The People's Pharmacy Radio ProgramEverything from home remedies to the latest breakthrough drugs are discussed on The People's Pharmacy. Pharmacologist Joe Graedon and medical anthropologist Terry Graedon talk to leading experts to discuss issues relating to drugs, herbs, home remedies, vitamins and related health topics.
Everything from home remedies to the latest breakthrough drugs are discussed on The People's Pharmacy. Pharmacologist Joe Graedon and medical anthropologist Terry Graedon talk to leading experts to discuss issues relating to drugs, herbs, home remedies, vitamins and related health topics.
Show 1359: Is the Food on Your Plate Real or Fake?
This week's radio show features two of the country's leading nutritional epidemiologists, Dr. Walter Willett of Harvard and Dr. Barry Popkin of the University of North Carolina. They discuss some of the challenges with the food on our grocery shelves and advise us on how to tell if the food we choose is real or fake. You may want to listen to the show through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. The American diet has undergone many changes over the last several decades. Some that were intended to promote health actually backfired. Substituting margarine for butter seemed like a good idea, for example, but resulted in people being exposed to dangerous trans fats. If you can't listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on October 16, 2023. Is the Sweetener in Your Soft Drink Real or Fake? Sugar-sweetened beverages have been around a long time, but they really started gaining prominence in our diets late in the 20th century. Nutrition scientists have linked sugary soft drink consumption to weight gain. Liquid calories don't register in our brains the way solid food does, so we don't compensate by eating less at mealtimes. Sugary beverages have also been associated with other health problems such as fatty liver, hypertension and kidney disease. Sweetness without Calories: Consequently, many people decided to change to sugar substitutes. Some of these, like aspartame, are artificial sweeteners. What could be better to enjoy sweetness without calories? Unfortunately, the promise of artificial sweeteners has not held up. It is not clear that using these sugar substitutes helps people lose weight or keep it off. In addition, some research has raised questions about the safety of aspartame and other sweeteners. Despite this, these compounds are now being used in many other foods besides soft drinks. Can you tell if your sweet treat is real or fake? Guidelines for Healthy Food Choices: The simplest guideline both experts offer is "Eat Real Food." That puts a responsibility on us to distinguish real or fake foods in our cupboard. Better yet, we should get help making such choices right in the grocery store. Dr. Popkin describes an experiment in one country in which taxes from ultra-processed junk food are applied to supporting the purchase of vegetables and fruits. What About Real or Fake Fat? Back in the 20th century, scientists were adamant that eating food containing saturated fat would clog coronary arteries. They told people that they should switch to margarine instead of butter. Later, they learned that the trans fats (hydrogenated oils) in margarine were even worse than sat fats for our health. The push for low-fat and non-fat foods was on. This too was a detour away from real food, so we ended up with many highly processed options full of refined starches and sugar. Unfortunately, the expected health benefits of a low-fat diet based on ultra-processed foods never materialized. Consuming such meals day after day can predispose us to type 2 diabetes as well as fatty liver disease. In this case, it makes sense to go for real fat over fake. But Dr. Willett argues that saturated fat is not ideal. Instead, he suggests, we should take a tip from the Mediterranean dietary pattern and use olive oil as our primary fat. Benefits of Olive Oil: Numerous studies indicate that following a Mediterranean diet is a path to better health. Sometimes it seems difficult to understand what we mean by a Mediterranean diet, though. There are so many countries surrounding the Mediterranean Sea, each with its own culinary traditions. Many Americans have misconceptions about what constitutes a Mediterranean way of eating. It's not pasta with lots of meatballs in sauce. To help us out, Dr. Willett suggests focusing on plant rather than animal protein sources for the most part, along with an emphasis on vegetables and fruits. When possible, grains should be whole or minimally processed. People may drink wine in moderation, but not all such diets include it. Above all, the primary fat is olive oil. Olive Oil Lowers the Risk of Disease: For many years, Dr. Willett has helped oversee the long-running Nurses Health Study, Nurses Health Study II and the Health Professionals Follow-up Study. With around 90,000 individuals providing critical data for decades, these studies permit important inferences about the effect of diet on health. An analysis published in the Journal of the American College of Cardiology (Jan. 18, 2022) demonstrated that people consuming as little as half a tablespoon of olive oil daily were 19 percent less likely to die of cardiovascular causes. A separate analysis of data from these studies indicates that people consuming olive oil are less vulnerable to death from dementia. We asked Dr. Willett whether extra-virgin olive oil is superior to ordinary olive oil, but the participants did not specify which they were using. Consequently, we cannot answer that question. Choosing a Healthful Diet: Dr. Willett offered his guidelines for making healthy dietary choices. We need to be clear on the differences between real or fake food and choose whole grains, unprocessed oils, fruits and vegetables and only small amounts of animal-sourced foods like meat or dairy. Emphasizing plants helps support our microbiome. On the other hand, artificial sweeteners and sugar alcohols like sorbitol or maltitol can disrupt the microbes in our digestive tracts. A plant-based diet is also better for the environment. That is important because you can't have healthy people on a sick planet. This Week's Guests: Barry M. Popkin, PhD, is W. R. Kenan, Jr. Distinguished Professor in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Dr. Popkin established the Division of Nutrition Epidemiology at UNC. He also established and led the UNC Interdisciplinary Obesity Center. Dr. Barry Popkin, W. R. Kenan, Jr. Distinguished Professor in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill Walter C. Willett, MD, DrPH, is physician and epidemiologist and Professor of Epidemiology and Nutrition at the Harvard T.H. Chan School of Public Health. He served as Chair of the Department of Nutrition at Harvard for 25 years. Much of his work has been on the development of methods, using both questionnaire and biochemical approaches, to study the effects of diet on the occurrence of major diseases. Dr. Willett is the author of several books, including Eat, Drink and Be Healthy. https://www.amazon.com/Eat-Drink-Be-Healthy-Harvard/dp/0743266420 https://www.hsph.harvard.edu/profile/walter-c-willett/ Dr. Walter C. Willett, Professor of Epidemiology and Nutrition at the Harvard T.H. Chan School of Public Health Listen to the Podcast: The podcast of this program will be available Monday, October 16, 2023, after broadcast on Oct. 14. You can stream the show from this site and download the podcast for free. Download the mp3.
