2 Docs Talk: The podcast about healthcare, the science of medicine and everything in between.

Kratom doesn't sound like your typical herbal supplement, but it does come with all the issues common to the supplement industry. Namely, it hasn't withstood the test of clinical trials to demonstrate safety and efficacy. 

And that causes problems. 

Problems like not knowing how much of the ingredient is in the supplement, or how much of other ingredients for that matter. Or wht kind of side effects might be evident if it were subjected to randomized placebo-controlled trials. 

But another problem is that it might actually offer a solution to a very big problem—opioid addiction But we don't know if it does because guess what? It hasn't been studied. 

This week, 2 Docs Talk about Kratom and why the regulatory requirements (or absence thereof) on the supplement industry might be causing us to miss out on some real benefits.

If you aren't taking an SSRI yourself, there it's almost certain you know someone who does. Selective Serotoning Reuptake Inhibitors are one of the most commonly prescribed classes of drugs out there.

Is their widespread use earned on the basis of good evidence? It's not clear - let's take a look.

References:

Genetic and clinical predictors of sexual dysfunction in citalopram-treated depressed patients.

Perlis RH, Laje G, Smoller JW, Fava M, Rush AJ, McMahon FJ

Neuropsychopharmacology. 2009;34(7):1819. Epub 2009 Mar 18. 

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Senator McCain has a malignant brain tumor called a Glioblastoma Multiforme, orglioblastoma or GBM for short.

He’s not the first person politically connected to get one of these things. I think this is what Senator Ted Kennedy had back in 2008 and also Beau Biden, Joe Biden’s son died of a glioblastoma.

Glioblastomas are one of a class of brain tumors called Gliomas. Gliomas can be low grade which are considered pre-malginant or pre-cancerous or they can be high grade malignancies such as GBMs.  

Today 2 Docs Talk about Glioblastoma Multiforme, and the difficulties associated with treating - or not treating - the tumor. 

Resources:

Don't Tell John McCain to Fight His Cancer

FDA approval of Optune device for Glioblastoma

2 Docs Talk episode on hospice

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

Resources:

About DSHEA 1994

ER visits due to supplements

Study showing supplement reduces LDL

AMA Ethics Statements on Supplement Sales

Pharmceutical marketing and prescribing habits

This has been a particularly bad year for the flu. More people are getting sicker than in most years. And the vaccine is not working well. 

In this episode, 2 Docs Talk about why the influenza virus circulating this year is causing so many problems. Beware there is a little bit of basic science involved. But not too much.

Resources: 

Our information is from the Centers for Disease Control: https://www.cdc.gov/flu/about/season/current.htm

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

But are the prices hikes all that bad?

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

Resources:

JAMA on Drug Pricing

Our episode on Hep C

Our episode on Alzheimers

Our episode on Pricing Transparency

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

NEJM study on vaccines and autism

Lancet study on vaccines and autism

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

About Cancer vaccines

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

Information on current research into an ebola vaccine

Check out this episode!

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All you have to do is take a quick drive around town to see that low testosterone clinics are all the rage. A little math will tell you why. Males make up around 50 percent of the population, and their testosterone declines, naturally, at a rate of 1 percent per year after age 30. If that decline merits treatment, it’s no wonder those clinics are everywhere.

But, does it merit treatment?

Is testosterone replacement safe?

Is it even effective?

We dig into those questions on this episode of 2 Docs Talk.

Resources

JAMA: Effects of Testosterone on Subclinical Atherosclerosis

Testosterone Reduces Cardiovascular Risk

Testosterone Increases Cardiovascular Risk

FDA Drug Safety Communication on Testosterone

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One of the latest technological advances in food production is the introduction of GMOs, or genetically modified organisms, to the food supply. They have the potential to offer many benefits including increased productivity, pest and herbicide resistance, longer shelf life, and the list goes on.

But many are concerned that this relatively new technology isn’t safe – for health, the environment or the economy. We dig into the evidence surrounding GMOs in this episode. We might even share an opinion or two on whether the crops are just GMOs or Frankenfood.

Resources:

Primer on the retracted study that indicated GMOs caused tumors

How GMOs are tested for safety

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Back pain is second only to cancer as a cause of long term disability. This health problem is damaging to individuals and costly to society. And we don’t have much in our arsenal that is effective at treating it.

This week, we discuss the difference between acute and chronic back pain with regard to treatment and outcomes. We also discuss the role of surgery, medications, alternative therapies, and some interesting new research on what helps resolve chronic back pain.

Resources:

Research on efficacy of epidural steroid injections for back pain

Trends in spinal fusion surgery

American College of Physicians Guidelines for the Treatment of Chronic Low Back Pain

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