The People's Pharmacy

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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This week, our guests share their expertise on how to deal with sniffles and congestion, whether you are reacting to seasonal triggers or suffer from year-round allergies. Can you reduce the amount of allergen you are exposed to? Which medications could help, and what are the downsides? We’ll also discuss some herbs that can help ease uncomfortable symptoms.

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 14, 2024.

We’ve been talking about the misery of allergies for decades, but it seems as though they are getting worse. Could there be a link to climate change?

Dr. David Peden says that is very likely. With climate change, plants start releasing their pollen earlier in the spring and continue later in the fall. Depending upon which pollens trigger a person’s allergic response, they could start suffering sooner or discover they are miserable later in the year.

Outdoor air carries pollen, but indoor air can also be full of allergens. Pet dander and dust mites are common culprits. What can you do to protect yourself from hazards inside?

Ventilation is key to getting enough clean air. One tool that can help assess the ventilation in your space is a carbon dioxide monitor. That’s not because you need to avoid carbon dioxide but rather because it tells you if the air around you is circulating or just sitting and accumulating contaminants. A good air filtration system is vital for controlling indoor allergens and managing year-round allergies.

Some of the best-recognized medications for allergies are antihistamines. Diphenhydramine (Benadryl) has been around for many decades. Although it blocks histamine quite effectively, it has a significant downside for daytime use. People taking Benadryl during the day may feel too sleepy to function. In fact, OTC nighttime pain relievers such as Advil PM or Tylenol PM continue diphenhydramine to cause drowsiness. Short-term use could help you breathe at night during allergy season. We worry about long-term use for year-round allergies because it could affect cognitive function. Moreover, using any of the antihistamines, including cetirizine (Zyrtec) or fexofenadine (Allegra), continuously for an extended period my result in reduced effectiveness.

Decongestants shrink the blood vessels that lead to swollen tissue in your nose. That can help you breathe much more easily, but of course there’s a catch: Decongestant nasal sprays are limited to about three days. If a person uses one for longer than that, their body may adapt, and stopping use could result in rebound congestion. Oral decongestants don’t usually create that problem, but they are much less likely to be helpful. Scientists know that one common ingredient, phenylephrine, is essentially ineffective.

Within the last decade, a number of steroid nasal sprays have become available over the counter. These can be very useful in alleviating congestion and other nasal symptoms. They are powerful anti-inflammatory compounds being delivered right where inflammation is causing the most trouble. None of these should be used indefinitely, however.

There is still a role for allergy shots in desensitizing people to certain allergens. Although doctors recommend them more often for severe allergies such as bee sting that could result in anaphylaxis, they can also be used for seasonal allergies. People who have had a series of allergy shots also seem to be less susceptible to respiratory infections.

Lavage is a fancy word for “washing.” You can clean allergens out of your nasal passages with a neti pot or saline nasal spray. Dr. Peden suggests this can be quite helpful.

As we have learned, many of the agents used to treat allergies can be helpful, but they have downsides. What natural products might be beneficial? Dr. Tieraona Low Dog suggests that the gut microbiome may play a role in the immune system reaction we call allergy. One way to address that might be with a probiotic. To find an appropriate choice, she recommends consulting usprobioticguide.com

Traditional healers around the world recognize the value of bitter herbs for a range of symptoms including congestion as well as digestive problems. The bitter taste receptors that are found throughout the body, including the lungs, prevent mast cell degranulation. One medication that The People’s Pharmacy often recommends for allergies also stabilizes mast cells so that they don’t release histamine or other inflammatory compounds. Cromolyn (NasalCrom) needs to be used preventively, before allergy season starts, to get the most benefit. Bitter herbs may sound exotic, but dandelion root is readily available. Another herb, Andrographis, is termed the king of bitters and can be useful for seasonal and year-round allergies as well as cold symptoms (PLoS One, Aug. 4, 2017).