Show 1359: Is the Food on Your Plate Real or Fake?
Show 1358: Upsides and Downsides of Immune-Modifying Drugs
This week's radio show features one of our favorite guests, Dr. Robynne Chutkan. She is a gastroenterologist in Washington, DC and is a brilliant communicator. You may want to listen to it through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. We will be talking about some of the most successful drugs in the pharmacy. They are referred to as "biologics" or immune modifying drugs. Perhaps you recognize brand names like Enbrel, Remicade or Humira. What do these medicines do well, and what are the downsides? If you can't listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on October 9, 2023. Upsides and Downsides of Immune-Modifying Drugs: The immune system has a lot of important work to do, warding off infections and scanning the body for cancerous growths. But sometimes it goes a bit haywire and begins attacking normal tissue. That is the reason behind autoimmune diseases like psoriasis, rheumatoid arthritis and ulcerative colitis. Doctors have many ways to treat these conditions, but the most potent medications are monoclonal antibodies like infliximab (Remicade). That "mab" at the end of the generic name is a signal for Monoclonal AntiBody. Remicade and other immune-modifying drugs like Enbrel or Humira calm the immune system down and ease inflammation. That's why they can be so helpful in serious situations. Doctors refer to them as "biologics" because they are produced by living organisms, mostly cells in this case. As a result, manufacturing them can be tricky, so the pharmaceutical firms that make them charge top dollar. Price Is Not the Only Downside: Even with good insurance, some of these drugs might cost thousands of dollars a month. Many people find the co-pay sums daunting. But cost is not the only consideration. If you have watched television commercials for these drugs (and there are many), you will have heard a long list of potentially serious side effects. By reducing the activity of the immune system, these medications can leave people vulnerable to severe infections, including tuberculosis. In addition, a damped-down immune system is less effective at cancer surveillance. Consequently, there may be an increased risk for tumors developing. Newly Discovered Hazards of Immune-Modifying Drugs: Scientists have recently uncovered another consequence of these medicines that is rather surprising (Clinical Gastroenterology and Hepatology, July 10, 2023). Patients in France and Denmark who were taking one of these drugs for their ulcerative colitis were 76 percent more likely to develop an additional autoimmune condition like psoriasis, psoriatic arthritis, rheumatoid arthritis or a miserable skin condition called hidradenitis suppurativa. Physicians use biologics to treat these conditions. Until this study was conducted, they assumed that people taking such drugs would be protected from additional autoimmune diseases. That is why the results were so unexpected. Stopping Immune-Modifying Drugs: If you want to stop taking one of these biologics, you will need to work closely with your healthcare provider. Dr. Chutkan points out in the interview that she has helped many patients rely more heavily on dietary changes and lifestyle modifications so that they don't need as much medication. Stopping is not a do-it-yourself project, though. Some of the drugs in this category need to have the dose tapered gradually to avoid flare-ups. People who are in rough shape may not be ready to quit their medicine. That's why discontinuation requires collaboration between patient and provider. Others may never be able to stop. Only a physician can help with that decision. Other Digestive Drugs That Can Be Tough to Stop: Proton pump inhibitors are among the most popular drugs for common digestive disorders like heartburn or ulcers. Esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec) have long been considered safe enough to use without a prescription. They are not as innocuous as some doctors have assumed, however. Moreover, many people have discovered that quitting one of these acid-suppressing drugs without medical supervision can become a challenge. Dr. Chutkan describes the difficulties and how to overcome them. The Gastrointestinal Effects of Diabetes and Weight-Loss Drugs: Semaglutide has been approved under two different brand names for two completely different (but not totally unrelated) purposes. Ozempic is used to treat type 2 diabetes and keep blood sugar under control. Wegovy reduces appetite and can help people lose weight. Since they contain the same active ingredient, it is not too surprising that they have similar effects on the digestive tract. In addition to nausea, vomiting and either diarrhea or constipation, semaglutide can sometimes cause more serious complications. The stomach may slow its emptying drastically, a condition called gastroparesis or stomach paralysis. What's more, the lower part of the gut may also stop working. Doctors call this condition ileus. Both can be dangerous. This Week's Guest: Robynne Chutkan, MD, a board-certified gastroenterologist, is a faculty member at Georgetown University Hospital and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice located in Washington DC. Dr. Chutkan is the author of the digestive health books Gutbliss, The Microbiome Solution, The Bloat Cure and The Anti-Viral Gut: Tackling Pathogens from the Inside Out. Robynne Chutkan, MD, author of The Anti-Viral Gut: Tackling Pathogens from the Inside Out Listen to the Podcast: The podcast of this program will be available Monday, October 9, 2023, after broadcast on Oct. 7. You can stream the show from this site and download the podcast for free. Download the mp3.
