developed ARC or AIDS. Burroughs Wellcome has already launched testing of AZT in asymptomatic hospital workers, pregnant women, and in children, who are getting liquid AZT. The liquid is left over from an aborted trial, and given to the children because they can mix it with water - children don't like to swallow pills. It has also been proposed that AZT be given to people who do not yet even test positive for HIV antibodies, but are "at risk." "I'm convinced that if you gave AZT to a perfectly healthy athlete," says Fedorko, "he would be dead in five years." In December 1988, the Lancet published a study that Burroughs Wellcome and the NIH do not include in their press kits. It was more expansive than the original AZT study and followed patients longer. It was not conducted in the United States, but in France, at the Claude Bernard Hospital in Paris, and concluded the same thing about AZT that Burroughs Wellcome's study did, except Burroughs Wellcome called their results "overwhelmingly positive," and the French doctors called theirs "disappointing." The French study found, once again, that AZT was too toxic for most to tolerate, had no lasting effect on HIV blood levels, and left the patients with fewer T-4 cells than they started with. Although they noticed a clinical improvement at first, they concluded that "by six months, these values had returned to their pretreatment levels and several opportunistic infections, malignancies and deaths occurred." "Thus the benefits of AZT are limited to a few months for ARC and AIDS patients," the Fench team concluded. After a few months, the study found, AZT was completely ineffective. The news that AZT will soon be prescribed to asymptomatic people has left many leading AIDS doctors dumbfounded and furious. Every doctor and scientist I asked felt that it was highly unprofessional and reckless to announce a study with no data to look at, making recommendations with such drastic public health implications. "This simply does not happen," says Bialy. "The government is reporting scientific facts before they've been reviewed? It's unheard of." "It's beyond belief," says Dr. Sonnabend in a voice tinged with desperation. "I don't know what to do. I have to go in and face an office full of patients asking for AZT. I'm terrified. I don't know what to do as a responsible physician. The first study was ridiculous. Margaret Fishl, who has done both of these studies, obviously doesn't know the first thing about clinical trials. I don't trust her. Or the others. They're simply not good enough. We're being held hostage by second-rate scientists. We let them get away with the first disaster; now they're doing it again." "It's a momentous decision to say to people, 'if you're HIV-positive and your T4-cells are below 500 start taking AZT,'" says the doctor who wished to remain anonymous. "I know dozens of people that I've seen personally every few months for several years now who have been in that state for more than five years, and have not progressed to any disease." "I'm ashamed of my colleagues," Sonnabend laments. "I'm embarrassed. This is such shoddy science it's hard to believe nobody is protesting. Damned cowards. The name of the game is protect your grants, don't open your mouth. It's all about money... it's grounds for just following the party line and not being critical, when there are obviously financial and political forces that are driving this." When Duesberg heard the latest announcement, he was particularly stunned over the reaction of Gay Men's Health Crisis President Richard Dunne, who said that GMHC now urged "everybody to get tested," and of course those who test positive to go on AZT. "These people are running into the gas chambers," says Duesberg. "Himmler would have been so happy if only the Jews were this cooperative."
On this week's PCP we discuss larger than life evangelical Gwen Shamblin Lara, her rise to fame and power in the Remnant Church, and her terrifying and abusive weight loss philosophy that bolstered her fortune and destroyed many in it's path. With the help of HBO Max's multi-part documentary The Weigh Down: God, Greed and the Cult of Gwen Shamblin Persephone examines how one skinny woman - and her out of work actor second husband - scammed their way to success. --- Send in a voice message: https://anchor.fm/theresa-pedone/message
Fragmented health care is a known issue for patients and providers, and nowhere is the problem as acute as it is in the over-65 population. Studies have shown that patients who have a strong relationship with a primary care provider (PCP) who coordinates their care have better outcomes. But care provided by specialists has expanded over the past 2 decades, and the average PCP has twice as many specialists involved in the care of their fee-for-service Medicare patients as they did 20 years ago, according to research published in Annals of Internal Medicine this week. On this episode of Managed Care Cast, we speak with one of the coauthors of the study, "Trends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019," which illustrates the changing trends in a PCP's panel of Medicare patients and how that translates to an increased workload for primary care doctors. Michael L. Barnett, MD, MS, an assistant professor in the Department of Health Policy and Management at the Harvard TH Chan School of Public Health, is also an assistant professor of medicine at Brigham and Women's Hospital in Boston. He earned his medical degree from Harvard Medical School and holds a master of science in health policy and management from the Harvard TH Chan School of Public Health.
Hey guys! I had the pleasure of sitting down with Dr. Elizabeth Bright for a second discussion on thyroid, hormones, and iodine. As an Osteopath and Naturopath Dr. Bright specializes in optimizing the body's natural power to regenerate. Osteopathy and Naturopathy remove obstacles to this power through gentle, efficient, and dynamic transformation.We discuss the following in chronological order:About Dr. Bright2. Discussing the basic thyroid markers, and how it breaks down into usable T3? So TSH to T4, T3 and RT3 and then antibodies? Why does low T3 occur?Why do people think carbs help with thyroid function? Low thyroid function impairs digestion so how does a hypothyroid sufferer tolerate fat?Beta Blockers and medicationsUndereating on low carb dietHow to transition to higher fatWhy 5 meals a dayThe role of the pancreas and thyroid inhibitorsWomen saying they sleep best at night with carbs? Especially during menopause?Why are people scared of iodine? Have you worked with anyone that doesn't need more iodine or has overdosed with iodine? Some clients/patients get off most of their thyroid medication but still have some need for it. They don't have autoimmune, they worked on the gut but why can't they fully get off their thyroid medications?Bioidentical hormones?The relationship between sodium and blood pressure with the thyroid. Where to find Dr. Elizabeth Bright_____WHERE TO FIND DR. ELIZABETH BRIGHT- Dr. Elizabeth Bright: https://elizbright.com/- Blog: https://elizbright.com/blog- Instagram: https://www.instagram.com/elizbright_bari/- Videos: https://elizbright.com/video-galleryCheck out the YouTube video for full list of resources: https://youtu.be/PTZooJ3AIpc____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER_____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
Thanks for tuning in to the Armor Men's Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.In this segment, Dr. Mistry and Donna Lee are joined by primary care physician Dr. Lamia Kadir of Family Medicine Austin. Today Dr. Mistry and Dr. Kadir are educating our listeners on what to expect from a Primary Care Physician, or PCP. While many people know they need to get an annual physical exam from the PCP, it can be more difficult to know what specifically should be tested and/or addressed by their provider. Dr. Kadir explains that not only should physicians gather all the standard data like weight, blood pressure, etc., but they should also ask detailed questions about family health history to assess your risk for major, life-threatening concerns like cancer, heart disease, stroke, diabetes, an so on. In addition, your PCP should do a full body skin check to screen for potential melanomas. Finally, some PCPs will offer you additional testing options like the Health Grades Analytics preventative screening. This head-to-toe examination includes a fundoscopy (eye exam); ultrasound of your aorta, looking for an aneurysm; an echocardiogram, which is actually a test of your heart function; ultrasound of your arteries, thyroid, and kidneys; a pulmonary function test, which classically has done for asthma; and an EEG, which is a cursory test for seizure disorder. If you're really looking to capitalize on your health in 2021, an ounce of prevention is worth a pound of cure, and you can take preventative measures to ensure long-term, holistic wellness with the right provider. To schedule an appointment or learn more about the Health Grades Analytics screening, you can reach Dr. Kadir at familymedicineaustin.com or call (512) 872-6868.This episode was previously aired on 7.24.21. Don't forget to like, subscribe, and share us with a friend! As always, be well!Check our our award winning podcast!https://blog.feedspot.com/sex_therapy_podcasts/https://blog.feedspot.com/mens_health_podcasts/Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.We enjoy hearing from you! Email us at email@example.com and we'll answer your question in an upcoming episode!Phone: (512) 238-0762Email: Armormenshealth@gmail.comWebsite: Armormenshealth.comOur Locations:Round Rock Office970 Hester's Crossing RoadSuite 101Round Rock, TX 78681South Austin Office6501 South CongressSuite 1-103Austin, TX 78745Lakeline Office12505 Hymeadow DriveSuite 2CAustin, TX 78750Dripping Springs Office170 Benney Lane Suite 202Dripping Springs, TX 78620
PCP Episode 285 – Castlevania & Popeye (ft. GamersTavern) ➤Full PCP Episode Playlist – https://goo.gl/mduhGw ➤iTunes – http://bit.ly/PCPApplePodcast ➤Google Play – http://bit.ly/PCPGooglePlay ➤Spotify – http://bit.ly/PCPSpotify ➤All PCP mp3s: https://goo.gl/WVbIw6 Support the PCP on Patreon conglomerate empire society! Join the PCP Minecraft Server: PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY PCP SHIRTS & MERCH! https://gumroad.com/theprocrastinators (radcon behind the … Continue reading "Castlevania & Popeye (ft. GamersTavern) – The Pro Crastinators Podcast, Episode 285"
Anxiety in kids during COVID-19: What parents should know by Jessica Cerretani Thank you Boston Children's Hospital.Just like adults, kids and teens can suffer from anxiety. COVID 19 has created a new normal and some may not be able to adjust easily. This article will share tips for parents to help their children. As a Psychiatric Mental Health Nurse Practitioner, I have encountered an increasing number of patients being diagnosed with anxiety and depression. See your PCP or MH Provider for any behavioral changes that are of concern.https://answers.childrenshospital.org/covid-anxiety-kids/ ************************************* ------------- Calm App ---------------*************************************VaccineFinder is a free, online service where users can search for locations that offer vaccinations. We work with partners such as clinics, pharmacies, and health departments to provide accurate and up-to-date information about vaccination services. VaccineFinder is operated by epidemiologists and software developers at Boston Children's Hospital" (Boston Children's Hospital, 2021).Vaccine Location Here!!! & HereSharing knowledge and educating those in the community for a healthier stronger safer community.MOTTO: GUMBO We'll teach your Grandma, Uncles, Mama, Brothers, and Others (GUMBO)The book is complete. It was written to help raise money for the Non-profit."Casey and the Crawfish" will be sold starting in January 2019.Everyone can purchase from http://gumboeducation.com/casey-and-the-crawfishOr try the Kindle Edition from Amazon https://www.amazon.com/dp/B08DLB473NAudioBook from Amazon - Casey and the CrawfishAll Books for Sale on Etsy: https://www.etsy.com/your/shops/MJAEnterprisesLLC/tools/listings BULLYING PREVENTION FOR NURSES - A REAL SOLUTION: CONTACT HOURS WILL BE AWARDED: BULLYING IN NURSING, THE WORKPLACE AND SCHOOLS IS STILL PREVALENT. NURSES CAN EARN CONTACT HOURS AND LEARN SOME IMPORTANT NEW TECHNIQUES!!!This nursing continuing professional development activity was approved by theTexas Nurses Association, an accredited approver by theAmerican Nurses Credentialing Commission on Accreditation. Thanks again for your support.
