Announcer:
0:00
Welcome to the MedEvidence podcast. This episode is a rebroadcast from a live MedEvidence presentation.
Kevin Geddings:
0:06
Thank you all for being here and this is a lot of fun, especially for me. Dr Koren and I have a lot of fun. Every Monday morning at about 8.25 on WSOS 103.9 in St Johns County and St. Augustine, we do a live call-in exchange and it's often topical. It has something to do with medical news that's been going on over the last couple of days and we don't ever really know what the topic is until about eight o'clock Monday morning, but it always seems to work out really, really well.
Kevin Geddings:
0:33
So we've been doing that for a number of years. So the thought was that we would bring it to you all today in sort of an elongated form and talk about medical conspiracies and medical information and how you get your health news from, hopefully some pretty reliable sources like WJCT and also in St St Augustine.
Dr. Michael Koren:
0:50
And MedEvidence.
Kevin Geddings:
0:51
And MedEvidence that's right.
Kevin Geddings:
0:53
We talk about that every week. We try to push people to take a look at the website MedEvidencecom, because so many folks just want to go to Dr. Google and, as I always laugh, you know Dr. Google always ends up with everybody dying from cancer. So you know, whether you start out searching I have a pimple on my cheek you're going to die from cancer, so you're not going to find that With MedEvidence, You're going to get good information and we're just trying to get the word out so that more folks utilize it.
Dr. Michael Koren:
1:19
Yeah, and the title here is Finding the Truth Behind the Data, and that's the tagline for MedEvidence, which is our platform to discuss medical findings, medical problems, medical dilemmas and also getting people involved in clinical research, which is my day job. So we find this to be a great way for people to know what's known in medicine for any particular problem, what's not known for any particular problem and how we're going to discover the truth Right. So, without further ado, yeah.
Kevin Geddings:
1:51
so we like to set this up where, if there's somebody that are new to this, where we kind of throw out audience questions, if you will, and then Dr. Koren kind of helps us get to the right answer. So one of the first questions we want to ask for the audience is what is the first step in the scientific method?
Dr. Michael Koren:
2:10
Yeah, so we like to say that there's no free lunch. So you come here, you listen to us, you get some food, but you've got to work for this. So this is how we get some audience feedback and also learn what different audiences know and don't know about whatever the medical issue is.
Kevin Geddings:
2:25
There will be a test at the end. So what is the first step in the scientific method to A formulate a hypothesis, conduct an experiment, make an observation, analyze data and then draw a conclusion. And of course, there's always healthy skepticism, right, doctor?
Dr. Michael Koren:
2:47
Yeah, so out of curiosity, who thinks the first step in the scientific method is A formulate, a hypothesis? Okay, a few, that's pretty good.
Dr. Michael Koren:
2:56
B conduct an experiment. C make an observation Interesting. D analyze data. E draw a conclusion. Or F healthy skepticism. So we had that one guy in the middle who jolted up his hand right away. And you're correct, my friend. So before you do anything in the scientific method, you need to have a healthy degree of skepticism. Do not fall in love with your hypothesis, do not fall in love with anything, but you should be looking at this to try to discover the truth and be skeptical about what the whole process might look at. So healthy skepticism is actually the right answer here.
Kevin Geddings:
3:40
So our audience. Question number two which of the following do medical scientists consider the gold standard in research? Your options are A case study, b observational study, c randomized controlled trials, d epidemiological studies and E quantitative meta-analysis.
Dr. Michael Koren:
4:02
All right, Same thing here. Who thinks it's A, who says B observational study Got a couple. Who says randomized clinical trial? There we go. Oh my God, this is a very smart audience. Who says D epidemiological study, and who says E quantitative meta-analysis? Who knows what quantitative meta-analysis is?
Kevin Geddings:
4:26
Yeah, we all do.
Dr. Michael Koren:
4:27
We got one hand a very smart audience and the answer is in fact C, randomized controlled clinical trial, and we'll talk a lot more about that. But that is actually considered the gold standard in medical research and it's actually the basis of evidence-based medicine and everybody in medicine that's worthwhile will say that we need more evidence in evidence-based medicine.
