This week, we look at the new pharmaceuticals that the FDA has approved for treating Alzheimer disease. Although they are effective at removing amyloid plaques from the brain, they don’t seem to help patients function better. Is it time to turn away from an exclusive focus on amyloid to consider other factors that might affect cognitive decline and change the course of Alzheimer disease?

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on December 23, 2024.

Even though pharmaceutical firms have spent billions of dollars developing drugs to reduce amyloid in the brain, they haven’t changed the course of Alzheimer disease. Perhaps we need to be looking beyond amyloid at other risk factors. Dr. Dale Bredesen says he and his colleagues have identified more than 36 risk factors. He asserts that when these these are addressed, people can slow or sometimes even reverse their cognitive decline. According to Dr. Bredesen, Alzheimer disease is multi-factorial and it needs a multi-pronged approach.

The plaques and tangles that are characteristic of the brain disease first identified by Alois Alzheimer more than 100 years ago only show up in pathology slides. Past studies have hinted that some individuals who have plaques or tangles in their brains don’t have serious cognitive difficulties. Dr. Bredesen urges us to look beyond amyloid pathology and use a physiology lens. What are the main drivers of problems?

Our bodies need to make, use and transfer energy efficiently. That involves the mitochondria, the energy factories within the cells. Nutrition is also critical here, as missing vitamins can block appropriate metabolism. The cardiovascular system is also crucial for the transfer of energy within the body and to the brain. Sleep apnea, which interferes with oxygen uptake overnight, is another big culprit.

Inflammation in the brain or even elsewhere in the body puts a huge strain on the neurons. Identifying and removing the sources of inflammation is important in treating someone struggling with cognitive problems. Where is the inflammation coming from? It might be an infection. Treatment can make a difference there. It might be dietary, in part. Changing the diet could change the course of Alzheimer disease. Wouldn’t that be worth the effort?

Heavy metals such as lead or mercury are definitely neurotoxic. However, other substances can also put neurons at risk. Toxins produced by mold are common and very difficult to treat.

There are at least three additional categories that should be considered. Do we have the essential ingredients to create the neurotransmitters we need? One example would be choline for acetylcholine, an essential neurotransmitter that may be in short supply in Alzheimer disease. Most American diets are not rich in choline. Second, how are the neurotrophins doing? These are substances such as BDNF, brain-derived neurotrophic factor. It supports the growth and differentiation of neurons. Third, and possibly most common, is chronic stress. Occasional acute stress is expected and shouldn’t be considered harmful. But chronic stress can damage neurons and make it harder to think even if your neurons are not damaged. High cortisol levels are associated with brain atrophy, which is a clear indication of damage.

Dr. Bredesen uses a metaphor of the brain as a house with a leaky roof. If you have a lot of places where the roof leaks, you need to fix all of them to stay dry. But your roof may leak in different places from your neighbor’s roof. Finding the weaknesses and addressing them with personalized medicine is key to changing the course of Alzheimer disease, in Dr. Bredesen’s opinion. It may require attention to diet, exercise, sleep (with adequate oxygen saturation), stress management, brain training, detoxification and possibly supplements such as omega-3 fats or vitamin D. You can learn more from his books and his recent publication in Biomedicines (Aug. 6, 2024).

Dale Bredesen, MD, is an internationally recognized expert in aging and neurodegenerative diseases. He is the Senior Director of Precision Brain Health at Pacific Neuroscience Institute, and former Professor of Molecular and Medical Pharmacology at UCLA. Dr. Bredesen is also the founding President and CEO of the Buck Institute for Research on Aging and the Co-founder of MPI Cognition. Dr. Bredesen is the author of the New York Time’s best seller The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline and The First Survivors of Alzheimer’s: How Patients Recovered Life and Hope in Their Own Words.

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

The podcast of this program will be available Monday, December 23, 2024, after broadcast on Dec. 21. You can stream the show from this site and download the podcast for free.

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This week, our guest discusses how to prevent and treat a surprisingly common condition, chronic kidney disease. One in three Americans faces the risk factors for kidney disease; one in seven is actually living with the condition, although they may not be aware of it.

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on December 16, 2024.

According to the CDC, 36 million American adults have some form of chronic kidney disease. There are six stages of this condition, with stages 1 and 2 so mild that they don’t warrant treatment. Doctors start paying attention to stages 3a and 3b. Dr. Emily Chang describes how kidney disease is diagnosed and why we need to pay attention. In the earlier stages, kidney disease does not cause symptoms, so doctors rely on blood and urine tests to monitor function.

Most people are aware that the kidneys produce urine, primarily by filtering the blood and removing chemicals that are not needed. However, the kidneys also have numerous other functions that are critical for our health. They are vital to blood pressure control, and they regulate hormones essential to the preservation of bone strength.

