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

Episode 136: Indpendent vs. Employed Physicians

Over the last several decades a shift from independent physicians to corporate-employed physicians has changed the healthcare landscape.  It would make sense to consolidate and take advantage of economies of scaled to make healthcare for efficient.  Today 2 Docs Talk about whether this supposition plays out. Who is happier - independent or employed physicians? And whose patients fare better. 

Episode 135: Sleeping with Bedbugs

With stronger regulations on pesticides (for good reason), bedbug infestations have been on the rise in recent years. These little parasites live in the nooks and crannies of places where humans like to rest and recharge.  Today, 2 Docs Talk about bedbugs, what they are, what they do, and why they are on the rise. 

Episode 134: A Look Back at HIV

When Kendall and Amy began medical training, the HIV/AIDS crisis was at its peak. The number of infections were blowing up, and people were dying in frightening numbers.  But looking back at the story of HIV, it's a lesson in how public health systems work and why fear should not guide our decisions.  Today 2 Docs Talk about the history of HIV and the current status of HIV-related disease.

Episode 133: The End of the Paper Chart

When EMRs or EHRS first started popping up, it was an exciting time to be alive. The promise of no longer having to dig through fat charts to locate a lab report or trying to decipher some all but illegible note from a consultant left many physicians downright hopeful. But, as with most changes in medicine over the past few decades, the real reason for shifting to electronic was financial. This means that many EMRs are not designed to better patient care, but to better the billing process....

Episode 132: Melanoma Medicine

A lot has changed over the past 50 years. We've gone from a society that used baby oil and reflective tanning mats in the 70s to one that will spend $50 and up on a rashguard with UV protection. These changes were prompted by the growing number of melanoma diagnoses.  In this episode, 2 Docs Talk about what melanoma is and how it's demographics have shifted over time. We also take a look at prevention, diagnosis, and treatment of melanoma. 

Episode 131: The Anti-Vax Movement and the Dunning-Kruger Effect

With the continued persistence of the modern anti-vaccination movement, even with the studies that originated it debunked, we have to ask some difficult questions about what we know and how we reach people with accurate medical evidence.  The Dunning-Kruger effect is the wrench in the works when we ask those questions. How does it, and our modern love of celebrity, stand in our way? Today, 2 Docs Talk about those questions and ponder some solutions.

Episode 130: Changing Thoughts on Colon Cancer Screening

For so long, colorectal cancer screening beginning at age 50 has been gospel in preventative medicine. But recently, trends in the incidence of colorectal cancer suggest we may be doing to much screening in the wrong people, and not enough screening in the right people. This means missed diagnoses and unnecessary interventions.  But recent research offers an alternative that we hope will target screening for the right people, while the rest of us get to avoid the "scope." Does this a...

Episode 129: Is There a Physician Shortage

For those who pay attention to the state of healthcare in the U.S., the idea that we face a looming physician shortage is nothing new. Today, 2 Docs Talk about where the idea of a potential shortfall comes from, what is being done to try to remedy the problem, and some numbers that suggest maybe a shortage isn't on the horizon anyway. Resources: AAMC predictions of physician shortage Ezekiel Emanuel's response to AAMC prediction    

Episode 128: Tracking Maternal Mortality

There has been a lot of commentary in the news and in medical journals about the problem of maternal mortality - specifically how we are really crappy at tracking it, which makes it really difficult to know if interventions are working or making things worse. In a country with healthcare as advanced as it is in the U.S., this is just stupid. I mean, we could use fancier words, but the bottom line is stupid.  Today, 2 Docs Talk about maternal mortality, the problems with tracking it, and o...

Episode 127: Is There Really and Advantage to Medicare Part C?

Medicare can be confusing for a lot of folks. Part A, Part B, Part C, Part D – some are automatic, some require enrollment; some have premiums, some don't; some have eligibility requirements besides age, some don't. It can get confusing.  To try to take some of the mystery out of Medicare, today 2 Docs Talk about Medicare Part C, also known as Medicare Advantage Plans. Take a listen and decide for yourself if these plans really offer any advantage.

Episode 127: Is There Really an Advantage to Medicare Part C?