Kevin Geddings:
4:52
So here's another question for you why would we want to address conspiracy theories, which have certainly been out there since the COVID time, Number one? I guess it's fairly entertaining, right it is? Yeah, we want to try to encourage a little critical thinking. We want to educate the public on the science if possible and that's what Dr. Koren's especially good at Promote accurate and reliable information, which is what medevidence. com is all about, and then uphold trust in the medical research that we read about.
Dr. Michael Koren:
5:23
And probably most importantly, is so that you can make good decisions for yourself and your family when it comes to health care issues. So this is not a multiple-choice question. It's all of the above clearly Right.
Kevin Geddings:
5:38
So what is the scientific method? Right? The process used to validate observations and answer questions in a fair and unbiased manner. A sequential process that generates clear outcomes and increases our knowledge, and then we use deductive reasoning to uncover truths. Right, doctor, absolutely.
Dr. Michael Koren:
5:56
So this again, these are all true things, and I'm going to spend a little bit of time with you to explain what deductive reasoning is, because this is the basis of evidence-based medicine and it's the basis of good decision making. And good decision making depends on using deductive reasoning rather than inductive reasoning to understand what the issues are and then to decide what your course of action is. So let's break this down a little bit for the audience Deductive versus inductive reasoning. Deductive reasoning is defined as something that follows the rules of logic and basically it says if all premises are true and the terms are clear, then the conclusion reached is necessarily true. That's the definition of deductive reasoning, Whereas inductive reasoning and that's kind of how we go about our lives, because we don't always have all the information we need but inductive reasoning means it's a body of knowledge or series of observations that become synthesized to form a hypothesis. So when we're generating a hypothesis, we use inductive reasoning. When we're trying to prove a hypothesis, we use deductive reasoning. So the conclusion of an inductive argument is always probable, not necessarily true. So this sounds a little nerdy and I realize that, but it's an important philosophical, theoretical basis for the practical things that we're going to talk about, and this is a practical thing. I'm going to give this example as a practical thing that shows the difference between inductive reasoning and deductive reasoning.
Dr. Michael Koren:
7:40
So we call this the great milk caper. Has it happened to you? So who in the audience has children? Okay, most people. Who in the audience has had the situation where your kids or other people haven't put a perishable back in the refrigerator after using it? Okay, so it's a pretty common scenario. Okay, so I'm going to lay out this scenario for you.
Dr. Michael Koren:
8:04
You return to your home from errands on Saturday morning. You get out into the kitchen and notice a carton of milk left out. The carton is warm and you become irritated. You have reprimanded your 10 and 14 year old kids to put perishables back into the refrigerator after use on numerous occasions. You summon them for their hearing and sentence Okay, your 14-year-old, fresh from criminology camp, listens to the allegations. Then she pulls out a fingerprint kit and establishes that the only fingerprint on the carton belongs to you.
Dr. Michael Koren:
8:46
Snap, you recall I did take out the milk for coffee right before I got the emergency phone call to go down to the office, and that was after the kids left for camp. You withdraw the charges humbly. So this is a great example, Kevin, of something where you make an immediate conclusion based on experience, and maybe the kids mostly are responsible for this, but in this particular case they weren't, and this is the difference between inductive reasoning and deductive reasoning. All right, so now let's transition that to drug development. So it's interesting is that you get a lot of skepticism about the pharmaceutical industry, but usually half the crowd would go to a gypsy that was cooking up something in their backyard.
Kevin Geddings:
9:29
What could go wrong?
Dr. Michael Koren:
9:29
Yeah, but the funny thing is that this is actually how drug development worked in the 50s, so before we had a lot of regulation. Basically, you can put anything together and the only thing that was required from a drug company was a list of ingredients and, you know, sometimes it worked and sometimes it didn't. So a lot of stuff that we take every day, that we take for granted, was actually developed during a time when there was no regulation, there was no clinical trials, there was no knowledge about all these things, and people kind of you know just took it and they went for it because Madam Ruth recommended it, but in fact, maybe that's not always the best thing, so, anyhow. So the point here, of course, is that the development of medical products has evolved over the years and it's very regulated. These days it's incredibly sophisticated, and we still have issues, though, about this. So it's funny.
Dr. Michael Koren:
10:29
This actually was a discussion point that happened with one of my patients and lots of other patients, so some of you may know this, but I was the principal investigator here in northeast Florida for the Pfizer COVID-19 vaccine, and we had some people that came in and said, well, I don't trust Pfizer. You know what do they put in that vaccine. This is up to no good. And then I actually learned this from an African-American physician at a national conference. He says well, when I get that comment, what I ask my patient is do you take Viagra? And did you know that Pfizer developed and owns Viagra? And you seem to be able to take that? Okay, so you can trust them for that. And maybe you could trust them for this other thing, and it's a very, very interesting point that this physician made and I think it's relevant for this discussion. So go ahead, let's go to the next audience.
Kevin Geddings:
11:17
So our third audience question which of the following procedures or products were tested in randomized blinded clinical trials prior to release? This is a really interesting question. Aspirin, frontal lobotomy, the mRNA COVID-19 vaccine or Thalidomide? And there's one more. Oh and morphine All right.
Dr. Michael Koren:
11:41
So which of the following procedures or products was tested in randomized blinded clinical trials, part to least, meaning that the others were not. Was it aspirin? Was it frontal lobotomies? Was it the COVID-19 vaccine? Yeah, yep, thalidomide, morphine Okay, so we don't use frontal lobotomy anymore, thank God. But the other things are actually being used and they've never been tested in clinical trials, except for the COVID-19 vaccine. So that's the right answer, and these are just talking about some of the other things that were done again back in the 50s and before we had regulation and actual clinical trials.
Dr. Michael Koren:
12:19
So thalidomide was actually widely used in Europe without clinical trials and, as you probably know, it was prescribed for pregnant women who were having morning sickness and unfortunately caused birth defects, and you've seen kids that have truncated limbs from thalidomide. But it actually was not a big problem in the United States because of one person. Her name was Frances Kelsey and she was a physician working at the FDA in the early 60s and she was looking at the information that was coming in from Europe about thalidomide, saying that this was the new wonder drug for women, and she said well, what about the safety? Did we ever test the safety? And because there was no, no information from the drug of about safety of thalidomide. She did not allow thalidomide in.
Dr. Michael Koren:
13:07
The United States one person FDA protected thousands and thousands of thousands of people from birth defects because she would not let the little mind in the United States. So you probably never heard of Frances Kelsey, but she is a hero in our world and if you go to the FDA headquarters they have a really beautiful display of her work and so. But that was the way things worked. There were no formal regulations and we were just dependent upon the good nature of certain people that cared about the public.
Kevin Geddings:
13:35
So what made doctors in Europe think that thalidomide was something that they should give ?
Dr. Michael Koren:
13:39
it prevented nausea. So it was a drug that prevented nausea. Pregnant women get nauseated. Try it in pregnant women and the attitude in those days is we didn't have to prove safety. If it seems to work in the first patient, try in the second patient. If it works in the second patient, try in the third patient. And of course, when you're dealing with pregnant women, you don't know what the consequences are until after the children are born, which is now months down the road or maybe even longer than that, right? So because of that, there was a big problem with phlegmite in Europe, but very, very little problem in the US, right?
Dr. Michael Koren:
14:12
And then who knows here that frontal lobotomies actually won the Nobel Prize in medicine? Can you believe that? So back in 1949, this was considered a miracle cure for severe psychiatric disorders. And you can see that there was a little brochure that was being sent out to neurosurgeons to show how to do the procedure. Crazy stuff, but this was never tested in clinical trials. But people were finding okay, if you were having really difficulties with psychiatric illness and you had a portion of your brain cut out, you seem to be more docile after that and wow, is this a cure? Well, it turns out that when they actually looked at it critically and compared drugs, drugs actually work better for psychosis than this. And of course there were incredible side effects of doing frontal lobotomies. So this has been repudiated at this point. But compare that with the COVID-19 vaccine. So the Pfizer vaccine had 46,331 participants before it was approved by the FDA. By the way, maybe about 700 of those participants were here in Northeast Florida. The Moderna vaccine had about 30,000 participants before FDA approval. About 400 of those were in northeast Florida. So at every step along the way we were looking very, very critically to make sure all these things were safe and fortunately it turned out to be incredibly safe, incredibly effective and the people that were involved in the clinical trials got these benefits prior to the general public. So a whole different environment for testing new medical products. So let's talk about some other conspiracy theories and how they develop.