Show 1358: Upsides and Downsides of Immune-Modifying Drugs
Show 1357: Revisiting Ventilation to Avoid Airborne Germs
According to the CDC, cases of COVID-19 have been rising in several parts of the country. Cases of hospitalization for COVID are also up. One way to protect ourselves from airborne germs like the SARS-CoV-2 virus is through better ventilation and air filtration. How well are we using these techniques? Maximizing Ventilation to Avoid Airborne Germs: The experience of the COVID-19 pandemic has shaped some scientists' research. For Dr. Prasad Kasibhatla, the question of whether or not to teach in person in the fall of 2020 inspired him to put his knowledge of atmospheric chemistry into a model. By that time, it had become clear that viral particles could behave like pollutants, especially like aerosols floating around a room for hours. This was an important revision of the earliest conception of viruses primarily traveling in droplets that would fall to the ground within six feet. Dr. Kasibhatla used research by Dr. Linsey Marr and others to calculate how many hourly air exchanges would give a reasonable level of risk. That is, how many times an hour do you need to replace stale classroom air with fresh air? It turned out that the classrooms he taught in were adequately ventilated to keep that risk of inhaling viral particles relatively low. How Well Can You Avoid Airborne Germs? Most of us do not spend our days in well-ventilated classrooms. How can we tell if the bank, pharmacy, shoe store or taco joint we have just walked into has adequate ventilation? We have standards for outdoor air pollution, but only a few organizations, such as hospitals or high-tech manufacturing facilities, have standards they enforce for indoor air quality. Benefits of Ventilation Have a Long History: The idea of improving ventilation for better health goes back a long way. In the middle of the 19th century, even before Koch developed the germ theory of disease, Florence Nightingale was crusading for better ventilation in hospitals. She may not have had any information on aerosolized airborne germs, but she was very attentive to data. Her careful observations told her that well-ventilated sickrooms were far more conducive to healing. Why didn't we remember those important lessons? Evaluating the Likelihood of Encountering Airborne Germs: The primary source of viral aerosols, whether SARS-CoV-2, influenza or respiratory syncytial virus (RSV), is an infected person breathing them out. That's why the fewer people sharing your air, the safer you may be. But how would you know how many people are breathing into your air? That is where the carbon dioxide monitor can be useful. Using a Carbon Dioxide Monitor: When people breathe, the exhalation is rich in carbon dioxide. Outdoors, that breath gets wafted away and diluted quickly in the fresh air. Inside, it may hang around and insinuate itself into every corner of the room. Measuring the level of carbon dioxide in the room will tell you how much of the air is fresh, and how much is being re-breathed. Outdoors, levels of carbon dioxide are typically around 400 ppm (parts per million). When indoor levels start to rise beyond 800 to 1,000 ppm, it indicates that there is less fresh air than you might prefer. For the calculation that Dr. Kasibhatla does, subtract 400 from the CO2 monitor reading, then divide that by 400. Thus a reading of 800 – 400 = 400. Divide that by 400 and you get 1. So 1 percent of the air you are breathing has been breathed by someone else. That is not too alarming. As the reading rises, it can serve as a red flag that the ventilation in the room needs attention. High-risk areas may also need extra filtration with HEPA (high-efficiency particulate-arresting) filters. In fact, if we want to protect ourselves from infection with airborne germs, we might consider layered protection in risky circumstances: start by maintaining at least six feet of distance, add masking, improve ventilation and filtration and, in some situations, provide mass testing. Schools that employed these approaches during the pandemic often minimized the spread of disease. Rethinking Air Quality and Infectious Disease: We spoke with aerosol expert Dr. José Jimenez to learn more about how to avoid airborne germs. He was able to explain the misunderstanding about the six-foot rule. (Dilution rather than gravity is responsible for droplets becoming less noticeable as you get farther away from a source.) In addition, he described how ultraviolet radiation might be used to help against pathogens. Years ago, scientists demonstrated that UV radiation could reduce transmission of the measles virus, another virus that often travels as an aerosol. However, using UV light to kill viruses can create some varieties of air pollution. As a result, ultraviolet disinfection may be useful, but it is not universal. Dr. Jimenez also endorsed the Corsi-Rosenthal box, a home-made filtration system that is both inexpensive and effective. You can learn more about it here, in our interview with Dr. Richard Corsi. This Week's Guests: Prasad Kasibhatla, PhD, is Professor of Environmental Chemistry and Senior Associate Dean of Research and Doctoral Programs at the Nicholas School of the Environment at Duke University. https://nicholas.duke.edu/people/faculty/kasibhatla José Jimenez, PhD, is Distinguished Professor of Chemistry at the University of Colorado, Boulder. He is also an Institute Fellow with CIRES, the Cooperative Institute for Research in Environmental Sciences. Listen to the Podcast: The podcast of this program will be available Monday, September 25, 2023, after broadcast on September 23. You can stream the show from this site and download the podcast for free. The podcast this week contains Dr. Jimenez's thoughts on how and when masks can be useful. Download the mp3.
