Full Scope: Recent Episodes

Bill Brandenburg, MD

A bi-weekly medical podcast designed to educate medical professionals and learners. As the name implies, any topic is fair game. However, the focus will be on keeping people safe and healthy in any environment. As such, disciplines like occupational, environmental, travel, wilderness, and aerospace medicine will be emphasized. This is an academic podcast coming to you from rural America and urban private practice. This podcast is intended to deliver high value medical knowledge at no cost to listeners.

Carotid Artery Ultrasound and Longevity

The opposite of longevity is death. If longevity is what we seek we must obsess about death, and those things that increase the risk of us dying.

1 Killer – Cardiovascular Disease

Cardiovascular disease is the biggest killer on the block claiming the lives of 1 in every 3 people worldwide. Almost 1 million people a year die from cardiovascular disease in the United States alone, often due to events like heart attacks and strokes. The main cause of cardiovascular disease is atherosclerosis.

Atherosclerosis

Thickening and hardening of the artery walls caused by the deposition of plaque (made of cholesterol, fats, other materials) into the blood vessel walls. Plaques can slowly grow causing occlusion of a blood vessel (stenosis). Plaques can also rupture, leading to blood clots (ischemic heart attacks, strokes, and other infarctions). Plaques can also break away from the walls, forming emboli (also causing ischemic heart attacks, strokes, and other infarctions).

Infarction: Obstruction of blood supply to an organ or region of tissue (usually from a blood clot or embolis)

Thickening of blood vessel walls, plaques, and restriction of blood flow can all be visualized using Carotid ultrasound. In the body, if blood vessel disease (e.g. atherosclerosis) is seen at one area, it is likely present in other areas as well. As such:

Carotid Ultrasound is a very important Longevity Metric.

For the complete blog post check out fullscope.org/blog or longetrics.org/blog

Visual Accuity and Longevity

Happy Halloween everybody! Hope everybody is dressing up, My kids are being Spiderman, Boba Fett, and a black cat. I am going out as Darth Vader. If you are new to parenting, you are probably also realizing that candy is an alcohol equivalent for children and they literally become “drunk” after several pieces of concentrated sugar. Sorry Mormon church…..concentrated sugar is a drug.

But enough about candy!

Today on Full Scope, we are going to talk about a very important Longevity Metric – Visual Accuity, or how clearly a person can see things.

For longevity metrics, we are going to look through 3 lenses

Common-Sense: Does it make sense that a given metric would impact longevity
Clinical: Do I see evidence that a given metric impacts longevity in my clinical practice
Research: Do research studies demonstrate that a metric impacts longevity.

So HERE WE GO

Check out fullscope.org/blog or longetrics.org/blog for the complete post.

To see how visual acuity is measured at Longetrics, check out our youtube channel Longevity Metrics @BillBrandenburgMD.

Health and longevity are measurable, quantifiable, and malleable. The first step toward health optimization is awareness. Awareness starts with measuring. Because:

“What gets measured gets managed”

Said by many, made famous by Peter Drucker (known for modern management theory)
This idea is why I moved from primary care to longevity medicine. More about this at the end.

Welcome to Season 6 of Full Scope! This season is all about how to measure health and longevity. We are going to go over:

All of the tests utilized at Longetrics to measure health and longevity in Your Longevity Report Card
Videos of how to perform each test (https://www.youtube.com/@BillBrandenburgMD)
A podcast and a blog about what each of these tests (the longevity metrics) means regarding a person’s health and longevity (+ some tips about how to improve them).

Saddle Up!

Visit Longetrics.org/blog or fullscope.org/blog for the complete post

Your Longevity Report Card

Today on Full Scope, I want to talk to you about Longetrics comprehensive, longevity focused, health screening, Your Longevity Report Card.

Full disclosure, this service is how I make a living. As such, all of the recommendations and ideas in this podcast contain an inherent conflict of interest.

But, please understand, I have spent over 1-million dollars, tens of thousands of hours, and shouldered great risk to build this. Hopefully this podcast will be useful for:

Patients considering Your Longevity Report Card or another comprehensive health screening.
Medical providers building health screenings for their own practice
Anyone thinking about how to optimize there health and wondering what strategies and diagnostics to think about.

Why Did I Build Your Longevity Report Card?

For the complete Blog post, visit Longetrics.org/blog or FullScope.org/blog

There is a buzz about longevity. Many people feel that we are on the brink of a lifespan revolution. There is talk of making living to 100 the new norm. But the reality is just the opposite.

So, I thought I should.

The truth:

Life expectancy is actually declining. Since its peak in 2014, the average lifespan in the United State has declined about 0.5 years. This may not sound like much. But considering the trend has been consistent and represents the average of a population of over 300 million people, it’s a hug deal.

My big fear…..This is just the beginning and that this trend will continue.

Why? Because even though we have more and better medical technology than ever, our environment is increasingly unhealthy. The world has become obesogenic, diabetogenic, and addicted. This is crippling our ability to live long and live well.

Figure 1: Life Expectancy from Birth (2003 – 2023)

Visit Longetrics.org/blog or fullscope.org/blog for the complete post!

The hype around longevity is huge in 2025. Money is pouring into the space. Longevity Start-ups are launching. Big claims are everywhere. But is all the hype justified?

What can longevity medicine actually deliver now?

Let's start with some quotes: Listen carefully. These come from leaders in the Longevity space. Do these quotes/claims sound true? Do you believe they are possible?

Dave Asprey: “Im going to live to atleast 180 years”

Mark Hyman: “Im 63 years old, but my biological age is 43”

David Sinclair: “Why we age, and why we don’t have to”

Fountain Life: “Live 100 healthy years”

My Responses to these Claims

Check out FullScope.org/blog or Longetrics.org/blog for the complete post!

Thanks for listening!

Bill Brandenburg, MD

Longevity Philosophy

5 Big Ideas That Will Deliver More Years NOW

The longevity space is filled with empty claims! For example:

This supplement will extend your life (C15, spermidine, D3, fish oil, etc.)

Truth:

No supplement has ever been shown to extend human life in all comers (outside of a nutrient deficiency). If your Longevity provider has you on a supplement subscription for life extension…..you are being played.

This drug, peptide, hormone will extend life

Truth:

No drug, peptide, or hormone has ever been shown to extend lifespan in all comers in a human clinical research trial (outside of a specific clinical indication. E.g. hypertension [referred to as a mortality benefit]). Some commonly used “longevity treatments” like growth hormone, may even shorten life.

AI will revolutionize longevity and we are close to longevity escape velocity.

Truth:

AI is revolutionizing data accumulation, handling, and analysis. However AI is yet to extend lifespan in humans at all. Until AI leads to any measurable life extension, this claim remains unproven. Until we can measurably slow aging (beyond proven lifestyle interventions), longevity escape velocity will remain in the realm of science fiction.

Visit Fullscope.org or longetrics.org for the complete blog post.

Today we are going over the basics of DEXA. This will help patients understand the test and what is being measured. It will also help clinical providers understand this test better. Let's dive in!

The Basics

DEXA stands for Dual Energy X-Ray Absorptiometry

Xray machine used for analyzing body composition
Great at telling the difference between bone, fat, and lean tissue (mostly muscle)
Uses 2 xray beams of different energies for this, hence Dual (via subtracting attenuation coefficients….or something like that)
Most studied and widely used tool for looking at bone density
USPSTF recommends all women over age 65 get one
But 65 is way to late to get your first DEXA. The Cliff of old age is already luming at that point.
I recommend getting one in your 20s or 30s to get a baseline and to help plan for the future. This will give you decades to improve things like bone density or get more muscled.

Check out FullScope.org or Longetrics.org for the complete blog posts.

Muscle is your bodies bank account. It is the currency of life. It is biological gold.

Quote: “I lift weights, and I lift weights for 1 reason, to be strong” – Arnold Schwarzenegger

Deadlifts

Deadlift: Lifting a weight from the floor to hip level. We use this movement anytime we pick something up off the ground.

Everyone should know this movement. Everyone should be able to deadlift their body weight, full stop (ideally much more)

Max weight ever Deadlifted:

Visit longetrics.org/blog or fullscope.org/blog for the complete blog post.

Quote: “In movement, there is life” – Aristotle

“Genius starts with the abs Max” – The Grinch

Muscle is your bodies bank account. It is the currency of life. It is biological gold.

Why Do People Need Nursing Homes?

As a hospitalist I frequently have to place people in nursing homes

. I estimate that the reason why >90% cannot live at home anymore…….NOT ENOUGH STRENGTH. Think: needs help standing, needs help walking, unable to go up steps, unable to lift a dinner plate, etc. Additionally, I have noticed that as soon as muscle goes, cognition follows. Want to maintain your independence as you age? Start by maintaining your physic (aka – muscle)

Most people are concerned about having enough money for retirement. But, what people should be concerned about is having enough muscle. No-one can give this to you. It must be earned over years and decades.

You cant just talk about it, you have to do it. – Arnold Schwarzenegger

Strength peaks in our late 20s and early 30s. After this it declines by about 1-2% per year in most people. This decline is accelerated in the last 1 or 2 decades of life as we literally wither away.

Functions of Skeletal Muscle

Movement
Posture, Stability, and Joint Health
Metabolic Health
Neurological and Brain Health
Store of Nutrients and Protein
Heat Production
Circulation (particularly venous)
Protection and Padding
Communication (facial expressions, posture, gesturing, etc.)
Attraction and Reproduction

Did you know:

**The best way to prevent dementia is physical exercise.

See https://www.longetrics.org/blog for the complete blog post**

Quote: “The greatest wealth is health”

Virgil, Roman poet < 2000 years ago

Higher VO2 Max = Much Lower Risk of Dying…….Get off your ass! Let's illustrate this point:

ICU Patient

68 year old man with diabetes type 2 presenting with weakness and shortness of breath found to have sepsis due to pneumonia. This man is critically ill with sepsis.

His vitals:

Heart Rate 150 (100% of estimated max heart rate: 220 – Age)

Respiratory Rate 54 breaths per minutes

Sweating and looks exhausted.

This man is literally fighting for his life. Can you see why fitness matters so much? How long can he hold on? Many of us will have to fight for our lives in this way at some point. FITNESS REALLY REALLY MATTERS

The Gold Standard for measuring cardiorespiratory fitness = VO2 Max

What is VO2 Max

VO2 Max = the maximum volume of oxygen that can be utilized per kilogram of body weight during maximal exertion

Most often Expressed as:

ml/kg/min (milliliters per kilogram of body weight per minute) [1ml = 1cm3]

This is the gold standard for measuring cardiorespiratory fitness in medicine, exercise science, and research.

Humans range from of VO2 max of 5 (bedbound) to 90s (elite endurance athletes)

Hummingbirds VO2 max = 600 ml/kg/min

Exercise training will improve VO2 Max

So, I hope since listening to part 1 you have gotten “off your ass”

Check out Longetrics.org or Fullscope.org for the complete post!

Title: VO2 Max, Part 1

This is just the 101 course:

Quote: “If you don’t make time for exercise, you will probably have to make time for illness”

Robin Sharma, Attorney, Writer, Consultant

What is VO2 Max

Perhaps the most important metric for longevity and health in 2024

V=Volume (actually volume per unit time in this case)

O2= oxygen

VO2 = volume of oxygen that can be utilized per unit time

VO2 Max = the maximum volume of oxygen that can be utilized during maximal exertion

Most often Expressed as:

ml/kg/min (milliliters per kilogram of body weight per minute)

This is the gold standard for measuring cardiorespiratory fitness in medicine, exercise science, and research. The best way to measure VO2 max is with a cardiopulmonary exercise test (CPET test). This is performed by hooking a person up to a closed breathing circuit via a facemask and measuring both inhaled and exhaled O2 and CO2. Other methods for estimating VO2 Max also exist. We will discuss measuring VO2 Max more thoroughly in part 2.

**VO2 Max Record Holders

Check out Longetrics.org or FullScope.org Blogs for the complete post**

Title: Health Report Cards

Quote:

“what gets measured gets managed”

unknown source

When you measure something you become aware of it and can objectively manage it.

Potential Pitfalls: The right things must be measured. Measurement must be accurate.

What is a Report Card:

an evaluation of performance

Benefits of Report Cards:

attempts to measure strength and weaknesses
allows for awareness of weaknesses (so they can be targeted and improved)
provides objective measures of performance normalized to the rest of the group (lets one know exactly how they measure up)
allows outsiders to evaluate and make decisions

Negatives of Report Cards

can hurt feelings (who fucking cares, life is tough, competitive, and requires constant improvement)
can leed to discrimination (of course….people, companies, and things with bad reports should be discriminated against). Discrimination = pressure to improve
the wrong things are often measured or given too much importance. If not, you will manage things that don’t matter. Importance of asking the right questions.
the things measured may be wrong or inaccurate. This is a big deal! Measuring things inaccurately is probably worse than not measuring things at all
subject to the bias of those creating report cards. We all remember that teacher that just didn’t seem to like us…..

See the full post on the Longetrics.org blog

Title: Longevity Conferences (ARDD and Dublin Longevity)

Quote: “Its not what you know but who you know”

Said by many across multiple cultures

Today we review:

The Aging Research and Drug Discovery Conference in Copenhagen, Denmark

The Dublin Longevity Summit in Dublin, Ireland

3 Plugs

keep moving until you find your place and your people
go to places where you can be useful and contribute
try not to lose what makes you, you along the way.

Hallmarks of Both Conferences

I highly recommend attending both of these events (and conferences in general)
Europe was a blast. People are out and about. The downtowns I went to were generally flourishing
Work Hard Play Hard – Lots of lectures, lots of late nights at the bar
All Day Every Day
Leaders in the field of Longevity Research (highly research focussed)
Research Focused, Less Clinical (but still some clinical content)
Startups and Funding/Funders was a big focus
Eccentric Personalities
Lots of Fun! Met a lot of great people

See full blog post at fullscope.org and longetrics.org

Quote: “The best physician is also a philosopher” – Galen (Claudius Galenus)

Reflection is key! What can I do better and why am I doing it in the first place? Harness failures as the great teachers that they are and constantly improve.

Why this person is important:

Roman and Greek Physician, Surgeon, and Philosopher (129-216 AD, 87 years). Used anatomy based care (from observing the corpses of dead gladiators) and this allowed him to outperform his piers.

Bags the Question: What are we not using right now in medical practice that will be obvious to future doctors that we should be using?

I think about bedside ultrasound in this light

-I also think about capturing more exam data through photos, sound clips, and videos and then harnessing new technology and big data insights to learn things not previously known

photos, sound clips, and videos have so much more data than a written physical exam in a note.

Philosophy Take: Asking the right questions is the key

In a changing world, answers, like epidemiology, are always changing. So in some ways all we will ever have are questions.

The Longevity Physician

We are going to talk about medical providers and physicians in this discussion. But the ideas may be useful for multiple other disciplines within healthcare. Everything from coaches, to personal trainers, physical therapists, pharmacists, etc. There is plenty of room for everyone in longevity and it will take a village to solve aging.

See Fullscope.org for the complete post

Quote: “Death gives meaning to our lives. It gives importance and value to time. Time would become meaningless if there were too much of it”

Ray Kurzweil

Too much time…..

Why this person is important:

Computer scientist, inventor, and futurist (one of the greatest of the modern era)

What is Longevity

Dictionary – long existence or service
Medicine and Science – long duration of individual life

What is Geroscience:

Gero (Greek - old)
A field of biomedical research that focusses on understanding the biology of aging and how aging contributes to disease
Geroscience, geroscientist, geroprotective, gerontocracy, gerontophobia

Why Longevity

Longer Life? People want to live longer and better? More time young. Not more time old.
live forever? Scares many. Plasticity of youth would be so important in this case
look good and do the things we love for longer? Yes!

I believe: Longevity and understanding/controlling aging are key to human advancement and long-term success.

See FullScope.org blog for complete post

Live Better, Longer
A Longevity Physicians Secrets to Health and Fulfillment
Available for free at: wondermedicine.com

See full written episode description on our blog available at:
https://www.wondermedicine.com/wonder-medicine-blog

4 Amazing Ways Ketamine Will Change Your Brain

Ketamine is an amazing medication. It is an anesthetic, painkiller, mental health treatment, and entheogen all wrapped into one. We have successfully treated hundreds of patients with depression, anxiety, PTSD, OCD, suicidal ideation, and addiction using ketamine at Wonder Medicine. Greater than 90% of the people we treat get better. But, having the right plan for therapy will greatly increase your odds of success.

What is an Entheogen?

An entheogen is a mind-altering substance that helps people develop spiritually. Ketamine causes a profoundly mind-altering experience that expands consciousness, understanding, and connectivity when used with intention in the right therapeutic setting.

Why do some Patients Not Respond to Ketamine?

Some people do not respond to ketamine treatments. Most often there is an identifiable reason. Some of these reasons include:

Abusing substances actively while undergoing therapy (e.g. going home and drinking a bottle or two of wine after therapy)
Not enough treatments received (major illness requires more therapy, sometimes > 6 treatments for response)
Trauma or Mindset roadblocks that prevent patients from continuing therapy.
Some people just don’t respond. This may be due to their underlying biology (estimated < 2%)

Why do > 90% of Ketamine Patients Experience Benefit

Ketamine does 4 amazing things that help people get their lives back on track.

