Gut Talk

In this podcast episode, we interview Barry Marshall, AC, FRACP, FRS, FAA, the legendary Nobel Laureate who discovered that peptic ulcer disease was caused by the bacteria Helicobacter pylori, not excess acid. Marshall fought for years against the notion that ulcers were caused by acid and finally infected himself with the bacteria and underwent endoscopy to prove his point. His research has saved countless lives, as untreated ulcer disease can lead to gastric cancer. We discuss numerous facets of his life and his pioneering work. Before antimicrobial therapy against Helicobacter, patients suffered for years without the right therapy.

• Intro :35
• About Dr. Marshall :37
• The interview 3:30
• Tell us about your upbringing. What was your childhood like? 3:38
• How did you meet Robin Warren? 6:35
• What was your ah-ha moment that made you want to follow it through? 13:11
• Were you met with skepticism? 41:13
• How did you interact with the naysayers at the time? 51:46
• What drove you to infect yourself with H. pylori? 1:01:28
• What was it like to win the Nobel prize? 1:10:14
• What advice do you have for young faculty members or GI fellows embarking on an investigative career? 1:18:18
• Thank you, Dr. Marshall 1:22:30

Barry Marshall, AC, FRACP, FRS, FAA, is an Australian physician, Nobel Prize Laureate in Physiology or Medicine, and professor of clinical microbiology at the University of Western Australia.

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. Healio was unable to confirm relevant financial disclosures for Marshall at the time of publication.

In this episode, Peter Gibson, MD, discusses the advent of FODMAPs, the importance of integrated care and preventive medicine, and how his research led to the development of a widely popular medical app.

• Intro :23
• About Peter Gibson, MD :24
• The interview 1:36
• What part of Australia are you originally from? 1:42
• How did you get interested in medicine and, in particular, GI? 2:12
• At first you were mostly in IBD, is that right? 2:45
• How did you end up being one of the foremost experts in functional bowel disease? 3:50
• Was including dieticians accepted by the GI community at large? 6:57
• How did the concept of FODMAPs come to be? 8:16
• Are there cultural differences regarding medical education and the importance of dietary interventions in nutrition? 11:50
• Is collaboration key? 15:52
• Why do you think having a behavioral psychologist and nutritionist on the team still hasn't taken off? 18:25
• We just completed a review on integrated care for Gastroenterology that should be published this year 21:37
• The approach to Western medicine is reactive; thinking preventively is still a long way's off 24:12
• Are these services covered for patients with functional GI disorders in the U.S.? 25:53
• Why did you choose "FODMAP"? 27:56
• What are the FODMAPs that most commonly cause problems? 31:49
• Do you see a way to use precision avoidance with FODMAPs in the near future? 35:50
• How did you get into designing a mobile app? 39:12
• Do you think the app is something that could replace the need for a dietician? 44:41
• Did you ever deal with people who dissuaded you from trying to commercial some of your research? 47:42
• How do you feel about other companies capitalizing on the FODMAP research? 50:06
• What are some of the best practices/things you've learned on studying the way diet impacts disease? 52:11
• What is the biggest misconception of FODMAPs among GI doctors? 56:50
• If you had a magic wand that could change one thing about the way we care for patients with functional GI disease, or GI disease in general, what would you do? 59:24
• Thank you so much for spending time with us, Dr. Gibson 1:01:58

Peter Gibson, MD, is director of gastroenterology at Monash University, he discovered the low-FODMAP diet and past president of the Gastroenterological Society of Australia.

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. Gibson works for Monash University, creator of the Monash University FODMAP diet app.

In this episode, we spoke with Congresswoman Debbie Dingell (D-Mich.) about her history in politics and her passion for advocating for health issues, as well as her thoughts on COVID-19 and how health care providers can effect change by engaging with their representatives.

• Intro :10
• About Congresswoman Dingell :14
• The interview 2:38
• Can you talk to us about your background? 2:40
• What positions did you hold at GM? 3:35
• Were you with GM during the auto crisis? 4:06
• How did you get involved in politics? 4:55
• Women's health issues 6:22
• Can you talk about Congressman Dingell's health care advocacy work? 7:07
• Do you think we're entering an environment where people will be more likely to engage in meaningful public health conversations? 9:46
• Can you talk about your brush with health care issues? 12:45
• What are your feelings on us cooperating on an international basis to reach a solution on COVID-19 as quickly as possible? 16:07
• How are you interacting on Capitol Hill? 18:42
• What will happen with the election? 20:41
• Do you think, at the national level, some regulations on state licensure for physicians will roll back to their old ways? 21:59
• The aftereffects of COVID-19 25:20
• What are some of the misconceptions that physicians or providers have about the role of a congressperson and their ability to affect change? 26:59
• Health care costs 30:59
• How can our listeners engage with their congressperson or senator? 33:25
• If you were advising Vice President Biden, what advice would you give him leading up to the election? 37:01
• What advice would you have for President Trump 37:50
• Thank you so much for spending time with us, Congresswoman Dingell 38:02

Congresswoman Debbie Dingell (D-Mich.) represents the 12th District of Michigan in the U.S. House of Representatives.