Medicare can be confusing for a lot of folks. Part A, Part B, Part C, Part D – some are automatic, some require enrollment; some have premiums, some don't; some have eligibility requirements besides age, some don't. It can get confusing.  To try to take some of the mystery out of Medicare, today 2 Docs Talk about Medicare Part C, also known as Medicare Advantage Plans. Take a listen and decide for yourself if these plans really offer any advantage.

Episode 126: The Cerumen Show

Have you ever had water in your ear after swimming, gotten a bug in there, or just felt the urge to clean that wax out of there? If so you might have experienced otitis externa, or an infection of the outer ear. In today's episode, 2 Docs Talk about cotton swabs (should you use them to clean out your ears?), ear wax (what is it, how do you get rid of it, and do you really want to get rid of it?), and how the outer ear can become infected (swimmer's ear anyone?).   

Episode 125: Kratomic Explosion

Kratom doesn't sound like your typical herbal supplement, but it does come with all the issues common to the supplement industry. Namely, it hasn't withstood the test of clinical trials to demonstrate safety and efficacy.  And that causes problems.  Problems like not knowing how much of the ingredient is in the supplement, or how much of other ingredients for that matter. Or wht kind of side effects might be evident if it were subjected to randomized placebo-controlled trials.  But a...

Episode 124: Treating Opioid Addiction

With our apologies to and appreciation of Frances McDormand. The opioid crisis is showing no signs of tapering off any time soon, so today, 2 Docs Talk about the cornerstone of opioid addiction treatment - medication assisted therapy or MAT. We also (because we can't resist) talk about the irony of the very company who triggered the epidemic with their deceitful marketing practices now profiting from selling the treatment for that very problem. Resources: Previously, we disucssed...

Episode 123: Fall 2018 Updates

After a hiatus that lasted much longer than planned, we are back with our fall 2018 season of 2 Docs Talk, with look back on previous topic and an update on what's been going on since we first discussed them. We'll talk about the following episodes: Hormone Supplementation and Menopause Right to Try Legislation The Flu, the Flu Shot and the Future Cervical Cancer and the HPV Vaccine Medicaid Expansion The Mumps   Other resources for this episode can be found here: JAMA a...

Episode 122: Does everyone get healthcare in the U.S. when they really need it? (Rebroadcast)

If you've had many conversations about healthcare reform, it is likely you've heard some variation on this theme:  "Hospitals have to provide care for people who show up. So everyone can get healthcare when they need it. So when people say that can't get healthcare, that isn't true." Is there any merit to that argument? Spoiler: NO. But if you want to hear more about where that idea comes from, take a listen.  Resources: https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTA...

Episode 121: Is There a Bright Side to SSRIs?

If you aren't taking an SSRI yourself, there it's almost certain you know someone who does. Selective Serotoning Reuptake Inhibitors are one of the most commonly prescribed classes of drugs out there. Is their widespread use earned on the basis of good evidence? It's not clear - let's take a look. References: Genetic and clinical predictors of sexual dysfunction in citalopram-treated depressed patients. Perlis RH, Laje G, Smoller JW, Fava M, Rush AJ, McMahon FJ Neuropsychopharmaco...

Episode 120: Who do Right to Try Laws Really Help?

Right to Try laws have come about as a response to cumbersome paperwork required to access the FDA's compassionate use program. However, the FDA has lessened the paperwork required for terminally ill patients to access investigational drugs.  So is Right to Try a meaningful movement, or is it simply one piece of an overaraching ideology. Today, 2 Docs Talk about Right to Try laws and who they help. Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d a...

Episode 119: Is Alchohol Good for Your Health

For decades, much has been made of the healthvbenefits of drinking alcohol. And those benefits are real. But, what exactly are the benefits, and how do they stack up against the risks associated with alcohol?  Today, 2 Docs Talk about the ways alcohol and help and harm your health, and we offer some of our opinions, too.  Resources: https://www.hsph.harvard.edu/nutritionsource/alcohol-full-story/ https://www.cdc.gov/features/costsofdrinking/index.html https://pubs.niaaa.nih.gov/pub...

Episode 118: Scratching the Surface of Varicella

If you are of a certain age, you remember a time when pretty much every kid got chicken pox. But those days are behind us as most of our children are vaccinated agains varicella, the virus that causes chicken pox. But for us old folks, shingles is the still around to remind of the old days when we still got chicken pox.  Today 2 docs talk about the effect of the varicella vaccine, the problem with shingles, and what you can do about it.   Be sure and subscribe in iTunes or Stitcher if ...

