The External Medicine Podcast

In this episode, Daniel Belkin and Mitch Belkin interview Eliot Siegel, MD about developing the first filmless healthcare enterprise at the Baltimore, VA in 1993 which revolutionized the practice of medicine. They discuss the challenges of this innovation, including the costs of computing, the difficulties of imaging compression and data management. They touch on theragnostics, a novel subspecialty in nuclear medicine, which utilizes molecular treatments to target cancer.Who is Eliot Siegel?Dr. Eliot Siegel is a Professor of Radiology at the University of Maryland School of Medicine. He is a prolific author and speaker, has written over 300 articles on medical imaging and PACS, has edited several books, and given more than 1,000 presentations worldwide. In addition to his interest in digital imaging and PACS, he’s interested in telemedicine, the electronic medical record, informatics and artificial intelligence/machine learning. Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this episode, Daniel Belkin and Mitch Belkin interview Marc Gosselin, MD about his journey to radiology, being a radiology program director, dealing with burnout, transitioning from academics to private practice, and overdiagnosis in radiology. They discuss in situ thrombosis versus pulmonary emboli, whether medical evidence should have an expiration date, and why physicians should admit fault when they are wrong.Who is Marc Gosselin?Dr. Marc Gosselin is the head of cardiopulmonary imaging at Vision radiology, a retired full professor at Oregon Health and Science University. Previously, Dr. Gosselin was a program director of the University of Utah’s radiology program.References:Clinical Features of Pulmonary Embolism (1961)Sensible Medicine: Why statins do not cause diabetesSupport the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this episode, Daniel Belkin and Mitch Belkin interview Hussam Alkaissi, MD about his journey in medicine, experience with populations with high consanguinity, and uncovering of rare diseases. They touch on several unusual cases Hussam has solved including one of CHILD syndrome, homocystinuria, and acute hypercalcemia.Who is Hussam Alkaissi?Dr. Hussam Alkaissi is an Endocrinology Clinical Fellow at the NIH/NIDDK. He has an interest in diabetes, glucose metabolism, insulin signaling, and insulin resistance.References:Hussam's TwitterHussam's Academic WorksNature paper on link between EBV and Multiple Sclerosis Gadolinium, NALCN channel, and metastasis in Mice Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this episode, Daniel Belkin and Mitch Belkin interview Bryan Carmody, MD, about physician shortages, resident unionization, and the OB/GYN ERAS divorce. They discuss the recent changes to legislation in Tennessee which allows international medical graduates to bypass the US residency system. They also touch on the Weisman versus Barnes Jewish Hospital court case.If you missed the initial episode with Bryan Carmody Episode #6, be sure to check that out.Who is Bryan Carmody?Dr. Bryan Carmody is a pediatric nephrologist at Eastern Virginia Medical School. He has made a name for himself as a critic of certain aspects of medical education and the residency application process.Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this episode, Daniel Belkin and Mitch Belkin interview Joann Elmore, MD, about screening mammography. Dr. Elmore shares insights on the USPSTF's new draft mammography recommendations, which lowers the breast cancer screening age from 50 to 40. They discuss the difference in American and European call back rates for biopsy and whether mammography screening programs have substantially improved breast cancer mortality rates or if improvements are primarily due to enhanced treatment methods. They also touch on the potential for AI to transform radiology and pathology.Who is Joann Elmore?Joann G. Elmore is as a professor at the David Geffen School of Medicine at UCLA and the UCLA Fielding School of Public Health. Her research interests include diagnostic accuracy, physician variability, cancer screening, patient engagement, and AI/machine learning in diagnostics. She has over 200 publications.References:Joann Elmore's UCLA pageUSPSTF May 2023 - proposed changes to Mammography ScreeningNEJM: Variability in Radiologists' Interpretations of MammogramsSupport the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview infectious diseases physician and epidemiologist Dan Morgan, MD, about infection prevention, diagnostic stewardship, diagnostic reasoning, and