Quercetin is a compound that is found in numerous plants, including many that we consume often, such as apples, garlic and tea. To use it for allergy symptoms, Dr. Low Dog often recommends a reliable extract (500 mg twice daily during allergy season). An herb that helps with symptoms of stuffiness, butterbur, requires careful shopping. If the toxic compounds (pyrrolizidine alkaloids) are not removed, there is a risk of liver damage. The brand name product Petadolex has been treated appropriately and is safe. Some people take 50 to 75 mg twice a day for symptoms (PLoS One, April 11, 2024).  Finally, an extract of stinging nettle (Urtica dioica) is also useful for calming symptoms of seasonal or year-round allergies.

David B. Peden, MD, MS, FAAAAI, is the Andrews Distinguished Professor of Pediatrics and Senior Associate Dean for Translational Research at the University of North Carolina at Chapel Hill. He also serves as the Chief Research Officer & Director of the UNC Clinical Research Alliance. In addition, he is Medical Director of the Center for Environmental Medicine, Asthma and Lung Biology in the Division of Pediatric Allergy & Immunology at The School of Medicine of The University of North Carolina at Chapel Hill.

David B. Peden, MD, MS
Harry S. Andrews Distinguished Professor of Pediatrics
Senior Associate Dean for Translational Research
Chief, Division of Allergy, Immunology & Rheumatology, Department of Pediatrics
Director, Center for Environmental Medicine, Asthma & Lung Biology

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: Healthy at Home: Get Well and Stay Well Without Prescriptions, Life Is Your Best Medicine, and Fortify Your Life: Your Guide to Vitamins, Minerals and More.

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Her website is:

Dr. Tieraona Low Dog describes natural ways to treat heartburn

The podcast of this program will be available Monday, September 30, 2024, after broadcast on Sept. 28. You can stream the show from this site and download the podcast for free.

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This week, Joe and Terry Graedon welcome your calls about how you can protect your precious eyesight. Have you been struggling with dry eyes or diagnosed with glaucoma? You can share your experience or ask your questions at 888-472-3366 between 7 and 8 am EDT on Saturday, October 5, 2024. We also invite you to send you comments in beforehand to [email protected].

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 Oct. 7, 2024.

The very back of the eye, where the images form when we see, is called the retina. Our guest, ophthalmologist Sharon Fekrat, has led cutting-edge research on retinal imaging and dementia diagnosis. Specialized imaging called optical coherence tomography angiography combined with artificial intelligence analyses can discriminate between people with serious brain changes and those with healthy brains. Not only does this offer earlier diagnosis of Alzheimer disease, Parkinson disease or other dementias, it also suggests that keeping the retina healthy might also benefit the brain.

If you have questions about retinal detachment or other retinal problems, please get them to us through email or phone. We will also be discussing diabetic retinopathy and welcome questions about screening and treatment for that condition.

A study published last month in the British Journal of Ophthalmology (Sep. 24, 2024) analyzed 276 studies covering more than 5 million children and youth. Rates of myopia, the technical term for nearsightedness, have been rising rapidly. Now, more than one third of youngsters are nearsighted and many need glasses to see well. Is there anything parents should be doing to try to prevent this problem?

As we grow older, the proteins in the lens of the eye begin to deteriorate. This can cause the lens, which starts out clear, to become cloudy. At some point, the cataract will impair vision. The standard treatment is surgical removal of the clouded lens and replacement with a synthetic lens. When should you have cataract surgery? What else might be causing your visual problems?

Glaucoma can begin so gradually that there may be no symptoms at first. Eventually, though, it can lead to vision loss because the optic nerve becomes damaged. When an eye doctor measures the pressure in your eyes, he or she is assessing you for glaucoma. Not every case presents with high intra-ocular pressure, though. What other diagnostic tests should you undergo? When do you need them? What treatments do doctors use when they diagnose glaucoma?

Like many of the other conditions that can undermine your precious eyesight, the risk of macular degeneration rises as we age. The macula is the central part of the retina responsible for clear vision. When it begins to break down, people may have trouble seeing directly in front of them. This makes driving dangerous and reading extremely challenging.

The two types of macular degeneration, dry and wet, have different characteristics and different treatments. The FDA recently approved two new treatments for dry macular degeneration with geographic atrophy. They are Syfovre and Izervay. When they are injected into the eye on a regular basis (every month or two), they can slow the progression of the atrophy. We don’t yet have treatments that can reverse it.