Dr. Michael Koren:
15:49
So in this actual auditorium I saw Ira Flatow, who came to that lecture when he was here a few of us, so I had a bite in my tongue during one of his comments. I have to say I didn't speak up because I didn't want to take the stage away from him. He's very good, I like him and more times than not I'll agree with him, but he did make one statement that I find objectionable, and he said that he was talking about the drug development process. He talked about a lot of things in science, but he happened to mention the drug development process and he says and this is a quote, this is actually from his transcript it doesn't lead to a cure.
Dr. Michael Koren:
16:26
Drug companies will make a lot of drugs and a lot of money because they don't want to lose a customer. They want to treat you for your whole life. They don't want to cure you. They want to treat you so they can make oodles and oodles of money on people being sick. That's the exact quote. So this quote, I believe, is inaccurate, and also the way kind of conspiracy theories develop that the drug companies are conspiring not to cure things. The only thing that's true about this statement is that the drug companies do want to make oodles and oodles of money on people being sick. So that part is true. But they will cure people. They absolutely will cure people, and people in the drug development business actually love to cure people. People like to make money, but we also like to be successful. We like to make a difference in people's lives. We like to impact public health and for that reason there's lots of people always working on cures in the drug development business, and it's easy to show this.
Dr. Michael Koren:
17:20
So one of the most famous examples is a drug that was developed by Gilead Science called Sovaldi, and this was a drug that was extremely controversial about a decade ago because originally they were asking $80,000 per patient for this treatment. But it absolutely cured hepatitis C Cured. It Didn't just reduce the levels of the virus, it cured it and people that took this drug didn't have hepatitis C. Moreover, the dissemination of this drug has almost eliminated hepatitis C from the US. Hepatitis C 10 years ago was by far and away the number one cause for liver transplants and cirrhosis. Liver transplants that's all gone away. So now the number one reason for liver transplants is fatty liver disease, is NASH. I saw somebody talking about alcohol. That's another one, but it's actually number two. So hepatitis C was number one and that's been cured, it's been eliminated. So, yeah, they made oodles and oodles of money, but they actually saved the system oodles and oodles of money by getting rid of the number one source for liver transplants and cirrhosis.
Dr. Michael Koren:
18:28
There's many other examples Smallpox was eliminated in North America in 1952, eradicated around the world in 1980 through the development of vaccine Polio. We haven't seen a case of polio in the US that came from the US. There's still a few pockets around the world but slowly but surely that's going to be eliminated. So there's plenty of examples of where drug development has actually completely cured or, even better, eliminated diseases, and that's true in a number of different cases in oncology, in cardiology and elsewhere. So let's talk about some other conspiracy theories. HIV-aids was a big one, right? Yeah? So you were working back in those days, weren't you?
Kevin Geddings:
19:11
Oh yeah, and so you always heard about things like only gay people could get AIDS, for example, flying insects could transmit HIV. That was a popular one, or that it was a virus created in some mysterious lab overseas right, we've heard that recently too.
Dr. Michael Koren:
19:24
No, totally Well. All that turns out to be nonsense, and obviously, multiple people can get AIDS. We understood the virus that causes it. We actually understood exactly how that virus moved from an animal reservoir to a human reservoir and fortunately we now have treatments that have turned AIDS from a lethal condition to something that's incredibly manageable, and Magic Johnson was a great spokesperson for that. It's remarkable that when he first came out discussing that he was HIV positive, it was a death sentence. But it was also the exact same time when drug development groups got together and learned how to treat this very, very effectively, and now we can take people that have been diagnosed with HIV or AIDS and get their counts down to zero. So it's just, you know, again another example of drug development that has transformed a disease and makes something that was literally a death sentence into something that's completely manageable.
Dr. Michael Koren:
20:33
All right, so let's talk about COVID-19. There's a lot of stuff out there, and you and I talked about a bunch of this stuff during our phone calls. Ivermectin do you remember that? It's basically a pill that's used to treat parasites in animals.
Kevin Geddings:
20:50
Horses, right, yeah, exactly.
