Announcer:
0:00
Welcome to the MedEvidence! podcast. This episode is a rebroadcast from a live MedEvidence! presentation.
Dr. Michael Koren:
0:06
So, Trevor, I'm really excited about this because it's always fun to have a conversation with an old friend, indeed, and we like to have an audience share this concept of two docs just talking about a topic and gleaning information from it. And, as you know, our whole MedEvidence platform is based on that: Two knowledgeable doctors talking about something and having the audience kind of eavesdrop and then ultimately ask questions about what they see and what they perceive. And that point of perception, I think, is so fascinating. So Trevor and I were just smiling and when Sharon and Vicki were doing their intro, they were showing you a couple of things about what we do, but they were also looking at this slide over their shoulders and it's a beautifully attractive slide with a beautiful heart in the middle of it. But Trevor and I look at this slide and our heart starts to race because this is a very abnormal EKG. So, Trevor, why don't you?
Dr. Michael Koren:
1:05
give us some insight on that
Dr. Trevor Greene:
1:09
Well, good afternoon. Thanks for having me here and coming out to share this thought with us. This EKG is abnormal. There's a lot of spikes and valleys and everything else, but the beautiful thing about it is that there's a heart holding everything together. So if you have a good heart, things will always be together.
Dr. Michael Koren:
1:32
All right, yeah, so when we see something like this, we don't know if your electrolytes are completely out of whack or you're about to have a heart attack, all right. So, as you know, we have a mantra for these programs that there's no such thing as a free lunch, and what we mean by that is audience participation is extremely important to us. So to start this process by a show of hands, who here in the audience has heard of HSCRP? Yes, show of hands. Very few.
Dr. Trevor Greene:
2:07
I don't see any hands at all no, okay.
Dr. Trevor Greene:
2:10
Oh, there you go, there you go, okay, so All right,
Dr. Michael Koren:
2:13
Not everybody's raising their hands, so don't bother me, I'm enjoying my lunch is the third option. Okay. And question two what is HSCRP? Just to see what the knowledge base is before we start. A blood test and marker for vascular inflammation, a politically correct way to express crap. Outreach to the underserved CRP community, an acronym for high-strung, clearly ridiculous politicians, or all of the above. All of the above, all right. Who says one Okay?
Dr. Michael Koren:
2:59
who says one of the other answers.
Dr. Trevor Greene:
3:02
You got your vote already,
Dr. Michael Koren:
3:03
All right. Well, One is correct, so congratulations on that.
Dr. Michael Koren:
3:08
And here's a tough one, which has the best ability to predict heart attacks and strokes in initially healthy women over 30 years. Is it LDL cholesterol? Is it lipoprotein A? Is it HSCRP? Is it your high school lover? Or listening to MedEvidence podcasts? So, interestingly, again, the best ability. Remember that's a very important word. So who says it's LDL cholesterol?
Dr. Michael Koren:
3:45
Who says?
Dr. Michael Koren:
3:45
it's lipoprotein A. Okay, I'm impressed that people even know what that is. Yeah, who says HSCRP?
Dr. Michael Koren:
3:54
Oh, a lot of hands there. Okay, they're good test takers.
Dr. Michael Koren:
3:57
They're good. How about your high school lover? Now there we go. Or listening who's listened to MedEvidence podcasts? No hands yet? No, we've got a couple, All right? Well, the answer is, in fact, HSCRP.
Dr. Michael Koren:
4:10
So Trevor and I are going to get into this a little bit more, but I mentioned the MedEvidence podcast a couple of times and sort of the international leader in this is a fellow named Paul Ritger, who I went to medical school with, and Paul and I had a great conversation about this on our MedEvidence podcast that you should all check out. I think you'll really enjoy it, and that goes into a lot of detail. It also explains how Paul has really spent his entire career studying this issue and he's had multiple very, very important publications, including a publication that showed that if you measured an HSCRP level in a woman 30 years ago, it would actually be more predictive of what would happen from a heart attack and stroke perspective over the next 30 years. So really, really super interesting stuff. So, Trevor, I'm going to let you take center stage here for a second, so give people just like a general sense for CRP as a predictor and help them understand that a little bit.