Executive Summary

The Longevity and Performance Program at Wonder Medicine is a physician directed-proactive healthcare program for high performing individuals. Its principle aims are health optimization, disease prediction and prevention, exceptional performance, emotional wellness, and longevity.

The program is anchored by a full day executive physical that we refer to as a program members “Biological Birthday”. On this day, program members subjective and objective biomarkers most strongly linked to health, performance, and longevity are collected and fed into a robust data structure. A report is then generated that predicts biological (functional) age and predicted death age. The report utilizes proprietary algorithms and technology to inform both patients and their care team regarding overall health status and disease risks. The Biological birthday is performed every year and information is tracked in real time so that any health issues can be identified at the earliest stage possible.

A multidisciplinary team including a physician, longevity coach, exercise physiologist, technician, registered nurse, and member concierge execute the program. This small team is in constant communication and reviews all patients as a group multiple times a year. Patients in the program will have encounters with each team member at least 3 to 5 times a year. These team members will know you and care deeply about your success.

Every year, program members have a 90-minute Longevity Visit with the physician. At this visit all data obtained is reviewed and a personalized longevity and performance plan is provided to be executed over the following calendar year.

Wonder Medicine is a research-based institution that runs clinical trials on all patients at all times with the goal of discovering those inputs that deliver exceptional longevity and performance. All program members have the opportunity to enroll in additional longevity focused clinical trials that include pharmaceuticals, nutraceuticals, regenerative therapeutics, and lifestyle protocols. Additionally, many chronic medications can be managed through the program. But optimizing mindset, behaviors, and environment to align with program member current and future goals is Wonder Medicine’s principle aim.

Being enrolled in the program affords members several additional benefits and add on services. These include movement therapy, behavioral change therapy, additional testing, and discounts on all Wonder Medicine services including IV infusions, ketamine therapy, and aesthetic services.

If exceptional health, longevity, disease prevention, emotional wellness, and high performance are desired, this is the program for you. If data, research, and the advancement of knowledge in longevity are important to you, this is your Center. The Program is capped at 360 members every year so that outstanding attention, communication, and collaboration can be provided to all members. Wonder Medicine is healthcare that performs at the same level you do. Join today and become exceptional!

Thanks,

Bill Brandenburg, MD

Holiday Season

October 31 – January 2nd

Halloween to New Years

Tough time of year
Loved ones, memories of past loved ones, relationships gone bad, events, obligations, good memories, bad memories, and even trauma.
Can be the best time of the year or a time of pain.
Take care of yourself, set an example for loved ones, and double down on pro-longevity behaviors during this holiday season.

Remember

Longevity = Health over a lifetime

By striving for longevity you must become the best, most-high performing version of yourself right now.

Ok so 4 tips. Plus two very important bonus tips at the very end that you will not want to miss!

See Wonder Medicine Blog for complete post at: https://www.wondermedicine.com/wonder-medicine-blog

Benjamin Franklin: “Search others for their virtues, thy self for thy vices”

Poor Richards Almanac

The best way to maximize longevity in 2023 is not a drug, supplement, or other high tech therapeutic; its Lifestyle medicine.

Wonder Medicine specializes in the translation of longevity technologies into clinical practice. This includes things like rapamycin, exosomes, and metformin. But we would be misguiding you if we did not focus, first and foremost, on lifestyle.

What is Lifestyle Medicine?

Per the American College of Preventative Medicine: Lifestyle medicine is a medical approach that uses evidence-based behavioral interventions to prevent, treat and manage chronic disease.

I would take this a step further even. For me, Lifestyle includes:

Thoughts

2. Behaviors

Environment
The People Around Us

With environment being particularly relevant and underappreciated in most medical settings. These 4 things drive both health and un-health. By optimizing these four things, a person can greatly extend both lifespan and health span.

Focusing on behaviors alone, will not be enough. This may be why conventional medicine downplays lifestyle changes. If you only address behaviors, changes don’t happen, and as such, the strategy fails.

But this is a shame because lifestyle changes are the only definitively proven way to extend the length of human life in 2023. From epidemiological studies, it appears that people who live a healthy lifestyle can add approximately twelve years to their life (range: 5-15 years).

Death at 88 instead of 76 years, most often accompanied by contraction of morbidity.

For the full post check out the Wonder Medicine Blog Available at: https://www.wondermedicine.com/wonder-medicine-blog

Dia de Los Muertos and Longevity

The day of the Dead. What can the dead and this Mexican cultural holiday teach us about longevity?

Is there more to the story than candy, spooky witches, monsters, tricks, and treats. Let's find out

What is day of the Dead?

A holiday most often celebrated on Nov 1st or 2nd.
Its strongest traditions and ties are to the Mexican culture.
On Dia de los Muertos, people remember and honor their past loved ones.
Representations of human skulls, marigold flowers, home alters with pictures of passed loved ones, pan de Muertos (the sharing of alimentacion or “nourishment”), are the hallmarks of this day.
The roots are debated, but this tradition may date back to Aztecs society.
Dia de los Muertos brings families and communities together, celebrates life, and death.
I encourage you to Celebrate this magical holiday, Dia de los Muertos, along with all the fun and spookiness of Halloween, and depending on your beliefs, along with Christian traditions of All hallows eve (all Saints Day and All souls day – that actually has a similar message that just isn’t really practiced in my experience)

See complete blog post at: https://www.wondermedicine.com/wonder-medicine-blog

The 6 BIG Benefits of Longevity

Be a victim or conquer longevity. You must choose!

Longevity

Longevity Definition: Long existence or service
Human longevity relates to both existence (remaining alive) and service (remaining useful).
I strive for nothing less than long existence and long service for both my patients and myself

My favorite part of Avatar II, Way of the Water:

“Teach them our ways so they don’t have to deal with the shame of being useless”
It blows my mind how many people are ok with being useless to society in 2023

My hospitalized elderly patient: “Keep me alive doc”

Me: “what makes you want to keep living”

Patient: “I have grandkids”

But these people cannot watch their grandkids because their health is too poor. In fact, they need assistance even to perform activities of daily living (ADL)
Like avatars of the sea, I would find this inability to contribute meaningfully: shameful.
Being useful is about more than just pride. It is about service to the community.
Service is what life is all about. If you are unhappy with your life, I suspect this is huge part of the problem.

Longevity is the Key

By striving for longevity you are forced to become the best version of yourself right now.
The best version of you, right now, will be able to live, thrive, and serve the longest.
As such longevity, or as we call here, the Full Scope, is your best vehicle for health, extreme productivity, and service both now and in the future

See Wonder Medicine blog for complete show notes.

Live to 100: Secrets of the Blue Zones

2023 Netflix documentary, 4 episodes
Based on the 2008 book: “The Blue Zones: Lessons for Living Longer from People Who’ve Lived the Longest.”
By Dan Buettner, Journalist, National Geographic Explorer, New York Times Best Seller

What is a Blue Zone

Geographic location where people’s life expectancies are much much higher than in other parts of the world
A much higher percent of people live to 100 years of age than other areas. 4x more people than in the USA.

Original 5 Blue Zones

Started with Gianni Pes and Michael Poulain's 2004 paper: Identification of a geographic area characterized by extreme longevity in the Sardinia Island.
Dan Buettner read this and then established 4 more Blue Zones with the help of epidemiologists (bluezones.com)
SARDINA, ITALY
OKINAWA, JAPAN
NICOYA, COSTA RICA
ICARIA, GREECE
LOMA LINDA, CALIFORNIA, USA

4x more likely to live to 100 than in the US. Life expectancies > 85 years, apposed to 76 years in the US.

Dan Buettner’s Theory on Why People in Blue Zones Live Longer

CONNECT (INVEST IN RELATIONSHIPS MORE. KEEP FAMILY AROUND MORE, FRIENDS)
OULOOK (DAILY RITUALS, FAITH, SHOW UP, PURPOSE VOCABULARY)
MOVE NATURALLY, (GARDEN, WORK, WALK everywhere, sit on the floor),
EAT WISELY (WHOLE FOODS, HEAVY PRODUCE, WINE, MODERATION)

According to the US CIA, Singapore has the second highest life expectancy at birth in the world at 86.5 years (second to Monaco, 89.6 year average life expectancy, < 1 sq mile in the French Riviera, < 40k residents, tax haven, wealthiest location in the world, high performers flock to Monaco)

SINGAPORE

Island in SE Asia. 2nd highest population density of any country in the world, globalized, one of four main languages is English. 283 square miles. 5.5 million residents.
80% of people own CARS in the US. 11% of people own CARS in SINGAPORE, PUBLIC TRANSIT USED BY HALF THE POPULATION EVERY DAY. Build in natural scapes in cities, good city planning with lots of walkways, < 10% obesity, Low healthcare costs (in spite of living longer)
KEEP OLDER FAMILY MEMBERS OUT OF CARE HOMES - (NEEDS TO BE EARNED, HARDER IN THE USA per below)

Singapore Physician Philosophy and how to live a long time.

Why do you like being a doctor?

1) TREAT A PATIENT, FEEL JOY (enjoy the process)

What advice would you give someone who wants to live a long time?

2) WORK HARD EVERYDAY, BE HONEST, HUMBLE (get to work)

Work hard and enjoy the process. No wonder the people in Singapore are living longer…..their doctors are giving much better advice and generally enjoying their job as a physician.

We all have weaknesses.

These weaknesses will eventually limit your life and longevity tremendously.

Train these weaknesses out and become the best version of yourself.

See full notes at:
https://www.wondermedicine.com/wonder-medicine-blog

Blog post about this podcast available at: https://www.wondermedicine.com/wonder-medicine-blog

Three Things to improve your longevity today.

Exercise
Stop pretending to care about longevity or health if you are not exercising
Bodies in motion stay in motion, bodies that stop, soon stop forever
Plus the best way to keep your brain health and prevent dementia is to exercise regularly.
Build your bank account of muscle and movement reserve
Your job is not exercise. Walking is not enough unless your are elderly. But even then you should be strength training as well
Dynamic movements through big ranges of motion always better. Don’t limit yourself
Be results driven. Measure strength, VO2 max, and other objective metrics.
Avoid injury by starting slow and progressing slow, injuries are killers as we get older.
Learn how to fall
Focus on Eccentric strength as well as concentric, stop dropping the weights.
You will only be is strong as your weakest component and this will be your Achilles heal when you age, so stop ignoring it and fix it. Stop skipping leg day
If you would talk to our exercise physiologist, Callie, ditch the chair
Sleep
Give yourself 8 protected every night. Don’t stress if you cant sleep the whole 8 hours
Living a healthy lifestyle will improve sleep. Do more during the day. Think and move more, vigorous exercise and light exposure early in the day can really help
Give your kids more time, particularly in the morning
Avoid z drugs, benzos, alcohol
Cannabis, makes you wake up more groggy, less REM sleep, people often require more sleep to feel the same amount rested
Perseverance with positivity
I have asked every person above 90 I have taken care of their secret to longevity. I am over 300 people at this point. 90+ percent of the time they either say “keep moving” or “stay positive.
Toughen up, life is hard
Work, retirement is a killer, work gives people meaning and keeps the brain active.
Force yourself to do hard things that are uncomfortable, cold plunge.
Lean into all your weakness always
Don’t give up.

Overview

new 10-to-20-minute podcast every Monday
the science, philosophies, and actional information around health, longevity, and performance
meant to help listeners become the highest performing individual possible
Increase your lifespan, healthspan, and view your life through the full scope

See a blog about this episode at: https://www.wondermedicine.com/wonder-medicine-blog

Disclaimer

Free content, no adds, no junk, just the facts
This podcast does not create a provider patient relationship between the listener and the full scope team.
This podcast is not intended to treat, diagnose, or cure your personal medical problem.
If you want professional medical advice, check out Wonder Medicines Longevity and Performance Program

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Death is coming for you, me, and all of this.

If you seek Longevity, stop avoiding this, assess your risks, and make a plan.

Blog post about this podcast available at: https://www.wondermedicine.com/wonder-medicine-blog

How to assess death

What are my current medical problems, risks, and exposures. Advanced diagnostics and biomarkers can help with this. But just asking some simple questions like:
a. What medical problems do I have?
b. How is my current level of fitness and where will it likely be in the final 1 to 2 decades of my life on my current trajectory.
c. What do my behaviors put me at risk of dying from (e.g. smoking tobacco or junk food addiction = multiple forms of cancer.
d. What environmental risks am I exposed to (e.g. polluted air = COPD and lung cancer)
How have genetically related family members have died. These people share your genetics and often times your environment. They are a window into your own mortality.
a. What things have killed my 1st and 2nd degree relatives?
b. At what age did these problems begin and at what age did they result in death.
c. Do I have a genetic predisposition to certain medical problems?
What things am I most worried about regarding death. People have strong intuitions that when trained can be incredibly accurate. Intuition is simply your brain analyzing a huge amount of data and coming to a conclusion that seems as if it came from a higher knowledge or being. The brain is a powerful supercomputer. If program members are worried about something, I am worried too, full stop. Granted, if someone is worried about everything due to severe anxiety they are essentially worried about nothing. If you goal is everything, it will in fact become nothing by default.

Summary

Phosphocreatine is a molecule that can recharge ADP into ATP. This provides energy to skeletal muscle and the brain. Dietary and supplemental creatine can raise the bodies stores of phosphocreatine, providing additional energy. In this podcast, we discuss creatine, what is is, how it works, why it is useful, and how to supplement it.

Morbidity and Mortality

After age 30, most people loose around 5% of their muscle mass per decade. Six million people in the United States are diagnosed with Alzheimer’s dementia and this number is increasing every year. As such, preserving muscle and brain function are cornerstone of all anti-aging strategies.

Story

Creatine was first discovered in muscle in 1832. For over 100 years, it has been known that supplementing creatine increases phosphocreatine levels in skeletal muscle. Since the early 1990s, creatine has been marked as a dietary supplement. The use of creatine has become extremely popular over the last 3 decades and its potential benefits to cognitive and nerve function have only recently been explored/discovered.

Key Points

Creatine is a small amino acid like, nitrogenous molecule found in skeletal muscle and the brain.
Creatine is phosphorylated to phosphocreatine by creatine kinase. Phosphocreatine can then transfer a phosphate to ADP, making ATP. ATP is a molecule that is the main source of energy for the body.
Improved strength, bone health, cognitive function, recovery from TBI, heart health, and improvements in triglyceride are often seen with creatine supplementation.
Supplementing 5 to 10g of creatine a day should be considered in many individuals, including non-athletes. Creatine has an excellent track record for safety, but possible side effects will be discussed.
Muscle cramps are common when taking creatine. Stay hydrated and consume adequate salt. Be careful not to overuse your muscles or injure yourself when taking creatine.

References

Forbes SC, Cordingley DM, Cornish SM, Gualano B, Roschel H, Ostojic SM, Rawson ES, Roy BD, Prokopidis K, Giannos P, Candow DG. Effects of Creatine Supplementation on Brain Function and Health. Nutrients. 2022
Creatine. Wikipedia.
de Souza E Silva A, Pertille A, Reis Barbosa CG, Aparecida de Oliveira Silva J, de Jesus DV, Ribeiro AGSV, Baganha RJ, de Oliveira JJ. Effects of Creatine Supplementation on Renal Function: A Systematic Review and Meta-Analysis. J Ren Nutr. 2019
Aguiar AF, Januario RS, Junior RP, et al. Long-term creatine supplementation improves muscular performance during resistance training in older women. Eur J Appl Physiol. 2013
Chilibeck PD, Chrusch MJ, Chad KE, Shawn Davison K, Burke DG. Creatine monohydrate and resistance training increase bone mineral content and density in older men. J Nutr Health Aging. 2005
Groeneveld GJ, Beijer C, Veldink JH, Kalmijn S, Wokke JH, van den Berg LH. Few adverse effects of long-term creatine supplementation in a placebo-controlled trial. Int J Sports Med. 2005

Introduction 2023

Summary

Metabolic syndrome is a medical condition characterized by unhealthy and markedly deranged metabolism. Over 50% of United States adults have metabolic syndrome and another 40% are at risk of developing it (90% of US adults!). Metabolic syndrome is the great killer of our time, a global pandemic, and the leading risk factor for most all major chronic diseases.

Story

Chronic diseases are contagious. This is because thoughts and behaviors are contagious. As fast food companies, ultra-processed food, soda and other sugar sweetened beverages, and the American lifestyle spreads around the globe, so too does metabolic syndrome.

Key Points

1 Metabolic syndrome is both caused by and can be cured by the way a person lives their life (behaviors).

Insulin resistance, unhealthy cholesterol, high blood pressure, and weight gain are symptoms of metabolic syndrome.
The risk of multiple chronic diseases including diabetes, heart attacks, strokes, and even cancer is increased in those with metabolic syndrome.
Avoiding ultra-processed foods, exercising regularly, sleeping adequately, and managing stress are the best ways to prevent and treat metabolic syndrome.

References

-https://www.nhlbi.nih.gov/health/metabolic-syndrome/diagnosis

Lustig, Robert. Metabolical: The Lure and Lies of Processed Food, Nutrition, and Modern Medicine. Harper Wave, 2021.
Saklayen MG. The Global Epidemic of the
Metabolic Syndrome. Curr Hypertens Rep. 2018
Lemieux I, Després J-P. Metabolic Syndrome:
Past, Present and Future. Nutrients. 2020
Shi TH, Wang B, Natarajan S. The Influence of
Metabolic Syndrome in Predicting Mortality Risk Among US Adults: Importance of
Metabolic Syndrome Even in Adults With Normal Weight. Prev Chronic Dis. 2020.
https://www.heart.org/en/health-topics/metabolic-syndrome/symptoms-and-diagnosis-of-metabolic-syndrome

Introduction 2023

Summary

What is your plan for medical care as you get older? Most people don’t know. While 87% of people say they want to die at home, just under half of people do. In this episode we discuss goals of care, comfort care, palliative care, hospice, code status and more.

Morbidity and Mortality

Medical errors are the 3rd leading cause of death in the United States (sorry healthcare team…its true). As people get older, sicker, and frailer, their chances of being hurt by healthcare increase dramatically. At some point for everyone, the benefits of aggressive medical care are outweighed by the risks.

Story

In 1900 the average life expectancy in the United States was 47.3 years. By 2019, life expectancy had increased to 78.8 years. This was largely due to public health measures like clean water, lifesaving antibiotics, and vaccines. However, life expectancy is now trending down-ward.

Key Points

Comfort care is when the main goal of care is person’s quality of life
Palliative care is a medical discipline that helps people cope mentally, physically, and spiritually with severe illness. People on aggressive medical and comfort care can utilize palliative care.
Code Status concerns a patient’s wishes when they are dead. It has nothing to do with their medical care while alive.
Hospice is a program centered around comfort care for those persons expected to live < 6 months. It is under-utilized and our current medical incentives push people away from it.

References

Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage. 2007 Mar;33(3):238-46.
https://hospicefoundation.org/Hospice-Care/Hospice-Services
Hughes MT, Smith TJ. The growth of palliative care in the United States. Annu Rev Public Health. 2014;35:459-75. doi: 10.1146/annurev-publhealth-032013-182406. PMID: 24641562.
Gomes, B., Calanzani, N., Gysels, M. et al. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12, 7 (2013)
Adair T
Who dies where? Estimating the percentage of deaths that occur at home
BMJ Global Health 2021
QuickStats: Percentage of Deaths, by Place of Death — National Vital Statistics System, United States, 2000–2018. MMWR Morb Mortal Wkly Rep 2020
Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016
Google searches and numerous sites describing “comfort care”, “palliative care”, “End of life care”

Sycamore is a physician staffing and independent locums company that encourages physicians to run their career like a business. Price transparency, low fees, direct contracts, and aligned incentives set Sycamore Health apart from other physician staffing companies. In this interview, I discuss medicine, health, business, and more with Sycamore CEO, Larson Hicks.

This episode covers my thoughts and opinions on several different topics.

Please enjoy. More medical knowledge episodes coming soon!

Thanks again,

Bill Brandenburg, MD

Alcohol Withdrawal, Part 2

Summary

Drinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting.

Morbidity and Mortality

Almost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment.

Story

Ever drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal.

Key Points

Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal.
Severe symptoms may include hallucinations, delirium, seizures, and death
Vitamin and electrolyte repletion are critical for sick alcohol dependent patients.
Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting!

References

-Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994

Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015
https://www.who.int/news-room/fact-sheets/detail/alcohol
Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal.
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/
Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019
Wikipedia, alcohol withdrawal syndrome
Personal experience treating ETOH withdrawal in the inpatient and outpatient setting

Summary

Drinking alcohol (specifically ethanol) on a regular basis leads to alcohol dependence. When alcohol dependent persons stop drinking, they experience withdrawal. Withdrawal from alcohol is very dangerous and should be managed aggressively in order to prevent long term complications and death. This podcast will teach you the ins and outs of recognizing and managing alcohol withdrawal both in the inpatient and outpatient setting.

Morbidity and Mortality

Almost 100,000 people die every year from ETOH abuse in the United States alone. It is not known how many people die a year from alcohol withdrawal. If delirium tremons develops, it is estimated that about 25% of people will die without treatment.

Story

Ever drink too much at night and then wake up suddenly at 5am feeling wide awake? Ever feel inner tension, agitation, or heart palpitations after a long party weekend with friends? If so, you have experienced symptoms of alcohol withdrawal.

Key Points

Tachycardia, tachypnea, hypertension, hyperthermia, tremors, anxiety, and GI upset are the hallmarks of alcohol withdrawal.
Severe symptoms may include hallucinations, delirium, seizures, and death
Vitamin and electrolyte repletion are critical for sick alcohol dependent patients.
Aggressively treating withdrawal by slowly coming off alcohol or using medications like barbiturates, benzodiazepines, and other CNS depressants can be lifesaving. Use medication liberally in this setting!

References

-Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994

Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015
https://www.who.int/news-room/fact-sheets/detail/alcohol
Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal.
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/
Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. Psychosomatics. 2019
Wikipedia, alcohol withdrawal syndrome
Personal experience treating ETOH withdrawal in the inpatient and outpatient setting

This is a conversation I had with Justin Cotton, host of the Policy not Politics podcast. It does not contain any medical knowledge. But it is a thought provoking conversations about my opinions regarding healthcare policy. Please enjoy. This will be the final episode of Full Scope season 2. I am going to take a hiatus for a couple of months in order to focus on Wander Medicine Clinic and Old Dougs Plaza. Full Scope will return with a season 3 though! Thanks for listening.

Summary

Sleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition (thinking), better body function, less disease, and a longer lifespan.

Morbidity and Mortality

At least 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die.

Other Animals

All known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time.

Key Points

Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.
Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.
Many medical diseases effect sleep. Being unhealthy appears to be both a cause of bad sleep as well as an effect of getting suboptimal sleep.
Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used as a last resort to help with sleep.

References

Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017
Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018
Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017
Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017
https://courses.drhyman.com/sleep-course-own
Getting a Good Night’s Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep
Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep
How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html
https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep

Summary

Sleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition, better body function, less disease, and a longer lifespan.

Morbidity and Mortality

Atleast 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die.

Story

All known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time.

Key Points

Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.
Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.
Many medical diseases effect sleep. Being unhealthy appear to be both a cause for bad sleep as well as an effect of getting suboptimal sleep.
Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used only as a last resort to help with sleep.

References

Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017
Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018
Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017
Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017
https://courses.drhyman.com/sleep-course-own
Getting a Good Night’s Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep
Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep
How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html
https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep

Summary

Sleep is the most important thing a person can do for themself. Getting 8 hours of quality sleep equals better cognition (thinking), better body function, less disease, and a longer lifespan.

Morbidity and Mortality

At least 20% of automobile accidents have been linked to sleep deprivation. Teenagers that start school earlier get lower test scores than those who start later. Doctors make more errors and kill more people when sleep deprived. Without sleep, a person will die.

Story

All known animals sleep. Some bats sleep almost 20 hours a day, while giraffes sleep < 2 hours a day. Birds and marine mammals can sleep half of their brain at a time.

Key Points

Sleep is a physiologic state that consists of various stages including light sleep, deep sleep, and REM sleep.
Most all people need > 7 hours of sleep a night to function optimally. Many of us are functioning sub-optimally and undermining our longevity through a lack of sleep.
Many medical diseases effect sleep. Being unhealthy appears to be both a cause of bad sleep as well as an effect of getting suboptimal sleep.
Improving sleep starts with improving lifestyle. Paying attention to light exposure is also very important. Grounding, cognitive behavioral therapy, certain types of sound, and sleep hygiene can also be useful. Many supplements can be helpful as well. Medications should be used as a last resort to help with sleep.

References

Walker, Matthew. Why We Sleep; Unlocking the Power of Sleep and Dreams. Scribner. 2017
Troynikov O, Watson CG, Nawaz N. Sleep environments and sleep physiology: A review. J Therm Biol. 2018
Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017
Owens JA, Weiss MR. Insufficient sleep in adolescents: causes and consequences. Minerva Pediatr. 2017
https://courses.drhyman.com/sleep-course-own
Getting a Good Night’s Sleep. NIH. https://www.nia.nih.gov/health/good-nights-sleep
Brain Basics: Understanding sleep. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
Stages of Sleep. https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep
How much do animals sleep. https://faculty.washington.edu/chudler/chasleep.html
https://www.nih.gov/news-events/nih-research-matters/gene-identified-people-who-need-little-sleep

Summary

Acute care in the United States is considered to be among the best in the world. But do not be fooled. Healthcare is widely considered the third leading cause of death in the US. Additionally, we have considerable room for improvement in the care of our acutely sick patients. This podcast reviews some of the “low hanging fruit” to improve our inpatient systems. These improvements have largely been ignored in my experience. This podcast represents my experiences and opinions. It is not medical advice and I do not cite any sources.

Morbidity and Mortality

None of the hospitals I have ever worked at have prioritized sleep. As sleep is necessary for healing and proper immunity, this is a tragedy.

Key Points

Sleep is completely overlooked in the hospital; we often keep patients up all night.
Hospital food is not the food I recommend my patients eat. As food is medicine. This is a big problem.
Hospitals offer patients little time outside and almost no natural sunlight. We almost never allow them contact with the earth.
We are so afraid of falls that we prevent patients from mobilizing. This is a huge detriment to them.

References

Personal experience working at over 30 rural and urban hospitals across 3 regions in the United States over the last 10 years.

Summary

Diversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the gene variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms also host diverse arrays of micro-organisms that our essential to health.

Morbidity and Mortality

Antibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years.

Story

Microbial fossils isolated from 1000 year old poop shows 38% novel species (now extinct)

Key Points

Human bodies are an ecosystem
A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.
The food we eat and the way we live our lives has profound effects on our microbiotia and health.
In the absence of a genetic disease, our microbiome contributes more to our health than our own genes.

References

Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019
Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018
Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020
Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020
https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299
https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics
https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet
https://academic.oup.com/jhered/article/108/6/671/3836924
Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140.
https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults
Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021

https://www.cdc.gov/ncbddd/autism/data.html

Summary

Diversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the gene variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms also host diverse arrays of micro-organisms that our essential to health.

Morbidity and Mortality

Antibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years.

Story

Microbial fossils isolated from 1000 year old poop shows 38% novel species (now extinct)

Key Points

Human bodies are an ecosystem
A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.
The food we eat and the way we live our lives has profound effects on our microbiotia and health.
In the absence of a genetic disease, our microbiome contributes more to our health than our own genes.

References

Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019
Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018
Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020
Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020
https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299
https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics
https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet
https://academic.oup.com/jhered/article/108/6/671/3836924
Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140.
https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults
Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021

https://www.cdc.gov/ncbddd/autism/data.html

Summary

Idaho entered a state wide crisis mode on Sept 16, 2021. Alaska has since followed. Many other state are also being hit hard. In this podcast, I discuss crisis care, leadership, and how front line healthcare workers have lost complete control of the healthcare industry.

Morbidity and Mortality

In September of 2021, approximately 700,000 people have died from COVID19 in the United States. Worldwide at least 4.5 million have died (likely more). I am not sure how many front line healthcare workers have left the job or been pushed out, but it seems like a lot!

Key Points

In crisis standards of healthcare, the focus shifts from taking care of individual patients to prioritizing care for a population of patients due to scarce resources and the need to prevent as much morbidity and mortality as possible.
At first, this can be fun and exciting as red tape disappears. However, when decisions have to be made about who receives care and who does not, the fun quickly fades away.
During times of crisis, communications lines must be increased greatly to facilitate effective operations.
Crisis represents an opportunity to view things through a new light as it forces us to understand the most important parts of what we do.
Additionally, crisis represents an unprecedented opportunity for training
Front line healthcare workers have lost complete control of our industry and this has contributed significantly to an unhealthy and unhappy workforce.

References

Giroir and Kadlec. Rapid Expert Consultation on Crisis Standards of Care for the Covid19 Pandemic. The National Academies of Sciences, Engineering, and Medicine. 2020.
https://coronavirus.idaho.gov/wp-content/uploads/2020/10/Crisis-Standards-of-Care-Plan_Final_Posted_Signed.pdf
Personal Experience

Summary

Diversity in ecology and genetics appears to be a very good thing. The human species has a genetic pool (all the genes variants from all the humans alive) that is diverse and protective for our species. Human bodies and all other multi-cellular organisms host diverse arrays of micro-organisms that our essential to health.

Morbidity and Mortality

Antibiotics, pesticide, cesarean sections, baby formula, monocrops, processed foods, disconnection with nature, other pharmaceuticals like proton-pump inhibitors, and other factors have all contributed to a mass extinction of the human gut microbiome. It is estimated that humans have lost 50% of our microbial diversity in the last few hundred years.

Story

Microbial fossils isolated from 1000 old poop shows 38% novel species (now extinct)

Key Points

Humans bodies are an ecosystem
A diverse ecosystem is associated with health. Dysbiosis is associated with numerous chronic diseases.
The food we eat and the way we live our lives has profound effects on our microbiotia and health.

References

Tu P, Chi L, Bodnar W, et al. Gut Microbiome Toxicity: Connecting the Environment and Gut Microbiome-Associated Diseases. Toxics. 2020;8(1):19. Published 2020 Mar 12. doi:10.3390/toxics8010019
Blaser MJ. The Past and Future Biology of the Human Microbiome in an Age of Extinctions. Cell. 2018
Manor O, Dai CL, Kornilov SA, Smith B, Price ND, Lovejoy JC, Gibbons SM, Magis AT. Health and disease markers correlate with gut microbiome composition across thousands of people. Nat Commun. 2020
Chichlowski M, Shah N, Wampler JL, Wu SS, Vanderhoof JA. Bifidobacterium longum Subspecies infantis (B. infantis) in Pediatric Nutrition: Current State of Knowledge. Nutrients. 2020;12(6):1581. Published 2020
https://www.the-scientist.com/features/neanderthal-dna-in-modern-human-genomes-is-not-silent-66299
https://www.genome.gov/about-genomics/fact-sheets/Genetics-vs-Genomics
https://www.genome.gov/about-genomics/fact-sheets/Comparative-Genomics-Fact-Sheet
https://academic.oup.com/jhered/article/108/6/671/3836924
Satoh, M; Kuroiwa, T (September 1991). "Organization of multiple nucleoids and DNA molecules in mitochondria of a human cell". Experimental Cell Research. 196 (1): 137–140.
https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults
Seneff, S. Toxic Legacy: Howe the Weedkiller Glyphosate is Destroying our Health and the Environment. 2021

Summary

We have been taught to not skip meals, make carbohydrates the most abundant macronutrient we consume, and to snack throughout the day. Sadly, this all appears to be wrong. Fasting exists in many forms and growing evidence suggests it is essential to health. We are all spending way too much time fed and not enough time fasting. Want to stimulate autophagy? Then eat less, exercise more, and feel better!

Morbidity and Mortality

Obesity rates have more than tripled worldwide since 1975. Over 50% of people in the United States are now obese and 30% or more have metabolic syndrome. Houston, we have a problem!

Story

Jesus fed for 40 days in the desert during what we now call Lent. Islamic peoples celebrate Ramadan, a remembrance of Mohamad’s 1st revelation. During this holy month, Islamic people do not eat during the daylight hours. Buddhist monks fast during religious retreats and the Buddha did not eat food after lunch. For a time fasting fell out of favor, but it is coming back, and just in time.

Key Points

Autophagy is biological process that allows cells to recycle nutrients and get rid of harmful waste. It is essential for health and best stimulated through fasting.
By fasting and/or limiting carbohydrate intake, mammals enter ketosis. Ketosis is marked by the mobilization of stored fat for nutrition, the synthesis of glucose from glycerol and amino acids, as well as the usage of ketones for nutrition. Maintaining the body in a state of ketosis is beneficial for the treatment of metabolic syndrome.
Metabolic syndrome is marked by obesity, hypertension, high bad cholesterols, low good cholesterols, high blood sugar, and high insulin levels. It predisposes individual to heart disease, cancer, and numerous other health problems. It is the great killer of our time.
Fasting and sleep are the best way to stimulate autophagy. Autophagy is essential to health, and we are increasingly understanding the link between autophagy and longevity.

References

Yoshinori Ohsumi. What is Autophagy. Lecture. Molecular Frontiers Symposium, Tokyo. 2017.
Chung KW, Chung HY. The Effects of Calorie Restriction on Autophagy: Role on Aging Intervention. Nutrients. 2019;
Hwangbo DS, Lee HY, Abozaid LS, Min KJ. Mechanisms of Lifespan Regulation by Calorie Restriction and Intermittent Fasting in Model Organisms. Nutrients. 2020
Ros M, Carrascosa JM. Current nutritional and pharmacological anti-aging interventions. Biochim Biophys Acta Mol Basis Dis. 2020
Wikipedia, Autophagy, Intermittant Fasting, ketosis
Colman RJ, Anderson RM. Nonhuman primate calorie restriction. Antioxid Redox Signal. 2011
Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018
Moore JX, Chaudhary N, Akinyemiju T. Metabolic Syndrome Prevalence by Race/Ethnicity and Sex in the United States, National Health and Nutrition Examination Survey, 1988–2012. Prev Chronic Dis 2017

Summary

Planet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not act quickly, it is likely that our planet will become unable to support human civilization as we know it.