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.

In this episode, we spoke with one of the luminaries of gastroenterology, Tachi Yamada, MD, about the guiding principles that led him through his GI career, the art of embracing change and what he learned about global health from working at the Gates Foundation.

• Intro :10
• About Dr. Yamada :14
• The interview 4:48
• Are there experiences from early in your life that you pull from today? 5:18
• How did you end up doing basic science research? 8:50
• How were you recruited to Michigan? 15:25
• Do you have any advice for choosing mentors? 19:45
• How did you decide to go to GSK as head of R&D? 26:28
• Were there any cultural differences when you made the switch to industry? 29:47
• What about the transition into philanthropy? 35:23
• Have you gained insights that might provide wisdom amid COVID-19? 42:39
• Are there open channels of communication that will help facilitate best practices? 49:54
• What advice do you have for early career physicians? 52:16
• Thanks for listening 55:00

Tachi Yamada, MD, is chief medical officer,Takeda Pharmaceuticals; former chief of GI, University of Michigan; and former president, AGA.

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. Yamada reports he owns stock in Agilent, Arcutis, CSL, Keysight, Passage and Phathom.

References:

Yamada T, Ogawa VA, Freire M. Nature. 2016;533:29-31.

In this episode, we talk to ACG presidents Mark Pochapin, MD, of NYU Langone, and David Greenwald, MD, of Mount Sinai, about the latest updates in COVID-19 for the gastroenterologist.

• Intro :10
• Why is this important for clinical gastroenterologists? 1:40
• Do we know whether the virus in stool can lead to transmission? 5:36
• How long can the virus live on surfaces? 7:12
• How are we handling social distancing differently than China? 10:29
• What personal protection should health care workers performing endoscopy be using? 16:06
• Are you using head gear? 18:12
• Are there any guidelines for elective procedures? 21:12
• Are you switching to telehealth visits? 29:45
• How long is this going to last? 33:29
• How is this situation affecting fellows? 37:00
• What about patients taking PPIs? 41:29
• What are the screening tests? Which test are we doing in the U.S.? 44:12
• Have either of you heard about broadening testing criteria? 49:00
• We're all in this together; make sure you're kind and you thank those around you 52:20
• Thank you, Drs. Pochapin and Greenwald 54:35

Mark Pochapin, MD, is chief of gastroenterology at NYU Langone Health and president of the American College of Gastroenterology. David Greenwald, MD, is director of clinical GI and endoscopy at Mount Sinai and president-elect of ACG.

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

Disclosures: The hosts and guests report no relevant financial disclosures.

In this Match Day episode, I speak with Justin Brandler, MD, first-year gastroenterology fellow at University of Michigan, about failure, the GI match and cultural shifts in the fellowship process.

• Intro :10
• Good luck and congrats to everyone :32
• The history of Match Day :43
• The match process today 5:55
• A hidden curriculum to fellowship interviewing 8:37
• Tell us about your Match Day experience 11:45
• What happened after you found out you didn't match? 14:11
• Where did you direct the blame? 16:58
• Why do you think it happened? 18:24
• For some reason it's not OK to be honest 19:30
• There's a strategy for interviewing 22:00
• Can you talk about the mental toll this takes on us as physicians? 25:41
• What type of failure are you writing about when you talk about our patients' failures? 30:33
• It's difficult to discuss failure 36:30
• What advice do you have for applicants who didn't match or aren't happy? 38:28
• Thanks for listening 41:43

Justin Brandler, MD, is a first-year GI fellow at University of Michigan.

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

In this episode, registered dietitian at Cedars-Sinai, Kelly Issokson, gives a basic overview of the role of RDs in clinical practice, nutrition pearls, useful diets like low-FODMAP and EEN, and dispels some of the current snake oil being touted in the wellness space.

