Narrator:
0:01
Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Kevin Geddings:
0:17
And we're spending time with Dr. Michael Koren today and we're talking about how to get good information about our health care status, all the health information that's out there, all these medical studies, all the research. You know how do we go through all that and make it work for our lives and the lives of our friends and loved ones? And so we're talking with Dr. Koren about that. There's a great resource out there that Dr. Koren and his team direct and are responsible for. It's the MedEvidence website. Go to MedEvidence. com. That's MedEvidence. com, and before we get into the details of what we want to talk about in this podcast, Dr. Koren summarize really quickly what people are going to find when they go to MedEvidence. com.
Dr. Michael Koren:
0:57
So thanks for that great question, Kevin, and MedEvidence is a platform where people can find the truth behind the data. Unfortunately, when you ask Dr. Google for some health information, typically what you get back is what somebody's trying to sell you. Nothing wrong with selling you stuff, but you need to be objective and you need to look at information that's relevant to you. So in our first session, we talked about not thinking about things that are good versus bad. Everything could be either good or bad, and there's nothing that's absolute. You should be thinking about the world as risk versus benefit and, as part of that risk versus benefit analysis, who you are is really, really important. So there are characteristics that are just your characteristics that will ultimately be important in terms of making good decisions about what health care claim you should believe, what product you should use, what service you should use, et cetera. So let's break that down a little bit more, okay, so let me use you as an example, Kevin, who you are. So, as a radio entrepreneur, I would say that when you are making a decision about what antibiotic to use for, let's say, urinary tract infection, you may not want to use something that has a side effect of hearing loss. That's true, right. So that's nothing to do with your race or your sex or gender, but it has to do with what you do for a living and what your personal risk versus benefit is. So we know that certain antibiotics called the macrolides example that would be a Z-Pak or azithromycin or vancomycin in particular that you get in the hospital. One of the side effects of that that's unique to that particular product is hearing problems, hearing loss. That would be a really bad risk for you, Kevin.
Kevin Geddings:
2:52
Yes, it would be.
Dr. Michael Koren:
2:54
So if you look up Google Best Antibiotics for a urinary tract infection, that element of your thinking is not going to be there. But we like to get that element of thinking in the MedEvidence podcast so that people can personalize things. During the break, right before the session, our producer was saying that she took glucosamine for the last 20 years and that it helped the arthritis pain in her knees. And is that good or bad? Well, how should I look at it? Well, glucosamine as a nutritional supplement isn't as well tested as drugs. Obviously, because of FDA mandates and government control over the drug supply, these things have a lot of information before they get on the market. Glucosamine as a nutritional supplement isn't subject to all those rules, but there are actually some studies with glucosamine that showed it has some benefits. And then, of course, there is the old trial and error assessment, which is a bit of a clinical trial, where an individual tries it, then takes herself off of it and tries it again, and you sense whether or not there is some benefit to these things and over time you figure out that this works for you. It doesn't work for you. Well, our producer, or happened to know is a pretty serious athlete and she's running and biking and using her knees all the time. So the who you are elements of it is that she's extremely active and needs some help for the pain in her knees. That will come with her activities and her choices will be taking ibuprofen or an anti-inflammatory like that that could have gastrointestinal side effects, or maybe taking something like glucosamine or some combination thereof. So for the who you are elements of it it's her day to day activities that are important, not her race or her gender, necessarily. We do know that women have more bone risk than men, but in this case, it's more about your day to day activity, and that's true based on your occupation. So, as a cardiologist, my day to day occupation doesn't necessarily put my knees at risk, but I happen to like playing soccer, which has put my knees, ankles, hips and my head at risk on many occasions, and so the things that I choose will be reflection of who I am and what I like to do. Now there's been a lot of focus in the media about race, for example, and what I like to tell people is you know, race is a consideration in terms of health care claims, but probably less than a lot of other things. So I like to remind people that genetically, we are 99.9% identical between blacks and whites, and Asians and whites, et cetera, et cetera. So, on average, things are going to be the same between blacks and whites. Women are men are fundamentally different. We have different chromosomes, so, although we're mostly the same, there are differences that could impact our health. But, having said that, in a lot of situations there's really no difference between the way men and women are going to respond to antibiotics or cholesterol drugs or most things. But there are some things where that would be a consideration, particularly when you get into hormonal issues and things that may affect us differently, or disease predisposition. So, for example, men tend to develop coronary artery disease and atherosclerosis 10 years earlier than women. Doesn't mean that women don't get benefits from the treatments that will help men, such as Statins, but that their risk profile may be different, and this is again the interface between who you are, risk profile and what decisions you make. Family history may be the most important thing, so is there anything in your family, Kevin, that is of a particular concern when you evaluate your health?
