Gut Talk

In this podcast episode, Mitch Albom, best-selling author, journalist, and radio and TV broadcaster, discusses how his philanthropy and writing have informed each other, his experiences with doctors as a patient and more.

• Intro :02
• Welcome to this episode of Gut Talk :23
• About Albom :30
• The interview :40
• Where did you grow up? :52
• Why do you think that [less people knowing their neighbors today] has happened? 2:07
• You obviously have had incredibly rich interpersonal relationships that influenced who you became. Are those people that you grew up and interacted with characters in your books? 4:34
• Are there philosophies that you learned as a student or growing up that inform, more than just the characters, but the recurring themes in your books? 7:12
• How did you become such an avid philanthropist? Tell us about that journey. 11:02
• How can we, as we're interacting with young people, help them to understand that it's not just about money? 16:08
• How would you say philanthropy has impacted your writing since Tuesdays with Morrie? 20:16
• What about the reverse? How does writing your books and your stories change your perspective on the lesson you're trying to impart on your readers? 22:29
• About Albom's work in Haiti and introducing his kids to the new orphanage 26:15
• Were there any insights that you gleaned from that experience [recent medical experiences and colonoscopy]? 36:51
• Thank you, Mitch 46:15
• Thanks for listening 46:36

Mitch Albom is a Best-selling author, journalist, and radio and TV broadcaster.

We'd love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc. For more from Mitch Albom, visit mitchalbom.com, saydetroit.org and havefaithhaiti.org.

Disclosures: Albom, Berry and Chey report no relevant financial disclosures.

In this podcast episode, Peter B. Cotton, MD, FRCP, FRCS, professor of medicine at the Medical University of South Carolina, discusses the development and invention of the ERCP procedure, the innovation of digestive disease centers and more.

• Intro :02
• Welcome to this episode of Gut Talk :23
• About Cotton :23
• The interview :37
• Where did you grow up? :37
• How did you get interested in gastroenterology? 1:38
• That [trainees wanting to come to the endoscopy lab and not go to the basic science lab] must have put you in a difficult situation at times. How did you navigate that? 6:12
• Could you tell us a little more about what that was like, from an operational perspective, of overseeing the endoscopy center, and perhaps how that role of operating in an endoscopy center as a trainee impacted you innovation in ER cepheid advanced endoscopy? 7:03
• How flexible is the shaft of those initial endoscopes, and did you use sedation? 8:49
• Is it a correct characterization that the building and innovation and inventions at this early stage in your career was really just to get the job done as opposed to you seeking out a role that was focused on inventing? 9:56
• You were the only gastroenterologist at Middlesex for many years, correct? 10:52
• How did that transition to Duke occur? … Did that [clinical load] drive a lot of your decision-making or was it more than that? 11:50
• Where did the ERCP start? 15:11
• How were you able to collaborate with other gastroenterologists and radiologists and surgeons? …What was that collaboration between these investigators that were really trying to drive this procedure forward like back in the Sixties and Seventies? 20:23
• Were you able to pass endoscopic videos back and forth, or was that not really the way cases were shared? 21:36
• About the Digestive Disorder Center at NUSC and Digestive Diseases Centers 24:43
• Has it worked out the way you had envisioned? … What are the potential downfalls as people think about that type of Digestive Health Center model? 27:43
• Summary of Cotton's memoir, The Tunnel at the End of the Light: My Endoscopic Journey in Six Decades 31:34
• You also have written books for young children as well. What prompted you to writing and teaching one of the most complicated procedures to your book about "Fred the Snake"? 32:10
• What are you most excited about with regards to opportunities facing younger gastroenterologists moving forward, and what advice would you give them to seize those opportunities? 34:54
• Thank you Peter 36:42
• Thanks for listening 36:58

Peter B. Cotton, MD, FRCP, FRCS, is professor of medicine at the Medical University of South Carolina.

We'd love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

Disclosures: Berry and Chey report no relevant financial disclosures. Cotton reports no relevant financial disclosures.

In this podcast episode, Lin Chang, MD, vice-chief of Vatche and Tamar Manoukian Division of Digestive Diseases, discusses her path to GI, her interest in IBS and some of the newest therapies coming down the pipe and more.