Morbidity and Mortality

70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 50% of their mass in just 40 years, and human health is at an all-time low.

Story

If humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly.

Key Points

The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.
There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.
New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.
Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet.
If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations.

References

Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.
Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix
Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M
Environmental Working Group. https://www.ewg.org/research/pollution-people
Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach’s Wilderness Medicine.
Experience as a medical doctor and naturalist

Summary

Planet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not act quickly, it is likely that our planet will become unable to support human civilization as we know it.

Morbidity and Mortality

70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 50% of their mass in just 40 years, and human health is at an all-time low.

Story

If humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly.

Key Points

The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.
There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.
New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.
Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet.
If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations.

References

Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.
Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix
Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M
Environmental Working Group. https://www.ewg.org/research/pollution-people
Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach’s Wilderness Medicine.
Experience as a medical doctor and naturalist

Summary

Planet earth is being destabilized as a result of human activity. Over half of the habitable land on earth is now used for human agriculture, 40% of our forests have been cut down, and humans now move more rock and sediment than any natural process. If we do not change our behavior quickly, it is likely that our planet will become unable to support human civilization as we know it.

Morbidity and Mortality

70% of our crops rely on insect pollinators, but insect populations are collapsing. 40% of the human population live on the coast and could be underwater within just 100 years. Deserts are expanding, forests are diminishing, wild fish stocks and wild animals have lost over 60% of their mass in just 40 years, and human health is at an all-time low.

Story

If humans act now and with great conviction, we can potentially avoid a catastrophe. But the window for action is closing rapidly.

Key Points

The earth is warming. In 50 years, the temperature has increased 1.1C, more than in the previous 10,000 years.
There is a mass extinction under way. The loss of species affects our own health. Even the micro-organisms that live on our body and promote health are becoming extinct.
New chemicals are hurting human health. Governments are all too willing to protect chemical companies over the health of people.
Eating healthy plant-based foods, supporting organic regenerative agriculture, protecting and expanding wild lands, planting trees and native plants, not using products that cannot be reused or recycled, and stopping all our carbon emissions by 2050 could save the planet.
If we can do these things, our own health will improve, and we will assure a safe planet to live on for future generations.

References

Steffen et al. Planetary boundaries: Guiding human development on a changing planet. Science. 2015.
Rockstrom and Attenborough. Breaking Boundaries – The Science of Our Planet. 2021. Netflix
Chemicals in the Environment – Dehumanizing Humanity. 2017. Royal College of London. https://www.youtube.com/watch?v=oq2K1IvRf8M
Environmental Working Group. https://www.ewg.org/research/pollution-people
Meyer and Lemery. Health Implications of Environmental Change. Ch 121. Aurerbach’s Wilderness Medicine.
Experience as a medical doctor and naturalist

Summary

Exposure to warm environments can cause a number of heat-related illnesses including muscle cramps, heat rash, edema, syncope, heat exhaustion, and heat stroke. All of these issues are preventable. Early recognition of heat stroke is paramount for improving survival. Cool patients with cold water immersion.

Morbidity and Mortality

Approximately 600 deaths occur every year in the United States related to heat. It is a leading cause of death in high school athletes. Mortality from heat stroke approaches 10% even in modern times.

Story

As many as 53 children die every year from heat related vehicle entrapment in the United States. Most of these cases are due to people forgetting the child was in the car. The second leading cause is children getting into unattended cars. Always know where your baby or child is and keep your unattended car locked.

A record-breaking heat wave in Europe in 2003 killed at least 30,000 people, mostly elderly. Taking cool baths throughout the day could have prevented many of these deaths.

Key Points

Risk factors for heat illness include older age, dehydration, impaired cooling capacity, lack of acclimatization, poor fitness, lack of sleep, chronic health issues, and obesity.
Temperature, wind, humidity, and solar radiation all effect the thermal strain felt by any individual.
Heat exhaustion is common and characterized by fatigue, thirst, weakness, anxiety, and dizziness. Heat stroke is much more severe and can be distinguished from exhaustion by the presence of altered coordination, balance, and/or mentation.
Rapid cooling is the most important treatment for heat stroke. Cold water emersion is the gold standard for lowering body temperature.

References

Lipman et al. WMS Practice Guidelines for the Prevention and Treatment of Heat-Related Illness. Wild & Env Med. 2014.
O’Brien et al. Clinical Management of Heat-Related Illnesses. Ch. 13. Auerbachs, Wilderness Medicine.
Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke. J Emerg Med. 2016
Wikipedia – Heat Stroke
Personal experience as a physician and athlete

Summary

Radon is a radioactive element that accumulates in homes and buildings. It is the second leading cause of lung cancer worldwide. All homes should be tested for radon, and if above actions levels (US - 4 pCi/L), a radon mitigations strategy (getting rid of the radon) should be utilized.

Morbidity and Mortality

Radon is often the largest contributor to an individual’s background radiation dose and is considered the leading environmental cause of cancer mortality. Worldwide, between 3 and 14% of lung cancers are due to radon in any giving country depending on smoking prevalence and background radon levels. In the United States approximately 21,000 lung cancer deaths are attributed to radon every year.

Story

Before 1984 radon was only thought to be a risk in uranium mines. That year Stanley Watras, and engineer was starting a job at Limerick nuclear power plant in Pottstown, Pennsylvania. Prior to nuclear fuel being added to the plant, Watras began setting off radiation detectors meant to keep workers safe. Each day he was setting machines off in spite of decontamination. An investigation was undertaken and Watras’s home was found to have a huge amount of radiation, 2,700 pCi/L. The source was determined to be radon. This amount of radon was the equivalent in lung cancer risk to smoking hundreds of packs of cigarettes a day. Watras’s family was moved out and the EPA began extensive testing. After this, the risk of radon in the home was recognized.

Key Points

Radon is chemical element 86. It is radioactive and gives off an ionizing alpha particle due to its inherent chemical instability.
This alpha particle is a helium atom with high energy and speed. If inhaled, ingested, or injected, alpha particles are harmful to human health.
Radon is colorless, odorless, and tasteless. All homes should be tested for is presence as it cannot be sensed.
There are several proven methods to reduce the level of radon in the home. As such, lung cancer due to radon inhalation is preventable.

References

Wikipedia – Radon, alpha decay
Field et al. Residential radon gas exposure and lung cancer: the Iowa Radon Lung Cancer Study. Am J Epidemiol. 2000
Hill et al. Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies. BMJ. 2005 Jan 29;330(7485)
Health Risk of Radon. EPA. https://www.epa.gov/radon/health-risk-radon
https://www.epa.gov/sites/production/files/2016-02/documents/2013_consumers_guide_to_radon_reduction.pdf
Radon and Health. https://www.epa.gov/sites/production/files/2016-02/documents/2013_consumers_guide_to_radon_reduction.pdf
Rella, Joseph. Ch. 128. Radiation. Goldfrank’s Toxicology. 2019.

Summary

Yellow Fever is a viral tropical disease. It is most prevalent in equatorial Africa (90%) and South America (10%). No specific treatments exist but it can be prevented with a highly affective vaccine. The disease is spread via mosquito vectors (arbovirus). Yellow refers to the jaundice that occurs in severe infection from liver damage. Bleeding (hemorrhagic fever) and kidney damage are other severe manifestations.

Morbidity and Mortality

About 5% of people infected with the Yellow Fever virus will die. Foreign visitors to endemic countries are at the higher risk of severe infection if exposed. Hemorrhagic fever, liver failure, and other organ failures can lead to shock and death. It is very difficult to know how many infections occur annually but the WHO estimates about 200,000 (likely many more). Epidemics periodically occur and usually have worse than normal case fatality rates.

Story

Yellow fever outbreaks plagued the America’s in the 18th and 19th centuries, having been introduced from Africa just few hundred years prior. The Yellow Fever Epidemic of 1793 killed 9% of the residents in Philadelphia. Many, including George Washington, fled the city. Yellow Fever has plagued the US military for years before the 17D vaccine was discovered in 1937 by Max Theiler (Noble Prize).

Key Points

Yellow fever is endemic to equatorial Africa and South America, but strangely not Asia.
People living and traveling to these areas should be vaccinated with the 17D live attenuated yellow fever vaccine.
Fever, chills, headache, and myalgias are common. A minority of cases progress to liver failure and hemorrhage. About half of cases that progress will be fatal
Treatment is supportive. As such, prevention with vaccine, vector control, and avoiding mosquito bites is very important. Avoid blood thinners and anti-platelets.

References

Keystone et al. Travel Medicine, 4th Ed. Elsevier 2019. Ch. 12. Torresi and Kollaritsch. Recommended/Required Travel Vaccines.
Farrar et al. Manson’s Tropical Diseases, 23rd Ed. Elsevier 2014. Ch. 14. Young et al. Arbovirus Infection.
Wikipedia. Yellow Fever, Yellow Fever Vaccine
WHO, Yellow Fever. https://www.who.int/news-room/fact-sheets/detail/yellow-fever
Vaccine Information Statement. CDC. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/yf.pdf.
Thomas R. E. (2016). Yellow fever vaccine-associated viscerotropic disease: current perspectives. Drug design, development and therapy, 10, 3345–335

Summary

Yellow Fever is a viral tropical disease. It is most prevalent in equatorial Africa (90%) and South America (10%). No specific treatments exist but it can be prevented with a highly affective vaccine. The disease is spread via mosquito vectors (arbovirus). Yellow refers to the jaundice that occurs in severe infection from liver damage. Bleeding (hemorrhagic fever) and kidney damage are other severe manifestations.

Morbidity and Mortality

About 5% of people infected with the Yellow Fever virus will die. Foreign visitors to endemic countries are at the higher risk of severe infection if exposed. Hemorrhagic fever, liver failure, and other organ failures can lead to shock and death. It is very difficult to know how many infections occur annually but the WHO estimates about 200,000 (likely many more). Epidemics periodically occur and usually have worse than normal case fatality rates.

Story

Yellow fever outbreaks plagued the America’s in the 18th and 19th centuries, having been introduced from Africa just few hundred years prior. The Yellow Fever Epidemic of 1793 killed 9% of the residents in Philadelphia. Many, including George Washington, fled the city. Yellow Fever has plagued the US military for years before the 17D vaccine was discovered in 1937 by Max Theiler (Noble Prize).

Key Points

Yellow fever is endemic to equatorial Africa and South America, but strangely not Asia.
People living and traveling to these areas should be vaccinated with the 17D live attenuated yellow fever vaccine.
Fever, chills, headache, and myalgias are common. A minority of cases progress to liver failure and hemorrhage. About half of cases that progress will be fatal
Treatment is supportive. As such, prevention with vaccine, vector control, and avoiding mosquito bites is very important. Avoid blood thinners and anti-platelets.

References

Keystone et al. Travel Medicine, 4th Ed. Elsevier 2019. Ch. 12. Torresi and Kollaritsch. Recommended/Required Travel Vaccines.
Farrar et al. Manson’s Tropical Diseases, 23rd Ed. Elsevier 2014. Ch. 14. Young et al. Arbovirus Infection.
Wikipedia. Yellow Fever, Yellow Fever Vaccine
WHO, Yellow Fever. https://www.who.int/news-room/fact-sheets/detail/yellow-fever
Vaccine Information Statement. CDC. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/yf.pdf.
Thomas R. E. (2016). Yellow fever vaccine-associated viscerotropic disease: current perspectives. Drug design, development and therapy, 10, 3345–335

This episode discusses my OPINIONS regarding Direct Primary Care. It is not intended to provide medical knowledge. Just an interesting discussion!

Summary

Direct Primary Care (DPC) is a new movement in primary care designed to improve the provider patient relationship, accessibility of providers to their patients, and transparency of pricing. At its core, it is defined by patients or their employers paying for primary care directly. This is in opposition to using medical insurance or another third party like the government. This new model is growing and has the potential to disrupt healthcare in an amazing way.

Morbidity and Mortality

United States healthcare is bankrupting people and companies at alarming rates. This is because healthcare costs are out of control. As financial security is a more important driver of health than access to medical care, I question whether the United States healthcare system actually helps more people then it hurts. DPC realigns incentives and seeks to control costs. This puts the breaks on healthcare spending.

Key Points

DPCs often utilize affordable subscription-based care. Patients can often call their providers directly whenever medically needed.
DPC providers take on about ½ to ¼ of the patients in traditional primary care. This allows them more time with patients and improves care.
DPC offices know the cost of everything they recommend, as such expensive treatments, medications, and diagnostics are appropriately avoided.
DPC doctors practice a broader scope of care than traditional primary care doctors. This prevents communications errors and adds value to consumers as the more providers someone sees the more expensive care gets.
Employers who use DPC save money on total healthcare expenses. One study of 10 clinics found a 20% reduction in total healthcare expenses, 40% less emergency department visits, and 26% less hospitalizations compared to traditional care.
DPC is thriving in spite of medical insurance and healthcare policies that undermine it. Imagine how successful it could be with the support of legislation.

References

Personal experience as a primary care physician that has worked in traditional insurance based primary care clinics as well as owns and operates Wander Medicine clinic, a DPC in Boise, ID.
Millman Inc. Direct Primary Care: Evaluating a New Model Of Delivery and Financing. 2020. Available at: https://www.soa.org/globalassets/assets/files/resources/research-report/2020/direct-primary-care-eval-model.pdf

Background

United States healthcare costs the most of any country in the world. Unfortunately, the health of our population and quality of care provided does not support the cost. We offer the worst healthcare value in the entire world (Value = Cost/Quality)! This has to change for the sake of ourselves and our children. The changes needed are simple. But, change is difficult because so many people are making so much money off of our toxic system.

This podcast is not meant to provide clinical medical knowledge. It represents the opinions of the author. It is intended to stimulate thought and conversion.

Some of the major problems are:

Lack of Transparency in Pricing
Insurance for Every Part of Medical Care (It should not be called insurance anymore)
Businesspeople that Provide no Additional Value
Regulations that are out of Date, Add Complexity, and Provide No Value
Poor Communication by Design
Drugs and Diagnostics that are Obscenely High Priced
Upside Down Provider Workforce
Fear and Defensive Medicine

Ask yourself everyday as a provider:

Would I make such a recommendation to someone in my own family?

Would I want myself to be my own doctor?

Upside Down Incentives Regarding Wellness and Disease Prevention
Lack of accessibility of providers when patients need them the most

Some of my solutions are:

Mandate that all healthcare entities make prices fully transparent
Provide medical insurance products that only cover catastrophic care on the individual and group insurance markets. These must be affordable, like 50$ a month or less for young healthy people.
Kick most of the businesspeople (suits) out of healthcare. Keep only those individuals who add value.
Modernize regulations to reduce regulatory burden.
Mandate that EMRs communicate with each other using a universal API.
Start paying the same prices for diagnostics and therapeutics that the rest of the developed world pays.
Incentivize primary care so that the smartest people enter this field and subsequently practice an extremely broad scope of care.
Stop worrying about being sued and start doing what is right for patients.
Incentivize preventative medicine and public health by paying for them
Develop systems were doctors are available to their patients in times of need. E.g. Direct Primary Care (coming next episode)

Summary

Space is a hostile environment. Microgravity, radiation, temperature extremes, vacuums, isolation, and forces related to takeoff and landing are just a few of the hazards faced by astronauts and other space voyagers. Humans have been capable of leaving planet earth for just 60 years. Since that time, we have learned a lot about how to keep humans safe and healthy in space. However, our knowledge remains primitive. To become multiplanetary, physicians, scientists, engineers, and other disciplines will need to take space medicine to the next level. This will be the greatest preventative medicine challenge ever undertaken.

Morbidity and Mortality

Space can kill you in 1000 different ways. Explosions, lethal radiation doses, and environmental control failures can all result in fatality. Those who spend long amounts of time in space can have long term vision issues, higher rates of cancer, and back problems. Longer space flight missions, and those outside of the earth’s magnetosphere will pose much higher risks to human in space.

Story

Getting things into space is getting cheaper. Adjusted for inflation (to year 2000), the price to put 1 kg into low earth orbit was about $85,000 in 1981. In 2019 that number had fallen to $951/kg or 1% of the cost from 40 years prior. Prices continue to get cheaper and space continues to become more accessible.

Key Points

Microgravity has a number of adverse effects including motion sickness, muscle and bone loss, and cardiovascular changes.
Ionizing radiation is a huge problem is space that we have no idea how to solve
The psychological and human factor components can never be understated, even when picking the best humans available.
Humans need to become multiplanetary in order to assure the long-term survival of our species. We also need to bring the rest of life on earth with us. Space medicine is booming as a result of the booming space industry.

References

Green et al. Handbood of Aviation and Space Medicine. 2019
Hodkinson PD, Anderton RA, Posselt BN, Fong KJ. An overview of space medicine. Br J Anaesth. 2017
Wikipedia- Karman Line, Armstrong limit, Space Medicine, Ionizing Radiation, Geocorona, etc.
https://www.nasa.gov/feature/nasa-station-astronaut-record-holders
https://www.futuretimeline.net/data-trends/6.htm
Belavy et al. Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?. Eur Spine J 25, 144–154 (2016)

Summary

Space is a hostile environment. Microgravity, radiation, temperature extremes, vacuums, isolation, and forces related to takeoff and landing are just a few of the hazards faced by astronauts and other space voyagers. Humans have been capable of leaving planet earth for just 60 years. Since that time, we have learned a lot about how to keep humans safe and healthy in space. However, our knowledge remains primitive. To become multi-planetary, physicians, scientists, engineers, and other disciplines will need to take space medicine to the next level. This will be the greatest preventative medicine challenge ever undertaken.

Morbidity and Mortality

Space can kill you in 1000 different ways. Explosions, lethal radiation doses, and environmental control failures can all result in fatality. Those who spend long amounts of time in space can have long term vision issues, higher rates of cancer, and back problems. Longer space flight missions, and those outside of the earth’s magnetosphere will pose much higher risks to human in space.

Story

Getting things into space is getting cheaper. Adjusted for inflation (to year 2000), the price to put 1 kg into low earth orbit was about $85,000 in 1981. In 2019 that number had fallen to $951/kg or 1% of the cost from 40 years prior. Prices continue to get cheaper and space continues to become more accessible.

Key Points

Microgravity has a number of adverse effects including motion sickness, muscle and bone loss, and cardiovascular changes.
Ionizing radiation is a huge problem is space that we have no idea how to solve
The psychological and human factor components can never be understated, even when picking the best humans available.
Humans need to become multiplanetary in order to assure the long-term survival of our species. We also need to bring the rest of life on earth with us. Space medicine is booming as a result of the booming space industry.

References

Green et al. Handbood of Aviation and Space Medicine. 2019
Hodkinson PD, Anderton RA, Posselt BN, Fong KJ. An overview of space medicine. Br J Anaesth. 2017
Wikipedia- Karman Line, Armstrong limit, Space Medicine, Ionizing Radiation, Geocorona, etc.
https://www.nasa.gov/feature/nasa-station-astronaut-record-holders
https://www.futuretimeline.net/data-trends/6.htm
Belavy et al. Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?. Eur Spine J 25, 144–154 (2016)

Summary

Drowning is defined as respiratory impairment caused by submersion in a liquid media. There are 3 outcomes; death, death with long term morbidity, and death without long term morbidity. Children are at particularly high risk. Over half of adult drowning involve alcohol. Most drownings are preventable.

Morbidity and Mortality

Drowning victims struggle to stay above water or may just be unconscious. Eventually rising blood CO2 levels trigger a breath. This leads to aspiration. Eventually hypoxia develops leading to tissue injury. This leads to hypoxic brain injury and finally death if the victim is not rescued. Worldwide, at least 500,000 people die a year from drowning, mostly in developing nations. Drowning is the leading cause of death in children age 1 to 4 years.

Story

When New Zealand was first being settled by European colonizers, so many people died trying to cross rivers that drowning became known as the New Zealand Death. Alcohol, dangerous beaches, and flash floods also contributed to the increased incidence of drowning deaths.

Key Points

Children, men, having a low income, being African American, having seizures, being elderly with health problems, inability to swim, and substance use are all risk factors for drowning.
learning to swim, being honest about swimming ability, using the buddy system, putting physical barriers around pools, having proper supervision, and using proper flotation devices can all prevent drowning.
Rescuers should be careful to not become a second victim. Remembering scene safety as well as the phrase reach, throw, row, go is very important.
Resuscitation should start with 2 good rescue breaths followed by high quality CPR. Remove wet clothing and begin warming the drowning victim immediately.
BIPAP and intubation are often utilized in the hospital setting for symptomatic drowning victims with significant pulmonary edema. Be sure to drain the stomach with and nasogastric tube to prevent further aspiration. Asymptomatic drowning victims are usually observed for 4 to 8 hours before they are allowed to return home.

References

Auerbach’s Wilderness Medicine, 7th Ed. Chapters on Marine Medicine. Ch 69-78 (1530-1794). 2017
Schmidt et al. WMS Practice Guidelines for the Prevention and Treatment of Drowning. 27(236-251). 2016.
Uptodate.com. Submersion Injuries
Wikipedia. drowning, free diving blackouts, etc
CDC and WHO websites
The New Zealand Death. Available at: https://ricky1871.wordpress.com/2013/06/14/376/
Personal Experience as an EMT and physician

Summary

For thousands of years indigenous Americans have used hallucinogenic mushrooms in religious ceremonies as entheogens. These mushrooms are now known to contain psilocybin, a small molecule with profound mind-altering properties. While many cultures have understood the therapeutic potential of psilocybin for thousands of years, most modern countries are only now accepting psilocybin’s potential as medicine.

Morbidity and Mortality

The profound mind-altering effects of psilocybin should not be under-estimated and have led to many fatal accidents. However, psilocybin is very safe from a purely toxicological standpoint. The LD50 (dose at which half of people die) is estimated to be 6g or 1000 times the normal recreational dose. Most all reported psilocybin fatalities have involved significant co-ingestions.

Story

The Aztecs called hallucinogenic mushrooms “tonanacatl” meaning “God’s Flesh”. In 1519 when Spain conquered the Aztec Empire, they banned cultural practices like the use of hallucinogenic mushrooms. Years later, in 1970 the United Nations required all member nations to ban psilocybin. However, this attitude is finally changing. Oregon became the first state to legalize psilocybin in 2020. However, it remains federally illegal.

Key Points

Psilocybin is a small molecule found in the fruiting bodies (mushrooms) of hundreds of species of fungi around the world
It is very similar to the neurotransmitter serotonin and is an agonist at various serotonin receptors, most importantly 5HT2A.
Though it is currently DEA schedule 1, psilocybin has numerous potential health benefits, most notably in the treatment of multiple psychiatric disorders like depression and substance abuse.
Those who have ever used psilocybin are probably less likely to commit violent crimes and often report enduring beneficial effects. Feeling of interconnectedness with other people, nature, and the universe are regularly reported by users.
Some things I forgot to say in the podcast:
**Make sure you get psilocybin from a trustworthy source. Fake and adulterated products are very common.
Calling a friend or loved one can be a great way to get through a "bad trip"
Everyone has a different metabolism. Some will get profound effects from a small dose while other may need larger doses.
Micro-dosing (taking about 1/10 a normal dose) is often done on an almost daily basis to help with depression, anxiety, and to improve creativity. Think about it like a daily antidepressant. This is a sub-hallucinogenic dose.**

References

Johnson, M. W., & Griffiths, R. R. (2017). Potential Therapeutic Effects of Psilocybin. Neurotherapeutics:14(3), 734–740.
Hendricks PS, Crawford MS, Cropsey KL, Copes H, Sweat NW, Walsh Z, Pavela G. The relationships of classic psychedelic use with criminal behavior in the United States adult population. J Psychopharmacol. 2018;32(1):37-48.
Neavyn MJ and Carey JL. Hallucinogens. GoldFrank’s Toxicology. 2019.
Wikipedia. Psilocybin, Psilocin, Serotonin, Psilocybin Decriminalization in the United States.
https://www.dea.gov/drug-scheduling
Mandrake K. The Psilocybin Mushroom Bible: The Definitive Guide and Growing and Using Magic Mushrooms. 2016.

SummaryG Force is a measure of acceleration, or a change in velocity and/or direction. All of us experience 1Gz, while standing on earth. However, military fighter pilots may have to perform under 9Gz. Such large G Forces can lead to loss of consciousness (G LOC) and even death. G Force Tolerance is a measure of how many Gs a person can withstand prior to loosing consciousness. Many factors can affect a person’s tolerance for Gs.

Morbidity and MortalityG Forces prevent blood from reaching the brain causing loss of consciousness. If you are flying a fighter jet this can lead to collisions or vulnerability to attack. If G Forces are sustained during G LOC, permanent brain damage, and then death will occur. Humans can handle incredible high G forces for short periods of time.

G Force Tolerance Thresholds for Severe Injury for Short Duration Exposures
| Axis | G Force
| +Gz | 25G
| -Gz | 15G
| +Gx | 50G
| -Gx | 45G
| +- Gy | 12G

Taken from Green’s, Handbook of Aviation and Space Medicine. 2019.

Story
Flight Surgeons and Aerospace Medicine researchers in the first half of the 20th century regularly used themselves as guinea pigs in physiologic tests. US Air Force Col. John Stapp, MD PhD took this idea to the extreme. He made rocket sleds at a New Mexico military base to test human tolerance for G Forces. On Dec. 10, 1954, after several runs (26 on himself), Stapp broke the land speed record traveling 662 mph, sustaining 46.2 Gx.

Key Points1. The danger of any G Force depends on the direction of force relative to the body, magnitude of the force, rate of onset, and duration sustained.
2. Subscripts are used to identify the direction of force relative to the body. +Gz travels from head to toe; - Gz travels from toe to head; + Gx travels from chest to back; - Gx travels from back to front; + Gy travels from right to left; - Gy travels from left to right.
3. g is the acceleration due to gravity on earth, equal to 9.8 m/sec/sec. G = acceleration/g. Therefore 10Gs = 98 m/sec/sec. A person feeling 10Gs would feel 10x heavier and their heart would have to pump blood the equivalent of 10 time the normal distance in order to reach the brain.
4. +Gz Forces cause blood to pool in the legs. This prevents blood from entering the brain. If gradual in onset, G forces will eventually cause vision loss, followed by blackout, and then loss of consciousness (G LOC). Rapid onset G forces may lead straight to blackout.
5. G tolerance, refers to a human’s capacity to sustain G Forces without G LOC. G tolerance is different for everyone. For example, +Gz tolerance ranges from 2.7 to 7.8 (mean 4.7) for most people.
6. Several factors can improve G tolerance. Examples include anti-G straining maneuvers, G suits, reclining the pilots seat, proper hydration, proper nutrition, drugs, physical fitness, and proper training.
7. -G immediately preceding +G will lower G tolerance significant. For instance, push-pull aviation maneuvers (nose diving the plain and then trying to pull up quickly) is particularly dangerous for G-LOC.

References
- Green, Gaydos, Hutchison, Nicol. Handbook of Aviation and Space Medicine. CRC Press. 2019
- Mackowski. Testing the Limits, Aviation Medicine and the Origons of Manned Space Flight. 2006
- Wikipedia. G Force, G Suit, High G Training, AGSM
- Youtube. Multiple videos showing centrifuges, John Stapps Sled, and fighter pilots
- Tesch PA, Hjort H, Balldin UI. Effects of strength training on G tolerance. Aviat Space Environ Med. 1983 Aug;54(8):691-5. PMID: 6626076.

SummaryMercury is a heavy metal and the 67th most common element in the earth’s crust. Its unique chemical properties have led to its use in a number of industries including laboratory equipment (thermometers), medical equipment (blood pressure cuffs and preservatives), dental amalgams, fluorescent lights, chlorine production, and gold and silver mining. Burning coal creates the majority of the mercury humans are exposed to.

Mercury has no known physiological role in humans. Exposure to mercury can result in nerve damage, brain damage, problems with walking, hearing, and seeing, skin rashes, kidney disease, and breathing problems. Mercury is particularly detrimental to the developing fetus. Avoiding mercury exposure in the expecting mother and young children are of paramount importance.

Morbidity and MortalityInhalation of large amounts of elemental mercury can lead to acute respiratory distress syndrome and death. Large inorganic mercury exposure can cause profound gastrointestinal disturbance, severe dehydration, end stage renal disease, and death (lethal dose 30 to 50 mg/kg). Dimethylmercury is so toxic that only a few drops onto the skin caused the death of Karen Wetterhahn, a chemistry professor. Methylmercury can bioaccumulate to high levels in humans that are continually exposed. Such individuals will develop ataxia, neuropathy, and sensory impairment, which can progress to severely altered mentation, paralysis, coma, and even death. Lower doses of methylmercury during fetal and childhood development can result in substantially lower IQs.

Story

Between 1932 and 1968, the Chisso Corp. released wastewater contaminated with mercury into Minamata Bay, Japan. This accumulated in local marine wildlife. Those who ingested the contaminated seafood often developed a severe neurological illness called Minamata disease. Around 1800 people died from this catastrophe.
In 1971 in Iraq around 100,000 tons of grain intented for planting was treated with methylmercury as a fungicide. This grain was then used to bake bread instead. This resulted in thousands of hospitalizations and atleast 400 deaths.

Key Points

Mercury has no physiological role in humans. All of its different forms have toxic risks.
Elemental, inorganic, and organic mercury compounds have very different pharmacology and toxicological effects.
Organic mercury can readily cross the placenta and blood brain barrier. Compounds like methylmercury can have profound effects on the neurological development of fetuses and children.
Methylmercury is accumulating in our water, largely from burning coal. This mercury bio-accumulates up the food chain. Apex predators can develop very high mercury levels as a result.
Pregnant women, woman of childbearing age, and young children should avoid the consumption of apex ocean predators. Consumption of other fish should be limited to < 12 oz a week in these at-risk groups.

References

Young-Jin Sue. Mercury. Chapter 95. Goldfrank’s Toxicological Emergencies, 11th Ed. 2019
Harada M. Minamata disease: methylmercury poisoning in Japan caused by environmental pollution. Crit Rev Toxicol. 1995
Mercury and Health. WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/mercury-and-health
Minamata Convention on Mercury. Available at: https://www.mercuryconvention.org/
Wikipedia. Mercury, Mercury Poisioning, Mad as a hatter, Minamata disease, Minimata convention, Karen Wetterhahn.

Summary

Lead is a dense elemental metal utilized by humans for possibly over 8,500 years. This toxic material has no known biological function in human physiology. It is particularly harmful to the brain, peripheral nervous system, blood, gastrointestinal tract, reproductive organs, mental health, and essentially every other major organ system.

Morbidity and Mortality

At very high exposure levels (usually > 100 ug/dL BLL), lead can cause seizures, coma, and death via cerebral edema. However low levels of lead exposure (> 5 ug/dL BLL) over time are really the bigger concern. Even low levels of lead have been shown to lower IQ and cause behavioral disturbances. 815 million children worldwide are believed to have dangerously high lead levels, 500,000 a which reside in the United States. An estimated 900,000 adults are killed every year from lead poisoning. Worldwide, lead may account for as much as 1% of the global burden of disease.

Story Time

Roman aristocratic society made a sweetener called sapa, a grape syrup simmered in lead containers. Many historians believe that extensive use of sapa, reduced the IQ of the ruling class, likely contributing to the fall of the empire. Before 1976 and 1978, lead was routinely added to gasoline and household paint in the United States. Blood lead levels (BLL) decreased from 12.8 ug/dL to 0.82 ug/dL over the 35 years following federal regulations banning lead additives in individuals age 1 to 74 years. This likely resulted in the average IQ increasing between 7 and 12 points.

Key Points

Children are at greatest risk for lead toxicity as they tend to put things in their mouth. Old houses with chipping lead paint are the greatest risk factor. Though blood lead levels have declined dramatically, the CDC and AAP still recommend routine screening in children.
Occupational exposures are the greatest risk factor for lead poisoning in adults. Lead smelters, constructions workers, automotive radiator repairmen, firing range instructions, battery manufacturers, lead abatement workers, and metal workers are at greatest risk.
The CDC has steadily decreased their definition of elevated blood levels from < 60 ug/dL to < 5 ug/dL over the past 60 years. There is no safe lead level.
Blood lead levels are currently the best screening and diagnostic test for lead poisoning. Most lead is absorbed into the bone and can leach out into the body over decades. In the future, we will likely judge cumulative exposure by looking at bone lead levels.
Removing the lead exposure is the most important treatment. At BLL > 45 in children and > 70 in adults, chelation therapy with substances like dimercaptal, CaNa2 EDTA, and succimer are both recommended and efficacious.

References

Calello and Henretig. Ch. 93. Lead. Goldfranks Toxicology, 11th Ed. 2019
Burki. Report says 815 million children have high blood lead levels. Lancet. 2020.
Dignam, Kaufmann, LeStourgeon, & Brown. Control of Lead Sources in the United States, 1970-2017: Public Health Progress and Current Challenges to Eliminating Lead Exposure. Journal of public health management and practice. 2019.
Wikipedia: Lead, lead poisoning
WHO. Lead, Assessing the Environmental Burden of Disease. Available at: https://www.who.int/quantifying_ehimpacts/publications/9241546107/en/#:~:text=It%20is%20estimated%20that%20lead,exposure%20to%20lead%20is%20required.

Lecture Summary

2020 was a crazy year. I learned so much and hope that every single public official has as well. This episode will be the final post of season 1. Episode 29 represents the authors opinion and will provide no medical knowledge. Join me on this more controversial than normal episode!

Key Points

COVID19 Pandemic Lessons

Society must distinguish between war time and peace time in the event of crisis. Wartime rules during peacetime was not well received in 2020.
Society is upside down. We invest no money, time, or effort in our youth. We close schools while strip clubs remain open.
United States citizens have become profoundly unhealthy, making us more susceptible to the infection.
We were/are greatly un-prepared from a disaster standpoint. Planning, training, and communication were all lacking.
Pandemics should be handled aggressively and decisively from the onset. The middle ground, which most of the world took, was a bad strategy.
More young people in power are needed. Every public official does not need to be 80. Minds this old are just not at the top of their game. I believe that 80-year-olds would make better consultants as opposed to ultimate policy makers.