Show 1357: Revisiting Ventilation to Avoid Airborne Germs
Show 1356: Looking Through the Windows to the Brain
Since at least the 16th century, people have suggested that the eyes are the windows to the soul. In the 21st century, ophthalmologists have developed technology that allows them to assess our health beyond our eyes. What do they see when they look through these windows to the brain? Eyes as the Windows to the Brain: Retinal health is an indicator of neurological health. Scientists have found that imaging the retina with novel technology including optical coherence tomography angiography, they can assess the presence of various eye conditions such as glaucoma, age-related macular degeneration and diabetic retinopathy. However, in addition to these potential causes of visual impairment, they can also detect early signs of certain brain conditions that may lead to cognitive dysfunction. Harnessing AI to analyze the sensitive retinal scans may allow researchers to distinguish between people with mild cognitive impairment and those who are cognitively normal. Scientists have found that such retinal imaging is consistent over time and can help them identify people with Alzheimer disease and Parkinson disease as well as mild cognitive impairment. This technology can detect signs of Parkinson disease earlier in the disease course. With further development of treatments, earlier detection could eventually lead to more timely intervention. Other Conditions That Show in Your Eyes: Your eye doctor can tell a lot about your health by checking your eyes. Surprisingly, high cholesterol can show up in the eyes. So does high blood pressure. Multiple sclerosis and myasthenia gravis are less common conditions that may be diagnosed partly on the basis of eye problems. Diabetes and giant cell arteritis can also produce telltale symptoms seen in the eyes. Talking About Eye Health: Our guest, Dr. Sharon Fekrat, is a retinal specialist and has done much of the research described above. As an ophthalmologist, she can also answer your questions about common eye conditions. Do you wonder about treatment for age-related macular degeneration? Have you been told you have glaucoma? Dr. Fekrat is standing by to answer your questions. On this live show, you can call in your question or your comment to 919-962-3366 between 7 and 8 am EDT on September 16, 2023. Please feel free to email your questions ahead of time to radio@peoplespharmacy.com. This Week's Guest: Sharon Fekrat, MD, FACS, FASRS, is professor of ophthalmology and associate professor of surgery at Duke University Medical School. She is associate chief of staff at the Durham VA Healthcare System. Dr. Fekrat has been Director of the Duke Vitreoretinal Surgery Fellowship Program, and Director of Ophthalmology Faculty Career Development. She is currently Director of Duke iMIND Research Group. Dr. Fekrat is the editor, along with Tanya Glaser, MD, and Henry Feng, MD, of All About Your Eyes. Sharon Fekrat, MD, FACS, FASRS Dr. Fekrat's research has been published in Ophthalmology Science (Jan. 31, 2023), British Journal of Ophthalmology (March 2022), JAMA Ophthalmology (Feb. 1, 2021) and many other scientific journals. Listen to the Podcast: The podcast of this program will be available Monday, September 18, 2023, after broadcast on Sept. 16. You can stream the show from this site and download the podcast for free. Download the mp3.
Show 1356: Looking Through the Windows to the Brain
Show 1355: Uncovering the Shocking Dangers of Misdiagnosis
When you develop a health problem with symptoms that trouble you, the first step is to find out what it is. Diagnosis may be the most basic task a doctor or other healthcare provider undertakes. That doesn't mean it is easy, though. New research is uncovering the shocking dangers of misdiagnosis. The Dangers of Misdiagnosis Include Death and Disability: How common are diagnostic errors? Estimates suggest that between 5 and 11 percent of diagnoses may be wrong, and sometimes those mistakes hurt patients. Doctors may believe that getting it right 90 percent of the time is a pretty good track record, especially since diagnosis can be anything but straightforward. Patients don't seem to feel the same way if they have experienced a misdiagnosis, and especially if it has harmed them. If you look at the rates of serious diseases and just how frequently they may be misdiagnosed, the results are alarming. A team of investigators calculate that problems with diagnosis may cause serious harm to an estimated 795,000 Americans each year. Their estimates actually range from 598,000 to 1,023,000, and include both deaths and permanent disability (BMJ Quality & Safety, July 17, 2023). The top five most dangerous diseases accounted for a disproportionate amount of the harms, nearly 40 percent. They include stroke, sepsis, pneumonia, venous thromboembolism and lung cancer. Overlooking Symptoms of a Stroke: Our guest, Dr. David Newman-Toker, is a neurologist who has been striving for decades to get his colleagues to recognize the subtler symptoms of a stroke. We read him an email we received from a listener named Ralph. Here is what he wrote: "Count me among the survivors of a diagnostic mistake if you will, but I call it simple laziness on the part of my former GP. For weeks, I complained of massive headaches, accompanied by nausea and vertigo. My GP had me keep a daily record of my blood pressure for 30 days. (No hurries, right?) "When I showed him the record, he shrugged and said my blood pressure was normal. He had nothing else to say. Two weeks later, I almost died from a serious stroke. It cost me my career and required eight months of rehab. My cardiologist was livid with my (now former) GP, saying he should have referred me to a specialist." Dr. Newman-Toker observes that most people now recognize the most obvious symptoms of stroke, such as one-sided weakness or paralysis and problems with understanding or producing speech as well as sudden vision problems. But difficulties with balance (dizziness), nausea and headache, fainting or double vision may be less well recognized. As Ralph's story shows, severe head pain or persistent dizziness deserves prompt attention. Fighting the Dangers of Misdiagnosis with the Four Ts: Dr. Newman-Toker and his colleagues promote the concept of four Ts to help reduce the burden of diagnostic mistakes. Those are: Teamwork Training Technology Tuning These approaches apply primarily to healthcare providers, but we want to know how patients can be part of the team. How Can Patients Avoid the Dangers of Misdiagnosis? Dr. Newman-Toker has three recommendations: 1. Prepare for your visit. Have a succinct synopsis of your symptoms and the time frame and order in which they appeared. 