Episode 117: Glioblastoma Multiforme - What would Jimmy V Do?

Senator McCain has a malignant brain tumor called a Glioblastoma Multiforme, orglioblastoma or GBM for short. He’s not the first person politically connected to get one of these things. I think this is what Senator Ted Kennedy had back in 2008 and also Beau Biden, Joe Biden’s son died of a glioblastoma. Glioblastomas are one of a class of brain tumors called Gliomas. Gliomas can be low grade which are considered pre-malginant or pre-cancerous or they can be high grade malignancies such a...

Episode 116: The Where, What and Why of Exercise

We all know that exercise is beneficial for our health. But how much  - how long - what type? Understanding what offers the best outcomes is tricky because it's difficult to conduct rigorous research with long term endpoints such as reduction of disease and death.  Today 2 Docs Talk about some interesting studies on exercise and what they reveal about the benefits of physical activity.  Resources: https://www.ncbi.nlm.nih.gov/pubmed/25844730 https://www.ncbi.nlm.nih.gov/pubmed/258448...

Episode 115: Pressure to Treat Hypertension

The normally staid world of hypertension was a bit controversial in 2017, so this week 2 Docs Talk about the recent recommendations — and their accompanying controversies — for treating high blood pressure.  Resources: Systolic Hypertension in the Elderly (SHEP) Study Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial. Systolic Blood Pressure Intervention Trial (SPRINT) JNC 8 blood pressure treatment guidelines

Episode 114: Supplemental Ethics?

Does your doctor sell dietary supplements? Have you considered the ethics of such an arrangement? The American Medical Association has, and they think it's a bad idea. 2 Docs Talk about the ethics of physicians profiting from supplement sales. Resources: About DSHEA 1994 ER visits due to supplements Study showing supplement reduces LDL AMA Ethics Statements on Supplement Sales Pharmceutical marketing and prescribing habits  

Episode 113: Influenza 2017-18 Update

This has been a particularly bad year for the flu. More people are getting sicker than in most years. And the vaccine is not working well.  In this episode, 2 Docs Talk about why the influenza virus circulating this year is causing so many problems. Beware there is a little bit of basic science involved. But not too much. Resources:  Our information is from the Centers for Disease Control: https://www.cdc.gov/flu/about/season/current.htm Be sure and subscribe in iTunes or Stitcher if...

Episode 112: Drug Pricing (Rebroadcast)

If you’ve paid any attention to the news over the past year or so, you’ve likely seen stories of greedy capitalists gouging the vulnerable by hiking up the prices of their life-saving drugs. But are the prices hikes all that bad? Yes. Yes, they are. And we talk about that to day on 2 Docs Talk. Resources: JAMA on Drug Pricing Our episode on Hep C Our episode on Alzheimers Our episode on Pricing Transparency Be sure and subscribe in iTunes or Stitcher if you haven’t already....

Episode 111: Drug Pricing (Rebroadcast)

If you’ve paid any attention to the news over the past year or so, you’ve likely seen stories of greedy capitalists gouging the vulnerable by hiking up the prices of their life-saving drugs. But are the prices hikes all that bad? Yes. Yes, they are. And we talk about that to day on 2 Docs Talk. Resources: JAMA on Drug Pricing Our episode on Hep C Our episode on Alzheimers Our episode on Pricing Transparency Be sure and subscribe in iTunes or Stitcher if you haven’t already....

Episode 110: The Prostate (Rebroadcast)

You’d think that something like screening for prostate cancer would be free of controversy, but that just isn’t the case. The benefits and risks of screening have been hotly debated by different medical organizations over the years. Today, 2 Docs Talk about how prostate screening and the various issues surrounding it. This is a topic every man should discuss with his physicians, and we hope this hepls you know what questions to ask when you do. Resources: Weiner AB, Matulewicz RS, Egge...

Episode 109: Healthcare Pricing Transparency (Rebroadcast)

If you’ve ever tried to figure out the price of a medical procedure, you know it’s not that easy. In fact, research shows that complete pricing for medical procedures is unavailable when requested over one-third of the time. As healthcare deductibles rise and indidviduals are affected more and directly by these costs, the issue of pricing transparency is growing. In this episode we talk about the problem posed by opaque medical pricing practices. We also dig into two innovative practice ...