General Lessons

Processed food has taken over the American diet and over half of us are now obese.
Hazardous chemicals and pollution represent the greatest modifiable threat to the health and the future of the human species.
Social media and artificial intelligence algorithms need regulation urgently.
Pharmaceuticals are a second line therapy in many chronic diseases. We need the healthcare industry to start acting this way.
Space exploration is exploding and extraterrestrial manufacturing practices may inform earth from a sustainability standpoint in the future.
Season 2 of full scope will focus more on travel, occupational, wilderness, and aerospace medicine. Shorter episodes, focused topics, and more stories will be a hallmark.

References

My experience living through the last year.

Lecture SummarymRNA, or messenger RNA, tells biological cells how to construct proteins from the code (genes) contained in our DNA. Using synthetic mRNA, multiple organizations have created vaccines that are very effective against COVID19 infection and very safe. The pace of progress has been extraordinary. Join me in learning about this new incredible technology as well as the results of two pandemic-breaking phase 3 clinical trials.

Key Points- On January 12, 2020 the Chinese CDC released the genome sequence of the SARs CoV-2 virus.
- The spike protein on the outside of the Covid viral particle was already identified as a good potential vaccination target from the SARs CoV-1 epidemic (Severe Acute Respiratory Syndrome 1).
- The COVID19 pandemic declared March 11, 2020 by the WHO, 9 months later we are getting vaccinated.
- 57 vaccine candidate where either in or finished with clinical trials as of Dec, 2020
- Since the 1990s, mRNA vaccines have been on the drawing board
- The first successful mRNA vaccines have now been produced and are being used against SARs CoV2 with 95% efficacy. The mRNA is contained in lipid nanoparticles.
- Side effects have been minimal
- The phase 3 clinical trials from the BNT162b2 (Pfizer) and mRNA-1273 will be discussed.
- Normally vaccines take 10 to 15 years to develop. New vaccines in < 1 year, using brand new technology is an insane accomplishment!
- Honor this extraordinary scientific work by getting the vaccine, stopping the pandemic, and resuming normal life.

References- Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Pérez Marc G, Moreira ED, Zerbini C, Bailey R, Swanson KA, Roychoudhury S, Koury K, Li P, Kalina WV, Cooper D, Frenck RW Jr, Hammitt LL, Türeci Ö, Nell H, Schaefer A, Ünal S, Tresnan DB, Mather S, Dormitzer PR, Şahin U, Jansen KU, Gruber WC; C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020 Dec 31;383(27):2603-2615.
- Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, Diemert D, Spector SA, Rouphael N, Creech CB, McGettigan J, Kehtan S, Segall N, Solis J, Brosz A, Fierro C, Schwartz H, Neuzil K, Corey L, Gilbert P, Janes H, Follmann D, Marovich M, Mascola J, Polakowski L, Ledgerwood J, Graham BS, Bennett H, Pajon R, Knightly C, Leav B, Deng W, Zhou H, Han S, Ivarsson M, Miller J, Zaks T; COVE Study Group. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2020 Dec 30.
- https://www.fda.gov/media/142749/download
- WHO BNT162b2 Info. WHO-2019-nCoV-vaccines-SAGE_evaluation-BNT162b2-2020.1-eng.pdf
- Huang, Y., Yang, C., Xu, Xf. et al. Structural and functional properties of SARS-CoV-2 spike protein: potential antivirus drug development for COVID-19. Acta Pharmacol Sin 41, 1141–1149 (2020)
- Wikipedia. Transcription, translation, Asian Palm Civet, SARs CoV-1, Bell’s Palsy,
- https://www.cdc.gov/sars/about/faq.html
- NIH. Clinical Research Trials and You. https://www.nih.gov/health-information/nih-clinical-research-trials-you/basics
- https://www.fda.gov/patients/drug-development-process/step-3-clinical-research

Lecture Summary

Vaccines are biological tools used to educate our acquired immune system. They have allowed for the prevention of numerous infectious diseases within populations throughout the world. Additionally, they have made it possible to eradicate diseases on a global scale. I believe that vaccines are the greatest clinical medicine advancement ever made. We depend on these biological tools for a modern life. Sadly, they are currently under attack, mostly from loud voices making scientifically baseless claims. Currently available vaccines prevent millions of deaths and hundreds of millions from suffering every single year.

Key Points

In 2020, there are vaccines available for the prevention of 27 infectious diseases in the United States. Most are highly efficacious.
Worldwide there are vaccines available for the prevention of an additional 5 or so diseases. Namely malaria, ebola, dengue, tick-borne encephalitis, and hepatitis E.
Vaccines against at least 30 additional diseases are currently in the pipeline for development.
While some vaccines (eg Anthrax) can be dangerous and have common side effects, all vaccines currently recommended for routine use in children and adults are exceptionally safe.
Vaccines come in different forms. These include inactivated whole organisms, live-attenuated, subunit (single or multiple antigens), subunit-conjugated, toxoid, heterotypic, mRNA, and other experimental designs.
Vaccines prevent infection in individuals. When enough people in a population are vaccinated, communicable diseases cannot effectively spread, thereby offering what is called “herd immunity”.
There are very few contraindications to routine vaccinations.
A history of severe allergic reaction to any vaccine or component within a vaccine is the most common (exceedingly rare) contraindication.
Live attenuated vaccines are contraindicated in pregnancy and certain types of immunodeficiency.
Titers are a good way to check for immunity if vaccination status is unknown.
Everybody needs to get back on board with vaccines. They are essential for modern life and will be needed to save us from current and future pandemics.

References

CDC. Vaccines schedules: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html;
CDC. Vaccine Information Statements. https://www.cdc.gov/vaccines/hcp/vis/index.html
CDC. Diarrhea global killer. https://www.cdc.gov/healthywater/pdf/global/programs/Globaldiarrhea508c.pdf
WHO. Vaccine recommendations by country: https://apps.who.int/immunization_monitoring/globalsummary
WHO. Individual vaccine pages. Eg. https://www.who.int/news-room/q-a-detail/poliomyelitis-vaccine-derived-polio
Wikipedia.org – Vaccines, pages for diseases prevented by vaccines, pages for individual vaccines.
Uptodate.com – Childhood vaccines, Adult vaccines, Pages for individual vaccines.

Lecture SummaryThe goal of the medical community is the eradication of communicable infectious diseases. Vaccines have given us the tools necessary to create such a disease-free future. Following complete eradication, vaccinations actually become unnecessary, as with smallpox. However new human diseases are a constant threat. In fact, this threat has never been greater. More pandemics will come that may be more deadly than COVID-19. We need to be ready and be on the lookout constantly.

Key Points
- Smallpox virus (Variola major) formerly killed about 30% of people infected and is thought to have killed 500 million people in its last 100 years of existence, before eradication in 1977.
- Emerging infectious disease are broadly defined as diseases that have recently increased in prevalence or possibly could in the near future.
- Completely new, previously unknown disease are also considered emerging.
- Most new disease come from animal reservoirs
- Diseases that infect humans from animal reservoirs can be dangerous as humans often lack immunity. Our bodies are caught off guard and lack defenses.
- When pathogens obtain mutations, that allow them to spread from human to human, epidemics and even pandemics can occur. This is a dangerous cascade of mutations.
- The prevalence of humans on earth along with our constant encroachment into the natural world, make the possibility of new diseases more likely than ever.
- Feeding our large populations with meat has also led to increased animal production. Chickens, pigs, cattle, and other livestock can harbor disease, become infected with diseases from wild animal populations, that may then potentially spread to humans.
- Many of our most intelligent minds were aware of the danger of truly novel infectious diseases prior to the COVID19 pandemic.
- Many of these scientists had been sounding alarm bells for years.
- The new mRNA vaccines used to combat COVID19 were first conceptualized in the 1990s. Such vaccines were meant to speed up the novel vaccine production pipeline, in anticipation of future epidemics and pandemics.
- Scientists and public health officials are being attacked right now. These individuals will save us from much more devastating pandemics in the future. This attack on science needs to stop, or we will pay dearly in the future!

References- Vourc'h, G., Bridges, V. E., Gibbens, J., De Groot, B. D., McIntyre, L., Poland, R....Barnouin, J. (2006). Detecting Emerging Diseases in Farm Animals through Clinical Observations. Emerging Infectious Diseases, 12(2), 204-210.
- USDA. National H5/H7 Avian Influenza Surveillance Plan. Available at: https://www.aphis.usda.gov/animal_health/downloads/animal_diseases/ai/surveillance-plan.pdf
- CDC. Understanding and Explaining mRNA COVID-19 Vaccines. Available at: https://www.cdc.gov/vaccines/covid-19/hcp/mrna-vaccine-basics.html
- McArthur DB. Emerging Infectious Diseases. Nurs Clin North Am. 2019 Jun;54(2):297-311. doi: 10.1016/j.cnur.2019.02.006. Epub 2019
- Moore ZS, Seward JF, Lane JM. Smallpox. Lancet. 2006 Feb 4;367(9508):425-35.
- Wikipedia. Smallpox, Emerging Infectious Disease, Eradications of Infectious Diseases, Rinderpest, influenza.
- Wolfe ND, Dunavan CP, Diamond J. Origins of major human infectious diseases. Nature. 2007 May 17;447(7142):279-83.

Lecture Summary

The basic reproduction number, R0 (R zero or R naught) is a measurement used in epidemiology focused on the infectivity of a given pathogen. It attempts to predict how many people will become infected by one infected person in the absence of any immunity within a given population. It is not a biological constant and can be affected by human behavior, societal infrastructure, geography, and climate.

Key Points

The basic reproduction number is not a constant, It depends on time, location, and can change based on the particular mathematical model used for calculation.
R0 is not based on time in anyway. An individual infected with HIV has their entire life to spread the virus. On the contrary, someone with COVID19 has only about a week.
The most important number regarding R0 is 1. If the R0 is above 1, the infection will spread. If R0 is below one, the infection will eventually die off.
Humans can alter the R0 of an infection with behavior, the goal is almost always to lower the number to < 1.
Infections are spread in different ways. Examples include aerosol generation, respiratory droplets, contact with body fluids, and the fecal to oral route.
Various infection control measures are utilized in the healthcare setting to combat these including masks, gloves, gowns, and other barrier protections.
Many of the infections with the highest R0 values have effectively been vaccinated out of our populations. Examples include measles, chickenpox, mumps, rubella, pertussis, and smallpox. We have forgotten the morbidity and mortality associated with these infections in a matter of decades.
Let’s compare Measles, HIV/AIDs, and SARs CoV-2 with regard to basic reproduction number. Listen to the show for this!
This is the first of a 4 part series, that will also cover smallpox, emerging infectious diseases, basic vaccine design, and the new messenger RNA. Saddle up!

References

van den Driessche P. Reproduction numbers of infectious disease models. Infect Dis Model. 2017;2(3):288-303. Published 2017 Jun 29. doi:10.1016/j.idm.2017.06.002
Delamater PL, Street EJ, Leslie TF, et al. Complexity of the Basic Reproduction Number (R0). Emerging Infectious Diseases. 2019;25(1):1-4. doi:10.3201/eid2501.171901.
Katul GG, Mrad A, Bonetti S, Manoli G, Parolari AJ (2020) Global convergence of COVID-19 basic reproduction number and estimation from early-time SIR dynamics. PLOS ONE 15(9): e0239800. https://doi.org/10.1371/journal.pone.0239800
Wikipedia, Basic Reproduction Number, Measles, COVID19, HIV
CDC, transmission based precautions. Available at: https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html
Tanne Janice Hopkins. Measles cases and deaths are increasing worldwide, warn health agencies BMJ 2020; 371 :m4450

Lecture SummaryPneumoconioses are fibrotic interstitial lung diseases caused by the inhalation of inorganic mineral dusts. Occupational exposure to asbestos, silica, and coal over many years are the most common causes. Sadly, this preventable disease is on the rise world-wide and no targeted treatments exist.

Key Points- Lung diseases are very common in the workplace and include occupational asthma, COPD, Metal-induced lung injury, acute inhalation injuries, bronchiolitis obliterans, hypersensitivity pneumonitis, tumor formation, as well as other diseases.
- Pneumoconiosis is caused by the inhalation of inorganic mineral dusts, often over many years.
- Those effected develop a fibrotic interstitial lung disease that is progressive.
- Pneumoconiosis is increasing worldwide, particularly in developing nations. It is thought to kill approximately 250,000 people every year.
- Crystalized silica, asbestos, coal, graphite, kaolin, diatomatious earth, aluminum oxide, nylon floc, talc, and mica are all known culprits.
- Silicosis is the most common cause. Silicon dioxide makes up 60% of earth’s crust.
- Generally, disease takes years to develop, but can occur more acutely over months to years.
- Dry cough and progressive shortness of breath are the most common symptoms
- Chest xray are often used for surveillance of disease in workers. The International Labor Organization has published standards to guide readers. CTs are more sensitive for disease and should be pursued following any diagnosis.
- Prevention with engineering and environmental controls, personal protective equipment, and medical surveillance is key.
- No treatment exists in 2020. Treatment is supportive with oxygen, improved physical fitness, and lung transplant in severe cases. Research is being done on antifibrotic medications.
- Workers should be educated about the dangers of working with respirable minerals as well as the additive negative effects of smoking tobacco.

References- Shi P, Xing X, Xi S, Jing H, Yuan J, Fu Z, Zhao H. Trends in global, regional and national incidence of pneumoconiosis caused by different aetiologies: an analysis from the Global Burden of Disease Study 2017. Occup Environ Med. 2020 Jun;77(6):407-414.
- Drbeen Medical Lectures – Pneumoconiosis. Available at: https://www.youtube.com/watch?v=DVQP4wKN7RQ
- Pulmonary Fibrosis Foundation – Pneumoconiosis: Pulmonary Fibrosis Caused by Occupational Lung Exposures. Available at: https://www.youtube.com/watch?v=k3AQyx3_ElU&t=2739s
- Wikipedia – Pneumoconiosis
- Ladou and Harrison. Occupational & Environmental Medicine: Current Diagnosis and Treatment, 5th Editiona. Balmes. Occupational Lung Diseases. 378 – 382. McGraw Hill. 2007
- Asbestos Contractor/Supervisor Manual. OSHA and EPA. 2015
- NIOSH/CDC B Reader Online Training. https://www.cdc.gov/niosh/learning/b-reader/radiograph/subset2/4.html
- ILO Standard Radiograms 2011
- DeLight and Sachs. Pneumoconiosis. Stat Pearls. 2020. https://www.ncbi.nlm.nih.gov/books/NBK555902/

Lecture SummaryPneumoconioses are fibrotic interstitial lung diseases caused by the inhalation of inorganic mineral dusts. Occupational exposure to asbestos, silica, and coal over many years are the most common causes. Sadly, this preventable disease is on the rise world-wide and no targeted treatments exist.

Key Points- Lung diseases are very common in the workplace and include occupational asthma, COPD, Metal-induced lung injury, acute inhalation injuries, bronchiolitis obliterans, hypersensitivity pneumonitis, tumor formation, as well as other diseases.
- Pneumoconiosis is caused by the inhalation of inorganic mineral dusts, often over many years.
- Those effected develop a fibrotic interstitial lung disease that is progressive.
- Pneumoconiosis is increasing worldwide, particularly in developing nations. It is thought to kill approximately 250,000 people every year.
- Crystalized silica, asbestos, coal, graphite, kaolin, diatomatious earth, aluminum oxide, nylon floc, talc, and mica are all known culprits.
- Silicosis is the most common cause. Silicon dioxide makes up 60% of earth’s crust.
- Generally, disease takes years to develop, but can occur more acutely over months to years.
- Dry cough and progressive shortness of breath are the most common symptoms
- Chest xray are often used for surveillance of disease in workers. The International Labor Organization has published standards to guide readers. CTs are more sensitive for disease and should be pursued following any diagnosis.
- Prevention with engineering and environmental controls, personal protective equipment, and medical surveillance is key.
- No treatment exists in 2020. Treatment is supportive with oxygen, improved physical fitness, and lung transplant in severe cases. Research is being done on antifibrotic medications.
- Workers should be educated about the dangers of working with respirable minerals as well as the additive negative effects of smoking tobacco.

References- Shi P, Xing X, Xi S, Jing H, Yuan J, Fu Z, Zhao H. Trends in global, regional and national incidence of pneumoconiosis caused by different aetiologies: an analysis from the Global Burden of Disease Study 2017. Occup Environ Med. 2020 Jun;77(6):407-414.
- Drbeen Medical Lectures – Pneumoconiosis. Available at: https://www.youtube.com/watch?v=DVQP4wKN7RQ
- Pulmonary Fibrosis Foundation – Pneumoconiosis: Pulmonary Fibrosis Caused by Occupational Lung Exposures. Available at: https://www.youtube.com/watch?v=k3AQyx3_ElU&t=2739s
- Wikipedia – Pneumoconiosis
- Ladou and Harrison. Occupational & Environmental Medicine: Current Diagnosis and Treatment, 5th Editiona. Balmes. Occupational Lung Diseases. 378 – 382. McGraw Hill. 2007
- Asbestos Contractor/Supervisor Manual. OSHA and EPA. 2015
- NIOSH/CDC B Reader Online Training. https://www.cdc.gov/niosh/learning/b-reader/radiograph/subset2/4.html
- ILO Standard Radiograms 2011
- DeLight and Sachs. Pneumoconiosis. Stat Pearls. 2020. https://www.ncbi.nlm.nih.gov/books/NBK555902/

Lecture Summary

Ketamine is a small molecule that works mainly through inhibition of the NMDA receptor in brain and nerve tissue. It has varying effects at different doses and can be used for a number of medical indications including depression, suicidal ideation, acute and chronic pain, sedation, and anesthesia. Ketamine is a very safe drug when used intermittently and appropriately. However, it can cause both harm and addiction. Many clinicians fear ketamine. This fear is misplaced as ketamine is very forgiving in the clinical setting and safer than other alternatives like opiates.

