This week, Joe and Terry Graedon welcome your questions and stories about the dangers of overdosing on OTC meds. Dr. Lisa Sanders, an acknowledged expert on medical diagnosis, starts us off with a story about a patient’s mysterious illness. How was it linked to the medicine he was taking? You can ask your questions about OTC drug safety and share your experience at 888-472-3366 between 7 and 8 am EDT. We receive email at [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 May 20, 2024.

The Dangers of Overdosing on OTC Meds:

For most of us, the first thing we turn to when we notice a minor medical problem is a nonprescription medicine. Why wouldn’t we? Drugstores, quick marts, vending machines and other places offer as many as 300,000 such products for a wide range of symptoms. According to the FDA, these drugs can be used for self-diagnosed conditions, don’t need a healthcare practitioner to supervise their use and have a low likelihood of abuse or misuse. OTC drugs are usually affordable and don’t require seeing a prescriber.

That might not mean they are completely safe, though. About 95% of the products that are currently sold over the counter once required a prescription. The FDA decided that they were safe enough not to need expert monitoring. Presumably, patients/consumers are undertaking the necessary monitoring themselves. How do they know what to watch for?

Consumer Information on OTC Meds:

Do you read the Drug Facts on the label of your over-the-counter meds? Generally, this will tell you about the active ingredient and may also include a list of inactive ingredients. It should list its use. For example, the label for Prilosec OTC states: “treats frequent heartburn (occurs 2 or more days a week)” and cautions that it will not provide immediate relief.

Drug Facts also include important warnings. These may be somewhat esoteric, as in the warning about glucose-6-phosphate dehydrogenase deficiency on a box of phenazopyridine for urinary pain relief. If you have G6PD deficiency, you’ll know the warning is important. Those who do not may well wonder about it briefly and then forget it. Other warnings appear more generally. Products containing salicylates, including aspirin and Pepto-Bismol, caution against giving them to children or teenagers with chickenpox or the flu. That could result in Reye’s syndrome, “a rare but serious illness.”

Prescription to OTC:

You are probably aware that prescription drugs generally come with a lengthy list of side effects. Take Prilosec (omeprazole) as just one example. The prescribing information for this important medication used to treat ulcers, erosive esophagitis, Zollinger-Ellison syndrome and GERD lists more than 100 adverse reactions. Some of them are extremely serious, such as anaphylactic shock, angioedema, pancreatitis and liver failure. The package containing Prilosec OTC does not list any side effects directly. It does suggest you stop use and see your doctor if you get diarrhea or develop a rash or joint pain. What happened to the side effects from prescription omeprazole? Presumably, the maker and the FDA figure that using the OTC drug for just two weeks at a time makes serious reactions unlikely. But what if you took it for longer than two weeks? Are you in danger of overdosing on these OTC meds?

How to Stay Safe:

We will discuss reading labels and finding other important sources of information about your OTC meds. We welcome your questions about these drugs and your stories about problems you may have had.

Please share your inquiries and anecdotes. You can email us: [email protected] or call 888-472-3366 between 7:00 and 7:50 am EDT on Saturday, May 18, 2024.

This Week’s Guests:

Stefanie Ferreri, Pharm.D., is the Henry L. Smith and James L. Olsen, Ph.D., Distinguished Professor in Pharmacy Practice and Chair of the Division of Practice Advancement and Clinical Education at the UNC Eshelman School of Pharmacy. Her main research interests include advancing clinical practice in the community-pharmacy setting.
https://pharmacy.unc.edu/directory/ferreri/

Stefanie Ferreri, PharmD

Dr. Lisa Sanders is the Medical Director of Yale’s Long Covid Multidisciplinary Care Center. In addition to her work as a physician and teacher, she writes the popular Diagnosis column for the New York Times Magazine. In 2019 Dr. Sanders collaborated with the New York Times on an eight-hour documentary series on the process of diagnosis for Netflix. Dr. Sanders is the author of Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis and Diagnosis: Solving the Most Baffling Medical Mysteries.

Dr. Lisa Sanders

Listen to the Podcast:

The podcast of this program will be available Monday, May 20, 2024, after broadcast on May 18. You can stream the show from this site and download the podcast for free.

Download the mp3.

This week on our nationally syndicated radio show, we examine the consequences of prescriptions for anxiety or grief. All of us, at some point in our lives, will experience some of these emotions. If we discuss them with a healthcare provider, there’s a chance we’ll end up with a prescription. When are medications helpful and when do they cause more harm than good? Are there risks in medicating normal emotions?

How Should We Understand Mental Illness?

For decades, neuroscientists have been telling us that mental illness is caused by a chemical imbalance in the brain. The logical conclusion from this premise is that emotional problems should be addressed with drugs that can alter the brain’s chemical balance. Unfortunately, however, the brain and its workings are still quite mysterious, much like a black box. The medications that may be prescribed could be thought of as a crude hammer–or, better yet, a giant experiment. This particular experiment is not well-controlled or randomized, though, and it wouldn’t pass muster as truly scientific.

Are We Medicating Normal Emotions?

When did we start thinking of everyday challenges as psychopathology? How can we change our perceptions? Both of the guests for this episode have been involved with an extraordinary documentary, Medicating Normal.

