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Luc van Loon is an internationally renowned expert in skeletal muscle metabolism. In this episode, Luc starts with an exploration of the roles of insulin and triglycerides in endurance exercise, highlighting their impact on skeletal muscle metabolism, and he offers profound insights into the significance of protein in this context. He elucidates how different protein types and forms influence muscle protein synthesis rates, exploring the nuances of protein absorption, digestibility, amino acid quality, and their implications for performance and recovery. Delving deeper, he differentiates between animal and plant protein sources, unraveling the distinctive properties of various protein types, from the differences between whey and casein to the emerging trends in collagen protein supplementation. Moreover, Luc dissects the intricate connections among physical activity, lean muscle mass, muscle protein synthesis induced by resistance training, and dietary protein.

We discuss:

• Luc’s background and insights about fuel selection during exercise [3:30];
• Fuel utilization during endurance exercise [9:30];
• Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15];
• The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15];
• Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15];
• How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45];
• The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30];
• How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45];
• Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30];
• Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00];
• Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15];
• Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30];
• Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00];
• How to preserve muscle while trying to lose weight [1:46:00];
• Anabolic resistance and overcoming it with physical activity [1:55:45];
• Importance of protein intake and physical activity in hospitalized patients [2:06:30];
• Reviewing the efficacy of collagen supplements [2:13:30];
• Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30];
• Future research: understanding protein metabolism in the brain [2:23:45]; and
• More.

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Paul Conti is an author and practicing psychiatrist who specializes in helping people heal from trauma. In this episode, Paul returns to The Drive to delve into the intricate relationship between emotional health, healthspan, and lifespan. He first challenges common assumptions about the inevitable decline of emotional health with age, providing strategies for conducting a comprehensive audit of internal emotional health. He establishes a framework for the foundation of good emotional health: a balance between the generative drive, the assertive drive, and the pleasure drive. Paul also explores the nuanced dynamics of motivation, happiness, and satisfaction as it relates to material possessions, draws connections between physical and emotional well-being, confronts the impact of negative self-talk, and describes how making peace with our mortality can foster a sense of hope, purpose and well-being. Additionally, Paul offers many practical insights into initiating emotional health improvements and navigating the search for a suitable therapist.

We discuss:

• The importance of prioritizing emotional health as we age [2:45];
• The impact of emotional health on healthspan and how to foster a proactive approach to emotional well-being [7:00];
• The discrepancy between outward success and inner fulfillment, and the importance of a healthy “generative drive” for genuine well-being [13:00];
• A deeper dive into generative drive: impact on human behavior, resilience, purpose, and more [23:15];
• Evaluating one’s inner self: introspection, self-awareness, challenging societal norms, and returning to the basics of physical and emotional well-being [29:00];
• Self-auditing tools: introspection, curiosity, and exploring underlying reasons for unwanted behaviors [41:45];
• Breaking free from destructive cycles by understanding the continuum of self-care and addictive behaviors and remaining curious [50:15];
• Critical self talk: the malleability of one’s inner dialogue and the potential for transformative change with perseverance and self-compassion [1:00:15];
• Slowing the anger response and gaining insights into the underlying triggers to achieve lasting change and self-understanding [1:13:45];
• Foster gratitude and humility by achieving balance between the three drives—assertion, pleasure, and generative [1:20:45];
• The conflict between intellectual understanding and emotional feelings, problematic comparison frameworks, and the importance of living in the present with intentionality [1:24:15];
• How making peace with our mortality can foster a sense of hope, purpose and well-being [1:34:45];
• Advice for finding a compatible therapist [1:43:45];
• The key components of therapeutic progress [1:57:00];
• The caricatures of four common patient phenotypes, and how to get through to them [2:05:30];
• How Paul manages his own well-being and the emotional challenges that come with his line of work [2:15:15]; and
• More.