• Intro :02
• Welcome to this episode of Gut Talk :22
• About Chang :28
• The interview :46
• Where did you grow up? :49
• Who are your early role models? 3:50
• How far along in college were you before you decided to apply for medical school? 4:58
• How did you get interested in GI? 5:32
• What advice would you give to the residents and fellows that you interact with in that regard? 8:42
• As you started your career you weren't necessarily thinking that you were going to be a clinical/academic icon … didn't you start mostly as a clinician? 11:56
• Early on when we started working together … you were the only woman in the room. How were you able to break through that glass ceiling and get into the room? 17:38
• What advice do you give your fellows who want to get more involved? 22:12
• How did you get interested in a condition like IBS? 24:02
• Could you explain to our listeners what it means by the biopsychosocial model when referring to IBS? 26:21
• Do you think that, in actuality, these could be completely separate diseases? 29:03
• Discussion on the layers of IBS 32:26
• Do you mind summarizing your key takeaways from an American Gastrological Association clinical practice update on the role of diet in patients with IBS? 38:03
• Another document we're working on right now is the first joint society (AGA, ACG) clinical practice guideline on treatment of chronic constipation … would you like to say a couple words about that one? 42:04
• What does your future look like? What are you thinking is next for Lin Chang? 44:39
• In your role as program director, what are the trends that you've noticed amongst trainees? 46:46
• What are you most excited about with regards to the newer therapies and treatment paradigms, the new care delivery models that are on the horizon to help patients with IBS? 49:13
• Lin, this has been a great discussion 51:00
• Thanks for listening 51:37

Lin Chang, MD, is the vice-chief of Vatche and Tamar Manoukian Division of Digestive Diseases, program director of the UCLA GI Fellowship Program and the co-director of the G. Oppenheimer Center for Neurobiology of Stress and Resilience.

We'd love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

Disclosures: Berry and Chey report no relevant financial disclosures. Chang reports no relevant financial disclosures.

In this podcast episode, Joe Rubinsztain, MD, the CEO of ChronWell, discusses his path to becoming a doctorpreneur, the creation of gMed and more.

Brought to you by Zeposia.

• Intro :02
• Welcome to this episode of Gut Talk :22
• About Rubinsztain :39
• The interview 1:14
• Tell us about your background … where did you grow up and how did you get interested in medicine? 1:16
• What "aha moment" steered you into this nontraditional direction? 2:45
• Was that the genesis of gMed or did something precede gMed? 3:54
• Where did gMed occur in this whole awakening that you experienced? 4:27
• Was it a success immediately or was it a steep uphill climb? 6:03
• What were some of the main things that you learned from this journey? What were some of the durable themes that came out of that experience for you? 7:21
• Was the EMR market just as saturated when you were starting gMed, and you were scaling the company? How did you sell this into physicians' offices? 9:47
• Policy changes in health care can make or break a company … could you talk to us a little about the acquisition and leading up to that - how did it happen? 11:24
• There must've been the temptation to go in a whole bunch of different directions … How did you resist that temptation and how did you decide to choose GI and dermatology? 13:09
• Did you organically create those relationships or how did those come about? 15:44
• It you were starting and scaling gMed now how would things be different with these integrated delivery systems and private equity consolidation? 17:25
• Are the incentives aligned to make digital therapeutics an attractive option right now? 20:08
• Do you think the future for digital therapeutics and the types of services that ChronWell provides are going to be driven more by the fee-for-service architecture or do you think GI as a specialty is closer to more bundled payments and value-based approach? 22:45
• Could you tell us a little bit more about ChronWell, your transition from gMed to ChronWell and what you're doing there now? 25:14
• Who are you selling these services to? Is this a service that's being provided the GI physician, a health plan, a self-insured employer? 27:20
• Do you mind just telling our audience what you mean by the term 'digital therapeutics'? 29:38
• Are you subject to regulatory standards? Do these digital therapeutics need to be FDA approved or is it more like the Wild West? 31:01
• As we transition to this accountable care/value-based system. Will there be the same level of profitability and interest on the part of equity in gastroenterology? 35:30
• It also sounds as if artificial intelligence and machine learning are going to play a big role in what you're building 38:15
• Do you think the key thing there is the size of the data set or the quality of the data? 40:06
• Should there be a medical school pathway for physician data scientists that specifically peg their careers for this type of development pathway? 41:55
• What are the biggest misconceptions you think physicians, and more particularly GI physicians, have about the entrance of these early stage technology companies into health care? 43:49
• What advice would you have for a young physician or someone in medical school who's got these crazy thoughts of a non-traditional career? 46:56
• Thank you, Joe 48:57
• Thanks for listening 49:29

Joe Rubinsztain, MD, is a physician entrepreneur and CEO/co-founder of ChronWell and founder of gMed.