Dr. Michael Koren:
20:51
That's right and that was being advocated as something to treat COVID. Ivermectin is cheap and effective, but they're trying to discredit it to maintain profits from vaccines. That was the statement that was made. Well, we wanted to analyze it. We wanted to do clinical trials to see whether or not it worked. We didn't want to keep this away from people and in fact a lot of people got it because it is on the market, so you couldn't really stop people from prescribing it. But it turned out that when you actually did the clinical trials and this is a study called the TOGETHER trial we did not participate in this, but if you look at this, a New England Journal paper that showed at the end of the day, treatment with ivermectin did not result in a lower incidence of medical admission to hospital due to progression of COVID or a prolonged emergency department observation among outpatients with early diagnosis of COVID. So when you actually do the studies, it did nothing, but it did cause side effects. So this is now considered discredited at this point.
Dr. Michael Koren:
21:46
Hydroxychloroquine there's another one that people talked about. Hydroxychloroquine is used all the time For rheumatological problems and that was being Touted as something that could treat COVID. In fact, some people are saying that In observational studies Hydroxychloroquine by the way that goes by the name, Plaquenil you might be familiar with that name Rather than hydroxychloroquine, , but this is a drug that's commonly used as an anti-inflammatory for inflammatory diseases, but in fact it did absolutely nothing when it was tested in clinical trial for COVID-19. The original observation was based on the fact that some people were getting it and some people weren't, and in an observational setting there was a sense that maybe the people that were getting it were people that were doing a little bit better. But really what it came down to is the people that were in the worst shape were on ventilators. They couldn't take this drug because of an oral drug, so all it was doing.
Dr. Michael Koren:
22:39
The people that were able to take this were people who were less sick, and when you did a randomized clinical trial, you found that there was absolutely no benefit of this therapy for COVID-19. Obviously it was absolutely no benefit of this therapy for COVID-19,. Obviously it's for other things. And not only did that happen behind the scenes, but the Lancet, probably the most prestigious journal in Europe formally retracted the original observation article, saying that it's been disproven, and formally retracted. So that's how science works. Is that we create a hypothesis, we don't jump to conclusions, we don't assume who left the milk cart now, but we actually do the testing Right, okay, so these are some other things. I know that you love to talk about this stuff, about radiation and crazy stuff like this.
Kevin Geddings:
23:27
That was all the rage for a while the whole notion of 5G for your cell phone. Was it going to, you know, cause brain cancer or what have you? And it ultimately turned out that that was not the case and we all have 5G, probably on our phones, sitting here today.
Dr. Michael Koren:
23:40
Right, right Now. The other thing that's interesting is that it was also supposed to like revolutionize our lives in terms of better internet access. That hasn't worked.
Kevin Geddings:
23:49
That hasn't worked either.
Dr. Michael Koren:
23:50
Yeah, so it hasn't done any harm. I'm not sure how much good it's done, right? And there's another famous case. You familiar with.
Kevin Geddings:
24:01
This one yeah, does the MMR vaccine cause autism? Right. We've also had other rumors that other childhood vaccines could perhaps cause autism as well Right, that's been greatly and widely disproven, right.
Dr. Michael Koren:
24:13
Yeah, so it's interesting. You still see a lot of that in social media that, oh, there's a medical argument that vaccines cause autism, but no one really knows the backstory. So it was actually started by a physician named Andrew Wakefield, who's considered a fraudster. He was an anti-vaccine activist, a former physician, and he did a study that was published, of only 12 children 12. And he went out and said that this is proof that there's a relationship between autism and the MMR vaccine.
Dr. Michael Koren:
24:46
This again was put into a medical journal as a hypothesis generation rather than as proof, but everybody looked at it and said, oh, it's in a medical journal, therefore it must be proof. Well, actually, when people actually looked into the details, it turned out that he didn't even do the study. He just looked for some people that had autism and had other people that were willing to say that there was an association, without doing a formal experiment like we do in a clinical trial. And the other thing that came out was that there was an attorney who paid him to create information so that they can sue the manufacturers of the MMR vaccine. And when this all played out, the General Medical Council in Britain revoked Dr. Wakefield former Dr. Wakefield's medical license. So, unfortunately, what happens, though, is that this conspiracy comes out, and it takes a life on its own. And the actual facts when the deductive reasoning is put into place and it turns out that the conclusion is not supported? You don't hear about that, Right?
Kevin Geddings:
25:47
And, given the structure of the Internet, that information is still out there today.
Dr. Michael Koren:
25:52
It is.