This film acknowledges that psychotropic drugs can be helpful or even lifesaving for some people. However, doctors are over-prescribing them, and the result is a public health crisis. The movie follows five individuals who experienced serious problems as a consequence of the prescription medications they were taking.

The Problems with Anti-Anxiety Drugs:

Among the most common psychotropic medications are the anti-anxiety pills called benzodiazepines. These compounds, such as alprazolam (Xanax), diazepam (Valium) or lorazepam (Ativan), can offer short-term relief from acute anxiety. Over months or years, however, the body adapts. As a result, the drug may stop working and the patient may need to take increasing amounts to get the same anti-anxiety effects. Withdrawal (a phenomenon doctors may call “discontinuation syndrome”) can sometimes result in anxiety symptoms far more severe than the original problem.

What Are the Alternatives to Medicating Normal Emotions?

Psychiatrists actually have a lot of other options besides a prescription. Cognitive behavioral therapy, exercise, or other forms of therapy aimed at changing behavior can be effective, but they require time and repetition, and thus patience. Healthcare reimbursement incentives encourage prescribing medications rather than supporting behavior change. In addition, medical students may not learn much about these alternative approaches. Medical education on discontinuing psychotropic medicines has been especially sparse. Consequently, many doctors may not feel well-equipped to help a patient get off one of these medicines.

This Week’s Guests:

Anna Lembke, MD, is the medical director of Stanford Addiction Medicine, program director for the Stanford Addiction Medicine Fellowship, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She is the recipient of numerous awards for outstanding research in mental illness, for excellence in teaching, and for clinical innovation in treatment. A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries in prestigious outlets such as The New England Journal of Medicine and JAMA.

She sits on the board of several state and national addiction-focused organizations, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar, and maintains a thriving clinical practice. Dr. Lembke is the author of Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop and Dopamine Nation: Finding Balance in the Age of Indulgence. Her website is https://profiles.stanford.edu/anna-lembke The photograph is of Dr. Lembke.

Nicole Lamberson is a physician assistant who took Xanax for work-related stress. Over the course of five years, she developed many classic symptoms of benzodiazepine tolerance withdrawal. Now, years after stopping the medicine, she still has some residual symptoms.
Nicole co-founded The Withdrawal Project and does marketing, distribution and outreach for Medicating Normal-The Film. She also serves on the Medical Advisory Board of Benzodiazepine Information Coalition.

Listen to the Podcast:

The podcast of this program will be available Monday, May 13, 2024, after broadcast on May 11. You can stream the show from this site and download the podcast for free. This podcast has additional information about stimulant drugs, how to support people with different brains, the consequences of a shortage of therapists and what happens when psychiatrists add antipsychotic medicines to antidepressants.

Download the mp3

. Decades ago, people trusted their doctors and assumed that physicians always had the patient’s best interests in mind. That belief has faded and trust in medicine seems to be in tatters following the divisive battles of the pandemic. In this episode, we consider how doctors might rebuild faith in medicine.

You may want to listen through your local public radio station. You could also 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 May 6, 2024.

Overcoming an Epidemic of Mistrust in Medicine:

Even before COVID-19, people were becoming skeptical about healthcare. Patients whose symptoms went undiagnosed and unaddressed felt that their doctors were not taking them seriously. Physicians reinforced that impression if they suggested that a problem like the extreme exhaustion experienced by people with myalgic encephalomyelitis/chronic fatigue syndrome might be psychosomatic. According to our guest, Dr. F. Perry Wilson, “The most powerful force in Medicine is trust.” It is the foundation for a therapeutic alliance in which patient and doctor can figure out what is wrong and how to make it better. Until we figure out how to rebuild faith in medicine, that kind of collaboration will be extremely difficult.

Building Trust Goes Both Ways:

Patients suspicious of their healthcare providers may withhold information that could be important for diagnosis or treatment. They may not disclose their recreational drug use, for example. Possibly, they may shade the truth more than usual when the discussion turns to alcohol or exercise. Clinicians need to have a sense that the patient is sharing the whole story, and patients need to perceive that the provider believes them and is working on their behalf.

The Problem with Motivated Reasoning:

If you are trying to make wise decisions about your own health, you need reliable evidence as the basis for those decisions. Unfortunately, a lot of the information we encounter online, in publications, or sometimes even in the clinic is tainted by the cognitive bias our guest calls “motivated reasoning.” Others have sometimes called it cherry-picking data.

Motivated reasoning is finding ways to support the arguments that we want to be true. You pick the data that conforms to your beliefs and ignore the rest. Or possibly you interpret evidence to allow yourself to explain away uncomfortable truths. This tendency is part of human nature. However, when it is brought to bear in the clinic or medical office, it undermines trust and makes it hard to rebuild faith in the practice of medicine.

Pharmaceuticals and Motivated Reasoning:

One of the arenas in which we see motivated reasoning at work is a discussion of the benefits and risks of medications. Science has come up with statistics to help analyze just how helpful a drug may be. We often refer to the Number Needed to Treat, or NNT, as one of these measures. We have observed that doctors who prescribe a lot of statins to lower cholesterol tend to rate the benefits high and downplay possible side effects.

Dietary Guidelines and Motivated Reasoning:

You can see similar motivated reasoning when you look at the history of dietary guidelines. Manufacturers of sugary, high-carb foods were able to get their opinion registered early on that heart disease was due to high-fat diets leading to high cholesterol. Decades later, scientists are still trying to overcome the effects of that extremely motivated reasoning.

What Doctors Must Do to Rebuild Faith:

Once trust is broken, a lot of care is required to repair it. Honesty, integrity, transparency and validation must all be part of the conversation. And both sides must avoid motivated reasoning as much as possible!

Patients can help doctors in the course of diagnosis by asking, “What else could this be?” That encourages a consideration of differential diagnoses and the possibility that the first guess might not be right. According to Dr. Wilson, we should all entertain the idea of medicine as a team sport and look for ways to form a therapeutic alliance with those charged with helping us heal.

This Week’s Guest:

F. Perry Wilson, MD, is a nephrologist, epidemiologist, and associate professor at Yale School of Medicine. His research focuses on using data and analytics to personalize medicine for each individual. He is the director of Yale Clinical and Translational Research Accelerator (CTRA) and co-director of the Yale Section of Nephrology Human Genetics and Clinical Research Core. He’s a columnist at Medscape where he hosts a popular series called “The Impact Factor,” which analyzes the strengths and weaknesses of published studies. Dr. Wilson is the author of How Medicine Works and When It Doesn’t: Learning Who to Trust to Get and Stay Healthy.

2020-08-13 Dr. Francis wilson. Photo Credit Anthony DeCarlo

Listen to the Podcast:

The podcast of this program will be available Monday, May 6, 2024, after broadcast on May 4. You can stream the show from this site and download the podcast for free. This week, Dr. Wilson answers some additional questions about kidney health. In addition, he offers thoughts on randomized controlled trials.

Download the mp3.

Plenty of issues in the public eye could well make anyone anxious. Some people suffer more than others, however. What we feed our gut microbes–and ourselves–can make a big difference. In this episode, a nutritional psychiatrist and professional chef explains how to calm your mind with smart food choices.

You may want to 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 April 29, 2024.

Can You Really Calm Your Mind with Food?

Our guest, Dr. Uma Naidoo, found that success can be stressful. Her first book, This Is Your Brain on Food, was popular and she was in great demand as a speaker. She was invited to present her work at a conference in London and to meet then-Prince Charles. The strenuous schedule diverted her from her usual routines, and she ended up cooking less and grabbing a quick bite more often. This practice actually increased her anxiety, until she realized that she was trapped in a vicious cycle and needed to break it. She describes how she did that with an approach anyone could try.

Breaking the Comfort Food Habit:

Many people have specific foods that they turn to when they start to feel upset or anxious. In our household, salty, crunchy foods like crackers or tortilla chips are favorites. But ice cream, cookies or candy are popular in other homes. Ultra-processed foods like these don’t nourish our gut microbes. On the contrary, they increase the inflammation in our digestive tracts, which in turn can disrupt the balance of our beneficial brain chemicals.

Most people have heard of the neurotransmitter serotonin. A large class of medications used to treat depression or anxiety, the selective serotonin re-uptake inhibitors or SSRIs, links serotonin and mood. However, few of us realize that most of our serotonin is actually made in the gut rather than the brain. No wonder the food we eat can affect our mood! Some can help us feel better, but others have a negative impact. We might assume that artificial sweeteners would be helpful because they have so few calories, but in fact they can disrupt our gut microbes, undermine weight loss efforts and make us feel more anxious.

Building an Anti-Anxiety Eating Plan to Calm Your Mind:

To create an anti-anxiety eating plan, we need to start by cutting back on ultra-processed foods and finding healthier alternatives. For example, instead of chicken nuggets from a fast-food counter, cooking actual chicken pieces at home provides cleaner protein with less salt and fat, and with practice, it doesn’t take very long.

An anti-anxiety plate should include at least 50 percent leafy greens and colorful veggies. The other half should include healthy whole grains, clean protein such as the aforementioned chicken, fish, egg or tofu, and healthy fats such as nuts, seeds, avocado or extra-virgin olive oil. This could be used to cook the food or to dress it. Learning to nourish yourself with delicious, healthful food choices is a skill that should itself help you feel less anxious.

This Week’s Guest:

Uma Naidoo, MD, is a board-certified Harvard Nutritional Psychiatrist, professional chef, and nutritional biologist. She is also the Founder and Director of the first and only hospital-based Nutritional and Metabolic Psychiatry Service in the United States, at Massachusetts General Hospital (MGH). She also serves as the Director of Nutritional Psychiatry at MGH Academy and serves on the faculty at Harvard Medical School, the Harvard Department of Nutrition, and is an instructor at The Cambridge School of Culinary Arts. Dr. Naidoo is the author of This Is Your Brain on Food. Her latest book is Calm Your Mind with Food. Her website is https://umanaidoomd.com/

Uma Naidoo, MD, author of Calm Your Mind with Food

Listen to the Podcast:

The podcast of this program will be available Monday, April 29, 2024, after broadcast on April 27. You can stream the show from this site and download the podcast for free.

Download the mp3.

Everyone is weary of the coronavirus pandemic and ready to be done with it. So the news that a new pandemic is already slowly unfolding is unwelcome. But unless we pay attention and do what we can to reverse the growing trend of antimicrobial resistant infections, they could end up causing even more death and disability than COVID-19.