We wondered why the rates of chronic kidney disease are increasing. The answer is fairly simple. More people have one or more of the factors that increase a person’s probability of experiencing kidney problems. These include high blood pressure and diabetes.

In addition, there are numerous medications that can contribute to trouble for your kidneys. Just imagine how many of us take an NSAID such as ibuprofen or naproxen multiple times a week. That can put a significant strain on the kidneys. If ibuprofen upsets your stomach–as it could–you might turn to a PPI such as omeprazole (Prilosec) or lansoprazole (Prevacid). These medications can also pose challenges for the kidneys.

In general, blood pressure medicines are a help to the kidneys, because blood pressure control is so important. But certain blood pressure meds, especially ACE inhibitors like lisinopril or ramipril or ARBs like losartan or irbesartan, are considered “sick day meds.” They should not be taken on days when a person is under the weather and may be dehydrated. Under those circumstances, they might do as much harm as good.

Another potential hazard for the kidneys is the contrast medium used in medical imaging. Sometimes this can be tough on the kidneys. That’s especially true for cardiac catheterization where the doses are higher and the exposure longer.

Besides controlling risk factors, we can all help protect our kidneys by making sure we stay hydrated. What and how much should you drink? Plain water is always great. Caffeinated soft drinks are not particularly helpful, and neither are dark sodas or tonic water. As for how much, that is individual. Most people can rely on thirst, but as we age, thirst may be a less sensitive indicator. Older people may need to make sure they are drinking enough fluid to produce a reasonable amount of light-colored urine.

According to Dr. Chang, most of us don’t need to obsess about the amount of protein in our diets. Except at the most severe stages of chronic kidney disease, your kidneys can handle the protein you need for good nutrition. She recommends that people follow a DASH diet or a Mediterranean diet. Both are loaded with fresh produce, low in salt and sugar, and rich in whole grains. Scientists have studied the effects of the DASH diet thoroughly, and they know that it can help with blood pressure control. Likewise, following a Mediterranean diet can also promote healthy blood pressure and blood sugar management.

Doctors are adopting a type of medicine called SGLT-2 inhibitors to treat chronic kidney disease. One example is dapagliflozin (Farxiga), a drug initially developed to treat type 2 diabetes. It may keep kidney disease from worsening. Other drugs in the same category may also prove helpful. Scientists are also looking at GLP-1 agonists like semaglutide (Ozempic, Wegovy) to see if they might also benefit your kidneys.

The podcast includes a discussion with Dr. Glenn Preminger of Duke University Health System about a related topic, preventing and managing kidney stones.

Emily Chang, MD, is Associate Professor of Medicine in the

Emily Chang MD

Glenn Preminger, MD, is the James F. Glenn, M.D. Distinguished Professor of Urology at Duke Medicine.

The podcast of this program will be available Monday, December 16, 2024, after broadcast on Dec. 14. You can stream the show from this site and download the podcast for free.

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This week, we talk with an expert on cancer epidemiology. Surprisingly, though, our discussion centers on the health aspects of practicing kindness and compassion. In our polarized world, anger and hostility are rampant. But kindness is not only good for the person who receives a kind gesture. It also has a biological impact on the person providing it.

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on December 9, 2024.

Dr. Immaculata DeVivo studies biological effects of behaviors. One of the ways she assesses their impact is through the response of telomeres. These are part of our chromosomes, rather like the little plastic tips on our shoelaces that keep them from raveling. Chronic stress shortens telomeres. On the other hand, long-lived people, like centenarians, tend to have longer telomeres. Is it because they avoid stress, or have they learned ways to dissipate it?

Optimists live longer, and they have longer telomeres and less cardiovascular disease. Is that because they practice random acts of kindness? Research shows that women practicing loving-kindness meditation have longer telomeres. Since this is generally a marker of lower inflammation and better health, it seems likely that meditators may be promoting their own health as they concentrate on loving kindness for others.

If kindness has biological benefits–and it does seem to–what are the implications for cancer patients? How can health care professionals practice kindness, and can we expect that practice to benefit them?

People often talk about Darwin’s work as demonstrating the survival of the fittest as if he meant the biggest, loudest or meanest. In truth, Darwin was talking about adaptability. Practicing kindness and related behaviors helps us be more adaptable. Dr. De Vivo also discusses the advantages of optimism, gratitude and forgiveness along with kindness. Practicing kindness doesn’t have to be a major effort; she tells about a stranger putting coins in her parking meter on a day when she was having a hard time finding the right change. How have you been practicing kindness?

Dr. Immaculata De Vivo is the Melanie Mason Niemiec ’71 Faculty Codirector of the Sciences at Harvard Radcliffe Institute, Professor of Medicine at Harvard Medical School and Professor of Epidemiology at the Harvard T.H. Chan School of Public Health and the Editor-in-Chief, Cancer Causes and Control. Her research focuses on how genetic variants interact with the environment to influence susceptibility to hormonal cancers, especially endometrial cancer. Dr. De Vivo, with Daniel Lumera, is the author of The Biology of Kindness: Six Daily Choices for Health, Well-Being and Longevity.   Her website is https://www.radcliffe.harvard.edu/people/immaculata-de-vivo-faculty-director

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Dr. Immaculata De Vivo, photo credit Kevin Grady

The podcast of this program will be available Monday, December 9, 2024, after broadcast on Dec. 7. You can stream the show from this site and download the podcast for free.