2. Ask important questions. These will vary with the individual situation. However, two of the most important questions are: What is the worst thing this could be? and Why do you think it is not that? 3. Stay vigilant. If your symptoms do not begin to resolve with treatment, bring this to the provider's attention. Ask the question: Might these symptoms be caused by something else? You will have already asked when to expect test results and how soon symptoms should respond to treatment. Don't assume that if you hear nothing you should keep quiet. The Society to Improve Diagnosis in Medicine: Dr. Newman-Toker is the current president of the Society to Improve Diagnosis in Medicine. This organization is dedicated to reducing the toll of diagnostic mistakes. It counts among its members some of the leading researchers on this topic as well as providers striving to limit the dangers of misdiagnosis. Patients can be members too. You'll find it at https://www.improvediagnosis.org The annual conference on The Future of Diagnosis is October 8-11, 2023. This Week's Guest: David Newman-Toker, MD, is Director of the Division of Neuro-Visual & Vestibular Disorders in the Department of Neurology and Professor of Neurology at the Johns Hopkins University School of Medicine. Dr. Newman-Toker is the Director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence, as well as the president of the Society to Improve Diagnosis in Medicine (SIDM). https://www.hopkinsmedicine.org/armstrong_institute/centers/center_for_diagnostic_excellence/ https://www.improvediagnosis.org/ David Newman-Toker, MD, PhD, Director of the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence.Photo courtesy of Johns Hopkins Medicine Listen to the Podcast: The podcast of this program will be available Monday, September 11, 2023, after broadcast on September 9. You can stream the show from this site and download the podcast for free. If you wish to listen to a previous interview with Dr. Newman-Toker, you will find it here: https://www.peoplespharmacy.com/articles/show-1186-what-happens-when-doctors-make-diagnostic-errors Download the mp3.
Show 1355: Uncovering the Shocking Dangers of Misdiagnosis
Would you be surprised to learn that hypnosis is a powerful tool for healing? If your primary exposure to this practice has been in books and movies, you may have a few misconceptions about how it works and what it can do. Some people imagine that when you are hypnotized, you lose control. Instead, it allows you great control of both your body and your mind. How could hypnosis help your health? The Origins of Hypnosis in Western Medicine: Shamans and other indigenous healers may have used techniques similar to this for healing in many different contexts. Europeans first learned of it from Dr. Franz Mesmer, an 18th century physician and showman who coined the term "animal magnetism." Others would later call it "mesmerism," but it was the first demonstration in medicine of the healing power of hypnosis. Dr. Mesmer may have discovered it somewhat by accident, but he figured out how to put it to use. Hypnosis Could Help Your Health: Our guest, Dr. David Spiegel, is probably the country's leading expert on the medical uses of hypnosis. He relates one of his first experiences as a medical student putting it into practice. A teenage girl was in the hospital with a severe asthma attack, struggling to breathe. He was able to help her relax and slow her breath, which in turn helped her breathe more easily and stop wheezing. There are many other conditions that respond well to this powerful approach. People who are hypnotizable can use this technique to ease anxiety and manage stress. Many individuals use it to help them cope with pain. For still others, it is an important part of a stop-smoking program or a way to overcome insomnia. The Status of Hypnosis as a Medical Tool: This approach has been well studied and found to be effective for many medical problems. However, the medical profession has not fully embraced it. Psychiatrists like Dr. Spiegel are more likely to be familiar with the practice than some other specialists. Are You Hypnotizable? Hypnosis can help your health only if you are hypnotizable. Luckily, most people are, at least to some degree. Hypnotizability does not depend upon an ability to visualize. Nor is it linked to intelligence. Dr. Spiegel and his colleagues have created an app (Reveri) to allow people to test their own hypnotizability and to put their aptitude for this technique into practice improving their health. How Can You Find an Expert? If you have a complicated health problem and would like to try hypnosis to manage it, you may wish to start with personal attention from a health professional. For less complex situations, the app itself may be enough. To find a person who has been trained in using hypnosis to help your health, check with one of the two professional associations that certify such specialists. They are the American Society for Clinical Hypnosis and the Society for Clinical and Experimental Hypnosis. This Week's Guest: Dr. David Spiegel is Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine. Dr. Spiegel has more than 40 years of clinical and research experience studying psycho-oncology, stress and health, pain control, sleep, hypnosis, utilizing neuroimaging and conducting randomized clinical trials. He has published thirteen books, 425 scientific journal articles, and 175 book chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. He is Past-President of the American College of Psychiatrists, the Society for Clinical and Experimental Hypnosis, and is a member of the National Academy of Medicine. Dr. Spiegel is Co-Founder and Chief Scientific Officer of REVERI, an interactive hypnosis App: https://www.reveri.com/ David Spiegel, MD, Stanford University School of Medicine The professional organizations for referral are: American Society of Clinical Hypnosis: ASCH. https://www.asch.net/aws/ASCH/pt/sp/find-member Society for Clinical and Experimental Hypnosis Listen to the Podcast: The podcast of this program will be available Monday, September 4, 2023, after broadcast on September 2. You can stream the show from this site and download the podcast for free. Download the mp3.
