Podcasts about rcts

Freddie sits down with Peter Simonson — a Georgia Tech-trained mechanical engineer who invented Medtronic's TSRH-3D spinal implant system before turning his focus to bone health as President and Co-Founder of Juvent — for a deep dive into micro-impact therapy and why bone may be the most overlooked organ system in longevity conversations. Peter walks through the history of vitamin discovery, starting with scurvy and vitamin C, as a framework for understanding micro-impact as a daily mechanical requirement rather than a treatment for any single condition. From there, the conversation moves into the engineering itself: why the Juvent Micro-Impact Platform® is capped at 0.3G, how frequency and load are two entirely different safety variables, and why a body of vibration-safety literature exists in occupational safety research that most clinicians have never encountered. Peter also references a study conducted at St. Jude on bone density outcomes in pediatric transplant patients, and the two share personal family stories — Freddie's mother and Peter's mother — about osteoporosis and mobility later in life. Note: this conversation covers emerging research and technology. Some figures and studies mentioned reflect the guest's own citations and firsthand experience shared in conversation. Peak Moments 0:00 – Intro: morning routine and setting up the conversation 1:18 – What is Juvent? Defining the category 1:57 – The scurvy & vitamin C history lesson 5:48 – Why micro-impact is a daily requirement, not a treatment 10:03 – What's actually inside the Juvent platform 11:15 – Why 0.3G — the bone science behind low-load, high-frequency 12:42 – Walking vs. jackhammer: the frequency/impact analogy 13:48 – The porcine brain study and "Faraday spikes" 15:33 – The hidden body of occupational vibration-safety literature 17:21 – Lawsuits, white papers & tearing apart a competitor's "rock shaker" plate 19:00 – Resonance explained: the swing, the wine glass, and personalized frequency scanning 23:20 – Origin story: Jack Ribey and the technology's early history 25:52 – Freddie's mom's pelvic fracture recovery story 28:20 – Bone as a metabolic and endocrine organ 33:12 – The economics of nursing homes, and Peter's mom's osteoporosis story 39:18 – The rodent study on stem cells and bone density 41:59 – The St. Jude study: bone density outcomes 45:25 – Buffalo Bills' Eric Wood and career longevity 48:20 – Biohacking vs. medical world: how RCTs actually work 53:20 – Lymphatic drainage: Juvent's secondary mechanism 58:12 – Quickfire: addressing deficiencies before treatment 1:03:37 – The two fundamentals: deficiency and toxin removal 1:07:10 – Peter's two walking life hacks 1:09:02 – Juvent discount code & buyback guarantee 1:11:16 – Newton's law: the quick safety litmus test 1:12:05 – Where to find Juvent + closing thoughts Connect with Peter: https://www.linkedin.com/in/peter-simonson-330443b/ Get Juvent: https://www.juvent.com/?ref=pugsstmo Use Code Beautifully broken Upgrade Your Wellness: LightPathLED Red Light Therapy: https://bit.ly/4gwYiUh Code: beautifullybroken Explore Aurawell PEMF and Magnawave: https://calendly.com/freddiekimmel/let-s-conect-clone Silver Biotics Wound Healing Gel: https://bit.ly/3JnxyDD 30% off with Code: BEAUTIFULLYBROKEN MaxGen Labs: https://maxgenlabs.com/BEAUTIFULLYBROKEN CONNECT WITH FREDDIEWork with Me: https://www.beautifullybroken.world/biological-blueprintWebsite and Store: (http://www.beautifullybroken.world) Instagram: (https://www.instagram.com/freddie.kimmelYouTube: https://www.youtube.com/@beautifullybrokenworld Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

The Derm on RheumNow podcast is a review of recent citations and content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, CTD skin disorders. dermatology drugs, biologics, andJAK inhibitors - their use, efficacy and side effects. Features Dr. Jack Cush, Editor at RheumNow.com. Show Notes: Latest #s: EHR estimates from 6 large US medical systems, estimated prevalence of autoimmune Dz (AID) to be 15 million (4.6% US population); 34% have 2+ AID. Women have 2x risk. Sex ratio of 1.7:1 F:M. https://buff.ly/fYgRfZ0 POETYK PsA-1: Deucravacitinib in Biologic-Naïve PsA POETYK PsA-1 trial tested the disease modifying efficacy of deucravacitinib, a tyrosine kinase 2 (TYK2) inhibitor, in PsA patients and was shown to be superior vs to placebo for clinical responses, patient-reported outcomes, https://t.co/VjwpCVKPz0 MoonLake announced positive phase 3 data from its IZAR-1 RCT using its dual A/F IL-17 inhibitor sonelokimab, showing significant responses at week 16: 66% ACR20, 42% ACR50, 41% minimal disease activity (MDA), & 61% PASI90 at week 16. a 2nd IZAR-2 PsA RCT is in progress https://t.co/eX0cxekRKG British Dermatology Biologics registry (BADBIR) 18976 #PSO pts had incidence serious infxns (SIE) 28 SEI/1000 Pt-Yrs; higher if they had prior infxn (79/1000 PYs). SIE signif lower w/ RIZankizumab (HR 0.74-.80) vs BROAD, ETN, other standards Rxs. SIE deaths rare (1.81/1000 PYs) https://t.co/GTr3DLCVXs 39 studies compared Juvenile systemic sclerosis (jSSc) & adult SSc. 935 jSSc vs 15,451 aSSc pts; jSSc had more diffuse cutaneous dz (70% vs 41%), more overlap myositis (33% vs. 5%), arthritis (33% vs 18%), digital ulcers (51% vs 20%), less renal crisis (0% vs 6%) & lower mortality jSSc (7.7% vs. 20.4%) https://t.co/vflarmwSyv Italian SPRING cohort of #SSc pts found only 5.3% (of 1689 pts) without the typical scleroderma pattern on nailfold change by NVC. They had milder dz, with less vascular dz (pitting scars 33 vs 48%), telangiectasias (52 vs 74%), calcinosis 3.4 vs 12%) & higher DLCOs at 12, 24, https://t.co/AoNAhVYfII Review of CAR-T 29 trials in systemic sclerosis (SSc): 27/29 target CD19 (other CD20, BCMA), 20/29 autologous. Only 2 RCTs; 1 w/ RTX comparator. Most included CREST. Schetts largest series had 6 dcSSc w/ skin/lung improvements. Need fewer & larger multicenter RCTs https://t.co/Me28HbaFhR SLE & Dermatomyositis rashes maybe classically red or violaceous in Whites,but different in people of color, where erythema often appears brown/violaceous, Gottron papules can be mistaken for "dry skin." This delays dx, especially in anti-MDA5+ RP-ILD, where rash may be the https://t.co/Savx5IOTcG Yesterday the EMA approved upadacitinib (Rinvoq) for the Treatment of Adults and Adolescents with Non-Segmental Vitiligo - the 1st therapy approved for the most common form of vitiligo. Based on positive results from the Phase 3 Viti-Up trials https://t.co/MMv5LjZclQ 3 Rx are FDA approved for hidradenitis supprativa (secukinumab, adalimumab, bimekizumab). New JAK1i Povorcitinib in STOP-HS1 and STOP-HS2 ph 3 PCTs (608/619 pts). Povo showed HiSCR50 ~42% vs PBO 29% @wk12. AE: acne, pharyngitis https://t.co/n3FJUOjNuo