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In this week’s interview, Dr. Robert Waldinger of Harvard University explains why overcoming loneliness is essential for our health. His research, summarized in The Good Life, shows that close relationships are crucial for a satisfying life. In addition, the Surgeon General has issued a comprehensive report on the epidemic of loneliness and its effects on physical as well as mental health. How do we reach out to others and vanquish their loneliness as well as ours?

You may want to listen to it through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on December 2, 2024.

Loneliness may not seem like an urgent health issue, but it is. That was clear even before US Surgeon General Vivek Murthy MD issued his 2023 report: Our Epidemic of Loneliness and Isolation. This report summarizes the research linking lack of social connection to serious health outcomes like heart disease, diabetes, high blood pressure and dementia. A graphic on page 25 demonstrates that social isolation is as dangerous to a person’s health as smoking half a pack a day or drinking too much.

These findings do not surprise our guest, Dr. Robert Waldinger. He is the director of the Harvard Study of Adult Development at Massachusetts General Hospital, the world’s longest-running scientific study on what makes a satisfying life. What Dr. Waldinger and the research team found is that relationships of all sorts–friendships, romantic partnerships, family ties, even casual acquaintances–are critical for a meaningful life. Warm relationships seem to provide a buffer against stress. Without them, we are literally on our own.

The United States is not the only country in the world where people are experiencing social isolation or loneliness. But there are some cultures where people place a higher priority on maintaining social connections with extended family or classmates. Our emphasis on maximizing productivity may interfere with placing a value on spending time with others.

This is not an entirely new phenomenon. Ever since most American homes acquired television, people started spending more time at home rather than interacting with neighbors. The small screens that currently scream for our attention are even more likely to result in isolation, even as we scroll through our “social media” feeds.

For the past century, at least, many Americans experienced social connection simply by showing up at work. Accomplishing a shared task might be one bond, but hanging out together around the water cooler is also a way to make work friends. The pandemic accelerated a trend towards working remotely and not interacting with coworkers casually. Companies might want to re-think their policies. People are more productive as well as happier and healthier if they have friendly interactions with others at work, and that means not being chained to the computer all day long.

Some people are introverts. They may find it hard to get to know new people. Extroverts, on the other hand, often make friends easily. However, they may also need more friendships to feel socially satisfied. Some schools are starting to teach children much-needed social and emotional skills. Even older people may find it useful to practice such skills. Both young people, between 16 and 24, and the elderly (over 65 in this context) are among the groups most likely to suffer social isolation.

There are some things we can do as individuals to help protect ourselves from the stressors of everyday life. Dr. Waldinger quotes Thich Nhat Hanh to the effect what we put into our minds becomes the content of our minds. He makes the argument that we should be mindful about how much news we consume every day as well as how we consume it.

Another practice that flows from the Buddhist teacher is to pay attention to what is good in your life. Acknowledging gratitude, whether by speaking or journaling, can help buffer the feeling of living on the edge of catastrophe. Being grateful for your friends, and letting them know it, is another approach to overcoming loneliness.

Finally, spend time with people who make your hands warm. This is a quick way of judging whether you are comfortable with them. Dr. Waldinger recognizes that we often let our busy lives get in the way of connecting. When he gives talks, he frequently invites the audience to send a text or email to someone they like but haven’t seen in a while. Sometimes, this results in plans to get together soon. Most of the time, people get a heartwarming response. His advice for all of us as we face the new year: turn toward people who make you feel hopeful.

Robert Waldinger, MD is a professor of psychiatry at Harvard Medical School, director of the Harvard Study of Adult Development at Massachusetts General Hospital, and cofounder of the Lifespan Research Foundation. Along with being a practicing psychiatrist and psychoanalyst, Dr. Waldinger is also a Zen master (Roshi) and teaches meditation in New England and around the world. Dr. Waldinger, with co-author Marc Schulz, PhD, is the author of The Good Life: Lessons From the World’s Longest Scientific Study on Happiness.

Robert Waldinger, MD, author of The Good Life

The podcast of this program will be available Monday, December 2, 2024, after broadcast on November 30. You can stream the show from this site and download the podcast for free.

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This Saturday morning, November 23, 2024, an expert from Australia helps us examine the hidden risks of healthcare. Healthcare providers have the best of intentions, but they simply cannot truly uphold the (apocryphal) part of the Hippocratic oath that urges “First, do no harm.” How can patients and their families become more familiar with the pitfalls of modern medicine and avoid them as much as possible?