Show 1353: Cutting Edge Cardiology from a Top Heart Doctor
When you think of preventing heart disease, what comes to mind? We hope you envision regular exercise and a healthful diet (whatever that means to you). Perhaps you also plan for regular checkups and know what your cholesterol levels are. If they have been high, you may be taking a statin cholesterol-lowering drug to get them down. What else does cutting edge cardiology have to offer? Cutting Edge Cardiology Goes Beyond Statins: Statins such as atorvastatin (Lipitor), rosuvastatin (Crestor) or simvastatin (Zocor) are quite effective at lowering cholesterol. However, not everyone is able to benefit from a statin. Some people find that they cause side effects that may be intolerable. Others need more cholesterol-lowering power than a statin can provide. Our guest today, Dr. Steve Nissen, describes the advantages of a relatively new drug called bempedoic acid (Nexletol). Is Nexletol the Next Thing for Lowering Cholesterol? The FDA approved Nexletol in 2020, and doctors have been wondering how best to use it. Initially, they were encouraged to add a prescription for Nexletol if a patient did not get enough response from a statin alone. Dr. Nissen and his colleagues conducted a world-wide study of nearly 14,000 people at high risk for cardiovascular events like heart attacks (JAMA, July 11, 2023). These were people who found statins challenging, so Nexletol was the only cholesterol-lowering therapy they used during 40 months of the trial. More than 4,000 volunteers didn't have heart disease at the start of the study. For them, Nexletol significantly reduced the chance of cardiovascular complications compared to placebo. According to the researchers, 43 people would need to take Nexletol for that time so that one person could avoid a serious outcome. This is what we call the "Number Needed to Treat," or NNT. Other Drugs Used in Cutting Edge Cardiology: Dr. Nissen's big study demonstrates that bempedoic acid has important health consequences as well as lowering cholesterol. We also asked him about other lipid-lowering medications known as PCSK-9 inhibitors. He reviewed the benefits and risks of alirocumab (Praluent), evolocumab (Repatha) and inclisiran (Leqvio). These long-acting injectable medications work differently from both statins and bempedoic acid to lower cholesterol, especially LDL cholesterol. They are especially helpful for people with familial hyperlipidemia, a genetic condition in which cholesterol soars. As it does, it raises the risk of heart disease. For such people, cardiologists try to get LDL down to 55 mg/dL or so. Have You Had Your Lp(a) Tested? Another genetic factor making its way into cutting edge cardiology is lipoprotein a, also called Lp(a) [ell-pee-little a]. Although doctors have known about this blood particle for decades, they have not given it much attention. Diets that are usually recommended for heart health don't seem to change Lp(a) levels much, and neither does exercise. Cardiologists have not had any prescription medicines to offer, either. They do work hard to help these people lower all their other cardiac risk factors and minimize their chances of a heart attack otherwise. Now that is about to change. Dr. Nissen has been overseeing a clinical trial of a drug, pelacarsen, that may be able to reduce the levels of this sticky substance that can clog arteries and cause blood clots. If the medication makes a real difference, the FDA could well approve it and cardiologists will begin to use it. Patients who could benefit most are those with a strong family history of early heart attacks as well as elevated levels of Lp(a). We will be interested to learn how much the medication is able to reduce rates of heart attack and death compared to placebo. One other topic in our discussion of cutting edge cardiology involves a drug that is more than a hundred years old! Cardiologists do not recommend aspirin for people who have never had a heart attack. But it can be quite helpful for those who do have heart disease. Moreover, aspirin can significantly reduce the risk of cardiovascular problems among people with elevated Lp(a) (Journal of the American College of Cardiology, Oct. 2022). This Week's Guest: Steven Nissen, MD, MACC, is Chief Academic Officer of the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at the Cleveland Clinic. Dr. Nissen holds the Lewis and Patricia Dickey Chair in Cardiovascular Medicine at the Lerner School of Medicine. He is the co-author, with Mark Gillinov, MD, of Heart 411: The only guide to heart health you'll ever need. His website is https://my.clevelandclinic.org/staff/1185-steven-nissen Steven E. Nissen, MD, MACC, of the Cleveland Clinic Listen to the Podcast: The podcast of this program will be available Monday, August 28, 2023, after broadcast on August 26. You can stream the show from this site and download the podcast for free. Download the mp3.
