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2 Docs Talk: The podcast about healthcare, the science of medicine and everything in between.

Welcome to 2 Docs Talk. Join cohosts Kendall Britt, MD and Amy Rogers, MD for a 15 minute check-up on current issues in health, healthcare policy, and evidence- based medicine.
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2 Docs Talk: The podcast about healthcare, the science of medicine and everything in between.
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Now displaying: Category: evidence based medicine
Jun 6, 2016

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

May 30, 2016

 

Our understanding of what sleep is and why it is important grows daily. It's clear that poor sleep plays a role in all sorts of disease states. Sadly, more and more people report sleep disturbances to their doctors. 

Is this a new epidemic we are facing, or is it just our awareness of the issue that makes it seem so?

In this episode, we take a look at the role sleep plays in our health, what happens when sleep is disturbed, and how insomnia can be treated. Take a listen and see what you think. We try not to put you to sleep, but you might want to grab a cup of coffee whiel you listen anyway.

Resources:

Arianna Huffington's story

Sleep and Chronic Disease

Sleep loss and inflammation

Sleep, ghrelin, leptin and weight gain

Meta analyis of melatoning and sleep duration

Cognitive Behavioral Therapy for insomnia

May 16, 2016

Both of us, Kendall and Amy, have dogs named Goose. This was purely coincidental, and we are as surprised by that fact as anyone. It's a little uncanny how much they resemble one another, too. If you'd like to see the Geese, we've added their pictures over at 2DocsTalk.com. These two certainly live the life of Riley, but they aren't the only canines who have it so good.

We are a country of pet lovers. We spend over $60 billion annually on food, vet bills, toys, and silly extravagances for our animal companions. We love them, and can't imagine life without them. But did you know your pet can make you sick - and the other way around? 

Today we discuss zoonotic infections - those infections that are spread from animal to human. Rabies, toxoplasmosis, and leptospirosis are a few diseases that fall into this category. We'll talk about how they are spread and treated, and give some tips on how to prevent the.

We'll also talk about how we can make our pets sick, too. It's a fun show!

Resources:

The Thanksgiving Effect

The CDC on pets and salmonella

CDC info on rabies 

May 9, 2016

Over the last couple of decades, the conversation surrounding hormone replacement therapy and menopause has been confusing. Does it work? Is it safe? What about alternative therapies? it's hard to sort out conflicting information coming from various sources. In this episode we discuss:

  • The recent history of hormone replacement therapy (HRT)
  • HRT for symptom relief
  • HRT, endometrial hyperplasia, and uterine cancer
  • HRT and cardiovascular disease
  • HRT and breast cancer
  • Bioidentical hormones
  • And more.

Resources

The Bitch is Back

Study of Women's Health Across the Naiton (SWAN)

The Women's Health Initiative

May 2, 2016

Because individuals with high cholesterol levels often develop heart disease, we've come to accept that high cholesterol - especially "bad" cholesterol, or LDL - causes heart disease.

But it can't be said often enough that correlation does not equal causation, and it is beginning to look more and more like a causal realtionship between cholesterol and heart disease just isn't there. 

In this episode we talk about the status of treating cholesterol to prevent heart disease and about a drug trial that punctuates the whole process with a giant question mark. 

Take a listen and see what you think.

Resources:

Number Needed to Treat with Statins for Primary Prevention

Number Needed to Treat with Statins for Secondary Prevention

Evacitrapib Study Stopped Because of Clinical Futility

American Heart Association Guidelines for Prevention with Statins

Apr 25, 2016

For decades we've been told that our high fat diet is making us obese and killing us with heart disease. But here's the deal. The concept of a lowfat diet, exemplified in the Mediterranean Diet, is based on faulty science. 

In this episode, we discuss how the high fat hypothesis became accepted science and public policy, without any good research to back it up. We also talk about the various kinds of fats that are out there and what we think is the biggest culprit in our obesity problems.