Key Points

Ketamine is a derivative of phencyclidine (PCP) and because it causes much less agitation, aggressive behavior, and sympathomimetic symptoms, it has enjoyed wide-spread and sustained clinical use.
Ketamine primarily acts as an inhibitor of the NMDA receptor. However, it has effects at a number of other targets including multiple opioid receptors. Ketamine also inhibits the reuptake of multiple neurotransmitters including serotonin, norepinephrine, and dopamine.
Ketamine can be used at lower doses for mental health conditions like depression, anxiety, OCD, and suicidal ideation.
NMDA receptors modulate neuronal development, plasticity, and connectivity. The author hypothesizes that acute plasticity afforded by ketamine allows individuals with mental health issues a unique opportunity to leave negative thought patterns and view themselves from a different level of consciousness.
Ketamine’s effectiveness in treating both acute and chronic pain makes it very desirable.
At higher doses, ketamine causes sedation with preserved respiratory function. This makes it ideal for resource limited settings.
Ketamine can cause a number of side effects. Most notably an emergence reaction some people experience when waking up from dissociative or sedative doses of ketamine.
This emergence reaction can be effectively treated by limiting sensory stimulation and administration of benzodiazepines like lorazepam. Alpha antagonists like clonidine and antihistamines like hydroxyzine may also be helpful. Avoiding antipsychotics in this setting is recommended by some due to the risks of dystonic reactions.
Ketamine can also cause hematuria, bladder, and urinary tract dysfunction. Particularly with frequent illicit use.
Memory impairment and depressive symptoms also can occur with chronic use.
Fatalities from ketamine toxicity are almost unheard of. The LD50 in mice was 600 mg/kg. However, accidents can certainly occur and be fatal in recreational use.
There is a lot of controversy regarding a number of Ketamine’s effects. For instance, is ketamine neuroprotective in trauma? What is its effect on seizures at lower doses? Does Ketamine raise intercranial pressure? Ketamine can cause hypotension, hypertension, tachycardia, and bradycardia. Its action at multiple receptors, dose dependent effects, and the heterogeneity of human subjects likely explains a lot of this controversy.
Ketamine’s proven safety record, low cost, unique clinical properties, multiple uses, as well as its ability to provide full anesthesia without significant respiratory depression, make it an absolute must have, in resource poor settings.

ReferencesSee Part 2 Notes

Lecture Summary

Ketamine is a small molecule that works mainly through inhibition of the NMDA receptor in brain and nerve tissue. It has varying effects at different doses and can be used for a number of medical indications including depression, suicidal ideation, acute and chronic pain, sedation, and anesthesia. Ketamine is a very safe drug when used intermittently and appropriately. However, it can cause both harm and addiction. Many clinicians fear ketamine. This fear is misplaced as ketamine is very forgiving in the clinical setting and safer than other alternatives like opiates.

References- Olson KR et al. Poisoning and drug Overdose, 6th ed. Arminian P. Phencyclidine and Ketamin. 2012. McGraw Hill. 325-327
- Nelson LS et al. GoldFrank’s Toxicological Emergencies, 11th ed. Olmedo RE. Phencyclidine and Ketamin, chapter 83. 2019. McGraw Hill. 1210-1221. (NMDA receptor information from other chapters as well)
- George D et al. Pilot randomized controlled trial of titrated subcutaneous ketamine in older patients with treatment-resistant depression. Am J Geriatr Pscychiatry. 2017; 25(11): 1199-1209.
- Murrough JW et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013; 170(100): 1134-1142.
- Rodriguez CI et al. Randomized controlled crossover trial of ketamine in obsessive-compulsive disorder: proof-of-concept. Neuropsychopharmacology. 2013; 38:2475-2483.
- Michelet D et al. Ketamine for chronic non-cancer pain: A meta-analysis and trial sequential analysis of randomized control trials. Eur J Pain. 2018; 22:632-646.
- Price RB et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014; 31(4): 335-343.
- Lapidus KAB et al. A randomized controlled trial of intrasal ketamine in major depressive disorder. Biol Pscyhiatry. 2014; 76(12): 970-976.
- Zanos P, Gould TD. Mechanisms of Ketamine Action as an Antidepressant. Mol Psychiatry. 2018; 23(4): 801-811.
- Orhurhu VJ et al. Ketamine Toxicity. StatPearls. 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541087/
- Wikipedia – Ketamine, Enantiomers, NMDA, etc.

Lecture SummaryKetamine is a small molecule that works mainly through inhibition of the NMDA receptor in brain and nerve tissue. It has varying effects at different doses and can be used for a number of medical indications including depression, suicidal ideation, acute and chronic pain, sedation, and anesthesia. Ketamine is a very safe drug when used intermittently and appropriately. However, it can cause both harm and addiction. Many clinicians fear ketamine. This fear is misplaced as ketamine is very forgiving in the clinical setting and safer than other alternatives like opiates.

Key Points- Ketamine is a derivative of phencyclidine (PCP) and because it causes much less agitation, aggressive behavior, and sympathomimetic symptoms, it has enjoyed wide-spread and sustained clinical use.
- Ketamine primarily acts as an inhibitor of the NMDA receptor. However, it has effects at a number of other targets including multiple opioid receptors. Ketamine also inhibits the reuptake of multiple neurotransmitters including serotonin, norepinephrine, and dopamine.
- Ketamine can be used at lower doses for mental health conditions like depression, anxiety, OCD, and suicidal ideation.
- NMDA receptors modulate neuronal development, plasticity, and connectivity. The author hypothesizes that acute plasticity afforded by ketamine allows individuals with mental health issues a unique opportunity to leave negative thought patterns and view themselves from a different level of consciousness.
- Ketamine’s effectiveness in treating both acute and chronic pain makes it very desirable.
- At higher doses, ketamine causes sedation with preserved respiratory function. This makes it ideal for resource limited settings.
- Ketamine can cause a number of side effects. Most notably an emergence reaction some people experience when waking up from dissociative or sedative doses of ketamine.
- This emergence reaction can be effectively treated by limiting sensory stimulation and administration of benzodiazepines like lorazepam. Alpha antagonists like clonidine and antihistamines like hydroxyzine may also be helpful. Avoiding antipsychotics in this setting is recommended by some due to the risks of dystonic reactions.
- Ketamine can also cause hematuria, bladder, and urinary tract dysfunction. Particularly with frequent illicit use.
- Memory impairment and depressive symptoms also can occur with chronic use.
- Fatalities from ketamine toxicity are almost unheard of. The LD50 in mice was 600 mg/kg. However, accidents can certainly occur and be fatal in recreational use.
- There is a lot of controversy regarding a number of Ketamine’s effects. For instance, is ketamine neuroprotective in trauma? What is its effect on seizures at lower doses? Does Ketamine raise intercranial pressure? Ketamine can cause hypotension, hypertension, tachycardia, and bradycardia. Its action at multiple receptors, dose dependent effects, and the heterogeneity of human subjects likely explains a lot of this controversy.
- Ketamine’s proven safety record, low cost, unique clinical properties, multiple uses, as well as its ability to provide full anesthesia without significant respiratory depression, make it an absolute must have, in resource poor settings.

See References In Part 2 Notes

Lecture SummaryThis podcast talks about disaster preparedness, how to prepare, the initial assessment, and the importance of reflection for constant improvement.

Key Points- We are not prepared for disasters and emergencies. COVID19 made this very clear.
- Preparing requires thinking through possible emergency scenarios, developing algorithms, training, gathering supplies, and periodically re-training.
- The initial assessment represents an algorithm which can be used when responding to any emergency involving human casualties.
- Having a written initial assessment and practicing its use is highly encouraged.
- The acronym SAD LAB CATS describes the algorithm I use in my initial assessment.
- It stands for scene safety, additional resources, disease protection, level of consciousness, airway, breathing, circulation, arterial bleeds, temperature, and spine.
- Reflection following any emergency or disaster is key to improving outcomes in the future.

References
I have learned so much about this topic through wilderness first aid/responder courses, my emergency medical technician training and work, advanced wilderness life support, as well as my work in the hospital setting. I have read numerous sources including but not limited to The American Red Cross Wilderness and Remote First Aid Handbook, Auerbach's Wilderness Medicine, Wilkerson's Medicine for Mountaineering, Prehospital Care textbook through St. Louis Community College, and so many other books on the subject I have read throughout the years. However, most of this podcasts comes from personal experience.

Lecture SummaryKeeping your brain healthy pays dividends. It can also help prevent dementia down the road. Join me on an interesting discussion regarding how to keep your brain working optimally for years and years.

Key Points- exercise your brain, think and challenge yourself mentally constantly.
- exercise your body, this has been well studied and will help prevent dementia
- eat good food
- get adequate sleep
- avoid illicit and pharmaceutical medications that impair thinking. If used long term these will predispose you to dementia.
- have a purpose and give back
- engage with other people and society.
- protect your eyes, ears, and other senses

References- Cabral et al. Exercise for Brain Health: An Investigation into the Underlying Mechanisms Guided by Dose. Neurotherapeutics. 2019.

Erickson et al. Physical Activity, Brain Plasticity, and Alzheimer Disease. Archives of Medical Research. 2012.
Blackwell, L., Dweck, C., & Trzesniewski, K. (2002). Achievement across the adolescent transition: A longitudinal study and an intervention. Manuscript in preparation.
Dweck, C., & Leggett, E. (1988). A social-cognitive approach to motivation and personality. Psychological Review, 95,256-273.
Wikipedia. dementia, donepezil, memantine, blue zone.
Uptodate. Evaluation of Cognitive Impairment in Adults and Treatment of Dementia.
Montreal Cognitive Assessment. Available at (https://www.parkinsons.va.gov/resources/MOCA-Test-English.pdf)
Sirishinha Stitaya. The potential impact of gut microbiota on your health: Current status and future challenges. Asian Pac J Allergy Immunol. 2016.
Veerman et al. Television viewing time and reduced life expectancy: a life table analysis. BMJ. 2012.
Ray et al. Dementia and hearing loss: A narrative review. Maturitas. 2019.

Lecture SummaryMany new cancer drugs have marginal benefit or do not work at all. Their prices are obscenely high. Sadly, like the idiots we are, we pay for them. This podcast reviews the first chapter of Vinayak Prasad's book Malignant. The first chapter is a must read for any physician and the entire book is fantastic.

Key Points
- Fojo et al performed an analysis of 71 consecutive drugs from 2002 to 2014 used for solid tumors like breast and colon cancer. They found that the median improvement in survival was just 2.1 months.
- New cancer drugs in 2015 cost an average of 100,000$ per year of treatment.
- Drug companies are making obscene amounts of money on drugs that do not work.
- The price of cancer medications in no way reflects how well they work.
- American healthcare has completely lost its way!

References
- Prasad, VK. Malignant: How Bad Policy and Bad Evidence Harm People with Cancer. Johns Hopkins University Press. 2020.
- Fojo et al. Unintended consequences of expensive cancer therapeutics-the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity. JAMA Otolaryngologists. 2014.

Lecture SummaryThis 2 part series will discuss what to eat for weight loss, wellness, as well as improving and sometimes even curing chronic medical conditions. The ideas around diet are simple! Staying on a diet long term is the difficult part.

Key Points- Avoid eating or try to severly limit consumption of fast food, sugar, unhealthy fats, fried foods, and simple carbohydrates like white bread and white rice.
- Eat a diet rich in raw vegetables and fruits. Shoot for a rainbow of different colors. Add in nuts and seeds for additional nutrients. This should be the cornerstone of any healthy diet.
- Try and get most of your protein from plant based sources like beans, legumes, nuts, seeds, and soy.
- Limit meat intake. Shoot for 2 to 5 meals a week with meat or avoid entirely. Enjoy high fat steaks or processed meats like bacon, only on rare-special occasions.
- Very strict diets like the Ornish diet can improve and sometimes even cure chronic medical conditions like morbid obesity, type 2 diabetes, heart disease, depression, Alzheimers, and low grade prostate cancer.
- Lifestyle changes like those utilized in the Undo It program (Ornish.com) should be the cornerstone of chronic disease treatment. Pharmaceutical medications can be important, but should be discussed after or alongside lifestyle changes in most instances.

References- Tuso PJ. Nutritional Update for Physicians: Plant-Based Diets. Perm J. 2013

Ornish et al. INTENSIVE LIFESTYLE CHANGES MAY AFFECT THE PROGRESSION OF PROSTATE CANCER. J. of Urology. 2005
Ornish et al. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998
Frattaroli et al. Angina Pectoris and Atherosclerotic Risk Factors in the Multisite Cardiac Lifestyle Intervention Program. Am J of Cardiology. 2008
Silberman et al. The Effectiveness and Efficacy of an Intensive Cardiac Rehabilitation Program in 24 Sites. Am J of Cardiology. 2009
Pischke et al. Lifestyle Changes are Related to Reductions in Depression in Depression in Persons with Elevated Coronary Risk Factors. Psychology and Health. 2010.

Lecture SummaryThis 2 part series will discuss what to eat for weight loss, wellness, as well as improving and sometimes even curing chronic medical conditions. The ideas around diet are simple! Staying on a diet long term is the difficult part.

Key Points- Combine dietary changes with exercise, stress reduction, and social support for the best chance of long term success. Love yourself and let the good food you put in your body be a manifestation of that love.
- The best diet for any person is the diet they can stick to.
- Reducing the total number of calories consumed over long periods of time will lead to weight loss.
- GMOs are not intrinsically harmful. However, what companies have actually done with GMOs is. This is why I try and eat mostly organic foods when avaialable.
- Processed foods are often high in sugars, salt, fat, and calories. They are designed to keep us wanting more. Say no to cheap, high-calorie, low-nutrient, processed foods.

References- Tuso PJ. Nutritional Update for Physicians: Plant-Based Diets. Perm J. 2013

Ornish et al. INTENSIVE LIFESTYLE CHANGES MAY AFFECT THE PROGRESSION OF PROSTATE CANCER. J. of Urology. 2005
Ornish et al. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998
Frattaroli et al. Angina Pectoris and Atherosclerotic Risk Factors in the Multisite Cardiac Lifestyle Intervention Program. Am J of Cardiology. 2008
Silberman et al. The Effectiveness and Efficacy of an Intensive Cardiac Rehabilitation Program in 24 Sites. Am J of Cardiology. 2009
Pischke et al. Lifestyle Changes are Related to Reductions in Depression in Depression in Persons with Elevated Coronary Risk Factors. Psychology and Health. 2010.

Lecture SummaryThis podcasts reviews all of prenatal care and recommendations for how pregnant woman can stay safe during pregnancy. Much of this episode is based on my own personal practice. So much of pregnancy care is based on the current standard of care, expert opinion, and "what we have always done". More clinical trials are needed to find out what parts of prenatal care are important and what parts may be causing harm.

Topics/Key Points- Pre-pregnancy
- Getting pregnant
- Finding out babies due date
- 1st prenatal visit
- Ongoing screenings throughout pregnancy
- Pregnancy medical visits
- Genetic testing
- Vaccines during pregnancy
- Later screenings
- RhD negative moms
- When to go to the hospital to have a baby
- Diet during pregnancy
- Foods to avoid in pregnancy
- Exercise
- Sexual intercourse
- Activities to Avoid

References
- Pope et al. Sugar substitutes during pregnancy. Can Fam Physician. 2014.
- Heuser C. Seafood, Spas, & Sandwiches presentation. University of Utah, Maternal Fetal Medicine. Available online.
- Weihe and Grandjean. Cohort studies of Faroese children concerning potential health effects after the mothers' exposure to marine contaminants during pregnancy. Acta Vet Scand. 2012.
- Golding et al. ALSPAC--the Avon longitudinal study of parents and children. I. Study methodology. Paediatr Perinat Epidemiol. 2001.
- CDC. About teen pregnancy. Available online: https://www.cdc.gov/teenpregnancy/about/index.htm - CDC. Pregnancy rates for US women continue to drop. Available online: cdc.gov/nchs/products/databriefs/db136.htm.
- Association for Safe International Road Travel. Road safety facts. Available online: https://www.asirt.org/safe-travel/road-safety-facts/#:~:text=Annual%20United%20States%20Road%20Crash,enough%20to%20require%20medical%20attention. - wikipedia.org, postpartum depression
- wikipedia.org, mercury in fish
- Keulen et al. Induction of labour at 41 weeks versus expectant management until 42 weeks (INDEX): multicentre, randomized non-inferiority trial. BMJ. 2019.
- uptodate.com, nutrition in pregnancy
- Jackson et al. Listeriosis outbreaks associated with soft cheeses, United States, 1998-2014. Emerg Inf Dis. 2018.
- Drevets et al. Listeria monocytogenies: epidemiology, human disease, and mechanics of brain invasion. FEMs Immunology and Medical Microbiology. 2008.
- JanakiramanV. Listeriosis in pregnancy: diagnosis, treatment, and prevention. Rev Obstet Gynecol. 2008.