The treatment of wet macular degeneration also involves injections into the eye. In this condition, small blood vessels start to grow under the retina where they don’t belong. If they leak, they can scar the retina. This serious condition is also treated with injections to stop the formation of blood vessels.

The eye doctor may also suggest taking a multivitamin with the AREDS2 formula since a randomized controlled trial demonstrated that this can slow progression of macular degeneration.

Any time you work with tools that might create flying shards, it is critical to wear safety glasses. People with impaired vision in one eye should be especially conscientious about wearing 3mm polycarbonate shatterproof lenses to protect the good eye.

Respectacle is a resource/website where used prescription glasses are repurposed (cleaned and posted on their website). At the website, one’s prescription can be entered and possible glasses prescription “matches” show up to consider as an option. The glasses cost $5 and provide an option for those who may not currently have the resources to pay for standard prescription glasses and as a result are doing without.

Please share your inquiries and your stories about protecting your vision. You can email us: [email protected] or call 888-472-3366 between 7:00 and 7:50 am EDT on Saturday, October 5, 2024.

Sharon Fekrat, MD, is a retina specialist at the Duke Eye Center and vice chair of faculty affairs and professor of ophthalmology and neurology at Duke University School of Medicine. She is associate chief of staff at the Durham VA Healthcare System and past interim chief of surgery there. She is currently Director of Duke iMIND Research Group and Chief Editor of the book All About Your Eyes. She also edits the Duke Journal of Case Reports in Ophthalmology. Dr. Fekrat is past President of the NC Society of Eye Physicians and Surgeons.

Sharon Fekrat, MD, FACS, FASRS

The podcast of this program will be available Monday, October 7, 2024, after broadcast on October 5. You can stream the show from this site and download the podcast for free.

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).

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This week, we talk with a physician who was struck with a catastrophic illness as a medical student. He nearly died from it; in fact, a priest administered last rites. But David Fajgenbaum wouldn’t give up. He helped find the treatment–an existing drug for a different health condition–that has kept him alive for more than a decade. Now he is working on unlocking the lifesaving potential of old drugs for other patients.

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 Sept. 30, 2024.

Our guest, Dr. Fajgenbaum, was excited when he discovered that his condition, Castleman disease, was associated with excess MTOR. The acronym stands for Mammalian Target of Rapamycin. Rapamycin, also called sirolimus, is prescribed to transplant patients to keep them from rejecting their new organs. As Dr. Fajgenbaum states, it was sitting on the shelf at the local CVS. Because it was an old drug, doctors had a pretty good idea of its potential side effects and pitfalls. Everyone was delighted to discover that it worked (and is still working) to keep Dr. Fajgenbaum’s Castleman disease in check.

Even during the darkest days of his illness, Dr. Fajgenbaum (a med student in those days) did not give up hope. But he realized that hope needed to be more muscular than simply wishing someone would come up with a cure. He needed action to reinforce the hope. Here are his three steps for overcoming adversity:

Medicine has developed numerous medications that work for specific conditions. There are, however, many more human ailments that have no cures or even good treatments. Dr. Fajgenbaum has dedicated himself to investigating the lifesaving potential of old drugs. If drugs exist that could be used to help people who have no other treatments, why not try? Of course, clinical trials are critical to this effort. A theoretical mechanism of action is not enough to ensure that a medication will actually make a difference for a sick patient. The COVID-19 pandemic gave us a few examples, including both meds that worked and ones that didn’t.

Dr. Fajgenbaum’s organization Every Cure has identified 14 drugs with lifesaving potential. One is the PD-1 inhibitor pembrolizumab, initially approved for the treatment of melanoma and certain types of lung cancer. Now, Every Cure has found that this medicine can be helpful against a devastating disease called angiosarcoma. Dr. Fajgenbaum has also found an unexpected use for an asthma drug called omalizumab (Xolair).