I'm talking all about two medications commonly given, to this day, without providing proper lab work and evaluation to figure out what's going on. Do you know how often a woman will see her PCP saying she doesn't feel well and something is off? Basic lab may be done, real basic, and when nothing shows up, "it must be psychosomatic." So many of my clients have told me this. And it's beyond frustrating because neither of these meds will work if she has thyroid issues, gut problems, etc. *This excludes anyone with a mental illness requiring medications and therapy. Want to connect with Margaret? Follow and connect with Margaret on Instagram - https://www.instagram.com/margaretromero/ Learn more on her website - https://www.margaretromero.com/ Take a walk with Margaret as she goes deeper into her personal journey when she was first diagnosed with multi-organ involvement lupus nephritis - From Flare to Fabulous -https://amzn.to/3uGsLoM Listen to another episode relating to Lupus - https://www.margaretromero.com/151-3-must-supplements-women-lupus/ Now is your time to start feeling better & finally living the life you have always wanted! Grab your copy of Margaret's free e-book: https://margaretromero.us16.list-manage.com/subscribe?u=a7ca94b07bda863bfdad3a311&id=edd1c9600b Want to learn the simple steps that have helped so many others transform their lives? Join the 7-day Lupus Challenge - https://margaretromero.com/challenge/ If you've been loving The Sacred Medicine Podcast, please be sure to subscribe and leave a review!
Hey guys, here's episode 5 of community Q&As! Why is my A1C is going up? When do you anticipate taking new clients?There are some influencers that say keto is bad long term. Your thoughts? Low carb caused hormonal imbalances?Chemical hormone replacement for menopause or natural herbs?Fruit and honey, yay or nay?Protein as the main energy source isn't accurate? Why is that?Fasting – best time for women with cycleCheese on carnivore, yes/no?Topical creams for face: Animal fats vs plant oils?Carnivore diet and the effect on the microbiome?Swallowing beef liver whole – ideal for digestion?Hives from allergies?Hair loss and prevention? Puffy/swelling face and body. Why? Dry mouth a thing? 7 months in Herbal treatments or supplements for SIBO?Thoughts on natural psychedelics?RESOURCES:People's Beef JerkyNwJ Carnivore BloodworkNwJ Symptom BurdenNwJ newsletterNwJ Stress EpisodeSIBO Study + YouTubeT3 and exercise study Honey and Fruit Q&ADairy Blog postThink Dirty and EWG's SkincareMicrobiome + CarnivoreGI MapLiver: Don't Eat Just Beef Histamine SupportOmega 3 TestingSole Water Recipe____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER_____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
A discussion about keeping up on your healthcare, particularly once you turn fifty. The importance of having a Primary Care Physician, [PCP] that you trust, being your own best advocate and when you should make appointments with a couple of specific specialty doctors for preventive care. I also share candid conversations that I have had with my PCP too, along with a couple of tasty exotic fruits I discovered and can't wait to share with you. So press play and tell a friend. If you would like to support this growing podcast, send your gifts to Cash APP: $Spoteat Thanks for sharing, liking, subscribing and telling your friends! Contact me at: Tromiepodcast50@gmail.com , or on IG @tina_romie With love and gratitude to you all! Enjoy life, Tina Romie --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/sonia-poteat/message
In this episode, Joe sits down with chemist, filmmaker, and science journalist Hamilton Morris. They discuss his time at Vice, PCP, “Hamilton's Pharmacopeia,” 5-MeO-DMT, and working with perceived enemies for the greater good. www.psychedelicstoday.com
On this week's episode hosts Aviv and Matt view and review season 9 episode 18 of SVU - Trade! Aviv starts out by stating his undying love for PJ. The guys discuss how these episodes get more and more normal as the seasons progress. The guys discuss who will inherit the podcast if/when they both die or call it quits. Matt found the ep to be boring until it goes ABSOLUTELY BATSHIT INSANE, or as Matt says 'the show does PCP.' Aviv shares a crazy story from class. All this and more! Give us a rate and review wherever fine podcasts are sold, tweet at us @svupodcast (which we cannot stress enough is the official Twitter handle of Law and Order SVU, and you can take that to the bank, the blood bank senator!) or for longer and weirder stuff send us an email firstname.lastname@example.org
Hey guys! I had such a fun time chatting with my friend, Austin Cavelli. Austin Cavelli is a a board certified, nationally accredited physician assistant. She has treated treated thousands of patients with acute and chronic inflammatory diseases, including various autoimmune conditions.In addition, she has worked for several years in research, studying addiction and the aging brain. Her background in research has taught her how to carefully conduct experiments, a skill which has proven extremely useful in helping clients find what works specifically for them. In 2014, Austin earned her Master's of Science degree from Weill Cornell Graduate School of Medical Sciences, in NYC. Prior to that, she received her bachelor's degree in psychobiology from Binghamton University.About Austin CavelliBloodwork on CarnivoreMCTs, PSMF and Trends on the InternetWhy Lean Protein Doesn't Work Long TermAustin's Beginner TipsCarnivore is Not (usually) a Weight Loss DietFruits and CarnivoreThyroid, Hormones and EnergyMacros and MeatsWeight Loss, Healing and Eating EnoughWhere to find and how to work with Austin Cavelli ____WHERE TO FIND AUSTIN CAVELLIAustin Cavelli: https://www.qualitycarnivore.com/Instagram: https://www.instagram.com/qualitycarnivore/Facebook: https://www.facebook.com/qualitycarnivore____RESOURCESFirst Interview with Austin Cavelli: https://www.youtube.com/watch?v=TzHLw5BqyfM&tSymptom Burden Assessment: https://nutritionwithjudy.com/shopping/health-tests/symptom-burden-assessment/Nutrition with Judy's Facebook: https://www.facebook.com/NutritionwJudy____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER: _____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
MIT Medical's Primary Care Providers (PCPs) include physicians and nurse practitioners. They are pediatricians for children, specialists in internal medicine and family practice for adults, and specialists in adolescent medicine and family practice for young adults.But how do you know which of our many providers is best for you? Today we are speaking with Israel Molina, MD, primary care provider (PCP) and family physician at MIT Medical.
Today we are traveling to Pennsylvania!My guest on today's show is the author of the crime thriller, The Long Last Out, and retired Sergeant, Mike Riley of the Philadelphia Police Department! Mike spent over 25 years with the Philadelphia Police Department where he worked in patrol, was promoted to detective, and eventually was promoted to sergeant. Mike worked the streets for the entirety of his career in patrol, working undercover in the narcotic's special operations unit and the detective bureau. After retiring from the Philadelphia Police Department, Mike also worked in the Philadelphia school system as a police officer. Mike and I also chat about his recently released debut crime thriller, The Long Last Out.In today's episode you will learn:• What is in a ‘real' Philly Cheesesteak!• What was it like to be a rookie police officer in Philadelphia in the 1970s and 80's?• What was the training and equipment for a rookie police officer in Philadelphia?• What was it like being an undercover police officer in the narcotic's special operations bureau?• How did he and his fellow officers “flip” suspects to go after big-time drug dealers. • Specific jargon and customs unique to the Philadelphia P.D.• What is it really like being a police officer assigned to public schools in Philadelphia.• The inside scoop on his crime thriller, “The Long Last Out.” All of this and more on today's episode of the Cops and Writers podcast.Check out Mike's book, The Long Last Out!Visit Mike on his Facebook page The Rookiewriter.comPlease visit the Cops and Writers website.If you have a question for the sarge, hit him up at his email.Come join the fun at the Cops and Writers Facebook groupCheck out my affiliate link to Adam Richards new Crime Fiction Guns CourseVisit super awesome Narrator Ryan Kennard Burke's website Support the show (https://patreon.com/copsandwriters)
READ CHAPTER 3 RIGHT NOW: PCP Episode 284 – CLARISSA GUNSMOKE CHAPTER 3 ➤Full PCP Episode Playlist – https://goo.gl/mduhGw ➤iTunes – http://bit.ly/PCPApplePodcast ➤Google Play – http://bit.ly/PCPGooglePlay ➤Spotify – http://bit.ly/PCPSpotify ➤All PCP mp3s: https://goo.gl/WVbIw6 Support the PCP on Patreon conglomerate empire society! Join the PCP Minecraft Server: PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY PCP SHIRTS & MERCH! … Continue reading "CLARISSA GUNSMOKE CHAPTER 3 – The Pro Crastinators Podcast, Episode 284"
In this week's podcast my guest, Dr. Beverley Rider, who is a speaker and nutritionist, and Founder of Rider4health. She wrote a book called Hives, Headaches and Heartburn: Heal Your Histamine Hangover. This book and our conversation highlight the blind spot that happens in conventional medicine. Someone walks into urgent care or PCP office and is given prednisone for a recurrent rash or itching. Now, in a dire situation, yes, it's absolutely appropriate but when a rash pops up every other week, it's time to take a closer look at what may be actually happening. We covered what histamine intolerance is, its symptoms, and what to do about it. More about Dr. Beverley Rider PhD in microbiology and Immunology Former biotech scientist A histamine intolerance expert Just accepted position as a teacher at Bauman College: Holistic Nutrition and Culinary Arts who was initially introduced to functional nutrition as a patient She struggled with many of the same issues she helps heal Now… she has made it her mission to help patients globally with her virtual practice. Founder of Rider4health.org and Histamine Hangover Author of Hives, headaches & heartburn: Heal your H hangover on Amazon rider4health.org- has a free survey to see if you have histamine intolerance Facebook and Instagram: @histaminehangover Want to connect with Margaret? Follow and connect with Margaret on Instagram - https://www.instagram.com/margaretromero/ Learn more on her website - https://www.margaretromero.com/ Take a walk with Margaret as she goes deeper into her personal journey when she was first diagnosed with multi-organ involvement lupus nephritis - From Flare to Fabulous https://amzn.to/3uGsLoM Now is your time to start feeling better & finally living the life you have always wanted! Grab your copy of Margaret's free e-book: https://margaretromero.us16.list-manage.com/subscribe?u=a7ca94b07bda863bfdad3a311&id=edd1c9600b Want to learn the simple steps that have helped so many others transform their lives? Join the 7-day Lupus Challenge - https://margaretromero.com/challenge/ If you've been loving The Sacred Medicine Podcast, please be sure to subscribe and leave a review!
