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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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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 22, 2018

Does your doctor sell dietary supplements? Have you considered the ethics of such an arrangement? The American Medical Association has, and they think it's a bad idea. 2 Docs Talk about the ethics of physicians profiting from supplement sales.

Resources:

About DSHEA 1994

ER visits due to supplements

Study showing supplement reduces LDL

AMA Ethics Statements on Supplement Sales

Pharmceutical marketing and prescribing habits

 

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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Jan 8, 2018

If you’ve paid any attention to the news over the past year or so, you’ve likely seen stories of greedy capitalists gouging the vulnerable by hiking up the prices of their life-saving drugs.

But are the prices hikes all that bad?

Yes. Yes, they are. And we talk about that to day on 2 Docs Talk.

Resources:

JAMA on Drug Pricing

Our episode on Hep C

Our episode on Alzheimers

Our episode on Pricing Transparency

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Jan 1, 2018

If you’ve paid any attention to the news over the past year or so, you’ve likely seen stories of greedy capitalists gouging the vulnerable by hiking up the prices of their life-saving drugs.

But are the prices hikes all that bad?

Yes. Yes, they are. And we talk about that to day on 2 Docs Talk.

Resources:

JAMA on Drug Pricing

Our episode on Hep C

Our episode on Alzheimers

Our episode on Pricing Transparency

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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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Dec 18, 2017

If you’ve ever tried to figure out the price of a medical procedure, you know it’s not that easy. In fact, research shows that complete pricing for medical procedures is unavailable when requested over one-third of the time.

As healthcare deductibles rise and indidviduals are affected more and directly by these costs, the issue of pricing transparency is growing. In this episode we talk about the problem posed by opaque medical pricing practices. We also dig into two innovative practice models that solve this transparency problem, as well as a few other issues in the delivery of healthcare and medicine.

Resources:

Surgery Center of Oklahoma

Turntable Health

Iora Health

JAMA: Availability of Consumer Prices from US Hospitals for a Common Surgical Procedure

 

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Dec 11, 2017

Vaccines are both one of the most widely used and most widely misunderstood preventive medical treatments available. People have concerns about autism, efficacy, the promotion of unhealthy behaviors. We dig into the evidence on some of those topics, as well as take a look at the effectiveness of vaccines against some of the scariest disease of our time – including cancer.

 

NEJM study on vaccines and autism

Lancet study on vaccines and autism

Adverse Effects of Vaccines: Evidence and Causality an ebook by the Institute of Medicine that states, “The evidence favors rejection of a causal relationship between MMR vaccine and autism.”

About Cancer vaccines

2014-2015 Flu vaccine info – why it was less effective, but did reduce disease severity

Information on current research into an ebola vaccine

 

 

Check out this episode!

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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 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.

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