Antimicrobial Resistant Infections:

Ever since the middle of the 20th century, when penicillin and later antibiotics were introduced, doctors have been able to cure most infections that would have been life-threatening a century earlier. Viruses are something of an exception, because antivirals weren’t developed until much later. We still have no effective compounds against many viruses. But public health experts are warning that too many pathogens have developed resistance to the medicines that used to knock them out. Sometimes even the drugs of last resort don’t work. How big is the problem?

What Can We Do About Antimicrobial Resistant Infections?

Part of the reason that pathogens have evolved to resist even new antibiotics and antifungal drugs is overexposure. Using them too frequently contributes to the problem. Eventually, doctors may end up trying to treat antimicrobial resistant infections that don’t respond to any medication.

However, prescriptions for people are not the whole problem. Even more alarming, too many of these antimicrobial compounds are being used in agriculture and aquaculture. The pork industry routinely uses nearly as much antibiotic as human medicine does. This kind of exposure offers bacteria the perfect opportunity to evolve. Can we reduce our reliance on drugs in food production? Dr. Marty Makary offers some straightforward steps each of us can take to combat the problem, as well as larger-scale changes that can make a difference.

Other Possible Sources of the Next Pandemic:

No one will dispute the need for close attention to antimicrobial resistant infections. However, there may also be other concerns. Now that we are (finally) gradually emerging from the COVID-19 pandemic, public health officials are preparing for the next global health threat.

Data being presented at the European Society of Clinical Microbiology and Infectious Diseases in Barcelona, Spain, on April 27, 2024, rates influenza as the most likely pathogen to trigger the next pandemic. Less likely contenders include an as yet unidentified pathogen called Disease X along with SARS-like viruses. Hemorrhagic fever, ebola virus, Nipah virus, Hanta virus and Rift Valley Fever virus are also potential problems.

Influenza as the Next Pandemic:

But the experts have ranked influenza by far and away as their biggest worry (Travel Medicine and Infectious Disease, Jan-Feb. 2024). That’s because the influenza virus is constantly mutating and circulating around the globe. Some experts that we have little to be worried about since scientists learned so much from the COVID-19 pandemic. Others, however, point out that people have gone back to their old bad habits, coughing into their hands and then shaking hands with others. Mask wearing has disappeared and is unlikely to make much of a comeback anytime soon.

Medical Errors and Transparency:

We also turn to Dr. Makary to discuss the topic of his first book, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. The zone of silence surrounding medical errors has prevented as much progress being made on this front as you might expect. Dr. Makary shocked his colleagues several years ago when he published an analysis in the BMJ demonstrating that medical errors are the third leading cause of death in the US. How can that be changed?

This Week’s Guest:

Marty Makary, MD, MPH, is a surgical oncologist, a New York Times bestselling author and a leading voice for transparency in health care. He is the recipient of the 2020 Business Book of the Year Award for The Price We Pay. A professor at the Johns Hopkins Bloomberg School of Public Health, he has published over 250 scientific articles on the re-design of health care.

He has been elected to the National Academy of Medicine and is Editor-in-Chief of Medpage Today. Dr. Makary has written for The Wall Street Journal, The New York Times, USA Today and is a frequent medical commentator on Fox News. His current research focuses on the underlying causes of disease, which is why we are discussing antimicrobial resistant infections. He is also investigating vulnerable populations and relationship-based medicine.

The website he mentioned is www.restoringmedicine.org

The photo of Dr. Marty Makary is courtesy of Johns Hopkins Medicine.

Listen to the Podcast:

The podcast of this program will be available Monday, March 15, 2021, after broadcast on March 13. You can stream the show from this site or download the podcast for free.

Download the free mp3

What do you want to know about prostate cancer? This week, Joe and Terry Graedon welcome your questions about the latest screening tools and treatments for prostate cancer.

Almost 300,000 men are diagnosed with prostate cancer each year, but stigma keeps many from discussing it. As a result, they may not learn about the latest treatments, which can be very effective. Our expert guests will tell you about new approaches. You can also share your experience at 888-472-3366 between 7 and 8 am EDT.

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 April 22, 2023.

What You Need to Know About Prostate Cancer:

The statistics are grim enough. According to the American Cancer Society, roughly 300,000 men will be diagnosed with prostate cancer this year. More than 35,000 Americans are expected to die as a result of this common cancer, which is expected to affect 1 man out of 8 over the course of a lifetime. Most men who develop prostate cancer do not die from it.

Beyond the statistics are the stories. In December 2023, Secretary of Defense Lloyd Austin was hospitalized due to complications from a prostatectomy. (That indicates surgical removal of the prostate gland to treat prostate cancer.) Many people were upset that Secretary Austin did not tell his subordinates he would be going in for surgery. Was that because there is a stigma attached to prostate cancer? Does the United States need a champion to disclose his diagnosis and treatment to remove the stigma? Former First Lady Betty Ford did that for breast cancer.

Secretary Austin is not the only high-profile individual to suffer from prostate cancer (and possibly its stigma) recently. Former director of the National Institutes of Health Dr. Francis Collins is undergoing treatment for prostate cancer. His physicians had been doing regular testing on a prostate cancer they had first detected five years ago. In the most recent test, the cancer that had seemed non-threatening and slow-growing had suddenly become quite aggressive. Dr. Collins will undergo prostatectomy himself while participating in a clinical trial of post-surgery treatment at NIH.  He points out that the MRI and PET imaging that revealed the change in his prostate cancer are not available to every man.