Do you have a primary care provider? Do you have a good relationship with them? The Docs discuss the importance of a primary care provider and how the trajectory of the COVID-19 pandemic may have changed if people had a trusting relationship with their PCP. The Docs talk about how difficult it has been to convince some of their patients and friends and family to take the COVID vaccine. Medical Mistrust (Listen to Episode 3) has made it difficult for the Black community to have a trusted source for medical information about the vaccine. Additionally, Black patients seek out regular primary care at two-thirds the rate of white patients, preferring instead Emergency visits and urgent care. This lack of relationship compounds the health disparities Black patients already face by reducing the amount of consistent care they can receive from their PCP. --New Episodes every Tuesday, available wherever you get your podcasts! Rate and Subscribe! Also, join us for our live streams on Facebook and Youtube!Sign Up for our newsletter here or at 3BlackDocs.com Please take a moment to fill out our survey so we can continue to bring you the content you love! Join the Conversation! Follow us on social media!3 Black Docsfacebook.com/3blackdocstwitter.com/3blackdocsinstagram.com/3blackdocsYouTube.com/3blackdocsDr. Karen Winkfieldfacebook.com/drwinkfieldtwitter.com/drwinkfieldinstagram.com/drwinkfieldDr. Zanetta Lamarfacebook.com/drzanettainstagram.com/drzanetta
Have you ever wanted to watch a movie about a Furby on PCP and spawned from hell?! Well Pooka is probably as close as you're going to get to that. Listen in as the guys breakdown the worst to slightly sub-par horror movie (depending on who's rating it) that they've seen. This is the second episode in their annual four part Halloween/Horror Movie podcast series. Sit back with some warm apple cider, grab a knife and carve a pumpkin while this episode plays through your speakers. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/wdtp/support
Hey guys! I had the pleasure of chatting with Bart Kay. Bart Kay is the Nutrition Science Watchdog on YouTube, debunking false science and helping people get to better health. Bart is a former senior lecturer in cardiovascular and respiratory physiology, exercise physiology, nutrition, research methods, and statistics. Bart has published a number of peer reviewed research and review articles, as well as book chapters. External consultancies include the NZ All Blacks, the NRL, and both NZ and Australian Defense Forces. 1. About Bart Kay2. Best Exercise for Longevity3. Strength Training vs. Cardio Vs. High Intensity4. Incidental Exercise5. The Reason Why Carnivore Doesn't Work for Some6. Insulin, Carnivore, Gluconeogenesis7. The Weakness of Nutritional Studies8. Thyroid Concerns on Carnivore9. Low Energy on Carnivore10. Doing Carnivore Long Term11. Bart's Diet12. Importance (or not) of Ketones and Glucose13. Microbiome and Sugar14. Bart's Diet Tips and Macros15. The Importance of the Randle Cycle16. The Power of Zero Carb17. How to Get Started18. Where to find and how to work with Bart Kay_____WHERE TO FIND BART KAY- Consults: https://bit.ly/bart-kay- YouTube: https://www.youtube.com/channel/UChi5M3k_K4yuRpWAp00xBQA- Facebook: https://www.facebook.com/Nutrition.Science.Watchdog/- LBRY: https://lbry.tv/$/invite/@Bart-Kay-Nutrition-Science-Watchdog____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER_____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
Growing up in Bakersfield, California Jerome experienced trauma with domestic abuse in his family, not having a father growing up, and trying to avoid the gang lifestyle that was prevalent in his neighborhood. He saw a lot of the people he knew in & out of jail and wanted no part of that. He found refuge in sports and was able to focus his energy and after-school time on something productive. Jerome eventually went to the College of Sequoias to play football. This is when the partying lifestyle started to take shape in his life. He felt the peer pressure of his friends to do all kinds of drugs. He tried cocaine & ecstasy for the first time, drank heavily, and partied every week. They partied so much, that they even went to Las Vegas 8 times in one month. He eventually started smoking crack, PCP, and even meth. It quickly spiraled out of control before he could get a hold of his addiction. The police even raided his grandparents' house, and this was a huge wake-up call for him. Jerome was arrested at one point, and this really shook him up. Also, When his third child, his youngest daughter was born this was a major turning point for him. They gave him the ultimatum of choosing his daughter or choosing the drugs. He chose his daughter. All this time he was going to school to be a teacher, and he came to a crossroads in his lifestyle, where it eventually caught up with him and his health and realized he needed help. He relapsed many times, and shifted careers many times, but eventually regained his stability. The facility that ended up helping him stay sober was the Sierra Vista Ebony Counseling center. His counselor inspired him to start a new career helping others. Jerome decided to start studying drug and addiction counseling. Now, at this stage in his life, Jerome wants to be of service to the community. He currently holds the title of Substance Use Disorder Certified Counselor (SUDCC) under the California Association of DUI Treatment Programs, and he is also a Certified Alcohol and Drug Counselor. Now his goal is to reach kids as early as possible in their lives so that they get a chance to grow and develop their minds without the hindrance of drugs or alcohol. He will go out of his way to help kids who can't afford his services and give them his personal cell which he says he will answer at any time of the day or night, to help these kids. For more on Jerome Piper https://aspirecounselingservice.com/fresno-program-staff/ This is Jerome Piper in his own words, on Knockin' Doorz Down. For more on the Knockin' Doorz Down podcast and to follow us on social media https://linktr.ee/knockindoorzdown For Carlos Vieira's autobiography Knockin' Doorz Down https://www.kddmediacompany.com/ For 51FIFTY use the discount code KDD20 for 20% off! https://51fiftyltm.com/ For more information on the Carlos Vieira Foundation and the Race 2B Drug-Free, Race to End the Stigma and Race for Autism programs visit: https://www.carlosvieirafoundation.org/ For more on the Recovery in the Middle Ages podcast www.MiddleAgesrecovery.com Listen to and Subscribe to the podcast wherever you listen for more Celebrity, everyday folks, and expert conversations at https://www.KDDPodcast.com © 2021 by KDD Media Company. All rights reserved.
Help Jackie move out of an abusive home: PCP Episode 283 – Minting Coins & Churning Cards ➤Full PCP Episode Playlist – https://goo.gl/mduhGw ➤iTunes – http://bit.ly/PCPApplePodcast ➤Google Play – http://bit.ly/PCPGooglePlay ➤Spotify – http://bit.ly/PCPSpotify ➤All PCP mp3s: https://goo.gl/WVbIw6 Support the PCP on Patreon conglomerate empire society! Join the PCP Minecraft Server: PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY … Continue reading "Minting Coins & Churning Cards – The Pro Crastinators Podcast, Episode 283"
Episode 70: HIV Prevention. Prevention is key in controlling HIV-AIDS. Listen to ways to prevent HIV, mainly by using condoms, PrEP and PEP.Introduction: HIV and AIDSBy Robert Dunn, MS3.Introduction: The Human Immunodeficiency Virus (HIV) is a retrovirus that is primarily transmitted via sex, needles or from mother to fetus. Once infected, the virus increases in its copies and decreases the individual's CD4+ cell count, thus leading to an immunocompromised state known as Acquired Immune Deficiency Syndrome (AIDS). Once with AIDS, the patient is susceptible to opportunistic infections. Prevention from AIDS includes several options. Condoms for safe sex practices are the least invasive and most readily accessible option for all patients. Pre-exposure prophylaxis (PrEP) is also an option for men who have sex with men (MSM) and transgender women. If the patient is also exposed to HIV, post-exposure prophylaxis (PEP) may also be an option to prevent infection but must be administer ideally 1-2 hours after exposure but no later than 72 hours after. Today we will briefly discuss how to prevent HIV infection.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.___________________________HIV Series IV: HIV Prevention. By Robert Dunn, MS3.Participation by Huda Quanungo, MS3; Bahar Hamidi, MS3; and Hector Arreaza, MD. HIV PreventionIntroductionThe Human Immunodeficiency Virus (HIV) is a retrovirus that is primarily transmitted via sex, needles or from mother to fetus. Once infected, the virus increases in its copies and decreases the individual's CD4+ cell count, thus leading to an immunocompromised state known as Acquired Immune Deficiency Syndrome (AIDS). Once with AIDS, the patient is susceptible to opportunistic infections. Prevention from AIDS includes several options. Condoms for safe sex practices are the least invasive and most readily accessible option for all patients. Pre-exposure prophylaxis (PrEP) is also an option for men who have sex with men (MSM) and transgender women. If the patient is also exposed to HIV, post-exposure prophylaxis (PEP) may also be an option to prevent infection, but it must be administered ideally 1-2 hours after exposure but no later than 72 hours after. We will concentrate in prevention during this episode. What is HIV?The Human Immunodeficiency Virus (HIV) is a retrovirus. When the virus gains access to our body via cuts on the skin or mucosa:The virus injects its 10kb sized RNA genome into our cells. The RNA is transcribed to DNA via viral reverse transcriptase and is incorporated into our cellular DNA genome. This causes our cells to become a virus producer. Viral proteins translated in the cell are transported to the edge of the cell and can bud off into new viruses without lysing the cell. Acute HIV symptoms. Some potential early symptoms of HIV can include fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, lymphadenopathy, and mouth ulcers. The most common acute symptom is NO SYMPTOM. Many people do not feel sick with the acute infection of HIV. Some people can live years with HIV in “clinical latency” without knowing they are infected, but they can still be contagious during this time. As viral load (the amount of virus copies you have in your blood stream) increases, the CD4+ cells that contribute to our adaptive immunity continues to fall. That's why the best test during this period is not going to be HIV antibody but you should test for antigens. Specifically, the 4th Generation HIV test, which tests for both antibody and p24 antigens.Chronic symptoms. Once patients begin to present with opportunistic infections (i.e. Pneumocystis pneumonia – PCP), or have a CD4 count below 200, the patient is considered to have Acquired Immune Deficiency Syndrome (AIDS) and makes them susceptible to more serious infections. Without treatment, patients with AIDS typically survive about 3 years. Epidemiology of HIVHIV incidence: In 2019, there were 34,800 new HIV infections in the United States. This is an 8% decline from 2015. Amongst age groups: Age 25-34 had the highest rate of incidence (30.1 per 100,000)Age 35-44 had the second highest rate (16.5 per 100,000)Age 45-54 remained stableAge 13-24 had decreasing rates of incidence Amongst ethnic groups: Black/African-American groups has the highest rate of incidence (42.1 per 100,000)Hispanic/Latino had the second highest rate (21.7 per 100,000)Person of multiple races had the third highest (18.4 per 100,000) Amongst sex: Males had the highest rate of incidence (21 per 100,000)Females had the lowest rate of incidence (4.5 per 100,000) HIV Prevalence:In 2019, 1.2 million people (Ages 13 and older) in the US have HIV and 13% of them do not even know it. In 2020, there were an estimated 1.5 million people worldwide that acquired a new HIV infection. This is a 30% decline since 2020. An estimated 66% are receiving some HIV care and 57% were virally suppressed. Mortality: In 2019, there were 15,815 deaths among adults and adolescents diagnosed with HIV in the US. Preventative ScreeningThe USPSTF gives a Grade A recommendation for HIV screening for: Pregnant people and everyone between 15-65 years of age. All pregnant people at any point of their pregnancy, including those who present in labor or delivery and have an unknown status of HIV.The USPSTF only recommends a one-time screening and shows no benefit of repeat screening thereafter. Women may also be screened for subsequent pregnanciesAlso screen all