We'd love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

Disclosures: Berry and Chey report no relevant financial disclosures. Rubinsztain is the CEO and co-founder of ChronWell.

In this podcast episode, Sophie M. Balzora, MD, FACG, discusses how she found an interest in gastroenterology, the importance of having a true diversity, equity and inclusion initiative in the health care field and more.

Brought to you by Zeposia.

• Intro :02
• The interview :22
• Can you tell us a bit about your background? :51
• Was your dad educated as an internist in the United States or in Haiti? 2:32
• How did you decide to become a gastroenterologist? 3:41
• Tell us about what you're doing these days and what's your day-to-day role at NYU? 5:13
• Was this a calling? Was it something early on that you knew you wanted to pursue, or did it more call on you? 7:23
• Do you think we're more likely to make substantive changes by taking smaller, more incremental changes, or making more sweeping changes? 9:37
• What do the words "diversity," "equity" and "inclusion" mean to you? What do you want the listeners to know for the remainder of the conversation? 11:09
• What motivates you to work on these issues? 14:30
• We've known about these inequities for a long time … Why do you think this is the case and what are we starting to do to close this gap? 16:04
• How do we start to tackle the "Minority Tax" and ensure we're not putting the sole responsibility to fix this system at the feet of Black and female patients and other people of color? 20:55
• You have key leadership roles in numerous organizations … What are some of the initiatives you've been focusing on recently and are there any key learnings that you can share about how organizations can improve diversity, equity and inclusion? 24:09
• Have you experienced any of the backlash or discriminatory gaslighting when it comes to the DEI initiatives and what are your thoughts on it? 29:38
• What are the key things that will really make a difference in terms of driving substantive change in the DEI space as opposed to paying lip service? 33:11
• What initiatives do you know going on at NYU or at the college to help improve our training mechanisms to deal with these types of issues? 35:26
• If you were to have any wish in terms of DEI that would happen through the course of your career and by the time you finish up, what would it be? What do you think is realistic as a goal? 40:07
• I want to thank you for all the work you're doing 43:20
• Thanks for listening 44:57

Sophie M. Balzora, MD, FACG, is a clinical associate professor at the NYU Grossman School of Medicine. She is vice chair of ACG's Diversity, Equity, and Inclusion Committee, senior associate editor of the American Journal of Gastroenterology, and co-founder of ACG's "#DiversityinGI" social media campaign. Balzora serves on the Patient Education Sub-Committee of the Crohn's and Colitis Foundation's National Scientific Advisory Committee, the social media team of the CCF's Inflammatory Bowel Disease Journal, and as a member of Fight CRC's Health Equity Committee. She was also accepted into the inaugural cohort of the Office of Diversity Affairs' Faculty Leadership Development Program through the NYU Langone Academy.

We'd love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

Disclosures: Balzora, Berry and Chey report no relevant financial disclosures.

In this podcast episode, Brennan Spiegel, MD, MSHS, discusses virtual and augmented reality in gastroenterology from both a clinical and research perspective, as well as his thoughts on the future of the field.

• Intro :02
• The interview :22
• How did you decide to be a doctor? :23
• What are your main takeaways from serving as editor of AJG over the last 6 years? 2:46
• What was your journey that led to what you're focusing on now? 5:47
• Can you give us a sense of what these words mean when you say "virtual reality" and "augmented reality"? 7:29
• As a professor of medicine, a gastroenterologist, a public health advocate and researcher, how did you come to think of this being your area of focus? 10:40
• How does this work from a clinical perspective? 15:21
• Can you tell us about how the clinical trials are run, what sham VR is and how are these high-quality trials designed? 19:53
• Have we studied the biochemical response? 22:13
• The discussion of virtual reality and its use in neuromodulation and nerve stimulation 25:07
• Where do you think the biggest challenge is in this widespread implementation? 31:34
• What about developing VR reimbursement strategies … Have you heard of virtual reality companies approaching things this way? 34:44
• How do you think about intellectual property with VR? 37:38
• Where do you think we stand in regard to regulatory hurdles? 39:52
• Are there any risks? Are these things that are being studied? Are these valid concerns? 42:00
• What do you want the listeners to take away from this? What's the call to action? 44:31
• Thank you, Dr. Spiegel 46:27

Brennan Spiegel, MD, MSHS, is the director of health services research for Cedars-Sinai and the director of the Cedars-Sinai Master's Degree Program in health delivery science. He directs the Cedars-Sinai Center for Outcomes Research and Education.

