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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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Now displaying: Category: evidence based medicine
Mar 12, 2018

If you aren't taking an SSRI yourself, there it's almost certain you know someone who does. Selective Serotoning Reuptake Inhibitors are one of the most commonly prescribed classes of drugs out there.

Is their widespread use earned on the basis of good evidence? It's not clear - let's take a look.

References:

Genetic and clinical predictors of sexual dysfunction in citalopram-treated depressed patients.

Perlis RH, Laje G, Smoller JW, Fava M, Rush AJ, McMahon FJ

Neuropsychopharmacology. 2009;34(7):1819. Epub 2009 Mar 18. 

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Feb 26, 2018

For decades, much has been made of the healthvbenefits of drinking alcohol. And those benefits are real. But, what exactly are the benefits, and how do they stack up against the risks associated with alcohol? 

Today, 2 Docs Talk about the ways alcohol and help and harm your health, and we offer some of our opinions, too. 

Resources:

https://www.hsph.harvard.edu/nutritionsource/alcohol-full-story/

https://www.cdc.gov/features/costsofdrinking/index.html

https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf

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Feb 19, 2018

If you are of a certain age, you remember a time when pretty much every kid got chicken pox. But those days are behind us as most of our children are vaccinated agains varicella, the virus that causes chicken pox. But for us old folks, shingles is the still around to remind of the old days when we still got chicken pox. 

Today 2 docs talk about the effect of the varicella vaccine, the problem with shingles, and what you can do about it.

 

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Feb 12, 2018

Senator McCain has a malignant brain tumor called a Glioblastoma Multiforme, orglioblastoma or GBM for short.

He’s not the first person politically connected to get one of these things. I think this is what Senator Ted Kennedy had back in 2008 and also Beau Biden, Joe Biden’s son died of a glioblastoma.

Glioblastomas are one of a class of brain tumors called Gliomas. Gliomas can be low grade which are considered pre-malginant or pre-cancerous or they can be high grade malignancies such as GBMs.  

Today 2 Docs Talk about Glioblastoma Multiforme, and the difficulties associated with treating - or not treating - the tumor. 

Resources:

Don't Tell John McCain to Fight His Cancer

FDA approval of Optune device for Glioblastoma

2 Docs Talk episode on hospice

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Feb 5, 2018

We all know that exercise is beneficial for our health. But how much  - how long - what type? Understanding what offers the best outcomes is tricky because it's difficult to conduct rigorous research with long term endpoints such as reduction of disease and death. 

Today 2 Docs Talk about some interesting studies on exercise and what they reveal about the benefits of physical activity. 

Resources:

https://www.ncbi.nlm.nih.gov/pubmed/25844730

https://www.ncbi.nlm.nih.gov/pubmed/25844882

https://www.hsph.harvard.edu/nutritionsource/mets-activity-table/

http://www.amjmed.com/article/S0002-9343%2814%2900138-7/abstract

https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-9-89

https://www.ncbi.nlm.nih.gov/pubmed/18332184

http://www.sciencedirect.com/science/article/pii/S0277953612003565

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852580/#R12

http://www.aacr.org/Newsroom/Pages/News-Release-Detail.aspx?ItemID=580#.Wlt9eSOZM_W

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Jan 29, 2018

The normally staid world of hypertension was a bit controversial in 2017, so this week 2 Docs Talk about the recent recommendations — and their accompanying controversies — for treating high blood pressure. 

Resources:

Systolic Hypertension in the Elderly (SHEP) Study

Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial.

Systolic Blood Pressure Intervention Trial (SPRINT)

JNC 8 blood pressure treatment guidelines

Jan 15, 2018

This has been a particularly bad year for the flu. More people are getting sicker than in most years. And the vaccine is not working well. 

In this episode, 2 Docs Talk about why the influenza virus circulating this year is causing so many problems. Beware there is a little bit of basic science involved. But not too much.

Resources: 

Our information is from the Centers for Disease Control: https://www.cdc.gov/flu/about/season/current.htm

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Dec 25, 2017

You’d think that something like screening for prostate cancer would be free of controversy, but that just isn’t the case. The benefits and risks of screening have been hotly debated by different medical organizations over the years.

Today, 2 Docs Talk about how prostate screening and the various issues surrounding it. This is a topic every man should discuss with his physicians, and we hope this hepls you know what questions to ask when you do.

Resources:

Weiner AB, Matulewicz RS, Eggener SE, Schaeffer EM. Increasing incidence of metastatic prostate cancer in the United States (2004-2013). Prostate Cancer Prostatic Dis. 2016 Jul 19.]

AU Tacklind J, Macdonald R, Rutks I, Stanke JU, Wilt TJ. TI Serenoa repens for benign prostatic hyperplasia. SO Cochrane Database Syst Rev. 2012;12:CD001423.

https://www.cancer.gov/types/prostate/hp/prostate-screening-pdq

 

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Nov 27, 2017

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

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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 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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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 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 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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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 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 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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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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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

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