You could listen through your local public radio station or get the live stream at 7 am EDT (11/23/2024) on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the live broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the audio stream on this post starting on November 25, 2024.

Historically, medical students were expected to take the Hippocratic oath upon graduation. Although the original Greek does not actually contain the warning to do no harm, the oath is widely believed to carry that intent. Yet it may be difficult for doctors to avoid harming some patients. We’ll examine where patients should be especially vigilant and how the evidence from careful studies can help. Other portions of the Hippocratic oath are also routinely violated in the context of current medical practice.

One problem is that we don’t always have evidence for the medicines or other interventions physicians are using. For a long time, rheumatologists prescribed hydroxychloroquine for their patients with lupus, expecting that it would be helpful. They had no real evidence that it would help until finally scientists conducted a randomized clinical trial. This showed that hydroxychloroquine is, in fact, better than placebo for treating lupus. That original lack of evidence, though, is one of the most serious hidden risks of healthcare.

Knee arthroscopy is another example. Surgeons assumed that looking into the knee joint and removing any bits of collagen debris they found there would reduce knee pain and improve function. But when a study was eventually done to confirm that assumption, it turned out not to be true.

When drugs are tested prior to approval, many people may be excluded from the clinical trials because their conditions might make the findings harder to interpret (or potentially make the benefits harder to see). Once a drug is available, do doctors also avoid prescribing it for those who were not included in clinical trials? Usually not. Also, if it was approved for a fairly narrow indication, healthcare providers may start using it far more widely.

Dr. Rachelle Buchbinder is Coordinating Editor of the Cochrane Musculoskeletal, Back and Neck division, along with many other responsibilities. Many people have not heard about the Cochrane Collaboration, so we asked her to describe it. Volunteers trained in objective methods of assessing clinical trials examine all the clinical trials that have examined a specific intervention. Quite often, what they find is that the existing studies have a lot of flaws. But occasionally, their high-quality systematic review shows that, yes, the research shows that this approach works for this problem. Or possibly, no, we should not use such an intervention for that problem. For example, a Cochrane review demonstrated that despite popular opinion, medical cannabis is NOT effective against chronic pain.

Americans can’t watch television without being bombarded by commercials for powerful prescription pharmaceuticals complete with lengthy lists of terrifying adverse effects. No worries, though: the people in these ads are all having a marvelous time as the side effects are listed. This does not happen in Australia. New Zealand and the United States are the only two countries in the world that allow drug companies to advertise prescription drugs directly to consumers. Isn’t this among the hidden risks of healthcare?

Dr. Buchbinder and her co-author also look at problems with getting an appropriate diagnosis. When a patient’s condition is not diagnosed correctly, they can’t be treated properly. That’s why missed diagnoses are problematic. Wrong diagnoses are also a problem. Sometimes serious conditions are underdiagnosed because the stereotype directs the provider’s attention elsewhere. For example, women may not be diagnosed with heart disease when the provider has been taught that it’s primarily a male problem. Conversely, men might suffer with horrible migraines and not get the correct diagnosis because these headaches are seen as far more common in women. Dr. Buchbinder also describes the problem of overdiagnosis, using as an example, thyroid cancer in South Korea.

Chances are you know something about the numbers that could be used to describe your health. Your blood pressure might be 120/80…or not. Your cholesterol may be over 200. Doctors use blood tests to measure HbA1c (a marker for blood sugar over time), TSH (a way of determining thyroid function), PSA (prostate-specific antigen, a way of tracking a man’s prostate gland) or any of hundreds of other markers. These can all be helpful, but providers need to be careful not to treat the numbers without looking at the big picture.

Just getting blood pressure down to 120/80 might make some individuals too dizzy and put them at risk for falls. Prescribing a statin to lower cholesterol makes sense for someone with heart disease. To tell if it is appropriate for a healthy person who is physically active and finds that the medication interferes with exercise needs to be determined with more attention to the patient than to the number.

The United States is not the only country where drug manufacturers have a lot of influence over doctors. The experts who serve on committees to draw up guidelines for doctors often have conflicts of interest. Sometimes these are disclosed, but not everyone reads the guidelines carefully enough to pick up that fine print. In addition, hospitals, clinics or individual providers may also be paid by pharmaceutical firms. In the US, patients can find out whether their own doctor has been paid (and how much) by going to the CMS website OpenPayments. This offers us the opportunity to evaluate just how objective a provider might be when recommending a procedure or prescribing a drug.

Professor Rachelle Buchbinder AO

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The podcast of this program will be available Monday, November 25, 2024, after broadcast on Nov. 23. You can stream the show from this site and download the podcast for free.

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This week, we discuss how making your own herbal medicine at home can provide you with safe, inexpensive and effective ways to ease symptoms of common problems like colds, cuts and scrapes or heartburn. Our guest is a long-time People’s Pharmacy favorite, Dr. Tieraona Low Dog. Learn about leaves and roots in remedies you can make at home.