We'd love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

Disclosures: Berry, Chey and Spiegel report no relevant financial disclosures.

In this episode, Brian E. Lacy, MD, PhD, joins us to discuss the American College of Gastroenterology's newest guidelines for irritable bowel syndrome, options for patients with IBS-D and IBS-C, and much more.

Brought to you by Red Hill Biopharma.

• Intro :02
• Can you briefly review the process that led to the final document? 1:31
• All recommendations are not created equal in this guideline or any guideline … do you think that is a fair statement? 3:56
• Do you have some key takeaways for listeners in regards to the diagnostic evaluation of patients with IBS? 4:38
• There's always this debate about fecal calprotectin or fecal lactoferrin or CRP … what do you do in your own practice? 6:13
• What do you want to tell the listeners in terms of testing to adequately screen for Celiac disease in their patients with IBS symptoms? 7:49
• Does it matter how you biopsy? 9:57
• What was your perspective on some of the new serologies for IBS? 11:51
• Can you review pelvic floor testing in patients with IBS and what the listeners should be thinking about and what they should do? 15:00
• Do you see potentially IBS-D and IBS-C-specific guidelines coming out in the future? 17:14
• Several commonly used therapies for IBS have weak recommendations or recommendations against their use. Can you talk about this or whether you use these therapies in your practice? 20:29
• What do you tell patients when they ask you about whether they should get their stool analyzed or provide you with a report from testing they've already done? 26:10
• Stool samples: are they even the best thing we should be measuring? 29:07
• What's the proportion of patients that possibly or potentially mismanaged getting colonoscopies, being started on expensive medications, being started on probiotics and how do we shift from this guideline and really getting this spread out in practice? 30:44
• The growing list of options for patients with IBS and constipation 37:57
• Opinions on the available options for patients with IBS-D? 39:49
• Thank you again, Dr. Lacy 41:15

Brian E. Lacy, MD, PhD, is a board certified gastroenterologist at the Mayo Clinic and the current co-editor in chief of the American Journal of Gastroenterology. He is the former editor in chief of Clinical and Translational Gastroenterology and was the co-chairman for the Rome IV Committee on Functional Bowel Disorders.

Disclosures: Berry, Chey and Lacy report no relevant financial disclosures.

We'd love to hear from you! Send your comments/questions to Dr. Berry and Dr. Chey at [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

In this episode, Eamonn Quigley, MD, joins us to discuss his journey into gastroenterology, probiotics and pearls of wisdom to the next generation of physician investigators.

Brought to you by Red Hill Biopharma.

• Intro :26
• Who was the person or persons that got you interested in GI? 1:01
• Was endoscopy available at the time that you started your GI training or did that come later? 3:39
• What's the story behind emigrating to the United States? 4:29
• The legacy of Sid Phillips 6:54
• Where did your travels take you after Mayo Clinic? 9:21
• When did you start looking at the microbiome? 9:27
• How did that partnership shape your thinking? 13:25
• Tell us the story behind Bifidobacterium infantis 35624 17:56
• What should patients and providers look for when they're considering a probiotic to purchase? 23:10
• How do you frame this to patients when they're so motivated to try probiotics for a disease or a symptom for which there's not strong data? 28:39
• How durably can you really shift a healthy person's microbiome? 30:18
• Is there something that you wish GI doctors were doing differently with regards to probiotics from what they're doing now? 34:53
• What do you think we need to get to a point where we can prescribe probiotics in a precision medicine perspective? 35:59
• Do you think it's going to be more microbiome or more metabolome that will really be the place to look for biomarkers? 38:13
• What are some of the big challenges that you think are unique to running clinical trials of probiotics? 40:26
• What has your experience been with regards to collaborative approaches with investigators outside of GI? 41:54
• Where do we move forward from here? What are the types of questions that young investigators should be thinking about in the near-term future? 43:31
• What advice would you give to other physician investigators, perhaps younger ones, who want to follow in your footsteps? 45:50
• Thank you, Dr. Quigley 51:05

Eamonn Quigley, MD, is the chief of the division of gastroenterology and hepatology at Weill Cornell Medical College at Houston Methodist Hospital, past president of the American College of Gastroenterology and past president of the World Gastroenterology Organization.

