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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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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 11, 2016

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.

Resources:

Primer on the retracted study that indicated GMOs caused tumors

How GMOs are tested for safety

 

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 28, 2016

In this episode, we dig into the terms being bandied about by politicians this year. Medicare for all, single-payer, socialized medicine. What do they all mean? Are they all the same or are there differences between these systems. 

And what would we do, today, to start making healthcare work a little better?

Resources:

Per Capita Health Spending by Country

Gallup Poll on Healthcare Satisfaction by Country

Mar 25, 2016

As we've produced more episodes, we've continues to see our listening audience grow. We appreciate the listeners, the comments, the emails, and the sharing of our little show. Since new listeners are showing up each week, we thought we'd re-run our intro episode so everyone knows where we're coming from and what we're all about.

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 15, 2016

Opioid abuse is at an ever increasing high in the U.S. with overdose being a significant cause of death. 

What role do physicians, pharmaceutical companies, and the drug users themselves play in this epidemic. We examine these questions and more in this episode on the opioid problem in the United States.

Resources:

Drug Overdose Deaths by State

Draft CDC Guidelines for Prescribing Opioids for Chronic Pain

Specific Populations and Prescription Drug Misuse and Abuse

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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Feb 1, 2016

If you live anywhere but under a rock, you know that Planned Parenthood has been the center of controversy in recent months. In this episode, we discuss the history of the organization and its founder Margaret Sanger. Then we dig into Planned Parenthood as it exists today and the controversy surrounding it.

The coverage of the controversy in the media is filled with innuendo and half-truths from both sides of the political spectrum. We wanted to know the facts, so we did a little searching. Since we recorded this episode, the courts in Houston did too, and found no evidence that they were profiting from the sale of fetal tissue or organs.

But, what role does Planned Parenthood play in healthcare today?

Do they provide needed services? What are those services? Is abortion their primary business? Should Medicaid funds cover their services? And finally, is there anything that can be done to curb the number of abortions performed today? (Hint: yes there is, and it has nothing to do with Roe v. Wade.)

Resources:

Where are Planned Parenthood Clinics Located?

Texas Tribune Articles on Planned Parenthood

Planned Parenthood Services by the Numbers

CDC Abortion Surveillance Report - 2012

New England Journal of Medicine on Planned Parenthood

Long Acting Reversible Contraception in Colorado

The Choice Project - LARCs in Colorado

Jan 25, 2016

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

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.

Jan 4, 2016

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

Dec 28, 2015

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

 

 

Dec 10, 2015

Since March 2010, health care in the U.S. has been subject to the Affordable Care Act, also known as Obamacare.

There is a significant amount of confusion about what exactly this law does or does not do. In this episode, we talk about the key provisions of the law and how it affects the delivery of healthcare in the U.S.

We cover:

  • the effect of the law on insurance
  • subsidies
  • the pre-exisiting conditions clause
  • the mandatory coverage provision
  • pharmaceutical pricing
  • and other key requirements of the law.

In this episode we refer to the following information:

Insurance companies requesting rate reviews under Obamacare

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

Dec 10, 2015

Hi and welcome to 2 Docs Talk, the podcast about healthcare, the science of medicine, and everything in between. We are your hosts, Kendall Britt, MD and Amy Rogers, MD and we look forward to sharing our thoughts on the best and worst of medical evidence and healthcare policy. Join us for a 15 minute appointment where the doctor is always in.

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