Episode 108: Vaccines (Rebroadcast)

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

Episode 107: Testosterone Trending (Rebroadcast)

All you have to do is take a quick drive around town to see that low testosterone clinics are all the rage. A little math will tell you why. Males make up around 50 percent of the population, and their testosterone declines, naturally, at a rate of 1 percent per year after age 30. If that decline merits treatment, it’s no wonder those clinics are everywhere. But, does it merit treatment? Is testosterone replacement safe? Is it even effective? We dig into those questions on this episo...

Episode 106: Longevity (Rebroadcast)

In healthcare, the holy graille seems to be longevity. We look at whether a treatment increases lifespan and use that as a barometer for it's value.  But should that be the yardstick we use? Or would we be better off with a more subjective measure of improving quality of life, even if that means sacrificing some of the quantity. Today, 2 Docs Talk about this question propose some things to consider as you consider your approach to aging and healthcare.   Resources: Colonoscopy stud...

Episode 105: Are GMO's or Frankenfood? (Rebroadcast)

One of the latest technological advances in food production is the introduction of GMOs, or genetically modified organisms, to the food supply. They have the potential to offer many benefits including increased productivity, pest and herbicide resistance, longer shelf life, and the list goes on. But many are concerned that this relatively new technology isn’t safe – for health, the environment or the economy. We dig into the evidence surrounding GMOs in this episode. We might even share an...

Episode 104: What to do About Chronic Back Pain (Rebroadcast)

Back pain is second only to cancer as a cause of long term disability. This health problem is damaging to individuals and costly to society. And we don’t have much in our arsenal that is effective at treating it. This week, we discuss the difference between acute and chronic back pain with regard to treatment and outcomes. We also discuss the role of surgery, medications, alternative therapies, and some interesting new research on what helps resolve chronic back pain. Resources: Resear...

Episode 103: Screening Mammography (Rebroadcast)

Screening mammography is widely used throughout the U.S. and is thought of as a great success in the prevention of breast cancer deaths. But what does the evidence say? Are we getting what we are paying for with mammography, or simply shouldering the extra cost of false positives and overdiagnosis? We examine these issues and more on this episode of 2 Docs Talk. References: What does the U.S. Preventive Services Task Force (USPSTF) do? USPSTF current (2009) breast cancer screening re...

Episode 102: Physician Burnout (Rebroadcast)

Physician burnout is a big issue in the medical community. According the the Medscape Lifestyle Report 2017, over half of physicians report burnout. But physician burnout isn’t just a problem for physicians. It is a problem for patients, for other medical staff, and for the health care economy. Today we dig into the causes of physician burnout and how it can be addressed. Here’s a hint: It doesn’t involve meditation or counseling. Resources: Medscape Lifestyle Report 2017 2 Docs Ta...

Episode 101: Direct to Consumer Marketing (Rebroadcast)

If you watch any tv at all, it’s likely you’ve seen a drug ad. These ads generally show seemingly healthy people living normal lives, the message being the drug did this for them. But are the drug ads telling the whole story? And should they even be advertising directly to consumers to begin with? We discuss this issue on today’s episode.   Resources: Nivolumab Research from New England Journal of Medicine What the FDA has to say about drug ads Be sure and subscribe in iTunes or...

Episode 100: Depression and Suicide (Rebroadcast)

With the recent release of the Netflix series, 13 Reasons Why, depression and suicide have been getting a lot of press time. In this episode, we talk about depression, what it is, how it is treated and what’s on the horizon for this far too common disorder. We also talk a bit about the Netflix series and the problem of suicide. Take a listen and see what you think. If you think you may be depressed please seek help from a trusted healthcare provider. And if you are contemplating suicide,...

Episode 99: Cervical Cancer and the HPV Vaccine

Historically, cervical cancer has been one of the major killers of young women. But since the advent of the pap smear, death from the disease has dropped dramatically. However, treatment of lesions identified on pap smear can lead to significant issues including infertility. And in other parts of the world where screenign is not easily accessed, cervical cancer remains a significant cause of death for women in the prime of life. As with any disease, prevention is better than treatment, and...

