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2 Docs Talk: Medicine | Health | Healthcare Policy | Evidence Based Medicine

Welcome to 2 Docs Talk, the podcast about healthcare, the science of medicine and everything in between. Join cohosts Kendall Britt, MD and Amy Rogers, MD for a 15 minute check-up on current issues in medicine and health policy. The doctor is always in.
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2 Docs Talk: Medicine | Health | Healthcare Policy | Evidence Based Medicine
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Nov 20, 2017

In healthcare, the holy graille seems to be longevity. We look at whether a treatment increases lifespan and use that as a barometer for it's value. 

But should that be the yardstick we use? Or would we be better off with a more subjective measure of improving quality of life, even if that means sacrificing some of the quantity.

Today, 2 Docs Talk about this question propose some things to consider as you consider your approach to aging and healthcare.

 

Resources:

Colonoscopy study in the Annals of Internal Medicine 

Research on lifespan in Nature

The Austad/Olshansky Wager

 

Nov 13, 2017

One of the latest technological advances in food production is the introduction of GMOs, or genetically modified organisms, to the food supply. They have the potential to offer many benefits including increased productivity, pest and herbicide resistance, longer shelf life, and the list goes on.

But many are concerned that this relatively new technology isn’t safe – for health, the environment or the economy. We dig into the evidence surrounding GMOs in this episode. We might even share an opinion or two on whether the crops are just GMOs or Frankenfood.

Resources:

Primer on the retracted study that indicated GMOs caused tumors

How GMOs are tested for safety

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Nov 6, 2017

Back pain is second only to cancer as a cause of long term disability. This health problem is damaging to individuals and costly to society. And we don’t have much in our arsenal that is effective at treating it.

This week, we discuss the difference between acute and chronic back pain with regard to treatment and outcomes. We also discuss the role of surgery, medications, alternative therapies, and some interesting new research on what helps resolve chronic back pain.

Resources:

Research on efficacy of epidural steroid injections for back pain

Trends in spinal fusion surgery

American College of Physicians Guidelines for the Treatment of Chronic Low Back Pain

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Oct 30, 2017

Screening mammography is widely used throughout the U.S. and is thought of as a great success in the prevention of breast cancer deaths.

But what does the evidence say? Are we getting what we are paying for with mammography, or simply shouldering the extra cost of false positives and overdiagnosis? We examine these issues and more on this episode of 2 Docs Talk.

References:

What does the U.S. Preventive Services Task Force (USPSTF) do?

USPSTF current (2009) breast cancer screening recs 

USPSTF proposed (2015) breast cancer screening recs

American Cancer Society updated breast cancer screening recs

American College of Obstetricians and Radiologists breast cancer screening recs

American College of Radiology breast cancer screening recs

Switzerland’s stance on screening mammography

Cost of false positive mammograms

BMJ study that showed no benefit from screening mammography performed in 1980’s

JAMA Oncology study on ductal carcinoma in situ (DCIS)

An excellent (and long!) discussion of overdiagnosis and screening mammography

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Oct 23, 2017

Physician burnout is a big issue in the medical community. According the the Medscape Lifestyle Report 2017, over half of physicians report burnout. But physician burnout isn’t just a problem for physicians. It is a problem for patients, for other medical staff, and for the health care economy.

Today we dig into the causes of physician burnout and how it can be addressed. Here’s a hint: It doesn’t involve meditation or counseling.

Resources:

Medscape Lifestyle Report 2017

2 Docs Talk About Pricing Transparency

2 Docs Talk About Medicare for All

2 Docs Talk About Drug Pricing

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Oct 16, 2017

If you watch any tv at all, it’s likely you’ve seen a drug ad. These ads generally show seemingly healthy people living normal lives, the message being the drug did this for them.

But are the drug ads telling the whole story? And should they even be advertising directly to consumers to begin with? We discuss this issue on today’s episode.

 

Resources:

Nivolumab Research from New England Journal of Medicine

What the FDA has to say about drug ads

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Oct 9, 2017

With the recent release of the Netflix series, 13 Reasons Why, depression and suicide have been getting a lot of press time. In this episode, we talk about depression, what it is, how it is treated and what’s on the horizon for this far too common disorder.

We also talk a bit about the Netflix series and the problem of suicide. Take a listen and see what you think.

If you think you may be depressed please seek help from a trusted healthcare provider. And if you are contemplating suicide, there is help for you – please contact the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). Someone will answer your call and help you find the resources you need to deal with your depression.