Dr. Trevor Greene:
5:10
Well, you know, when I first started out actually here in Florida 20 years ago about 13 years before that in Massachusetts the inflammation was a big topic and for some reason it just seemed to fall below the radar with all the background noise that we're getting in terms of cancer and all the other issues. But what we've come to realize is that inflammation is very important in the human body, and you can look at it in terms of the way you look at wear and tear. Your brakes wear and tear your muffler wear and tear. So too does the rest of your body, and as you get more and more birthdays and as you are exposed to more and more bad stuff from the environment, inflammation builds up in the body.
Dr. Michael Koren:
6:01
Right, and then we have actually statistics to support that.
Dr. Trevor Greene:
6:07
Because we tell you, make sure that that LDL is as low as possible. We want to figure out, together with the LDL and together with the CRP, what numbers that you need to pay attention to. So what? This slide shows very clearly that if you're LDL, that's the low density lipid protein, that's the one that is supposedly the bad guy. If that's too high, greater than 130 milligrams per deciliter, and the C-reactive protein, if it is greater than two, then your cardiovascular mortality, the risk of getting a stroke, the risk of heart disease, increases exponentially.
Dr. Michael Koren:
6:48
Yeah, so that's this point right here. So when both the LDL and the CRP are elevated, that's bad news and this tells you. Your risk goes up about 70%. And the flip side is that when your CRP is lower, even if your LDL is a little bit higher, your risk does not go up that much, so it's an interesting slide. And how about statin intolerant patients? Help them understand that a little bit.
Dr. Trevor Greene:
7:16
Well, statins. Statins is a sexy drug. It's been out for a while. Unfortunately, if you go to the internet, you're going to see good things about statins. You're going to see bad things about statins and it's not unusual for me to have one of my patients say to me I'm not going to take a statin. I heard bad things about statins but, truth be told, statins have had a big shift in protection for heart disease, especially when you come to control the cholesterol, especially getting the LDL cholesterol under control. So it's something that you should discuss with your physician and keep an open mind because, yes, there are side effects, as there are side effects with any drug, any medicine, and some people can't take them because of the achiness and that kind of stuff, and there are alternatives. But it is a very important conversation that you should have with your physician.
Dr. Michael Koren:
8:12
Right, and statins, as you know, lower cholesterol, particularly LDL cholesterol, but they also lower CRP, and a lot of the other drugs that lower LDL cholesterol don't lower CRP, so that is a unique property of statins, and then just tell people about what you consider an optimal level for these numbers and how they should maybe communicate with their physicians about it.
Dr. Trevor Greene:
8:37
Yeah well, once you get your blood work done from your primary care physician or your cardiologist or both, you'll be throwing these numbers out at you and the goal for most people who have coronary artery disease or diabetes or hypertension or a combination of all the above, the aim is to get that low, the LDL cholesterol as low as possible, and that number for us is less than 100. And if you can get it below 70, that also is optimal. And the CRP, of course, we want that to be less than 1. Understanding, if your CRP is greater than 2, you're in bad land. You want to get back to a situation where your CRP is less than 1.
Dr. Michael Koren:
9:20
Right. And the other point here that I think is really valuable for people to know is that LDL cholesterol response to treatment is very predictable. So if we have a patient that has an LDL of 130 and we put them on rosuvastatin or torvastatin, we know they're going to be around 70 after we do that. We're pretty sure that we'll get them in that range, so it's pretty predictable.
Dr. Michael Koren:
9:44
But hsCRP is not
Dr. Trevor Greene:
9:45
Right
Dr. Trevor Greene:
9:46
That's exactly right.
Dr. Michael Koren:
9:47
And we don't have great ways for lowering that to date and we're going to get more into that concept. But the reason the focus has been on LDL for many years is because we can reliably bring that down.
Dr. Trevor Greene:
9:59
Yeah, and the reason for that too is because normally you usually look where the light is. If you drop your dollar bill here and the light is over there, the human nature is to tend towards where the light is. The point there is that we had something to treat the LDL, but we really don't have something yet to niche on to get that CRP down. But we're working on it and that's why it's important that we have studies. That's the important way we have groups like this and we are very fortunate to have good research people notwithstanding Dr. Koren, of course in town to guide us through these kind of studies that are necessary and they are no harm to you. You turn up, you have your blood work done and then we go behind the scenes and literally sort out the value of having these tests done.
Dr. Michael Koren:
10:52
So, out of curiosity now, who in the audience has had their CRP measured? I'm just really curious about it. Show of hands, yes, have you had your CRP measured? Very few interesting, no.
Dr. Trevor Greene:
11:03
I'm not sure if that is a reflection of you or your physician, but either way. But now you'll go back to your physician and say, hmm,
Dr. Michael Koren:
11:10
Exactly who says who is no for CRP?
Dr. Michael Koren:
11:15
measured, that is a whole crowd.
Dr. Trevor Greene:
11:17
Okay.
Dr. Michael Koren:
11:18
Well, there's still people that haven't raised their hands, so that must be excuse me, I'm still eating my lunch, okay, all right. So, Trevor, just kind of walk through. Even though we can't reliably get hsCRP levels down, there are some things that kind of move it in the right direction.
Dr. Trevor Greene:
11:38
These are the favorites. These are the five favorites. Weight loss I discovered something very interesting a couple of nights ago. I'm not sure what it was listening to, but I come to found out that the 74% there's a pretty impressive number 74% of the American population is obese.
Dr. Michael Koren:
12:01
That was the Super Bowl commercial.
Dr. Trevor Greene:
12:02
Ah, that's correct. Him and hers. Yeah, yeah, that's right. Yeah, that's right.
Dr. Michael Koren:
12:06
It might be a slight exaggeration,
Dr. Michael Koren:
12:08
but I was.
Dr. Michael Koren:
12:09
I was impressed by that.
Dr. Trevor Greene:
12:10
Yeah, I would say whoa.
Dr. Trevor Greene:
12:12
is that true? Now I happen to know that in the in the in the third world, particularly countries, for example, where I'm from, Barbados, where diabetes is very rampant, obesity is a big issue, and in a place like Barbados you can have 80% of the population who are obese. But what do we mean by obese BMI body mass index? You have to have some kind of a reference BMI which is worked out on the basis of your height and your weight is above 25, then you are mildly obese, up to 30, moderately obese and greater than 30, we're talking about morbidly obese. So that's a, that's a. That's a flag.
Dr. Trevor Greene:
12:59
Getting and staying at 25 is not easy because of our diet. So that leads me into diet. What is a good diet? Now, if you break again to the internet and social media, where we all are, there's a variety of things that you can do there paleo, keto, I mean. You could spend a whole lifetime trying to figure out what the best diet is, and there's a lot of research and there's a lot of myths and a lot of fantasies out there. But the two things that you have to pay attention to in your diet is carbohydrates, which would be sugar, and salt. So I usually submit to my patients the ones who I get around with a lot, and I get around with a lot of my patients and I say to them if you want to live to be as old as Methuselah, the diet that you should have is one that has no salt and no sugar.
Dr. Michael Koren:
13:56
And they say what do I do about taste?
Dr. Trevor Greene:
14:01
I still have a practice, so they do come back to me. I say it lovingly, but the truth is the. The bedrock of diet really is to cut back as much as you possibly can on your free carbohydrate intake. Low calorie intake is probably the best way to start. I happen to like the Mediterranean diet because it gives you a better taste. There's a lot about it that is good, and so that is something that you should discuss with your, with your physician.
Dr. Trevor Greene:
14:36
Exercising, the one of the beautiful things I I once heard about aspirin. Aspirin is good and I and I I might have stole this from you, Michael, okay. Well, um, in terms of exercising the, the when you take your blood pressure medicines or you take your cholesterol medicines, or you take your rheumatoid medicines, one of the best ways to get that medicine to work, to get your blood pressure down, to get your glucose down, one of the best ways to get it to work is to take that medicine for a five-day walk and then take it. Exercise Now. Exercise should be something that you enjoy. If you're like me and your wife is beating up on you at seven o'clock at night because you're not going to the gym with her. That is not the kind of exercise that you want.
Dr. Michael Koren:
15:32
That's what you're saying publicly is the reason she's beating on you.
Dr. Trevor Greene:
15:36
Publicly Exercise, but you've got to enjoy the exercise. If you can find that form of exercise that you enjoy, you're going to accrue a much better benefit from it than if you're doing it as another chore of the day, and the exercise does not have to be really vigorous, and you don't want to look like Arnold Schwarzenegger. What you want to do is something that will give you good repetition. It is part of your philosophy of what a good day is, and you do it on a regular basis. The unfortunate thing about exercise is that you can't store it, so it doesn't matter how much you do today, it doesn't come for tomorrow. That's the sad part of it all, but you don't have to be brutal about it either. It has to be repetitious and continuous and something that you enjoy, and smoking is a no-brainer.
Dr. Trevor Greene:
16:31
Smoking increases inflammation in the body in a very big way and, interestingly enough, the next thing that we're dealing with, particularly in the young population most of you guys are here would have grandchildren and great-grandchildren that generation. You call them all sorts of names Zs and Ys and Ks and whatever else but their biggest problem is not cigarettes. Like you knew when you were growing up, their biggest problem now for smoking is actually vaping. Vaping is a big problem because it is a highly sophisticated way of getting nicotine in the system. It's very addictive. So if your grandkids come and they say to you, oh, but grandmommy and granddad, I don't smoke, I'm into vaping, and you, oh, my God, you got rid of the tar, yes, but the inflammatory consequences of smoking and vaping is still there and with all the vaping tastes that are out there, it becomes very addictive.
Dr. Trevor Greene:
17:39
Aspirin Aspirin has gone from one end of the spectrum to the other and, like I said, the best thing you can do with aspirin is to take it for a five-mile walk and it will work even better. As we get older. We've got to be very careful with aspirin and bleeding aspirin and bruising. It's tough. But low-dose aspirin, we do know, is beneficial and that's something that you should discuss with your physician to the extent that you might be taking other medicines as well. So there's no real one hardcore statement on aspirin, but low-dose aspirin is also very good.
Dr. Michael Koren:
18:15
Yeah, all excellent points. I would just add a couple of quick things on aspirin. What we learned over time is if you can get to 70 years old and have absolutely no evidence of atherosclerosis, aspirin doesn't help anymore because you're just not at high risk. But that means you have no coronary calcium, you really have no atherosclerosis. But if you're in that moderate risk category, even if you haven't had a heart attack, aspirin helps.
Dr. Michael Koren:
18:43
And of course, if you had a heart attack, then you should definitely be on something like aspirin or another type of blood thinner, and I loved your concept of taking a pill for a five-minute walk. Let's go for 10 minutes, how's?
Dr. Trevor Greene:
18:53
that 10 minutes, there you go.
Dr. Michael Koren:
18:57
And getting results from exercise is all about doing something you like and getting it in your schedule. It really comes down to that, all right. So I think we covered all this really well and there's just some numbers for everybody to see that all these things have been scientifically validated. So, if you exercise more than once a week, how much exercise do you recommend to your patients as a target?
Dr. Trevor Greene:
19:22
Well, the number that I have to deal with personally, because my wife throws this number, at me is that we should get at least 10,000 steps a day.