One barrier to uncovering the lifesaving potential for old drugs is that most of these existing compounds are no longer on patent. Consequently, the pharmaceutical firms that created and marketed them initially no longer have an incentive to invest in research on them. That is why the work that Every Cure is doing is so important.

David Fajgenbaum, MD, MBA, MSc, is Associate Professor of Medicine and Founding Director of the Center for Cytokine Storm Treatment & Laboratory (CSTL) at the University of Pennsylvania where he is one of the youngest tenured professors in the history of Penn Medicine. In addition, Dr. Fajgenbaum is Co-Founder & President of Every Cure and Co-Founder & President of the Castleman Disease Collaborative Network (CDCN). He is national bestselling author of Chasing My Cure: A Doctor’s Race to Turn Hope Into Action. The photo of Dr. Fajgenbaum is by Rebecca McAlpin.

You can buy his book from the Amazon link above or from Bookshop.org here: Chasing My Cure: A Doctor’s Race to Turn Hope Into Action.

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. David Fajgenbaum, University of Pennsylvania

The podcast of this program will be available Monday, September 30, 2024, after broadcast on Sept. 28. You can stream the show from this site and download the podcast for free.

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This week, our guest calls attention to beliefs and practices in medicine that are based on dogma rather than data. Why don’t doctors or researchers question these blind spots? You’ll hear about some of the most striking myths, and maybe you’ll be surprised.

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 at your convenience. 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 Sept. 23, 2024.

Our guest, Dr. Marty Makary, defines blind spots as statements that go unquestioned even though they are not supported by evidence. These reveal a medical culture of groupthink. Unfortunately, this is not a new phenomenon. Back in the mid-19th century, Dr. Ignaz Semmelweis investigated the high mortality rate in one maternity clinic he managed. When he found that doctors were going straight from cadaver dissection to delivery, he demanded that doctors wash their hands with disinfectant. His experiment was a great success, since the maternal mortality rate plummeted.

On the other hand, doctors did not believe that washing their hands could possibly make a difference. They refused to adopt the practice, and Dr. Semmelweis became a pariah. Even though this was before people understood the germ theory of disease, the evidence that Dr. Semmelweis had collected was compelling. Despite this, it took more than a century for doctors to accept the necessity of washing their hands before and after every patient.

Surely, an event of this sort could only happen in a benighted era before medicine understood the theory behind infection. At least, so we would hope. However, Dr. Makary cites multiple discoveries that are overlooked for years because they don’t happen to be part of an NIH Center. In some senses, these Centers are silos.

If people are reluctant to stray beyond the accepted wisdom, they won’t make room for new evidence to change how they approach a problem. However, that is the essence of science. Dr. Makary described his participation in grand rounds presenting new information. The committee responsible for overseeing the presentation wanted an assurance that none of the information presented would go beyond the bounds of currently accepted knowledge. He was planning to present new information, which is, after all, the point of education. Consequently, he had to discuss this controversial approach with the committee. It is another way that blind spots get reinforced.

One medical myth that we have railed against for years is the idea that eating eggs puts your heart at risk. For many years, healthcare professionals maintained that eating foods rich in cholesterol (as eggs are) would raise blood cholesterol. Since elevated cholesterol is a risk factor for heart disease, many people were advised to avoid eggs and to spread margarine instead of butter on their toast. None of those recommendations were based on evidence, but they are among the most persistent blind spots in medicine.

Another example is medicine’s initial resistance to the idea that stomach ulcers can be caused by bacterial infection, specifically Helicobacter pylori. When Australian gastroenterologist Barry Marshall presented the evidence to his colleagues in 1982, they were slow to stop blaming stress as the primary cause of stomach ulcers. Dr. Marshall persisted and continued to gather evidence. In 2005, the Nobel committee awarded him and his collaborator J. Robin Warren the Nobel Prize for Physiology or Medicine for that research.

Another ongoing case of doctors doggedly ignoring evidence relates to medications to treat Alzheimer disease. Pharmaceutical firms have spent billions of dollars developing drugs to remove amyloid from the brain, even though the original research that set off the stampede has been questioned. People with Alzheimer disease usually have an accumulation of amyloid plaque in their brains. However, it is not clear whether the amyloid is the principal actor or a bystander of sorts. What is clear is that removing amyloid, as many of these medications do, does not produce impressive clinical benefit. Should medicine rethink this approach?