Kevin Geddings:
25:54
Fluoride in our water supply is a government plot that's been out there for quite some time. Fluoride can cause cancer and thyroid issues, or fluoride is a byproduct of industrial processes, for example, that it can cause all sorts of issues.
Dr. Michael Koren:
26:07
Yeah, and again, the only issue it causes is you have fewer cavities, right, and I think that's been shown over and over again and again. There's never been a scientific study that shows that there are long-term health issues, right, and what's interesting is that when your teeth are better, your heart is better. Links showing that people that develop gum disease and other problems have more inflammation in their body, which in turn, leads to worse outcomes from a cardiovascular standpoint Right. And of course, we have all these crazy theories.
Dr. Michael Koren:
26:43
Yeah, All the whole litany of COVID-19 conspiracy theories right that we've been dealing with for the last couple of years have you had calls in your radio show after I talked about COVID-19 saying get this guy off.
Kevin Geddings:
26:54
Yeah, we usually don't share those with you. Yeah, you always. There's a good percentage of people out there that still believe in most of these. You know, maybe upwards of 30 or 40%.
Dr. Michael Koren:
27:04
Yeah, we'll get to questions in a second, but you'll have the opportunity. But yeah, so there's all kinds of crazy things. These are all actual quotes that we've heard from patients or when we do social media posts or on our website, people will put this information out. Well, the truth is that when you break down COVID-19, it's a devastating illness in people who are vulnerable and it's a very mild illness in people who are not vulnerable. It's a very mild illness for in people who are not vulnerable. That's the take-home message. So if you're an 18 year old and you got the cover 19, you would have a very mild illness and that wouldn't be much a problem. But if you brought that home to your grandmother and who has diabetes, it's a whole different story. Right, and every viral infection has a little bit of a different epidemiology, and we've talked about this.
Dr. Michael Koren:
27:51
On your show that the Spanish flu was devastating to teenagers. So there's a famous case at Fort Devens in Massachusetts where they had 15,000 recruits for World War I, all healthy 18-year-old men and a lot of them got the Spanish flu and 700 died. 700 young people died. But for COVID-19, it was the opposite. If you were over 80 and you got sick, you had a 20% mortality rate, but young people didn't.
Dr. Michael Koren:
28:21
So the point there is that the vaccine was incredibly protective for vulnerable people. Maybe less so for for vulnerable people, maybe less so for younger, healthy people, except to the extent that younger, healthy people pass it along to the vulnerable people and unfortunately that very basic logic that's been demonstrated in multiple studies is not necessarily articulated and people start yelling at each other about. You know, this is all a conspiracy. I remember I was working out in the gym and somebody very, very interesting comment. I was working in the gym during the teeth of the crisis and they asked me to wear a mask when I was in the gym, which was fine, and I put the mask on and I was experimenting with different masks. I actually had a N95 mask and another mask and I went back and forth trying different masks to see if it affected my ability to exercise and as I was changing masks, I got reprimanded from somebody that said keep your mask on.
Dr. Michael Koren:
29:15
They got really mad at me and said people like you are causing the spread of COVID-19. They didn't know what I do for a living, of course, and then I started to say what I was doing for a living and then the person decided that they didn't want to talk to me anymore. And then another person said yeah, I'm glad you put that person in their place. She said all this is going to go away after the election.
Kevin Geddings:
29:35
Right. So much for that.
Dr. Michael Koren:
29:37
So, anyway, you get both sides, and there was a lot of theories out there, but fortunately we have an incredible amount of science that tells us really what's going on, and I'll be happy to answer questions about it. So how about social media? I know this is your area of expertise, right?
Kevin Geddings:
29:51
So how does social media impact conspiracy theories? The platforms allow misinformation to spread fairly quickly. We all know that. You can basically, you know, do a Facebook post in a matter of seconds, right? Some algorithms tend to, you know, prioritize the more controversial stuff, because social media wants to get you engaged and we all tend to be a little more engaged if something is controversial and kind of gets our ire up right. Social media can also create echo chambers. We tend to follow people that agree with us. You know the whole notion that we follow within our tribe and then we just keep feeding more information to the tribe. All that, and then, of course, celebrities getting involved even intensifies that right.