How Do Doctors Detect Prostate Cancer?

The prostate is a small gland that produces seminal fluid to help carry sperm. Because it is tucked away inside the body, you can’t see it and it is difficult to feel it except with a rectal exam. For screening purposes, doctors usually recommend tracking prostate specific antigen (PSA). Even a healthy prostate gland produces low levels of this compound. However, when prostate cells start to grow quickly due to a cancer, PSA levels may increase quite markedly. Recommendations on who should have PSA levels measured and when have varied widely in recent years. Our guests will describe why.

Any man with troublesome symptoms such as difficulty urinating, painful urination, or blood in urine or semen should undergo screening. But experts do not always agree on the best screening protocol for men with no symptoms. African American men and those with a family history of prostate cancer are at higher risk and will probably benefit from starting screening at an earlier age. If the PSA starts to rise, MRI of the prostate may offer important additional information.

We will hear about the role of active surveillance. When is it appropriate, and when might it be too risky? What additional tools are urologists/oncologists employing to help with this process? New diagnostic tools such as mpMRI, PSMA PET or the AI pathology tool Artera can be very helpful in determining the extent and aggressiveness of the cancer. Genomic biomarkers and genetic testing can also be used for detection and prevention.

What You Should Know About Prostate Cancer Treatment:

One of the most challenging aspects of a prostate cancer diagnosis–besides having to face your own mortality–is choosing a treatment. One of the most common treatments is prostatectomy, as we mentioned above. Many men find the idea of just taking the cancer out very appealing. On the other hand, surgery can have unpleasant side effects. Some men experience impotence; others may have urinary difficulties. Although prostatectomy may be presented as the primary or only option, that is far from the case.

Androgen Deprivation Therapy:

Another component of prostate cancer therapy is reducing the amount of testosterone circulating in the body. Protocols that combine radiation treatment with androgen deprivation therapy have been extremely successful in preventing recurrence. Radiation can also treat metastases, cancers that have spread out of the prostate gland into the rest of the body. Immunotherapy is another recent option.

We welcome your questions:

Please call to ask what you would like to know about prostate cancer. Have you been diagnosed or treated? How can you improve your chances of avoiding a recurrence? You can email us: [email protected] or call 888-472-3366 between 7:00 and 7:50 am EST on Saturday, April 20, 2024.

This Week’s Guests:

Dr. Armstrong:

Andrew J. Armstrong, MD, ScM, FACP, is Professor of Medicine, Surgery, Pharmacology and Cancer Biology. He is Director of Research at the Duke Cancer Institute Center for Prostate and Urologic Cancers in the Divisions of Medical Oncology and Urology at Duke University.

Dr. Koontz:

Bridget F. Koontz, MD, FASTRO, is an Affiliate Teaching Professor at the East Carolina University Brody School of Medicine. She will join
AdventHealth Cancer Institute in Orlando as Director for Radiation Oncology in summer 2024.
Dr. Koontz trained at Harvard Medical School, University of North Carolina-Chapel Hill, and Duke University School of Medicine. She has served as Medical Director of the Duke Regional Radiation Oncology and the Duke Cancer Clinics of North Durham and the inaugural Director of Radiation Oncology for the Duke Center for Prostate. From 2021 to 2023, she was the US Chief Medical Officer for GenesisCare, a global oncology network and research organization.

Her interests are in promoting excellence of clinical care for patients with genitourinary malignancies and developing clinical and translational research to improve both the treatment of and recovery from cancer. She is the senior editor of the practical handbook Radiation Therapy Treatment Effects: An Evidence-Based Guide to Managing Toxicity, published in 2017. Dr. Koontz continues to investigate clinical efforts to improve the quality of life of cancer survivors through technology such as eHealth apps and activity trackers. Currently, she represents the field of radiation oncology as a member of the NCI’s Genitourinary Steering Committee for NCTN trials.

Bridget Koontz, MD, FASTRO

Drs. Armstrong and Koontz will describe a clinical trial utilizing abiraterone (Zytiga) and radiation they conducted at Duke University Health System. If you would like to read about it, here are links:

International Journal of Radiation Oncology, Biology, Physics, April 1, 2021.

Prostate Cancer and Prostatic Diseases, Feb. 22, 2024.

Listen to the Podcast:

The podcast of this program will be available Monday, April 22, 2024, after broadcast on April 20. You can stream the show from this site and download the podcast for free.

Download the mp3.

Chemists use compounds such as bisphenols and phthalates to help make plastic packaging strong and durable. In this episode, two experts describe how these chemicals get into our food and how we can minimize our exposure. They share their advice on how to eat less plastic.

You may want to 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 April 15, 2024.

Plastic in Our Lives:

Plastic may have seemed something of a novelty when the movie “The Graduate” was released in 1967. It wasn’t really, though. RCA had been selling vinyl records since the early 1930s, and women had been wearing nylon stockings since the 1940s. But it wasn’t until the 1960s that high-density polyethylene bottles began replacing glass bottles for many purposes.

Because it didn’t break as easily or weigh as much, plastic seemed superior to glass. But even in the 1960s, the industry manufacturing plastic containers was aware that plasticizer compounds could leach into beverages and foods. It wasn’t until much later that scientists realized these compounds could mimic our own hormones, potentially interfering with normal biological processes.