Episode 98: Medical Errors (Rebroadcast)

A BMJ report earlier this year declared that 1 in 3 hospital deaths were the result of medical errors. A flurry of headlines about the dangers of hospitals soon followed. Just what is a medical error? What are the dangers of being in a hospital? And what can we do about it? We talk about these questions in today's episode.  Resources: BMJ on medical error KATZ scale To Err is Human: Building a Safer Health System Hospital at Home Be sure and subscribe in iTunes or Stitcher if...

Episode 97: The Flu, the Flu Shot, and the Future

Thousands of people die each year from influenza. The CDC recommends that almost all people (with a few rare exceptions) receive the flu vaccine every year. But the disease and the vaccine are poorly understood. In this episode, we discuss the flu, its treatment and its prevention. Resources: Influenza vaccine effectiveness in preventing outpatient, inpatient, and severe cases of laboratory-confirmed influenza Oseltamivir treatment for influenza in adults: a meta-analysis of randomise...

Episode 96: Hospice Care (Rebroadcast)

Kendall and Amy are in agreement that hospice care is an important, compassionate aspect of healthcare that humanizes what can be a very clinical, impersonal process. We've both experience with hospice - personally and professionally.  Sadly, like most aspects of healthcare, the potential for profit has introduced some ugly practices into what should be focused solely on the needs of dying patients and their families. Today, Kendall and Amy talk about the good and the bad of hospice as i...

Episode 95: Are We Overscreening for Thyroid Disease

Most people probably know someone who has had thyroid disease of some sort, most commonly hypothyroidism - the term low thyroid hormone. But there has been a significant rise in diagnosed thyroid disease in the past couple of decades due to screening. These diagnoses include problems with thyroid hormone as well as thyroid cancers. It's easy to get excited about diagnosing more disease - you catch it earlier and help people prevent the consequences of the disease. Or do you? Today we are...

Episode 94: Medicaid, Medicaid Expansion and the Uninsured

Medicaid is the subject of a lot of talk in today's political environment. Sadly much of what is said isn't based in fact, or it focuses on parts of the program that represent a tiny portion of its cost.  Today, 2 Docs Talk about Medicaid, who it serves, and how it was affected (or, rather, supposed to be affected) by the Affordable Care Act.

Episode 93: Ovarian Cysts

Episode 92: End Stage Renal Disease

End stage renal disease, ESRD, is a growing problem in the U.S. When Medicare began covering renal dialysis, there were on 16,000 patient who required that type of care. Today that number exceeds 650,000 and continues to grow. Today, 2 Docs Talk about what causes end stage renal disease, how can it be treated, and, most importantly, how can it be prevented.    Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell ...

Episode 91: EMTALA

If you've had many conversations about healthcare reform, it is likely you've heard some variation on this theme:  "Hospitals have to provide care for people who show up. So everyone can get healthcare when they need it. So when people say that can't get healthcare, that isn't true." Is there any merit to that argument? Spoiler: NO. But if you want to hear more about where that idea comes from, take a listen.  Resources: https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTA...

Episode 90: Cervical Cancer Screening

The pap smear has been one of the greatest public health wins of the past century. Deaths from cervical cancer in the U.S. have dropped from 37.5 per 100,000 women to 7.5 per 100,000 women as a result of the simple screening test. But with our increasing understanding of the role of human papillomavirus (HPV) in the development of cervical cancer, the pap test may end up being pushed aside by HPV screening. Today, 2 Docs Talk about Pap smears, HPV screening, the current recommendations f...

Episode 89: The Ethics of New Drug Approvals (Rebroadcast)

The process of drug approval is long and expensive. To complicate matters, pharmaceutical companies, patients, an the FDA are all invested in the process, for different reasons – and they aren’t always the same. Today we discuss the story of how a new drug came to market and the unusual circumstances around its approval.  Resources: FDA grants accelerated approval to first drug for Duchenne muscular dystrophy CDC on Duchenne Muscular Dystrophy Right to Try Compassionate Use B...

Episode 88: The Past, Present and Future (we hope) of Contraception (Rebroadcast)

If there is a hot button issue in politics these days, it's abortion. But abortion is the result of a long line of issues that are being inadequately addressed in this country. Today we take a look at contraception - what it is, how it works, its history and its future.  We also offer a look at an innovative program that has the potential to help both pro-choice and pro-life groups happy.    Resources: Details on various types of birth control The Choice Project Use of LARCs in ...