Dr. Michael Koren:
30:30
Absolutely, and they're certainly out there. So this gets to how we started, by trusting an objective source rather than Dr. Google, right, and what we do in MedEvidence is we have physicians having conversations or other experts having conversations, and sometimes we'll have experts that have different opinions on things, and we'll talk about what's known for sure, what's not known at all, and how we're going to learn about the stuff that we don't know about.
Dr. Michael Koren:
30:58
Right and um, we have these podcasts that won't be anywhere between our quick hitters, you know uh, you know we would do about seven minutes or so where you get a quick hit on a particular area, or hour-long podcasts where you really dig in deep in terms of what the issue is, and we're getting incredible feedback on this. We're getting a lot of people that are saying they find it very enlightening that they can dig into an issue or get a quick hit, depending on what their time constraints are, and that they can make good decisions for themselves and their family once they have that information, knowing that we're very clear on what we don't know. We know stuff, we don't know stuff and we're going to try to figure out stuff and once you have that kind of disclosure and transparency, you can make much better decisions. So, to that point, as we speak, there's lots of stuff that we're doing right here in northeast florida answering questions that we don't know the answers to. So, for example, right now we're doing about to start a study using an oral covid vaccine. So obviously some people are concerned when you get an injection, but the truth is is that you can give vaccines in oral form. So, about to start off, start a program that's looking at oral vaccines, that may be more acceptable for some people. So if you or somebody you know is interested in getting involved with that. Let us know.
Dr. Michael Koren:
32:16
We have people in the audience that will be happy to follow up with you. I'm a cardiologist, so I'm particularly interested in things that affect heart disease and one of the questions is can we prevent heart disease by treating a bad lipoprotein called lipoprotein little a? You and I have talked about that several times. Who has heard of that lipoprotein little a in the audience? So maybe a third. Well, this is what I like to call the really, really, really really bad cholesterol. So most people have heard of really, really, really bad cholesterol. So most people have heard of HDL, which is the good cholesterol. They've heard of LDL, which is the bad cholesterol, but few have heard of lipoprotein little a. But as we speak, 20% of you in the audience has high levels of lipoprotein little a and this is actually a more potent risk factor for heart disease and stroke than LDL cholesterol. But you haven't heard of it because we haven't had a way to treat it in the past. But that's changed. Now in clinical research we have four products that will actually lower lipoprotein little a by up to 95% and we're enrolling in studies that are looking at that. We've already had thousands of people dose with these, these products around the world. So we have basic safety information and now we're just looking to see if it's as effective as we think it should be.
Dr. Michael Koren:
33:33
Other questions we had a session here the last session was with Dr. Mitch Rothstein and we talked about some of the work we're doing to see if weight loss can improve sleep apnea. So sleeping problems are very common. Probably a third of all people have sleep apnea at a more serious level. That can cause a health problem, and we find that as people lose weight, they have lesser problem with sleep. But it hasn't been studied critically. So we're actually doing studies as we speak that are looking at people that have had the diagnosis of sleep apnea and seeing whether or not these ozempic and mounjaro-like drugs actually help you sleep better. Right, imagine that. So that's a question that's unanswered that we're trying to answer.
Dr. Michael Koren:
34:16
We're also doing things. We don't just work with drugs, by the way. So, um, we do studies with, uh, microbiome transplants. Who's heard of a stool transplant? Has anybody heard of that? Yeah, so imagine that, taking somebody else's stool and putting it into your colon.
Dr. Michael Koren:
34:34
Well, it turns out that the bacteria in your gut are very important for your health and if that becomes unhealthy, there may be ways of making it more healthy and that can help people that have inflammatory bowel disease, such as ulcerative colitis. It may help with weight loss. It may help with irritable bowel. So we're doing a lot of work with our colleagues at Borland Groover on those kind of questions and, speaking of that, there's a lot of cross-pollination between different specialties now. So, interestingly, we're looking at doing a procedure in your intestines to see if it can change your diabetes or cure you of diabetes. So it turns out that the cells in the duodenum are responsible for absorbing glucose and other carbohydrate-type components. Well, if you reduce the number of cells that are doing that, can you change somebody from being diabetic to being non-diabetic? And, if you're interested in that, if you have diabetes. We actually are enrolling in a study that's looking at that specifically, including a procedure, and, of course, all this is free of charge. We have external study grants to cover all these questions.
Kevin Geddings:
35:41
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