Brains of people with depression are different

Brain imaging reveals different types of depression

Summary of effectiveness of SSRIs and other antidepressant medications

 

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Oct 2, 2017

Historically, cervical cancer has been one of the major killers of young women. But since the advent of the pap smear, death from the disease has dropped dramatically. However, treatment of lesions identified on pap smear can lead to significant issues including infertility. And in other parts of the world where screenign is not easily accessed, cervical cancer remains a significant cause of death for women in the prime of life.

As with any disease, prevention is better than treatment, and this is where the HPV vaccine comes into play. Known mainly by its trade name, Gardasil, the vaccine has been on the market for over a decade. That’s long enough to provide data to draw reasonable conclusions about its safety and efficacy.

Resources:

Prevalence of HPV after introduction of vaccine

Population-Based Incidence Rates of Cervical Intraepithelial Neoplasia in the Human Papillomavirus Vaccine Era

 

Safety Resources:

https://www.ncbi.nlm.nih.gov/pubmed/21907257

https://www.ncbi.nlm.nih.gov/pubmed/23027469

https://www.ncbi.nlm.nih.gov/pubmed/24108159

http://jamanetwork.com/journals/jama/fullarticle/1886177

https://www.cdc.gov/vaccinesafety/pdf/data-summary-hpv-gardasil-vaccine-is-safe.pdf

 

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Sep 25, 2017

A BMJ report earlier this year declared that 1 in 3 hospital deaths were the result of medical errors. A flurry of headlines about the dangers of hospitals soon followed.

Just what is a medical error? What are the dangers of being in a hospital? And what can we do about it? We talk about these questions in today's episode. 

Resources:

BMJ on medical error

KATZ scale

To Err is Human: Building a Safer Health System

Hospital at Home

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Sep 18, 2017

Thousands of people die each year from influenza. The CDC recommends that almost all people (with a few rare exceptions) receive the flu vaccine every year. But the disease and the vaccine are poorly understood. In this episode, we discuss the flu, its treatment and its prevention.

Resources:

Influenza vaccine effectiveness in preventing outpatient, inpatient, and severe cases of laboratory-confirmed influenza

Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials.

 

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Sep 11, 2017

Kendall and Amy are in agreement that hospice care is an important, compassionate aspect of healthcare that humanizes what can be a very clinical, impersonal process. We've both experience with hospice - personally and professionally. 

Sadly, like most aspects of healthcare, the potential for profit has introduced some ugly practices into what should be focused solely on the needs of dying patients and their families.

Today, Kendall and Amy talk about the good and the bad of hospice as it exists in 2017.

Resources:

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Sep 4, 2017

Most people probably know someone who has had thyroid disease of some sort, most commonly hypothyroidism - the term low thyroid hormone.

But there has been a significant rise in diagnosed thyroid disease in the past couple of decades due to screening. These diagnoses include problems with thyroid hormone as well as thyroid cancers. It's easy to get excited about diagnosing more disease - you catch it earlier and help people prevent the consequences of the disease. Or do you?

Today we are going to talk about screening asymptomatic patients for thyroid disease. We're also going to address that slipppery category of "subclinical" thyroid disease. 

Resources

British Medical Journal on Increased Diagnosis of Thyroid Cancer

Thyroid Cancer in Korea

Aug 28, 2017

Medicaid is the subject of a lot of talk in today's political environment. Sadly much of what is said isn't based in fact, or it focuses on parts of the program that represent a tiny portion of its cost. 

Today, 2 Docs Talk about Medicaid, who it serves, and how it was affected (or, rather, supposed to be affected) by the Affordable Care Act.

Aug 14, 2017

End stage renal disease, ESRD, is a growing problem in the U.S. When Medicare began covering renal dialysis, there were on 16,000 patient who required that type of care. Today that number exceeds 650,000 and continues to grow.

Today, 2 Docs Talk about what causes end stage renal disease, how can it be treated, and, most importantly, how can it be prevented. 

 

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Aug 7, 2017

If you've had many conversations about healthcare reform, it is likely you've heard some variation on this theme: 

"Hospitals have to provide care for people who show up. So everyone can get healthcare when they need it. So when people say that can't get healthcare, that isn't true."

Is there any merit to that argument? Spoiler: NO. But if you want to hear more about where that idea comes from, take a listen. 

Resources:

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/

http://www.kff.org/medicaid/state-indicator/medicaid-income-eligibility-limits-for-parents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

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Jul 31, 2017

The pap smear has been one of the greatest public health wins of the past century. Deaths from cervical cancer in the U.S. have dropped from 37.5 per 100,000 women to 7.5 per 100,000 women as a result of the simple screening test.

But with our increasing understanding of the role of human papillomavirus (HPV) in the development of cervical cancer, the pap test may end up being pushed aside by HPV screening.

Today, 2 Docs Talk about Pap smears, HPV screening, the current recommendations for cervical cancer screening, and the research that may push us to shifting away from the pap smear to the HPV test.