You could listen through your local public radio station or get the live stream at 7 am EST on your computer or smart phone (wvtf.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on November 18, 2024.

Utilizing herbal medicine may seem complicated or exotic, but it doesn’t have to be. Herbal medicine is based on plants, and there are lots of plants that are easy to grow in a patch of backyard or even in a planter. Consider peppermint, for example. It grows readily–a little too readily. If you plant it in your garden, it may take over, so be sure to keep it confined to a pot or planter. The leaves are cooling in the summer. Frozen cubes of mint tea can be used to calm a fever, soothe a bug bite or relieve a headache. Many cough drops contain menthol, so we expect peppermint tea might ease a cough as well.

Other handy plants include thyme and sage. Their utility goes way beyond Thanksgiving dinner. A gargle made with sage leaves can make a sore throat feel better, and thyme tea or thyme syrup is a great way to manage a pesky cough.

Dr. Low Dog describes how her travels to other parts of the world have broadened her knowledge and appreciation for herbal home remedies. She observes that in many regions, people let their exploration of roots and remedies be guided by the local animals. Primates, in particular, are similar enough to humans that watching how they use particular plants can point people in the direction of potential helpful herbs. People living in the Bwindi Impenetrable Forest of Uganda have learned a good deal by paying attention to plants the gorillas use, for example.

The most important thing to take along when you travel is your curiosity. That has stood Dr. Low Dog in good stead over the years. In Mexico, for example, she witnessed the wild yams originally used to source the building blocks for steroid medications. These include progesterone used in oral contraceptives.

A bit further south, in Costa Rica, she participated in a cacao ceremony. While we can’t grow wild yams or cacao trees in our gardens in the United States, we can still take advantage of some of the medicinal effects of these plants. Did you know that dark chocolate, with as little sugar as you can stand, is an excellent cough remedy? Of course, if you want to get the benefits of cacao without the sugar and fat in chocolate candy, you might want to take the proven, concentrated cacao flavanol extract found in CocoaVia. Full disclosure: CocoaVia provides financial support for our radio show and podcast.

A round trip brings us back home. For Dr. Low Dog, that is New Mexico, where Diné people on the Navaho reservation use dock, a common weed, for healing. In other regions, the healing weed may be plantain. For wounds, a poultice of yarrow or calendula can be very helpful. Dr. Low Dog describes treating a serious cut on her mare’s leg with honey in which sage leaves had been steeped.

Dr. Low Dog reminds us, “We have the potential in every moment to open our hearts to each other.” Focusing on the meaning and purpose behind our acts can make them stronger.

She offers a free tutorial on her website about making simple herbal medicine at home. Be sure to check it out, and don’t miss the list of offerings from Medicine Lodge Ranch.

Tieraona Low Dog, MD, is a founding member of the American Board of Physician Specialties, American Board of Integrative Medicine and the Academy of Women’s Health. She was elected Chair of the US Pharmacopeia Dietary Supplements/Botanicals Expert Committee and was appointed to the Scientific Advisory Council for the National Center for Complementary and Alternative Medicine. Her books include: Women’s Health in Complementary and Integrative Medicine; Life Is Your Best Medicine and Fortify Your Life: Your Guide to Vitamins, Minerals and More. Dr. Low Dog’s latest eBook is Healing Heartburn Naturally.

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Dr. Tieraona Low Dog

The podcast of this program will be available Monday, November 18, 2024, after broadcast on Nov. 16. You can stream the show from this site and download the podcast for free.

When you listen to the podcast, you will hear us suggest Gaia Herbs as a source for the herbal medicine you don’t make at home. Their onsite laboratory ensures quality control that few other companies can match. As a result, the quality is outstanding; they grow many of the herbs they sell on their Regenerative Organic Certified farm in Western North Carolina and source others thoughtfully from around the world. The promo code PEOPLE15 will get you a 15% discount through Dec. 31, 2024, at GaiaHerbs.com.

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This week, we consider whether viruses might be able to overcome bacterial infections that resist all antibiotics. We start with a thrilling story from a few years ago in which a scientist saved her husband’s life with bacteriophages. Then we turn to a journalist who grew up in Russia where bacteriophages are common remedies. She explains what they are and how they work. Will we soon be relying more on nature’s viral warriors?

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the streaming audio on this post starting on November 11, 2024.

Almost ten years ago, Dr. Tom Patterson became ill while on vacation in Egypt. His wife, Dr. Steffanie Strathdee, is an infectious disease expert. She recognized the danger when Egyptian doctors identified his infection as due to Acinetobacter baumannii that did not respond to the usual antibiotics.

By the time he was medevacked back home to California, even the last resort medications failed to work against his infection, and he was in a coma. Dr. Strathdee frantically searched for something that might help. What she came up with was bacteriophages. Tom’s doctor agreed to administer the phages if Steffanie could find a source that would match his infection. You won’t want to miss this amazing story.