When we first dicsussed the Summer of Simulative AI in 2024 we knew it would be a brief summer, but it has recently come back with a vengeance with SimGym in April and now Simile AI's $2B Series B, backed by GreenOaks and Index Ventures with prominent backers like Fei-Fei Li and Andrej Karpathy, running tens of millions of simulations for Fortune 100 clients like CVS and 85–99% accuracy vs human focus groups. Time to catch up on why this Second Summer of simulation is working!From creating Smallville, the landmark 2023 paper on Generative Agents that showed AI characters could remember, plan, socialize, and develop emergent behaviors, to now building foundation models of human behavior, Joon Sung Park is trying to answer a much bigger question: what if we could simulate the world before making decisions in it? In this episode, the Simile co-founder and CEO joins us to unpack the path from generative agents to digital twins, why today's frontier models still fail to capture how humans actually behave, and what it would take to eventually simulate all 8 billion people on Earth.We go deep on Simile's approach to modeling human behavior: long-form interviews, observational and transaction data, randomized controlled trials, population-level and individual-level models, and post-training on the causal mechanisms behind why people make decisions. Joon explains how his research created digital twins that reproduced human behavior and attitudes 85% as accurately as people reproduced their own responses, why models optimized to be rational can be bad simulations of irrational humans, and why understanding “social physics” may require changing model weights rather than simply prompting frontier LLMs.We also explore the much larger ambition behind simulation: testing products and policies before deploying them, finding counterintuitive paths toward desired outcomes, modeling emergent behavior across entire societies, and potentially tackling problems like climate change, democratic instability, and UBI. Joon reflects on scaling laws for simulation, the economics of data-center-scale simulated worlds, the connection to Thomas Schelling and psychohistory, why simulation is surprisingly similar to painting, and whether we might already be living in one.We discuss:* How Smallville and Generative Agents led to Simile* Why Joon's team asked: “What if we can just recreate the world that we live in?”* Why useful personal agents require deep models of their users* Memory architectures, Markdown files, and the limits of prompting* “Social physics” and behavioral foundation models* Why web data captures what people say more than what they actually do* Interviews, transactions, observational data, and randomized controlled trials* Why predicting the future matters less than understanding how to shape it* How Simile creates representative simulated populations* Simulation versus prediction and the connection to Foundation's psychohistory* How to evaluate simulations instead of simply stacking LLM hallucinations* Creating digital twins of 1,000 real people and reaching 85% behavioral accuracy* Why frontier models can struggle to reproduce real human behavior* Why good simulations need to reproduce human biases and mistakes* Post-training models on randomized controlled trials* Population-level versus individual-level simulation* Scaling laws for human simulation* The long-term ambition to simulate all 8 billion people on Earth* Whether simulations could help solve climate change or detect collapsing democracy* Thomas Schelling and the history of agent-based modeling* Why future simulations could require an entire data center* Multi-agent simulations and what happens when simulated people interact* Replacing expensive human panels with synthetic populations* Why market research is only the starting point for simulation* Why Joon sees simulation as surprisingly similar to painting* Using simulation to study questions like UBI* Whether we are already living in a simulation* Why AGI and simulation may be the twin technologies of advanced civilizationsJoon Sung Park* LinkedIn: https://www.linkedin.com/in/joonspark* X: https://x.com/joon_s_pk* Website: https://www.joonsungpark.com* Simile: https://www.simile.comTimestamps00:00:00 Introduction and Joon's Path from Art to AI00:01:46 Smallville, Generative Agents, and the Origins of Simulation00:05:03 “Let's Just Create a World” and the Future of Personal Agents00:09:53 Social Physics and Behavioral Foundation Models00:14:08 Prediction vs. Simulation: How Do You Shape the Future?00:16:59 How Simile Models Real People and Populations00:25:35 Evaluating Simulations, Digital Twins, and 85% Accuracy00:30:23 Post-Training Models to Reproduce Human Behavior00:40:04 Scaling Laws and Simulating 8 Billion People00:43:10 From Schelling to Society-Scale Agent Simulations00:46:13 The Cost and Economics of Simulating the World00:52:05 Real-World Use Cases, Synthetic Populations, and the Market00:57:27 The Future of Simulation, Painting, and UBI01:04:23 Are We Already Living in a Simulation?01:06:08 Building Simile and HiringTranscriptIntroduction: Joon Sung Park, Simile, and the Story So FarVibhu [00:00:00]: Today, we have Joon in the podcast. Excited to kick this one off. Very exciting company. I wanna kick off and ask you the question, talk us through the story of your life. How have you gotten here?Joon [00:00:13]: Yeah, for sure. I'm really excited to be here. A story of my life. So I was born in Korea, and I lived there for a good 11 years or so of my life, and then my family moved to Boston. So we moved when I was 11, and my parents were doctors, so they were going through their postdoctoral studies. My dad was a surgeon, so he was doing his sabbatical years at the Boston Children's Hospital. So I grew up there, not too close to tech. I was very much a music and artsy, painting kind of guy.Vibhu [00:00:49]: Painting.Joon [00:00:49]: Exactly. I got into painting a little bit later, in high school, but that's what I used to do. And then I grew up mostly in the East Coast after Korea. So I lived a good number of years in New Hampshire, and then I went to college in Pennsylvania. And I got into more of this tech scene, in college. So I was originally trained to be an artist. I thought that would be my professional career. So it wasn't a hobby. It was like, “Hey, let's make a living out of this.” And then gradually, I got really interested in this idea of, hey, the greatest artist often creates their own medium, and the best medium that we had available today was in computation. So I decided to go deeper into that, and one thing led to another, and we can go deeper into this, but I decided that research was something that I gradually got interested in, and here I am.Smallville, Generative Agents, and the 2023 Breakout PaperSwyx [00:01:46]: So there's a lot that you packed into the research components. You had one of the best papers of 2023, which was the generative agents paper, commonly known as the Smallville paper.Swyx [00:01:58]: Feel free to call back to anything else that you mentioned, but most people would have heard of you from this. Do you have any statistics on how many people have, like, read it? arXiv gives you something, right? Some stats.Joon [00:02:10]: Yeah, it's a good question. How many people have read it, I'm not sure.Joon [00:02:14]: I know we do keep track of citations, and they are going up quite fast.Swyx [00:02:23]: Yeah, Google Scholar has 7,200 citations.Vibhu [00:02:25]: I feel like it made a bigger hit than that, and it was a pretty instrumental paper. It got cited so many times.Swyx [00:02:34]: It is frequently the answer when people ask, “What is the best paper you've read recently?” It's this one.Vibhu [00:02:39]: I thought the memory component was pretty underrated. It was a very good early memory system, and one of the biggest papers.Foundation Models and the Search for Killer ApplicationsJoon [00:02:47]: Yeah, so maybe I can talk a little bit about how this particular paper came together. So when I got into research, it was back in 2020 when I started my PhD program at Stanford, and that was the year, when we were about to get GPT-3 to be available. So we already had GPT-2, and you could sense that there was this new class of models that was just becoming available in the market, and the team got very intrigued. And the general consensus was, “Well, is this model going to be useful for anything?” “It's really strange that these models are not trained to do any particular task.” But we decided to take a bet. So a large group of scholars at Stanford, and it was led by one of my co-founders, Percy Liang, and we came togetherSwyx [00:03:35]: Who coined foundation models.Joon [00:03:36]: Who coined the term foundation models. We wrote this paper, where that term came from called Opportunities and Risks of Foundation Models. And during that process, really the thing that I started to think deeply about was, here is a model that is fundamentally new in our ecosystem. The reason why this was new was it wasn't, again, trained to do anything in particular, but its premise was it could do anything and everything. It was like a stem cell, if you were to take a biology analogy. And I got really interested in this idea that, well, if we were to really think about what are the killer applications that this particular technology would enable, what would that be? Many of my colleagues were using this for simple classification, simple generations. Interesting that these models can do that, but from an interaction perspective, not that interesting. We've known how to do that for many decades. And what we came down to was these models are trained on this very broad data from the web, right? So these are human behavioral data. It's social media, Wikipedia, all these data. So if you poke at the right angle, then you could see human behavior that would just pop out that's quite realistic, and we've never seen that before.The Time Machine Game and Recreating the WorldJoon [00:04:45]: So that got us really interested. The exercise that we decided to do, with this particular group of colleagues, Michael Bernstein, Percy Liang, and myself, who ended up becoming my co-founder at Simile, we sat down and we played this game that we call the time machine game.Joon [00:05:03]: Imagine we were to get on a time machine and fast-forward 10 years and look back. What would have been the single application that will have mattered that would be the most interesting and inspiring? And when we thought, “Well, what if we can just recreate the world that we live in?” it's really hard to get more ambitious than that. Like, let's just create a world.Joon [00:05:24]: And that's where we started. And initially, we had this paper that was a precursor to the generative agents paper called Social Simulacra.Swyx [00:05:32]: Before you go further, were there other candidates for the most ambitious thing in the time machine exercise? What was number two or number three?Personal Agents, User Models, and Why Simulation Came FirstJoon [00:05:44]: There is a close second that we were considering, which ended up becoming more of these automation tools, especially the vision around really personalized agents that would do things for you.Swyx [00:05:59]: That's also happening.Joon [00:06:00]: It's also happening. But it was interesting for us, right, in that the reason why, we decided to go with the idea of simulation, one, I was a huge science fiction nerd, and this idea of creating simulation, I was personally really just fascinated. I loved the idea. It's really cool to see, like, a game town like this and just see these agents live in it. But at the same time, my bet was if you were to create a really amazing personal assistant out of this technology, what you need first is an amazing model of your users. So I told a model, “Hey, can you go buy late dinner for me?” And it orders Hawaiian pizza, and I do not like pineapples on my pizza. Then it totally failed. The way for it to not make that mistake is only by having a deep understanding of who I am. And I gave a very simple and dumb example here, but you can imagine how this core understanding of people is instrumental. This is how, if we have our family and closest friends, they have a good mental model of who we are. That's the basis of our social connection. So our bet also was this technology around simulation, creating accurate representation of people ought to precede the more complex agents that would automate the world that we live in. So that was the bet. But that was a very close second, and I'm still very much fascinated by it. I think there's a lot of interesting work that's going around. My hot take here, though, is I don't think we've seen a true personal assistant that's useful, in ways that meet the ambition of that particular line of work. I think there are early applications that are interesting, and if you talk to even ChatGPT nowadays or Claude, they know a lot about us. So a lot of the generation it's doing, I do think it's much more tailored, but I think the ambition is quite large in that field, and I don't think we quite have all the right ingredients just yet.Swyx [00:08:01]: So OpenClaw and these personal agents, what do you want to see from them that they don't currently have?Memory, Markdown, and the Limits of PromptingJoon [00:08:09]: I do think it's slowly getting there, but I do generally want them to have much deeper understanding of the person. Right now, you look at the models. OpenClaw, what it's leveraging is a Markdown file, and I think it's quite clever, right? So if you look at the generative agents paper, this was the same intuition that we had, where initially when we were creating the memory architecture for the generative agents, and, like, this is, like, back in 2022, so we didn't really quite have the idea of even agentive architecture or the term agent. But the intuition that we shared with some of the work that's coming out today was we initially thought, “Well, do we want to make the memory into, let's say, knowledge graph? Do we want to train a bespoke model?” All of these things. And what we decided to do was, “No. Just forget about all this.” These language models are quite good at modeling text and understanding and reasoning about text. So just put everything in a Markdown file or a text file. You're done. I thought that was quite interesting that we could do that, and there's a lot of strength in doing that. But also, there are limitations. It's the way you retrieve and make sense of data that's extremely large, it takes a lot of work. So I think that technology is getting better. I also do, however, think, there are certain things you just cannot shape just by prompting the model. So to some degree, you do need to touch the parameters of the model itself. So there is this work that I do think does need to happen, and it is happening. The question is, how far can we take it? How do we source data, and how do you also create an ecosystem where people are continuously feeding data to this model so it's learning about you?Vibhu [00:09:50]: What's the intuition between why you need to do it in the model?Social Physics and Behavior Foundation ModelsJoon [00:09:53]: My intuition behind the actual when do you train or even post-train a model versus just prompt a model is if the model has to learn the underlying physics of the world that it's operating in. So it has to learn new social physics. The places where it doesn't have to train are the places where it already has the physics. We trust the physics. It already has the base statistics, but it's just trying to react to an environment. Then I think you can just prompt your way into getting the actions out of it. I don't think the models that are out in the open have yet learned the complete mapping of social physics of humanity. This is one of the core theses of Simile, right? And one of the core reasons why that is the case is if you look at the data that the model was trained on, these models were trained on the web data, like, whatever was available on the web. And these are really interesting data sets, but they are fundamentally the self-exposed attitudinal data with some behavior data that's sprinkled around here and there. And it has yet to learn the really deep behavioral nature of people, not just what people say they do online, but what they do in real life. And this is one of what I would consider to be the dark knowledge of humanity that we haven't quite captured. And it's these data that would also need to get factored into the model creation.Vibhu [00:11:21]: You call it behavior foundation model.Vibhu [00:11:23]: There's a good one-liner here, but outside of that, what type of data do you need? What are you changing on the model level? How do you go about modeling, doing a behavior foundation model?The Three Data Buckets: Interviews, Behavior, and CausalityJoon [00:11:35]: We think about data in three buckets. So one bucket is interview data. It's quite interesting. Rich qualitative data is interesting. It's not behavioral, but we would literally ask people, “Hey, tell me the story of your life.”Vibhu [00:11:53]: It's just what we're doing here exactly.Joon [00:11:54]: The question that you all asked at the beginning of this interview literally is the question we also ask. And we ask our participants to go a little bit deeper, than how far I went. Maybe I can give more of my life story in lieu of this. But the reason why that data is interesting is by learning about this very long-tail information about people, you get a lot of texture around this model, like, this person as a model. So even understanding their childhood memory or even their trauma, their first love, these things, quite informative in ways that's really hard to predict. So that's one. Then there are two tranches of what I would consider to be the behavioral data. One kind of behavioral data is observational. So these might be like transaction data, or these might be data that you can get by scraping the web, right? So you can imagine why these data sets would be interesting, right, because they give you the base statistics of people's behavior.Joon [00:12:55]: But then there is the last category of data, that I personally think is perhaps the most important, which is the data that describes the causal mechanism, the whys of people. Some of this is covered by the interview data, the qualitative, because people talk about why they made certain decisions. But really, where you get to see the most behavioral aspect of this is in randomized controlled trials, like RCTs. Imagine you have the same setup, but you have a few different variables that you are trying to tweak. Can you get realistic human behavior out of it in ways where, imagine you had this particular option. Imagine you're even trying to choose whether you're going to drink coffee or not. The day you drink coffee versus the day you didn't drink coffee, does your behavior change? That's a data set that describes a causal mechanism. This is quite important in modeling people. The reason why this is important is oftentimes when people come to us, or not just to us, but the reason why people are interested in simulation isn't because they want to predict the future. If you're trying to win against the stock market, predicting the future is interesting.Prediction vs. Simulation: Shaping the FutureJoon [00:14:08]: But most people, most decision-makers, what they want to know is, how can we shape the future? It doesn't really help you to hear that your sales are going to tank in two quarters. They're just gonna say, “Wow, that sucks.” What they want to know is, well, what do we need to do now to avoid that future? That's the causal mechanism. And this is also very hard data to come by, right, because the world is our ground truth, but it happens once. So in a very controlled setup where everything is equal except for one variable, this kind of data set rarely happens. So this is a reason why this data set is both hard to come by and quite important if you're trying to model human behavior.Swyx [00:14:50]: So behavior, I think, is the hardest data set to acquire. What is out there? What is even possible? You're not going to know a lot of details about my life. I don't even have data for myself on my own health or habits, and I just don't log everything. So how can you have that data?Joon [00:15:14]: So we run a lot of randomized controlled trials.Swyx [00:15:17]: But you put people in the lab, they watch them sleep, or what?Joon [00:15:20]: We do care a lot about the consent process. People know that we invite them to be a member of this community to both share data and have themselves represented in different forms. But we bring a lot of people to the lab, or virtual lab, where we design experiments that would pose them real behavioral decisions. And often in these experimental setups, what makes the difference between what is attitudinal versus behavioral is whether the stake in your decision is real. That's ultimately what makes it behavioral. So in these setups, we are inspired by our colleagues in social sciences, psychology, and so forth. So when they run studies, the techniques they utilize is imagine there's an online store that you're inviting people to come by. Then whatever they purchase in this experiment, they actually get that item delivered. Like, these are the things that make the stakes real. So we run a lot of these experiments, and we also do partner with firms. Right now, we also have customers who are quite excited to at least give us a glimpse of the behaviors that their users exhibit so that we can get a little bit deeper understanding of how people behave in these different platforms.How Customers Use Simile: Populations, Queries, and ExperimentsVibhu [00:16:39]: I think on the customer side, they have a lot of data about their users, who has bought. They have the action data.Vibhu [00:16:47]: Can you walk us through an example of what someone comes to you for? What questions would they want solved? Do you customize a model for them? Do you have something off the shelf? What does that look like?Joon [00:16:59]: Today, when people leverage our models, it's often to better understand the population of their interest. So usually, the start of the relationship, we come together and hear about what population they want us to model, right? So it might be that if you're a CPG company that's selling to all of the US, then maybe it's fairly straightforward. You want to model the gen pop of the US. But at the same time, if there is a vertical or if there's a market that they're trying to go into, imagine, they want to better understand, let's say, people in their 20s and 30s living in California. That's a much more specific population. So we hear about this population, and we go recruit these people, with consent, and with incentives, and we collect some of their data and create a model of these people. Then what our product allows you to do is query them. So it can take as input a filter that is a description of the population that you want to talk to, just like the one I just mentioned, and an environment. The environment can literally be survey questions, behavioral experiments, It can be A/B testing. Oftentimes, the core use cases are things like concept testing, to start with. But also, people sometimes want to do focus groups or one of the fun use cases that we also serve is even modeling things like earnings calls for public companies.Joon [00:18:21]: So these are the use cases that we often start with.Swyx [00:18:23]: Concept testing, is that an established term? I've never heard of concept testing.Concept Testing, Gallup, and PoliticsJoon [00:18:27]: Yeah. So it has to do with they have, let's say, different messaging, different products, different ideas.Swyx [00:18:32]: It's like a marketing exercise.Swyx [00:18:33]: Okay, got it. Got it. Politics?Joon [00:18:36]: We do, have a strategic partnership with Gallup, and of course, Gallup is deep into policy space and so forth. Right now, we have not worked deeply with politics, like that area just yet, however.Swyx [00:18:49]: I'm curious if there is demand or if they really would have different needs that somehow fundamentally don't mix with your existing, users or people.Joon [00:19:00]: I think there's certainly demand.Joon [00:19:02]: But we are very much mindful of how this technology gets adopted and the societal impact that we'll end up having with this technology. And I do see politics as an area where a company has to be particularly thoughtful about the way they operate and make impact. So this is where we also want to make sure that we form enough of guardrail and perspective on how to leverage this technology before we go on to serve markets like the politics.Swyx [00:19:29]: I'll give people an example. one of my favorite shows is The West Wing. I don't know if people have watched.Swyx [00:19:34]: One of the key storylines is, like, the president has, multiple sclerosis, but they haven't. they need to figure out how to disclose it. So they run a poll with a fake governor and ask people to respond on the poll,Counterfactuals, Polling, and When Simulation Is UsefulSwyx [00:19:47]: They try to make decisions based on the results of that poll on, like, how well they'll be received, like where, how should we play this?Swyx [00:19:54]: And I'm like, well, I think those counterfactual things, I would use a simulation for this if I could trust it.Joon [00:20:01]: For sure.Joon [00:20:02]: In that show, how'd it go?Swyx [00:20:04]: In that show, it was, like a foregone conclusion. They were like, “We know it's bad. We just don't know how bad.” And then the poll came back. It was like, “It's really bad.” And then they just did it anyway.Joon [00:20:14]: Part of it is to show, right? So you're, you're looking at the ideaSwyx [00:20:17]: Maximizing drama.Joon [00:20:18]: How bad could it be? Oh, it's horrible.Swyx [00:20:20]: And to some extent, I think that is part of the trick of the, or the challenge or with being a customer of yours, which is that if I know it's. if I roughly know and can intuitSwyx [00:20:35]: What the effect is going to be, do I need you? What sensitivity of it, of effect do I need in order to make a decision, right? So for example, if I, my approval rating is 50%Swyx [00:20:48]: And I, they have this negative piece, news item comes out, and it drops to 30.Swyx [00:20:52]: If it drops to 20, if it drops to 40, do I care? No. It, I know it drops. It's negative. So when do I care about simulations?Joon [00:21:01]: You do something that's clearly bad, that's not popular, and people don't like you, like, yeah, it's likeSwyx [00:21:05]: You don't need a simulation.Joon [00:21:07]: Yeah. Well, so there are a couple of things. one is, there are use cases where, like every day, developers, designers, policymakers, marketers, every single day, they create assets. They create new products. And turns out, it's many of the decisions in hindsight is obvious. Yes, of course this is bad, but we still run those studies because understanding the magnitude and understanding how acute something is quite difficult, even if, we feel like, of course, like this makes sense. this is the reason why we make so many mistakes. Like, every time somebody goes online and say something that has huge backlash, you look at that and like, “What an idiot.” However, it's tough. That's one. There's also another aspect here, which is, again, this is the reason why simulation is different from prediction. In simulation, in the ideal case scenario. So what simulation is trying to show is it's trying to show each step of the way or each step that we need to take to get to a certain outcome, right? So in the most advanced simulations, sometimes the next step that we're suggesting might be quite counterintuitive. The analogy that I sometimes give, and I ground it in a more realistic example, but, I, as I mentioned, I'm a huge fan of science fiction, and I don't know how, many of the audience members have read, like, things like the Foundation series by Asimov.Simulation as a Path, Not Just a PredictionSwyx [00:22:37]: Oh, yeah. We've mentioned psychohistory a number of times.Joon [00:22:39]: Okay, fantastic. So I might be, talking to the right crew. If you read Foundation series, literally the first act is there's a group of scientists who have found out that, “Oh, our galactic empire is going to collapse, and we're going to have 30,000 years of unrest.” And they run psychohistory, the simulator that tries to teach them, “Okay, how can we keep this unrest to a 1,000 years?” And they plan this out, and the first step of that plan is to get the scientists who say, “Okay, this is coming,” exiled into this random place in this, galax- galaxy.Swyx [00:23:18]: Terminus.Joon [00:23:19]: Exactly. And that's so counterintuitive. Like, what a strange move that you literally sent the group of scientists who was raising voice around this potential collapse of galactic empire into nowhere. How is that the right first move? Well, it turns out in this particular simulation, that was the move.Joon [00:23:40]: It's these things, right? And the reason why these reasoning is possible is because you're showing the step function or each step that results in a particular outcome. So really what simulation allows you to do in its highest form is you give it not a problem or question, like what would people answer to the survey? That's not what we do. What we tell it is, “Here is a goal that we have. In the context of foundation, we want to keep the unrest to a 1,000 years. What is the path that we need to take now to get to that particular future?” And that's what simulation allows you to do. Now, translating that into real market, imagine you're a automobile company and you're about to release a, EV, and you're trying to understand, well, how do we market EV, to make sure that our stock price goes up? But what if the answer comes down that, well, you can market your EV in XYZ way, but that might change people's perception around the cars that's not EV and make your overall sales to go down. Not very intuitive, especially all you're trying to optimize is EV salesss, and that's the only thing that you're tracking, then that might result in a completely wrong solution, or at least different solution than what you would have expected, whether it's right or wrong.Joon [00:24:57]: That's the power of simulation.Swyx [00:24:58]: For listeners, we covered a similar topic with Mikhail Parakhin from Shopify, where they are working on SimGym. I don't know if he ever talked to you about it. it's very similar.Joon [00:25:07]: ISwyx [00:25:07]: The goal is increased conversion, but then the journey is very unusual.Joon [00:25:12]: Journey is unusual.Swyx [00:25:12]: Yeah. The-- He's trying to look for interventions on a shopping trajectory, which is similar to what you're saying. Like, it's not about the attitudinal, is your word for it.Swyx [00:25:24]: It's about behavior.Joon [00:25:25]: It's about behavior.Swyx [00:25:25]: And that's exactly the difference, right? It's, like, not about the near-term direction about-- but it's more about, like, how do you affect multiple turns of interactions.Vibhu [00:25:35]: You had a good quote at the start about this as well. It's not about people wanting to know the outcome. It's about how they can change it, change the way to get there, something like that. But I wanna take it back to how do we know this is grounded? LikeGrounding and Evaluating Digital TwinsVibhu [00:25:47]: How do you run evals? How do you test that simulations come through? if I was to do the same thing that you described with, say, your favorite LLM, Opus, GPT-5.6, have some agent to map out these thingsVibhu [00:26:02]: How different are the answers we would get if I give it the same goal, the same objective, make a decent system? You're saying that you need to change the model weight. You have your own solution to this. But how far off are we, and how do you check if it's grounded? you have some interesting stuff on your site that points to how you run real evals, but if you could take us through that side. I think that's one of the big concerns that people have. They're like, “LLMs hallucinate.”Vibhu [00:26:27]: “You're just hallucinating layer after layer,” right?Joon [00:26:30]: The way we do this, and this is the paper that we worked on after the generative agents paper that really became the, at least for Simile and also the field of simulation and synthetic panels, really became the foundation. Yeah, this is the paper. the paper is called Generative Agent Simulations of 1000 People. Here's what we've done. For this paper, we brought 1,000 people that's representatively sampled from the US to a virtual lab. And what we have done was we spent two hours collecting fairly wide-ranging data. In this particular study, we focused a lot on this interview data, that was, whose script was taken from this project called American Voices Project. And then we would also pair that with a lot of behavior data and so forth, whatever we can collect within two hours. And then we would send these people away for a couple of weeks. And during that time, I would use this data to create their digital twins. And I would bring the humans, participants back after 2 weeks and have them complete a battery of surveys, experiments, behavior studies. So we have the list here, which included things like behavioral economics games. We would run literally, like, Big Five personality test, General Social Survey. We would also go ahead and run the randomized controlled trials that were published on PNAS. And we would have their digital twins predict how the source individuals would have acted in these studies and surveys. And this is where we could replicate people's behaviors and attitudes 85 percent as accurately as people would replicate their own. So that was the first really paper that gave this validated results that we can model individuals in an accurate way. And what we ended up finding now, of course, in AI space, so this paper came out at the end of 2024. AI space, a year and a half, 2 years, that's a lifetime.85% Accuracy and Why Frontier Models Miss Human BehaviorSwyx [00:28:24]: Yeah. Just, for listeners who are not seeing the YouTube, I just wanna say, like, the headline figure is 85 percent accuracy, like, which is a big improvement over all the otherSwyx [00:28:34]: Methods that you showed.Joon [00:28:36]: But the part that was particularly striking to us, especially as we improved this technology even further, was the generative AI models like ChatGPT, Claude that's coming out, it does give you the right foundation. However, what they do not consider is the true attitudinal and behavioral aspect of people, especially in the population that you care about. So what these models are really good at today is they're trying to become the super rational, objective machines, right? So you go get their data from places like Mercor, Scale. You talk to professional programmers, scientists to create model that's amazing at reasoning. That's what they do. Simile doesn't care about any of this. The models that we're talking about here, what we're trying to create are models that are as dumb as I am, right? So if I make some mistakes, the model has to make the same mistake.Swyx [00:29:34]: Oh, that's very hard.Joon [00:29:35]: That's very hard.Swyx [00:29:36]: You're solving Murphy's paradox.Joon [00:29:37]: That's exactly. And this is a completely different data and training objective. This is also where we see quite a bit of discrepancy in the performance in human behavior prediction between the frontier models, Simile's model, and the models being created in this space, where in some cases, the model performance of frontier models go all the way down to 20, 30 percent, especially if you go into that more niche population on topics that our customers would care about. On more gen pop, it might be around 50 to 60 percent. So it's not very robust. Like, you wouldn't want to make your decision off of these and these findings. If you can bring that up to 85 percent, that is ultimately what people end up getting very excited about.Swyx [00:30:20]: Yeah. Do we wanna keep going on the paper, routes?Joon [00:30:23]: Yeah, for sure. So the last one, was an interesting one. So this, paper was the follow-up paper that we had, to the 1000 agents paper, where the idea was now can we augment the models even further and post-train a model based on a lot of randomized controlled trials? So this was an interesting one. The data is always the most interesting part of modeling in many ways. The data that we got here was there's this, there's this platform called Open Science Framework. So some, the audience might be familiar with this. And there has been, especially in the social sciences over the past 5 years or so, there has been this concern around replicability of studies. And so it was a bit of a crisis, the scientists acknowledged, where we rerun the study and we don't see the same finding.Post-Training on RCTs and Replication StudiesVibhu [00:31:12]: Oof.Joon [00:31:12]: It's tough. And the reason why it's there-- that was often the case was there's this survival bias where the papers that get published often need to maintain what we call the value of less than 0.05 in the experiments that we ran. That suggests that only-- there's only 5% chance that the results that we saw is false positive. But the tricky part was all the papers that were not published, and there's still a 5% chance that whatever we publish is totally just randomly generated. Like, there's a 5% chance that, hey, this effect is not real, but it just happened to be real because of the sampling bias. So because of that, what scientists started to do was they started to register their studies. So before running an experiment, they would go to this platform and say, “Here is the data. Here is the population that we're collecting, and here's the hypotheses.” And they would just say, “Here is our hypothesis.” Like, “This is what we believe.” And you cannot retroactively change those hypotheses. This is what gives us more scientific statistical confidence that whatever effect that you ended up seeing is true. So that ended up creating this really interesting platform where there's one platform that has now contains tens of thousands of real-world experiments and hypotheses. And a lot of these are really high-quality, like, professionally designed behavior studies and random- randomized controlled trials. So we got the data and the studies from this platform and used that to make a point. And this particular, model is not, something that we're serving commercially because this was a part of the open science. But this particular data set, helped us make a point that by collecting a lot of these randomized controlled trials, that are really well-designed, we can make significant improvement in model's capability to predict human behaviors. So that's what this paper was about.Vibhu [00:33:10]: Is this stuff done on a individual level? Like, do I need to tune the model per individual, per company? Is there foundation model changes and then some slight post-training? Anything you can share there?Population-Level vs. Individual-Level ModelsJoon [00:33:21]: So this particular model was trained. the data we had at the level of individuals, but this particular model was trained. We experimented with both. And this is what we end up doing at Simile too. We always train 2, distinct model. One is what we call the population-level model. The other is what we call the individual-level model. And both take very similar input, which is the description of a subpopulation or individual and a stimuli. In this particular work, we've done the same. Here, the results that we are reporting are much more geared towards individuals because we do think that is a harder task in many ways, but that's what we have done.Vibhu [00:34:02]: You seen anything on the questions that humans can solve that models can't solve? So likeHuman Biases, Mundane Choices, and What Models MissVibhu [00:34:09]: Currently, it's, I live 5 minutes walk away from a car wash. It's a 10-minute drive. Should I walk or drive?Joon [00:34:16]: Huh.Vibhu [00:34:16]: The model will say, “Oh, walk to the car wash.” And, you don't have your car.Vibhu [00:34:20]: Is anything like this a problem in simulation? You would assume, like, very simple for human to think about, but if the model is saying you should walk to the car wash, anything here?Joon [00:34:32]: It's less, what can we solve, but I think it's more about what biases or mistakes do people make that models miss. Like, imagine that you are, like the. When I was still at Stanford, I lived in Palo Alto. So it's about, I would say, 40-minute walk from the campus. You ask the model, “Okay, let's go home. What can I, what can I do?” It would likely call an Uber or, give me, the bus time. But for the longest time, I really liked walking back. And the reason why I wanted to do that was not for efficiency. It really helped me think. And I like to walk for, half an hour or 40 minutes or so a day, where I just get to, just think about ideas, research, just get lost in my thoughts. That's very human activity. Unless the model has seen that and understands the importance of that activity, it would miss these kinds of features. So that I think, is fundamentally what we're trying to model. Like, what is fundamentally human might not be the most efficient thing to do, might not be the right thing to do, but things that make us who we are.Swyx [00:35:43]: I'm curious if, there are some data sets that you really want that would materially help you. One version of this may be interesting, which is more valuable to you to acquire as a data set, all of LinkedIn, all of Twitter, all of Facebook?What Data Matters: Social Media, Transactions, and FacebookJoon [00:35:57]: It's a little bit hard to rank, in part because, there's, there's this product saying where no feedback is wrong because it teaches you something about your users. Doesn't matter what feedback.Joon [00:36:11]: I think it's a little bit like that.Swyx [00:36:12]: So just whatever is bigger.Vibhu [00:36:13]: What about a different domain? Say it was. What about all of Amazon data?Joon [00:36:17]: Oh, yeah.Vibhu [00:36:18]: Shopping data, right?Joon [00:36:18]: Shopping data. So Amazon data is interesting in that it's very much behavioral, although, like, what people do on social media, you could squint and say that is also behavioral. But the transaction data is always interesting. It is also most commonly available, however.Joon [00:36:33]: If we were to look at purely social media, like if you really, if I were, if I had to really pick, Facebook likely is interesting because I do think it is most a default version of people. Because you go to LinkedIn, it's very much professional environment. So people put up their, they have their guards up, right? And that still is interesting because that is true human attitude and behavior, but it is not your base state. you go to Twitter- Twitter, people have their own crazy personas, or depending on who you are. Like, my Twitter profile and, persona is very much, initially was I was very much an academic. “Hey, I'm here to share my studies.” Now, I share, things that's related to Simile. But Facebook is one of those more private space where people just connect with their friends. In that way, I do think it shows you a little bit more about who that person is. So if I had to pick, I'd likely pick, Facebook.Swyx [00:37:30]: Yeah. And you're interested in, like, the whole person and their background and philosophy. I, is it too clinical or too machine learning-oriented to just say this is just ways to inject variance and biases? The broad question, is, like, is this any better than a randomized, like, combinatorial explosion version? So we have a link to the TencentBillion Personas, Synthetic Demographics, and Bespoke DataSwyx [00:37:54]: Billion persona paper, where they did not do any of the groundwork that you are doing.Swyx [00:37:59]: They just did like a cross matrix of here's all the professions in the world, here's all the people, possible backgrounds in the world, do a dot product across all of them, and that's it. That's your prompt for a billion people.Swyx [00:38:12]: This will do something. I don't know if it'll do what you do, but it gets you some way, some percent of the way there.Joon [00:38:18]: So this was an interesting paper. Like, what I admired about this paper when it came out was the scale. And you do gradually want to be able to simulate really large societies and interactions. So the scale is definitely admirable. it is relying heavily on the known statistics that went into training the model. So to the extent that you believe that statistics is correct, this is not a bad way to go about this. But the thesis here, and this is something that we also have seen in the market, like if this works, then we have solved simulation.Joon [00:38:54]: It,Swyx [00:38:55]: Because I survey, like, okay, 5% of the US population is in construction.Swyx [00:39:01]: The other 5% is in medicine, whatever, right? And then you just keep going down the list, and then you do the other side. 5% has, like, the big 5 personalitySwyx [00:39:08]: Of, like, neurotic or whatever. That's it.Joon [00:39:11]: That's it. So if you believe that the underlying data set and the platform that we're leveraging has all the right statistics, then this will have solved it. you're at that point merely retrieving the knowledge that is already embedded in the model, in the model parameters. That's not, unfortunately, what we see, where there is such detailed and also niche knowledge about people that if you just take one example, it might feel very mundane, but it's quite rich when you put together, that you do need to do a lot of bespoke data collection to better understand people. And this is also, I think what makes this particular, job fun, which you want to deeply understand people, and the process of deeply understanding them requires a lot of attention to the details. And you do need to pay attention to and pay respect to the daily lives that people lead.Scaling Simulation: From Thousands to SocietiesVibhu [00:40:04]: I wanna talk about scaling simulation.Vibhu [00:40:07]: So what can't we simulate, what can we simulate, and how does scaling affect this? So how big are the models? What if we go from, 8B, like, couple 100 billionVibhu [00:40:18]: Like billion000 parameters, billion000? Do we get scaling? Any interesting emergence? Like, at a certain scale, at a certain amount of training, you uncover anything unusual and any learnings from that?Joon [00:40:31]: What we are seeing is at Simile, so we do post-train our own model. The thing that we're seeing is the early glimpse of scaling law in simulations. The more data about humans and more compute you ingest, you start to get predictive and predictable gains of the model performance in simulating it, simulating people.Vibhu [00:40:51]: Ooh. We need a scaling law curve.Joon [00:40:52]: It's scaling law. Whenever you find it's a beautiful thing. And we're starting to see the glimpse of it, which is quite exciting. But if you talk about the ambition of simulation as a whole, it's not merely about building a model. It's about building a model, then creating the agents that become the individuals in a much larger ecosystem. So they're creating this multi-agent simulation. Down the line, you want these multi-agent simulation to also live in a very rich environment, right? What we are really trying to get to at that point is, hey, can we create. All right, let's do a time machine game again, and 5 years, 10 years into the future, can we create a simulation of 8 billion people living on Earth? I think that's quite interesting. And that really is the vision. And once you get to that state, the questions that you can help answer for the society also start to change from my perspective. The answers are fundamentally about emergence of the emergent behavior of society and large groups of people.Joon [00:41:53]: So the questions that I get excited by, and maybe this is a stodgy- a bit. I have my, academic side of me.Joon [00:42:01]: And for me, it's questions like, can we help solve climate change? If you look at climate change as a problem space, this is what we, like social scientists would often call it the wicked problems, problem where you have many actors with competing incentives for trying to make a very complex decision and coordinating that coordination decision. Very difficult to really solve in real life, which is also the reason why we couldn't solve it. Can simulation help us solve that? Another one is, can we understand the signals for collapsing democracy, or can we understand or can we uncover the origin story of the monetary system? These are societal questions that we never really had a good way of answering. If we can create simulations of our society, you have to believe that these are the problems that we can solve. So that's really the ambition of this field. And, I also think, yes, I think there's a Nobel Prize to be won there, which wouldn't be surprising. And I think there's some amazing societal impact that we can have to help people make better decisions.Climate Change, Democracy, and Societal SimulationSwyx [00:43:04]: Nobel Prize in economics?Joon [00:43:06]: In economics.Swyx [00:43:06]: Oh, I see. I see. Rooting for you to write that paper.Joon [00:43:10]: One of these days. But, one of the scholars that I was deeply inspired by, When I was coming into the space of simulation, is this scholar, named Thomas Schelling.Schelling, Agent-Based Models, and the Nobel PrizeSwyx [00:43:23]: Schelling point?Joon [00:43:24]: So the canonical example of the work that he's done was he was one of the creators of agent-based modeling. So this was, like, in the 1970s and 80s. It's very early days, but this was truly one of the first exemplars of simulations. And one of the canonical model from that time, and of course many of these simulations are trying to tackle the societal problems that's most relevant for their era, it was called the model of segregation. So racial segregation was a big topic, that, we cared about. And what they've done was they created this grid world where they had red dots and blue dots. And these dots were, back in the day, like, they were the agents, and they had a simple rule that governed their behavior. If certain percentage of your neighbors are of different color and if that goes above certain threshold, then you move to a new location at random.Joon [00:44:21]: One of the striking finding of this paper or this agent-based model was for the longest time, people thought the segregation within society was caused by explicit and overt racism.Joon [00:44:34]: But if you look at this model, people's preference towards living with people of the same color, that preference can be very minute.Joon [00:44:42]: But the very small difference causes the society to segregate completely over time. This was very counterintuitive for a lot of people. And this particular work ended up informing housing policies. Mixed income housing, got really inspired by this work. And Thomas Schelling ends up winning the Nobel Prize for having laid the groundwork for very early versions of simulations. The opportunity that I do see here in the more scientific terms, is agent-based models for the longest, had impact in the 1980s, 90s, to some extent, early 2000s, but it has now gotten forgotten by the community a little bit. Because as you can imagine, red dots and blue dots is not really a rich description of people.Joon [00:45:31]: But with the emergence of things like generative AI and, in particular, generative agents, we do have an opportunity to create these agent-based models that are high fidelity enough to help us make really complex decisions. And that's the opportunity that I see. If that truly works, then yes, that is the work that will result in a Nobel Prize.Swyx [00:45:53]: Yeah. For what it's worth, and I grew up in Singapore. 80% of Singapore is in public housing, and public housing has, enforced racial quotas for exactly that reason, which is very interesting. okay, so we talk about scaling, we talk about all these, the agent possible applications.Cost, Reuse, and the Economics of SimulationSwyx [00:46:13]: I'm scared about the cost. if you even-- let's just keep it to the US, about 8 billion people.Swyx [00:46:21]: But, how much does it cost to model so many hundreds of millions of people?Joon [00:46:26]: Oftentimes today, we don't start at that scale, this stage of the, of industry and simulation as technology. But we can get our users extremely rich and meaningful insights even by modeling thousands, tens of thousands of people. And today what we do is every week we are collecting data on the scale of tens of thousands people's data, and we have panel partnerships that gets us to tens of millions of people globally. So that's what we do today.Swyx [00:46:55]: And just as a side note once you've collected one person for one studySwyx [00:46:59]: Can you reuse that same person for all the subsequent studies?Joon [00:47:03]: That's exactly right.Swyx [00:47:03]: Okay.Joon [00:47:04]: The beauty of this model and these agents is the fact that they are domain-agnostic.Joon [00:47:08]: That what you're really trying to understand is what is the fundamental nature of these people? What's their social physics? And there are a lot of, a lot of, people that does change over time. Like, even, like, even things like, how many times have you gone have you been to, like, CVS the past week? that will change. But there's so many traits about people that are also known to never change. Like, your risk tolerance doesn't really change over time. It's very consistent. So it's these things that we're trying to learn. But the scale we are operating is right now hundreds or, tens of thousands to hundreds of thousands. And in many of the core use cases that we are deployed in, and this is more than enough population, to cover those. Really, at that point, what you care about is less the number of people, but more do you have the right subpopulation of interest covered? And this is also the reason why people want a larger sample. It's not because they want, stronger statistical guarantees. It's more that can they filter down to any population of their interest. However, you can also imagine in 10 years, if we truly believe that the compute is going to scale, that we'll have much more availability for compute, and our ambition for simulation is also going to scale accordingly, there's definitely a reason for us to create an entire data center worth of simulations.Joon [00:48:35]: Or in my hunch here is I do think in the next some number of years, we will start creating simulations that will cost as much as training a foundation model. But perhaps it's going to be so valuable to the society that it would be a no-brainer. Right now, even today, like, we are training bunch of new foundation model just so we can say we trained one and we spent tens of millions. But if we can create a simulation at the level of society that would solve climate change, I would run that today. I would raise the money right now just to run that.Multi-Agent Simulation and Social InfluenceSwyx [00:49:10]: Amazing. the follow-up question is, does it also compound if you let the simulations talk to each other?Swyx [00:49:18]: Or do they already do that today? They don't, right, as far as I understand?Joon [00:49:22]: It depends on what simulation you're trying to run.Joon [00:49:24]: In the multi-agent simulation setup, the agents do talk to each other.Swyx [00:49:28]: Right, which is exactly Smallville, right?Joon [00:49:29]: That's right.Swyx [00:49:30]: But a lot of times, for example, in commerce, you're just by yourself, so there's no point talking. which is way cheaper.Vibhu [00:49:37]: But they use all these levels, right? Like, you decide what you will buy based on what other people around you buy and talk about, right?Swyx [00:49:43]: It depends.Vibhu [00:49:44]: It depends.Swyx [00:49:45]: Again, I'm, I'm coming at this from a cost point of view. I'm like, “Oh my God.” LikeVibhu [00:49:48]: I thinkSwyx [00:49:49]: If there is, like, some combinatorial thing of, like, thousands of people talking to thousands of people, then that one million X's might cost.Vibhu [00:49:56]: I have a very different view as the cost point aside. Like, running these studies in reality is a lot more expensive, right? Running any study like this is you gotta have people do it, you gotta sign people up. It's very expensive and sometimes, like, not feasible to run the study.Vibhu [00:50:14]: But the outcome or the decisions you make are very expensive on them, right? So spend X million on something that, the overall process costs 100 million might as well, right? There's, there's a lot of value to be had there. It's a small cost, but I'm excited on the cost side.Joon [00:50:33]: To some extent, and when you deploy technology, you often want to deploy in a way where you can replace existing budget or you can make things more efficient, and that is the best way to deploy. However, the way you capture the long-term value of the technology is making the argument that, no, it's the upside, that by making this better decision using simulation, you have saved yourself or made yourself hundreds of millions or even billions of dollars, and that's a case to be made.Vibhu [00:51:06]: Random tangent question. So if you're doing a lot of inference, a lot of model multi-agent stuff, are you at the point where it makes sense to, train a model that' very sparse? You're expecting to do multi-million dollar runs. Are you thinking about this in model architecture standpoint or inference efficiency, or, you're still at the research phase of it works, we're not super there yet?Joon [00:51:34]: Efficiency, we do think quite a bit about. this is technology that is deployed now in some of the largest enterprise companies in the world, and we do process significant number of queries, that are trying to, simulate the populations in the world. So efficiency is a consistent thing. we don't want to over-optimize too early, so I wouldn't say, like, this is the higher bid Right now, but this is definitely something that we think pretty carefully about.Swyx [00:52:05]: Yeah. Are there other case studies? So we, you talked about CVS, talked about Gallup, Deloitte, Wealthfront.Efficiency, Enterprise Use, and Real-World Case StudiesJoon [00:52:12]: Wealthfront is an interesting one, because one of the things they were trying to do, they were one of the first customers that wanted to do product testing that goes beyond just asking people what they think about, let's say, behavior experiments and so forth. So there, really what we had to do was reason about multimodal input, so images, but also you can also imagine, like, these agents traversing through Figma mockups or websites. So some of the things that our agents can also do is it can be given a domain, like, or, like, a website URL and go use it for a while. It's these things. And Wealthfront was one of the first, customers, that was very excited about this possibility.Vibhu [00:52:53]: What have people been asking? Like, is there any demand that we have not covered? Like, UI testing, right?Vibhu [00:52:59]: I wanna try a new. I wanna ship a new feature, test the UI, simulate how people will do it. Any interesting things that you're seeing demand for?Product Testing, Websites, and Synthetic PanelsJoon [00:53:08]: Today, a lot of the demand does come from like, the places where people have historically used human panels, we can now replace with agents, and these synthetic populations. And this is not replacing human panel. in many ways, the simulation that Simile is building is grounded. So the way that I think about this is we are trying to represent humanity at scale. And in that way, the use cases are what we would expect, but it's the scale of deployment that surprises me.Joon [00:53:44]: Turns out there are so many decisions that people make every day in these organizations, groups, and we want to be able to say, “We listen to people. We have consulted our users.” But in reality, that is rarely the case because getting to people and asking them many questions, it's difficult. It's both costly, time-consuming, but most importantly, people are just not available. If I had to answer 1000 survey questions for this one particular, vendor, even if I wanted to do that, like, I would never do it. And that's very much the case. What simulation can do is ensure that the voices of people are always represented in rooms where the decisions for them is made, right? So all the stakeholders of this particular product launch, ideally they're consulted. That's what this technology really is trying to enable.Market Size, TAM, and Human Decision-MakingSwyx [00:54:39]: In my mind, that means it skews towards more consumer focus, right? Like, anything with a wide enough customer base where you do benefit from the diversity that you represent. What are some rough statistics, just for people who are not familiar with this market in general, what's the market size that. I'm sure you have some, like, rough numbers. market size is, like, a vague questionSwyx [00:55:01]: But, like, how much do people spend?Joon [00:55:03]: So market research is a $100 billion industry.Joon [00:55:06]: But the thing about simulation is not a tool for market research. Simulation is a tool for human decision-making. So the question around what is a TAM here is quite tricky, right? Because it's easy to say, “Well, market research TAM is roughly 100 million or 100 billion.” so is it a TAM? And not really, right? Because in many ways, you're trying to inform all human decision-making. You're trying to inform every decision that are made about humans for humans. What is a TAM for that? It's really unclear. And I'll be honest. Like, I have a scientific background, I have a research background, so I didn't come into the field calculating, oh, what is the TAM for human decision-making? But I just had to assume, well, if we can inform every decision that is made about human for human, that has to be big.Swyx [00:55:58]: Some- something valuable.Joon [00:55:59]: Exactly.Swyx [00:55:59]: To some extent, you are a unicorn founder now, and you have to care as a CEO. But, like, I do think, like, yeah, when you go into these boardrooms with people that you're quoting millions of dollars of contracts for, like, you have to say, “Well, here's what you spend on humans-”Swyx [00:56:15]: “. And here's what we save you, and it's 85% similar.”Joon [00:56:19]: And certainly, the value case, is something that we care deeply about. Like, what is the value that we provide to the users and the decision-makers? But this is also where, like, as a founder, I think valuation only tells one very superficial aspect of the story, and I try not to think too much about valuation, in general, because that's not what also motivates a team or certainly doesn't. I'm, I-- Again, the interesting thing about researchers is we are happy living in academia, getting paid next to. we get paid okay. we don't get paid that much, as a researcher here in academia, but it's the impact and it's the, it's the value that we can provide to the individuals and the society that really drives us. And in that way, ultimately what drives us is the impact. Does the simulation we provide have a real impact in people's decision-making in ways that progresses our society forward? If the answer is yes, then yes. that has to be great business, and we see that in numbers, and we do care deeply about that upside story, but that's the heart of it.Where Simulation Goes NextVibhu [00:57:27]: Do you have any timeline predictions? So we talked about scaling laws of simulations.Vibhu [00:57:33]: You brought up, okay, maybe one day we can simulate how to solve climate change.Vibhu [00:57:38]: Where are we now?Vibhu [00:57:40]: If that's not the end state, what is an end state, and what does progress look like?Joon [00:57:45]: So what I sometimes tell people is simulation as industry, it feels a lot like where GPT-3.5, GPT-4 was, for the AGI saga, which is we have now technology that is powerful enough to do real damage on the verticals that we are tackling. At the same time, there's a lot of progress that is yet to come. And that's, I think, where this is. So the way I see it, I do think there will continue to be breakthroughs both in data, in algorithms, and there will be much more aggressive scaling that will also happen over the next few years. But I think that's roughly where we are.Swyx [00:58:27]: I think that was about the ro

You know you need to strength train in midlife to protect your bones, muscle mass, and metabolic health. But every time you try to lift weights or join a class, your back seizes, your knees throb, or your neck locks up. You are trapped in the Midlife Exercise Catch-22: terrified of losing mobility if you don't lift, but terrified of crippling pain if you do.In this episode, Mandy Ryle breaks you out of that all-or-nothing trap. Clinical evidence shows progressive exercise isn't something you earn after you're out of pain—it is the primary treatment for chronic pain itself. Discover why rest makes tendons stiffer, how progressive overload retrains a hyper-vigilant nervous system, and how Graded Exposure is somatic strength, and allows you to build strength without flaring!Timestamps00:00 – The Midlife Exercise Catch-2201:19 – The Real Purpose of Somatics: Getting Strong02:15 – Estrogen Decline, Muscle Loss & Bone Health05:37 – Muscle as Your Primary Metabolic Organ07:44 – Why Mainstream Fitness Advice Fails Pain Sufferers09:51 – The Science: Exercise as #1 Chronic Pain Treatment11:42 – Research on Osteoarthritis & Joint Health13:01 – Why Tendons Need Loading, Not Rest15:03 – Desensitizing Nervous System Threat Algorithms18:26 – Graded Exposure: Micro-Dosing Resistance20:20 – Movement Variables to Prevent Flare-UpsKey TakeawaysThe Midlife Catch-22: Declining estrogen makes loading mandatory, but traditional workout intensity triggers protective nervous system flare-ups.Rest Makes Tendons Worse: Tendinopathies and osteoarthritis require controlled mechanical load to remodel tissue. Rest increases stiffness.Graded Exposure is the Key: Micro-dosing resistance and tweaking variables (range of motion, tempo, load) builds strength safely in the "Goldilocks zone."Scientific Research CitedHayden et al. (Cochrane Review): 240+ RCTs showing progressive exercise outperforms passive care for pain and disability.Fransen et al. (Cochrane Review): Therapeutic exercise produces OA pain reductions comparable to NSAIDs without gut side effects.Malliaras & Lewis: Tendons require progressive mechanical load to remodel; rest increases sensitivity.Geneen et al.: Exercise consistently improves function and quality of life across persistent pain conditions.Resources & Links

In this episode, host Dr. Nick Rainey is joined by Dr. Bremen Abuhl and Dr. Dallas Ehrmantraut to discuss their 2025 Physical Therapy Journal article, “First Contact Physical Therapy Compared to Usual Primary Care for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of RCTs.”The conversation explores whether physical therapists should serve as the first point of contact for patients with musculoskeletal disorders and how first contact PT compares with usual primary care.Dr. Abuhl and Dr. Ehrmantraut discuss their findings, including reduced imaging utilization, reduced prescription medication utilization, and similar clinical outcomes for pain, disability, and health-related quality of life. They also unpack the terminology around direct access, first contact PT, and primary care PT, and explain why direct triage models may offer a more efficient pathway for patients.The episode also addresses real-world implementation barriers, including reimbursement models, state scope-of-practice variation, imaging privileges, medication prescribing, stakeholder buy-in, and the need for PTs to step confidently into first contact roles.Key TakeawaysFirst contact PT is not the same as direct access. Direct access means patients can choose PT without referral. First contact PT means the PT is the first provider evaluating the patient for that episode of care.The study found lower healthcare utilization. First contact PT was associated with 45% less imaging and 71% less prescription medication utilization compared with usual primary care.Clinical outcomes were similar. Pain, disability, and health-related quality of life outcomes were statistically similar between first contact PT and usual primary care.Less imaging is not automatically the goal. The more important question is appropriate utilization: avoiding both overuse and underuse.Implementation is a system problem. Scope of practice, reimbursement, stakeholder buy-in, state law, and health system workflows all influence whether first contact PT can work.Direct triage may be the stronger model. Compared with warm handoffs, direct triage allows patients with appropriate MSK presentations to start with PT as the first provider.PTs need to be ready for real-world first contact care. That includes identifying red flags, determining urgency, ordering or recommending imaging when appropriate, and referring to the right provider when needed. Chapters: 00:00 — Welcome and guest introductions 01:17 — Dr. Bremen Abuhl's path into first contact PT research 03:13 — Dr. Dallas Ehrmantraut's clinical spark for the topic 06:16 — Overview of the PTJ systematic review and meta-analysis 09:52 — Direct access vs first contact PT vs primary care PT 13:15 — Global evidence and limited U.S.-based RCTs 16:24 — Imaging findings and appropriate utilization 20:37 — Medication utilization findings 23:27 — Clinical outcomes: pain, disability, and quality of life 25:20 — Study limitations and downstream utilization 27:13 — Why longer-term outcomes matter 31:15 — Risk of bias and crossover between groups 33:36 — U.S. system barriers to first contact PT 36:37 — Reimbursement, payer models, and stakeholder concerns 40:45 — Direct triage vs warm handoff models 44:15 — Scope of practice and state-level barriers 46:08 — Real-world safety, red flags, and PT decision-making 48:01 — Call to action for physical therapists 50:06 — Closing thoughts

In this School of Doza episode, Nurse Doza opens the Metabolic Series with the adrenal glands — and why you may feel tired all day, crash between 2 and 4 PM, and wake up unrested. He explains how chronic stress can keep the body stuck in fight-or-flight, why that pattern is hard to shift, and the daily levers he leans on: belly breathing, less screen time at night, and morning sunlight. Then he breaks down Zen by MSW Nutrition — adrenal glandular plus four adaptogens — for stress support. FEATURED PARTNER Zen by MSW Nutrition is built in three layers rather than a single botanical: **125 mg of adrenal glandular tissue** (bovine, sourced from Argentina), **four standardized adaptogens** — Asian ginseng, rhodiola, eleuthero, and schisandra — plus **cofactor nutrients** (vitamin C, B6 as P5P, and pantothenic acid). Licorice rounds out the 9-ingredient formula. It's the supplement Nurse Doza reaches for when the goal is supporting the adrenal glands and the body's stress response, instead of layering more caffeine on top of a depleted system.

Ketamine clinics have exploded worldwide, offering low-dose intravenous infusions for chronic pain patients who've run out of options. But is this practice actually backed by evidence, or has off-label use outpaced the science? In this episode of the PainExam Podcast, Dr. David Rosenblum reviews the current literature on subanaesthetic-dose ketamine infusions (SDKIs) for chronic pain, drawing on the 2023 British Journal of Pain review by Harry M. Griffiths, "Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice?" Topics covered: Why conventional analgesics (opioids, anticonvulsants, antidepressants) fail in 60–70% of chronic pain patients How ketamine works as an NMDA receptor antagonist, and why that mechanism is likely an oversimplification Typical SDKI dosing (~0.35–0.5 mg/kg) versus anesthetic dosing, and why the IV route dominates the evidence base What the meta-analyses actually show: modest, time-limited pain reduction (mean difference around -1.83 on a 0–10 scale) with higher efficacy but more side effects at higher doses Key trials — Corriger et al.'s 1-year follow-up (256 patients), Orhurhu et al.'s systematic review and meta-analysis, and smaller RCTs in CRPS, fibromyalgia, and ischemic limb pain Common side effects (nausea, psychomimetic symptoms) versus rare but serious adverse events (hepatic, cardiac, urogenital) — and how dose and premedication with clonidine/midazolam affect risk Why blinding failure (up to 93% of patients correctly guessing their treatment in one trial) may be inflating reported effect sizes The absence of standardized protocols, guidelines, or a clear "exit strategy" for patients on long-term SDKI therapy What needs to happen next: larger multicenter RCTs, ketamine clinic registries, and better outcome measures beyond simple pain scores Bottom line: SDKIs offer a promising but still under-evidenced option for refractory chronic pain — reserved for the right patient, with modest expectations and careful monitoring. Reference: Griffiths HM. Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice? Br J Pain. 2023;17(5). https://journals.sagepub.com/doi/full/10.1177/20494637231182804 Show Image About the Host David Rosenblum, MD is Director of Pain Management at Maimonides Medical Center and Co-Owner/Clinic Director of AABP Integrative Pain Care and Wellness in Brooklyn, NY. Dual board-certified in Anesthesiology and Pain Medicine, he is a co-author of the ASIPP Peripheral Nerve Stimulation (PNS) guidelines and a widely recognized educator in regenerative pain medicine (PRP, BMAC, amniotic therapies). As founder of NRAP Academy, he has trained 3,500+ physicians for pain board certification since 2008, and hosts the PainExam, AnesthesiaExam, and PMRExam podcasts. He has been named a New York Magazine "Top Doctor" from 2016–2026. Living with chronic pain? Dr. Rosenblum sees patients for interventional and regenerative pain treatment — including epidurals, nerve blocks, spinal cord & peripheral nerve stimulation, and PRP/BMAC — at his Brooklyn, NY office. Visit RosenblumPain.com for more information. For Physicians & APPs — Continue Your Education: CME Course Calendar: https://www.nrappain.org/pages/upcoming-pain-management-conferences Virtual Pain Fellowship: https://www.nrappain.org/bundles/Virtual-Pain-Fellowship PainExam Board Prep: https://www.nrappain.org/pages/pain-management-cme-couåçrses This episode is brought to you by NRAP Academy and PainExam — visit www.NRAPpain.org for CME in neuromodulation, regional anesthesia, and pain medicine.

Ketamine clinics have exploded worldwide, offering low-dose intravenous infusions for chronic pain patients who've run out of options. But is this practice actually backed by evidence, or has off-label use outpaced the science? In this episode of the PainExam Podcast, Dr. David Rosenblum reviews the current literature on subanaesthetic-dose ketamine infusions (SDKIs) for chronic pain, drawing on the 2023 British Journal of Pain review by Harry M. Griffiths, "Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice?" Topics covered: Why conventional analgesics (opioids, anticonvulsants, antidepressants) fail in 60–70% of chronic pain patients How ketamine works as an NMDA receptor antagonist, and why that mechanism is likely an oversimplification Typical SDKI dosing (~0.35–0.5 mg/kg) versus anesthetic dosing, and why the IV route dominates the evidence base What the meta-analyses actually show: modest, time-limited pain reduction (mean difference around -1.83 on a 0–10 scale) with higher efficacy but more side effects at higher doses Key trials — Corriger et al.'s 1-year follow-up (256 patients), Orhurhu et al.'s systematic review and meta-analysis, and smaller RCTs in CRPS, fibromyalgia, and ischemic limb pain Common side effects (nausea, psychomimetic symptoms) versus rare but serious adverse events (hepatic, cardiac, urogenital) — and how dose and premedication with clonidine/midazolam affect risk Why blinding failure (up to 93% of patients correctly guessing their treatment in one trial) may be inflating reported effect sizes The absence of standardized protocols, guidelines, or a clear "exit strategy" for patients on long-term SDKI therapy What needs to happen next: larger multicenter RCTs, ketamine clinic registries, and better outcome measures beyond simple pain scores Bottom line: SDKIs offer a promising but still under-evidenced option for refractory chronic pain — reserved for the right patient, with modest expectations and careful monitoring. Reference: Griffiths HM. Low-dose ketamine infusions for chronic pain management: Does this qualify as evidence-based practice? Br J Pain. 2023;17(5). https://journals.sagepub.com/doi/full/10.1177/20494637231182804 Show Image About the Host David Rosenblum, MD is Director of Pain Management at Maimonides Medical Center and Co-Owner/Clinic Director of AABP Integrative Pain Care and Wellness in Brooklyn, NY. Dual board-certified in Anesthesiology and Pain Medicine, he is a co-author of the ASIPP Peripheral Nerve Stimulation (PNS) guidelines and a widely recognized educator in regenerative pain medicine (PRP, BMAC, amniotic therapies). As founder of NRAP Academy, he has trained 3,500+ physicians for pain board certification since 2008, and hosts the PainExam, AnesthesiaExam, and PMRExam podcasts. He has been named a New York Magazine "Top Doctor" from 2016–2026. Living with chronic pain? Dr. Rosenblum sees patients for interventional and regenerative pain treatment — including epidurals, nerve blocks, spinal cord & peripheral nerve stimulation, and PRP/BMAC — at his Brooklyn, NY office. Visit RosenblumPain.com for more information. For Physicians & APPs — Continue Your Education: CME Course Calendar: https://www.nrappain.org/pages/upcoming-pain-management-conferences Virtual Pain Fellowship: https://www.nrappain.org/bundles/Virtual-Pain-Fellowship PainExam Board Prep: https://www.nrappain.org/pages/pain-management-cme-couåçrses This episode is brought to you by NRAP Academy and PainExam — visit www.NRAPpain.org for CME in neuromodulation, regional anesthesia, and pain medicine.

We talk with Eleanor Williams from the Australian Centre for Evaluation about making evaluation fast, rigorous, and genuinely useful for public service decisions. We move from a 40,000-person employment services RCT to the practical steps that make testing possible, then unpack why transparency and mixed methods matter when the stakes are high. Along the way we discuss:turning a mutual obligation debate into a 'fact question'  through a large three-arm randomised controlled trialwhy a null result can be a powerful policy signalthe enablers that make responsive RCTs feasible, from systems to leadership to ethics and consenthow ACE partners with departments through a hub-and-spoke model, secondments, and capability buildingplanning evaluation from day one using program logic and theory of changeseparating program cost from evaluation cost to make smarter investment decisionspublishing and normalising evidence through the ACE Evaluation Libraryusing developmental evaluation and test-and-learn without getting stuck refining measures foreverwhat decision makers value under time pressure, including “killer stats” plus narrative and qualitative insightimproving services with small, fast trials like pre-call SMS nudges at Services AustraliaMentioned in this episode:Australian Centre for EvaluationACE Evaluation Library, hosted on the Australian Policy ObservatoryThe Magenta BookAnthony Costello, The Social EdgeThis podcast was recorded on Kaurna land, and we recognise Kaurna elders past and present. Always was, always will be.Now for some appropriately bureaucratic disclaimers....While we have tried to be as thorough in our research as busy full time jobs and lives allow, we definitely don't guarantee that we've got all the details right.Please feel free to email us corrections, episode suggestions, or anything else, at thewestminstertraditionpod@gmail.com.Thanks to PanPot audio for our intro and outro music. 'Til next time!

Most apple cider vinegar on supermarket shelves is dead. Pasteurized. Filtered. Stripped of the mother, the enzymes, and the polyphenols that made vinegar a medical remedy for over 2,000 years — sold back to you at a 33-fold markup for what's essentially acidified water. In this episode, we make genuine raw, unpasteurized apple cider vinegar from scratch — for about 30 cents a batch. You'll learn the two-stage fermentation process, how to avoid mold and spoilage, and why homemade ACV is more biologically active than anything you can buy. ⏱ Cost breakdown: $10 vs $0.30 11:00 — Safety rules you must follow

ACOG first recommended antiviral suppressive therapy at 36 weeks of gestation for women with a history of genital herpes in 2007, with the publication of Practice Bulletin No. 82 ("Management of Herpes in Pregnancy," June 2007). This was the first ACOG practice bulletin specifically dedicated to genital herpes management in pregnancy, and it established the 36-week suppressive therapy recommendation based on the RCTs available at that time (including the Watts 2003, Sheffield 2006, and Andrews 2006 trials). The recommendation was subsequently reaffirmed and updated in Practice Bulletin No. 220, published in May 2020, which is the current version. However, these trials had patients who ultimately delivered at/after 38 weeks. In a patient with a history of genital HSV for whom suppression is recommended but who will have a medically indicated delivery at 37 weeks, say for a hypertension disorder of pregnancy, is 36 week initiation of HSV antiviral medication enough time for suppression? There is a gap in high quality data on this. In this episode, we will review the published data and reach a clinical decision as to whether one week suppression is enough, or if initiation earlier is reasonable. 1. ACOG PB 822. ACOG PB 220

HEALTH NEWS   Review finds blueberry and grape polyphenols may improve vascular health Plant compound shows promise for treating rheumatoid arthritis at its source, study finds Screen Time at Ages 1 and 6 Linked to Lasting Learning and Memory Effects Some caffeinated drinks are linked to poorer memory Study: Morning Exercise Linked to Lower Daily Calorie Intake Compared to Evening Workouts   Review finds blueberry and grape polyphenols may improve vascular health Universidad Católica de Murcia (Spain), July 27 2026 (News-Medical) A recent review published in the journal Nutrients examined the evidence on the effects of blueberries, grapes, and their bioactive compounds on cardiovascular risk markers. In the present study, a comprehensive systematic literature search was conducted to identify randomized controlled trials (RCTs), systematic reviews, and meta-analyses published from January 2015 through April 2026.  Two systematic reviews and meta-analyses reported that grape polyphenols at doses exceeding 500 mg/day for at least 12 weeks significantly reduced C-reactive protein levels, while the other reported improvements in vascular function or BP in 84% of the human studies it assessed, including a significant reduction in systolic BP. One found a modest reduction in BP and improvement in endothelial function with flavan-3-ol foods, such as tea, apples, cocoa, and grape-derived products. Moderate- and high-quality RCTs reported improvements in lipid peroxidation, lipid profiles, flow-mediated dilation, diastolic BP, and paraoxonase activity. Resveratrol and blueberry RCTs mainly reported endothelial and vascular benefits, such as improved nitric oxide production and flow-mediated dilation and reduced BP and inflammatory markers. One high-quality RCT involving older men with metabolic syndrome showed significant improvements in arterial stiffness and endothelial function after six months of daily blueberry consumption.     Plant compound shows promise for treating rheumatoid arthritis at its source, study finds Guangzhou University of Chinese Medicine, July 27 2026 (Natural News) A plant-derived compound called obakulactone (OL) reduced swelling, inflammation and joint damage in rats with rheumatoid arthritis, according to a study published in Engineering.   The compound, a tetracyclic triterpenoid from the bark of Phellodendri cortex, also rebalanced immune activity and corrected disrupted fatty acid metabolismd. P. cortex has been used in traditional medicine and contains OL along with other constituents, Researchers tested OL in rats with rheumatoid arthritis, administering low, medium and high doses for 21 days. Treatment significantly reduced joint swelling and helped restore the normal structure of cartilage and the synovium, the tissue lining the joints, according to the report.   Blood tests showed dose-dependent decreases in inflammatory molecules including IL-1, IL-6, IL-17 and TNF, as well as rheumatoid arthritis markers RF, CCP-Ab, CRP and MMP-3, officials said. The compound also reduced abnormally high levels of CD3+ T cells and CD68+ macrophages within the joints and shifted macrophages from a proinflammatory M1 state toward an anti-inflammatory M2 state.   Screen Time at Ages 1 and 6 Linked to Lasting Learning and Memory Effects National University of Singapore & Zhejiang University (China), July 28, 2026 (SciTech Daily) A study that tracked children from age 1 through age 8 found that greater screen viewing time, especially during infancy and near the start of school, was associated with lower academic performance at age 9 and weaker working memory at age 10.5. The results indicate that when children use screens may matter as much as how long they spend using them. The World Health Organization (WHO) and the American Academy of Pediatrics advise avoiding screens before 18 to 24 months and limiting viewing to less than one hour per day between ages 2 and 5. Many children exceed those recommendations, yet previous research on screens and cognitive development has produced inconsistent results. The analysis included 502 children followed from infancy into middle childhood. Higher screen viewing during particular stages was associated with poorer academic results and weaker working memory later on. The clearest and most consistent relationships appeared during infancy and near school entry, suggesting that these may be especially sensitive periods for cognitive development. Children with greater total screen exposure across childhood also generally performed less well in school. Together, the findings suggest that both the timing and overall amount of viewing may have implications for learning and memory.   Some caffeinated drinks are linked to poorer memory Applied Science Private University (Jordan), July 28 2026 (News-Medical) A recent study in the Journal of Education and Health Promotion examined the association between caffeine-containing products and memory performance, anxiety, and stress among university students in Jordan. 204 students were ultimately included in the study.  Mild psychological distress was the most common category, with 38.2% reporting such symptoms. About four in ten reported mild depression, and over a quarter experienced moderate anxiety. Only a small minority showed severe or extremely severe stress. Caramel or nut-filled chocolate was the most frequently consumed item, reported by 54.9% of students, followed by Arabic coffee (40.2%) and red tea (35.8%). Milk chocolate was also popular, typically consumed once or twice a day. Dark chocolate was less common, while American coffee and green tea were less popular, and decaffeinated coffee was rarely chosen. Overall DASS scores, representing depression, anxiety, and stress symptoms, showed positive correlations with the consumption of dark chocolate, American/instant coffee, decaffeinated coffee, and red tea, indicating these items were linked to higher psychological distress scores. Memory ability was negatively associated with higher intake of American coffee, Arabic coffee, and soft drinks.  The authors note that chocolate and green tea also contain bioactive compounds such as cocoa flavanols and L-theanine, which may have contributed to these associations alongside caffeine.   Study: Morning Exercise Linked to Lower Daily Calorie Intake Compared to Evening Workouts Copenhagen University Hospital (Denmark), July 27 2026 (Natural News)   A new study has found that morning exercise was associated with lower calorie consumption throughout the day compared to evening workouts, according to the research. Participants who exercised in the morning consumed about 400 fewer calories at the post-workout meal and roughly 547 fewer calories over the full 24-hour period, the study reported.   The study, which involved 35 healthy young adults. Each participant completed 30 minutes of treadmill running multiple times under varying conditions: morning fasted, evening fasted for 12 hours or 6 hours, and morning or evening fed, the study stated. The repeated-measures design enabled researchers to compare the same person's responses across different scenarios, officials said. After evening sessions, participants reported higher hunger, a stronger desire to eat, and lower fullness compared to morning sessions, the study found. Those who worked out in the evening consumed about 400 more calories at the post-workout meal and roughly 547 more calories over the full day, according to the research.   The appetite advantage was attributed to circadian rhythms, researchers said. The hunger hormone ghrelin naturally rises in the evening, while satiety hormones are more active in the morning,.

Too many young people are getting a "desiccated" education – narrow, information-transfer schooling optimised for exams. In this episode, James and David are joined by Liz Robinson and Sarah Seleznyov of Big Education – the "feisty little multi-academy trust" behind School 21, School 360 and Surrey Square – to make the case for something bigger: an education of the head (academic learning), heart (wellbeing and relationships) and hand (creativity and skills). The conversation centres on the new book from the Rethinking School project, A Practical Guide to a Big Education: Balancing Head, Heart and Hand, edited by Sarah Seleznyov and Robert Lobatto – a collection of chapters written by school leaders and teachers who are actually doing this work, each paired with a vignette from another school and reflective questions to help you find your own way in. Not a recipe book, but an invitation to be a little bit braver. In this episode we explore: -Why pedagogy was written out of the Curriculum and Assessment Review – and why curriculum, pedagogy and assessment have to change together ("if you only pull one string in the marionette, it jerks") -England's uniquely narrow definition of curriculum and learning – and how it compares with models from around the world -What Big Education is, and what an education of the head, heart and hand actually means -The Milburn report on youth unemployment – and why the problems start in Year 1, not at upper secondary -Liz's "soapbox rant": Every Child Matters, extended schools, co-located services – and what was lost when it was all set on fire -Think systemically, act systematically: systems thinking, design thinking and vertical slice change teams Authentic leadership: vulnerability, ego, the kelp metaphor – and why Liz is learning to bring "Lizzie" to work -Being evidence-informed: why data is richer than numbers, the trouble with RCTs and the EEF toolkit, and engaging with research and in research -Interdisciplinary project-based learning – and the jaw-dropping story of the Ofsted inspector who withheld 'outstanding' because children didn't know their learning was called history -Can we teach and assess transferable competencies? And do we have to trade exam results for a broader education? (Spoiler: no) -Lessons from curriculum reform in Scotland, Wales and British Columbia – why transforming practice takes time, investment and serious professional development -Why we need revolution, not evolution About the guests Liz Robinson is co-founder and CEO of Big Education. She became a headteacher at 29, leading Surrey Square Primary in south London for many years, and created the Big Leadership Adventure. She advocates for – and models – an authentic, reflective and relational approach to leadership. Sarah Seleznyov is Strategic Project Lead at Big Education and leads the Rethinking School project. She has worked in London schools for over 25 years as a deputy head, school improvement consultant and teaching school director, and previously led research-informed leadership programmes at the UCL Institute of Education. Her research specialism is Japanese lesson study. Links Get the book: A Practical Guide to a Big Education: Balancing Head, Heart and Hand – https://www.bloomsbury.com/uk/practical-guide-to-a-big-education-9781801997928/ Big Education: https://bigeducation.org The Rethinking School project (subsidised places available – get in touch!): https://bigeducation.org/rethinking-school/ Rethinking Assessment: https://rethinkingassessment.com Support the show This podcast is brought to you by Crown House Publishing. Get 20% off all titles at https://www.crownhouse.co.uk with the promo code REPOD20 (excludes bundles and existing promotions). Become a patron at https://www.patreon.com/repod or make a one-off donation at https://www.buymeacoffee.com/repod – and help us keep these conversations coming.

CardioNerds co-chairs Dr. Dinu Balanescu and Dr. Billy Joe Mullinax, along with FIT lead Dr. Shiavax Rao, discuss the evolving landscape of randomized controlled trials in pulmonary embolism with Dr. Jay Giri, interventional cardiologist, Associate Professor of Medicine, and Director of the Cardiovascular Catheterization Laboratories at the Hospital of the University of Pennsylvania. This episode examines the historical evidence behind systemic thrombolysis, the emergence of catheter-directed therapies and mechanical thrombectomy, and the landmark RCTs – STORM-PE, PEERLESS, HI-PEITHO, and PEERLESS II – that are reshaping intermediate-risk PE management. The discussion highlights challenges in PE trial design, the critical importance of clinical deterioration as an endpoint, and why this era represents an unprecedented wave of evidence generation in PE. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls: Systemic thrombolysis in intermediate-risk PE reduces hemodynamic decompensation but at the cost of ~1.5–2% intracranial hemorrhage risk – a near-zero net benefit that has driven the search for safer catheter-based alternatives. “Focus on clinical deterioration, not mortality” – Due to crossover design in contemporary PE RCTs, control-arm patients who decompensate are rescued with advanced therapies, biasing mortality toward the null. Clinical deterioration is the most informative endpoint to watch in HI-PEITHO, PRAGUE-26, and PEERLESS II. HI-PEITHO is the first large RCT to demonstrate that catheter-directed fibrinolysis plus anticoagulation significantly reduces the composite of PE-related death, cardiorespiratory decompensation, or PE recurrence versus anticoagulation alone (RR 0.39; 95% CI 0.20–0.77; P=0.005), with no intracranial hemorrhage in either arm. The four major upcoming/recently reported PE RCTs (HI-PEITHO, PRAGUE-26, PEERLESS II, PE-TRACT) enroll progressively different risk populations – from the most enriched (HI-PEITHO) to the most permissive (PE-TRACT, which includes intermediate-low risk patients) – enabling a nuanced understanding of which patients benefit most from intervention. PE device clearance follows a fundamentally different FDA pathway than structural heart devices (single-arm safety/efficacy studies vs. mandated RCTs), yet market forces and clinical need have ultimately driven industry and government to sponsor large-scale RCTs – a lesson in how evidence development can evolve organically alongside regulatory frameworks. Notes: Notes drafted by Dr. Shiavax Rao. Question #1: What is the current evidence behind advanced PE therapies? Systemic thrombolysis: Sixteen RCTs over 40 years (1972–2014) enrolling nearly 2,000 patients have studied systemic thrombolysis in intermediate-risk PE. The landmark PEITHO trial (n=1,006) showed that tenecteplase reduced the composite of death or hemodynamic collapse (2.6% vs. 5.6%; P=0.015), driven primarily by reduced hemodynamic decompensation (1.6% vs. 5.0%; P=0.002). However, this came at the cost of increased major bleeding (6.3% vs. 1.5%; P

Whether it's joint pain, fatigue, brain fog, poor sleep, hot flushes or anxiety, it can feel frustrating when symptoms linger long after treatment ends. For many people, supplements seem like a logical place to look for menopause support, but with endless products, conflicting advice and cupboards full of half-used bottles, how do you know what's actually worth taking?In this episode, I am once again joined by leading oncologist, researcher and integrative medicine specialist Professor Robert Thomas to explore the role supplements may play in supporting health and wellbeing after cancer.Make sure to have pen and paper ready, as I think you'll need it!In this episode, we discuss:Why so many cancer survivors turn to supplementsHow to identify what symptoms you're actually trying to supportWhich supplements have anti-cancer properties?Which supplements help with joint pain?Supplements that may help with sleepThe role of vitamin D, probiotics and omega-3What should I NOT have too much of?The debate around multivitamins after cancerCommon supplement mistakes that waste moneyCreatine: what we know and what we still don't know for cancer survivorsOne of the most powerful messages from this conversation is that there is rarely one magic supplement. Instead, the best results often come from understanding your symptoms, focusing on overall health and making informed decisions based on evidence rather than marketing.Episode Highlights:00:00 Introduction05:06 Discussing supplements with oncologists08:34 Discussing supplement safety and benefits11:13 Improving gut health in menopause16:03 Concerns about multivitamins and antioxidants17:52 Discussing supplements and deficiencies20:57 Understanding Mineral Intake from Food25:44 Discussing creatine vs collagen benefitsResourcesKeep Healthy: keep-healthy.com and https://keep-healthy.com/polyphenols/Rob's bestselling book "How to Live"About Dr Robert ThomasDr Robert Thomas is a Consultant Oncologist, Professor of Nutritional and Sports Science, researcher, author and Head of Integrative Oncology at UCLH. His work focuses on helping people combine conventional cancer treatments with evidence-based lifestyle strategies to improve outcomes and quality of life.He also leads a research unit that has designed landmark scientific studies which provide the evidence that guide nutritionists, support groups, doctors and patients across the World.As well as mainstream oncology studies, the team focuses on randomised trials that evaluate the impact of exercise, diet, gut health and natural therapies on cancer, long covid and exercise performance, menopause and cancer.This included 5 RCT's addressing hormone related symptons after breast cancer including patient choice as a primary end point.His latest two double blind RCTs, discovered that boosting dietary phytochemicals (with Yourphyto) and gut health (with Yourgutplus) slowed prostate cancer progression, improved erectile function and urinary symptoms and improved three key biomarkers of longevity.Dani's links:Join my NEW blog ‘Still Becoming' on Substack: https://substack.com/@danibinnington?r=1osz6a&utm_campaign=profile&utm_medium=profile-pageBuy my book ‘Navigating Menopause After Cancer': https://amzn.eu/d/07dUoYBbJoin the 12th September Thames Bridges Trek: https://fundraiseformenopauseandcancer.raiselysite.com/thamesbridgestrekultrachallengeSet up your own fundraiser: https://fundraiseformenopauseandcancer.raiselysite.com/fundraisingideasMentioned in this episode:Fundraiser Walk: And walk: https://fundraiseformenopauseandcancer.raiselysite.com/thamesbridgestrekultrachallenge Substack: https://danibinnington.substack.com/

Can turmeric really help with joint pain, inflammation and gut health after cancer? And why are so many people being told to avoid it?In this fascinating conversation, I sit down with leading oncologist, researcher and integrative medicine expert Professor Robert Thomas to unpack the science behind turmeric, gut health and cancer recovery.Prof Thomas shares why he believes many patients are receiving outdated advice about turmeric, explains where concerns about tamoxifen interactions originated, and explores what the latest research actually tells us. Together, we discuss the role of gut health in long-term wellbeing, why exercise remains one of the most powerful tools available after cancer, and how lifestyle medicine can work alongside conventional cancer treatments.In this episode, we discuss:The surprising evidence behind turmeric and cancerWhy turmeric became controversial in breast cancer careThe difference between turmeric, curcumin and supplementsGut health, inflammation and the microbiomeManaging joint pain and menopausal symptoms after cancerExercise as a tool to improve cancer outcomesHow integrative oncology combines medical treatment with lifestyle strategiesCommon myths surrounding supplements and cancerResourcesKeep Healthy: keep-healthy.com and https://keep-healthy.com/polyphenols/Rob's bestselling book "How to Live"Episode Highlights:00:00 Introduction09:33 Discussing hormone therapy options12:30 Discussing health and patient advocacy15:00 Discussing menopause treatments20:06 Turmeric's rise in health circles22:24 Antioxidant and anti-inflammatory benefits24:21 Curcumin study and dosage discussion28:01 Addressing turmeric's cancer misconceptions32:28 Simplifying Supplement ChoicesAbout Prof Robert Thomas:Thomas is a Consultant Oncologist, Professor of Nutritional and Sports Science, author, researcher and Head of Integrative Oncology at UCLH. He has published extensively on lifestyle medicine, cancer prevention and survivorship, and is passionate about helping patients make informed decisions about their health using evidence-based approaches.He also leads a research unit that has designed landmark scientific studies which provide the evidence that guide nutritionists, support groups, doctors and patients across the World.As well as mainstream oncology studies, the team focuses on randomised trials that evaluate the impact of exercise, diet, gut health and natural therapies on cancer, long covid and exercise performance, menopause and cancer.This included 5 RCT's addressing hormone related symptons after breast cancer including patient choice as a primary end point.His latest two double blind RCTs, discovered that boosting dietary phytochemicals (with Yourphyto) and gut health (with Yourgutplus) slowed prostate cancer progression, improved erectile function and urinary symptoms and improved three key biomarkers of longevity.Connect with us:For more information and resources visit our website: www.menopauseandcancer.org Or follow us on Instagram @menopause_and_cancerJoin our Facebook group: www.facebook.com/groups/menopauseandcancerchathub Mentioned in this episode:Substack: https://danibinnington.substack.com/ Fundraiser Walk: https://fundraiseformenopauseandcancer.raiselysite.com/thamesbridgestrekultrachallenge

In this special in-person roundtable recorded in Washington, D.C., the HOMeHOPe faculty sit down to decode one of the most important perspective shifts in modern health: the Holobiont. Moving away from the traditional, siloed medical model of "organology" (treating the heart, gut, and brain as isolated systems managed by different specialists), the faculty discusses why true health optimization requires viewing the human body as a complex, interconnected ecosystem of ecosystems. Join us as we delve into: The Holobiont Paradigm: Why you are not just a single organism, but a super-ecosystem made up of human cells and trillions of cooperating microbiota (including in your cornea, ureters, and gut). The Danger of "Organ" Medicine: How specializing solely in individual organs leads to clinical blind spots, and why common prescriptions like statins and PPIs can quietly disrupt cellular energy (CoQ10) and nutrient absorption system-wide. Metabolomics vs. Genetics: Why your DNA only tells you what might happen, while clinical metabolomics tells you exactly what is happening right now. The Cell Danger Response (CDR): How your metabolites act as powerful epigenetic signalers, turning genes on and off to regulate systemic health and recovery. The N-of-1 Future: Why large randomized controlled trials (RCTs) often fail by completely ignoring the gut microbiome, and why personalized, N-of-1 medicine is the only true path forward. This episode is for you if: You are tired of being bounced between specialists for interconnected symptoms like mood disturbances, fatigue, and chronic bloating. You want to understand the limitations of DNA testing and why measuring real-time metabolites is the gold standard for biohacking. You are a clinician looking to shift your practice from illness management to foundational cellular optimization. You can also find this episode on… YouTube: https://youtu.be/ILwab838zVM Find more from Health Optimization Medicine and Practice (HOMeHOPe): Website: https://homehope.org/ Instagram: https://www.instagram.com/homehopeorg/ HOMeHOPe Conference: https://homehope.org/ Use PODCAST10 to get 10% OFF your purchase of the Clinical Metabolomics Module at https://homehope.org/products/clinical-metabolomics Find more from Troscriptions: Website: https://troscriptions.com/ Instagram: https://www.instagram.com/troscriptions/ Use POD10 to get 10% OFF your Troscriptions purchase at https://troscriptions.com/collections/our-products  

Lion’s Mane Mushroom and Brain Health: What Four Clinical Trials Actually Found Many stroke survivors and people managing cognitive decline more broadly eventually ask the same question: Is there anything beyond physiotherapy and medication that can actively support brain healing? Not symptom management. Actual repair. Lion’s Mane mushroom (Hericium erinaceus) is one compound that has gathered genuine clinical attention. It is not a cure, the human trial evidence is still limited in scale, and it is not a replacement for the fundamentals of brain health. But the mechanism is unusual, the safety profile is consistently good, and for anyone serious about their brain, the research warrants an honest look. Why Lion’s Mane Is Neurologically Unusual Most supplements that claim to support brain health cannot cross the blood-brain barrier, the tightly regulated membrane that controls what enters the brain. Without crossing it, any direct effect on brain tissue is limited. Lion’s Mane contains two families of bioactive compounds found almost nowhere else in nature. Hericenones come from the fruiting body, the visible mushroom. Erinacines come from the mycelium, the root-like underground network. Both stimulate the production of Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF). These are proteins the brain uses to grow new neurons, maintain existing ones, and strengthen the connections between them. Crucially, erinacine A, one of the key mycelium compounds, has been confirmed in preclinical studies to cross the blood-brain barrier. That is not a trivial distinction. It is one of the reasons researchers have taken this mushroom seriously. “These are proteins your brain uses to grow new neurons, maintain existing ones, and build and strengthen the connections between them. They are, in a very real sense, your brain’s repair and maintenance crew.” — Bill Gasiamis What the Human Clinical Trials Found Four published human clinical trials have examined Lion’s Mane. Here is what each found: Mori et al. (2009): In a randomised, double-blind, placebo-controlled trial, 30 older adults with mild cognitive impairment (MCI) took Lion’s Mane supplement or placebo for 16 weeks. The Lion’s Mane group showed significantly better cognitive function scores at weeks 8, 12, and 16. When supplementation stopped, scores declined again within four weeks, suggesting the effect was tied to ongoing intake, not a placebo response. Saitsu et al. (2019): A multicenter RCT tested 12 weeks of oral Lion’s Mane in older adults. Participants in the treatment group showed significant improvement on the Mini-Mental State Examination (MMSE) compared to placebo. No adverse effects were observed. Nagano et al. (2010): A 4-week RCT using Lion’s Mane-enriched cookies found significant reductions in self-reported depression and anxiety in women compared to placebo, suggesting effects extend beyond cognition to mood and emotional regulation, possibly via the gut-brain axis. Docherty et al. (2023): A double-blind pilot study from Northumbria University tested 41 healthy young adults aged 18–45. After a single dose, participants performed significantly faster on the Stroop task, a measure of cognitive processing speed and flexibility. After 28 days, there was a trend toward reduced subjective stress. This was a small study, and results should be interpreted cautiously, but it suggests Lion’s Mane effects are not limited to populations already experiencing cognitive decline. The Stroke-Specific Preclinical Data For stroke survivors, the preclinical research adds another dimension. In a 2014 animal study, erinacine A reduced brain infarct volume by 22–44% in ischemic stroke models (depending on dose), and significantly lowered pro-inflammatory cytokines, including IL-1β, IL-6, and TNF-α markers of the neuroinflammatory cascade that follows stroke. A 2022 study found that erinacine A helps preserve glutamate clearance in the brain after ischemic injury. Excess glutamate is one of the key mechanisms of neuronal death after stroke, so anything that helps regulate it post-injury is clinically relevant. These are animal studies. They do not translate directly to human outcomes. But they provide a biological rationale that supports why clinical researchers are now investigating Lion’s Mane in neurological recovery contexts. What the Research Does Not Yet Tell Us The limitations matter, and any honest assessment must include them. All four human trials are relatively small, none exceeds 100 participants. We do not yet have large-scale, long-term RCTs in stroke survivor populations specifically. The optimal dose, duration, and form (fruiting body vs mycelium vs dual extract) have not been established in human trials. Direct confirmation that erinacines cross the blood-brain barrier in humans rather than in animal models does not yet exist. Bill says it directly in the video: “The human trial data is still relatively limited in scale. We need larger, longer trials.” Practical Questions to Raise with Your Doctor If you are considering Lion’s Mane supplementation, the following questions are worth raising with your neurologist or GP: Is it safe alongside my current medications? Theoretical interactions exist with anticoagulants (warfarin, aspirin, clopidogrel) and antidepressants, not confirmed in human trials, but worth disclosing. Anyone on blood thinners following a stroke should have this conversation before starting. What form should I look for? Products should specify standardised hericenone content (fruiting body extract) or erinacine A content (mycelium extract). Products listed only as “mycelial biomass on grain” typically contain very low levels of active compounds and high levels of starch from the growth substrate. If the label does not specify active compound content, treat that as a quality flag. Are there any trials I could join? ClinicalTrials.gov lists current recruiting studies for Hericium erinaceus and cognitive function worth checking if you are interested in contributing to the evidence base. More information: https://recoveryafterstroke.com/book | Support the podcast: https://patreon.com/recoveryafterstroke *This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. The post Can a Mushroom Help Your Brain Heal? The Science Says Maybe appeared first on Recovery After Stroke.

Det är äntligen dags för Jacobs utlovade avsnitt kring fröoljor, eller seed oils som de ofta kallas på internet. I avsnittet får du veta lite mer om var termen fröoljor innebär och vad det är som har gjort att det blivit ett sånt surr kring termen på sociala medier de senaste åren. Du kommer också att få lära dig en hel del om vad oljorna påstås göra och varför det mesta som påstås är antingen fel eller baserat på ingenting mer än vilda spekulationer. Det här avsnittet finns också att se på Youtube vilket bör underlätta för dig att följa med då det är en del tabeller och diagram som kan vara bra att se samtidigt som vi diskuterar dem. Dessutom är det med en del roliga klipp som definitivt gör sig bättre om du får både ljud och bild istället för bara ljud. Videoavsnittet hittar du på Jacobs egen youtubekanal som kort och enkelt bara heter gudiol. Till det här avsnittet finns det även en artikel på Tyngre där du kan hitta ytterligare referenser utöver de som visas i bild på youtube. Du hittar den artikeln här, Varför snackar alla om fröoljor?. På Tyngre Träningssnacks instagram kan du hitta bilder relaterat till detta och tidigare avsnitt. Hålltider (00:00:00) Introsnack om fotbolls-VM (00:08:40) Fröoljor, aka seed oils, vad säger forskningen? (00:11:46) Joe Rogan och Paul Saladino som katalysator bakom oron kring fröoljor (00:17:20) De vanliga fröoljorna i USA är väldigt annorlunda mot de vanliga i Sveriga (00:20:15) Litet sidospår om personen Paul Saladino, tidigare Carnivore MD (00:33:28) Svenska influensers som kopierar snack från USA som content (00:35:32) Fröoljor är en dålig kategorisering av livsmedel och används inte i forskning normalt sett (00:40:26) Varför omega-6 påstås vara inflammatoriskt (00:43:08) Forskning visar inte att omega-6 är inflammatoriskt i praktiken (00:48:45) Omega-6 ger inte inflammation i interventionsstudier (01:01:24) Vi vet att fleromättade fetter istället för mättade fetter är positivt för blodfetterna (01:03:12) Observationsstudier med objektiva biomarkörer visar på neutrala eller positiva effekter från omega-6 (01:09:33) De långsiktiga RCTs som finns är stökiga och svårtolkade (01:12:23) Sydney diet hart study och Minnesota coronary experiment (01:16:33) Ration mellan omega-6 och omega-3 (01:20:59) Ditt omega-3 intag har väldigt stor inverkan på ration mellan omega-6 och omega-3 (01:26:05) De flesta animaliska livsmedel vi äter idag har högre ratio än rapsolja (01:31:30) Hur är det med uppvärmning av oljor? (01:36:00) Många näringsrekommenationer avråder från väldigt högt intag av fleromättade fetter (01:43:46) Dieter som lurar människor till att börja äta lite bättre

This is my personal favorite topic, but probably your least favorite: strength training.  Before you run away, hear me out! Because whether you’re bed-bound, housebound, or just convinced your body can’t handle it right now, this episode is for you. I’m breaking down exactly WHY resistance and strength training isn’t just helpful for vestibular disorders—it’s essential.  You Have to Move Your Body to Manage Your Dizziness From the dizzy-anxious-dizzy cycle to blood sugar regulation to better sleep to reduced inflammation, strength training touches virtually every struggle vestibular warriors face. I’m not letting anyone off the hook, but I am meeting you exactly where you are. Starting with 3 minutes? That counts.  Walking to the mailbox and back? That counts too.  Because the goal here is progress, not perfection. And you know I have the science to back every single word of it! In this episode, we'll dig into: Why strength training is non-negotiable for vestibular disorder management How exercise helps break the dizzy-anxious-dizzy cycle “In the moment” vs. “hangover” dizziness and how to adjust your approach Why EDS, HSD, or MCAS makes building muscle even more critical The truth about the fear of getting “bulky” How to start exercising when you’re bedbound or couch-bound What physical activity guidelines actually say, and where most people fall short How functional movements like the deadlift directly support vestibular patients How Vestibular Group Fit makes strength and resistance training accessible Whether you start with 3 minutes or 30, the most important thing is that you start. Because your vestibular system, your mood, your balance, and your future self are all counting on it. Links Mentioned: Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit Free Resources: ⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n ⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd ⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership ⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit ⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor Work with Dr. Madison: For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com Otherwise, I'll see ya in Vestibular Group Fit! Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/ Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit Citations: Adriano Oliveira, Andressa Fidalgo, Paulo Farinatti, Walace Monteiro,Effects of high-intensity interval and continuous moderate aerobic training on fitness and health markers of older adults: A systematic review and meta-analysis,Archives of Gerontology and Geriatrics,Volume 124,2024,105451,ISSN 0167-4943,https://doi.org/10.1016/j.archger.2024.105451.(https://www.sciencedirect.com/science/article/pii/S0167494324001274) Yu Y, Wang J, Xu J. Optimal dose and type of exercise to improve cognitive function in patients with mild cognitive impairment: a systematic review and network meta-analysis of RCTs. Front Psychiatry. 2024 Sep 12;15:1436499. doi: 10.3389/fpsyt.2024.1436499. PMID: 39328348; PMCID: PMC11424528. Zhang Y, Zhou M, Yin Z, Zhuang W, Wang Y. Relationship between physical activities and mental health in older people: a bibliometric analysis. Front Psychiatry. 2024 Oct 21;15:1424745. doi: 10.3389/fpsyt.2024.1424745. PMID: 39497901; PMCID: PMC11532734. Garcia Meneguci, C. A., Meneguci, J., Sasaki, J. E., Tribess, S., & Júnior, J. S. V. (2021). Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis. PloS one, 16(1), e0246275. https://doi.org/10.1371/journal.pone.0246275 Mennitti C, Farina G, Imperatore A, De Fonzo G, Gentile A, La Civita E, Carbone G, De Simone RR, Di Iorio MR, Tinto N, Frisso G, D’Argenio V, Lombardo B, Terracciano D, Crescioli C, Scudiero O. How Does Physical Activity Modulate Hormone Responses? Biomolecules. 2024 Nov 7;14(11):1418. doi: 10.3390/biom14111418. PMID: 39595594; PMCID: PMC11591795. Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta. 2010 Jun 3;411(11-12):785-93. doi: 10.1016/j.cca.2010.02.069. Epub 2010 Feb 25. PMID: 20188719; PMCID: PMC3629815.  Chastin, S.F.M., Abaraogu, U., Bourgois, J.G. et al. Effects of Regular Physical Activity on the Immune System, Vaccination and Risk of Community-Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis. Sports Med 51, 1673–1686 (2021). https://doi.org/10.1007/s40279-021-01466-1 Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc. 2022 Jan;70(1):49-59. doi: 10.1111/jgs.17477. Epub 2021 Sep 24. PMID: 34536288. Rey-Lopez JP, Rimm EB, Tabung FK, Giovannucci EL. Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults. Circulation. 2022 Aug 16;146(7):523-534. doi: 10.1161/CIRCULATIONAHA.121.058162. Epub 2022 Jul 25. PMID: 35876019; PMCID: PMC9378548. Hupin D, Roche F, Gremeaux V, Chatard JC, Oriol M, Gaspoz JM, Barthélémy JC, Edouard P. Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(19):1262-7. doi: 10.1136/bjsports-2014-094306. Epub 2015 Aug 3. PMID: 26238869. Chandrasekaran B, Ganesan TB. Sedentarism and chronic disease risk in COVID 19 lockdown – a scoping review. Scott Med J. 2021 Feb;66(1):3-10. doi: 10.1177/0036933020946336. Epub 2020 Jul 27. PMID: 32718266; PMCID: PMC8685753. Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging. 2021;25(7):824-853. doi: 10.1007/s12603-021-1665-8. PMID: 34409961; PMCID: PMC12369211. Bunnell E, Stratton MT. The Impact of Functional Training on Balance and Vestibular Function: A Narrative Review. J Funct Morphol Kinesiol. 2024 Dec 3;9(4):251. doi: 10.3390/jfmk9040251. PMID: 39728235; PMCID: PMC11679947. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985 Mar-Apr;100(2):126-31. PMID: 3920711; PMCID: PMC1424733. Warner A, Vanicek N, Benson A, Myers T, Abt G. Agreement and relationship between measures of absolute and relative intensity during walking: A systematic review with meta-regression. PLoS One. 2022 Nov 3;17(11):e0277031. doi: 10.1371/journal.pone.0277031. PMID: 36327341; PMCID: PMC9632890. “Metabolic Equivalent (MET): Pick the Best Exercise for Longevity.” Whyiexercise.com, www.whyiexercise.com/metabolic-equivalent.html. Love what you heard?Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you! This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. ————————————— strength and resistance training, exercises for vestibular disorders, living with vestibular migraine, guidelines of physical activity, anxiety and depression, chronic dizziness, couch bound, bed bound, dizzy-anxious-dizzy cycle, physical therapist

The following question refers to Section 7.1 of the 2025 ACS Guidelines. The question is asked by Thomas Jefferson medical student and CardioNerds Academy Intern Dr. Grace Qiu, answered first by University of Michigan fellow and CardioNerds FIT Ambassador Dr. Kayla Secrest, and then by expert faculty Dr. Sunil Rao. Dr. Rao is an interventional cardiologist, Professor of Medicine at NYU Grossman School of Medicine, Deputy Director of the Leon H. Charney Division of Cardiology, and the Director of Interventional Cardiology for the NYU Langone Health System. He is the Editor-in-Chief for Circulation Cardiovascular Interventions and was the Chair of the Writing Committee for the 2025 ACS Guidelines. This episode is part of our comprehensive Decipher the Guidelines Series covering the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Question #1 A 68-year-old man with a history of hypertension, hyperlipidemia, stage III chronic kidney disease, and prior tobacco use presents to a local emergency department with reports of chest pain while raking leaves at home. Upon arrival, he is hemodynamically stable with a heart rate of 86 beats per minute and a blood pressure of 133/85 mmHg. His EKG reveals ST elevations in the septal and anterior leads (V1-V4). He is given 324mg of aspirin and is promptly evaluated by the interventional cardiology team, who elects to take him emergently to the catheterization lab. Upon arrival to the catheterization lab, the nurse asks the interventional fellow which access sites they should prep for this case? How should the interventional fellow respond? A Right radial artery only B Radial + bilateral femoral C Bilateral femoral only Answer #1 Explanation  The correct answer is B. Radial and bilateral femoral Radial artery access is the preferred vascular access site for coronary angiography and PCI in patients with ACS. Transradial access has been shown to reduce mortality, bleeding, and vascular complications compared with transfemoral access (Class I, LOE A). Radial access also allows earlier ambulation and is associated with greater patient comfort. Although the right radial artery is the most widely studied upper-extremity access site, alternative sites such as the ulnar and distal radial arteries have demonstrated similar outcomes. However, the radial artery may be required as a bypass conduit for CABG. In institutions where the radial artery is routinely used for surgical grafting, this potential future use should be considered when selecting vascular access. In addition, transfemoral access—preferably performed with ultrasound guidance—should be considered in patients in whom temporary mechanical circulatory support (MCS) is anticipated or in those for whom radial access is not feasible due to anatomical or technical constraints. Prepping bilateral groins in addition to the radial artery provides a backup strategy for urgent MCS placement or for transition to femoral access should radial access fail. For these reasons, prepping both the radial artery and bilateral groins is the most appropriate response. Radial-only preparation is incorrect because, although radial access is preferred, patients with STEMI may still require emergent MCS or alternative access if the radial artery is unsuitable. Preparing only the wrist without backup femoral access may delay care should hemodynamic instability occur. Femoral-only preparation is incorrect because transradial access provides superior outcomes in ACS, including significant reductions in all-cause mortality, major bleeding, and vascular complications. RCTs and meta-analyses, including MATRIX (which showed lower MACE and net adverse clinical events with radial access) and SAFARI-STEMI (which showed no difference in mortality but was underpowered)—support radial as first-line access when feasible. Main Takeaway For patients with ACS undergoing PCI, radial access is strongly preferred to reduce mortality, bleeding, and vascular complications. Guideline Loc. Section 7.1  

It's in the News! The top diabetes stories and headlines happening now. Top stories this week include: Afrezza inhaled Insulin is Approved for Kids, CGM + Ketone Monitor gets European approval, Food Coloring & Diabetes Study, Device Recalls include Omnipod and Dexcom, Beta Bionics shares more about their patch pump, ADA conference info and more! This podcast is not intended as medical advice. If you have those kinds of questions, please contact your health care provider. Announcing Community Commericals! Learn how to get your message on the show here. Learn more about studies and research at Thrivable here Please visit our Sponsors & Partners - they help make the show possible! Omnipod - Simplify Life All about Dexcom  All about VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Episode transcripts: Welcome! I'm your host Stacey Simms and this is an In The News episode.. where we bring you the top diabetes stories and headlines happening now. A reminder that you can find the sources and links and a transcript and more info for every story mentioned here in the show notes. ADA starts this week – safe travels to those of you heading to New Orleans. We'll be covering remotely so please follow on social – make sure to Like the FB page or join the group. We've got a wrap up episode planned for this podcast as well as some indepth interviews with the newsmakers from the conference. I will see some of you next week in Chicago. We have a couple of seats left for our Club 1921 dinner on June 10th in Northbrook – this is a FREE dinner for HCPs and patient leaders – all about screening for T1D. More info on the website under the events tab. Okay.. our top story this week: XX Afrezza inhaled insulin is now approved for kids and teens. The FDA okayed MannKind's afrezza for children 6 and older with type 1 and type 2 diabetes. MannKind says its proprietary Technosphere drug delivery platform enables the rapid absorption of insulin into systemic circulation. This follows FDA approval earlier this year for an update that revises recommendations for the starting mealtime dosage when patients switch from subcutaneous mealtime insulin regimens. MannKind also completed enrollment in February for a study evaluating the initiation of Afrezza therapy shortly after type 1 diabetes diagnosis in pediatric patients.   The company said it made Afrezza available for eligible patients for $35 or less per month. Desmond Schatz, professor of pediatrics at the University of Florida College of Medicine, said: "Mealtime insulin can be especially challenging for children because eating and snacking patterns, activity levels, and daily settings like school and sports often vary. With its rapid onset and dosing at the start of a meal, Afrezza may help clinicians better match insulin therapy to how children and families live day to day, while offering a needle-free mealtime option." Lots more to come on this – we're working on a bonus episode with one of the pediatric endos who worked on the clinical trials that led to this approval – hopefully have that out later this week. https://www.massdevice.com/mannkind-fda-approval-inhaled-insulin-children/ XX FDA has agreed to consider a new drug for the treatment of adults with type 1 and chronic kidney disease. Finerenone (fy-near-uh-known) is currently approved in the US for adults with CKD associated with type 2 diabetes and for adults with heart failure with left ventricular ejection fraction of 40% or greater. Chronic kidney disease (CKD) is present in over one-third of adults with diabetes, and because it's such a serious condition, interventions are needed to reduce its incidence and help people live a long and prosperous life. https://www.docwirenews.com/post/fda-grants-priority-review-to-finerenone-snda-for-type-1-diabetes-associated-ckd XX Abbot gets European approval for the world's first dual glucose‑ketone sensing technology for people with diabetes. They're calling this Libre Duo and Libre Duo 10 Day, and it's designed to continuously measure glucose and ketone levels every minute. Abbott plans to begin launching Libre Duo systems in select European countries later this year. Libre Duo delivers up to 15 days of wear and will be offered to adults ages 18 and older. Libre Duo 10 Day offers up to 10 days of wear and is intended for people ages 2 and older. Abbott is also working with leading pump companies to allow automated insulin delivery (AID) systems to connect with the sensors. https://abbott.mediaroom.com/2026-05-27-Abbott-secures-CE-Mark-for-worlds-first-dual-glucose-ketone-sensing-technology-for-people-with-diabetes   XX Huge recall for Omnipod. Insulin says a manufacturing issue through ongoing product monitoring that could result in insulin under-delivery  with specific lots of its Omnipod 5, Dash and Eros pods. Insulet said the scope of this action reaches approximately 7 million pods. This issue is separate from the March recall that affected certain Omnipod 5 lots. According to the Acton, Massachusetts-based company, some of its affected pods may have a small tear in the tubing (cannula) just above the skin. This tear lands between the pod and the point where the cannula enters the body. If this occurs, insulin may leak outside of the device instead of being fully delivered into the body as intended. This may lead to under-delivery of the therapeutic.   Individuals using an affected pod may notice wetness on the skin or pod adhesive or detect the smell of insulin. However, some cases may prove difficult to detect and go unnoticed. Of the approximately 7 million pods included in the action, approximately 60% have been consumed or are expired. The pods affected by the correction represent approximately 8.5% of the 2025 global Omnipod pod prodcution. Insulet says it has sufficient supply to replace affected pods. It expects no disruption to product availability. The company said it has notified the FDA and all other relevant regulatory authorities of its action.   The full list of affected pod lots can be found here. https://www.massdevice.com/insulet-another-omnipod-5-recall-dash-eros/ XX Dexcom is warning that certain scrapped glucose sensors have been stolen and resold. Dexcom said it has not received any reports of severe adverse events associated with the stolen product. One lot of scrapped devices carries a risk of infection for sensors that are not properly sterilized, and another lot had an elevated internal testing failure rate, meaning users would have an increased risk of having no sensor readings available. Dexcom said the affected sensors were stolen during the destruction process and then sold by third parties. The company routinely scraps sensors that do not meet its standards. The sensors are sent to a third-party vendor for destruction and recycling.   Dexcom said it traced sales of the stolen devices to Pharmsource, which is not an authorized Dexcom distributor but supplies some independent pharmacies and U.S. durable medical equipment distributors. Because of this, pharmacies that purchase products from Pharmsource should review their inventory, Dexcom said.   People with sensors from the affected lots should not use those sensors and can call customer support to request replacements. Dexcom has set up a website to help users check if their devices are affected. https://www.medtechdive.com/news/dexcom-warns-of-scrapped-glucose-sensors-being-resold/821139/ XX XX   Beta Bionics plans to debut its first insulin patch pump by the end of the second quarter of 2027, subject to Food and Drug Administration clearance. The device, called Mint, would be compatible with Beta Bionics' interoperable automated glycemic controller, a software that allows for the pump to automatically adjust insulin delivery based on readings from a glucose sensor. Beta Bionics first unveiled the prototype for Mint last year at the American Diabetes Association's Scientific Sessions. The device is expected to have a similar size and wear time, at three days, to Insulet's patch pumps on the market. It would have a 200-unit insulin reservoir.   Mint differs by containing a mix of reusable and disposable components. Beta Bionics plans to make the device exclusively available in the pharmacy channel, building on its existing agreements for its current iLet insulin pump. Beta Bionics is one of several diabetes tech companies developing patch pumps to compete with market leader Insulet. Tandem Diabetes Care and Medtronic spinoff MiniMed have also announced planned patch pumps. Tandem said it plans to file a 510(k) submission this quarter for a tubeless version of its small, durable pump, and Medtronic plans to submit its patch pump to the FDA this fall.   https://www.medtechdive.com/news/beta-bionics-to-launch-its-first-insulin-patch-pump-to-compete-with-insulet/821091/ XX CVS puts Zepbound back on it's coverage list – with it's Caremark PBM. They also added Foundayo, Lilly's obesity pill. CVS had dropped Lilly's Zepound last summer but kept competitor Wegovy. It'll be back at Caremark October first. All three of the nation's largest pharmacy ⁠benefit managers ​now cover Lilly's full obesity medicine portfolio. https://www.reuters.com/legal/litigation/cvs-brings-back-coverage-lillys-obesity-drug-zepbound-2026-05-28/   More to come, including a new benefit from metformin for women, something new from Tidepool, big news for T1D in Austalia and more.. XX A new study suggests that higher long-term exposure to food colouring additives — including both synthetic and natural colourings commonly found in processed foods and beverages — may be associated with an increased risk of developing type 2 diabetes. Researchers analyzed data from more than 108,000 adults in the French NutriNet-Santé cohort between 2009 and 2023, following participants for a median of just over eight years. During that time, 1,131 participants developed type 2 diabetes. The study found that people with the highest intake of total food colouring additives had a 38% higher risk of developing type 2 diabetes compared with non- or low-consumers.   Several specific additives were linked to increased risk, including caramel colouring additives such as total caramel (E150 family), plain caramel (E150a), sulphite ammonia caramel (E150d), and beta-carotene (E160a). Additional associations were observed for curcumin (E100), anthocyanins (E163), paprika extract (E160c), lutein (E161b), and cochineal-derived colourings (E120). "Our findings revealed positive associations between widely consumed food colouring additives and type 2 diabetes incidence," the authors wrote, adding that further research is needed to better understand the mechanisms behind the findings and whether food colouring regulations should be reevaluated. https://www.medscape.com/viewarticle/use-common-food-colours-tied-high-type-2-diabetes-risk-2026a1000hes XX Big news for Australia – their Therapeutic Goods Administration (TGA) approves Tzield. Tzield is now approved in Australia to delay the onset of stage 3 (or clinical) T1D in people aged eight years and older with stage 2 T1D – the early, pre-symptomatic stage of the condition, where changes in blood glucose levels have begun but insulin therapy is not yet required. Breakthrough T1D Australia Chief Executive Officer, Sydney Yovic, said the approval represented a transformational moment for Australians affected by T1D. https://newshub.medianet.com.au/2026/05/landmark-approval-of-tzield-in-australia-ushers-in-a-new-era-of-delay-for-type-1-diabetes/155036/ XX https://www.theatlantic.com/health/2026/05/diabetes-pregnancy/687324/ XX A common diabetes drug may hold great potential to help with aging, even if scientists aren't exactly sure why. According to a study, the drug metformin doesn't just help patients to effectively manage their type 2 diabetes. it may also give older women a better chance of living to 90. Scientists in the US and Germany used data from a long-term US study of postmenopausal women.   Records for a total of 438 people were selected – half of whom took metformin to treat diabetes, and half of whom took a different diabetes drug, sulfonylurea.   While there are some caveats and asterisks to the study, those in the metformin group were calculated to have a 30 percent lower risk of dying before the age of 90 than those in the sulfonylurea group. The study used age 90 as the marker for 'exceptional' longevity. However, scientists aren't yet sure that the drug extends lifespan, especially in humans – which is part of the reason for this study. RCTs could follow further down the line to dig deeper into these results, the researchers suggest. In the meantime, as the global population continues to skew older, studies continue to find ways to keep us healthier for longer and reduce damage to the body as we age. https://www.sciencealert.com/a-common-diabetes-drug-is-linked-with-exceptional-longevity-in-women XX The American Diabetes Association® (ADA) will host the 2026 Scientific Sessions from June 5-8 in New Orleans. The ADA's Scientific Sessions is the world's largest diabetes meeting, convening an expected audience of over 12,000 leading physicians, scientists, researchers, and healthcare professionals from around the globe. The premier diabetes meeting, which is also offered virtually, will feature the latest scientific findings in diabetes and obesity, where leading experts and peers will share findings in research for prevention, care, and cures at the Ernest N. Morial Convention Center. Key themes will include: Advancing obesity and metabolic health: Prevention, early detection, and disease modification: Improving cardiometabolic outcomes: Transforming care through innovation and access: New research will highlight how technology, artificial intelligence, and implementation strategies are reshaping diabetes care—reducing treatment burden, expanding access, and enabling more person-centered care. Advancing beta cell replacement and cure strategies: Fostering innovation: On Saturday, June 6, from 4:30-6:00 p.m., the Innovation Challenge, which debuted in 2023, invites emerging companies to pitch novel ideas to improve the lives of people living with diabetes. A panel of judges, with input from a live audience, determines which contestants will earn a private audience with potential funders. XX Tidepool, the nonprofit leader advancing innovation in diabetes technology, announced that Tidepool+ Direct Connect is now available through the Epic Showroom. Built on SMART on FHIR, Direct Connect brings interactive diabetes device data directly into Epic workflows, helping clinicians use patient data during routine care. "Tidepool has always focused on making diabetes data more accessible and actionable," said Brandon Arbiter, CEO. "We're excited to empower clinicians using Epic with insightful, intuitive patient data that fits directly into their encounter workflow so they can use it to improve care in the moment it matters."   Tidepool+ Direct Connect supports scalable deployment across Epic-enabled health systems. This architecture enables faster, more intuitive rollouts, enhancing Tidepool's existing EHR integration capabilities.   Direct Connect is part of Tidepool's ongoing work to improve how clinicians can use timely and relevant diabetes device data during patient visits to help drive better health outcomes.   The feature is now available in the Connection Hub of the Epic Showroom.   https://www.businesswire.com/news/home/20260527780274/en/Tidepool-Launches-in-Epic-Showroom-to-Bring-Diabetes-Device-Data-into-the-Point-of-Care XX

Jonathan Howard and Wendy Orent call this week their "Red Wedding": within days, FDA Commissioner Marty Makary resigned, Vinay Prasad was pushed out of CBER, Tracy Beth Hoeg was fired, and Senator Bill Cassidy lost his Louisiana primary. The hosts argue this is not a tragedy but a long-foretold collapse — a group of physicians who built careers as COVID-era contrarian podcasters discovering that running a regulatory agency is fundamentally different from posting about one. Howard works through the wreckage: Makary's reported approval of flavored nicotine products days before his ouster, the FDA's treatment of the rare disease community, the leaked memo claiming pediatric COVID vaccine deaths that career staff refused to sign off on, and the broader pattern of "regulatory whiplash" that drove the agency into dysfunction. The episode then turns to who is still standing — Jay Bhattacharya at NIH, Robert F. Kennedy Jr. at HHS — and what Kennedy is reportedly doing to vaccines from behind the scenes via Martin Kulldorff's review effort. Throughout, the hosts return to a single thesis: the skills that made Makary, Prasad, Hoeg, and Cassidy famous during COVID — opinion, tweeting, posturing — do not translate into running institutions, and the medical commentators who vouched for them (John Mandrola, Adam Cifu) have lost any remaining credibility. Key Topics Discussed Bill Cassidy's primary loss and the cost of the Kennedy confirmation vote Cassidy's earlier vote to convict Trump after January 6 followed by his decisive vote advancing RFK Jr. as HHS Secretary. Howard and Orent's view that Cassidy's promise to "keep Kennedy in line" was hollow from the start. What Cassidy's defeat signals about Trump's grip on the Republican base in Louisiana — and the hosts' read that his lame-duck status may give him cover to block the next round of HHS nominees. Marty Makary's resignation and the "worst FDA Commissioner in 25 years" framing The Stat News piece characterizing Makary's tenure, and the reporting that flavored nicotine was the precipitating issue with Trump's tobacco-industry donors. Howard's counterpoint: Makary reportedly approved a batch of electronic nicotine delivery systems (ENDS) on May 5, 2026 — the weekend before he resigned — undercutting the "principled stand" narrative. The pattern of selfie videos, public-facing performance, and what former FDA staff describe as hostile management of career scientists. Makary's pre-FDA record: the "medical error is the third leading cause of death" claim, Omicron as "nature's vaccine," "Omicold," herd immunity calls in May 2021, and the Nazi-bioweapon Lyme disease theory amplification. Vinay Prasad, regulatory whiplash, and the rare disease community How Prasad's stated preference for randomized controlled trials translated into rejection of rare disease therapies — and the disconnect between calling for RCTs on Twitter and the practical impossibility of running them for small patient populations. Right-to-try advocates, the libertarian wing of MAHA (Senator Ron Johnson), and why they turned on Prasad. Howard's point: Pfizer's halted COVID vaccine RCT in 50–65-year-olds is the case study — the trials Prasad demanded couldn't actually be enrolled. Tracy Beth Hoeg, the leaked pediatric deaths memo, and the Maryanne Demasi interview Hoeg's insistence she was fired, not resigned, and her interview with Brownstone Institute–adjacent journalist Maryanne Demasi. Her claim that the chaos at the FDA was "created by the media" rather than real. The memo alleging 10 pediatric deaths from the COVID vaccine that career FDA staff would not sign off on — and Howard's contrast with the J&J/thrombosis response, where nine deaths produced immediate, transparent action. Hoeg's role in the Denmark-style vaccine schedule rollback memo alongside Makary. The Makary–Prasad ZDoggMD clip on FDA "vindictiveness" — and the irony Audio pulled from a pre-appointment Prasad/Makary appearance describing the FDA as "erratic," "capricious," and politically pressured. Howard's read: every criticism they leveled at the Biden-era FDA describes their own tenure — political pressure from Trump, demoted career staff, inconsistent standards. The Peter Marks / Marion Gruber / Phil Krause booster episode reframed in light of what followed. John Mandrola, Adam Cifu, and the cost of vouching Mandrola's "Can We Give the New FDA's Leadership a Chance?" piece a year earlier — and the line about Prasad and Makary inducing companies to run proper RCTs, set against Pfizer's halted trial. Howard's account of an email exchange with Cifu following Cifu's visit to NYU — Howard's offer of a serious content-level conversation, and Cifu's decline. The broader "medical conservatives" project and what the hosts argue has happened to its credibility. Jay Bhattacharya, NIH, and the resignation letter from departing staff The letter from a senior NIH scientist on Bhattacharya's leadership — political termination of grants, deals institutions are making to recover funding, and Bhattacharya's silence. Howard and Orent's read on Bhattacharya's visible deterioration and his retreat into Great Barrington nostalgia. Kennedy's behind-the-scenes vaccine review and Martin Kulldorff The New York Times reporting (Christina Jewett and Sheryl Gay Stolberg) on Kennedy's vaccine inquiry being led by Kulldorff. Howard's pushback on the framing of Kulldorff as merely "a critic of restrictions and mandates" — and the 2020 record of his herd-immunity-through-infection advocacy, including his Stockholm "almost at herd immunity" claim in April 2020. The hosts' concern that the COVID amnesia project lets pandemic-era pro-infection figures re-enter regulatory power with their record sanitized. Casey Means, Surgeon General nomination withdrawal, and MAHA fracturing The withdrawn Surgeon General nomination and what it signals. The Robert Malone vs. Makary public falling-out over the unreleased pediatric deaths data. Why the MAHA coalition — held together by shared COVID grievance — is coming apart now that COVID has receded from headlines. Notable Moments On Cassidy: "He betrayed his oath as a physician, he betrayed the American people, and he's going down into the ignominious dust." — Wendy Orent On the Makary–Prasad–Hoeg trio: "The same skill sets that catapulted these guys to power — essentially being excellent podcasters — do not translate into leading a government agency of tens of thousands of employees that regulates 20 percent of the US economy." — Jonathan Howard On the legacy: "These guys are now cautionary tales for medical students. I would love to teach a course called 'Be the Opposite of Bill Cassidy, Marty Makary, Vinay Prasad, and Tracy Beth Hoeg.'" — Jonathan Howard On Bhattacharya: "His soul has been totally corrupted by the people who he teamed up with. You also see it in his face. He's not the same person that took the position." — Jonathan Howard References Mentioned in the Episode Stat News — "Why Marty Makary Was the Worst FDA Commissioner in 25 Years" Vinay Prasad's 2016 Stat News rebuttal of Makary's "medical error" claim David Gorski (Science-Based Medicine, 2016) — rebuttal of the medical-error-as-third-leading-cause-of-death claim Jonathan Howard, Science-Based Medicine — recent piece compiling Makary's COVID-era statements New York Times — Christina Jewett and Sheryl Gay Stolberg on Kennedy's vaccine inquiry Washington Post — "Ouster of RFK's Allies Tests MAHA-Trump Alliance" Ben Mazer, The Atlantic — on whether Makary and Prasad enacted lasting change Francis Lee — In COVID's Wake Alfred Crosby — America's Forgotten Pandemic Maryanne Demasi interview with Tracy Beth Hoeg MedPage Today — Makary and Prasad, "The Importance of Humility in Medicine" People Referenced Marty Makary — outgoing FDA Commissioner Vinay Prasad — former CBER Director Tracy Beth Hoeg — fired FDA official Senator Bill Cassidy (R-LA) — lost primary Robert F. Kennedy Jr. — HHS Secretary Jay Bhattacharya — NIH Director Martin Kulldorff — leading Kennedy's vaccine review Peter Marks — former CBER Director, Operation Warp Speed Bob Kadlec — Operation Warp Speed David Kessler — former FDA Commissioner (referenced) Marion Gruber and Phil Krause — former FDA vaccine reviewers John Mandrola and Adam Cifu — "medical conservative" commentators Robert Malone — anti-vaccine activist Casey Means — withdrawn Surgeon General nominee Senator Ron Johnson (R-WI) Representative Jake Auchincloss — opened FDA whistleblower line Art Caplan — bioethicist (retirement) Erica Schwartz — CDC Director nominee, unconfirmed  

 Dr. Matthew Nagra makes his fourth appearance on the podcast. And this time he's laser-focused on the social media-driven controversy around seed oils. Dr. Nagra and his team put in the hours and reviewed the science around seed oils, examining three main, viral claims we bust down in this episode, including:  1.     “Seed oils cause inflammation”, 2.     “The RCTs prove harm”, 3.     And “Heating or processing creates toxic compounds”. Dr. Nagra is a Naturopathic Doctor devoted to bringing the most up-to-date, evidence-based nutrition information to his patients in his Vancouver-based practice, and to the public via social media, presentations, and scientific publications. He aims to correct mis- and disinformation in a way that is easily digestible, helping people make fully informed dietary choices. He has also contributed to multiple nutrition textbooks, including Springer Nature's Handbook of Public Health Nutrition, and is a nutrition science advisor for the highly anticipated documentary, The Game Changers 2. You can also catch him in Episode 84, where we look at evidence around swapping out animal and plant-based meat; Episode 47, focused on misinformation around the Food Compass System; and Episode 2, where we talk about nutrition myths and misinformation more broadly. RESOURCES Concerns about the health effects of industrially produced seed oils are without scientific foundation: a scoping narrative review of the clinical and observational evidence Dr. Nagra's Website Instagram Facebook X Support the show

Gina, a perinatal fitness trainer, birth doula, and founder of MamasteFit in North Carolina, explains how exercising during pregnancy improves quality of life during pregnancy and postpartum—not just birth outcomes—while noting prenatal exercise research is still limited. She highlights a 2025/2026 American Journal of Obstetrics and Gynecology systematic review (11 RCTs) finding the strongest biomarker benefits from 12+ week programs done 2–3 times/week at moderate-to-vigorous intensity, including reduced pro-inflammatory markers, improved glucose/insulin regulation (supporting lower gestational diabetes risk), better lipid regulation, and favorable hormone/growth-factor changes linked to placental function and possibly baby brain development. Another 2025 review (9 RCTs, 1,500+ participants) suggests strength training may reduce excessive weight gain, low back/sciatic pain, and improve mood, sleep, fatigue, and well-being. She also cites studies indicating high-intensity lifting and even Valsalva can be well-tolerated with adequate rest and self-monitoring, then outlines MamasteFit's endurance-focused programming (compound lifts, accessory multi-plane work, myofascial slings, and posterior-chain emphasis) and promotes their app/video programs with a discount code.00:00 Why Prenatal Exercise Matters00:46 Meet Gina and MamasteFit01:38 What Research Can Tell Us02:23 Biomarkers and Training Dose05:11 Inflammation and Glucose Control08:05 Lipids Hormones and Baby Brain10:46 Strength Training Quality of Life13:17 Heavy Lifting and Valsalva Safety18:03 Listening to Your Body18:58 How to Program Prenatal Lifting20:54 Movement Variety and Posterior Chain23:04 Programs and Final Takeaways————

Welcome to Episode 1 of the SciTech Critical Evaluation of Literature and AI Series: “Evidence Unlocked: Separating Gold from Gravel"Not all evidence is created equal, so how do you separate gold from gravel? Join experts from the MAPS Scientific & Technical Knowledge Domain for a fast-paced session designed to simplify critical appraisal for busy professionals. In just a few minutes, you'll learn how to navigate the hierarchy of evidence and apply practical frameworks. We'll also share a step-by-step approach for rapid evaluation, helping you assess robustness, and clinical relevance without getting lost in complexity. If you want to make smarter, faster evidence-based decisions, this podcast is for you!Learning Objectives: Understand the hierarchy of evidenceExplain the differences between randomized controlled trials (RCTs), observational studies, real-world data, and preprints, and why they matter for evidence quality.Recognize key frameworks for critical appraisalIntroduce GRADE, PRISMA, and CONSORT as practical tools for evaluating robustness, reproducibility, and clinical relevance.Apply a rapid evaluation approachProvide a simple, step-by-step method for quickly assessing scientific literature without compromising rigor.Hear more from the Scientific & Technical Knowledge Domain through their position paper: "Safeguarding Scientific Rigor in the Critical Evaluation of Literature"

Creatine Beyond Muscle: Cognitive Benefits, Supplement Basics, and Pragmatic Sports Nutrition with Dr. Jose Antonio Jason Wright interviews Dr. Jose Antonio about creatine's mainstream status, dosing (3–5 g/day vs. 10–20 g/day), and emerging cognition data, noting higher doses may be needed to raise brain creatine and benefits appear mainly under stress such as sleep deprivation, with vegans/vegetarians responding more. Antonio argues for a pragmatic approach that values RCTs but also real-world evidence, and debunks myths about “better” creatine forms (monohydrate is best studied), puffiness, and liver/kidney harm. He recommends focusing on exercise first, then basics like post-workout protein, creatine, a multivitamin, and omega-3s, with performance aids (sodium bicarbonate, beta-alanine, nitrates, carbs) depending on sport. They discuss EAAs, fasting, GLP-1 weight loss and lean mass loss, and Antonio's current research on energy drinks (mostly caffeine), beta-hydroxybutyrate, and a planned creatine/eye-tracking study relevant to sports. Antonio invites listeners to the ISSN conference in Fort Lauderdale (June 17–19). 00:00 Creatine Comes Full Circle 03:56 Creatine Mainstream and Brain Dosing 05:33 Science Pragmatism Over Purism 11:17 Mechanisms Sleep and Vegans 14:40 Creatine Myths and Forms 18:00 Safety Kidneys and Liver 20:02 Simple Supplement Stack Over 40 28:27 EAAs Protein and Fasting 31:43 GLP-1s and Lean Mass Concerns 33:25 GLP-1 Lean Mass Tradeoffs 34:28 Body Positivity Backlash 35:46 Staying On Drugs Long Term 37:06 Building Exercise Habits 42:21 Health Over Vanity 42:59 Sponsor Authentic Health 44:30 Supplements Compliance Reality 48:08 Energy Drinks And BHB 49:57 Creatine For Eye Tracking 54:38 Training For Longevity 58:01 Lateral Movement And Balance 01:00:12 Conference Invite And Wrap 01:01:21 Medical Disclaimer

Wherever Roshaneh Zafar went in Pakistan in the early 1990s, documenting World Bank social development projects, women told her the same thing: the water and sanitation are fine, but what about economic opportunity?Zafar tells Tim Phillips how that question led her to train with Muhammad Yunus and the Grameen Bank, and then back to Pakistan to found Kashf Foundation in 1996 — the country's first specialised microfinance institution for women. Thirty years on, Kashf serves more than one million clients, has covered six million lives through micro-health insurance, and has financed over 3,000 low-cost private schools. Zafar describes a model that long ago outgrew its Grameen origins: customised for Pakistan's diversity, run on a partnership rather than a hierarchical footing, and now embracing climate risk, ultra-poor programmes and AI-assisted credit decisions.The episode also confronts the question: Does microfinance actually empower women? Research has questioned whether it makes a difference. Zafar has ten years of longitudinal data that tells a different story, and a view on why the two bodies of evidence are not as contradictory as they appear.Research and references discussed in this episode:Banerjee, Abhijit, Esther Duflo, Rachel Glennerster, and Cynthia Kinnan. 2015. "The Miracle of Microfinance? Evidence from a Randomized Evaluation." American Economic Journal: Applied Economics 7(1): 22–53.Rana, Annum Ather. 2025. Evidence on the Impact of Microfinance Program on Poverty Reduction and Income Security. Kashf Foundation Focus Note Series, April To cite this episode:Phillips, Tim, and Roshaneh Zafar. 2026. "Roshaneh Zafar on 30 years of microfinance and mindset change in Pakistan." VoxDev Talk (podcast). Assign this as extra listening. The citation above is formatted and ready for a reading list or VLE.About Roshaneh ZafarRoshaneh Zafar is the founder and managing director of Kashf Foundation, Pakistan's first specialised microfinance institution. A development economist by training, she worked at the World Bank before leaving to found Kashf in 1996 after training under Muhammad Yunus at Grameen Bank in Bangladesh. Her work spans microfinance, micro-insurance, women's economic empowerment, low-cost private education and behaviour change communication. Research and context cited in this episodeGrameen Bank and the Grameen model. Founded by Muhammad Yunus in Bangladesh in 1983, Grameen Bank pioneered group-based lending to poor women without requiring collateral, on the premise that social accountability within borrower groups could substitute for asset security. Yunus received the Nobel Peace Prize in 2006. Kashf was established as a Grameen replicator but diverged significantly in its approach: hiring women loan officers from the outset, replacing the group hierarchy with a peer partnership model (using the Urdu term baji, meaning sister, for both client and staff), and adapting products for Pakistan's religious, linguistic and cultural diversity.The 2008 microfinance delinquency crisis in Pakistan. Over-indebtedness, predatory lending practices and the absence of a credit information bureau led to a sector-wide delinquency crisis in Pakistan in 2008. Following the crisis, regulators, lenders and the Pakistan Microfinance Network introduced enhanced consumer protection standards and a credit bureau to prevent multiple borrowing. Kashf now limits lending to clients with no more than two active loans from any provider.Banerjee et al. (2015) randomised controlled trial. The paper, a randomised evaluation of a microcredit expansion in Hyderabad, India by Spandana Sphoorty, found no statistically significant effect on women's empowerment, health, education or consumption over an 18-to-24-month follow-up period. It became the most-cited challenge to microfinance's development impact. Zafar's counter-argument turns on time horizon: empowerment, she argues, is a decade-scale process that short-panel RCTs cannot capture. A University of Minnesota longitudinal analysis of ten years of Kashf client data found a statistically significant positive correlation between the number of loans taken and business income, and between savings behaviour and subsequent business investment.Behaviour change communication: theater and television. Kashf has used street theater for thirty years to communicate on topics including child marriage, girls' education, reproductive health and insurance take-up. After Zafar attended a conference session on the impact of telenovelas on gender norms in Brazil and Mexico, the foundation moved into television drama production, covering topics including child sexual abuse, human trafficking and cybercrime. A child sexual abuse drama prompted a legal notice from PEMRA (the Pakistan Electronic Media Regulatory Authority), which was successfully contested. The dramas are produced with a media and creative team to ensure sensitive handling of difficult subjects.The gender bond and gender sukuk. In 2005, Zafar rang the opening bell at the New York Stock Exchange. The experience prompted a long-term ambition to connect micro women entrepreneurs to capital markets. Kashf subsequently issued a gender bond listed on the Pakistan Stock Exchange, followed by a gender sukuk (Sharia-compliant bond) listed on the Luxembourg Stock Exchange — the first such instrument linking Pakistani microfinance to international Islamic capital markets.Low-cost private schools. Research by Kashf found that clients, once they had access to income, were moving their children from public to low-cost private schools; teacher absenteeism in private schools was far lower. Further research showed 70% of these schools were run by women. Kashf began financing them; it now supports over 3,000 such schools, with a requirement that girls constitute at least 50% of enrolment.More VoxDev Talks on this topicBreaking down access constraints faced by women: Experimental evidence from Pakistan, a VoxDev Talk on how removing specific barriers to vocational training take-up shifts economic participation among women in Pakistan — the supply-side complement to Kashf's demand-side model.How safe transport could unlock women's labour force participation in Pakistan, a VoxDev Talk on how mobility constraints suppress women's economic activity in urban Pakistan, and how subsidised women-only transport services can shift that.Related reading on VoxDevWhat have we learned about microfinance?, a VoxDev article reviewing the evidence base on microfinance impact, including the conditions under which credit does and does not produce lasting change in household welfare.Women's microcredit groups empower women politically, a VoxDev article on evidence that participation in group lending schemes produces political voice and civic engagement even when economic empowerment effects are limited.Empowering women through digital financial services, a VoxDev article on how mobile money and digital accounts give women a private, named financial identity — and what that does to their control over household resources.

CoQ10 and Stroke Recovery: What the Science Actually Shows Your brain is the most energy-hungry organ in your body. It accounts for roughly 2% of your body weight but consumes about 20% of all the energy you produce. One of the key molecules driving that energy, CoQ10, quietly declines from your 30s onwards. For stroke survivors navigating fatigue, cognitive changes, and the long arc of recovery, that raises an obvious question: could supplementing with CoQ10 actually help? This mini-episode examines the peer-reviewed evidence — not marketing copy, not supplement industry claims, but what clinical research actually shows. What Is CoQ10 and Why Does It Matter After a Stroke? Coenzyme Q10, also known as CoQ10, or ubiquinol in its active form, is a molecule your body produces naturally. It lives primarily in the mitochondria, the energy-producing structures inside your cells, where it plays two roles: generating ATP (the cellular energy currency everything in your biology runs on) and acting as a powerful antioxidant that neutralises free radicals. When a stroke occurs, whether ischemic or hemorrhagic, the brain undergoes what is called ischemia-reperfusion injury. Blood flow is cut off, then restored. That restoration triggers inflammation and a surge of oxidative stress. Mitochondria in neurons start failing. Cells die not just from the original event but from the metabolic fallout that follows. CoQ10 goes directly to the site of that problem. If levels can be sustained or supplemented adequately, the theory is that it could reduce the secondary damage unfolding in the hours, days, and weeks after stroke. What Does the Clinical Research Actually Show? A landmark 2025 review published in the journal Nutrients analysed 12 animal studies and 8 human randomised controlled trials examining CoQ10’s effects on the brain. The findings are genuinely mixed, which is exactly what honest science looks like. In animal models, the evidence is consistent and compelling. Across Alzheimer’s, Parkinson’s, and epilepsy models, CoQ10 supplementation produced meaningful improvements in cognitive function via reduced oxidative stress, decreased neuroinflammation, increased ATP production in the hippocampus, and reductions in amyloid plaque burden. In humans, the picture is more complex. Of the 8 human RCTs reviewed, 4 showed evidence of benefit in specific conditions. In Progressive Supranuclear Palsy, frontal lobe cognitive function improved significantly. In Chronic Fatigue Syndrome, 150mg daily for 8 to 12 weeks improved working memory and reduced oxidative stress markers. In one Parkinson’s trial combining CoQ10 with creatine, cognitive improvements were measured at 12 and 18 months. However, trials in Alzheimer’s disease and Mild Cognitive Impairment showed no significant cognitive benefit, even at high doses. There is also an unresolved question: whether supplemental CoQ10 can cross the blood-brain barrier in meaningful quantities. Indirect pathways improved cerebral blood flow, reduced systemic inflammation, and may account for observed effects rather than direct brain-level action. What This Means for Stroke Survivors The honest assessment: the research supports a biologically plausible mechanism. CoQ10 is depleted by the conditions that cause and follow stroke. Supplementation shows real benefit in some neurological conditions. Animal evidence is consistently positive. But large-scale human RCTs specifically in stroke populations are still limited. Two practical points worth raising with your treating team before starting CoQ10: Form matters. Ubiquinol (the reduced form) has significantly higher bioavailability than standard ubiquinone, particularly important for older adults whose absorption is lower. Drug interactions. CoQ10 can reduce the anticoagulant effect of warfarin, a medication many stroke survivors take. It may also amplify blood-pressure-lowering effects of antihypertensive medications. Take the research, not the marketing, to your neurologist or GP. Ask whether it is appropriate, given your specific stroke type and current medications, what dose the evidence supports, and how long a reasonable trial period looks like. For more evidence-based tools and conversations with people who have walked this road, Bill’s book is a good place to start: https://recoveryafterstroke.com/book Support the community on Patreon: https://patreon.com/recoveryafterstroke This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. The post CoQ10 and Stroke Recovery: What the Science Actually Shows appeared first on Recovery After Stroke.

This month for the April 2026 episode of the RCEM Learning Podcast I speak with eight amazing speakers from the RCEM Annual Conference. This will be an absolutely bumper episode, and next month I will be speaking to seven speakers who are just as interesting. If you'd like to email us, please feel free to do so here. After listening, complete a short quiz to have your time accredited for CPD at the RCEMLearning website! (02:53) RCEM AC Interview Megamix - Part 1 of 2 (02:53) Andrew Lockey - Defibrillation strategies: To dual or not to dual? (15:01) Chelcie Jewitt - Not just a surgical problem: Sexual misconduct in EM (23:49) Michael Barrett - The MAGPIE Trial (42:30) Rebecca Whiticar - Top 5 common claims in EM (51:02) Ben McKenzie - AMAX4 (01:03:58) Annette Rickard and Ali Griffiths - Making dying better in the ED (01:17:36) Dan Horner - Diagnosis and management of pulmonary embolism in the ED (01:28:45) Dan Perry - Getting CRAFFTy about SCIENCE: Results from international RCTs in paediatric orthopaedic trauma Further Links and Reading Cheskes et al. - Defibrillation Strategies for Refractory Ventricular Fibrillation Surviving in Scrubs Hartshorn et al. - Treatment of acute trauma-related pain in children and adolescents with methoxyflurane (Penthrox®) compared to placebo (MAGPIE): A randomised clinical trial MPS & Rebecca Whiticar - Law at the front door AMAX4 Plymouth Hospital End of Life Pathway High Five for High PEITHO? Intermediate-high risk PE (St. Emlyn's) The CRAFFT Study

Event Objectives:Use the See/Believe/Create framework to identify at least one actionable, evidence-based change in their practice or community to reduce preventable morbidity and mortality among their patients.Apply the Burden × Amenability framework to rank preventable conditions by their potential for population-level impact—and explain why that ranking should drive clinical and advocacy priorities.Distinguish the strengths and limitations of RCTs from other forms of evidence—using examples such as back-to-sleep—to evaluate clinical and public health recommendations critically.Claim CME Credit Here!

Near-Infrared Light Therapy After Stroke: Does the Science Hold Up? A viewer reached out recently with a question I have been getting more frequently: Does near infrared light therapy actually help the brain recover after stroke? It is a fair question — the claims circulating online range from cautiously promising to outright extraordinary. In this post, I am going to cut through the noise and look at what the peer-reviewed research actually shows. What is Near-Infrared Light Therapy? Near infrared (NIR) light therapy — also called photobiomodulation (PBM) or transcranial photobiomodulation (tPBM) when applied to the head — uses specific wavelengths of light (typically 630-1100 nm) to penetrate tissue and interact with cells at a biological level. This is not a tanning lamp or a heat lamp. The mechanism is specific: NIR light at the right wavelengths is absorbed by cytochrome c oxidase, a key enzyme in mitochondrial energy production. When stimulated, cytochrome c oxidase increases ATP synthesis — essentially giving cells more energy to carry out repair and function. For neurons recovering from ischaemic or haemorrhagic stroke, the theory is compelling: damaged brain cells that are energy-starved might benefit from an additional energy stimulus. The Mechanism: What the Biology Says The cytochrome c oxidase pathway is well-established in photobiology. What is less settled is whether light at therapeutic intensities can penetrate the skull deeply enough to reach relevant brain structures. Skull and scalp tissue absorb and scatter light substantially. Transcranial delivery requires sufficient power density (irradiance) at the source and long enough exposure to accumulate meaningful fluence (energy dose) at depth. Studies using ex vivo human skull specimens suggest that only 1-3% of surface irradiance reaches cortical tissue at clinically relevant depths — and deeper subcortical structures receive even less. This does not make tPBM ineffective — it means dosing is everything. And most consumer devices do not disclose their irradiance or fluence specifications, which makes comparing them to clinical trials nearly impossible. What the Research Shows Animal Studies: Encouraging Signals Several well-designed rodent studies have demonstrated that tPBM applied within hours to days of stroke onset reduces infarct volume, improves functional recovery, and modulates neuroinflammation. A 2019 study by Thunshelle et al. found tPBM reduced lesion size in ischaemic stroke models and improved neurobehavioural scores. Animal models are useful for mechanistic insights. However, rodent skulls are thinner and brain structures are more superficial than in humans — so translational accuracy is limited. Human Clinical Trials: More Complicated The human evidence is where the story becomes nuanced. The NeuroThera Effectiveness and Safety Trial (NEST-1 and NEST-2) were the most prominent early RCTs. NEST-1 (2007) reported positive outcomes for acute ischaemic stroke patients treated within 24 hours. However, NEST-2 (2009), a larger double-blind RCT with 660 patients, failed to replicate those results on its primary outcome measure. NEST-3 was halted early in 2013 after an interim analysis showed it was unlikely to meet its primary endpoint. What went wrong? Researchers identified several issues: heterogeneous stroke populations, inconsistent dosing protocols, and the fundamental challenge of transcranial light delivery in adults with varying skull thickness and tissue composition. More recent work has shifted focus. A 2023 review by Zomorrodi et al. examined pulsed tPBM and found preliminary evidence for cognitive and neurological benefits in traumatic brain injury and neurodegeneration — but noted the absence of large, well-powered RCTs in stroke specifically. The Consumer Device Problem Here is where I have to be direct with anyone considering purchasing a NIR device for home use. Clinical studies use medical-grade devices with precisely calibrated irradiance, typically 10-700 mW/cm2 at the source, with controlled exposure times to achieve specific fluence targets (often 0.9-36 J/cm2). Consumer devices vary enormously — and most do not publish their specifications at all. Buying a NIR cap or helmet marketed for brain wellness is not equivalent to receiving the protocol used in clinical research. This does not mean it is harmful. It means we do not know whether you are getting a therapeutic dose, a sub-therapeutic dose, or anything in between. The Stakes If you are in recovery from a stroke or brain injury and you are exploring every option — which I completely understand — the risk here is not primarily financial. The risk is investing hope, time, and energy into something that may or may not be delivering what clinical trials suggest is therapeutic. The opportunity, on the other hand, is real: the underlying biology is sound, and the research pipeline is active. This is an area worth watching closely. Three Actionable Steps Talk to your neurologist or rehab physician before purchasing any device. Ask specifically whether tPBM has been considered in your care plan and what the current clinical guidance is. If you want to explore the evidence yourself, search PubMed (pubmed.ncbi.nlm.nih.gov) for transcranial photobiomodulation stroke — filter for systematic reviews and RCTs published after 2018 for the most current picture. Check ClinicalTrials.gov (clinicaltrials.gov) for active trials recruiting stroke survivors for tPBM studies. Participation in a trial gives you access to a properly calibrated protocol and contributes to the evidence base. What Recovery Can Look Like When the brain is given the right conditions — adequate sleep, nutrition, rehabilitation, reduced inflammation, and potentially adjunct therapies that the evidence supports — healing happens in ways that can surprise both patients and clinicians. I have spoken with hundreds of stroke survivors on this channel who found approaches that contributed meaningfully to their recovery. Not a single one found a shortcut. But many found tools — used thoughtfully, in partnership with their medical team — that made a genuine difference. That is what this channel is about: doing the work so you can make informed decisions. References Lampl Y et al. Infrared laser therapy for ischemic stroke: a new treatment strategy. Stroke. 2007;38(6):1843-9. PMID: 17463313. pubmed.ncbi.nlm.nih.gov/17463313 Zivin JA et al. Effectiveness and Safety of Transcranial Laser Therapy for Acute Ischemic Stroke (NEST-2). Stroke. 2009;40(4):1359-64. PMID: 19233936. pubmed.ncbi.nlm.nih.gov/19233936 Thunshelle C, Hamblin MR. Transcranial Low-Level Laser (Light) Therapy for Brain Injury. Photomed Laser Surg. 2016;34(12):587-598. PMID: 27854434. pubmed.ncbi.nlm.nih.gov/27854434 Zomorrodi R et al. Pulsed Near Infrared Transcranial and Intranasal Photobiomodulation Significantly Modulates Neural Oscillations. Sci Rep. 2019;9(1):6309. PMID: 31004089. pubmed.ncbi.nlm.nih.gov/31004089 Bill Gasiamis is a stroke survivor and the host of the Recovery After Stroke podcast. He is not a medical professional. Nothing in this post constitutes medical advice. Always consult your treating physician before starting any new therapy. The post Near-Infrared Light Therapy After Stroke: Does the Science Hold Up? appeared first on Recovery After Stroke.

Send us Fan MailDr. Brandon Tucker and Dr. Jenelle Ferry share two studies tackling some of the most pressing challenges in the care of extremely low birth weight infants. Dr. Tucker presents a quality improvement initiative examining whether switching from PRN glycerin suppositories to scheduled glycerin enemas every 12 hours reduces feeding intolerance and spontaneous intestinal perforation in babies under 1,000 grams — with early results trending in the right direction. Dr. Ferry then shares findings from a meta-analysis of 14 studies and nearly 4,700 babies showing that an exclusive human milk diet is associated with a roughly 20% reduction in the odds of death — a finding that reached statistical significance when RCTs and observational cohorts were pooled together, and one that carries real weight for units still weighing the evidence on human milk-based nutrition.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Jonathan and Wendy unpack the most surprising political move of Trump's second term: the nomination of Dr. Erica Schwartz — a physician, lawyer, former Coast Guard public health official, and unapologetic architect of military vaccine mandates — to run the CDC. Praised by figures like Jerome Adams, Vin Gupta, and Dorit Reiss, and openly loathed by RFK Jr.'s attack-dog attorney Aaron Siri, Schwartz's selection is read as a signal that the White House is quietly sidelining Kennedy ahead of the midterms and trying to win back the saner corners of the GOP. From there, the hosts dig into the widening fault lines inside MAHA: Marty Makary vs. Robert Malone — the "10 children killed by the COVID vaccine" report Makary promised has never materialized, and Malone is now publicly accusing him of the exact cover-up Makary accused his predecessors of. Vinay Prasad's exit from the FDA — his much-hyped randomized controlled trial of the Pfizer COVID vaccine in healthy 50–64-year-olds failed to recruit, proving (again) that tweeting about RCTs is easier than running them. Jonathan plays Prasad's own year-old promise back against him. The rumored FDA replacement — ophthalmologist and Twitter personality David Hooman, whose COVID-vaccine misinformation record would send exactly the wrong signal. Jay Bhattacharya on the rally circuit — CPAC, Turning Point USA, Kennedy rallies, DeSantis rallies — all while insisting "science shouldn't be political." Plus his role in suppressing a CDC vaccine-safety study and the UCSF faculty petition to block Prasad's return. The peptides free-for-all at the FDA, and why Kennedy still has enough juice to throw bones to his wellness-grifter base. Also: measles in Utah, a Moab travel detour, and a plea to every journalist, clinician, and listener still pushing back. MAHA is on its back foot — the job now is to keep the pressure on.

RCTs and intervention studies show plant-based diets improve survival and treatment response for prostate, breast, and colorectal cancer. #CancerSurvivorship #WholeFoodHealing #NutritionScience #OncologyCare

In episode 620, Mike K and James bring back Danielle Perry, this time to talk about the evidence around the use of colchicine for secondary cardiovascular prevention. There are some large RCTs so we talk about all the numbers and as always put them into the proper context. Show Notes Tools For Practice Back on […]

Feeling drained, foggy, and inflamed — and can't figure out why? In this episode of the supplement ingredient series, Nurse Doza breaks down glutathione, the body's master antioxidant. Produced in the liver and essential for fighting oxidative stress, glutathione levels are depleted in 1 in 4 people with fatty liver — making supplementation a game-changer for energy, brain clarity, digestion, and overall detox capacity.    Featured Partner: SHED   SHED delivers glutathione in a direct-to-bloodstream vial format — bypassing the gut degradation that makes most oral supplements ineffective. For anyone battling fatty liver, brain fog, low energy, or chronic inflammation (exactly the conditions discussed in this episode), SHED's bioavailable glutathione offers what diet alone can't replicate: fast, measurable antioxidant replenishment at the cellular level.

What does it really take to lift millions out of poverty and prevent needless deaths?In this special compilation episode, 17 past guests — including economists, nonprofit founders, and policy advisors — share their most powerful and actionable insights from the front lines of global health and development. You'll hear about the critical need to boost agricultural productivity in sub-Saharan Africa, the staggering impact of lead poisoning on children in low-income countries, and the social forces that contribute to high neonatal mortality rates in India.What's so striking is how some of the most effective interventions sound almost too simple to work: banning certain pesticides, replacing thatch roofs, or identifying village “influencers” to spread health information.Full transcript and links to learn more: https://80k.info/ghdChapters:Cold open (00:00:00)Luisa's intro (00:00:58)Development consultant Karen Levy on why pushing for “sustainable” programmes isn't as good as it sounds (00:02:15)Economist Dean Spears on the social forces and gender inequality that contribute to neonatal mortality in Uttar Pradesh (00:06:55)Charity founder Sarah Eustis-Guthrie on what we can learn from the massive failure of PlayPumps (00:14:33)Economist Rachel Glennerster on how randomised controlled trials are just one way to better understand tricky development problems (00:19:05)Data scientist Hannah Ritchie on why improving agricultural productivity in sub-Saharan Africa is critical to solving global poverty (00:24:36)Charity founder Lucia Coulter on the huge, neglected upsides of reducing lead exposure (00:47:48)Malaria expert James Tibenderana on using gene drives to wipe out the species of mosquitoes that cause malaria (00:53:11)Charity founder Varsha Venugopal on using village gossip to get kids their critical immunisations (01:04:14)Rachel Glennerster on solving tough global problems by creating the right incentives for innovation (01:11:31)Karen Levy on when governments should pay for programmes instead of NGOs (01:26:51)Open Philanthropy lead Alexander Berger on declining returns in global health, and finding and funding the most cost-effective interventions (01:29:40)GiveWell researcher James Snowden on making funding decisions with tricky moral weights (01:34:44)Lucia Coulter on “hits-based giving” approaches to funding global health and development projects (01:43:01)Rachel Glennerster on whether it's better to fix problems in education with small-scale interventions versus systemic reforms (01:48:12)GiveDirectly cofounder Paul Niehaus on why it's so important to give aid recipients a choice in how they spend their money (01:51:09)Sarah Eustis-Guthrie on whether more charities should scale back or shut down, and aligning incentives with beneficiaries (01:56:12)James Tibenderana on why we need loads better data to harness the power of AI to eradicate malaria (02:11:22)Lucia Coulter on rapidly scaling a light-touch intervention to more countries (02:20:14)Karen Levy on why pre-policy plans are so great at aligning perspectives (02:32:47)Rachel Glennerster on the value we get from doing the right RCTs well (02:40:04)Economist Mushtaq Khan on really drilling down into why “context matters” for development work (02:50:13)GiveWell cofounder Elie Hassenfeld on contrasting GiveWell's approach with the subjective wellbeing approach of Happier Lives Institute (02:57:24)James Tibenderana on whether people actually use antimalarial bed nets for fishing — and why that's the wrong thing to focus on (03:05:30)Karen Levy on working with governments to get big results (03:10:53)Leah Utyasheva on how a simple intervention reduced suicide in Sri Lanka by 70% (03:17:38)Karen Levy on working with academics to get the best results on the ground (03:29:03)James Tibenderana on the value of working with local researchers (03:32:15)Lucia Coulter on getting buy-in from both industry and government (03:35:05)Alexander Berger on reasons neartermist work makes sense even by longtermist standards (03:39:26)Economist Shruti Rajagopalan on the key skills to succeed in public policy careers, and seeing economics in everything (03:47:42)J-PAL lead Claire Walsh on her career advice for young people who want to get involved in global health and development (03:55:20)Audio engineering: Ben Cordell, Milo McGuire, Simon Monsour, and Dominic ArmstrongContent editing: Katy Moore and Milo McGuireMusic: CORBITCoordination, transcriptions, and web: Katy Moore

Walking Home from the ICU PodcastTranslating the ICU with Stephen Ramsey — Series 1, Episode 1Episode SummaryKali Dayton officially welcomes Stephen Ramsey — CVICU physical therapist, creator of the Ramsey Protocol, and lead author of the ELSO guidelines — as the newest member of the Dayton ICU Consulting team. In this kickoff episode of Translating the ICU, Kali and Stephen explore why physical therapists and occupational therapists are often rotating generalists in the ICU rather than dedicated specialists, and what needs to change to elevate rehab's impact on critically ill patients.Key Topics Covered​Introducing "Translating the ICU" — a new podcast series focused on physiology, pathophysiology, and critical thinking applied to real and theoretical ICU case studies​CSM 2024 recap — Stephen's talks on redefining PT's role in the ICU and point-of-care ultrasound; Kali's panel on what early mobility should actually look like​The case for dedicated ICU rehab staffing — why rotating therapists undermine momentum, relationships, and patient outcomes​PT/OT education gaps in critical care — invasive hemodynamics, pharmacology, diagnostic imaging, and ventilator management are largely absent from training​Competency vs. potential — why redefining practice standards matters more than questioning individual intelligence or capability​Mobility as a physiology test — Steven's framework for PT as "physiology tester," using mobilization to generate clinical data and drive medical decision-making​Johnson 2019 data — dedicated CVICU PT/OT staffing increased from 2 to 4 clinicians → ICU length of stay decreased by 3.6 days​The 2025 meta-analysis (60+ RCTs, ~8,500 patients) — timing matters more than intensity in early mobility​Ventilator management and SBTs — why PTs need to understand spontaneous breathing trials and provide physiologic feedback before extubation decisions​Building trust on the ICU team — demonstrating competency through relationships, not just credentials​Barriers facing revolutionists — fear of mistakes, leadership pressure, staffing rotations, and how to push forward anywayResources & People Mentioned- Steven Ramsey — @ThePOCUSPT | The Ramsey Protocol | ELSO Guidelines​Kali Dayton — DaytonICUConsulting.com​Christina Perme's ICU Rehab Course​Heidi Engel & Jenna Hightower​Johnson 2019 CVICU staffing study​2025 early mobility meta-analysis (60+ RCTs)Connect & Work With Us​Consult with Kali on transforming your ICU's sedation and mobility practices → DaytonICUConsulting.com​Coaching with Stephen Ramsey — one-on-one or team sessions for ICU rehab staff → www.DaytonICUConsulting.com and @ThepocusPT​Online courses — coming soon from both Kali and Stephen​Critical care ultrasound course for ICU clinicians — available now at ThePocusPT.comFollow Kali on Instagram for open discussion, anonymous Q&A, and cross-disciplinary ICU conversations.