Resources:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60644-9/fulltext?rss=yes

https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening

https://www.acog.org/Patients/FAQs/Cervical-Cancer-Screening

https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/cervical-cancer-screening#consider

Jul 24, 2017

The process of drug approval is long and expensive. To complicate matters, pharmaceutical companies, patients, an the FDA are all invested in the process, for different reasons – and they aren’t always the same.

Today we discuss the story of how a new drug came to market and the unusual circumstances around its approval. 

Resources:

FDA grants accelerated approval to first drug for Duchenne muscular dystrophy

CDC on Duchenne Muscular Dystrophy

Right to Try

Compassionate Use

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Jul 17, 2017

If there is a hot button issue in politics these days, it's abortion. But abortion is the result of a long line of issues that are being inadequately addressed in this country. Today we take a look at contraception - what it is, how it works, its history and its future. 

We also offer a look at an innovative program that has the potential to help both pro-choice and pro-life groups happy. 

 

Resources:

Details on various types of birth control

The Choice Project

Use of LARCs in Colorado

Slang for using a condom (adult humor - you've been warned)

 

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Jul 10, 2017

As we enter primary season for this election year, gun violence and control is a hot topic. However, much of the discussion lives in one of two extremes, and little of it is based on actual evidence. 

With over 30,000 gun deaths each year, and over 20,000 of those death from suicide, the reality is that gun violence is a public health issue. This means we need to treat this issue from the point of view of the medical evidence. 

Today we look at the scope of the problem, what has and hasn't worked, and some thougths about what lies ahead. 

Resources:

CDC All Injuries Statistics

CDC Accidental Death Statistics

CDC Homicide and Assault Statistics

CDC Suicide and Self-Inflicted Injury Statistics

CDC Depression Statistics

Discussion of Australia's Gun Laws in the New York Times

Discussion of Missouri's Gun Laws in the New York Times

Survey of Defensive Gun Use Cited Frequently by NRA 

Methodological issues with Defensive Gun Use Survey

Jul 3, 2017

Concussions are not uncommon in contact sports such as football, soccer and basketball.  But we aren't trying to scare or shock anyone. On today's podcast we'd like to educate and inform so that parents and players can make decisions that aren't based on fear and misinformation.

We'll cover

  • concussions
  • return-to-play policies
  • second impact syndrome
  • post-concussive syndrome
  • chronic traumatic encephalopathy

Take a listen and let us know what you think.

Article referenced in podcast:

McKinney ISD Concussion Protocol

Jun 26, 2017

As the the political winds shift in favor of legalizing medical marijuana, it's important to consider the evidence that supports it. 

But the 23 states that have legalized it and the FDA don't agree on when marijuana helps and when it doesn't. In this episode, we take a look at the evidence supporting the move toward legalizing the use of marijuana and cannabinoids for medical purposes.

 

References from the show:

Cannabinoids for Medical Use: A Systematic Review and Meta-Analysis

Jun 19, 2017

We’ve got a lot of questions marks ahead of us this year when it comes to healthcare. What will happen with the Affordable Care Act, Medicare, Medicaid, Planned Parenthood, etc. etc.

The future of healthcare under the new administration is a big unknown. But one thing we do know - healthcare costs far too much.

One of the key contributors to these costs is the over $200 billion per year in unnecessary medical care. 

In today's episode, we dig in to the reasons for these costs, and more importantly, we talk about the things we can do as healthcare consumers to reduce unnecessary medical care in our own lives. 

Resources:

Unnecessary Medical Costs

Low Value Care in Medicine

Unnecessary Tests and Treatments

Freakonomics Radio: Bad Medicine

Choosing Wisely

 

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Jun 12, 2017

Parkinson Disease is the second most common neurodegenerative disease in the U.S. and it appears to be increasing in prevalence. So what is Parkinson Disease, what causes it and what can we do about it? 2 Docs Talk about it today.

Resources:

JAMA Neurology Increasing Incidence of Parkinson Disease

Metformin and Parkinson Disease

Braak Hypothesis

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Jun 5, 2017

Sometimes there are news items that just need to be discussed, but they don't really generate enough material for a podcast of their own. Today we are talking about those headlines.

Resources:

Stroke Study: Diet Soda, Stroke, and Dementia

Association of Hormonal Contraception with Depression

Tom Price on Preventive Services Mandate

New York Times on the Contraception Mandate

CNN Report on Minnesota Measles Outbreak

Stat Review of Vaxxed

California Immunization Rates After SB277

Handgun Acquisition After Mass Shootings

Bystander CPR and Outcomes After Cardiac Arrest

Learn CPR

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