Show 1353: Cutting Edge Cardiology from a Top Heart Doctor
Show 1352: Home Tests, Tech and Tools to Improve Your Health
Only a few decades ago, most households had very limited ways of measuring their members' health. There were thermometers to tell if someone had a fever. A bathroom scale could tell if you were losing or gaining weight. For quite a while, if you wanted to know about your blood sugar or your blood pressure, you had to go to the doctor's office. Now, most people can measure those themselves. Home tests, tech and tools can help you monitor your health. Home Tests, Tech and Tools to Improve Your Health: Today, there are dozens of devices. People can monitor their physical activity with a device they wear on their wrist like a watch. In fact, a device very much like a watch can monitor your heartbeat and alert you if it becomes irregular. Some listeners have learned they had atrial fibrillation through such a device. That allowed them to contact the doctor so it could be addressed. Individuals with diabetes no longer have to stick their fingers with a lancet and feed the spot of blood on a little strip of special paper through a reader. (Some still do that, and even that is far more convenient than having blood sugar measured only at the clinic. It's also much more accurate that the urine tests that people with diabetes had to use back in the 20th century.) Now, blood sugar can be monitored continuously with a device about the size of a half-dollar. You attach it to your body for two weeks at a time, and any time you want to know your blood sugar, you wave your smart phone near it. As a result, you'll be able to see how exercise affects your blood sugar. In addition, you can track which foods send it soaring and whether folding them into an entire meal makes any difference. Blood Pressure Monitors at Home: Of all the home tests, tech and tools you could use, blood pressure monitors might be among the most common. Many doctors encourage their patients to track their blood pressure at home. Others don't, in the belief that this activity can make some individuals with hypertension anxious. (Of course, anxiety can make blood pressure rise as well, putting these folks into a vicious cycle.) Do you have a home blood pressure monitor? How often do you use it, and do you share the readings with your primary care provider? On this live show, you are the star. Call in your story about your favorite home health tech to 919-962-3366 between 7 and 8 am EDT on August 19, 2023. The People's Pharmacy Pediatrician Shares His Home Tech and Tools: We asked pediatrician and frequent guest on The People's Pharmacy Dr. Alan Greene about the home tests, tech and tools he likes. Dr. Greene is enthusiastic about the Oura ring he has been wearing for seven years. It tracks his sleep and physical activity. Moreover, it also monitors "readiness," as a way of assessing cardiovascular health. Its measure of oxygen saturation can alert a wearer to sleep apnea, and changes in heart rate variability are among the first signs of a viral infection such as COVID. The pandemic also introduced a lot of us to the value of an inexpensive home oximeter that fits on the finger to measure oxygen. Home Tests That You May Like: Dr. Greene also discussed the value of home tests. Here again, many people have begun using home tests for COVID-19 as a result of the pandemic. A home strep test is now available and quite helpful for parents. (Other people may also find it useful.) One of Dr. Greene's favorite apps is called TrendWeight, because it gives you the long view instead of focusing on short-term fluctuations. Please feel free to email your stories and questions ahead of time to radio@peoplespharmacy.com. Or call us at 919-962-3366 between 7 and 8 am EDT on 8/19/23. What home tests have you found most helpful? This Week's Guest: Alan Greene, MD, is a pediatrician in private practice, committed to giving extraordinary care to his patients. In 1995, he launched DrGreene.com, cited by the AMA as "the pioneer physician Website." In 2022 he launched DrGreene.ai which provides answers to health questions for over half the world's population in their native language. Dr. Greene is the founder of La Conexión and the founding president of the Society for Participatory Medicine. He is the author of Feeding Baby Green, Raising Baby Green, and From First Kicks to First Steps. He published his first children's book, Flower Moon, in 2023. Alan Greene MD Listen to the Podcast: The podcast of this program will be available Monday, August 21, 2023, after broadcast on August 19. You can stream the show from this site and download the podcast for free. Download the mp3.
Show 1352: Home Tests, Tech and Tools to Improve Your Health
Show 1351: Are You Risking Your Life Trusting Mail Order Medicines?
Have you ever taken a package out of your mailbox on a hot day and noticed that it was warm to the touch? If the pouch contained a tee shirt or a pair of sneakers, you probably didn't think much more of it. But millions of people get their medications by mail, and some medicines are not supposed to get warm. Do life-saving medicines lose potency during shipping? Does It Matter If Medicines Lose Potency During Shipping? Our guest, Loretta Boesing, is a mother with a young son who needed a liver transplant to save his life when he was two years old. Immediately, he required injections of medication twice daily to keep his body from rejecting the transplanted liver. Loretta has been very conscientious about this. But when her insurance required her to get the medicine by mail order, it arrived on a hot day (102 F) and was warm or possibly hot to the touch. Within two weeks, her son was suffering the effects of rejection because the medicine was no longer doing its job. In the hospital, the same compound was able to reverse the setback, because the hospital's injection had not been subjected to intense heat. Problems with Mail Order Pharmacy: Like many Americans, Loretta was pressured to get her son's medicine through the mail. Unlike most, she was sufficiently motivated to fight that pressure. After all, her son's life depends on the medication, and she had discovered the possibility that mail order medicines lose potency when they get too warm. (Extreme cold can also compromise medication effectiveness, but we are more likely to think of that in the winter months rather than in the summer.) Loretta found that she had to enlist the media so that her insurance would allow her to pick the medicine up at the pharmacy. What Loretta Learned: Millions of people may be taking medications that have not been held within the temperature range that the FDA specifies. It is very difficult for a patient to determine whether these medicines lose potency in transit. However, pharmacy students in Oklahoma conducted a study in collaboration with Loretta's group. They mailed out packages to 100 members of the group. Each one contained a data logger and temperature sensor that would tell them if the inside of the package had exceeded the limits for a common medication. Sadly, 80% of the packages did. This trial suggests that ordinary shipping methods may be inappropriate for delicate drugs such as, for example, monoclonal antibodies. Mail order pharmacies