Dr. Trevor Greene:
19:33
10,000 steps a day is hard, it's hard. I'm up and about doing my stuff in the lab and running around. I seldom use the elevator, I run the stairs, things like that. I don't try to park too close to the establishment. You park in the parking lot and walk. You can get in your steps in that kind of a nebulous way. And uh, there was a recent I saw a recent study that showed that 7 000 is about optimal, primarily because 10 000 is just too much. And if you, if you ask some person to do 10 000, after a while they get so dejected that they can't get there that they just give it up, whereas if you say, you know what, let's go for seven, and if you get the five, that's still better than zero.
Dr. Michael Koren:
20:23
So exercise that's the number and steps is one element of exercise. Obviously, there are different ways of exercising, so if you're swimming, that's not steps necessarily, or?
Dr. Michael Koren:
20:40
you're biking.
Dr. Michael Koren:
20:41
I like to tell my patients to try to do two hours of aerobic exercise per week and try to make those sessions at least 20 minutes long. So personally, I'm pretty good at doing at least 30 minutes four days a week, and I like to go to the gym, ride the bike and that's what works for me. But finding the thing that you like to do is so important, and it could be collecting seashells on the beach, it could be working in the garden, and as long as you're sort of moving around getting up and down, that would count. It doesn't really matter what you do, but doing it for two hours a week, 30-minute sessions, to me is really what you should be targeting, and I think it's pretty clear that if you're smoking now, please work with your physician to get off of it, all right. So you want to jump into this a little bit in terms of exactly the mechanism by which CRP leads to cardiac problems exactly the mechanism by which CRP leads to cardiac problems.
Dr. Trevor Greene:
21:37
Yeah, we don't want to bog you down with too much clinical detail, but certainly the inflammation causes the reactions in your body that will promote inflammation, and they're very, very complex pathways in the body and we go after all of them in our different ways of coming at it. The big thing really would be coagulation and clotting. Clotting is a big issue, particularly if there is anyone in the room who might be suffering from atrial fibrillation and your physician puts you on your blood thinners. That's where that plays into this whole complex, but it's very sophisticated. The main thing really would be to make sure that you get your hsCRP high-sensitivity CRP and go from there work with your physician.
Dr. Michael Koren:
22:31
Yeah, and this is an area of confusion for some people. So hsCRP was actually first discovered because it's expressed in extremely high levels when people come in with pneumonia, particularly pneumococcal pneumonia, and it's thought that this is part of the body's mechanism to identify a foreign invader and to help the immune system attack it. And we are probably built to have this response because of prehistoric days when we didn't have modern medicine and this is all we had. But if you had to compare hsCRP to penicillin in terms of fighting bacteria, you're going to choose penicillin and, of course, hsCRP, Although it may have some beneficial effects with regard to responding to infections in modern times, it's probably a net negative because, as Dr. Greene mentioned, it leads to blood clots, it leads to what we call inflammatory cytokines, which are these chemicals that get the immune system all hot and heavy, and then there's something called the complement pathway that gets your antibodies all fired up. So by getting your immune system fired up is not necessarily good for your heart and blood vessels
Dr. Trevor Greene:
23:48
Or like a good thing going bad.
Dr. Michael Koren:
23:49
Exactly and again this also summarizes it that short-term that there could be some benefit for infection or injury, but long-term there's much more harm and frankly, in modern society. The long-term issues kill many, many more people than the short-term issues, and we have lots of good ways for dealing with short-term infections. So we don't necessarily need this system to kick in, and these are just a little bit more sophisticated slides, but it just tells you all the different ways.