Dr. Marty Makary is the chief of Islet Transplant Surgery at Johns Hopkins. A public health researcher, Dr. Makary leads efforts to improve the health of communities and focuses on the “re-design of health care” to make healthcare more reliable, holistic, and coordinated, especially for vulnerable populations. He leads national efforts to increase medical transparency and lower health care costs for everyday businesses and consumers. Dr. Makary is a New York Times bestselling author. He is the recipient of the 2020 Business Book of the Year Award for his book, The Price We Pay. Dr. Makary’s most recent book is Blind Spots: When Medicine Gets It Wrong, and What it Means for Our Health. The website is https://geni.us/blindspots

Dr. Marty Makary of Johns Hopkins University

The podcast of this program will be available Monday, September 23, 2024, after broadcast on Sept. 21. You can stream the show from this site and download the podcast for free. This week the podcast features additional information on how Johns Hopkins is redesigning healthcare. We also discuss making informed consent truly informed and how treatment guidelines may put patients and providers at odds.

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).

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This week, we talk with a sociologist and a neurologist about the extremely painful condition known as cluster headaches. The sociologist has studied how patients have sought out relief that the medical profession could not provide. They found it in magic mushrooms and shared the details among patient groups termed ClusterBusters. The neurologist has studied the use of psilocybin to alleviate cluster headaches.

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 Sept. 16, 2024.

Cluster headaches could well be termed the headaches from hell. Although they are less common than migraine headaches–which are terrible enough–people find the pain worse. In fact, people who have had gunshot wounds or kidney stones say their cluster headaches surpass those kinds of pain. The head pain is often a burning or stabbing pain centered on one eye.

Unlike migraines, they don’t usually last very long, but they do recur. They may happen at the same time each day, or they may occur on a regular schedule. Anticipating the pain really impairs the quality of a person’s life. People have taken extreme measures to try to escape cluster headaches.

Doctors do have some treatments for cluster headaches, but they aren’t always effective. Part of that has to do with the head pain itself, which may be recalcitrant. In addition, doctors don’t always know exactly how to apply therapies that have been shown to be effective, such as high-flow oxygen. However, oxygen, even when applied properly, stops cluster headaches but does not prevent them.

Other therapies that show promise for treating cluster headaches include galcanezumab (Emgality), a medication that FDA approved for preventing migraines. In addition, vagus nerve stimulation can stop some cluster headaches.

Cluster headaches are exceptionally difficult to study because they are sporadic and relatively short-lasting in many cases. Although some people have headache cycles that are very regular, everyone’s recurrence is different. That level of unpredictability is a nightmare for clinical trial investigators. Moreover, doctors and patients alike would like a way to prevent cluster headaches, as that would be the best approach to managing them well. That is where magic mushrooms come in.

Patient groups were meeting online to provide each other support and information about how to deal with cluster headaches. Then one person reported on his personal experimentation with magic mushrooms and how well they worked to prevent his cluster headaches. Although it took nearly a year to catch on, eventually other patients followed his lead and found that low doses hallucinogenic mushrooms do indeed help prevent the headaches. Scientists such as our guest, Dr. Schindler, are now studying psilocybin for this purpose. It should not be taken by people with cardiovascular problems such as unstable blood pressure or a history of heart attack or stroke. Likewise, anyone with a history of psychosis should not take psilocybin or the magic mushrooms it comes from.

Joanna Kempner, PhD, associate professor in the Department of Sociology at Rutgers University, is an award-winning sociologist of science, medicine, technology, and inequality, and the author of Psychedelic Outlaws: The Movement Revolutionizing Modern Medicine and Not Tonight: Migraine and the Politics of Gender and Health. Her website is https://www.joannakempner.com/

Joanna Kempner, PhD, Rutgers author of Psychedelic Outlaws

Emmanuelle Schindler, MD, PhD, is a board-certified neurologist and headache medicine specialist. She is Medical Director of the Headache Center of Excellence at Veterans Affairs Connecticut Healthcare System and Assistant Professor of Neurology at Yale School of Medicine. Among her efforts to optimize the management of headache disorders, she has executed the first controlled trials of psilocybin in headache disorders. She has published the results in Headache (Nov. 2022) and in the Journal of the Neurological Sciences (May 15, 2024).

Emanuelle Schindler, MD, PhD, Medical Director of the Headache Center of Excellence at Veterans Affairs Connecticut Healthcare System

The podcast of this program will be available Monday, September 16, 2024, after broadcast on Sept. 14. You can stream the show from this site and download the podcast for free. This week, the podcast contains additional information about the timeline of psychedelic use over history and other uses for psilocybin such as depression of PTSD. We also discuss certain other types of headaches and possible treatments. How can you choose the correct treatment when there are so many options?

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This week, we talk with the People’s Pharmacy Pediatrician, Dr. Alan Greene, about the incredible proliferation of plastic particles in our environment and our bodies. Children are especially vulnerable, as their bodies and brains are still developing. Find out about protecting children from plastic microparticles.

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 Sept. 9, 2024.

We all appreciate the benefits of plastic. It is lightweight, economical (so long as you don’t consider disposal costs) and durable. No doubt that is why plastic has become ubiquitous in food packaging and countless other uses.

But what do we know about the perils of plastic? Several of the compounds used to make plastics are known endocrine disruptors. That is, they interfere with the way our hormones work. This is a particular concern for children exposed to plasticizers, as most are.

Chemicals are not the only way we are exposed to plastic, however. Recent research shows that microscopic particles of plastic have gotten into our bodies through the foods we eat, the water we drink and the air we breathe. They circulate through our bloodstream and have lodged in our organs. Researchers report that nanoplastics are found in arterial plaque, (New England Journal of Medicine, March 7, 2024) in our livers, kidneys, testicles (Toxicological Sciences, May 15, 2024), placentas and brains.  While the full implications of nanoplastics in our bodies are still not clear, most evidence suggests they do not benefit health.

Younger people appear to be more likely to have absorbed plastics into their bodies than older folks. Yet we worry that accumulating plastic nanoparticles could be especially harmful to children. Dr. Greene offers a number of practical recommendations to help parents protecting children from plastics. We discuss how to recognize and avoid ultraprocessed foods, as one common source. (Limiting ultraprocessed foods also has other health benefits for both adults and kids.) Storing and microwaving food is another point where we can make a difference. Dr. Greene also recommends pacifiers made of silicone rather than plastic. Toys that kids will chew should not be made of plastic.

On a separate occasion, we asked Dr. Greene about how to treat some of the most common health problems children may experience. We offered him a hypothetical trip to a desert island in which he would be responsible for keeping a group of youngsters healthy. (Dr. Greene is especially well-equipped to meet this challenge.) What medications would he need?

Life-threatening allergic reactions happen unpredictably in children. To address them, you need epinephrine on hand, either Auvi-Q or EpiPen. In addition, an antihistamine such as cetirizine (Zyrtec) could be useful.

This is another common problem that can quickly become dangerous, as small children get dehydrated quickly. Dr. Greene would pack the anti-nausea drug ondansetron and an antibiotic that could work against a bacterial infection. The most important medicine for this problem might be oral rehydration solution. He also helped develop a treatment for diarrhea called DiaResQ. That too would go into his medicine kit for the desert island.

Finally, we discuss two other problems: bellyaches, often caused by constipation, and poison oak, poison ivy or poison sumac. An over-the-counter product called Zanafel is extremely effective for washing away urushiol and getting to the cause of a poison ivy rash.

Alan Greene, MD, is a pediatrician in private practice, committed to giving extraordinary care to his patients. In 1995, he launched DrGreene.com, cited by the AMA as “the pioneer physician Website.” In 2022 he launched DrGreene.ai which provides answers to health questions for over half the world’s population in their native language. Dr. Greene is the founder of La Conexión and the founding president of the Society for Participatory Medicine. He is the author of Feeding Baby Green, Raising Baby Green, and From First Kicks to First Steps. He published his first children’s book, Flower Moon, in 2023.