Resources:

The Big Fat Surprise

PREDIMED Study

Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease

Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis

Profiling Food Consumption in America

Apr 18, 2016

Stem cell research, regenerative medicine, or whatever you want to call it, was a real hot button issue for a while. The policitics around it have cooled somewhat, but controversy remains even if the media isn't reporting on it.

What have we learned from stem cell research, what advances have been made, and can we really trust it? 

We get in to all this and more on this week's episode.

Resources:

 ISCCR Draft Guidelines for Stem Cell Science Translation

A nice summary of where the FDA got involved with Stem Cell therapy and who many of the players are

Apr 4, 2016

All you have to do is take a quick drive around town to see that low testosterone clinics are all the rage. A little math will tell you why. Males make up around 50 percent of the population, and their testosterone declines, naturally, at a rate of 1 percent per year after age 30. If that decline merits treatment, it's no wonder those clinics are everywhere.

But, does it merit treatment?

Is testosterone replacement safe?

Is it even effective?

We dig into those questions on this episode of 2 Docs Talk.

Resources

JAMA: Effects of Testosterone on Subclinical Atherosclerosis

Testosterone Reduces Cardiovascular Risk

Testosterone Increases Cardiovascular Risk

FDA Drug Safety Communication on Testosterone

Mar 21, 2016

If you've paid any attention to the news in the last year you've heard about the trials of businesses such as Blue Bell Ice Cream and Chipotle. The outbreaks of food borne illnesses from these and other establishments have cause disease, death, and no small amount of economic hardship. 

Why is it that these issues feel like they are happening more frequently? And more importantly, what can we do to keep ourselves healthy, if anything?

On this episode of 2 Docs Talk, we dig into the facts about food borne illness.

Resources:

A great list of facts about raw vs. pasteurized milk, with an excellent list of references at the end.

States that permit the sale of raw milk in retail stores include:

Arizona,California, Connecticut, Idaho, Maine, New Mexico, Nevada, Pennsylvania. South Carolina, Utah, Washington, New Hampshire

States that allow the sale of raw milk on the farm include:

Arkansas, Illinois, Kansas, Kentucky, Massachusetts, Minnesota, Nebraska, New York, Oklahoma, Rhode Island, Texas, Wisconsin, Mississippi

**Arkansas, Kentucky, Mississippi and Rhode Island restrict sales to goat milk, with Kentucky and Rhode Island requiring a prescription from a physician.

Five states allow for the sale of raw milk at farmers’ markets or through other avenues:

Colorado, South Dakota, Missouri, Vermont, Oregon

We referred to a couple of previous podcasts in this episode. If you haven't already listened to these, there is some good info in them:

Is Gluten Free the Answer?

Bugs and Drugs

Mar 14, 2016

One of the big scary pieces of growing old is the possiblity of developing Alzheimer Dementia. This progressive neurological disease is poorly understood, meaning the options for prevention and treatment have a long way to go.

In this episode, we talk about what the disease is, current options for treatment, the reality of prevention, and an approach to choosing long term care.

 

Resources:

Systematic review of studies on cholinesterase inhibitors

JAMA Neurology meta analysis of memantine

Risk reducing effect of education on in Alzheimer's disease

Lumosity fined $2 million for deceptive advertising

Non-profit vs. for profit nursing homes

CMS Five Star Rating

Mar 7, 2016

One of the foundational values of this show is emphasizing the importance of using the best available evidence when making decisions about medical care. 

Unfortunately the drive to publish has driven some to game the scientific publishing system. From circumventing the peer-review process to outright fraud, scientific literature is plagued with misinformation.

The scientific community is responding, though. With tools like retraction databases, research reproducibility efforts and post-publication peer review, scientists are working to maintain the highest level of inegrity in the scientific literature.

Be sure to listen all the way to the end, we get a littel personal.