Bacteriophages–viruses that exclusively infect bacteria–were discovered independently more than 100 years ago in two different countries, France and Georgia. However, you may well never have heard of these viral warriors. They are very specialized, with each bacteriophage grabbing only one type of bacterium. As a result, getting the right bacteriophage for treating a serious infection may require some personalized research.

When antibiotics work, that extra time to find the perfect phage is a drawback. But if antibiotics fail, getting nature’s viral warriors to go to work for the patient can save lives.

Science writer Lina Zeldovich grew up in Russia when it was part of the Soviet Union. She became fascinated with phages as a child, and her new book, The Living Medicine, outlines the history of these remarkable therapies. In fact, even the title of her book might be controversial. Scientists don’t unanimously agree that viruses are alive, because they rely on their host cells for energy, protein manufacture and replication.

For most of the 20th century, viruses have existed in the popular imagination primarily as pathogens. A virus that attacks your cells will make you sick. That is certainly true. Common but potentially dangerous viruses include influenza and SARS-CoV-2, while more exotic viruses like Eastern Equine Encephalitis or West Nile virus are also frightening. But bacterial infections are also common and can be lethal.

Early in the 20th century, two researchers working independently found that something in sewage or contaminated river water could kill dangerous disease-causing bacteria. One, self-taught bacteriologist Félix d’Hérelle, worked at the Institut Pasteur. The other, Georgian Giorgi Eliava, was working in Tbilisi. Around 1920, he went to study at the Pasteur Institute, where he met d’Hérelle. The two became friends and collaborators. If it had not been for World War II and the subsequent Cold War, very likely the West would have learned far more about bacteriophages. Eliava’s work promoted their use in Georgia and throughout the Soviet Union. The connection with the Soviet Union was a big drawback for recognition in the United States and Western Europe.

Antimicrobial resistance has been growing over the last few decades, and infectious disease experts are concerned. Could nature’s viral warriors really rescue us when antibiotics fail? For the most part, drug companies have ignored phages. Find out why scientists should learn more about how to use bacteriophages to fight infection.

Steffanie A. Strathdee, PhD, is Associate Dean of Global Health Sciences and Harold Simon Professor in the Department of Medicine at the University of California San Diego School of Medicine. She is also an Adjunct Professor at Johns Hopkins and Simon Fraser Universities. She co-directs the UCSD Global Health Institute and the International Core of the University’s Center for AIDS Research. She is also co-director of UCSD’s new Center for Innovative Phage Applications and Therapeutics (IPATH). To email IPATH: [email protected]

Dr. Strathdee’s TEDX talk is here. She is the author, with Tom Patterson, of  The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug: A Memoir. You’ll find more information about the UCSD program on bacteriophages here.

Steffanie Strathdee, PhD, UCSD IPATH

Lina Zeldovich grew up in a dissident family of Soviet scientists and learned English as a second language in her twenties, as an immigrant New Yorker. Now an award-winning journalist, author, speaker, and Columbia Journalism School alumna, she has contributed hundreds of stories for leading publications including Popular Science Magazine, The New York Times, Reader’s Digest, Scientific American, Smithsonian, National Geographic, and BBC, and appeared on radio, podcasts and TV. Lina is the author of The Other Dark Matter: The Science and Business of Turning Waste into Wealth and Health, and her new book new book is THE LIVING MEDICINE: How a Lifesaving Cure Was Nearly Lost―and Why It Will Rescue Us When Antibiotics Fail

It is available on Amazon and Bookshop.org. Also from the publisher: https://us.macmillan.com/books/9781250283382/thelivingmedicine

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Lina Zeldovich, author of The Living Medicine

The podcast of this program will be available Monday, November 11, 2024, after broadcast on Nov. 9. You can stream the show from this site and download the podcast for free.

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This week, a nationally-renowned expert on hypnotherapy describes how this tool can be used to help people heal from stress or pain. Have you tried it?

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on November 4, 2024.

People who see a healthcare provider for pain, anxiety or insomnia are frequently offered a prescription for a pain reliever or an anti-anxiety drug. While these may work in the short term, they are far from ideal for addressing an ongoing problem. Why not use hypnotherapy, which puts relief right into the patients’ own hands? Evidence shows that this can be very effective.

Research has shown that hypnosis has three components: focusing on a goal, putting everything else outside of the immediate attention, and practicing cognitive flexibility. This allows the person to try on different ways of being to see how that feels. You might believe that you could not be assertive, because you’re just not that kind of person. But during hypnosis, you could practice standing up for yourself and discover it feels good. Perhaps it isn’t quite as hard as you imagined. When setting goals for hypnosis, it is important to focus on what you are for rather than worry about what you are against.