We hear a lot about why healthcare providers are so burned out. Most of the discussion is centered around the horrible systems we work in, medical insurance frustration, loss of provider autonomy, increasing complexity, and long hours. However, another important factor related to provider burnout is our increasingly unhealthy patients who do not take any responsibility for their own health and seam to ask the world of us. In practice, we complain about these people all the time. We cringe when we see them on our schedules. Alarmingly, this group of people appears to be growing, both in size and number! I believe that these patients and the lack of personal responsibility in healthcare is a huge problem. This podcast discusses these issues. It is all based on my opinion and personal experience. I think it will resonate with many of the listeners....assuming anyone is actually listening that is.

Lecture SummaryListeria is a gram positive rod that can cause rare but devastating infections in humans. The young, old, pregnant, and immunocompromised are at highest risk for listeriosis, the disease caused by this ubiquitous environmental bacteria. This podcast will review the basic bacteriology, epidemiology, diagnosis, treatment, and prevention of listeriosis.

Key Points- Listeria is ubiquitous in nature and the gastrointestinal tracts of many animals including humans are often colonized. Most infections are from Listeria monocytogenes, but other listeria can also cause infection.

Invasive infections are rare but carry a high mortality.
Most infections come from food.
Infections in pregnancy are often more mild but can cross the placenta causing fetal demise and neonatal sepsis.
Queso Fresco and other Latin soft cheeses account for the majority of soft cheese related infections and have occurred in both pasteurized and unpasteurized cheeses. Hispanic pregnant woman are disproportionately affected by listeria, likely for this reason.
Listeria should be cultured from sterile body sources like blood, CSF, or placental tissue to confirm infection.
Ampicillin or Penicillin are the first line treatments. Trimethoprim Sulfamethoxazole, meropenum, and even Vancomycin have also gotten the job done.

References

Listeriosis. WHO. Available at https://www.who.int/news-room/fact-sheets/detail/listeriosis

FoodNet 2015 Report. CDC. Available at https://www.cdc.gov/foodnet/pdfs/FoodNet-Annual-Report-2015-508c.pdf

Listeriosis – wikipidia.org

Listeria – uptodate.com

Jackson et al. Listeriosis outbreaks associated with soft cheeses, United States, 1998-2014. Emerg Inf Dis. 2018.

Drevets et al. Listeria monocytogenies: epidemiology, human disease, and mechanics of brain invasion. FEMs Immunology and Medical Microbiology. 2008.

JanakiramanV. Listeriosis in pregnancy: diagnosis, treatment, and prevention. Rev Obstet Gynecol. 2008.

Lecture SummaryIn this podcast I talk about my experiences with adverse drug reactions working as a Hospitalist. I then provide a brief summary of the 2019 American Geriatric Society Beers Criteria. "Beers List" reviews medications which are potentially inappropriate to use in elderly patients.

Key Points
- At least 10% of the patients I admit to the hospital are the direct result of the medications they have been prescribed.
- Bleeding, falls, altered mentation, kidney and electrolyte problems, and overdose are the most common adverse reactions I see in my practice
- The American Geriatric Society publishes a Beers Criteria, every 3 years, to highlight medications that are potentially harmful in elderly patients (> 65 years)
- Avoid mixing multiple medications with strong anticholinergic properties.
- Read this paper if you treat elderly patients!
- I often break these guidelines in my practice, but I try to be aware of potential problems so I can identify adverse reactions quickly and remove culprit medications.

ReferencesBeers Criteria/List. American Geriatric Society. 2019 addition

Lecture SummaryThis podcasts talks about an epidemic in the United States called polypharmacy. This is when a person takes multiple medications and it is becoming an increasing problem in the elderly.

Key Points- The opioid epidemic is still happening
- Polypharmacy occurs when an individual takes 5 or more medications
- Many people are being harmed by the drugs which are meant to help them
- Polypharmacy is one of the biggest ways that healthcare harms people and why iatrogenesis is thought to be the third leading cause of death in the United States.

ReferencesCharlesworth et al. Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988-2010. J Gerontol A Biol Sci Med Sci. 2015.

Morin et al. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018.

Rawle et al. Assocations Between Polypharmacy and Cognitive and Physical Capabilities. J Am Geriatr Soc. 2018.

Fried et al. Health outcomes associated with polypharmcy in community-dwelling older aduls: a systematic reveiew.. J Am Geriatr Soc. 2014.

Wimmer et al. Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review. J Am Geriatr Soc. 2017.

Beers Criteria/List. American Geriatrical Society. 2019 addition

Lecture SummaryThis podcasts reviews obesity epidemiology and comorbidities. It then goes on to discuss obesity under the paradigm of addiction.

Key Points- Obesity is the great pandemic of our time, it is on the rise, and it is disproportionately effecting children.
- Most all of our common and serious health problems are linked in some way to obesity
- The behavior of the obese, sick patients only makes sense to me when viewed through the lens of addiction.
- Healthcare providers, policymakers, and the greater society need to take aggressive action against obesity.
- Loosing weight presents an opportunity to potentially cure serious health issues. We have very few cures in chronic medicine today! This is such a golden opportunity. Providers should never omit discussions regarding obesity, as it is so often the root cause of disease.

References

Adult Obesity Facts. CDC. Available at https://www.cdc.gov/obesity/data/adult.html

Obesity and Overweight. WHO. Available at https://www.who.int/news-room/fact-sheets/detail/obesity-andoverweight#:~:text=Worldwide%20obesity%20has%20nearly%20tripled,years%20and%20older%2C%20were%20overweight.&text=39%25%20of%20adults%20aged%2018,kills%20more%20people%20than%20underweight.

Numerous papers on Pubmed debate the idea of overeating being an addiction. Just type in “food and addiction” on pubmed.com.

Apovian AM. Obesity: definitions, comorbidities, causes, and burden. Am J Managed Care. 2016.

So many papers exist to support the statements in this blog it was hard to pick just a few.

Lecture SummaryLearn about pathological, immature, and mature defense mechanisms in part 2 of the crazy inside all of us!

Key Point- All of us have unacceptable impulses, emotions, desires, and anxieties which would be unacceptable to act upon.
- Our unconscious minds deploy a number of tactics, most notably defense or coping mechanisms to protect our rational minds from these anxiety provoking stimuli.
- Pathological defense mechanisms discussed include delusional projection, denial, and distortion.
- Immature defense mechanisms discussed include idealization, introjection, passive aggressive, withdrawal, social comparisons (racism), regression, acting out, projection, fantasy, somatization, conversion, repression, intellectualization, dissociation, and reaction formation.
- Mature defense mechanisms discussed include altruism, humor, sublimation, and suppression.

References

- First Aid for Step 1, Medical Board Exam Review Book

- Sigmund Freud

- Utah Psych Defense Mechanisms. Available at: http://www.utahpsych.org/defensemechanisms.htm

- DSM5, personality disorder section

- Wikipedia, defense mechanisms

- Personal experience treating and dealing with crazy people

- The crazy inside me

Lecture SummaryThis lecture talks about my opinions and experience treating COVID19 in the outpatient, inpatient, and ICU setting.

Key Points- Public health is always more important than clinical medicine for the health of any population.
- So much information has changed so rapidly regarding COVID19, we need to focus on what really matters.
- Everything about Remdesivir points to a drug that works very poorly or not at all. From my perspective it looks like the manufacturers are delaying the real evidence to try and make big bucks before the truth comes out. I predict no mortality benefit.
- 80s are the new 90s for oxygen saturation. Consider proning patients early and for at least 16 hours a day if tolerated.

ReferencesThis lecture is for the most part based on my opinions and experiences. I do cite a few things in the text. But please take everything in this lecture as mostly my opinion!
- CDC, available at https://www.cdc.gov/coronavirus/2019-ncov/index.html
- WHO, available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=CjwKCAjwsO_4BRBBEiwAyagRTXlcLwmvRu9TKu22ZWDMcoK1zlS_IlUELlb6_1EdUcvuWtpKlJQnmxoCtx4QAvD_BwE
- Beigel et al. Remdesivir RCT. NEJM. 2020
- My experience living through the past 7 months

Lecture SummaryThis podcast reviews the 10 personality disorders listed in the DSM5.

Key Points1. Personality disorders are mental health disorders characterized by maladaptive patterns of behavior present throughout an individuals life. They cannot be explained by substance abuse or other mental health disorders and typically cause serious hardship.
2. They are divided into 3 categories, odd, dramatic, and anxious.
3. Recognizing these personality disorder traits in ourselves and those around us can help us become better people and better providers.

References

- Diagnostic and Statistical Manual of Mental Disorders 1, 2, 3, 4, and 5. American Psychiatric Association.

- Guze S. Criminality and Psychiatric Disorders. Oxford University Press. New York. 1976.

- World Health Organization, Personality Disorders.

- Wikipedia

- Personal experience treating and dealing with crazy people

- The crazy that lives inside me!

Lecture Summary

This four-part podcast reviews all of the current recommendations for preventative screening by the USPSTF. Many key concepts, interesting pearls, and opinions to facilitate discussion will also be included.

Key Points

· Disease prevention is very important and often underutilized

· Recommendations are not static, they are constantly changing due to factors like disease prevalence, tests available, and new research. Doctors should consider reviewing preventative screenings at least every couple years in order to stay current, maybe more.

· “Expert” panels like the USPSTF are often unable to agree with each other. Discordances exist, largely due to insufficient evidence. The pervasive influence of money must always be considered as well when evaluating such discordances.

· Every medical provider should be familiar with the most efficacious screenings. These screening should be discussed with and offered to appropriate patients.

· Stop doing things shown to cause more harm than benefit

· Support more research. If no one is studying something important, consider studying it yourself!

· For patient oriented education, see the corresponding blog post available at WanderMedicine.com.

References

United States Preventative Service Task Force. (https://www.uspreventiveservicestaskforce.org/uspstf/).
United States Preventative Service Task Force. Wikipedia. (https://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force)
CDC Childhood Vaccine Recommendations. (https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html)
Federal Advisory Committee. Recommended Uniform Screening Panels. (https://www.hrsa.gov/advisory-committees/heritable-disorders/rusp/index.html)
Achievement in Public Health, 1900-1999: Healthier Mothers and Babies. MMWR. CDC publication. 1999.
Additional references were utilized and cited orally during the podcast.

Lecture Summary

This four-part podcast reviews all of the current recommendations for preventative screening by the USPSTF. Many key concepts, interesting pearls, and opinions to facilitate discussion will also be included.

Key Points

· Disease prevention is very important and often underutilized

· Recommendations are not static, they are constantly changing due to factors like disease prevalence, tests available, and new research. Doctors should consider reviewing preventative screenings at least every couple years in order to stay current, maybe more.

· “Expert” panels like the USPSTF are often unable to agree with each other. Discordances exist, largely due to insufficient evidence. The pervasive influence of money must always be considered as well when evaluating such discordances.

· Every medical provider should be familiar with the most efficacious screenings. These screening should be discussed with and offered to appropriate patients.

· Stop doing things shown to cause more harm than benefit

· Support more research. If no one is studying something important, consider studying it yourself!

· For patient oriented education, see the corresponding blog post available at WanderMedicine.com.

References

United States Preventative Service Task Force. (https://www.uspreventiveservicestaskforce.org/uspstf/).
United States Preventative Service Task Force. Wikipedia. (https://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force)
CDC Childhood Vaccine Recommendations. (https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html)
Federal Advisory Committee. Recommended Uniform Screening Panels. (https://www.hrsa.gov/advisory-committees/heritable-disorders/rusp/index.html)
Achievement in Public Health, 1900-1999: Healthier Mothers and Babies. MMWR. CDC publication. 1999.
Additional references were utilized and cited orally during the podcast.

Lecture Summary

This four-part podcast reviews all of the current recommendations for preventative screening by the USPSTF. Many key concepts, interesting pearls, and opinions to facilitate discussion will also be included.

Key Points

· Disease prevention is very important and often underutilized

· Recommendations are not static, they are constantly changing due to factors like disease prevalence, tests available, and new research. Doctors should consider reviewing preventative screenings at least every couple years in order to stay current, maybe more.

· “Expert” panels like the USPSTF are often unable to agree with each other. Discordances exist, largely due to insufficient evidence. The pervasive influence of money must always be considered as well when evaluating such discordances.

· Every medical provider should be familiar with the most efficacious screenings. These screening should be discussed with and offered to appropriate patients.

· Stop doing things shown to cause more harm than benefit

· Support more research. If no one is studying something important, consider studying it yourself!

· For patient oriented education, see the corresponding blog post available at WanderMedicine.com.

References

United States Preventative Service Task Force. (https://www.uspreventiveservicestaskforce.org/uspstf/).
United States Preventative Service Task Force. Wikipedia. (https://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force)
CDC Childhood Vaccine Recommendations. (https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html)
Federal Advisory Committee. Recommended Uniform Screening Panels. (https://www.hrsa.gov/advisory-committees/heritable-disorders/rusp/index.html)
Achievement in Public Health, 1900-1999: Healthier Mothers and Babies. MMWR. CDC publication. 1999.
Additional references were utilized and cited orally during the podcast.

Lecture Summary

Full scope is a free medical podcast designed to educate those working or training to work in healthcare. The target audience includes physicians, advanced practice providers, nurses, medical assistants, therapists of all types, students, administrators, and anyone else working in healthcare. However, anyone willing to listen is encouraged to. Education is something we carry with us wherever we go and it is immediately apparent to anyone we communicate with.

The writer and voice of Full Scope is Dr. Bill Brandenburg, a Board Certified, Family Medicine physician.

Bill Practices “full scope” medicine. This means he takes care of adults, children, and obstetric patients both in the acute and chronic care settings. It also means he provides medical care with no or limited input from specialist providers. A Full scope practice is often a necessity in rural areas. However many urban providers may also enjoy a broad scope of practice for a variety of different reasons.

As a full scope provider, one must be knowledgeable about all of medicine. As such, Full Scope will attempt to cover topics relating to every field of medicine. Additionally full scope will cover various topics related to general health, the business of medicine, teamwork, philosophy, and science in general.

This podcast is designed to make you more knowledgable in the applied science of medicine, improve your clinical judgment, and change the way you think about medicine, society, the environment, and the future of mankind.

Key Points

Bill Brandenburg is a Medical Doctor. He works as a rural hospitalist. He also owns and operates a outpatient medical clinic Wander Medicine.
Full Scope is a free podcast, which will cover topics related to health and medicine. It may also cover other topics related to science, business, and philosophy.
The content will be thought provoking and often very controversial. Medicine is bankrupting and killing people. Hard to fix a mess without making things a bit dirtier at the start.
A new episode will be released bi-weekly (approximately). Episodes will typically be 10 – 20 minutes long
Free online medical education has been become a fundamental part of modern medical education.
Thank you so much to the below podcasts. You have done so much for everyone in the medical industry! If you have not been following the below podcasts, strongly consider giving them a listen. Also, consider listening to medical podcasts, which cover content, outside of your scope of practice. Learning from other disciplines will make you much better at your own.
Most medical podcasts currently come from providers working in academic settings. Full Scope comes from a rural community doctor’s point of view. This should provide a new prospective for listeners.
Every podcast episode will have an accompanying patient oriented blog post on our clinic website, wandermedicine.com, under the “blog” tab.
If the podcast or the blog are helpful to you or anyone you know, please share them. We want people to use our knowledge to better the world, just as we have been using knowledge from others to do the same for many years.

Lecture Summary

This four-part podcast reviews all of the current recommendations for preventative screening by the USPSTF. Many key concepts, interesting pearls, and opinions to facilitate discussion will also be included.

Key Points

· Disease prevention is very important and often underutilized

· Recommendations are not static, they are constantly changing due to factors like disease prevalence, tests available, and new research. Doctors should consider reviewing preventative screenings at least every couple years in order to stay current, maybe more.

· “Expert” panels like the USPSTF are often unable to agree with each other. Discordances exist, largely due to insufficient evidence. The pervasive influence of money must always be considered as well when evaluating such discordances.

· Every medical provider should be familiar with the most efficacious screenings. These screening should be discussed with and offered to appropriate patients.

· Stop doing things shown to cause more harm than benefit

· Support more research. If no one is studying something important, consider studying it yourself!

· For patient oriented education, see the corresponding blog post available at WanderMedicine.com.

References

United States Preventative Service Task Force. (https://www.uspreventiveservicestaskforce.org/uspstf/).
United States Preventative Service Task Force. Wikipedia. (https://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force)
CDC Childhood Vaccine Recommendations. (https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html)
Federal Advisory Committee. Recommended Uniform Screening Panels. (https://www.hrsa.gov/advisory-committees/heritable-disorders/rusp/index.html)
Achievement in Public Health, 1900-1999: Healthier Mothers and Babies. MMWR. CDC publication. 1999.
Additional references were utilized and cited orally during the podcast.