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In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial yet often overlooked topic of iron and iron deficiency. He explores why iron is indispensable for the body, explains the repercussions of iron deficiency, and sheds light on the prevalence of this issue and who is most susceptible. Peter outlines strategies for increasing iron levels, covering dietary iron, supplementation, and infusion options, while also discussing the suitability of each approach for different individuals. Shifting gears, Peter tackles rapid-fire questions on creatine and sodium, as well as inquiries related to his book.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #58 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• Overview of today’s topics and the importance of understanding iron levels in the body [1:45];
• The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30];
• The processes of iron absorption, utilization, and transportation [9:30];
• Options for testing iron levels and how to interpret the results [13:45];
• What does it mean to be iron deficient, and how is it different from anemia? [17:15];
• Symptoms of iron deficiency and/or anemia [22:15];
• How prevalent is iron deficiency, and who is most susceptible? [24:30];
• The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30];
• The best way to improve iron levels for someone who is deficient [34:45];
• Iron supplementation: various formulations and potential side effects [37:45];
• Intravenous iron infusion as an alternative to oral supplements -- plus restless legs syndrome and other topics [42:00];
• Iron supplementation: who should and should not consider it [44:00];
• Peter’s approach to creatine and his pre- and post-workout supplements [50:15];
• Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45];
• Peter’s thoughts about the potential of writing another book [57:15]; and
• More.

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Courtney Conley is an internationally renowned foot and gait specialist. In this episode, Courtney delves into the intricate world of foot anatomy and functionality. She explores the complexities of the foot, discussing its anatomy, common injuries, and the importance of understanding its structure in preventing issues. She covers a range of foot ailments, factors contributing to them, treatment options, and prevention strategies. She delves into the significance of loading, balance, range of motion, and posture, emphasizing the crucial role of strength in preventing both injuries and falls. Additionally, she sheds light on the interconnectedness of the kinetic chain, from the leg muscles down to the foot, and how issues within this chain can cascade downstream, leading to various injuries and pathologies. Additionally, she provides a comprehensive overview of footwear, discussing suitable options for both adults and children to promote foot health and mitigate potential problems.

In addition to this interview, Courtney also recorded a series of videos to better explain a number of the concepts discussed such as diagnostic tests that are used to determine mobility and strength and the exercises one should perform to improve the outcomes based on the diagnostics. The interview will be available to everyone while the videos from the gym will only be available to paid subscribers (found at the end of the show notes page).

We discuss:

• Why Courtney chose to specialize in the foot [3:30];
• The vital role of foot strength, function, and health in human movement and well-being [6:15];
• Anatomy of the rear foot and midfoot [10:15];
• The development of flat feet, the impact of footwear, and the benefits of going barefoot [19:45];
• Anatomy of the forefoot, common injuries, and why most injuries occur in the forefoot [23:15];
• Foot musculature and its role in maintaining foot stability and preventing deformities like bunions and hammer toes [30:15];
• The intrinsic musculature of the foot, plantar fasciitis, footwear, and more [39:00];
• Plantar fasciitis: diagnosis, causes, and treatment [51:30];
• Posterior leg muscles: strength assessment methods, role in ACL injuries, and more [59:15];
• Lateral and medial muscles: ankle stability, arch support, big toe stabilization, and exercises to strengthen and prevent injuries [1:04:15];
• Importance of strength of lower leg muscles for gait and preventing shin splints, stress injuries, and more [1:08:15];
• Tendinopathies and other common pathologies related to the anterior and lateral compartments of the foot [1:13:00];
• The importance of midfoot integrity, ankle dorsiflexion, and a discussion of gait alterations [1:19:45];
• Proximal stability and its implications for posture and movement patterns [1:27:00];
• The age-related decline in foot sensation and strength [1:32:45];
• Common toe injuries, treatment, and how to prevent further progression of the injury [1:36:30];
• Preventing falls and managing arthritis with proactive foot care and exercises [1:46:45];
• Footwear: advice for picking shoes that promote foot health [1:54:45];
• Footwear for runners [2:05:30];
• The importance of prioritizing footwear that promotes natural foot movement and strength while considering individual comfort and foot health needs [2:09:30]; and
• More.

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Mark Rosekind is an expert on road safety and a policy leader with more than 30 years of experience enacting strategic, practical, and effective data-based solutions that enhance driver and pedestrian safety and health in complex environments. In this episode, Mark delves into the persistent issue of accidental deaths resulting from roadway accidents, a concern for those focused on longevity given its consistent risk throughout life. From exploring statistics on car crashes to identifying the demographics most at risk and the key locations of incidents, he uncovers various risk factors including distractions like smartphone usage, the influence of alcohol and cannabis, the dangers of sleep deprivation, and speeding. Mark also provides practical advice for both drivers and pedestrians to enhance safety, while delving into the potential and challenges of emerging technologies such as autonomous vehicles. Additionally, Mark provides valuable resources for listeners, particularly parents navigating the road safety landscape with teenage drivers.