Anyone who could be hypnotized might potentially benefit from this mode of treatment. Although some people are more hypnotizable than others, most people can enter a trance state and use it to make changes they need in their lives. Dr. Spiegel classifies people into three groups based on ease of hypnosis: poets, who are very easily hypnotized, diplomats, who tend to analyze the experience later, and researchers, who are hard to hypnotize because they tend to keep their attention on the multiple other stimuli in their environs. He has found that transcranial stimulation can temporarily increase hypnotizability and improve the patient’s motivation to change.

The crisis of opioid overdose deaths underscores how many Americans are in pain that has not been adequately treated. Unfortunately, when narcotics have been used for more than a short period of time, the nervous system adapts. The consequence is that when a person stops taking the medicine, they may experience “withdrawal hyperalgesia,” more pain than before. This is an advantage of using hypnotherapy for pain relief instead. It does not result in unpleasant withdrawal symptoms.

Studies suggest that one in four veterans who have seen combat may experience post-traumatic stress. This does not respond well to the usual medications, but hypnotherapy can be very helpful. In addition, veterans are not the only ones to suffer PTSD. This treatment can be useful for those recovering from all sorts of trauma.

The ultimate use of hypnosis is to help us achieve our best selves. The common misconception that you might lose control under hypnosis is exactly backwards. Done properly, hypnotherapy can help us team up our body and mind together to accomplish our aspirations.

We can do that in multiple contexts, potentially reviewing the best aspects of our sexual relationships. There is some discussion of the ability of hypnotherapy to help people overcome pornography addiction near the end of the show, so parents may want to use discretion in listening with children.

Here are a few of Dr. Spiegel’s papers:

Dr. David Spiegel is Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine. Dr. Spiegel has more than 40 years of clinical and research experience studying psycho-oncology, stress and health, pain control, sleep, hypnosis, utilizing neuroimaging and conducting randomized clinical trials. He has published thirteen books, 425 scientific journal articles, and 175 book chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. He is Past-President of the American College of Psychiatrists, the Society for Clinical and Experimental Hypnosis, and is a member of the National Academy of Medicine. Dr. Spiegel is Co-Founder and Chief Scientific Officer of REVERI, an interactive hypnosis App: https://www.reveri.com/

David Spiegel, MD, Stanford University School of Medicine

The podcast of this program will be available Monday, November 4, 2024, after broadcast on Nov. 2. You can stream the show from this site and download the podcast for free.

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This week, we’ll dive into the research on how emotions affect your heart health. Specifically, we talk with two scientists who have studied the impact of anger on blood vessels. How might that shape your risk of a heart attack? Can you change your impulse to react with anger when somebody else is thoughtless or rude?

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on October 28, 2024.

Decades ago, a pair of cardiologists noticed that many of their heart-attack patients had a similar emotional profile: impatient, hard-charging, competitive and irritable (International Journal of Psychiatry, May 1968). They inspired many investigators to look at the personality characteristics of people in research studies. The idea was to tease out whether time urgency, competitiveness or irritability and hostility were more important in determining the increased risk.

By the 1980s, some scientists had begun to determine that hostility, anger and cynical mistrust of others were more important than other aspects of the type A behavior pattern in driving cardiovascular risk (American Journal of Cardiology, Dec. 28, 1987). Dr. Redford Williams was one of the pre-eminent researchers in this field, confirming that anger can harm the heart.

More recently, investigators have been striving to determine the mechanisms. What is it about anger and hostility that is so bad for the body? Scientists have learned that people have differing reactions to recalling a situation that made them angry. Some people can tell the anecdote like a story, without attaching much emotion to it in the retelling. For others, remembering the situation upsets them greatly and they become angry once again. They may even hang on to their anger for hours.

A study published earlier this year demonstrated that for these individuals, recalling something that made them angry affects the lining of their blood vessels. This surprisingly long-lasting reaction of the endothelium reduces the flexibility of their blood vessels, including their coronary arteries (Journal of the American Heart Association, May 1, 2024). Dr. Matthew Burg, one of the investigators, describes the study and its implications.

If your cholesterol is high, your doctor will probably prescribe a statin to lower it. When blood pressure is an apparent risk factor, you’ll be encouraged to control it with a medication. We know that loneliness, depression and hostility are bad for physical as well as emotional health. Surprisingly, though, few physicians appear to think they can or should intervene to change hostile reactions. Perhaps they don’t think that is possible, or maybe they just don’t know how. No doubt they might benefit from training in medical school to help them (Academic Psychiatry, May-June 2008).

Dr. Williams and his wife Virginia have written about a number of strategies to help people moderate their tendency to react with hostility to any challenge. The first step could be to recognize when you are angry and what triggered that emotion. Keep in mind that sometimes anger may be useful. Dr. Williams suggests this shortcut: I AM worth it. I stands for is this matter Important? A: is my anger Appropriate? M reminds us to assess if the situation can be Modified. Then we need to evaluate if the action we would take would be WORTH IT. If so, then the next step is to take the most effective action possible.