How Does Plastic Get into Our Food?

Consumer Reports offered a cover story in February 2024, “How to Eat Less Plastic.” In it, writer Lauren Friedman describes how plastic can move from landfills into soils and aquifers. Many farms use plastic to mulch their crops, which can then incorporate certain plasticizer compounds. Animals consuming contaminated grass or browse may also have plastic-derived chemicals in their bodies. In addition, food processing equipment such as milking machines may rely on flexible plastic tubing that can shed compounds into whatever is flowing through them. Of course, the plastic bottles or containers in the grocery store are also possible sources of chemicals like bisphenols or phthalates, depending on the specific type of plastic.

How Can We Eat Less Plastic?

One way to consume less plastic is to look for food that is provided in non-plastic containers. Glass milk bottles are rare, but you can buy milk in glass in some markets. When we have a choice, we purchase vinegar or condiments like hot sauce in glass bottles rather than plastic. Unless you need a printed receipt, choose the email option or refuse it. Thermal printed receipts often contain quite a bit of bisphenol A (BPA) or bisphenol S (BPS). To avoid plasticizing compounds, cut down on fast food and increase your consumption of minimally processed food. These practices offer health benefits even beyond reducing exposure to compounds in plastic.

The exposé from Consumer Reports reveals some surprises. You might expect that organic foods would have lower amounts of plasticizing chemicals; that is not the case. Moreover, some apparently similar foods contain vastly different levels of plasticizers. We don’t know why. Consumer Reports’ Director of Food Safety Research and Testing James Rogers suggests that the discrepancies might be due to different food sources or to differences in the processing plants. You would need more research to be able to pinpoint the exact reason.

In the meantime, it makes sense to pay attention to the results Consumer Reports published and stay away from foods with the highest levels of plastic chemicals. Dr. Rogers also suggests voicing your concerns to the manufacturers themselves and to your legislators. Politicians and policy makers may not understand how long it could take for negative consequences of plasticizers to show up. Based on animal research, however, scientists are concerned that these chemicals might contribute to neurodevelopmental problems in children.

To Eat Less Plastic, Be Cautious with the Microwave:

Heating foods in plastic containers speeds up the leaching process. Dr. Rogers, along with other experts we have interviewed, urges us not to use plastic containers in the microwave, no matter how convenient it may appear. Instead, what they do is transfer frozen food into a dish made of ceramic or heat-proof glass before setting it in the microwave. It is one simple step that can help you eat less plastic.

Consumer Reports Petition:

Consumer organizations can put pressure on manufacturers and regulators to pay more attention to these chemicals and reduce our exposure overall. You will find three articles at this link: https://www.consumerreports.org/magazine/2024/02/
The link to the petition is in the first article, “The Plastic Chemicals Hiding in Your Food.”

This Week’s Guests:

Lauren F. Friedman is a health and science journalist, writer, and editor. She is currently the lead health editor at Consumer Reports and an adjunct lecturer at the Craig Newmark Graduate School of Journalism at CUNY.
https://www.laurenffriedman.com/

Lauren Friedman, lead health editor Consumer Reports

James E. Rogers, Ph.D., is the Director of Food Safety Research and Testing at Consumer Reports. He is responsible for leading the food safety and sustainability operations of the organization, including food testing, data analysis, and risk and safety assessments. As acting head of Product Safety Testing, he also oversees the team that assesses safe operation and use of consumer products.
https://www.consumerreports.org/cro/about-us/our-people/our-experts/james-roger/index.htm

James Rogers, PhD, Director of Food Safety Research and Testing at Consumer Reports

Listen to the Podcast:

The podcast of this program will be available Monday, April 15, 2024, after broadcast on April 13. You can stream the show from this site and download the podcast for free.

Download the mp3.

In this episode, two experts draw on the latest research about avoiding Lyme disease and other infections that may be transmitted through tick bites. Why are these conditions so difficult to diagnose? Most importantly, how can people with lingering symptoms from Lyme get help and start to feel better? We consider both conventional and alternative approaches.

You may want to 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 April 8, 2024.

The Basics of Lyme Disease:

We begin with a quick review of the history of Lyme disease, which was first identified in Old Lyme, Connecticut, in the 1970s. Researchers eventually identified the pathogen causing the symptoms as Borrelia burgdorferi and means of transmission as bites from a black-legged tick (aka deer tick). Even though it was originally thought to be limited to New England, epidemiologists now recognize that Lyme disease is widespread across the country. Half a million people will come down with Lyme disease this year. Many others will suffer symptoms from other pathogens transmitted through tick bites.

Persistent Symptoms of Lyme Disease:

For much too long, doctors thought that any symptoms persisting after a course of antibiotics were psychosomatic. Patients were understandably distressed by this dismissal of their suffering. Many people report fatigue, body aches and brain fog. Some have difficulties with balance or feeling weak or faint when they stand and have been diagnosed with POTS (postural orthostatic tachycardia syndrome). Headaches, rashes, heart palpitations and joint pain may also be part of the picture. If you think some of these symptoms ring a bell, you are right. Many people with long COVID or even chronic fatigue suffer with similar problems.

