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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
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

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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Mar 6, 2017

Hepatitis C infection is on the rise in recent years. The growing opioid epidemic has multiplied the problem, as the primary means of spread is IV drug use. 

Surprisingly only 35 percent of those infected received treatment even though excellent treatment available is for this devastating disease. Not surprisingly, drug costs are a major factor in this issue.

Join us as we discuss the issue of Hep C and what can be done about it.

Resources:

American Journal of Managed Care Special Issue on Hepatitis C Virus

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Feb 27, 2017

 

Lice are an issue that many parents of elementary students have to deal with, often more than once.

In this episode we discuss the three different types of lice - body lice, pubic lice, and head lice - how to get them, the health threats associated with them, and what works to get rid of them. 

Resources:

The CDC on head lice treatment

An Interesting Paper if You Want to Get Totally Geeky on Lice

Dr. Pearlman's Site on the Cetaphil Treatment and Lice

 

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Feb 13, 2017

Diabetes is an old disease that hasn't had a many new solutions in a long time. In this episode we look at what Type 1 and Type 2 diabetes are, how they are treated, and some potential game changers for their treatment on the horizon.

Resources:

Diabetes Stats

The exorbitant cost of diabetes

ACP Guidelines for Treatment of Type 2 Diabetes

Digital Start-up Trying to Help Low Income Diabetes Patients

Research into the Utility of the BCG Vaccine for the Treatment of Diabetes

 

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Feb 6, 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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Jan 9, 2017

In a country (the U.S.) where people drink, on average, 44.7 gallons of soda per person, it's smart to think about what we are putting into our bodies. 

Most of us have figured out that all that sugar is a bad idea, but what about sugar substitutes? Diet sodas make up a big portion of that 44.7 gallons. But is it really any better than plain old sugar?

Resources:

Generally Recognized as Safe

San Antonio Heart Study

Fueling the obesity epidemic: Artificially sweetened beverage use and long term weight gain

Artificial Sweeteners and Gut Microbiota in Rats

 

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Jan 2, 2017

America has a weight problem. A full one third of us are classified as obese, and other third are obese. This has implications for individuals, families and society that cut across social and economic factors.

We take a look at a handful of studies that take a look at the weight problem from a variety of angles.

Metabolic rate, BMI, whole grain intake,physical inactivity, and more.

 

Resources:

CDC Info on Obesity

“The Biggest Loser” Study

BMI study

Whole Grain Study

Exercise to Offset Sitting

Cost of Physical Inactivity

 

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Dec 19, 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

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Dec 5, 2016

The media serves us a lot of news about some very flashy diseases. Sometimes is skews our perception of what the most serious threats to our health really are. But no matter what new danger the latest headlines proclaim, heart disease remains the number one cause of death in the United States. Often, those deaths are caused by heart attacks. 

In today's episode, 2 Docs Talk about heart attacks, what they are, how they are treated, and how you should respond if you think you or someone near you is having one. 

Resources:

Prognosis after out of hospital cardiac arrest with and without automatic external defibrillation.

A stem cell treatment for heart disease currently being pursued.

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Oct 31, 2016

It's one of those things that doesn't feel so big and important compared to other medical problems, but in reality, acne can be a difficult problem to deal with.

For teens it can be a huge blow to already fragile self-confidence. It isn't a walk in the park for adults who find themselves with a break-out, either.

So today, we are talking about what causes acne, what the science says about dietary approaches to reducing it, and what the most current treatments are. 

Resources:

Acne: A Disease of Western Civilization

Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study.

Our podcast on supplements

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Oct 17, 2016

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

Oct 10, 2016

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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Oct 3, 2016

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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Sep 26, 2016

These days you can buy e-Books  for your e-Reader and participate in e-Commerce. You can send your friends Evites, e-file your taxes, and meet the love of your life on eHarmony. 

So it's really no surpise that e-Cigarettes have become as popular as they are. Hats off to whoever named them, since they are actually physical items that you can hold in your hands, unlike most e-products.

The question, of course, is if there are any health advantages to e-Cigarettes. Do they really help you stop smoking?

And, do they create their own set of health problems? 

That's what we're talking about this week.

 

Resources:

E-Cigs and Poison Control

Southern California Children's Health Study

USPSTF on Smoking Cessation

Aphthous Ulcers and Nicotine

 

Sep 12, 2016

In a country (the U.S.) where people drink, on average, 44.7 gallons of soda per person, it's smart to think about what we are putting into our bodies. 

Most of us have figured out that all that sugar is a bad idea, but what about sugar substitutes? Diet sodas make up a big portion of that 44.7 gallons. But is it really any better than plain old sugar?

Resources:

Generally Recognized as Safe

San Antonio Heart Study

Fueling the obesity epidemic: Artificially sweetened beverage use and long term weight gain

Artificial Sweeteners and Gut Microbiota in Rats

 

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Sep 5, 2016

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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