Nature Magazine on the Peer Review Scam

Retraction Watch Leaderboard

Retraction Watch Timeline of Events Regarding Dr. Macchiarini

PubPeer

The Reproducibility Initiative

Why Asparagus Makes Your Pee Stink

Feb 29, 2016

With Zika in the news, it seemed like a good time to examine the vector borne diseases making headway here in the U.S.

In addition to Zika, we need to pay attention to Dengue Fever. Like the West Nile virus and yellow fever, these viruses are spread by the Aedes mosquito - most often Aedes aegypti. 

But don't think mosquitoes are the only issue. The Kissing Bug, which isn't nearly as sweet as it sounds, is responsible for the increasing burden of Chagas disease in the southern states. Without giving away their secret, let me just say you might not want to listen to this episode right before bedtime.

Note: This episode was recorded in mid-February. Our understanding of Zika, and its impact on the U.S. is rapidly evolving. Please keep an eye on the CDC pages linked below for the most current information.

Resources:

CDC map of areas affected by Zika

Sexual Transmission of Zika

Zika Virus

Dengue Virus

Chagas Disease

61% of Kissing Bugs Carrying Trypansoma Cruzii

Feb 22, 2016

This week we started talking about bugs and drugs, or infections and their treatments and we got into Clostridium difficile infection and fecal transplants. Because when it comes to this topic, we are all middle school boys. We can't not talk about it. 

In all seriousness, C. diff can be a devastating disease and the success of this treatment is beyond exciting. As Kendall likes to remind us, though, we have to watch out for the law of unintended consequences.

 

World Health Organization Survey on Antibiotic Use

Great Explainer Video About C. Difficile and Fecal Transplant

Freeze-dried poop for weight loss (I told you so)

Everything You Don't Want to Have to Know About Norovirus from the CDC

Feb 19, 2016

After a few of our previous episodes we got some great questions from a few of our listeners. In this brief update, we answer questions about our episodes on medical marijuana, breast cancer screening and concussions.

Feb 8, 2016

Colorectal screening is an effective tool in the prevention of deaths from colon cancer. The question is if the screening tools we use now are the most effective and safe available to us. Technological advances are making less invasive, safer tests a possibility - and sooner rather than later if we're lucky.

But today, what tests do we have, which ones work, and what should you as a patient choose when it comes to your own screening.

Resources:

Current USPSTF Guidelines for Colorectal Screening

USPSTF Draft Update Status for Colorectal Screening

Pillcam Accuracy and Safety

Cologard and FIT (Fecal Immunochemical Testing)

We can use your help! Please pop on over to iTunes if you are an Apple user, or Stitcher for Android, and leave a rating and review for 2 Docs Talk. It will only take two minutes and you will have our undying gratitude!

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Jan 18, 2016

The supplement industry is a big one - estimates place it anywhere from $12 billion to $37 billion. 

However, if you put that number in the context of healthcare spending overall, it's not too crazy...if supplements are effective and safe.

But issues with the approval and regulations of dietary supplements make leave us with many unanswered questions about the so-called "natural" products on the market.

In this episode we examine supplements, homeopathic remedies, the placebo effect and much more. So take a listen, and leave a comment if you have thoughts on the topic.

References:

Dietary Supplement Health and Education Act of 1994

National Center for Complementary and Integrative Health

Placebos Without Deception

Perception of Drug Cost Influences Placebo Effect

Be sure and leave a comment if you have any thoughts on the show. And you know we'd appreciate it so much if you would leave us a review in iTunes!

Listen on iTunes

Listen on Stitcher

Jan 11, 2016

The gluten-free phenomenon has grown into a $2.5 billion industry in the U.S. The question we have to ask is if the medical concern from gluten is enough to justify such a huge national expenditure. In this episode, we look at the disorders behind gluten and wheat allergies, gluten sensitivities and the science that supports these diagnoses.

Dec 10, 2015

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

Dec 10, 2015

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

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