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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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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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May 29, 2017

Lyme Disease has been a known tickborne infectious disease since the early 80s. Treatment for Lyme Disease is surprisingly straightforward, but you would never guess that from the controversy surrouding the infection.

Part of the problem stems from "Chronic Lyme Disease," which is now more appropriately knwon as Post-Treatment Lyme Disease Syndrome, to indicate that the infection is no longer present in these patients. There is some explanation for their symtoms other than persisttent bacteremia.

Todayw e talk about all this, and dig into a little of the history and the controversy surroudning Lyme Disease.

Resources:

http://www.nejm.org/doi/full/10.1056/NEJMoa1505425

http://www.sciencedirect.com/science/article/pii/S0891552015000203

http://www.nejm.org/doi/full/10.1056/NEJMra072023#t=article

http://www.nejm.org/doi/full/10.1056/NEJM200107123450202#t=abstract

https://www.ncbi.nlm.nih.gov/pubmed/18452806

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May 22, 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. 

RESOURCES:

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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May 15, 2017

So spring breakers on South Padre Island in Texas are coming down with the mumps. Since the MMR (measles, mumps, rubella) vaccine was introduced in 1967, we've stopped expecting these outbreaks. 

But recent increases in those who choose to have their children forego vaccines has led to a loss of herd immunity and an increase in these outbreaks.

To further complicate the issue, it seems that immunity wanes with time, which is why many college students (hello spring break!) find themselves falling ill eight to ten years after their last booster at age 12 to 15. 

Resources:

Mumps at South Padre

Learn more about the Mumps and the Mumps vaccine from the CDC

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May 8, 2017

If you've ever felt like you had a handle on the evidence about a certain medical topic only to read a headline telling you science now says the opposite, you aren't alone. 

But science isn't about headlines. It's about evaluating the evidence to decide what's real, and it doesn't always conform to what we want. But that doesn't stop the media, (and maybe some journals), from selectively reporting the research that will generate the most buzz.

Today we talk about this issue and ideas that are being discussed to help be sure all the evidence, including the unremarkable evidence, is adequately reported.

Resources:

Nurse's Health Study

Women's Health Initiative

Calcium and Heart Disease Risk

Results-Blind Study

PLOS on Data

2 Docs Talk about Hormone Replacement Therapy

2 Docs Talk about Supplements

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May 1, 2017

Each year, under Obamacare rules, the USPSTF is required to issue a report on evidence gaps. These are areas of preventive medicine that they decide we are lacking sufficient evidence to determine if the harms outweight the risk.

This week, we take a look at the primary areas of evidence shortfall. If you are wondering about a screening test, take a listen to see if it made the list.

 

Resources:

Sixth Annual Report to Congress on High Priority Evidence Gaps

2 Docs Talk about Smoking Cessation

2 Docs Talk about dietary supplements

2 Docs Talk about skin cancer prevention

Apr 24, 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

Apr 17, 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

Apr 10, 2017

GERD or gastroesophageal reflux disease is the very common disorder where acid backs up from the stomach into the esophagus. It results in that all too common problem we call heartburn, along with a slew of other symptoms.

Today we take a look at GERD, the commonly recommended remedies, and the one thing the evidence shows really works to get rid of the burn.

Resources

Risk of dementia in elderly patients with the use of proton pump inhibitors.

Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis.

Acupuncture for functional gastrointestinal disorders.

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