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. 

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. 

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.

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.  ...

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. 

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.

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.  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."

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    

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...

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.

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?).   

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...

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...

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 article...

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: ...

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 Neuropsychopharmacology....

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...

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 ...

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 you...

Senator McCain has a malignant brain tumor called a Glioblastoma Multiforme, or glioblastoma or GBM for short. 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 as GBMs.   Today 2 Docs Talk about Glioblastoma Multiforme, and the difficulties associated with treating - or not treating - the tumor. 

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/25844882 ...

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

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  

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 you...