Alan Greene MD

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

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This week, our guest is renowned addiction psychiatrist Jud Brewer. He teaches at Brown University in both the School of Public Health and the Medical School, and he has developed programs that utilize mindfulness to help us figure out why we overeat, get hooked on social media or drink too much. His approach has helped countless people break their own bad habits, whether it’s smoking or giving in to food cravings.

You may want to listen to this rebroadcast 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 September 2, 2024.

Have you ever come to the bottom of a bag of potato chips and wondered where they all went? How could they have disappeared so quickly? After all, you weren’t actually inhaling them.

Or perhaps the empty bag in your hand once held M&Ms. Plenty of foods have been carefully designed to hit the bliss point–a nearly irresistible combination of sugar, salt and fat. As a result, we may frequently find ourselves munching on something when we aren’t even hungry. Instead, we are eating from habit.

Habits are not unique to humans. Even sea slugs develop habits, because they save effort and require fewer decisions. The habit starts when the organism (that could be you) notices a cue or trigger. They then try a behavior to manage that trigger, and if the result is useful in some way, we can call it a reward. That’s how it works. However, you may have noticed that some habits are helpful and some (like the M&M munching habit) are less beneficial. Sometimes a habit may start off as helpful but get applied more widely so that it is now more of a hindrance.

Dr. Jud Brewer points out that we have to eat in order to survive. So if we are feeling anxious because we are hungry, and we find some M&Ms and eat them, the reward is that we no longer feel hungry. The danger is that we begin to associate M&M eating behavior with alleviating an anxious feeling. That’s one way food cravings can get started and set us on a path of eating even though we are not hungry. Unless we pay attention, we may even forget exactly how we feel when we are hungry.

Lots of us have heard that all you need to deal with food cravings is willpower. Many people believe that, but it turns out willpower doesn’t really work. Moreover, if we give in to food cravings (because willpower doesn’t work, but we expect that it should), we may end up blaming ourselves and beating ourselves up emotionally. Feelings of shame and guilt often lead us right back to feeling bad about ourselves, which might be the trigger for food cravings and overeating behavior. You can see how easily this could set up a vicious cycle that might be tough to stop. To help us start to break these habit loops, Dr. Brewer recommends self-kindness or self-compassion instead of self-judgment.

One way of breaking our habit loops is to find a bigger, better reward. To do this, it helps to practice mindfulness, paying attention to how we feel as we consume whatever food-like substance has us in its grip. Slowing down, we might be able to determine if the first and second spoonfuls of ice cream make us feel good, but by the fifth spoonful the enchantment is gone. Or we might realize that after we eat a bowl of nachos, the heartburn was not worth the momentary pleasure. What behavior can we substitute that will offer a better and more lasting reward?

Another step in breaking the cycle of food cravings is to accept the craving monster. Acknowledge the craving (I feel like eating mint chocolate chip ice cream) and explore what it feels like. Get curious about it. Cravings come and go, and if we can learn to investigate them as phenomena, we don’t have to act on them. Curiosity and kindness can help us step out of the cycle.

Jud Brewer, MD, PhD, is an internationally renowned addiction psychiatrist and neuroscientist. He is a professor in the School of Public Health and Medical School at Brown University. His 2016 TED Talk, “A Simple Way to Break a Bad Habit,” has been viewed more than 19 million times. He has trained Olympic athletes and coaches, government ministers, and business leaders. Dr. Brewer is the author of The Craving Mind: from cigarettes to smartphones to love, why we get hooked and how we can break bad habits, the New York Times best-seller, Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind, and his latest book is The Hunger Habit: Why We Eat When We’re Not Hungry and How to Stop.

You can find more information on the Eat Right Now app that Dr. Brewer developed at https://goeatrightnow.com or in the app store.

Jud Brewer, MD, PhD, Brown University

The podcast of this program will be available Monday, September 2, 2024, after broadcast on Aug. 31. You can stream the show from this site and download the podcast for free.

Download the mp3.