Adolescents and adults ages 15-65. An effective approach is routine opt-out HIV screening. This approach includes HIV screening as part of the standard preventive tests. This approach removes the stigma associated with HIV testing, it promotes earlier diagnosis and treatment, reduces risk of transmission, and it is cost-effective. The determination for repeated screening of individuals should take into account the following risk factors: -Men who have sex with men (MSM)-Individuals who live in areas with high prevalence of HIVIncluding attending to tuberculosis clinics, stay in a correctional facility, or homelessness-Injection drug use-Transactional/commercial sex work-1 or more new sexual partners -History of previous STIs Annual screening for HIV is reasonable, however, clinicians may want to screen patients every 3-6 months if they have an increased risk of HIV. CondomsA simple and very effective method in HIV prevention is the use of condoms for safe sex practices. In 2009, the American College of Physicians (ACP) and the HIV medicine Association called for the wider availability of condoms and education to minimize HIV transmission. A meta-analysis of 12 HIV studies amongst heterosexual couples demonstrated the use of condoms in all penetrative sex acts reduced the risk of HIV transmission 7.4 times in comparison to those who never used condoms. Other studies show a 90-95% effectiveness in HIV prevention when “consistently” using condoms. A Cochrane review shoed that the use of a male latex condom in all acts of penetrative vaginal sex reduced HIV incidence by 80%. Overall, condoms are effective in HIV prevention.Pre-Exposure Prophylaxis (PrEP)Truvada and Descovy:Another option for prevention amongst HIV negative individuals is the use of Pre-Exposure Prophylaxis (PrEP). It is an anti-retroviral pill that is taken daily to maintain a steady-state level of the medication in the blood stream. The medication specifically a combination of 2 antiretroviral medications – Tenofovir and Emtricitabine. Both medications are nucleoside reverse transcriptase inhibitors (NRTIs) that work by blocking the viral reverse transcriptase from HIV and prevent the enzyme from copying the RNA genome into DNA. Therefore, it stops viral replications. There are 2 formulations of PrEP: Truvada and Descovy. Truvada's primary side effects are renal and bone toxicity with long-term use. Descovy's primary side effects are mild weight gain and dyslipidemia. Truvada is the most commonly prescribed PrEP because it has the most data since it has been around the longest. However, extra consideration should be taken for: Adolescents should weigh at least 35 kg before being prescribed PrEPDescovy may be preferred for adolescents by the prescribing physician as it is not associated with reduction in bone density, as Truvada is. Estimated GFR between 30 – 60Truvada is associated with acute and chronic kidney disease whereas Descovy is safe for patients with a GFR greater than 30Patients with osteoporosisTruvada is associated with bone toxicity, whereas Descovy is not. It is important to note that PrEP has only been studied in men or people who were assigned men at birth. So, its efficacy in vaginal sex and with vaginal fluids cannot be generalized at this time. Future of PrEP: In May 2020, the HIV Prevention Trials Network (HPTN) 083 randomized trial demonstrated the potential of an injectable PrEP. Carbotegravir, is an integrase inhibitor, which prevents the HIV integrase from incorporating the HIV genome into the cellular genome. This study demonstrated its efficacy as PrEP in comparison to Truvada with few new infections (13 versus 39, respectively). Carbotegravir would be given via injection once every 8 weeks. In September 2021, the pharmaceutical company Moderna will begin 2 human clinical trials for an HIV vaccine that use mRNA technology. Previous studies conducted with non-mRNA vaccines demonstrated that B cells can be stimulated to create antibodies against HIV. Since HIV becomes integrated in the cellular genome within 72 hours of transmission, a high level of antibodies must be produced and present in the body to offer an adequate level of immunity. Post-Exposure Prophylaxis (PEP)If an individual is exposed to blood or bodily fluids with high risk of HIV via percutaneous, mucus membrane or nonintact skin route, post-exposure prophylaxis (PEP) may be an option. PEP is indicated when the HIV status of the exposure source is unknown and are awaiting test results, or if the exposure source is HIV positive. Therapy should be started within 1 or 2 hours of exposure and it is not effective after 72 hours of initial exposure. The recommended duration of therapy is 4 weeks but no evidence has been shown for an optimal duration. Occupational exposure. There are 2 regimens for PEP: Truvada with Dolutegravir Truvada with Raltegravir Both Doltegravir and Raltegravir are integrase inhibitors which block the integration of the viral genome into the cellular DNA. The regiments are chosen based on efficacy, side effects, patient convenience, and completion rates. Dolutegravir is chosen because it is given once daily. While Raltegravir is taken twice daily, most experience with PEP has been with Raltegravir. Other risk with Raltegravir are potential skeletal muscle toxicity and systemic-cutaneous reactions resembling Steven-Johnson syndrome. One final word about prevention of vertical transmission is making sure pregnant women are treated during pregnancy and if the baby is delivered from a patient whose viral load is “detectable”, the baby needs to be treated, but we'll let that topic for another time to discuss. Joke: What do you call the patient zero of HIV? First Aids.HIV incidence is decreasing thanks to many prevention measures taken globally, and we discussed screening, condoms, PrEP and PEP as part of this prevention efforts. Stay tuned for more relevant medical information in our next episode. ____ Now we conclude our episode number 70 “HIV Prevention.” Robert, Huda and Bahar explained some ways to prevent HIV, mainly by screening those at risk, using condoms, PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis). Let's also remember that having a monogamous relationship and avoiding high risk sexual behaviors confer significant protection against HIV. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Robert Dunn, Huda Quanungo, and Bahar Hamidi. Audio edition: Suraj Amrutia. See you next week! References:About HIV. Center for Disease Control and Prevention, CDC.gov, June 1, 2021. https://www.cdc.gov/hiv/basics/whatishiv.html . Accessed September 21, 2021. Simon V, Ho DD, Abdool Karim Q. HIV/AIDS epidemiology, pathogenesis, prevention, and treatment. Lancet. 2006 Aug 5;368(9534):489-504. doi: 10.1016/S0140-6736(06)69157-5. PMID: 16890836; PMCID: PMC2913538. [https://pubmed.ncbi.nlm.nih.gov/16890836/] US Statistics. HIV.gov, June 2, 2021. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics . Accessed September 21, 2021. The global HIV/AIDS Epidemic. HIV.gov, June 25, 2021. https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics. Accessed September 21, 2021. Human Immunodeficiency Virus (HIV) Infection: Screening. U.S. Preventative Services Task Force, June 11, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening. Accessed September 21, 2021. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ. 2004 Jun;82(6):454-61. PMID: 15356939; PMCID: PMC2622864. [https://pubmed.ncbi.nlm.nih.gov/15356939/] Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;(1):CD003255. doi: 10.1002/14651858.CD003255. PMID: 11869658. [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003255/full] Mayer, Kenneth H, MD, and Douglas Krakower, MD. Administration of pre-exposure prophylaxis against HIV infection. UpToDate, June 24, 2020. Accessed September 21, 2021. [https://www.uptodate.com/contents/administration-of-pre-exposure-prophylaxis-against-hiv-infection?search=8)%09Administration%20of%20pre-exposure%20prophylaxis%20against%20HIV%20infection&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1] Zachary, Kimon C, MD. Management of health care personnel exposed to HIV. UpToDate, June 07, 2019. Accessed September 21, 2021. [https://www.uptodate.com/contents/management-of-health-care-personnel-exposed-to-hiv?search=9)%09Management%20of%20health%20care%20personnel%20exposed%20to%20HIV&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1]
On this week's episode, Ame and Kenzie cover the story of Maksim Gelman from the A&E series The Killer Speaks. At 23-years-old, Max, who went by Wes on the streets, was a cocaine dealing and PCP using character with visions of grandeur. One day in early February 2011, the chronic drug use caught up with him in the form of paranoia as he's convinced himself that the feds were onto his dealings and after him. In an attempt to flee Brooklyn, he winds up at his mother's house in search of his passport. A confrontation with his stepfather that morning would change the course of his life as Max would go on to stab the man 55 times, his mother bearing witness to it all, leaving Gelman on the run. That would be the beginning of a 28-hour anger and revenge spree that would leave 4 people dead and another 4 people injured, some clinging to life. An all points bulletin goes out over the city of New York for the man the media has dubbed 'Mad Max'. After he's arrested, many wonder if the lack of remorse was due to the anger inside of him, or was this truly the work of an insane mad man?
“Yu-Gi-Oh! Gx 101: Based and Slifer Red-pilled”https://www.youtube.com/watch?v=XUGhUKwZPRM&t=10900s PCP Episode 278 – Helluva Boss & Melted Plastic (ft. GamersTavern, Simmsy & Cheesy Manfredo)➤Full PCP Episode Playlist – https://goo.gl/mduhGw➤iTunes – http://bit.ly/PCPApplePodcast➤Google Play – http://bit.ly/PCPGooglePlay➤Spotify – http://bit.ly/PCPSpotify➤All PCP mp3s: https://goo.gl/WVbIw6 Support the PCP on Patreon conglomerate empire society!https://www.patreon.com/TheProCrastinators Join the PCP Minecraft Server:https://www.patreon.com/PCPMinecraft PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY … Continue reading "Helluva Boss & Melted Plastic (ft. GamersTavern, Simmsy & Cheesy Manfredo) – The PCP, Episode 278"
Funny Episode Template Description PCP Episode 281- THAT NEW PONY MOVIE➤Full PCP Episode Playlist – https://goo.gl/mduhGw➤iTunes – http://bit.ly/PCPApplePodcast➤Google Play – http://bit.ly/PCPGooglePlay➤Spotify – http://bit.ly/PCPSpotify➤All PCP mp3s: https://goo.gl/WVbIw6 Support the PCP on Patreon conglomerate empire society!https://www.patreon.com/TheProCrastinators Join the PCP Minecraft Server:https://www.patreon.com/PCPMinecraft PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY PCP SHIRTS & MERCH!https://teespring.com/stores/the-pro-crastinatorshttps://www.redbubble.com/people/ProCrastinators/shophttps://gumroad.com/theprocrastinators (radcon behind the scenes) TPC Twitter: https://twitter.com/TPCrastinatorsTPC … Continue reading "THAT NEW PONY MOVIE ft. Krak and Kazee – The Pro Crastinators Podcast, Episode 281"
Hey guys! I am excited to share this very personal share of one my clients, Kaye McClaren. Make sure to listen to this full podcast to hear her journey and how she's healing. About Kaye McClarenSigns of Breast IllnessCarnivore Diet and Breast IllnessRisks of Improper Explanting Breast Implant StatisticsAre Breast Implants Safe for Anyone?Mindset (not enough and trauma)What Kaye is Healing NowBest Tips for ExplantsThe Process of RemovalResources for Healing and DetoxHow long after did Kaye realize something was wrong?What if you just put in new implants? Implants a choice after a mastectomy? How intense is the removal process compared to getting them? Does insurance cover removal?_____RESOURCES- Kaye McClaren's NwJ Blog Post Feature: https://nutritionwithjudy.com/breast-implant-illness-a-survivors-story/ - Mental Health: https://compasspathways.com/- NwJ's Symptom Burden Assessment: https://nutritionwithjudy.com/shopping/health-tests/symptom-burden-assessment/____CHECK OUT MY BOOK, Carnivore CureSIGN UP FOR MY WEEKLY NEWSLETTER_____ ADDITIONAL RESOURCESNutrition with Judy ArticlesNutrition with Judy ResourcesCutting Against the Grain Podcast_____ FIND ME
Day 10 goes to the zoo with special guest Dan Bone of The Podcast On Haunted Hill carrying the feed bag on this one. What happens when PCP gets into the water supply at a zoo? Mass carnage all over the streets. YOu get all this and more in Wild Beasts from 1984. Look for another solo review tomorrow from me covering The Beast In The Cellar. Watch Wild Beasts with the link below. The post 31 Days Of Howling Beasts Day 10 : Wild Beasts (1984) first appeared on Legion.