Cognitive Behavior Therapy can be a great help. The Life Skills that Redford and Virginia Williams recommend are also impactful. Learning to listen carefully and respectfully and reflect back what you have heard can make a huge difference in relationships.

Ideally, this type of training would be part of every middle school curriculum. Helping people change before their cardiovascular systems have been exposed to years of damage could contribute to life-long health. The most important message, in conclusion, is that even if you discover you are a hostile individual in too many situations, you CAN change. And changing could save your life.

Matthew M. Burg, PhD, is Professor of Medicine in the section of Cardiology at Yale School of Medicine. His website is: https://medicine.yale.edu/profile/matthew-burg/  Dr. Burg is author of Psychological Treatment of Cardiac Patients

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Redford Williams Jr, MD, is Professor Emeritus of Psychiatry and Behavioral Sciences at Duke University School of Medicine. His website is https://medicine.duke.edu/profile/redford-b-williams

Redford Williams, Jr, MD, Professor Emeritus Duke University

The podcast of this program will be available Monday, October 28, 2024, after broadcast on Oct. 26. You can stream the show from this site and download the podcast for free.

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This week, an eminent toxicologist, now retired, describes the concerns about PFAS compounds, also known as forever chemicals. Although scientists have known for decades that they get into our bodies readily, the apparent benefits led to their widespread use. These are compounds that do a wonderful job keeping your boots and rain gear dry, keeping the grease from your fast food inside the package and preventing stains in carpets, upholstery and clothing. Are you still using nonstick pans? If so, there’s a chance you are ingesting some type of PFAS every time you cook. How can you avoid the harms from forever chemicals?

You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on October 21, 2024.

Per- and polyfluoroalkyl substances (PFAS) were first created in the 1930s and 1940s. Since then, they have become nearly ubiquitous. They are, of course, essential to Teflon for nonstick pans, but they are also found in kids’ school uniforms, exercise clothes, fast-food packaging of various sorts and automobiles. You’ll even find them in cosmetics like waterproof mascara, not to mention their use in fire-fighting foam for large fires. No wonder almost all of us have PFAS detectable in our bodies.

Because these are not natural compounds, we do not have good ways to remove them from our organs and blood streams. No chelating agents can pull them out. As a consequence, our best defense against the harms from forever chemicals is to avoid the products that contain them as much as possible.

Much of our drinking water contains PFAS. If you are on a municipal water system, you may get an annual report to tell you which ones have been detected and at what levels. Home purifiers can help, though. Water filters with granulated charcoal can remove most of the forever chemicals. Even better, water filters using reverse osmosis remove virtually all of them. To continue getting these benefits, we do have to change the filters on the recommended schedule. What’s more, we should be treating these used filters as hazardous waste rather than simply chucking them in the trash bound for the landfill.

If upholstery, carpets, clothing and shoes are made with PFAS–as so many are–it is inevitable that dust in the home or the office will be loaded with some of these forever chemicals. There are, after all, an estimated 12,000 to 16,000 different compounds with at least 200 use categories. No wonder they are so hard to escape. To minimize ingestion, wash your hands carefully after cleaning and before eating. And don’t leave food sitting out. The likelihood of dust getting on it or into it and contaminating it increases with time.

That’s indoors. Three states have recently asked the US Environmental Protection Agency to add four specific compounds in the PFAS category to the list of Hazardous Air Pollutants. That would also governmental regulation to minimize their emission.

PFAS don’t usually seem to cause acute problems. Instead, they are more insidious, apparently contributing as risk factors to many common chronic conditions. High levels have been linked to problems with fertility and low birth weight in both humans and domestic animals. Moreover, obesity, high cholesterol and type 2 diabetes have all been linked to PFAS by numerous studies. These compounds may also affect the immune system, possibly reducing its ability to fight infection. In other cases, forever chemicals appear to increase a person’s chance of developing autoimmune disease. Some experts have called for routine toxicity testing (Current Environmental Health Reports, June 2024). Tests are available for some, but not all, PFAS compounds. They are not part of routine health screening, and insurance companies may be reluctant to pay for them.

We asked Dr. Birnbaum to summarize her recommendations. She suggests:

Linda Birnbaum, PhD, is a toxicologist and scientist emeritus. She was director of the of the National Institute of Environmental Health Sciences and the National Toxicology Program for many years. Prior to that, she directed environmental health research at the EPA. Dr. Birnbaum served as president of the Society of Toxicology and chaired the Division of Toxicology at the American Society for Pharmacology and Experimental Therapeutics. She is a scholar in residence at Duke University.

Dr. Linda Birnbaum, scientist emeritus, former director of NIEHS

The podcast of this program will be available Monday, October 21, 2024, after broadcast on Oct. 19. You can stream the show from this site and download the podcast for free.

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