Dr. Michael Koren:
24:25
I'll turn this way. These are all the different cells in the body that are responsible for inflammatory reactions and the cytokines are the chemicals that amplify that response. And the reason we're bringing this up is because a lot of the research that we're doing now is specifically targeting cytokines, Not so much the CRP, which is sort of the end result of the inflammatory cascade or the immediate reaction, as the case may be, but getting very specific, because there are now dozens of cytokines that have been identified and we think by blocking specific cytokines that are important in terms of cardiac and vascular inflammation, we can come up with that magic bullet that does what it needs to do for the heart and blood vessels without bothering the immune system when it comes to other things. So we're particularly excited about this whole concept. I don't know if you have any comments about that. And there's our picture close-up. Good job to our presentation staff for getting such a beautiful picture. I appreciate that.
Dr. Trevor Greene:
25:36
I think it helps me understand it at least.
Dr. Michael Koren:
25:41
All right back to audience questions. So which of these cytokines is currently under investigation for its potential to reduce vascular inflammation? If anybody gets this right, I'll be impressed. Vascular information Now. If anybody gets this right, I'll be impressed. So interleukin 1, I should mean interleukin 6,. Tnf-alpha or interleukin 10. Show of hands who thinks it's 1? Okay. Who's going to raise their hand for this question? Who thinks it's 2? We get 1, okay. And who thinks it's three, okay, interesting. Well, there are TNF-alpha drugs on the market, but that's a cytokine, that's more for general inflammation, for example rheumatoid arthritis.
Dr. Michael Koren:
26:28
We have TNF-alpha drugs for inflammatory bowel disease, for example Crohn's disease. Interleukin-10 is interesting, but the actual answer is interleukin-6. And, as I mentioned, I would have been surprised if anybody got that. We've looked at other of these cytokines over the years and we're really, really excited about this particular one because we think this is the most specific trigger for vascular inflammation and as we speak, we're doing studies looking specifically at blocking interleukin-6 and seeing whether or not people do better from a heart disease standpoint. So you want to give a little Lp(a)?
Dr. Trevor Greene:
27:07
Yeah well.
Dr. Trevor Greene:
27:07
Lp(a) lipoprotein Any African-Americans in the crowd? Yeah, definitely Be a. I feel like high levels of lipoprotein kind of plague the African-American population, primarily because of genetics. The only way you can fix that is if you change your parents, and that would be a little tricky. So once you're stuck with that, we know that.
Dr. Trevor Greene:
27:30
One in five people around the world.
Dr. Michael Koren:
27:31
My kids have been trying that. It hasn't worked
Dr. Trevor Greene:
27:33
It hasn't quite worked.
Dr. Trevor Greene:
27:35
So that is another marker that your physician can use to look to see if you're particularly having trouble getting your lipid levels as we call them as a general group under control.
Dr. Michael Koren:
27:52
Yeah, we're particularly interested in this because we have a number of molecules in clinical research that actually lower lipoprotein(a) up to 95%, and lipoprotein(a) is responsible for vascular inflammation.
Dr. Michael Koren:
28:05
So it's one of the factors that increases your hsCRP and, as Dr. Greene mentioned, it's very highly concentrated in certain families. So if you have a risk of heart disease in your family, so if you have a risk of heart disease in your family say, a mother, a father or brother or sister or an uncle or aunt who died before age 65 of cardiovascular disease or had a heart attack or stroke before 60 you should know your Lp(a) and we're happy to do that for free at the research office and, interestingly, most people have Lp(a)s that are what we call normal, which would be below 50 milligrams per deciliter, but we see some people with this family history that can have Lp(a) levels of 500, just huge elevations. So that's something you should know and this connection between Lp(a) and hsCRP is something that we're studying now and we do have some really, really interesting clinical trials to lower lipoprotein( a) if we find that you have high levels.
Dr. Trevor Greene:
29:00
So you've just became a very, very well-educated audience. So when you speak to your primary care physician or your cardiologist and you mention Lp(a), you might very well hear what are you talking about.
Dr. Trevor Greene:
29:13
What is that?
Dr. Trevor Greene:
29:15
And you'll be able to say oh well, I know about that stuff, I heard all about it, so it's good stuff.
Dr. Michael Koren:
29:20
Yeah, three years ago, when we started teaching people about LP(a) and hsCRP, most of the physicians really didn't even know what it was, and more and more doctors are now learning it and we're finding more and more doctors very open to this message, but it's still not a standard in practice, although a lot of us agree that it should be
Dr. Trevor Greene:
29:41
and that's the beauty of having stuff like this, where we bring that information directly to you, so to speak, so that we can kind of expand it more, because, depending on your relationship with your physician, you might actually get to spend that extra minute or two thinking about ways of trying to control that cholesterol that you just simply can't get control, or the statins might not be working the best, and then you're running from one statin to the next. Are you going on to the new? You say, could we take a look at our Lp(a)? You know my old uncle Right?
Dr. Michael Koren:
30:15
right, right, exactly.
Dr. Trevor Greene:
30:17
That's the kind of sense that we want to pass on.
Dr. Michael Koren:
30:20
Yeah, and here's a little pearl that, again, a lot of physicians do not know. So when you go to Quest or LabCorp one of these places and you get your LDL measured, it's measured indirectly.
Dr. Michael Koren:
30:30
It's not actually being measured directly, and within that measurement is actually Lp(a), because Lp(a) is a form of LDL cholesterol. So you might have a slightly elevated level of LDL and you may not think that much about it, but if that LDL slight elevation is due to Lp(a), that's a big threat. It's a really big threat, and so doctors don't always understand that direct measurement of LDL doesn't show lipoprotein(a), but most people who get their LDL measured are lumping all the forms of.
Dr. Michael Koren:
31:03
LDL in the same measurement and not breaking it down. And you don't even know how much of that is Lp(a).
Dr. Trevor Greene:
31:10
Which brings up the golden code; you see what you look for. You recognize what you know. Right, there you go, exactly. If you're not looking for it, then it's there.
Dr. Trevor Greene:
31:19
You're not going to see it,
Dr. Michael Koren:
31:20
right and we call it the triple threat, because it's pro-atherogenic, meaning it causes plaques, it's pro-thrombotic, which means it causes clots, and it's pro-inflammatory, which creates irritation and other problems within your blood vessels. And, as mentioned, Lp(a) tests are inexpensive. They can be ordered by any physician and more and more doctors are adding it as part of their standard lipid panel, but it usually is not in the panel unless the doctor asks for it specifically. Right, and anybody here in the audience just let us know and we'll do it for you for free. So we'll do it at the research office, we'll set a time for you to come over and it's simple and you'll know what you're dealing with.
Dr. Michael Koren:
32:09
And so we're going to kind of end with talking a little bit about clinical trials and these data just absolutely fascinate me, Trevor, is when you go to people in either US or Europe who have never been exposed to a clinical trial just general, normal people in the population and you say, do you have any interest in participating in a clinical trial? Just ask that question. Surveys have shown between 31% and 50%. On average, about 38% to 40% say they have interest. In Europe it's actually a little less than the US. For whatever reasons it is.
Dr. Michael Koren:
32:45
Yeah, interestingly.
Dr. Michael Koren:
32:46
But if you go to somebody that's done a clinical trial before and you say, will you participate in a second clinical trial, over 97% say yes. In our centers here in Jacksonville it's 99%. So how many things in life can you say that there's a lot of skepticism the first time you try it, but once you've been exposed to it you become a big believer and supporter of it. Not too many things, not very many things.
Dr. Michael Koren:
33:11
Yeah, and so I find this fascinating and it's also why we want to get the message out, to help people at least have some experience with this, because it's also why we want to get the message out to help people at least have some experience with this, because it's a very nurturing process and people learn a lot from being in a clinical trial and I believe that there's a lot of value that's derived in multiple different ways. All right, so then we have our MedEvidence! platform. I think we had a couple of people that raised their hands looking at it and again, it's kind of like Trevor and I just talking about it. We have now online lots of discussions with people about the issues of the day and you can decide what you want to glean from it, but there's always going to be insights. So a couple of the MedEvidence! podcasts that we've done recently I encourage you to look at is one with Jerome Adams. I don't know if you recognize this, but Jerome Adams was actually the Surgeon General during the first Trump administration, so he worked closely with Mike Pence and he was part of the first Trump administration and he and I had a wonderful podcast together, wonderful podcast together Recently.
Dr. Michael Koren:
34:21
This is kind of interesting, just the timing of it is that the last public interview that Tony Fauci did before he got his get out of jail free card from Joe Biden was with me in MedEvidence! so it was just a coincidence. But Tony and I had a nice conversation about his career, which is really a spectacular career. It's just mind-boggling how many things he did during the course of his career. That kind of got lost in all the politics. But if you want to find out what his opinion is about where COVID-19 came from or did he make any mistakes or things he would do differently, check out the podcast and we say hero or villain. I find this so fascinating, Trevor, when I tell people check out the podcast, they already have these ingrained opinions about Tony.
Dr. Michael Koren:
35:06
Fauci mostly based on politics and have never really heard him speak as a physician.
Dr. Michael Koren:
35:14
Check it out. I'd be curious to see what your reaction is.
Dr. Trevor Greene:
35:17
The quote that goes there, and you notice I'm giving you these little quotes: Perception sometimes is more powerful than truth,
Dr. Michael Koren:
35:23
exactly.
Dr. Michael Koren:
35:24
Yep, all right, that's spot on.
Dr. Michael Koren:
35:27
And then another one that we did that was interesting was with a local investigator and a good friend, Bharat Misra. He's done programs here with me, he's a gastroenterologist, and we talked about this concept of having warning labels on alcohol, and you might know that the surgeon general, before the change in administrations, submitted to Congress a proposal to put warning labels on alcohol because alcohol is associated with higher risk for certain cancers. But in our world we think alcohol probably has a slight beneficial effect for coronary disease. So me as a cardiologist and Bharat as a gastroenterologist had discussion about whether or not there should be warning labels on alcohol. So people have enjoyed that podcast.
Dr. Michael Koren:
36:11
And then, finally, as we mentioned, there are some ongoing studies in our community that are looking at the concept of inflammation, and just let anybody here know that you're interested and we'll get you involved. Or if you have a friend or family member who you think might benefit, we'll get you involved. You know so, for example, people that have had a diagnosis of heart disease may not even know what their CRP is, and we have a study that's just looking at your numbers. Help you look at your numbers and understand whether or not the average person in the community is elevated or not. So very simple study be an introduction into clinical trials and I think you'll enjoy it. And then we're doing more sophisticated studies.
Dr. Michael Koren:
36:49
As I mentioned, we're looking specifically at blocking IL-6. And if you look at the podcast that I did with Dr. Paul Ridker, you get a lot more details about that particular approach. But that's a very sort of cutting-edge research to see if a new monoclonal antibody will protect people against the effects of IL-6. And my final word before we get to questions is just sign up. We have about 100,000 people now that are part of our overall email and podcast universe. It's free information. There's no obligation. We protect your information. We never sell your information. So it's a nice opportunity for you to just be exposed to people that will give you objective information. We're not trying to sell a weight loss drug. We're not trying to sell our supplements. Sell a weight loss drug, we're not trying to sell our supplements.
Dr. Michael Koren:
37:41
We're not trying to sell our crazy diet book or we're not trying to either promote or diss vaccines. We're just trying to get to the truth of the matter. And so I think you'll find it interesting and we'd encourage you to sign up, and it's as easy as just taking the sheet in front of you writing your name and email address or phone number, and that will get you into the community and hopefully get you more involved in what we're doing in clinical research.
Announcer:
38:02
Thanks for joining the MedEvidence! podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.