Day 10 goes to the zoo with special guest Dan Bone of The Podcast On Haunted Hill carrying the feed bag on this one. What happens when PCP gets into the water supply at a zoo? Mass carnage all over the streets. YOu get all this and more in Wild Beasts from 1984. Look for another solo review tomorrow from me covering The Beast In The Cellar. Watch Wild Beasts with the link below. The post 31 Days Of Howling Beasts Day 10 : Wild Beasts (1984) first appeared on Legion.
Day 10 goes to the zoo with special guest Dan Bone of The Podcast On Haunted Hill carrying the feed bag on this one. What happens when PCP gets into the water supply at a zoo? Mass carnage all over the streets. YOu get all this and more in Wild Beasts from 1984. Look for another solo review tomorrow from me covering The Beast In The Cellar. Watch Wild Beasts with the link below. The post 31 Days Of Howling Beasts Day 10 : Wild Beasts (1984) first appeared on Legion.
Thanks for tuning in to the Armor Men's Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.In this segment, Dr. Mistry and Donna Lee are joined by Dr. Kevin Spencer of Premier Family Physicians. Dr. Spencer explains the purpose of primary care and the philosophy of his practice. According to Dr. Spencer, PCP's should offer more holistic, patient-centered care by asking such questions as, "What are [the patient's] health goals? What's their life view? What do they want out of health? What scares them about sickness? What's happened to their family? What are things that we could prevent much earlier?" Questions such as these establish trust as patient and provider lay the foundations for an effective relationship. At NAU Urology Specialists, we are fortunate to have many excellent providers to refer our patients to when issues outside the scope of urology arise. If you or a loved one are in search of a primary care physician, please visit Dr. Spencer's website at www.pfpdocs.com.This episode originally aired on 10.10.20. Don't forget to like, subscribe, and share us with a friend! As always, be well!Check our our award winning podcast! https://blog.feedspot.com/sex_therapy_podcasts/https://blog.feedspot.com/mens_health_podcasts/Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.We enjoy hearing from you! Email us at email@example.com and we'll answer your question in an upcoming episode!Phone: (512) 238-0762Email: Armormenshealth@gmail.comWebsite: Armormenshealth.comOur Locations:Round Rock Office970 Hester's Crossing Road Suite 101 Round Rock, TX 78681South Austin Office6501 South Congress Suite 1-103 Austin, TX 78745Lakeline Office12505 Hymeadow Drive Suite 2C Austin, TX 78750Dripping Springs Office170 Benney Lane Suite 202 Dripping Springs, TX 78620
PCP Episode 282 – Drawcast & Broken Backs (ft. OblivionFall) ➤Full PCP Episode Playlist – https://goo.gl/mduhGw ➤iTunes – http://bit.ly/PCPApplePodcast ➤Google Play – http://bit.ly/PCPGooglePlay ➤Spotify – http://bit.ly/PCPSpotify ➤All PCP mp3s: https://goo.gl/WVbIw6 Support the PCP on Patreon conglomerate empire society! Join the PCP Minecraft Server: PCP Highlights Channel: https://www.youtube.com/channel/UCNBP4BmPEbhRFPxkm60HAaw BUY PCP SHIRTS & MERCH! https://gumroad.com/theprocrastinators (radcon behind … Continue reading "Drawcast & Broken Backs (ft. OblivionFall) – The Pro Crastinators Podcast, Episode 282"
The podcast is back with a new name and a new, expanded focus! Harry will soon be publishing his new book The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer. Like his previous book MoneyBall Medicine, it's all about AI and the other big technologies that are transforming healthcare. But this time Harry takes the consumer's point of view, sharing tips, techniques, and insights we can all use to become smarter, more proactive participants in our own health. The show's first guest under this expanded mission is Dave deBronkart, better known as "E-Patient Dave" for his relentless efforts to persuade medical providers to cede control over health data and make patients into more equal partners in their own care. Dave explains how he got his nickname, why it's so important for patients to be more engaged in the healthcare system, and what kinds of technology changes at hospitals and physician practices can facilitate that engagement. Today we're bringing you the first half of Harry and Dave's wide-ranging conversation, and we'll be back on October 12 with Part 2.Dave deBronkart is the author of the highly rated Let Patients Help: A Patient Engagement Handbook and one of the world's leading advocates for patient engagement. After beating stage IV kidney cancer in 2007, he became a blogger, health policy advisor, and international keynote speaker, and today is the best-known spokesman for the patient engagement movement. He is the co-founder and chair emeritus of the Society for Participatory Medicine, and has been quoted in Time, U.S. News, USA Today, Wired, MIT Technology Review, and the HealthLeaders cover story “Patient of the Future.” His writings have been published in the British Medical Journal, the Patient Experience Journal, iHealthBeat, and the conference journal of the American Society for Clinical Oncology. Dave's 2011 TEDx talk went viral, and is one the most viewed TED Talks of all time with nearly 700,000 views.Please rate and review The Harry Glorikian Show on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to The Harry Glorikian Show podcast. You can find it by searching for it or selecting it from your library. Just note that you'll have to go to the series page which shows all the episodes, not just the page for a single episode.3. Scroll down to find the subhead titled "Ratings & Reviews."4. Under one of the highlighted reviews, select "Write a Review."5. Next, select a star rating at the top — you have the option of choosing between one and five stars. 6. Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.7. Once you've finished, select "Send" or "Save" in the top-right corner. 8. If you've never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out. 9. After selecting a nickname, tap OK. Your review may not be immediately visible.That's it! Thanks so much.Full TranscriptHarry Glorikian: Hello. I'm Harry Glorikian. Welcome to The Harry Glorikian Show.You heard me right! The podcast has a new name. And as you're about to learn, we have an exciting new focus. But we're coming to you in the same feed as our old show, MoneyBall Medicine. So if you were already subscribed to the show in your favorite podcast app, you don't have to do anything! Just keep listening as we publish new episodes. If you're not a regular listener, please take a second to hit the Subscribe or Follow button right now. And thank you.Okay. So. Why are we rebranding the show?Well, I've got some exciting news to share. Soon we'll be publishing my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer. It's all about how AI and big data are changing almost everything we know about our healthcare.Now, that might sound a bit like my last book, MoneyBall Medicine. But I wrote that book mainly to inform all the industry insiders who deliver healthcare. Like people who work at pharmaceutical companies, hospitals, health plans, insurance companies, and health-tech startups.With this new book, The Future You, I'm turning the lens around and I'm explaining the impact of the AI revolution on people who consume healthcare. Which, of course, means everyone. That impact is going to be significant, and it's going to change everything from the way you interact with your doctors, to the kind of medicines you take, to the ways you stay fit and healthy.We want you to be prepared for this new world. So we're expanding the focus of the podcast, too. To go along with the new name, we're bringing you interviews with a new lineup of fascinating people who are changing the way patients experience healthcare. And there's nobody better to start out with than today's guest, Dave deBronkart.Dave is best known by the moniker he earned back in the late 2000s: E-Patient Dave. We'll talk about what the E stands for. But all you need to know going in is that ever since 2007, when he survived his own fight with kidney cancer, Dave has been a relentless, tireless advocate for the idea that the U.S. medical system needs to open up so that patients can play a more central role in their own healthcare. He's pushed for changes that would give patients more access to their medical records. And he hasn't been afraid to call out the institutions that are doing a poor job at that. In fact, some folks inside the business of healthcare might even call Dave an irritant or a gadfly. But you know what? Sometimes the world needs people who aren't afraid to shake things up.And what's amazing is that in the years since Dave threw himself into this debate, the world of healthcare policy has started to catch up with him. The Affordable Care Act created big incentives for hospitals and physician practices to switch over to digital recordkeeping. In 2016 the Twenty-First Century Cures Act prohibited providers from blocking access to patients' electronic health information. And now there's a new interface standard called FHIR that promises to do for medical records what HTML and HTTP did for the World Wide Web, and make all our health data more shareable, from our hospital records to our genomics data to the fitness info on our smartphones.But there's a lot of work left to do. And Dave and I had such a deep and detailed conversation about his past work and how patients experience healthcare today that we're going to break up the interview into two parts. Today we'll play the first half of our interview. And in two weeks we'll be back with Part 2. Here we go.Harry Glorikian: Dave, welcome to the show.Dave deBronkart: Thank you so much. This is a fascinating subject, I love your angle on the whole subject of medicine.Harry Glorikian: Thank you. Thank you. So, Dave, I mean, you have been known widely as what's termed as E-patient Dave. And that's like a nickname you've been using in public discussions for, God, at least a decade, as far as I can remember. But a lot of our listeners haven't heard about that jargon word E-patient or know what E stands for. To me, it means somebody who is assertive or provocative when it comes to managing their own health, you know, with added element of being, say, tech savvy or knowing how to use the Internet, you know, mobile, wearable devices and other digital tools to monitor and organize and direct their own care—-all of which happens to describe the type of reader I had in mind when I wrote this new book that I have coming out called The Future You. So how would you describe what E- patient [means]?Dave deBronkart: You know, it's funny because when you see an E-patient or talk with them, they don't stick out as a particularly odd, nerdy, unusual sort of person. But the the term, we can get into its origins back in the 90s someday if you want to, the term has to do with somebody who is involved. What today is in medicine is called patient engagement. And it's funny because to a lot of people in health care, patient engagement means getting the patient to do what they tell us to. Right. Well, tvhere's somebody who's actually an activated, thinking patient, like, I'm engaged in the sense that I want to tell you what's important to me. Right. And I don't just want to do what I'm told. I want to educate myself. That's another version of the E. In general, it means empowered, engaged, equipped, enabled. And these days, as you point out, naturally, anybody who's empowered, engaged and enabled is going to be doing digital things, you know, which weren't possible 20 years ago when the term patient was invented.Harry Glorikian: Yeah, and it's interesting because I was thinking like the E could stand for so many things like, you know, electronic, empowered, engaged, equipped, enabled, right. All of the above. Right. And, you know, I mean, at some point, you know, I do want to talk about access, right, to all levels. But just out of curiosity, right, you've been doing this for a long time, and I'm sure that people have reached out to you. How many E-patients do you think are out there, or as a proportion of all patients at this point?Dave deBronkart: You know, that depends a lot on demographics and stage of life. The, not surprisingly, digital natives are more likely to be actively involved in things just because they're so digital. And these days, by federal policy, we have the ability to look at parts of our medical information online if we want to. As opposed to older people in general are more likely to say just what the doctors do, what they want to. It's funny, because my parents, my dad died a few years ago. My mother's 92. We're very different on this. My dad was "Let them do their work." And my mother is just all over knowing what's going on. And it's a good thing because twice in the last five years, important mistakes were found in her medical record, you know. So what we're at here, this is in addition to the scientific and technological and data oriented changes that the Internet has brought along. We're also in the early stages of what is clearly going to be a massive sociological revolution. And it has strong parallels. I first had this idea years ago in a blog post, but I was a hippie in the 60s and 70s, and I lived through the women's movement as it swept through Boston. And so I've seen lots of parallels. You go back 100 years. I think the you know, we recently hit the 100th anniversary of the 19th Amendment, giving women the right to vote. There were skeptics when the idea was proposed and those skeptics opinions and the things they said and wrote have splendid parallels with many physicians' beliefs about patients.Dave deBronkart: As one example I blogged some years ago, I can send you a link about a wonderful flyer published in 1912 by the National Association Opposed to Women's Suffrage. And it included such spectacular logic as for, I mean, their bullets, their talking points, why we should not give women the vote, the first was "Most women aren't asking for it." Which is precisely parallel to "Most patients aren't acting like Dave, right? So why should we accommodate, why should we adjust? Why should we provide for that? The second thing, and this is another part, is really a nastier part of the social revolution. The second talking point was "Most women eligible to vote are married and all they could do is duplicate or cancel their husband's vote." It's like, what are you thinking? The underlying is we've already got somebody who's voting. Why do we need to bring in somebody else who could only muddy the picture? And clearly all they could do is duplicate or cancel their husband's vote. Just says that the women or the patients, all right, all I could do is get in the way and not improve anything. I bring this up because it's a real mental error for people to say I don't know a lot of E-patients. So it must not be worth thinking about. Harry Glorikian: Yeah, I mean, so, just as a preview so of what we're going to talk about, what's your high-level argument for how we could make it easier for traditional patients to become E-patients?Dave deBronkart: Well, several dimensions on that. The most important thing, though, the most important thing is data and the apps. Harry Glorikian: Yes.Dave deBronkart: When people don't have access to their information, it's much harder for them to ask an intelligent question. It's like, hey, I just noticed this. Why didn't we do something? What's this about? Right. And now the flip side of it and of course, there's something I'm sure we'll be talking about is the so-called final rule that was just published in April of this year or just took effect of this year, that says over the course of the next year, all of our data in medical records systems has to be made available to us through APIs, which means there will be all these apps. And to anybody middle aged who thinks I don't really care that much, all you have to do is think about when it comes down to taking care of your kids or your parents when you want to know what's going on with them. Harry Glorikian: Would you think there would be more E-patients if the health care system gave them easier access to their data? What are some of the big roadblocks right now?Dave deBronkart: Well, one big roadblock is that even though this final federal rule has come out now, the American Medical Group Management Association is pushing back, saying, "Wait, wait, wait, this is a bad idea. We don't need patients getting in the way of what doctors are already doing." There will be foot dragging. There's no question about that. Part of that is craven commercial interests. There are and there have been numerous cases of hospital administrators explicitly saying -- there's one recording from the Connected Health conference a few years ago, Harlan Krumholtz, a cardiologist at Yale, quoted a hospital president who told him, "Why wouldn't I want to make it a little harder for people to take their business elsewhere?"Harry Glorikian: Well, if I remember correctly, I think it was the CEO of Epic who said, “Why would anybody want their data?”Dave deBronkart: Yes. Well, first of all, why I would want my data is none of her damn business. Well, and but that's what Joe Biden -- this was a conversation with Joe Biden. Now, Joe has a, what, the specific thing was, why would you want to see your data? It's 10,000 pages of which you would understand maybe 100. And what he said was, "None of your damn business. And I'll find people that help me understand the parts I want."Harry Glorikian: Yeah. And so but it's so interesting, right? Because I believe right now we're in a we're in a state of a push me, pull you. Right? So if you look at, when you said apps, I think Apple, Microsoft, Google, all these guys would love this data to be accessible because they can then apps can be available to make it more understandable or accessible to a patient population. I mean, I have sleep apps. I have, you know, I just got a CGM, which is under my shirt here, so that I can see how different foods affect me from, you know, and glucose, insulin level. And, you know, I'm wearing my Apple Watch, which tracks me. I mean, this is all interpretable because there are apps that are trying to at least explain what's happening to me physiologically or at least look at my data. And the other day I was talking to, I interviewed the CEO of a company called Seqster, which allows you to download your entire record. And it was interesting because there were some of the panels that I looked at that some of the numbers looked off for a long period of time, so I'm like, I need to talk to my doctor about those particular ones that are off. But they're still somewhat of a, you know, I'm in the business, you've almost learned the business. There's still an educational level that and in our arcane jargon that gets used that sort of, you know, everybody can't very easily cross that dimension.Dave deBronkart: Ah, so what? So what? Ok, this is, that's a beautiful observation because you're right, it's not easy for people to absorb. Not everybody, not off the bat. Look, and I don't claim that I'm a doctor. You know, I still go to doctors. I go to physical therapists and so on and so on. And that is no reason to keep us apart from the data. Some doctors and Judy Faulkner of Epic will say, you know, you'll scare yourself, you're better off not knowing. Well, ladies and gentlemen, welcome to the classic specimen called paternalism. "No, honey, you won't understand." Right now paternal -- this is important because this is a major change enabled by technology and data, right -- the paternal caring is incredibly important when the cared-for party cannot comprehend. And so the art of optimizing and this is where MoneyBall thinking comes in. The art of optimizing is to understand people's evolving capacity and support them in developing that capacity so that the net sum of all the people working on my health care has more competence because I do. Harry Glorikian: Right. And that's where I believe like. You know, hopefully my book The Future You will help people see that they're, and I can see technology apps evolving that are making it easier graphically, making it more digestible so someone can manage themselves more appropriately and optimally. But you mentioned your cancer. And I want to go and at least for the listeners, you know, go a little bit through your biography, your personal history, sort of helping set the stage of why we're having this conversation. So you started your professional work in, I think it was typesetting and then later software development, which is a far cry from E-patient Dave, right? But what what qualities or experiences, do you think, predisposed you to be an E-patient? Is it fair to say that you were already pretty tech savvy or but would you consider yourself unusually so?Dave deBronkart: Well, you know, the unusually so, I mean, I'm not sure there's a valid reason for that question to be relevant. There are in any field, there are pioneers, you know, the first people who do something. I mean, think about the movie Lorenzo's Oil, people back in the 1980s who greatly extended their child's life by being so super engaged and hunting and hunting through libraries and phone calls. That was before there was the Internet. I was online. So here are some examples of how I, and I mentioned that my daughter was gestating in 1983. I took a snapshot of her ultrasound and had it framed and sitting on my office desk at work, and people would say, what's that? Nobody knew that that was going to be a thing now and now commonplace thing. In 1999, I met my second wife online on Match.com. And when I first started mentioning this in speeches, people were like, "Whoa, you found your wife on the Internet?" Well, so here's the thing, 20 years later, it's like no big deal. But that's right. If you want to think about the future, you better be thinking about or at least you have every right to be thinking about what are the emerging possibilities. Harry Glorikian: So, tell us the story about your, you know, renal cancer diagnosis in 2007. I mean, you got better, thank God. And you know, what experience it taught you about the power of patients to become involved in their decision making about the course of treatment?Dave deBronkart: So I want to mention that I'm right in the middle of reading on audio, a book that I'd never heard of by a doctor who nearly died. It's titled In Shock. And I'm going to recommend it for the way she tells the story of being a patient, observing the near fatal process. And as a newly trained doctor. In my case, I went in for a routine physical. I had a shoulder X-ray and the doctor called me the next morning and said, "Your shoulder is going to be fine, but the X-ray showed that there's something in your lung that shouldn't be there." And to make a long story short, what we soon found out was that it was kidney cancer that had already spread. I had five tumors, kidney cancer tumors in both lungs. We soon learned that I had one growing in my skull, a bone metastasis. I had one in my right femur and my thigh bone, which broke in May. I now have a steel rod in my in my thigh. I was really sick. And the best available data, there wasn't much good data, but the best available data said that my median survival. Half the people like me would be dead in 24 weeks. 24 weeks!Harry Glorikian: Yeah.Dave deBronkart: And now a really pivotal moment was that as soon as the biopsy confirmed the disease, that it was kidney cancer, my physician, the famous doctor, Danny Sands, my PCP, because he knew me so well -- and this is why I hate any company that thinks doctors are interchangeable, OK? They they should all fry in hell. They're doing it wrong. They should have their license to do business removed -- because he knew me he said, "Dave, you're an online kind of guy. You might like to join this patient community." Now, think how important this is. This was January 2007, not 2021. Right. Today, many doctors still say stay off the Internet. Dr. Sands showed me where to find the good stuff.Harry Glorikian: Right. Yeah, that's important.Dave deBronkart: Well, right, exactly. So now and this turned out to be part of my surviving. Within two hours of posting my first message in that online community, I heard back. "Thanks for the, welcome to the club that nobody wants to join." Now, that might sound foolish, but I'd never known anybody who had kidney cancer. And here I am thinking I'm likely to die. But now I'm talking to people who got diagnosed 10 years ago and they're not dead. Right? Opening a mental space of hope is a huge factor in a person having the push to move forward. And they said there's no cure for this disease. That was not good news. But the but there's this one thing called high dose Interleukin 2. That usually doesn't work. So this was the patient community telling me usually doesn't work. But if you respond at all, about half the time, the response is complete and permanent. And you've got to find a hospital that does it because it's really difficult. And most hospitals won't even tell you it exists because it's difficult and the odds are bad. And here are four doctors in your area who do it, and here are their phone numbers. Now, ladies and gentlemen, I assert that from the point of view of the consumer, the person who has the need, this is valuable information. Harry, this is such a profound case for patient autonomy. We are all aware that physicians today are very overworked, they're under financial pressure from the evil insurance companies and their employers who get their money from the insurance companies. For a patient to be able to define their own priorities and bring additional information to the table should never be prohibited. At the same time, we have to realize that, you know, the doctors are under time pressure anyway. To make a long story short, they said this this treatment usually doesn't work. They also said when it does work, about four percent of the time, the side effects kill people.Harry Glorikian: So here's a question. Here's a question, though, Dave. So, you know, being in this world for my entire career, it's my first question is, you see something posted in a club, a space. How do you validate that this is real, right, that it's bona fide, that it's not just...I mean, as we've seen because of this whole vaccine, there's stuff online that makes my head want to explode because I know that it's not real just by looking at it. How do you as as a patient validate whether this is real, when it's not coming from a, you know, certified professional?Dave deBronkart: It's a perfect question for the whole concept of The Future You. The future you has more autonomy and more freedom to do things, has more information. You could say that's the good news. The bad news is you've got all this information now and there's no certain source of authority. So here you are, you're just like emancipation of a teenager into the adult life. You have to learn how to figure out who you trust. Yeah, the the good news is you've got some autonomy and some ability to act, some agency, as people say. The bad news is you get to live with the consequences as well. But don't just think "That's it, I'm going to go back and let the doctors make all the decisions, because they're perfect," because they're not, you know, medical errors happen. Diagnostic errors happen. The overall. The good news is that you are in a position to raise the overall level of quality of the conversations.Harry Glorikian: So, you know, talk about your journey after your cancer diagnosis from, say, average patient to E-patient to, now, you're