We discuss:

• Mark’s background and education, and the profound impact of transportation accidents on human lives [4:15];
• From sleep science to safety leadership: Mark’s journey in transportation innovation [14:15];
• Stats on transportation accidents and fatalities [18:00];
• Historical trends in road fatalities and the key contributors—impairment, distraction, and more [28:00];
• The demographics of drivers involved in crashes, and the life-saving potential of better driver education programs [34:30];
• The most critical areas where drivers need to be hyper-aware to protect themselves [41:00];
• The role of the National Transportation Safety Board (NTSB) in accident investigations, and the importance of data sources like event data recorders (EDRs) in accident reconstruction and investigations [47:00];
• The dangers of phone use while driving [53:45];
• How drunk driving was addressed through advocacy and legal changes [1:01:30];
• The need to address distracted driving and the psychological impact of distracted driving accidents on both victims and perpetrators[1:07:15];
• Navigating the roads and lowering your risk of accidents: weather, human error, and defensive driving [1:15:45];
• The impact of impaired driving: alcohol, cannabis, prescription drugs, and more [1:26:15];
• Mitigating the effects of vehicle speed [1:38:15];
• The promise and challenges of autonomous vehicles for road safety [1:44:15];
• Automatic emergency braking (AEB): the effectiveness and challenges of implementing AEB as a standard feature in new vehicles [1:53:00];
• Sleep deprivation: the impact of poor sleep, drowsiness, and disrupted circadian rhythm on driving [1:58:15];
• Protecting pedestrians: strategies for reducing the risk of fatal accidents with pedestrians on foot or bicycle [2:02:30];
• Empowering safe driving: essential resources and tips for parents and teenage drivers [2:14:00];
• Promoting a culture of proactive safety: parting thoughts from Mark [2:19:15]; and
• More.

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Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav delves deep into the intricacies of VO2 max and its profound impact on performance. They explore the relationship between VO2 max and ATP production, energy efficiency, and power, as well as the impact of low-intensity training on VO2 max. The conversation extends to Olav’s experiences pushing the boundaries with high-performance athletes and the data driven interventions he uses to improve performance. They also dissect the role of lactate threshold, discuss other important metrics to track, and explore the exciting possibility of utilizing a portable VO2 testing device as a practical alternative to traditional lab-based assessments.

We discuss:

• Olav’s background, expertise in exercise physiology, coaching experience, and interest in the extremes of human capability [4:15];
• The processes of energy conversion within the human body and its implications for performance [9:30];
• Improving movement efficiency, and the importance of mindfulness in training to optimize performance [20:00];
• The relationship between VO2 max, power output, and endurance performance in different sporting contexts [34:45];
• How VO2 max is measured in the lab, and why it’s a crucial predictor of both lifespan and quality of life [44:45];
• Absolute vs relative VO2 max, the significance of functional threshold power in cycling, and the importance of longer duration tests for accurate assessments [54:00];
• Portable VO2 testing devices as a practical alternative to lab-based tests [1:05:15];
• The complexities of measuring ventilation and its impact on performance metrics like VO2 max and heart rate [1:15:45];
• Training interventions to increase VO2 max, and factors that impact performance outcomes [1:23:30];
• The respiratory exchange ratio (RER) and endurance sports, and how factors such as diet composition and exercise intensity influence RER values and performance [1:32:45];
• Science-guided training for versatile athletes: maximizing VO2 max, power, torque, and cadence in cycling, and the importance of incorporating diverse stimuli to enhance performance [1:41:00];
• Physiological limitations on VO2 max [2:02:15];
• The different energy systems used during work, and other things to monitor like VCO2 and heart rate [2:06:00];
• Lactate threshold and other metrics to guide your training [2:10:30];
• Analysis of a lactate power curve: exploring lactate dynamics in endurance training and performance [2:23:15]; and
• More.