Send us Fan MailIn this interview episode, Ben and Daphna sit down with Professor Brett Manley to discuss a paradigm shift in neonatal research: adaptive platform trials. Frustrated by the inefficiencies and underpowered results of traditional RCTs, Dr. Manley outlines the ambitious Platypus Adaptive Platform Trial launching in Australia and New Zealand. They dive into how shared primary outcomes, novel consent models, and massive cross-center collaboration can answer pressing clinical questions—like optimal PPROM antibiotics and caffeine dosing—simultaneously. Tune in for a fascinating conversation on moving beyond medical dogma, embracing humility, and keeping families at the center of NICU research!Learn more about the Platipus trial here: https://www.platipustrial.org/ Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

This episode examines whether unprocessed red meat has a causal role in (1) type 2 diabetes risk and intermediate measures of glucose intolerance (insulin resistance, beta cell dysfunction, glycemic markers) and (2) cardiovascular disease (CVD) risk. While there is commonly observed risk signal from observational cohorts, there exist short-term randomized controlled trials (RCTs) that show largely null effects on glucose homeostasis. This had led to differing opinions and interpretations of the evidence base. Some feel that in the context of an otherwise healthy diet, there isn't much to suggest concern about consuming unprocessed red meat. While others are of the view that there does exist a risk and that limiting or even avoiding consumption is prudent. The crucial concept of replacement effects is discussed. Increasing red meat intake always means decreasing something else or increasing total energy intake. Therefore, interpreting evidence requires specifying the comparator food(s), the background dietary pattern, the dose, the cut (lean vs fatty), and how the meat is prepared. To discuss their interpretations of this contentious evidence base, Dr. Mario Kratz and Dr. Gil Carvalho join the podcast to go through the studies most directly related to these questions. Timestamps [06:20] Red meat's impact is debated [10:54] Mechanisms linking meat to diabetes [15:31] Cohort evidence on diabetes risk [24:43] Differences between cohorts and threshold effects [33:13] RCT evidence and substitution trials [45:49] Why comparator foods matter [50:43] RCT examples and mixed results [01:00:30] Is there cardiovascular risk beyond saturated fat? [01:08:10] Epidemiology patterns and dose thresholds [01:11:36] Personal recommendations and risk tolerance [01:16:19] Key ideas Related Resources Go to episode page (study links, guest bios, additional resources) Join the Sigma email newsletter for free Subscribe to Sigma Nutrition Premium Enroll in the next cohort of our Applied Nutrition Literacy course Mario's YouTube channel: Nourished By Science Gil's YouTube channel: Nutrition Made Simple!

Can a ketogenic diet improve mental health?This week marks a significant moment for metabolic psychiatry and ketogenic therapy for serious mental illness.A New York Times piece highlighted early research from Stanford University, The Ohio State University, and the University of Edinburgh—alongside stories from individuals who have shared their lived experience here on Metabolic Mind.This kind of visibility matters. It reflects years of work by researchers and clinicians like Drs. Chris Palmer, Shebani Sethi, and Iain Campbell, research funded by Baszucki Group, advocates like Jan Baszucki, as well as the many people who have been willing to share their personal stories.Lived experience alone isn't enough. Early data alone isn't enough. But together, they point to something that must be tested, confirmed — or challenged — through high-quality science. That's why we are excited about several RCTs currently completed or underway around the world.We need to continue efforts to advance education, public awareness and research on a scale that will require public funding. That's how medicine moves forward. And that's the exciting work ahead.

The conversation with formulator Matt Legge pulls back the curtain on the supplement industry, framing it as a metaphysical struggle between genuine intent and the corporate Machine. Matt's journey is a hero's exile from structures like Metagenics, which prioritize efficiency over the soul of the product. This machine churns out soulless, AI-generated formulas that chase "white space," utterly neglecting the deep clinical insight of Root Cause Analysis—a meditation of the pulse. The founder's sacrifice creates the Pearl of Reciprocity, the organizational soul. The primary struggle is protecting this soul from "middle management" by constantly acting as the Chief Reminding Officer (CRO). The ultimate takeaway is a profound choice: to ethically play the regulatory puzzle with a full-spectrum approach and prioritize being the most respected—the "early bird gets the worm"—over merely being the biggest.   CORE INSIGHTS: [1:00-1:50] The Formulator's "Exile" and the Call to Invent: Deemed "unemployable" by a major practitioner brand due to his excess of innovative ideas, Matt Legge was effectively pushed to start his own supplement brand. [2:30-3:30] Critique of Claim-Driven Formulation: The core problem in the supplement industry is formulating for claims using single, trademarked extracts, disregarding the natural synergy of multi-ingredient or whole-herb formulations. [5:30-6:30] The Threat of AI-Generated Formulas: New brands often use AI or agencies to formulate identical, "soulless" products (e.g., Ashwagandha, B6, Magnesium Glycinate) based on market "white space," which sidesteps genuine root cause analysis. [9:30-10:30] Root Cause as Clinical "Meditation": Identifying the true root cause is subjective, requiring deep clinical insight—like a "meditation" of the pulse—that goes beyond generic university diagnoses. [11:30-13:00] The Limitations of RCTs in Natural Medicine: The parachute analogy to argue that natural medicine, with thousands of years of traditional use, does not always require modern RCTs that often exclude the sick people the medicine is meant to help. [14:00-15:30] The "Pearl of Reciprocity" and Organizational Soul: Mason views a founder's genuine intent and sacrifice as creating the "Pearl of Reciprocity"—a metaphysical, organizational soul that guides the company toward its purpose of "health and harmony." [29:00-30:00] The Chief Reminding Officer (CRO): To combat high staff turnover ("The Wiggles Theory"), the founder must act as the "Chief Reminding Officer" (CRO), perpetually repeating the brand's foundational ethos and "campfire stories" to maintain its core cultural spirit. [35:30-36:30] Innovation Stifled by Middle Management: Middle management, lacking the company's ethos, stifled innovation by rejecting Matt's inventions because a market segment for the original ideas did not yet exist. [54:30-56:00] The Ethical Full-Spectrum Formulation Approach: Modern ethical formulation uses a nuanced approach: combining standardized extracts (for regulatory claims) with full-spectrum whole herbs to ensure nature's full synergy. RESOURCE: Instagram: leggylegge. LINKEDIN: Matt Legge

The Derm on RheumNow podcast is a collection of Citations and Content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, other CTD skin disorders. dermatology drugs, biiologics, JAKs - their use, efficacy and side effects.  Features Dr. Jack Cush, Editor at RheumNow.com.  SHOW NOTES FDA sent a complete response letter to AstraZeneca on their application (BLA) for anifrolumabs (Saphnelo) subcutaneous use in SLE. Despite a positive TULIP-SC trial & EU approval of SC-anifrolumab, FDA & sponsor still have to work things out. CRL reasons are unknown https://t.co/3dNwEyolrj Review of Calcinosis Cutis - Surgical intervent. most effective (excision, curettage, laser ablation, etc). Medical measures inconsistently, partially effective, best if used early & localized (CCB, TCN, probenecid, immunomodulation, biologics, colchicine, NA thiosulfate, & JAKi https://t.co/rv0hQBv6nX Systematic Review of Targeted Rx for Systemic Sclerosis: from 32 RCTs & 2036 pts Rx w/ 23 targeted agents. Guselkumab had greatest effect on mRSS, followed by tofacitinib, inebilizumab, & baricitinib. For FVC, B-cell Rx (belimumab, RTX) had highest efficacy https://buff.ly/vHOSRws Dermatomyositis outcomes w/ 2475 pts (claims) & 1196 pts (EHR). Half had myositis panels & 35% had + MSAbs. Steroid use common in 69% & 74%. HCQ, MTX, MMF. Outocmes (per 1000PYs) wereL all-cause hospitalisation 92, malignancy 15.3, ILD 6.4, and myocarditis 2.1 https://t.co/DJqKGNGX76 Danish DERMBIO registry of psoriasis pts Rx w/ biologics. Among 3790 bionaive pts ustekinumab had best 1-5 yr survival vs (ADA & SEC). In 3403 bioexperienced pts, bimekizumab, guselkumab, & risankizumab had highest 2-year drug survival rate. https://t.co/TInyLPMYkb Real-world study of 1202 #PsA pts shows that secukinumab retention rates were lower w/ smoking (79%/73%/72% in never/former/current smokers) but not w/ obesity (72%/77%/77% in normal/overweight/obese), Adh HR signif. higher w/ former (1.32) & current smokers (1.27)   https://t.co/1REWmod73W Together PSO Trial - Combination Ixekizumab and Tirzepatide Today Lilly announced top line results of the TOGETHER-PsO open-label, Phase 3b trial demonstrating the significant benefits of concomitant ixekizumab (IXE: an IL-17A inhibitor) and tirzepatide (TIR: GLP-1agonist) over https://t.co/YWCjN2NyGM

EVOLUT Low Risk data, a provocative meta-analysis, DNR orders, targeted hypothermia, good news in HFpEF evidence, and GLP-1s as AF drugs are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I EVOLUT Low Risk 6-year Results and a 5-year Meta-Analysis of TAVR vs SAVR 6-Year Outcomes of TAVR vs SAVR https://www.jacc.org/doi/10.1016/j.jacc.2026.02.5063 EVOLUT Low Risk Trial at 2 years https://www.nejm.org/doi/full/10.1056/NEJMoa1816885 EVOLUT Low Risk Trial at 3 years https://www.jacc.org/doi/10.1016/j.jacc.2023.02.017 EVOLUT Low Risk Trial at 4 years https://www.jacc.org/doi/10.1016/j.jacc.2023.09.813 Nonproportional Hazards for Time-to-Event Outcomes in Clinical Trials https://www.jacc.org/doi/10.1016/j.jacc.2019.08.1034 TAVR vs SAVR 5-Year Outcomes - Systematic Review https://heart.bmj.com/content/early/2026/02/11/heartjnl-2025-327092 TAVR vs SAVR Updated Meta-Analysis of RCTs https://www.jacc.org/doi/10.1016/j.jacc.2024.12.031 UK TAVI Trial https://jamanetwork.com/journals/jama/fullarticle/2792251 Dr David Cohen on X https://x.com/djc795/status/2023556582030852172?s=46&t=zXMCUoVjSsdyemzWlzeBjA II DNR in the Hospital Inadequate Documentation of Unilateral DNR Orders https://jamanetwork.com/journals/jama/fullarticle/2829203 GeriPal Blog Unilateral DNR Orders https://geripal.org/unilateral-dnr-gina-piscitello-erin-demartino-will-parker/ III Yet another failure of Targeted Hypothermia 2-Year Follow-Up of TTM2 Trial https://jamanetwork.com/journals/jamaneurology/fullarticle/2845193 TTM2 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2100591 IV Good news in HFpEF Evidence ALT-FLOW II Trial https://doi.org/10.1093/ejhf/xuaf016 V GLP-1 as AF drugs Semaglutide as Adjunctive Therapy in Obesity-Related PAF https://doi.org/10.1093/europace/euag018 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this episode of A Whole New Level, Christopher Gardner, PhD, joins Mike to discuss his decades in nutrition research, the challenges of conducting randomized controlled trials (RCTs) on diet, and how to communicate complex science to the public. Gardner has led some of the most rigorous research ever comparing dietary approaches in real-world conditions, so his insights about what works (cutting processed food and sugar) and what doesn't (obsessing about macronutrients) are worth a listen. Sign Up to Get Your Free Ultimate Guide to Glucose: https://levels.link/wnlIn this episode, we cover:What a nutritional interventionist is – someone who studies people who are asked to change their diet, tracking them and taking samples to see what might have changed.How to square widely-accepted lessons about nutrition (i.e., junk food=bad) with the high degree of individuality in diets that work.The concept of "equipoise" in study design, which means making sure both diets being compared are well-represented versions of that diet (e.g., a "kick butt diet A and a crappy diet B" is avoided).The dilemma of communicating single-study results to the public and the role of the Netflix documentary on Gardner's famous twin study in making science engaging.Dr. Gardner's experience on the Dietary Guidelines Advisory Committee and the methodology used to reach conclusions.The focus on ultra-processed foods and the need to message the consensus points of eating more whole foods and vegetables, and avoiding added sugar and refined grains.The learnings from the DIETFITS study, which compared low-carb and low-fat diets among 600 people for a year, and why there was more variation among people within a diet than between the two diets.

I was shocked at the comments on this post. Many people, some of them I know to be smart, thought I was nuts for suggesting two middle-aged women who had isolated high LDL-C needn't take meds because their calculated 10-year risk was less than 3% What shocked me is that our guidelines suggest treatment with statins when 10-year risk is ≥ 7.5%. You may not know this but clinicians are supposed to consider cholesterol (and BP) based on overall risk, which include things like age, blood pressure, smoking status as well as HDL. Here is a link to the PCE. It drives me bananas that clinicians don't go over this with patients. They just look at LDL-c in isolation. Content like this comes free of industry support. Please consider becoming a free or paid subscriber.Experts chose this a 7.5% threshold because they felt it was the point where the absolute risk reduction from statins (about 20-25% relative risk reduction) for nonfatal cardiac events outweighed any potential downsides of statins. It is an arbitrary threshold. The thinking: We know from many RCTs that statins reduce future risk by about 20-25% over 5 years. So .25 x the estimated risk outputs the absolute risk reduction. Let's say a person has a calculated risk of 10%. They can expect a 2.5% risk reduction (.25 x 10% = 2.5%) over 10 years. But .25 x 3% = .75, so a person with an estimated risk of 3% who takes a daily pill for 10 years goes to 2.25%. That's not much. Here are some pics of the pushback I recieved:My colleagues rightly point out that atherosclerosis of the coronary arteries is a slow process and longer exposure to lower LDL-c is beneficial. They feel that the 10-year horizon is too short. They cite something called Mendelian randomization studies which find that people who were born with genetic profiles that cause low cholesterol also have low rates of heart attacks. I wrote a post about this. I actually think that statins and blood pressure drugs may have greater effects in younger people who are at lower risk. But come on. Both individuals who I helped calculate risk were below 3%. That's too low to worry about. Further, if you think we treat people with elevated LDL levels who have this low of a risk, why do we need risk calculators? Or…why don't we just treat everyone above a certain age, since age is the largest driver in the calculators? These are issues I spoke with Drs Foy and Murthy about. I learned a ton. I hope you will too. Topics include:* The value of risk calculators* The uncertainty of prediction* The best time window to consider (statin trials were for 5 years; can we assume effect sizes over 5 years are similar at 30 years?) * The causal role of LDL-c vs “metabolic health”* The value of coronary artery calcium testing * Lipoprotein (a) Academic people like to make fun of podcasts, but I can't imagine a more educational 40 minutes. Andrew and Venk are two of the most thoughtful people in cardiology today. Enjoy and consider supporting Sensible Medicine This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

In this episode of the Smarter Not Harder Podcast, Dr. Matthew Bernstein joins Jodi Duval for a pioneering conversation about the rise of metabolic psychiatry — the intersection of mitochondrial health, nutrition, and brain performance. From ketogenic therapy to personalized mental health biomarkers, this episode offers a radically hopeful perspective on treating conditions like depression, OCD, bipolar disorder, and schizophrenia. Join us as we explore: • What metabolic psychiatry is and why it matters now   • How insulin resistance, inflammation, and mitochondria affect mood and cognition   • Why ketones aren't just fuel — but also powerful brain signals   • Tools like CGMs, RCTs, and the ACCORD program   • Supplements and real-world protocols for psychiatric healing This episode is for you if: • You or someone you love has struggled with medication-resistant mental illness   • You're curious how nutrition and metabolism affect the brain   • You want a psychiatrist's view on keto, CGMs, and continuous feedback   • You believe mental health deserves smarter, not harder solutions You can also find this episode on…   YouTube: https://youtu.be/-B6A63IG9p4 Find more from Dr. Matthew Bernstein:   Accord Program: https://accordmh.com/ LinkedIn: https://www.linkedin.com/in/mattbernsteinmd/ Instagram: https://www.instagram.com/accordmh/ Find more from Smarter Not Harder:   Website: https://troscriptions.com/blogs/podcast?utm_source=youtube&utm_medium=video&utm_campaign=snh_podcast_guest_episode_2025_10&utm_content=podcast_asset Instagram: https://www.instagram.com/troscriptions Get 10% Off your purchase of the Clinical Metabolomics Module by using PODCAST10 at https://www.homehope.org  Get 10% Off your Troscriptions purchase with code POD10 at https://www.troscriptions.com  Get daily content from the hosts of Smarter Not Harder by following @troscriptions on Instagram.

An elegant study in post-TAVI atrioventricular block, a PSA for my structural colleagues, revascularization in women, and a CTO PCI trial are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I AV Block After TAVR Heart Blocks During vs After TAVR Show Distinct Patterns https://www.medscape.com/viewarticle/heart-blocks-during-vs-after-tavr-show-distinct-patterns-2025a1000ypp Mechanisms Underlying Alterations in Cardiac Conduction After TAVR https://jamanetwork.com/journals/jamacardiology/fullarticle/2842748 II Related PSA Announcement to My Structural Colleagues III Revascularization Strategies in Women with Severe Chronic CAD Women With Chronic Severe CAD Fare Better With CABG vs PCI https://www.medscape.com/viewarticle/women-chronic-severe-cad-fare-better-cabg-vs-pci-2025a1000ygd PCI vs CABG in Women With Chronic CAD https://doi.org/10.1093/eurheartj/ehaf806 PCI vs CABG - Meta-Analysis of 4 RCTs https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02334-5/abstract CABG vs Drug-Eluting Stent Implantation for CAD - Meta-Analysis https://www.jacc.org/doi/10.1016/j.jcin.2016.10.008 RECHARGE trial https://therechargetrial.com/ IV A CTO PCI RCT – But don't get your hopes up Early vs Late-Staged PCI After Subintimal Tracking and Re-entry for CTO https://doi.org/10.1016/j.jacc.2025.09.1598 DECISION CTO trial https://pubmed.ncbi.nlm.nih.gov/30813758/ National Inpatient Sample Database PCI CTO Associated With Higher Mortality https://pubmed.ncbi.nlm.nih.gov/37356643/ V Mandrola's Top 10 Stories You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this high-impact solo episode, Darin strips away the noise, hacks, and hype to deliver a clear, no-BS roadmap for transforming your body, brain, energy, and direction in life. This is a straight-talk breakdown of the 5 foundational habits that matter most — the habits backed by science, ancient wisdom, and Darin's decades-long experience living this work every day. Expect practical steps, micro-experiments, timing rules, and the mindset needed to reclaim sovereignty in a world full of distraction. If you're ready to build a stronger, clearer, more powerful version of yourself… this is the episode.     What You'll Learn 00:00 – Welcome to SuperLife How this podcast helps you build sovereignty through real habits, real truth, and real practices. 03:07 – Why this episode is different Darin lays out the mission: habits, hacks, hard truths — without dogma or fluff. 03:44 – The 5 foundational moves that change your biology A preview of the metabolic, physical, mental, and behavioral levers that create huge shifts.     1. METABOLIC EDGE — Eat Like You're Building a Future 04:03 – Terrain theory + why your food timing matters How altering the internal environment of your cells changes everything. 05:02 – The two levers that unlock metabolic health Time-restricted eating + plant-forward whole foods. 05:23 – Compressing your eating window Why 8–10 hours is ideal, how it improves glucose, insulin, weight, and inflammation. 06:18 – Practical weekly ramp-up Week 1: 12 hours. Week 2: 8–10 hours. Simple, sustainable, achievable. 07:10 – Darin's personal eating window 10 a.m. to 6 p.m. — and why eating earlier aligns with digestive fire.     2. MOVEMENT THAT MATTERS — Strength Is Survival 11:04 – Why strength training is non-negotiable Muscle protects metabolism, bone density, insulin sensitivity, and longevity. 11:51 – What the evidence says Huge cohort studies show strength training reduces all-cause mortality. 12:23 – The perfect weekly formula 3x/week compound lifts + daily movement + micro-bursts every hour. 13:06 – Real-life practicality Darin's routine of walking, sprinting dogs, mountain biking, and breaking up the day with movement.     3. SLEEP — The Ultimate Biological Reset 16:26 – The truth everyone ignores You cannot out-supplement or out-biohack poor sleep. 16:40 – The real impact of chronic sleep loss Cognition, memory, hormones, emotional regulation — all decline. 17:37 – The universal rule: consistent timing Same bedtime ± 30 minutes, every night. 17:52 – 60-minute wind-down protocol Screens off, light down, nervous system softening. 18:32 – Using sauna as a down-regulation tool Infrared benefits + why Darin does it twice a day in winter.     4. MINDSET & CONSCIOUSNESS — Your Attention Is Your Power 20:00 – Why optimization fails without attention training You can master food, workouts, and sleep — but scattered attention destroys progress. 20:48 – Darin's morning protocol Water → elixir → infrared pad → meditation → visualization → journaling. Every day. Everywhere. 21:01 – Meta-analysis proof Meditation reduces anxiety, depression, stress — and rewires your brain. 21:23 – The perfect 10-minute breathwork formula 5–5–5–5 or 4–4–4–4 cycles for nervous system reset. 21:56 – Journaling as medicine Stream-of-consciousness to activate clarity and emotional release.     5. WEALTH — Treat Your Time Like Capital 22:36 – Redefining wealth It's not money — it's your magnetism, output, relationships, and purpose. 23:16 – The compounding effect of tiny decisions Time batching, micro-actions, and protecting your attention from the social media attention economy. 24:02 – Mini productivity framework 90 seconds → 3 important calls. Every Friday → 1 paragraph on what scaled this week. 25:14 – Darin's post-meditation rule No scrolling — replace with proactive actions: reading, outreach, Patreon replies.     FINAL TAKEAWAYS 26:02 – The master checklist: • Time-restricted eating • Plant-focused meals • Resistance training • Daily meditation • Consistent sleep • Sauna recovery • Treating time like capital 26:11 – The real danger Chasing hacks before mastering fundamentals leads to burnout, confusion, and stress. 27:58 – Your power is in the basics These are simple, accessible, and life-changing. 28:04 – Closing message "Have your best Super Life Day ever."     Thank You to Our Sponsors Our Place: Toxic-free, durable cookware that supports healthy cooking. Go to their website at fromourplace.com/darin and get 35% off sitewide in their largest sale of the year. Manna Vitality: Go to mannavitality.com/ and use code DARIN12 for 12% off your order.     Join the SuperLife Community Get Darin's deeper wellness breakdowns — beyond social media restrictions: Weekly voice notes Ingredient deep dives Wellness challenges Energy + consciousness tools Community accountability Extended episodes Join for $7.49/month → https://patreon.com/darinolien     Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences     Key Takeaway "Your biology changes when your decisions change. Nail your sleep, nail your strength, honor your attention, and treat your time like capital — and you will build a Super Life from the ground up."     Bibliography Time-restricted eating (human RCTs / reviews) — Wilkinson et al., 10-hour TRE reduced weight and improved cardiometabolic markers (2019). PMC  Intermittent fasting / metabolic health review — comprehensive reviews showing metabolic switching benefits. PMC+1  Plant-forward/vegetarian diets & cardiometabolic outcomes — BMJ/Nutrition reviews and JAMA network evidence showing improved CVD risk markers and metabolic benefits. BMJ Nutrition+1  Sleep and cognition / brain health — Nature/Harvard coverage & meta-analyses: short sleep impairs cognition and links to amyloid processes. Nature+1  Resistance training & mortality / physical function — systematic and cohort evidence that muscle-strengthening activity lowers risk and preserves function. British Journal of Sports Medicine+1  Mindfulness & mental health meta-analysis — Goyal et al. 2014 and subsequent meta-analyses showing reductions in anxiety/stress. PubMed+1  Sauna bathing and cardiovascular outcomes — JAMA Internal Medicine / Mayo Clinic Proceedings reviews on sauna and lower CVD risk signals.