a prominent open data advocate in health care.Dave deBronkart: Yes. So I just want to close the loop on what happened, because although I was diagnosed in January, the kidney came out in March, and my interleukin treatments started in April. And by July, six months after diagnosis, by July, the treatment had ended and I was all better. It's an immunotherapy. When immunotherapy works, it's incredible because follow up scans showed the remaining tumors all through my body shrinking for the next two years. And so I was like, go out and play! And I started blogging. I mean, I had really I had pictured my mother's face at my funeral. It's a, it's a grim thought. But that's how perhaps one of my strengths was that I was willing to look that situation in the eye, which let me then move forward. But in 2008, I just started blogging about health care and statistics and anything I felt like. And in 2009 something that -- I'm actually about to publish a free eBook about that, it's just it's a compilation of the 12 blog posts that led to the world exploding on me late in 2008 -- the financial structure of the U.S. health system meant that even though we're the most expensive system in the world, 50 percent more expensive than the second place country, if we could somehow fix that, because we're the most expensive and we don't have the best outcomes, so some money's being wasted there somewhere. All right. If we could somehow fix that, it would mean an immense amount of revenue for some companies somewhere was going to disappear.Dave deBronkart: Back then, it was $2.4 trillion, was the US health system. Now it's $4 trillion. And I realized if we could cut out the one third that excess, that would be $800 billion that would disappear. And that was, I think, three times as much as if Google went out of business, Apple went out of business and and Microsoft, something like that. So I thought if we want to improve how the system works, I'm happy if there are think tanks that are rethinking everything, but for you and me in this century, we got to get in control of our health. And that had to start with having access to our data. All right. And totally, unbeknownst to me, when the Obama administration came in in early 2009, this big bill was passed, the Recovery Act, that included $40 billion of incentives for hospitals to install medical computers. And one of the rules that came out of that was that we, the patients, had to be able to look at parts of our stuff. And little did I know I tried to use to try to look at my data. I tried to use the thing back then called Google Health. And what my hospital sent to Google was garbage. And I blogged about it, and to my huge surprise, The Boston Globe newspaper called and said they wanted to write about it, and it wasn't the local newspaper, it was the Washington health policy desk. And they put it on Page One. And my life spun out of control.Harry Glorikian: Yeah, no, I remember I remember Google Health and I remember you know, I always try to tell people, medicine was super late to the digitization party. Like if it wasn't for that the Reinvestment and Recovery Act putting that in place, there would still be file folders in everybody's office. So we're still at the baby stage of digitization and then the analytics that go with it. And all I see is the curve moving at a ridiculous rate based on artificial intelligence, machine learning being applied to this, and then the digitized information being able to come into one place. But you said something here that was interesting. You've mentioned this phenomenon of garbage in, garbage out. Right. Can you say more about one of the hospitals that treated you? I think it was Beth Israel. You mentioned Google Health. What went wrong there and what were the lessons you took away from that?Dave deBronkart: Well, there were, so what this revealed to me, much to my amazement, much to my amazement, because I assumed that these genius doctors just had the world's most amazing computers, right, and the computers that I imagined are the computers that we're just now beginning to move toward. Right. RI was wrong. But the other important thing that happened was, you know, the vast majority of our medical records are blocks of text, long paragraphs of text or were back then. Now, it was in a computer then, it wasn't notes on paper, but it was not the kind of thing you could analyze, any more than you could run a computer program to read a book and write a book report on it. And so but I didn't know that. I didn't know what Google Health might do. The next thing that happened was as a result, since Google Health was looking for what's called structured data -- now, a classic example of structured data is your blood pressure. It's fill in a form, the high number, the low number, what's your heart rate? What's your weight, you know? The key value pairs, as some people call them. Very little of my medical history existed in that kind of form. So for some insane reason, what they decided to send Google instead was my insurance billing history.Dave deBronkart: Now, insurance data is profoundly inappropriate as a model of reality for a number of reasons. One of one reason is that insurance form data buckets don't have to be very precise. So at one point I was tested for metastases to the brain to see if I had kidney cancer tumors growing in my brain. The answer came back No. All right. Well, there's only one billing code for it. Metastases to the brain. And that's a legitimate billing code for either one. But it got sent to Google Health as metastases to the brain, which I never had. All right. Another problem is something called up-coding, where insurance billing clerks are trained you can bill for something based on the keywords that the doctors and nurses put in the computer. So at one point during my treatment, I had a CAT scan of my lungs to look for tumors. And the radiologist noted, by the way, his aorta is slightly enlarged. The billing clerk didn't care that they were only checking for kidney cancer tumors. The billing clerk saw aorta, enlarged, aneurysm, and billed the insurance company for an aneurysm, which I never had. Corruption. Corruption. People ask, why are our health care costs so high? It's this system of keyword-driven billing. But then on top of that, I had things that I never had anything like it. There was, when this blew up in the newspaper, the hospital finally released all my insurance billing codes. It turns out they had billed the insurance company for volvulus of the intestine. That's a lethal kink of the intestine that will kill you in a couple of days if it's not treated. Never had anything of the sort. Billing fraud.Harry Glorikian: Interesting.Dave deBronkart: Anyway, because a random patient had just tried to use Google Health and I knew enough about data from my day job to be able to say, "Wait a minute, this makes no sense, why is all this happening?" And I couldn't get a straight answer. You know, it's a common experience. Sometimes you ask a company, "I've got a problem. This isn't right." And sometimes they just blow you off. Well, that's what my hospital did to me. I asked about these specific questions and they just blew me off. So then once it was on the front page of the newspaper, the hospital is like, "We will be working with the E-patient Dave and his doctor." And there's nothing like publicity, huh?[musical interlude]Harry Glorikian: Let's pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that's to make it easier for other listeners discover the show by leaving a rating and a review on Apple Podcasts.All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments. It'll only take a minute, but you'll be doing us a huge favor.And one more thing. If you like the interviews we do here on the show I know you'll like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.It's a friendly and accessible tour of all the ways today's information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.The book comes out soon, so keep an eye out for the next announcement.Thanks. And now back to our show.[musical interlude]Harry Glorikian: One of your slogans is "Gimme my damn data," meaning, you know, your patient records. And so can you summarize first, the state of the art prior to this digital transformation? Why was it historically the case that patients didn't have easy access to charts from their doctor's office or their visits? Why has the medical establishment traditionally been reluctant or maybe even unable to share this data?Dave deBronkart: Well, first, I want to explain the origin of that of that term. Because the speech in September of that year that launched the global speaking had that title. What happened was that summer of 2009, my world was spinning out of control as I tried to answer people's questions and get involved in the blogging that was going on and health policy arguments in Washington and so on. And so a real visionary in Toronto, a man named Gunther Eisenbach, who had quite a history in pioneering in this area, invited me to give the opening keynote speech for his annual conference in Toronto that fall. And several times during the summer, he asked me a question I'd never been asked. I came to learn that it was normal, but it was "For our brochure, we need to know what do you want to call the speech? What's the title of the speech?" And I remember very well sitting in my office at work one day saying into the telephone, "I don't know, just call it 'Give me my damn data, because you guys can't be trusted." And much to my amazement, It stuck.Dave deBronkart: I want to be clear. Under the 1996 health information law called hip hop, you are entitled to a copy of every single thing they have about you. All right, and a major reason for that. Back in the beginning was to detect mistakes. So it's interesting because HIPAA arose from health insurance portability. 1996 was when it first became mandatory that you had to be able to take your insurance business elsewhere and therefore your records. And that's the origin of the requirement that anybody who holds your health information as part of your insurance or anything else has to be really careful about not letting it leak out. And therefore and it has to be accurate. Therefore, you have a right to look at it and get any mistakes fixed. But. Foot dragging, foot dragging, foot dragging. I don't want to. As we discussed earlier, there are some doctors who simply wanted to keep you captive. But there are also, the data was also handwritten garbage at times, just scribbles that were never intended to be read by anyone other than the person who wrote the note in the first place. Harry Glorikian: Well, but, you know, I'm not trying to necessarily defend or anything, but but, you know, as you found at Beth Israel Deaconess, and I talk about this in The Future You as well, part of the problem is most of these things that people look at as large electronic health record systems were are still are in my mind designed as accounting and billing systems, not to help the doctors or the patients. And that's still a major problem. I mean, I think until we have, you know, a Satya Nadella taking over Microsoft where he, you know, went down and started rewriting the code for Microsoft Office, you're not going to get to management of patients for the betterment of their health as opposed to let me make sure that I bill for that last Tylenol.Dave deBronkart: Absolutely. Well, and where I think this will end up, and I don't know if it'll be five years or 10 or 20, but where this will end up is, the system as it exists now is not sustainable as a platform for patient-centered care. The early stage that we're seeing now, there is an incredibly important software interface that's been developed in the last five or six years still going on called FHIR, F-H-I-R. Which is part of that final rule, all that. So all of our data increasingly in the next couple of years has to be available through an API. All right. So, yeah, using FHIR. And I've done some early work on collecting my own data from the different doctors in the hospitals I've gone to. And what you get what you get when you bring those all in, having told each of them your history and what medications you're on and so on, is you get the digital equivalent of a fax of all of that from all of them. That's not coordinated, right. The medication list from one hospital might not match even the structure, much less the content of the medication list. And here's where it gets tricky, because anybody who's ever tried to have any mistake fixed at a hospital, like "I discontinued that medicine two years ago," never mind something like, "No, I never had that diagnosis," it's a tedious process, tons of paperwork, and you've got to keep track of that because they so often take a long time to get them fixed. And I having been through something similar in graphic arts when desktop publishing took over decades ago. I really wonder, are we will we ultimately end up with all the hospitals getting their act together? Not bloody likely. All right. Or are we more likely to end up with you and me and all of us out here eventually collecting all the data and the big thing the apps will do is organize it, make sense of it. And here's a juicy thing. It will be able to automatically send off corrections back to the hospital that had the wrong information. And so I really think this will be autonomy enabled by the future, you holding your own like you are the master copy of your medical reality.Harry Glorikian: Yeah, I always you know, I always tell like what I like having as a longitudinal view of myself so that I can sort of see something happening before it happens. Right. I don't want to go in once the car is making noise. I like just I'd like to have the warning light go off early before it goes wrong. But. So you mentioned this, but do