• Intro :10
• The interview :29
• What is a registered dietitian (RD)?:31
• Have you heard anything to suggest that additional nutrition education will be incorporated into medical school? 3:12
• What trends are you're seeing in patients that might not have much science-backed evidence behind them? 5:00
• Why would someone tout the benefits of celery juice? 7:05
• Is there something you wish your patients would do more of, or that you wish physicians would discuss with patients more? 7:45
• Are there some patients for whom the keto diet is helpful? 10:16
• What lab do you wish physicians would order more often? 12:10
• Which supplement brands do you recommend for patients? 13:30
• What labs are overused to determine nutritional status? 14:56
• What about prealbumin? 16:15
• What is your approach to assess nutritional status? 16:43
• What is your role as a registered dietitian at Cedars Sinai? 17:41
• What misconceptions exist of RDs in clinical practice? 20:02
• Can you talk about the low-FODMAP and EEN diets? 22:00
• When instituting the low-FODMAP diet, how do you handle patients with different cultural identities? 24:00

Kelly Issokson, MS, RD, CNSC, is a registered dietitian and certified nutrition support clinician at Cedars-Sinai.

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

In this episode, I speak to Naresh T. Gunaratnum, MD, who completed his GI fellowship at Univ of Michigan and an advanced endoscopy fellowship at Mayo Clinic. He shares his perspective on transitioning from a large academic medical center to private practice in a community hospital. He also talks about balancing clinical practice with research, gives his thoughts on direct-to-consumer screening tools and presents pearls for gastroenterology fellows.

• Intro :10
• The interview :58
• Cultural differences between academic and community centers 1:31
• How did you create a path that allows you to publish research but maintain a busy clinical practice? 3:02
• Research challenges in a community setting 4:24
• What motivates you to spend time coordinating and conducting research? 6:00
• Do you feel that community advanced endoscopists must defend their outcomes compared with large academic centers? 8:38
• How do private practice centers afford expensive machines and technology that may or may not be covered by payors? 12:42
• What are the challenges of creating a community weight loss program from the ground up? 15:15
• What are your thoughts on direct-to-consumer tests like Cologuard? 22:10
• Do you see an at-home, noninvasive test on the horizon that will be just as good as colonoscopy? 24:51
• Do you have a routine to help you stay abreast of the literature? 27:00
• You mentioned earlier that 80% of your time is spent gathering patient data, and that in the future that will be cut down to 20%. What do you mean by this and how will this happen? 28:30
• Are you using midlevel providers such as NPs and PAs? What is your take on their role in the future? 30:55
• If you had a magic wand and could change one thing regarding socioeconomics and social determinants of health, what would you change? 33:28
• If you could go back to GI fellowship, what's one thing you could do differently? 35:44
• Thank you, Dr. Gunaratnum 37:44

Naresh Gunaratnum, MD, is a gastroenterologist in private practice at Huron Gastro Center for Digestive Care in Ypsilanti, Michigan, and 2019 recipient of the American Gastroenterological Association's Distinguished Clinician Award.

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

In this inaugural episode, social media guru, Austin Chiang, MD, MPH, of Jefferson University, joins me to discuss the importance of developing a professional social media presence. He also gives his take on where the field is heading and offers advice for early career physicians looking to get started on various platforms.

• Intro :10
• How did you decide to develop a professional social media presence? :49
• Were you involved in social media as an IM resident? 2:04
• Should professional accounts be separate from personal accounts? 2:34
• Do you think major associations have developed social media guidelines that may be outdated? 5:15
• Can you talk about the #VerifyHealthcare campaign? 6:30
• Do you encounter vulnerability or fear of posting something that may be misinterpreted? 9:48
• Is there a standardized set of rules for physicians regarding what can and cannot be posted online? 11:30
• Are you aware of any rules regarding posting pictures or videos from endoscopy? Are you required to get patient consent? 12:45
• What are you working on at the Association for Healthcare Social Media (AHSM)? 14:25
• Where do you think social media is going? Where's the next trend? 15:32
• Would you suggest physicians open Instagram and Twitter accounts and develop profiles on LinkedIn all at once, or take things slow with one platform at a time? 17:33
• Physicians are busy. What tips can you provide for developing creative and thoughtful social media posts? 19:00
• What advice would you give to early career physicians who are looking to take this next step into social media? 21:21
• Thank you, Dr. Chiang 23:47

Austin Chiang, MD, MPH, is a practicing gastroenterologist, director of the endoscopic bariatric program and chief medical social media officer at the Jefferson Health System in Philadelphia. Follow him on Twitter @AustinChiangMD.

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