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In this “Ask Me Anything” (AMA) episode, Peter delves into the topic of high-intensity interval training (HIIT), starting with addressing some common misunderstandings around this type of exercise and breaking down what HIIT truly entails. He examines the correlation between HIIT and VO2 max, a vital metric for overall health and longevity, and describes the beneficial impact of HIIT on longevity when incorporated properly. Additionally, he emphasizes the importance of building a wide base of cardiovascular fitness, reveals the optimal protocols for incorporating HIIT into a balanced routine, and discusses the risk of injury and other potential drawbacks of HIIT.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #57 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• Common questions about high-intensity interval training (HIIT) [1:30];
• The origins of HIIT [3:15];
• Defining HIIT training and differentiating it from sprint interval training (SIT) [5:45];
• Why HIIT is often touted as a more efficient way to exercise [14:00];
• Navigating the nuances of HIIT research: understanding limitations and the importance of a blended exercise routine [20:30];
• The four pillars of exercise [24:15];
• Using HIIT to improve VO2 max [26:00];
• HIIT training for the untrained individual: impact on VO2 max and the interplay between exercise-induced adaptations and potential weight loss [33:00];
• Sprint interval training (SIT) vs. HIIT: comparing the relative improvements in VO2 max and the impact of longer duration intervals [40:00];
• Benefits and limitations of HIIT, drawbacks of overtraining with HIIT, and the importance of a diversified routine to increase total cardiorespiratory capacity [44:15];
• HIIT protocols Peter recommends [58:45];
• The risk of injury and other potential drawbacks of HIIT [1:02:15];
• The importance of incorporating a balance of continuous moderate-intensity cardio and HIIT when aiming for longevity [1:04:00]; and
• More.

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Jason McCarthy is a former US Special Forces member and the founder of GORUCK, a company specializing in rucking equipment. In this episode, Jason recounts his journey from military service to navigating the challenging transition back into civilian life and ultimately embracing the mission of introducing rucking to the masses. Delving into the significance of rucking in military training and its applicability to the wider population, he discusses the mental and physical benefits of rucking as a mode of training, provides practical tips for beginners, and answers frequently asked questions about packs, weights, footwear, and more.

We discuss:

• Jason’s upbringing and what inspired him to join the military [3:15];
• Jason’s path to becoming a Green Beret, his calling to serve, and staying true to oneself [10:30];
• About the Green Berets: their role in the military, unique abilities, missions, and more [20:00];
• The mental and physical challenges of special forces training and selection [25:00];
• Rucking challenges as a Green Beret [37:00];
• How Jason trained in his off-time and stayed mentally prepared [46:30];
• Jason’s difficult decision to leave the army, and the challenges many veterans face returning to civilian life [51:30];
• Jason’s struggles after leaving the army: loss of identity, feelings of shame, and the how he overcame a period of despair [57:15];
• The origin of GORUCK [1:10:30];
• The GORUCK Challenge [1:24:30];
• The company's evolution from event organizer to manufacturing specialist, spurred by the growing interest in rucking as a form of training [1:35:30];
• FAQs about rucking: packs, weight, rucksack vs. weighted vest, chest straps, and more [1:38:45];
• Commemorating Normandy: GORUCK's plans for the 80th anniversary of the Normandy landings [1:51:30];
• Footwear for rucking, and how GORUCK got into the footwear business [1:57:30];
• How to avoid the most common injuries from rucking, and the benefits of rucking for VO2 max, strength, and sleep quality [2:05:00];
• Advice for using rucking as a mode of training, and the advantages of rucking over other forms of training [2:12:45]; and
• More.

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Derek is a fitness educator, the entrepreneur behind More Plates More Dates, and an expert in exogenous molecules commonly used and misused by bodybuilders and athletes. In this episode, Derek returns to the podcast to explore the impact of exogenous molecules on male and female health. He covers testosterone, DHT, DHEA, progesterone, clomiphene (Clomid), hCG, and various peptides, alongside updates from the FDA affecting peptide use. Additionally, he addresses the recent hype around increasing muscle mass through myostatin inhibition via follistatin gene therapy and supplementation. Additionally, Derek discusses the various strategies that bodybuilders use for losing fat while preserving muscle, including insights on weight loss drugs.

We discuss:

• Testosterone and DHT: mechanisms of action, regulation of muscle growth, and influence on male and female characteristics [2:15];
• TRT in women: the complexities and potential risks associated with testosterone use in women [9:00];
• DHEA supplementation: exploring the benefits and risks for women, and the differing effects on men vs. women [22:00];
• The role of progesterone in both men and women, pros and cons of supplementation, the importance of tailored doses, and more [28:00];
• Measuring levels of free testosterone [37:15];
• The trend towards earlier interest in TRT, and the risks of underground sources of testosterone [42:00];
• The complexities and considerations surrounding the use of Clomid, E-Clomid, and hCG in TRT [46:00];
• Low testosterone: diagnosis, potential causes, treatment options, and other considerations [53:45];
• Growth hormone-releasing peptides: rationale and implications of the recent FDA categorization as high-risk substances [1:03:45];
• Follistatin gene therapy and myostatin inhibition for increasing muscle mass: the recent hype online, human and animal data, and the need for more research [1:14:45];
• Simple tips for lowering calorie intake and losing fat [1:32:30];
• Methods of sustainable fat loss with muscle preservation: insights gleaned from bodybuilders [1:40:00];
• Could prolonged fasting impact testosterone levels? [1:55:30];
• High-protein ice cream [1:57:00];
• Exploring fat loss supplements and drugs: L-carnitine, yohimbine, and more [2:02:15];
• Potential remedies for individuals experiencing metabolic dysfunction due to hypercortisolemia [2:12:30];
• The cornerstones of body composition improvement remain nutrition and exercise, even in the presence of exogenous testosterone [2:19:15];
• The importance of approaching health advice found online with a critical eye and a healthy dose of skepticism [2:23:30]; and
• More.

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Alex Aravanis is a leader in research and development of technologies and clinical tests utilizing the latest tools in DNA analysis and data science. In this episode, Alex delves into two interconnected topics: liquid biopsies and epigenetics. He begins by tracing the trajectory of genome sequencing and tumor sequencing, setting the stage for a detailed exploration of liquid biopsies as an early cancer detection method. The discussion encompasses key concepts such as cell-free DNA, DNA methylation, sensitivity, specificity, and the predictive values associated with liquid biopsies. Transitioning to epigenetics, Alex examines the intricate interplay of DNA methylation and aging biology and explores the possibility of using cellular reprogramming to reverse epigenetic changes that occur with aging.

We discuss:

• Alex’s background in applying engineering to problems in medicine [3:15];
• A primer on human genetics, and the history and current landscape of DNA sequencing [11:00];
• The advent and evolution of liquid biopsies for early detection of cancer [23:15];
• The role of cell-free DNA in cancer detection: how incidental findings in non-invasive prenatal testing led to the development of liquid biopsies [40:15];
• The development of a universal blood test for cancer detection and a discussion of specificity of tests [46:00];
• Advancements in cell-free DNA analysis and development of a multi-cancer screening test at GRAIL [51:00];
• DNA methylation explained [58:15];
• Optimizing cancer detection with methylation analysis of cfDNA in small blood samples [1:02:45];
• The importance of understanding sensitivity, specificity, positive predictive value, and negative predictive value in cancer screening [1:08:00];
• The performance of the GRAIL Galleri test and its ability to detect various types and stages of cancer [1:21:00];
• Do early cancer detection methods, like liquid biopsies, translate to improvement in overall survival? [1:27:45];
• The role of epigenetics in aging [1:39:30];
• How cell-free DNA methylation patterns can help identify a cancer’s tissue of origin [1:45:30];
• Cellular and epigenetic reprogramming and other exciting work in the field of aging [1:52:30]; and
• More.

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In this “Ask Me Anything” (AMA) episode, the conversation focuses on cancer screening, a topic often shrouded in confusion yet crucial to understand given that early identification of a cancer is an essential part of survival strategy. Peter examines the arguments both for and against cancer screening, including addressing why some trials may show no benefit to screening. He then delves into the various screening modalities available for different cancers, highlights the pros and cons associated with each, and explains how to interpret the results. Additionally, Peter provides guidance for navigating outside of the relatively narrow and confined screening guidelines for various types of screening tests.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #56 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• Why understanding cancer screening is crucial [2:45];
• The prevalence of cancer diagnosis and mortality rates [4:30];
• Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00];
• Data on how cancer screening impacts survivability of cancer [16:30];
• Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45];
• What are some of the reasons why clinical trials don’t always improve cancer-specific mortality? [30:15];
• What are the arguments against population-level cancer screening? [42:00];
• Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00];
• Understanding sensitivity and specificity when reviewing screening results [52:30];
• Risks and complications associated with colonoscopies [55:45];
• Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30];
• The strengths and limitations of various types of cancer screening [1:02:15];
• Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45];
• Factors that influence an individual's pretest probability of cancer [1:13:45];
• How to interpret cancer screening results [1:18:15];
• The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30];
• How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30];
• Advice and guidance for making decisions related to cancer screening [1:31:15]; and
• More.

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