you have any are there any favorite examples of patient friendly systems or institutions that are doing data access correctly?Dave deBronkart: I don't want to finger any particular one as doing a great job, because I haven't studied it. Ok. I know there are apps, the one that I personally use, which doesn't yet give me a useful it gives me a pile of fax pages, but it does pull together all the data, it's it's not even an app, it's called My Patient Link. And anybody can get it. It's free. And as long as the hospitals you're using have this FHIR software interface, which they're all required to, by the way, but some still don't. As long as they do this, My Patient Link will go and pull it all together. Now it's still up to you to do anything with it. So we're just at the dawn of the age that I actually envisioned back in 2008 when I decided to do the Google Health thing and the world blew up in my face.Harry Glorikian: Yeah. I mean, I have access to my chart. And, you know, that's useful because I can go look at stuff, but I have to admit, and again, this is presentation and sort of making it easy to digest, but Seqster sort of puts it in a graphical format that's easier for me to sort of absorb. The information is the same. It's just how it gets communicated to me, which is half the problem. But but, you know, playing devil's advocate, how useful is the data in the charts, really? I mean, sometimes we talk as if our data is some kind of treasure trove of accurate, actionable data. But you've helped show that a lot of it could be, I don't want to say useless, but there's errors in it which technically could make it worse than useless. But how do you think about that when you when you think about this?Dave deBronkart: Very good. First note. First of all, you're right. It will...a lot of the actual consumer patient value will, and any time I think about that again, I think a lot of young adults, I think of parents taking care of a sick kid, you know, or middle aged people taking care of elders who have many declining conditions. Right. There's a ton of data that you really don't care about. All right, it's sort of it's like if you use anything like Quicken or Mint, you probably don't scrutinize every detail that's in there and look for obscure patterns or so on. But you want to know what's going on. And here's the thing. Where the details matter is when trouble hits. And what I guarantee we will see some time, I don't know if it'll be five years, 10, or 20, but I guarantee what we will see someday is apps or features within apps that are tuned to a specific problem. If my blood pressure is something I'm.... Six years ago my doctor said, dude, you're prediabetic, your A1C is too high. Well, that all of a sudden brings my focus on a small set of numbers. And it makes it really important for me to not just be tracking the numbers in the computer, but integrate it with my fitness watch and my diet app.Harry Glorikian: Right. Dave deBronkart: Yeah, I lost 30 pounds in a year. And then at the age of 65, I ran a mile for the first time in my life because my behavior changed. My behavior had changed to my benefit, not because of the doctor micromanaging me, but because I was all of a sudden more engaged in getting off my ass and doing something that was important to me.Harry Glorikian: well, Dave, you need to write a diet book, because I could use I could stand to lose like 10 or 20 pounds.Dave deBronkart: Well, no, I'm not writing any diet books. That's a project for another day. Harry Glorikian: That's it for this week's episode. Dave and I had a lot more to talk about, and we'll bring you the second part of the conversation in the next episode, two weeks from now.You can find past episodes of The Harry Glorikian Show and MoneyBall Medicine at my website, glorikian.com. Don't forget to go to Apple Podcasts to leave a rating and review for the show. You can find me on Twitter at hglorikian. And we always love it when listeners post about the show there, or on other social media. Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview.
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My overarching thought throughout a lot of this interview was that improving rural health will take everyone remembering to not let perfect be the enemy of the good. If I live in rural America, there's no subspecialists. Forget about even seeing a garden-variety kind of specialist. I might have to drive hours to even get to a PCP. There are NPs (nurse practitioners) in a lot of these remote communities, but everybody's fighting over whether to let them practice independently, even in places where there's zero PCPs for hundreds of miles, effectively leaving everyone in the vicinity with basically zero access to any care. Or here's another issue: Maternal mortality in this country is not only heartbreaking—a mother dying in what should be a precious moment—it's also embarrassing as an industrialized nation to be so far in last place. I don't know this for a fact, really, but women who have to drive literally hours to see a provider during their pregnancy or—God forbid!—they go into labor unexpectedly … is that a factor in our horrific maternal mortality rates? Consider that in Canada, which has, by the way, substantially better maternal mortality rates than the USA, PCPs and NPs deliver babies in low-risk pregnancies even in areas that have access to ob-gyns, unlike a lot of rural America. When do we start wondering if we're letting perfect be the enemy of the good? When do we start considering if no access to care is worse than some access, even if the “some” access is not with, perhaps, the ideal type of provider? These are not questions with easy answers, so we need data. We need to think in shades of gray—not in binary terms where good and bad have static definitions unaltered by wildly different circumstances. That said, one way to potentially make many parties happy might be to do something like the Nuka system has done for Native Americans in rural Alaska. Listen to EP312 for more info on that. It's pretty cool. But let's just back up a sec with a little situation analysis: The thing with rural hospitals closing—and they are surely running in the red and closing—is the very pernicious cycle that develops. A hospital closing is kind of a bellwether for a community caught in a downward spiral in ways I did not realize until my conversation with Nikki King in this healthcare podcast. The main industry shuts its doors—maybe coal, or I grew up in a steel town when they were “closing all the factories down.” That was a Billy Joel quote there, and I spent a few years as a kid in the very same Allentown that song is about. Community trauma is no joke. Oh, and also, now there's no commercial lives. So, say the hospital in that town isn't prepared for this new payer mix reality and it closes. Then maybe a few hundred doctors and nurses move away, along with their spending habits, so other jobs go away. Then the more affluent senior citizens don't move back to their hometown to retire because who wants to live in a town with no hospital? Also, young families who have a choice might choose to go elsewhere. Former population centers start to disperse, and now there's not even a population big enough to support a hospital even if one would decide to go there. And when that hospital goes, so does its maternity department—and likely, even OB/GYN practices. Forget about a laborist. You then will have local PCPs leave town because, right, a PCP connected to a hospital can make twice as much as an indie. Reference the huge number of PCPs in this country who are employed by a health system. Most of these employed PCPs will not work in rural communities where their employer health system has no facilities to refer to. There's no jobs there for an employed physician. Obviously, no specialists can stay in business in this environment either. Things go from bad to worse: Child abuse rises, and multigenerational diseases of despair start to set in. And there's no healthcare to treat these diseases or prevent them. Things go from bad to worse to even more worse. In this healthcare podcast, I am honored and thrilled to talk with Nikki King, DHA, who offers up three community-centric ideas around solving the crisis of access that people in rural communities face. In short, these ideas include: Freestanding ERs (ERs that have the financial discipline to not take advantage of the communities they claim to serve, that is) Telehealth that recognizes broadband issues, which is possible Expanding nurse practitioner rights and maybe even the scope of PCP practices to, for example, include maternity care for low-risk pregnancies in areas that have zero or very minimal access to healthcare otherwise Here's the shorter-than-short version: Perfect can't be the enemy of the good when we're talking about some of these communities that have no healthcare options. Nikki King grew up in Kentucky in the coalfields of central Appalachia. She managed a behavioral health and addictions unit at a critical access hospital and also worked in biostatistics. She is on the board of directors of the Indiana Rural Health Association and has developed policies as a member of the National Rural Health Association, among a whole list of other achievements. Nikki is innovative and compassionate, and she understands the culture of those she serves. She talks about a few things that she worked on during the pandemic that are truly inspirational. You can learn more by emailing Nikki at firstname.lastname@example.org. You can also connect with her on LinkedIn and follow her on Twitter. Nikki King, MHSA, DHA, was born and raised in the coalfields of Southeastern Kentucky. Prior to working in the healthcare industry, she worked for the Center of Business and Economic Research studying models of sustainability in rural communities with a single economic engine. She has been working at Margaret Mary Health since 2015, occupying roles in clinical statistics, as well as currently managing the behavioral health and addiction services department. In addition to her role at Margaret Mary, Nikki completed her DHA at the Medical University of South Carolina and her MHSA from Xavier University. She currently serves on the Indiana Rural Health Association's Board of Directors, the American Hospital Association's Opioid Stewardship Advisory Group, and the National Rural Health Association's Policy Congress and Government Action Committee, and as the Board Chair of Rural Health Leadership Radio Board of Directors. 05:57 How dire is the rural hospital situation right now? 06:18 How could freestanding ERs be a potential solution for rural hospitals? 08:21 What are other potential rural health access solutions? 09:25 Why is broadband a roadblock to telehealth as a solution for rural health access? 14:06 The “hot potato” of nurse practitioners in the healthcare world. 15:05 “The number of residencies for physicians each year is not increasing, but the population … is increasing.” 19:06 EP312 with Douglas Eby, MD, MPH, CPE, of the Nuka System of Care. 20:41 What's the issue with maternity care in rural America? 22:53 “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.” 26:50 How is mental health care affected in rural communities? 27:23 “Rural communities are trying very hard to hang on to what they have.” 28:49 “When you look at the one market plan that's available in a rural community, you probably can't afford it.” 30:39 What's the single biggest challenge to moving to a model that incentivizes keeping people healthy? 31:33 “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.” You can learn more by emailing Nikki at email@example.com. You can also connect with her on LinkedIn and follow her on Twitter. @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth How dire is the rural hospital situation right now? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth How could freestanding ERs be a potential solution for rural hospitals? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth What are other potential rural health access solutions? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth Why is broadband a roadblock to telehealth as a solution for rural health access? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth The “hot potato” of nurse practitioners in the healthcare world. @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “The number of residencies for physicians each year is not increasing, but the population … is increasing.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth What's the issue with maternity care in rural America? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “As healthcare becomes more and more specialized, [the] ability to treat high-risk cases is better, but access gets worse.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth How is mental health care affected in rural communities? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “Rural communities are trying very hard to hang on to what they have.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “When you look at the one market plan that's available in a rural community, you probably can't afford it.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth What's the single biggest challenge to moving to a model that incentivizes keeping people healthy? @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth “The easiest low-hanging fruit … is having national Medicaid and have that put under the same hood as Medicare.” @NikkiKing0911, DHA, discusses #ruralhealthcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ruralhealth Recent past interviews: Click a guest's name for their latest RHV episode! Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco, Dr David Carmouche (AEE15), Christian Milaster, Dr Grace Terrell, Troy Larsgard, Josh LaRosa, Dr David Carmouche (EP316), Bob Matthews