Avoiding Lyme or Treating It Over the Long Term:

One of our expert guests, Dr. John Aucott, does research on Lyme disease and directs the Johns Hopkins Lyme Disease Clinical Research Center. His study utilizing functional MRI was very revealing. When regular imaging studies are done on people with persistent Lyme disease symptoms, the results are not particularly striking. But functional MRI results, when people are asked to do cognitive tasks while undergoing magnetic resonance imaging, show a different picture. These people’s brains are not functioning normally. No wonder they are upset about brain fog or struggling to concentrate!

There are several possible explanations for why Lyme disease symptoms may persist. The spirochete responsible for these symptoms does not require oxygen and is very good at “hiding out” within tissues. When reactivated, it could cause symptoms. On the other hand, the immune system may become hyper-activated and have a hard time calming down. That too could contribute to symptoms. Non-governmental organizations have funded the Study of Lyme Immunology and Clinical Events (SLICE). In this trial, researchers have identified some risk factors associated with post-treatment Lyme disease (PTLD, aka long Lyme). They are also enrolling patients in a treatment trial.

Standard of Care for Lyme Disease:

Naturopathic doctor Alexis Chesney points out that there are different standards of care for Lyme disease. The CDC has published guidelines for treating “four important manifestations of Lyme disease.” Those are erythema migrans (the classic “bulls-eye” rash), neurologic Lyme disease, Lyme carditis and Lyme arthritis. The International Lyme and Associated Diseases Society (ILADS) offers its own treatment guidelines.

Both experts agree that early treatment is preferable to late treatment. Dr. Chesney describes the ability of the Borrelia spirochete to protect itself by changing to a “round form” as well as by forming a biofilm that wards off antibacterial medicines. One way to combat this is by utilizing herbs that can counteract biofilm formation, such as cats’ claw or Japanese knotweed. She also pays attention to supporting patients experiencing a Herxheimer reaction, in which dying spirochetes release toxins. This can make a person feel very ill indeed. Natural ways to mitigate this response include milk thistle, burdock or Epsom salt baths.

Avoiding Lyme Disease by Preventing Tick Bites:

Even better than early treatment is prevention. The best prevention is to avoid tick bites. Wear shoes and socks that have been treated with permethrin. (Do not apply permethrin directly to the skin.) Using an effective insect repellent also helps, and a thorough tick check upon coming in from outdoors is indispensable. It takes ticks some time to transmit Borrelia, so prompt tick removal can help prevent illness.

This Week’s Guests:

Dr. John Aucott is the Barbara Townsend Cromwell Professor in Lyme Disease and Tick-borne Illness at the Johns Hopkins University School of Medicine. An infectious diseases specialist and Lyme disease expert in the Division of Rheumatology, he is the director of the Johns Hopkins Lyme Disease Clinical Research Center. https://www.hopkinslyme.org/

John Aucott, MD, Johns Hopkins University

Alexis Chesney, MS, ND, Lac, is a naturopathic physician, acupuncturist, author and educator. Since 2010, Dr. Chesney has worked with people of all ages on chronic disease, general wellness, nutrition and lifestyle counseling. She has dedicated herself to working with clients who have complex chronic illness, and who often have diagnoses such as Lyme and vector-borne diseases, mold toxicity, mast cell activation syndrome, among other conditions. Dr. Chesney is the author of Preventing Lyme & Other Tick-Borne Diseases: Control Ticks in the Home Landscape; Prevent Infection Using Herbal Protocols; Treat Tick Bites with Natural Remedies. Dr. Chesney offers an online course, Preventing Lyme and Tick-Borne Disease: Ticks and Tick-Borne Diseases, Prevention, and Acute Lyme & TBD Treatment. Here is the link: https://health-transformations.teachable.com/p/preventing-lyme-and-other-tick-borne-diseases.
Her website is https://www.dralexischesney.com/

Alexis Chesney, MS, ND, Lac, author of Preventing Lyme and Other Tick-Borne Diseases

Listen to the Podcast:

The podcast of this program will be available Monday, April 8, 2024, after broadcast on April 6. You can stream the show from this site and download the podcast for free.

Download the mp3.

If you tell your healthcare provider that you’re feeling anxious or depressed, chances are they will prescribe you a medication. Millions of people take anti-anxiety pills or antidepressants, and many find that the medicine makes life more bearable. But can you understand what makes your life meaningful? For that, you might need to tell your story to a compassionate listener who can reflect it back to you and help you make sense of it. That’s why psychotherapy matters.

Talking with Dr. Robert Waldinger About Why Psychotherapy Matters:

A few months ago, we spoke with Dr. Robert Waldinger about his book, The Good Life. In it he described a long-running study about the factors that contribute to happiness and a meaningful life. For more than eight decades, Harvard researchers have studied two groups of people as they proceed through life: Harvard undergraduates and kids from struggling families in the Boston area. The scientists wanted to learn what helps people thrive, and they found that relationships are key. We were so intrigued by Dr. Waldinger’s background as a Zen master, meditation expert and psychiatrist that we wanted to know more about how the study affected him and how he uses psychodynamic therapy in his practice. In this conversation, we discuss why psychotherapy matters.

Psychotherapy Matters, and So Do Medications:

In treating people with mental illness, psychiatrists often use some psychoactive medicines, including antipsychotics like Zyprexa or Geodon as well as antidepressants like Paxil or anti-anxiety drugs like Xanax. Insurance companies rarely balk at covering these medications. However, insurance doesn’t always cover talk therapy. Why don’t they embrace it as enthusiastically as pharmacotherapy? It may take concerted lobbying to get them to acknowledge that psychotherapy matters too.