Kevin Geddings:
6:41
Well, history of diabetes type two diabetes on both sides of my family, so obviously you have to be somewhat conscious of that.
Dr. Michael Koren:
6:49
Yeah. So something like diabetes is going to be more related to situational things, so physical activity that's going to be related to your diet and things of that nature. So my guess is that if you stay fit and trim the way you are, you'll be okay. But maybe, because of your family history, if you get a little bit overweight, you think this will go in the wrong direction. Big example of that. Obviously we know there are certain cancers that run in families. There are certain other conditions. One that I deal with a lot is called familial hypercholesterolemia, where the function of your LDL receptors these are the receptors that clear cholesterol from your circulation is impaired and these people, genetically, have extraordinarily high risk and they have to be looked at differently than other people that may have high cholesterol just based on eating too much fried food, for example. Another example that you and I have talked about this more than once is lipoprotein-a, which is a type of lipid particle that we couldn't do anything about until very recently, and now we have strategies through clinical trials that expose people to products that can lower their lipoprotein-a by more than 90%. So again, who you are has to do with your genetics and family history. And, by the way, LP(a) affects all races, all religions, it affects all genders, so this is something that crosses those lines, and it's just about what your family tree looks like and whether or not you inherited the gene that causes a high level of this lipoprotein.
Kevin Geddings:
8:26
Well and clearly the takeaway right. Whether we're considering risk versus benefits to some of the health information we get, or who we are, you know, in terms of our genetic makeup or where our socioeconomic status is, or what have you, it makes it really hard just to go to Dr. Google and just start looking at the results of you know, the media talking about some recent health care study. Right, because that information is going to be so synthesized it's not going to consider any of those two issues.
Dr. Michael Koren:
8:50
No, exactly, exactly. And then the other piece of who you are is your belief systems, and I think we should spend a few moments looking at that. So you know, there's certain people that have belief systems that will favor, for example, exercise as their primary way of treating things. And you know, exercise is wonderful, exercise is intimately associated with longevity and prevents a lot of problems. But there are certain situations where you can exercise all you want and it's still not going to change your health course. And then you need to look at other things, and I brought up a familial hypercholesterolemia before, and that's a great example of it is that you can exercise 24 hours a day, if that were possible, and you're still going to have high cholesterol because genetically you're predisposed to it. So belief systems are important. You get into religious belief systems Jehovah's Witnesses, for example that don't want to take blood products. That's always a challenge, and if that's the belief system and that's the trade-off you want to make, then that's fine. We'll do the best we can with treatments that don't involve blood products. But sometimes they're belief systems that are not internally consistent, and I think it's fair for our MedEvidence platform to challenge those belief systems, or for me, as a physician, to challenge those belief systems. So an example of that is I've had people that have rejected the messenger RNA vaccines because they don't want genetic material in their body. So let's think about that for a second. Well, every time you eat a steak, genetic material from something foreign gets into your body. Think about that. Or, if you're really fearful of genetic material in your body, you should be super fearful of viruses. Because what are viruses trying to do? Viruses are trying to get RNA or DNA in your body. Now, fortunately, we have ways of protecting ourselves against that. But the beauty of the messenger RNA is that you're just taking a small little snippet of genetic material that's coding for a protein. You don't even get the whole RNA or the whole DNA, it's just a little snippet, and so that's going to be intrinsically safer. And by producing a protein based on that little email that we get from the vaccine, you're protecting your body against getting RNA and DNA in your body from viruses. So when you think about it in those terms, sure we love to respect patients' belief systems, but let's at least make those belief systems cohesive and internally consistent.
Kevin Geddings:
11:22
It would seem to you that we have an issue with you know, when people see four or five items on a Facebook feed or something and their cousin says it, that's almost assigned the same amount of weight as something that comes from a group of research scientists who've been working on something for 10 years.
Dr. Michael Koren:
11:38
Yeah, Well, again, sometimes the cousin may be more right than research scientists, and you know we all make mistakes, but again, the evidence is what's important. So, again, I don't hopefully I sound credible, but you should trust me. Not because I sound credible, but you should trust me because I'm looking at the data and I'm trying to help people understand the data. And, as we ended our last session, it's not about absolutes, it's about looking at the data and one determining that we know the risk versus benefit and we know how that plays out based on who we are. And with those first two elements, I think people will make much better decisions than just trusting their cousin on Facebook saying you should take zinc because it's good for you, and maybe we'll get into that for the next session.
Kevin Geddings:
12:27
In the meantime, check out the website MEedvidence. com. That's MedEvidence. com.
Narrator:
12:32
Thanks for joining the MedEvidence Podcast. To learn more, head over to medevidencecom or subscribe to our podcast on your favorite podcast platform.