Disclosures: Berry and Chey report no relevant financial disclosures. Quigley discovered Align Probiotic (Procter & Gamble).

We'd love to hear from you! Send your comments/questions to Dr. Berry and Dr. Chey at [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

In this episode, Douglas A. Drossman, MD, joins us to discuss his path into medicine, the history and influence of brain-gut interactions and what gastroenterologists can expect for Rome V criteria.

• Intro :22
• Drossman's experiences growing up in New York :33
• Drossman's experience performing in a rock and roll band 1:20
• How did Drossman migrate from playing in a rock band to going to medical school and choosing a career in functional GI disorders? 2:14
• The history of functional GI disorders and the brain 6:05
• The influence of brain-gut interactions on motility and sensation and the evolution of opinions 9:29
• The formation of Rome and its impact on the field of functional GI disorders 13:33
• Were there other frameworks that were considered at these meetings early on before Rome criteria ever evolved or came out aside from symptom-based diagnosis? 20:15
• In the various iterations of Rome, what are your proudest moments? 27:06
• What can gastroenterologists expect for Rome V? 31:00
• The transformative nature of behavioral therapy 33:13
• Has there been research on how disorders of brain-gut interaction vary by different countries and different types of upbringings and culture? 37:12
• Why is it important for providers to better communicate with patients? 42:19
• Are you going to alter the way you do your notes given the fact patients will have free access to everything that you write? 47:41
• What advice would you give to fellows, younger faculty to have the same sort of impact and really fight for what they believe in? 48:44
• What can you tell us about Rome V? 50:17
• Thank so much, Dr. Drossman 51:24

Douglas A. Drossman, MD, is professor emeritus of medicine and psychiatry at University of North Carolina, and president emeritus of Rome Foundation.

Disclosures: Berry, Chey and Drossman report no relevant financial disclosures.

To order Drossman's new book Gut Feelings: Disorders of Gut-Brain Interaction and the Patient-Doctor Relationship A Guide for Patients and Doctors, visit https://romedross.video/GutFeelingsWebsite

To learn more about the Rome Foundation, visit theromefoundation.org

We'd love to hear from you! Send your comments/questions to Dr. Berry and Dr. Chey at [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

In this episode, Gil Y. Melmed, MD, MS, joins us to discuss the available evidence regarding COVID-19 risk among patients with IBD, the pandemic's effect on elective procedures, the future of telehealth for gastroenterologists and the importance of vaccination in these patients.

Editor's Note: This episode was recorded in August 2020.

• Intro :22
• Addressing questions about COVID-19 and the risk to IBD patients :35
• Any insight to why patients with IBD aren't at increased risk? 3:48
• How are you dealing with deferral of elective procedures? 5:50
• Is there any discussion about what the red lines will be in terms of closing down again? 9:32
• How are you adjusting to telehealth? Do you think we'll see an acceleration of remote care for our IBD patients? 11:53
• Are there unique challenges to telemedicine for patients with IBD? 14:23
• If we seize the moment, things may change for the better 15:51
• Challenges may be different between tertiary care centers and community practices 18:22
• Have you noticed an improvement in appointment compliance with telehealth? 19:05
• How has the pandemic impacted your research? 21:03
• Immunizations we should focus on for IBD patients 24:44
• Differences in viability of the vaccination based upon the aggressiveness of immunosuppression 27:40
• Do you check follow-up titers? 29:28
• Are there other vaccines besides yellow fever we should avoid? 30:45
• How will politicizing the pandemic effect our patients in terms of vaccination? 31:42
• The threshold for an effective vaccine is 50%, according to the FDA 34:27
• The prolonged nature of the pandemic may force payers to continue remunerating for virtual care 37:36
• Of the various IBD treatment candidates, are there any that gastroenterologists in the trenches should pay attention to? 39:32
• How are you addressing questions from IBD patients regarding travel, school and work? 41:45
• We need to adapt and move quickly as information keeps coming 44:46
• Are there formal mechanisms in place for sharing information as it pertains to the pandemic? 46:15
• Thank you for your time, Dr. Melmed 48:24

Gil Y. Melmed, MD, MS, is co-director of the Inflammatory Bowel Disease Center and professor of medicine at Cedars-Sinai Medical Center.

We'd love to hear from you! Send your comments/questions to Dr. Berry and Dr. Chey at [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc

Disclosures: Berry, Chey and Melmed report no relevant financial disclosures.