How does psychodynamic therapy, which is what Dr. Waldinger practices, differ from classic psychoanalysis? We find out how he prepares psychiatry residents for this kind of healing. Talk therapy can be used as part of the treatment for serious mental illness as well as to help people with less acute suffering gain some perspective on their situations.

We also discuss why the unconscious mind is so powerful. It is what seems to drive us to make similar mistakes in relationships over and over again. When we start to understand what we are doing, we can adopt a different approach that may be more successful. We were intrigued to learn how Dr. Waldinger’s experience with Zen has shaped his approach to psychotherapy.

Finding a Listener:

Telling your story is crucial, and so is a compassionate listener. Dr. Waldinger suggests that finding a person who “gets” you is more important than that the therapist have a certain type of credential. In some cases, clergy may be able to fill this role. A nurse practitioner or a social worker may also be skilled in listening and helping a person reframe their own story. Compassion and understanding are why psychotherapy matters.

This Week’s Guest:

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

Robert Waldinger, MD, author of The Good Life

Listen to the Podcast:

The podcast of this program will be available Monday, April 1, 2024, after broadcast on March 30. You can stream the show from this site and download the podcast for free.

Download the mp3.

This week, Joe and Terry Graedon welcome your stories and questions about living with animals. Does a cat purring on your lap help you calm down after a hectic day? Has walking the dog become a part of your exercise routine? Tell us about your pets at 888-472-3366 between 7 and 8 am EST. Or send us your stories ahead of time: [email protected]. Veterinarian Chuck Miller and veterinary technician Kevlin Swepston will be answering your questions and responding to your reports.

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 March 25, 2023.

The Healing Power of Pets:

On March 16, 2024, Scott Simon described on Weekend Edition how his family’s life has been taken over by animals: a French poodle, a white cat, a hamster. Many of us share our homes with animals and wouldn’t have it any other way. Despite occasional challenges (Scott Simon’s dog Daisy ate a chocolate bar and needed emergency veterinary care!), our animal friends enrich our lives. Research shows that dog owners are more likely to survive a heart attack or stroke (Circulation: Cardiovascular Quality and Outcomes, Oct. 8, 2019). Previous studies have shown that people who live with dogs usually get more exercise, so that may be part of the picture. But it may not be the whole story.

Dogs and cats are not the only creatures to share our homes. Fish tanks are popular, and research shows that watching fish swim in an aquarium might help humans relax. Heart rate and blood pressure drops (PLoS One, July 29, 2019).  Some people feel that their fish offer companionship, although it is unclear that the fish feel the same way.

How Do Pets Affect Our Health?

Some scientific studies have focused on harmful pathogens that animals and humans in the same household might share. But one study that examined the microbiome of pet owners found a decrease in pathogenic bacteria and an increase in beneficial bacteria (Research in Veterinary Science, March 11, 2024).  Researchers point out that in the last several decades, people have changed the way they treat their pets and that research is still struggling to catch up with the impacts on both human and animal health.

The Amazing Ability of Dogs to Sniff Out Danger:

Dogs have a highly developed sense of smell, which is their primary way of experiencing the world. As a result, people have found that dogs can be trained to detect tell-tale odors from a range of cancers, including melanoma, lung cancer, colorectal cancer, prostate cancer or breast cancer. With training, dogs can also learn to detect infections with a high degree of accuracy. During the COVID-19 pandemic, researchers were able to train dogs to detect COVID infections quickly. A few airports utilized this capability to screen air travelers.

Dogs may also be able to alert people to episodes of hypoglycemia or epileptic seizures. Very few of our household pets are actually providing these important medical services, but in many cases they could.

Welcoming Therapy Animals:

Some hospitals, including Duke, maintain a program that allows certain patients to interact with therapy animals. These specially trained pets (usually dogs) provide companionship, cheer and a reminder of home. The coordinator of Duke’s pet therapy program for cancer patients joins us to answer questions.

Please tell us about your household companions. How do you see human-animal interactions affecting your health? You can email us before or during the show: [email protected]. You can also call 888-472-3366 between 7:00 and 7:50 am EST on Saturday, March 23, 2024.

This Week’s Guests:

Charles Miller, DVM, is the owner of Triangle Veterinary Hospital in Durham, North Carolina. Dr. Miller has been serving the pets and animal owners of the area for 32 years. His website is https://trianglevet.com/

Charles Miller, DVM

Kevlin Swepston, RVT, is the coordinator for Oncology Volunteer Services & Pets at Duke. She serves as the primary contact for pet therapy at Duke Health by overseeing the Pets at Duke program’s operations including initial and ongoing evaluations of therapy dog teams. Kevlin ensures that therapy dog teams provide patients with vital companionship, develop and maintain physical function, emotional support, and are a welcomed distraction throughout their time at Duke.

Kevlin Swepston, RVT

Listen to the Podcast:

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

Download the mp3.

This week, two guests describe their work with the healing power of medicinal herbs. They draw upon family histories of herbalism along with their own studies of how to use botanical medicines. You may want to listen through your local public radio station or get the live stream at 7 am EDT on your computer […]