could include these inexpensive temperature monitors in their packages, and some may. We once ordered probiotics for a pet. The supplier shipped them in an insulated container with a temperature strip. (We were relieved to see the probiotics had not gotten too warm.) Such devices register when a temperature has exceeded a specified maximum. Manufacturers often include them in shipments of vaccines or frozen foods. But too often, medicines are not treated with the same care you might use in shipping chocolates in hot weather. (That's despite the fact the outcome for your health is far more serious!) Loretta was appalled to learn that often wholesalers ship to pharmacies in the same vehicles used for general package delivery. Try Independent Pharmacies: One tip for other patients: Loretta found that many independent pharmacies will deliver prescriptions in temperature-controlled vehicles (possibly a private car with air conditioning). This is an option worth exploring even if it costs a bit more. We have heard from a very organized reader who logged the temperatures in his Arizona mailbox for more than a month. That experiment convinced him to switch from mail order delivery of his medications to picking them up at the pharmacy and taking them straight home. Like Loretta, he found "Neither the drug companies nor the FDA seemed to provide helpful information when I asked them about this problem." Who Is in Charge? Loretta contacted the FDA, thinking that the organization that sets temperature guidelines would be involved in enforcing them. The Food and Drug Administration told her it is not responsible. The mail order pharmacies say they can't control the shipping companies. Of course, the shipping companies say it's not their problem if customers choose their services for shipping. Ultimately, she contacted the National Association of Boards of Pharmacy, but got very little traction there, either. As a result, she has been addressing individual state Boards of Pharmacy. The Oklahoma Board of Pharmacy has recently issued new regulations that should make medicines shipped in that state safer for patient. She and her organization are approaching Boards of Pharmacy in other states to educate them that life-saving drugs lose potency when exposed to extreme conditions en route. Perhaps if consumers apply enough pressure, the professional organizations will respond. Loretta suggests that some pharmacists suffer moral injury because they are dispensing drugs that they know may not be as effective as they ought to be. The patients receiving those drugs may suffer even more when life-saving medications begin to fail. This Week's Guest: Loretta Boesing founded Unite for Safe Medications after a series of events led to Loretta's son being unable to access his medications safely. She is an expert on the unregulated temperature extremes in mail order pharmacy. www.uniteforsafemeds.com The phone number for Unite for Safe Medications is 877-474-9777 Loretta Boesing, founder of Unite for Safe Medications Listen to the Podcast: The podcast of this program will be available Monday, August 14, 2023, after broadcast on August 12. You can stream the show from this site and download the podcast for free. Download the mp3.
Show 1351: Are You Risking Your Life Trusting Mail Order Medicines?
Show 1350: Why Psychotherapy Matters: Lessons from a Harvard Zen Master and Psychiatrist
If you tell your healthcare provider that you're feeling anxious or depressed, chances are they will prescribe you a medication. Millions of people take anti-anxiety pills or antidepressants, and many find that the medicine makes life more bearable. But can you understand what makes your life meaningful? For that, you might need to tell your story to a compassionate listener who can reflect it back to you and help you make sense of it. That's why psychotherapy matters. Talking with Dr. Robert Waldinger About Why Psychotherapy Matters: A few months ago, we spoke with Dr. Robert Waldinger about his book, The Good Life. In it he described a long-running study about the factors that contribute to happiness and a meaningful life. For more than eight decades, Harvard researchers have studied two groups of people as they proceed through life: Harvard undergraduates and kids from struggling families in the Boston area. The scientists wanted to learn what helps people thrive, and they found that relationships are key. We were so intrigued by Dr. Waldinger's background as a Zen master, meditation expert and psychiatrist that we wanted to know more about how the study affected him and how he uses psychodynamic therapy in his practice. In this conversation, we discuss why psychotherapy matters. Psychotherapy Matters, and So Do Medications: In treating people with mental illness, psychiatrists often use some psychoactive medicines, including antipsychotics like Zyprexa or Geodon as well as antidepressants like Paxil or anti-anxiety drugs like Xanax. Insurance companies rarely balk at covering these medications. However, insurance doesn't always cover talk therapy. Why don't they embrace it as enthusiastically as pharmacotherapy? It may take concerted lobbying to get them to acknowledge that psychotherapy matters too. How does psychodynamic therapy, which is what Dr. Waldinger practices, differ from classic psychoanalysis? We find out how he prepares psychiatry residents for this kind of healing. Talk therapy can be used as part of the treatment for serious mental illness as well as to help people with less acute suffering gain some perspective on their situations. We also discuss why the unconscious mind is so powerful. It is what seems to drive us to make similar mistakes in relationships over and over again. When we start to understand what we are doing, we can adopt a different approach that may be more successful. We were intrigued to learn how Dr. Waldinger's experience with Zen has shaped his approach to psychotherapy. Finding a Listener: Telling your story is crucial, and so is a compassionate listener. Dr. Waldinger suggests that finding a person who "gets" you is more important than that the therapist have a certain type of credential. In some cases, clergy may be able to fill this role. A nurse practitioner or a social worker may also be skilled in listening and helping a person reframe their own story. Compassion and understanding are why psychotherapy matters. This Week's Guest: Robert Waldinger, MD is a professor of psychiatry at Harvard Medical School, director of the Harvard Study of Adult Development at Massachusetts General Hospital, and cofounder of the Lifespan Research Foundation. Along with being a practicing psychiatrist and psychoanalyst, Dr. Waldinger is also a Zen master (Roshi) and teaches meditation in New England and around the world. Dr. Waldinger, with co-author Marc Schulz, PhD, is the author of The Good Life: Lessons From the World's Longest Scientific Study on Happiness. Robert Waldinger, MD, author of The Good Life Listen to the Podcast: The podcast of this program will be available Monday, August 7, 2023, after broadcast on August 5. You can stream the show from this site and download the podcast for free. Download the mp3.
Show 1350: Why Psychotherapy Matters: Lessons from a Harvard Zen Master and Psychiatrist