medical overuse. They discuss regional differences in medical use and delve into a cluster-randomized controlled trial of contact precautions in ICU patients to evaluate whether this prevents C. Diff, MRSA, and VRE. They also touch on AI's potential role in clinical decision support, and the question of how to improve clinician statistical reasoning.Who is Dan Morgan?Dan Morgan, MD, MS is a physician and epidemiologist at University of Maryland School of Medicine. He directs the Center for Innovation in Diagnosis and is Chief of Epidemiology at the VA Maryland Healthcare System. His research interests include probability in medicine, medical overuse, diagnostic stewardship, and infection prevention.If you enjoyed this episode, be sure to check out our episodes with Paul Offit and Deborah Korenstein on medical overuse.Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Robin Hanson, PhD, about healthcare and medicine. They discuss three randomized controlled trials on the population-wide benefits of medicine (RAND health insurance experiment, Oregon Health Insurance Experiment, and the Karnataka Hospital Insurance Experiment), which do not demonstrate benefit for more medical care. They talk about the conspicuous caring hypothesis put forward in Robin's book The Elephant in the Brain. Other topics discussed include end-of-life care, medicine as something Sacred, and prediction markets in medicine.Who is Robin Hanson?Robin Hanson, PhD, is an associate professor of economics at George Mason University and a research associate at Oxford University. He is known for his wide-ranging interests, including artificial intelligence, prediction markets, and signaling. He is the author of several books, including The Age of Em and The Elephant in the Brain.Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Simon Whitney, MD, JD, about his book From Oversight to Overkill. They discuss the history of Institutional Review Boards (IRBs), including ethically questionable experiments such as Chester Southam's cancer cell injections, the Willowbrook experiment, as well as the US Public Health Service Syphilis Study (AKA Tuskegee experiment). They then discuss Peter Buxton, Henry Beecher, James Shannon, and the congressional oversight of federally funded research. Finally, they touch on the ISIS-2 study, Pronovost's checklist, OHRP's crackdown in the late 1990s, and discuss whether research is too safe, IRB infallibility, autonomy in the Belmont Report, and the risks and benefits of restricting research in the name of safety.Who is Simon Whitney?Simon Whitney, MD, JD, is a family medicine physician and ethicist. He previously taught at Baylor College of Medicine for 22 years. He is currently retired from the practice of medicine but continues to publish and teach medical ethics. He is the author of the book "From Oversight to Overkill: Inside the Broken System That Blocks Medical Breakthroughs—And How We Can Fix It."Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview John Ayers, PhD about ChatGPT and its potential to revolutionize the practice of medicine. We delve into his recent JAMA internal medicine study, which evaluated ChatGPT answers to questions posed on the subreddit r/AskDocs. We also touch on responses to his article discussed on a recent Sensible Medicine Podcast. Finally, we discuss Dr. Ayer's previous work on e-cigarettes, cannabis, and the sociology of suicide.Who is John Ayers?John Ayers, PhD is a computational epidemiologist who uses big data to study public health. He is the Vice Chief of Innovation in the Division of Infectious Diseases and Global Public Health at UCSD.References:JohnwAyers.comChatGPT JAMA Internal Medicine ArticleSupport the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Andrew Foy, MD, about evidence-based medicine, applying Guideline-Directed Medical Therapy (GDMT) to hospitalized patients, and evaluating aggressive versus conservative blood pressure goals in patients with comorbitidies. They discuss Dr. Foy's article on Hayek, critical appraisal of the medical literature, medical conservatism, and his skepticism around Coronary Computed Tomography Angiography as compared to Functional Stress Testing in patients with coronary artery disease. Finally, they touch on alternative visions of medical practice, content expertise in COVID, as well as statins as a potential cause of diabetes.Who is Parker Rogers?Andrew Foy, MD is a cardiologist and Associate Professor of Medicine and Public Health Sciences at Penn State College of Medicine. His research interests include management of emergency department patients with low-risk chest pain, management of patients with benign and renovascular hypertension, as well as unnecessary and overly-aggressive medical care. Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Parker Rogers about his recent job-market paper "Regulating the Innovators: Approval Costs and Innovation in Medical Technologies" which examines the impact of FDA regulation on innovation, market structure, and product safety. They discuss the FDA's medical device risk classification and his analysis of down-classification events (from higher to lower risk categories), which shows deregulation has a positive impact on innovation, firms producing devices, as well as product safety. They also touch on the value of regulation versus litigation, legal liability exposure of small versus large firms, and the European Medicine Agency.Who is Parker Rogers?Parker Rogers is a Ph.D. Candidate in Economics at the University of California, San Diego. In the fall of 2023, he will be a Postdoctoral Fellow in Aging and Health Research at the National Bureau of Economic Research. In the fall of 2024, he will be joining the School of Business at Indiana University as an Assistant Professor.Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Ross Levine, MD, PhD about Acute Myeloid Leukemia and its treatment. They discuss the different types of leukemias, the history of AML treatment, including chemotherapy and stem cell transplantation. They touch on Graft vs Host Disease, treatment after relapse, and open questions in leukemia, including future trials, and further investigation of ven/aza (Azacitidine/venetoclax).Who is Ross Levine?Dr. Ross Levine of the Memorial Sloan Kettering Cancer Center. Dr. Levine studies hematologic malignancies and is a world-renowned expert on myeloproliferative neoplasms and acute myeloid leukemia. Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Adam J Brown, MD about the field of Rheumatology, autoimmune diseases, and his podcast Rheuminations. They discuss the history of gout, plaquenil, the relationship between infectious diseases and rheumatologic conditions, the inflammasome, autoinflammatory disorders, vasculitis, fibromyalgia, Covid, and much more.Who is Adam J Brown?Dr. Adam J. Brown is a Rheumatologist at the Cleveland Clinic. Dr. Brown is the author of the book Rheumatology Made Ridiculously Simple. He is also the host of the Healio podcast Rheuminations, which focuses on autoimmunity, rare diseases, and the history of medicine. References:Twitter - @AdamJBrownMDAdam J Brown's Quiz Platform Rheum and BoardsHealio Rheuminations Podcast   Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Saloni Dattani about the genetics of psychiatric disorders and how to improve science. They discuss the lack of division of labor in academia, the history of peer review, ways to improve peer review, human challenge trials, and much more.Who is Saloni Dattani?Saloni Dattani is a PhD student at King’s College London. She is the founding editor of the online magazine Works in Progress. She is also an editor at Stripe Press and a researcher at Our World in Data. References:Saloni's SubstackSaloni's TwitterFoxes and HedgehogsSaloni Dattani's Works In Progress Article on Peer ReviewWorks in Progress - Elements of Scientific Style Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Polly Matzinger, PhD, about her model of immunology, which she calls 'The Danger Model'. They discuss how The Danger Model helps explain aspects of immunology ignored by the self/non-self model, including why mothers don't reject their fetuses, autoimmune diseases, organ transplant rejection, cancer surveillance, allergy and more.Who is Polly Matzinger?Polly Matzinger received her PhD in Biology from UCSD before completing a postdoc at Cambridge. She then worked at the Basel Institute for Immunology before moving to the NIH, where she was a section head at the National Institute of Allergy and Infectious Diseases of the so-called “Ghost Lab”. She is the creator of the Danger Model (1994), which argues the immune system discriminates between dangerous and safe by recognition of pathogens or alarm signals from injured or stressed cells and tissues. Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Derek Lowe, PhD, about drug discovery, clinical trials, drug patents, Alzheimer’s disease, the FDA, and his blog “In The Pipeline”. They discuss the potential role for machine learning in pharmaceutical development, whether Big Pharma spends excessively on marketing, and much much more. Who is Derek Lowe?Derek Lowe, PhD, is a medicinal chemist who works in preclinical drug discovery. He received a PhD in organic chemistry from Duke University and completed a Humboldt Fellowship in Germany for his post-doc. His blog about the pharmaceutical industry “In The Pipeline” has been continuously operating since 2002. Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Jean Hébert, PhD about aging, brain plasticity, and progressive neocortical replacement. They discuss one hallmark of aging—extracellular matrix damage—as well as how tissue replacement is a possible solution to aging. In addition, they explore the practicalities of progressive neocortex replacement, dopaminergic neuron transplants in Parkinson's patients, and Professor Hébert's work on stroke.Who is Jean Hébert?Jean Hebert, PhD, is a Professor of Neuroscience and Genetics at the Albert Einstein College of Medicine where he focuses on age-related brain degeneration in the adult neocortex. He is one of the world’s leading researchers on brain cell and tissue replacement. He is the author of the book Replacing Aging.Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin interview Paul Offit, MD about his book You Bet Your Life, how banning DDT caused increased deaths from malaria, and the data regarding the bivalent booster as of October 2022. They discuss the human price paid for medical advances, sins of commission versus sins of omission, which populations should get bivalent boosters, short versus long incubation period viruses, and vaccine-related myocarditis.Who is Paul Offit?Dr. Offit is the Director of the Vaccine Education Center and an attending in the Division of Infectious Diseases at the Children's Hospital of Philadelphia. He is on the FDA's Vaccines and Related Biological Products Advisory Committee. In addition, he was the co-inventor of the RotaTeq vaccine for rotavirus, has published over 130 papers in medical and scientific journals, and is the author of many books on vaccines, antibiotics, medical overuse, and medical history. including You Bet Your Life.If you didn’t see our initial episode with Dr. Paul Offit, check it out.What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this colorful conversation, Daniel Belkin and Mitch Belkin speak with Carl Schneider, JD about informed consent and the problematic nature of IRBs. We discuss the difficulties of patient education and whether patients actually want medical knowledge in order to guide their decision-making. We discuss the onerousness of IRB regulation, event licensing, the costs of inhibiting knowledge generation, as well as the paternalism of IRBs. We cover how "protections" for vulnerable groups counterintuitively harms these groups by preventing both the generation of knowledge and the development of treatments. Professor Schneider argues that IRBs should be abolished and the system of informed consent ought to be reconsidered.Who is Carl Schneider?Professor Carl Schneider is a lawyer and bioethicist. He is a Professor of Ethics, Morality, and the Practice of Law at University of Michigan. After attending University of Michigan Law School, he served as law clerk to Justice Potter Stewart of the United States Supreme Court. Schneider has authored several books, including The Censor's Hand: The Misregulation of Human-Subject Research and The Practice of Autonomy: Patients, Doctors, and Medical Decisions.What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin speak with Adam Cifu, MD, about how to improve medical education, the importance of evidence-based medicine, and medical reversals. We discuss his collaboration with Vinay Prasad, MD, why we should swap the order of medical school curricula, and landmark trials that changed his clinical practice .Who is Adam Cifu?Adam Cifu a general internist and professor of medicine at the University of Chicago. He is a clinical educator, a podcast host, and the author of over 100-peer reviewed articles as well as two books: Ending Medical Reversal: Improving Outcomes, Saving Lives (2015) and Symptom to Diagnosis: An Evidence Based Guide (4th Edition, 2019)References:AdamCifu.comTwitter Adam Cifu's podcast: Symptoms 2 Diagnosis Transfusion Strategies for Acute Upper Gastrointestinal BleedingRandomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT)Mortality and Morbidity in Patients Receiving Encainide, Flecainide, or Placebo — The Cardiac Arrhythmia Suppression TrialCoffee and Cancer of the Pancreas ____________________________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the Show.Follow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon