The People's Pharmacy Podcast
Empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.
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Show 1494: When Cancer Changes Your Future, How Do You Live Today?
11/07/2026
Show 1494: When Cancer Changes Your Future, How Do You Live Today?
Most of us fear a diagnosis of cancer. If it has a serious prognosis, as lung cancer does, the diagnosis suddenly changes your life expectancy and how you imagine your life unfolding. In this episode, we talk with a physician who did research with patients who had lung cancer. Then this nonsmoker was diagnosed with lung cancer himself, at stage 4. We ask him, when cancer changes your future, how do you live today? At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. A Diagnosis of Lung Cancer Lung cancer is still the leading cause of cancer-related death in the US. Most people imagine that this dreaded malignancy results from smoking, but nearly 20% of lung cancer patients are nonsmokers. Possibly because of the association with smoking, there still appears to be a stigma attached to lung cancer. Perhaps the example of Pope Leo, a nonsmoker recently diagnosed and treated for lung cancer will help change that. While less well known than the pope, our guest Bryant Lin, MD, is also striving to set an example for how to react when cancer changes your future. Better Screening for Lung Cancer? The United States Preventive Services Task Force (USPSTF) does not recommend screening the population for lung cancer. In fact, its recommendation is that only smokers undergo screening. However, screening also makes sense for people with certain risk factors. Nonsmokers are at increased risk if there is lung cancer in their family tree. Asian women, in particular, may benefit from screening, as they have a higher likelihood of lung cancer despite not smoking. Scientists are not entirely certain why, but that is what the epidemiological data demonstrate. Screening for Lung Cancer Screening for lung cancer consists of a low-dose CT [computed tomography] scan. If a suspicious area shows up on the image, further testing is required. In many cases, this will include a biopsy in which a small bit of tissue is removed from that part of the lung for detailed microscopic examination. When Cancer Changes Your Future, Why Not Teach a Course? Dr. Lin shared the diagnosis with his wife and adolescent sons with great transparency. Then he went further, and decided that medical students at Stanford, where he teaches, should have the opportunity to learn from his experience. To make this happen, he organized a course titled “From Diagnosis to Dialog: A Doctor’s Real-Time Battle with Cancer.” Despite feeling nauseated or fatigued from chemotherapy, Dr. Lin found that the classes and the students’ positive reactions to them were uplifting. Afterwards, he expanded his syllabus into the book, “Sunshine: An Exploration of Living When You Are Dying.” Even though Dr. Lin had taken care of many patients with lung cancer, he found that the actual experience of being a patient changed his perspective significantly. It feels different to be the person with the cough or shortness of breath, the one who is trying to cope with symptoms caused by treatment. One aspect he had not anticipated was becoming the recipient of numerous well-meaning recommendations for unproven and sometimes quite dubious supplements or treatments. Despite his natural optimism, he would appreciate people refraining from such recommendations. No doubt many other cancer patients harbor similar feelings. When Cancer Changes Your Future, Your Insurance Company Shouldn’t Make Treatment More Difficult Throughout our conversation, Dr. Lin acknowledged that he has privileges as a physician at a research-oriented medical school. His oncologists know about the latest research and the most promising treatments. Plus, he has good insurance. Consequently, he was shocked when the insurance company denied authorization for a medication essential to the next step of his treatment. How did he overcome this challenge? He put up a post on LinkedIn that quickly went viral. Not every patient can do this to achieve the goal, but he also offers advice for others to help them if they must battle insurance company negativity. When Cancer Changes Your Future, Make the Most of Today Dr. Lin tells us spirituality has turned out to be surprisingly important to him during this experience, although he is not a religious person. He is doing well emotionally and spiritually, but the cancer is still progressing. He is hoping for a clinical trial that will be able to halt it, at least for a while. In the meantime, he is savoring the good days that he has right now. This Week's Guest Bryant Lin, MD, author of Sunshine Bryant Lin, MD, is a primary care physician, educator and researcher at the Stanford University School of Medicine. In 2024, Dr. Lin was diagnosed with Stage 4 Lung Cancer, despite never having smoked. He started a course "From Diagnosis to Dialog: A Doctor's Real-Time Battle with Cancer," based on his case. Dr. Bryant is the author of The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).
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Show 1493: How Doctors Are Changing the Odds Against Breast & Prostate Cancer
10/31/2026
Show 1493: How Doctors Are Changing the Odds Against Breast & Prostate Cancer
Breast cancer is the most common cancer affecting women, while prostate cancer is the most common for men. In 2022, the CDC found that approximately 255,000 men got a prostate cancer diagnosis. The same year, doctors diagnosed nearly 280,000 women with breast cancer. Breast & prostate cancer affect different patient populations and different parts of the body. Nonetheless, doctors have found common themes in diagnosing and treating these malignancies. We’ll learn how they are changing the odds. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Changing the Odds Against Breast & Prostate Cancer Over the course of a lifetime, one in eight American women will get a breast cancer diagnosis. The odds for prostate cancer in men are similar. So are the chances of dying from these conditions: one in 43 women die of breast cancer. One in 44 men die of prostate cancer. How are oncologists changing the odds to improve survival from breast & prostate cancer? Better Screening The first step in controlling a condition is diagnosis. Screening techniques for breast & prostate cancer differ because breasts are easier to image. That’s why doctors prescribe mammograms to detect early signs of breast cancer. Screening for prostate cancer starts with a blood test for prostate-specific antigen (PSA). Although it is imperfect, middle-aged men should find it a fairly easy first step. If the PSA turns up something alarming, doctors will probably proceed to order imaging, in this case an MRI of the prostate. An MRI reveals prostate tumors with greater accuracy than the old-fashioned unguided prostate biopsy could. A biopsy may still be needed as part of the diagnosis, but it is more likely to be guided by imaging, either MRI or ultrasound, than in previous decades. Screening Controversies Over the past few decades, public health experts have scrutinized screening in an effort to limit overdiagnosis. For several years, the United States Preventive Services Task Force (USPSTF) advised doctors against ordering PSA tests for men without symptoms. However, that approach led to more men being diagnosed at advanced stages of prostate cancer. These are more difficult to treat effectively. Now, men diagnosed with an early stage of cancer that does not require urgent treatment may be offered active surveillance. They are screened on a regular basis, and if the cancer starts to progress, the doctor offers surgery, radiation, chemotherapy or other treatment. Mammography has also seen some controversy. Sometimes doctors disagree about when women should have their baseline mammogram and how often these should be done. Dr. Anders treats breast cancer patients. She recommends women start at age 40 and undergo mammograms every year. Causes of Breast & Prostate Cancer When we asked our guest experts about the causes of these cancers, they suggested that diet and lifestyle contribute. They also emphasized the importance of genetics. BRCA1 and BRCA2 gene mutations are well known for their role in elevating the risk for breast cancer. In addition, about 12% of men diagnosed with stage IV metastatic prostate cancer have a BRCA mutation. These genes also raise a person’s chance for ovarian or pancreatic cancer as well as melanoma. Treating Breast & Prostate Cancer by Blocking Hormones Both cancers are fueled by sex hormones. Many breast cancers (though not all) respond to therapies that block estrogen and/or sometimes progestogen. One example of such a medication is tamoxifen, a selective estrogen receptor modulator. Hormonal therapy for breast cancer might include a multiyear regimen of aromatase inhibitors such as letrozole, which block cells from manufacturing estrogen. Other treatment options include PARP inhibitors, which block DNA repair in actively dividing cells found in tumors. Doctors frequently treat prostate cancer by blocking androgens such as testosterone. One exciting (though pricey) new therapy uses a radioisotope to target prostate-specific membrane antigen. This is an entirely different protein from the PSA used in screening for prostate cancer. It appears to extend life expectancy of men with advanced, metastatic prostate cancer by about half a year. Preventing Recurrence People who have completed treatment for either breast or prostate cancer will readily describe the sensation that they are living under a sword of Damocles for several years afterwards. What can people do to reduce the risk for recurrence? A healthful diet without plastic or chemical exposures is key. A Mediterranean-style eating plan seems to work well for many people. Research indicates that physical activity can play an important role. Unfortunately, the insurance companies that compensate people for cardiac rehab have not yet seen fit to reimburse for cancer rehabilitation. That is despite the quite modest cost of prescribed exercise when compared to treatment for a recurrence. Social support, especially for breast cancer patients, is another crucial pillar. Bone Health After Treatment Bones use hormones to maintain their strength. Consequently, hormone-blocking therapies for both breast & prostate cancer can weaken bones and put patients at higher risk for osteoporosis. Unfortunately, administering these hormones creates a quandary–how much and what form of estradiol for women will strengthen bones without triggering recurrence? Likewise for men, there are questions regarding the safety of testosterone. It may strengthen bone, but it may not be safe for every man who has been treated for prostate cancer. This Week's Guests Carey K. Anders, MD, FASCO, is Professor of Medicine in the Division of Medical Oncology at Duke University Health System. She is Director of the Duke Center for Brain and Spine Metastasis, Associate Director of Clinical Research and Translating Duke Health Scholar at Duke Cancer Institute & Duke University Health System. Dr. Carey Anders, Division of Medical Oncology, DUHS Photo by K. Huth Andrew Armstrong, MD, is the George Barth Geller Distinguished Professor for Research in Cancer. He is Professor of Medicine at Duke University School of Medicine and Professor in Urology, Professor in Pharmacology and Cancer Biology, and Professor in Pathology. Dr. Armstrong is a Member of the Duke Cancer Institute. Dr. Andrew Armstrong
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Show 1492: What Really Works Against Winter Infections
10/24/2026
Show 1492: What Really Works Against Winter Infections
We are only about a month into fall, but flu season is already underway. Today we are considering the best actions to take against winter infections. First, however, we asked our guest expert about measles. There have been large outbreaks in so many places this year. Why is measles such a big deal? One reason is that measles induces “immune amnesia,” so that our bodies forget how to fight off infections they have previously overcome. The MMR vaccine for measles, which prevents infection extremely well, does not have the same deleterious effect on the immune system. Consequently, vaccinated people maintain their protection not only against measles but also against polio or diphtheria if they have gotten those immunizations. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Really Works Against Winter Infections? Our guest, Dr. Roger Seheult, is certified in pulmonary and critical care medicine, as well as internal medicine and sleep medicine. So he is eminently qualified to tell us how to prevent and treat respiratory infections that are so common in the wintertime. We asked him why these problems are so prevalent in winter. He suggested that lower levels of humidity, temperature and sunlight might all play a role. When we asked whether the phenomenon of people gathering from across the country for Thanksgiving and Christmas might be important, he pointed out that Australians also gather for Christmas and New Year’s. Yet their flu season does not coincide with those holidays, but rather with their wintertime in June and July. Limited sunlight might be far more relevant than most of us imagine. The immune system is more active when exposed to sunlight. As with measles, where the immune amnesia is a serious lingering problem, the consequences of many winter infections can go far beyond coughing and sneezing. More people die from heart attacks during flu season than at other times of the year. In fact, there are more cardiac deaths than deaths from influenza. Other infections also have deleterious impacts on the rest of the body systems. As we learned during the pandemic, COVID-19 can trigger diabetes. Consequently, we ought not dismiss these infections lightly. Testing for Winter Infections In the hospital, when Dr. Seheult and his colleagues admit a patient, they test to see what type of infection has made the person so sick. Most of the usual infections produce similar symptoms: cough, congestion, runny nose, fever, wheezing and body aches. Body aches are more common with influenza than with colds, but there is a significant overlap in symptoms that makes it hard or impossible to diagnose based on clinical appearance alone. To treat inpatients, doctors first test them. The test will reveal quickly which of 13 different viruses have made the patient ill. Sometimes, more than infection is contributing to the misery. While we do not have access to such sophisticated tests at home, we can purchase tests that will identify COVID-19, influenza A and influenza B. Knowing what infection is causing trouble can help a doctor prescribe a treatment, if there is one. Treating Respiratory Infections Once the physicians have identified the cause of the infection, they can determine if there is a treatment. There are a few for influenza A. Perhaps the best known is oseltamivir (Tamiflu). However, while Tamiflu have been shown to shorten the duration of the flu, Dr. Seheult cautioned us not to expect too much. Taking Tamiflu can shorten the duration of the flu from about a week to roughly six days, on average. For many other infections, we do not have effective treatments. Influenza B, for example, does not respond well to Tamiflu. There are no treatments for infections like human metapneumovirus either. Tapping the Power of Fever What people often do in such cases may be counterproductive. Very often parents give their children acetaminophen to bring a fever down. Adults may take an NSAID such as ibuprofen or naproxen, or perhaps they too will take acetaminophen. That is a mistake because fever is part of the body’s natural defense against infection. Instead of suppressing a fever–as long as it’s not too high–we should consider augmenting it. In the 19th century, doctors prescribed balneotherapy, in which the patient is draped with hot wet towels or actually immersed in hot water. An early Nobel Prize went to a physician who cured neurosyphilis, a dangerous bacterial infection, by infecting patients with malaria, which produced a high fever. Once the syphilis had been eradicated, the malaria could be treated. In the 1940s, medicine shifted from this labor-intensive approach to utilizing aspirin to lower fever and penicillin to fight bacterial infections. The motivation was not that aspirin is more effective. Rather, it is far more efficient for nurses to administer a medication than to spend half an hour heating up wet towels and applying them to a patient. You can do this at home if you are careful to avoid burning yourself or the patient. A hot bath or a sauna can boost the body’s defense against winter infections. Of course, if you are sneezing and coughing you will need to take care not to contaminate the air for anyone else who might be using the sauna. You should also take care that the hot water treatment does not lower blood pressure unexpectedly. Calming a Cough The cough that accompanies a cold or other infection can be very annoying, keeping the patient and anyone else in the vicinity awake all night. We asked what to do in this case. Dr. Seheult suggested checking if the cough is bringing up phlegm. If so, the doctor might need to check for a bacterial infection. If the cough is not bringing up phlegm, it might be due to a post-nasal drip in the back of the throat. In that case, nose spray might be the best treatment. Fluticasone (Flonase) or azelastine (Astepro) are both available over the counter. Azelastine has the further distinction of being able to reduce the risk of contracting COVID-19. If neither of those works, the doctor may prescribe Tessalon Perles (benzonatate). These should be swallowed, not chewed or sucked. They contain an anesthetic that numbs the cough center and should offer relief. Preventing Winter Infections Step Outside Considering the limitations on treatment of these nasty infections, we asked Dr. Seheult about prevention. The top of his list might be a surprise: spend 15 minutes outside early every day to get natural light. Even if the day is overcast or rainy, the amount of light available outside is far greater than what we can manage indoors. Moreover, following this practice early helps set the circadian rhythm for better sleep in the evening and a stronger immune defense throughout the day. Healthy Hand Hygiene Some infections are transmitted through droplets or even tiny aerosols that a person emits while coughing or sneezing. If you must be exposed to an infected person, wearing a high-quality mask with a tight fit such as an N95 would be prudent. But good hand hygiene always make sense. We discussed the touch screens that have become so common in public places including pharmacies. They may not be disinfected regularly, and many people touch them and leave their germs behind for you to pick up. Frequent, thorough hand washing after touching a screen, a doorknob or a shopping cart is a rational precaution. Supplements to Maintain Good Health Dr. Seheult takes n-acetylcysteine, also known as NAC, throughout the cold and flu season. He takes 600 mg twice a day. Another supplement he uses himself is quercetin. Of course, we also asked about vitamin C. He responded that he takes it only if he comes down with something. It works better to speed healing than to prevent infection. Hot and Cold Research on sauna bathing shows that exposure to heat and then abrupt cooling can strengthen the immune response. Most Americans don’t have ready access to a sauna bath. But we can mimic the effect by taking a hot shower and following it with a cold rinse. Vaccine You will not be surprised that vaccination is also on the list. There are no vaccines for many winter infections, including those we refer to as the “common cold.” But people who get vaccinated against influenza are also protecting themselves against cardiovascular complications and lowering their future risk for dementia. An additional motivation for some people is to protect the infants and toddlers in their lives. Babies do receive vaccines, but they spend a good part of their first year vulnerable to infections. Their immature immune systems cannot protect them, so it is important for family members and friends to get vaccinated so they don’t inadvertently expose the child to a potentially deadly condition. This Week's Guest Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine. He is also an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. His current practice is in Beaumont, California. He is a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult lectures routinely across the country at conferences and for medical, PA, and RT societies. He is the director of a sleep lab and the Medical Director for the Crafton Hills College Respiratory Care Program. He is co-founder and presenter for , a site that offers concise and easy-to-follow medical videos on a range of topics. Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside
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Show 1491: Would Eating Better Reduce Brain Fog?
10/18/2026
Show 1491: Would Eating Better Reduce Brain Fog?
Do you run out of go-power in the middle of the morning? Maybe you find it hard to focus and your ability to call on your memory is strained. Or perhaps you suffer from an after-lunch slump. Some people find that their brain fog is troublesome most of the time. While there are some medical conditions that produce brain fog, you just might find that changing what you eat could help your mental clarity and reduce brain fog. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How Could Eating Better Reduce Brain Fog? Our guest, Dr. Uma Naidoo, is a leader in nutritional psychiatry. She found in her practice that what people eat can make a big difference for their mood and even their cognition. Breakfasting on coffee and donuts is often a preamble to needing (not just wanting) a coffee break mid-morning. Evidence has been growing that people may perform differently depending on the type of breakfast that they had. This could well vary from one person to the next. Some thrive on a bowl of steel cut oats with yogurt and berries, while others notice that it doesn’t carry them through the morning. Dr. Naidoo suggests that in most cases a low-carb breakfast with plenty of protein will serve us better than the typical Danish and coffee. The Impact of Sugar on Cognitive Health A fascinating study published earlier this year demonstrated the surprisingly persistent effects of consuming sugar. The investigators took advantage of a natural experiment occasioned by the rationing of sugar during and after World War II (). They . Some of these were exposed to sugar rationing only while in utero, some were exposed to it in utero and up to age two, while the third group was conceived and born after sugar rationing had stopped. Those babies are now in their 70s. Those with their first thousand days under sugar rationing have dramatically lower risk for developing dementia–a 27% lower risk for any type of dementia and a 46% lower risk for Alzheimer disease. We don’t have any studies showing that limiting sugar in adulthood can benefit the brain in the same way, but the evidence we do have suggests eating less sugar might reduce brain fog. Is Your Medicine Causing Brain Fog? When psychiatrists prescribe pills to treat depression, anxiety or other mental illnesses, they are aware that one of the effects might be confusion or lack of mental clarity. These are not the only types of medication that can cause trouble, though. Many people rely on over-the-counter sleep aids night after night. Nearly all of these contain diphenhydramine (DPH) as their active ingredient. DPH counteracts the activity of a neurotransmitter called acetylcholine. As a result, pharmacologists classify it as an “anticholinergic” drug. Even by itself, but certainly in combination with other anticholinergic medicines, DPH can lead to brain fog. If you are interested in exploring what those other anticholinergic drugs are, you will find a . The Insomniac’s Dilemma Many people who frequently have trouble sleeping feel like they’ve been put between a rock and a hard place. To function at their best, they need adequate sleep. But the sleeping meds they rely on, whether they contain DPH or a Z drug like zaleplon (Lunesta), zolpidem (Ambien) or eszopiclone (Sonata), may lead to next-day fuzziness or eventually chronic brain fog. When possible, lifestyle measures such as early-morning light exposure, vigorous exercise during the day and avoiding caffeine after midday might help a person avoid this difficult dilemma. What Diet Is Best to Reduce Brain Fog? If you want to improve your mood and mental alertness, what diet should you choose? Recently, we spoke with a nutritional psychiatrist who is enthusiastic about a ketogenic diet for treating anxiety or depression. Dr. Naidoo says a thoughtful approach can allow for a keto diet, or a paleo diet, a vegetarian diet or a vegan diet. The keto diet can be effective, but it requires a great deal of attentive management, which may be just too much for some patients. It is very important that the diet be based on whole foods rather than highly processed foods. It should also be tailored to the individual’s cultural preferences. Doctors often recommend a Mediterranean diet because so much evidence points to its benefits. But other diets, such as a Nordic diet (in Scandinavia) or a North Indian diet (in Punjab, for example), can also be healthful within a cultural context ( 2025). Do Hormones Affect Brain Fog? Many people are convinced that hormonal changes can contribute to brain fog. Some women find their focus shifts throughout the menstrual cycle. Others report increased brain fog as one of the troublesome symptoms of menopause. People who have experienced thyroid hormone imbalances have noted that their attention and alertness is diminished until balance is restored. Favorite Foods from our Guest We asked Dr. Naidoo about her favorite recipes. As a chef, she is very fond of the French tradition. She also loves the Indian foods she grew up with. One of her favorites is chicken tikka masala. Substituting tofu for the chicken produces a delicious vegetarian dish. She also recommended miso-glazed sweet potatoes and a kaleidoscope salad with multi-colored veggies. For dessert, she suggests an avocado-cacao mousse. Utilizing Food as Medicine Dr. Naidoo points out that the gut microbes begin to respond to dietary changes within 24 hours. However, it could take a week or more–up to a month–for a person to notice differences in how they are feeling. Some of her colleagues are quite interested in the opportunities to utilize natural approaches along with or in place of conventional medications. The theme of the 2025 annual meeting of the American Psychiatric Association was “Lifestyle for Positive Physical and Mental Health.” Moreover, Harvard Medical School is in the process of integrating lifestyle psychiatry into its curriculum, so future healthcare professionals are likely to be more open to this approach. This Week's Guest Uma Naidoo, MD, is the founding director of the first hospital-based Nutritional Psychiatry Service in the United States. She is the Director of Nutritional, Lifestyle and Metabolic Psychiatry at Massachusetts General Hospital while serving on the faculty at Harvard Medical School. Dr. Naidoo is also a professional chef, graduating from the Cambridge School of Culinary Arts and receiving the school’s most coveted award, the MFK Fisher Award for Innovation. She is the author of and . Dr. Naidoo’s new book, will be released in March 2027. Her website is:
Dr. Uma Naidoo, Massachusetts General Hospital
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Show 1490: Could It Be Parkinson's? Symptoms People Often Miss
10/10/2026
Show 1490: Could It Be Parkinson's? Symptoms People Often Miss
Neurological conditions have been increasing over the past several decades, but none more quickly than Parkinson disease. What is this disorder, and what is driving the increase? We’ll discuss symptoms people often miss and find out about treatments. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Is Parkinson Disease? This movement disorder is named after the doctor who first described it in a publication in 1817. As we mentioned, it has become more common in recent years, so you may not be surprised to learn of numerous celebrities who have or have had Parkinson disease (PD). Michael J. Fox may be one of the best known because he has worked so hard to gain recognition that PD can affect people in their 30s and 40s. Of course, like most degenerative conditions, it is more common as people age. Parkinson disease is characterized by a relative lack of dopamine. The areas of the brain that would normally produce this crucial neurotransmitter stop making it, for reasons that are not completely understood. What Dopamine Does We need dopamine for proper functioning with regard to movement, mood, sleep, attention and memory. This explains why some people with PD may experience cognitive challenges or depression. The FDA approved levodopa (AKA L-dopa) in 1970. It is still a mainstay of treatment for Parkinson disease, often with carbidopa. This therapy is more helpful for movement symptoms than for the other aspects of Parkinson disease, however. Symptoms People Often Miss In the past, it wasn’t possible to tell how much dopamine the brain might be making. A person might search for years to get the appropriate diagnosis because symptoms people often miss weren’t noticed. People do think of tremor as a primary symptom of Parkinson disease, but they may confuse it with essential tremor. The tremor of PD occurs when the person is at rest. For example, the hands may shake while lying in the person’s lap. Essential tremor is completely different and occurs while the person is active, such as applying make-up or putting on earrings. Another common symptom of PD is slower motion. It may take longer to cook a meal or get dressed. That is because we need dopamine to move. However, under some circumstances, slow-moving people can move remarkably quickly. Joe has noticed this with a tennis partner, and other people have seen it in emergencies. New technology called DAT spect scan (for dopamine tags) makes it possible to tell if the brain is producing dopamine. The doctor may also order a MRI to make sure that the problem is with the dopamine area of the brain and not caused by a stroke or a tumor. After a diagnosis is established, the doctor may ask the patient to perform toe-tapping and finger-tapping exercises to assess how they are doing. How Do Doctors Treat Parkinson Disease? When we asked our guest, Dr. Nina Browner, what is at the top of her prescription pad for PD patients, she told us it is not a treatment but a conversation. Understanding the person and what is important to them is crucial in guiding the treatment. For example, one of her patients likes to run with his grown sons. This is their way of connecting. For this patient, treatment to maintain mobility is key. High-Intensity Exercise for PD Research, specifically the SPARKS 3 study, has shown that after 17 minutes of vigorous exercise, the brain produces more dopamine. Consequently, the recommendation is to exercise beyond 17 minutes and then stretch to loosen the muscles. For best results, people with PD need much more exercise than other individuals; 30 minutes three times a day provides a good baseline. For even greater efficacy, people might increase their activity up to 150 minutes a day. They can benefit from a wide range of activities, ranging from bicycling to boxing, from tai chi chuan to ping pong, Zumba or dancing. The social aspects of ping pong and Zumba might be especially helpful. Beyond Movement to Symptoms People Often Miss Levodopa, the prescription drug used to replace the missing dopamine, helps improve movement but it does little or nothing for the symptoms people often miss. Dr. Browner may refer patients for other treatments, such as speech therapy. Digestive difficulties (especially constipation) are very common, although people may not necessarily associate them with Parkinson disease. Patients frequently need help dealing with that. Another area that can pose challenges is sleep. People with PD may be prone to something called REM sleep behavior disorder. As a result, instead of being immobilized during a dream as most of us are, they may act out their dreams, kicking, punching or leaping out of bed. Needless to say, this can result in injury for either the patient or their bed partner. The doctor may prescribe clonazepam for some of these sleep difficulties. Cutting Edge Treatments People with Parkinson disease may benefit from a treatment known as deep brain stimulation. This surgical procedure implants wires into the part of the brain most affected by PD. The battery to power the stimulation remains outside the body so that it can be changed when necessary. Those who undergo this procedure often benefit for an extended time. Another nonpharmacological treatment is focused ultrasound. This acts similar to surgery, but it uses sound instead of a scalpel. You can hear more about this treatment in This Week's Guest Nina Browner, MD, is the Bryson Distinguished Professor of Neurology at the UNC School of Medicine and Director of the UNC Parkinson Foundation Center of Excellence. A nationally recognized expert in Parkinson's disease and movement disorders, she leads clinical, research and educational programs dedicated to improving care for people living with neurological disease. Dr. Nina Browner, Bryson Distinguished Professor of Neurology at the UNC School of Medicine Photo credit: UNC Health
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Show 1489: The Baby Bust: Why Is Fertility Falling and What Can You Do About It?
10/03/2026
Show 1489: The Baby Bust: Why Is Fertility Falling and What Can You Do About It?
Birth rates have been dropping for years. This is happening in many parts of the world, not just the US. Demographers estimate that women need to have 2.1 children, on average, to replace the population. (The US is currently at about 1.7 or 1.8 children per woman.) Where the average number of babies falls below replacement, the country may end up with more elderly people than children. Eventually, this can have economic and social consequences. In this episode, we explore the baby bust. Why is fertility falling? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Why Is Fertility Falling? Fertility in the US is at a historical low, according to our guest, Dr. Linnea Zimmerman. Whether or not this baby bust constitutes a crisis depends upon your perspective, however. Those who see young people primarily as eager working hands could perceive the economic effects of falling fertility as a future crisis. Others who worry that we are straining the ecological limits of the planet might view a decline in fertility more positively. We asked Dr. Zimmerman about the sources of this baby bust, and she explained that the factors are complex. Although there will almost certainly be some economic consequences of a steep drop in fertility, economic considerations are also important for people considering parenthood. Housing is expensive, and so is childcare. Do they feel confident about their healthcare coverage? It is not clear that the lifetime fertility rate of American women has declined as steeply as the statistics suggest. One good aspect of the current situation is fewer teenage pregnancies. In addition, many women in their 20s, when past generations would have been bearing babies, may be waiting until they feel more settled in their lives, or until they find a suitable partner to raise children with. This can take time. Has Environmental Contamination Affected Fertility? We asked Dr. Zimmerman if we could attribute fertility falling to exposure to environmental factors such as forever chemicals. While PFAS compounds are certainly not good for humans and should be avoided as much as possible, we don’t yet have evidence that they are contributing to a baby bust. What Can You Do About Fertility Challenges? We turned to Dr. Genevieve Neal-Perry to learn about what options people might have if they discover they need help conceiving. According to Dr. Neal-Perry, the available technology has improved greatly over the years, and fertility specialists are frequently able to help a woman conceive and carry the pregnancy to term. Moreover, many more people now have fertility benefits as part of their health insurance. In past years, this was much less common. The source of a fertility challenge is not always obvious. Dr. Neal-Perry suggests that a third of the time, the difficulty lies with the female, a third of the time with the male and a third of the time with the combination. If a woman has endometriosis and is not ovulating, that would need to be addressed first. Men’s fertility begins to drop when they are in their 40s or 50s. Men who take testosterone may have lower sperm counts. In addition, people with very high BMI (40 or above) often have reduced fertility. How Long Should You Wait for Nature to Take its Course? Dr. Neal-Perry suggests that healthy women 35 and under could try for a year before seeking out assistance. Beyond that age, six months is a more realistic time frame. Women who plan to freeze their eggs for future pregnancy should also consider doing this while they are in their mid30s, as they have the best chance of retrieving viable eggs for future use at that age. How Do Medications Affect Conception and Pregnancy? Obstetricians do not recommend that people undertake major weight loss while they are trying to become pregnant. Although there has been some media attention to the phenomenon of “Ozempic babies,” we do not have safety data for GLP-1 agonists such as semaglutide or tirzepatide during pregnancy. In fact, a preconception review of medications a few months before beginning the attempt for a pregnancy is highly advised. Interventions to Promote Conception If the woman has intact fallopian tubes, intrauterine insemination may be helpful. It overcomes barriers that may exist at the cervix and helps the sperm unite successfully with the egg. If the fallopian tubes are not open or not present, the best option may be in vitro fertilization. The eggs are removed and inseminated in the laboratory (“in vitro” implies in glass). The embryos are incubated for the first few days of development. The doctor may then take tiny samples of the embryo to do genetic testing before introducing it into the uterus. As Dr. Neal-Perry put it, the implantation is “out of our hands.” Throughout the fertility journey, from before conception to after birth, people are encouraged to continue their best health practices: following a well-balanced diet without junk food, getting regular physical activity and sleep, avoiding chemicals that may be harmful. This Week's Guests Linnea Zimmerman, PhD, MPH, is an associate professor of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Dr. Zimmerman studies family planning and women's reproductive health, evaluates use and barriers to critical maternal and newborn health interventions. Her website is Linnea Zimmerman, PhD, MPH, Johns Hopkins University Genevieve Neal-Perry, MD, PhD, is Department Chair of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. She is the Robert A. Ross Distinguished Professor of Reproductive Endocrinology and Infertility. Genevieve Neal-Perry, MD, PhD, UNC Chair of OB-GYN
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Show 1488: What Can Near-Death Experiences Teach Us About Consciousness?
09/26/2026
Show 1488: What Can Near-Death Experiences Teach Us About Consciousness?
After years of dementia, many people have reduced their communication to minimal levels. Sometimes, they don’t say anything at all, and family members may be tempted to assume that memories have disappeared along with cognitive function. Occasionally, such a person will become surprisingly coherent and able to discuss aspects of their lives for a few minutes or even hours. Because they often die within days of such an episode, researchers have termed the phenomenon “terminal lucidity.” Our guest, Dr. Marjorie Woollacott, suggests that the more inclusive term “paradoxical lucidity” might be more appropriate. What do these unexpected events have in common with near-death experiences? Can they teach us about consciousness? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Is Terminal Lucidity? An article by Billy Brennan in the New York Times Magazine (July 15, 2026) was titled, “” The subtitle explained, “As they near death, some dementia patients recover mental faculties assumed to be long lost. Researchers want to know why.” We were fascinated by the story Mr. Brennan shares about a conversation with a grandmother a few days before her death. It reminded us of an experience a friend of ours had shared about his own mother. She had dementia and had not communicated much with anyone for a long time. When the nursing home called him and told him she had broken her hip, he expected she would be even more incoherent because of the opioids she would be administered for the pain. So when he arrived at the hospital to find her oriented to time and place and aware of the situation, he was astonished. In this instance, her unexplained clarity continued for a few weeks. We can’t call it “terminal” lucidity, though, as she survived several more years. Such tales suggest that even a disordered brain is not completely lacking in consciousness. But what do we mean by consciousness? A Stroke of Insight to Teach Us About Consciousness Neuroscientists usually assume that the brain creates consciousness, although they haven’t explained exactly how it does so. Some philosophers postulate that consciousness is a fundamental property of the universe. In this view, our brains act as filters so that we don’t become entirely overwhelmed and unable to function. Many years ago, we interviewed , a neuroanatomist, about her brilliant book, My Stroke of Insight. In it, she recounts her own experience and perceptions as she suffered a massive hemorrhagic stroke that affected the left side of her brain. She observed as her brain circuits went offline, one by one. In particular, she was struck by a sense of joy and unity with the entire universe. Our guest for this episode, Dr. Marjorie Woollacott, suggests that during this time, Dr. Bolte Taylor’s stroke removed the usual filters that our brain puts on our consciousness. How Else Might People Have a Different Access to Consciousness? Dr. Woollacott is a meditator as well as a neuroscientist, and she describes her initiation into meditation. To her, it felt as though she were participating in a larger consciousness. Meditation might facilitate a lowering of the filters that usually limit our awareness of a broader consciousness. Dr. Woollacott describes this as a spiritual awakening. Sometimes people describe an experience under the influence of psilocybin in similar terms. Many people who have died and then been revived have described their feelings about such a near-death experience. Dr. Sam Parnia and have both discussed these phenomena for People’s Pharmacy listeners. In such situations, people often accurately depict events that occurred while they were unconscious or technically dead. Most people who have survived a near-death experience consider it a spiritual awakening. They may change their lives from there on. Near Death in a Healthcare Setting Not everyone who undergoes a near-death experience is in a healthcare setting where heart rate (or lack of heart beat), brain activity, respiration and so forth can be observed and recorded. In one instance, a woman named Pamela Reynolds required surgery on a brain aneurysm. It was a very delicate operation, and to conduct it properly, the surgical team chilled her body and drained the blood from her brain. She told us about leaving her body and observing the operation from above. The descriptions she gave of the surgical drill and the music the team was playing have been corroborated by the people involved, although Ms. Reynolds had no visual or auditory input and should have had absolutely no consciousness whatsoever. Dr. Bettina Peyton Comes Back Dr. Woollacott described another, more recent incident in which a patient who should have had no awareness described watching her own resuscitation. Bettina Peyton, a physician, needed a C-section to deliver her third baby, but the operation went badly and she started to hemorrhage. She described accessing a much broader consciousness and then being commanded to live. When she revived, she was able to relate the events that had occurred in the delivery room although she had not been able to see or hear them. Could we use such case histories to teach us about consciousness? Do Nonverbal Children Participate in Nonlocal Consciousness? Dr. Woollacott has been interacting with parents and family members of certain children with autism who do not speak. They do communicate through other means. Some of these youngsters describe meeting and communing with other autistic kids on The Hill. They describe it in remarkably similar terms, even though they have not met face to face. Dr. Woollacott believes that these young people may have reduced neural filters. Perhaps that explains why they seem to be more skilled at telepathy than the rest of us. Although it is foreign to our materialist world view, we may need to take the idea of nonlocal consciousness seriously. This Week's Guest Marjorie Woollacott, PhD, is an Emeritus Professor of Human Physiology and member of the Institute of Neuroscience at the University of Oregon. She is Research Director for the International Association of Near-Death Studies and President of the Academy for the Advancement of Postmaterialist Sciences. Dr. Woollacott has published more than 200 scientific articles and written or co-edited eight books, including . The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Marjorie Woollacott, PhD, author of Infinite Awareness
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Show 1487: Hair Loss and Nail Problems: A Dermatologist's Guide to What Actually Works
09/19/2026
Show 1487: Hair Loss and Nail Problems: A Dermatologist's Guide to What Actually Works
Do you worry that your hair is thinning? You may wonder what treatments could make a real difference. After all, you wouldn’t want to spend money on something that has no chance of helping. Many people also have concerns about their nails. Perhaps they are ridged, or loose, or too thick. Could that be due to nail fungus, or might it have another cause? Most importantly, what could you do about it? In this episode, you’ll get a dermatologist’s guide to what actually works. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Actually Works for Hair and Nail Problems Dr. Chris Adigun practices both general and cosmetic dermatology. We wanted to ask her about nail problems in particular because they are very common and she maintains a specialty in treating them. We asked her about the most common nail problems she sees, and she named simple onycholysis (pronounced Oh-nick-oh-LYE-sis). In this condition, the nail begins to lift away from the nail bed. You can identify it because the white area at the fingertip becomes much more extensive than usual. Usually, this is due to exposure to acids such as citrus juices or cleaning solutions. Having your hands in and out of irritants or even water (with or without soap) could lead to onycholysis. An overactive thyroid gland could also lead to onycholysis. To prevent it, try to avoid putting your hands into that sort of liquid. If you must do so, use gloves. And of course, a good hand cream to bolster the skin barrier is a very good idea. If these approaches don’t do the trick, especially if there are other symptoms, the doctor may want to test for thyroid function. Another common problem is allergic contact dermatitis. This could be caused by some of the same irritating substances responsible for onycholysis, but cosmetics are common culprits here. Nail polish and remover, especially nail polish remover, can cause nail problems for some people. If you are one of them, what actually works best might mean finding a less irritating product or, even better, leaving the nails unadorned. White Spots on Nails Many people have noticed white spots on their nails. We asked Dr. Adigun what causes these, and she replied that usually they are not worrisome. If you bang your fingertip, as you might if you slammed it in a door or a drawer, the trauma may show up several weeks later as a white spot. (More serious trauma could show up as a dark spot due to blood pooling under the nail; we discussed that with podiatrist Jane Anderson , but not with Dr. Adigun.) What About Ridges on the Nails? Nail ridges are very common, and the ones that run lengthwise along the same axis as the finger are due to aging. Just as our skin develops wrinkles, so do our nails. Consequently, there are no effective treatments. Nail ridges in children are a different story. They might show up as nails having the texture of sandpaper, or they could be horizontal ridges. Such nails should be seen by a physician, as they could signal an inflammatory condition called lichen planus or even an early sign of psoriasis. While we don’t have cures for these conditions, there are effective medications to manage them. Hangnails and Cuticle Problems Are you surprised that dermatologists have a fancy term to describe cuticle problems and other trouble affecting the skin around the nail? They call it paronychia (PEAR-oh-nick-ee-ya). If it is caused by an infection, it might be treated with an antimicrobial compound. The best preventative is not to pull, bite or clip off hangnails or rough spots in the cuticles, the skin near the nails. Instead, moisturize and possibly cover the spot with a bandage to remove the temptation while it softens and heals. Instant glue is another simple remedy that really works for hangnails. Treating Nail Fungus When the nails are thick, ugly and hard to trim, often people blame nail fungus. But surprisingly, it isn’t always the culprit. Mechanical trauma can also create thick nails that are hard to cut. If the nail is thick because it is on a hammer toe so it bumps against the insole of the shoe, antifungal treatment won’t help. If a healthcare professional addresses it when it first appears, it may be treatable, but once the body has grown accustomed to producing that thick nail, there may be no effective treatment. Some nail infections are bacterial as well as fungal. Both may show up together, or the infection may be one or the other. A dermatologist has techniques for diagnosing whether the problem is due to a fungus or to bacteria such as Corynebacterium. Different types of antimicrobial medicines are effective for these infections. Athlete’s foot also needs a real diagnosis, since it too might be bacterial rather than fungal in nature. OTC athlete’s foot medicines target fungal infections. Handling Hair Loss Both men and women experience hair thinning, and no one is pleased about it. The patterns differ, with men noticing a receding hairline and less hair on their temples. Women’s hair loss tends to form a Christmas-tree pattern, with the tip of the tree right behind the hairline and the base spreading out over the crown of the head. Women are also prone to hair loss after giving birth to a baby. However, while that may be alarming in the moment, it often corrects itself without treatment over the following months. Hormonal Treatments for Hair Loss With men, scientists have identified testosterone metabolites as contributing factors. Drugs such as finasteride (Propecia) or dutasteride block those metabolites and help men regrow hair. Dr. Adigun has begun using these compounds in women who are beyond childbearing. (They are off limits for a person who might become pregnant because they could interfere with the normal development of genitals in a fetus.) A different hormonal treatment for hair loss is spironolactone. Dermatologists have long used it to treat female pattern hair loss. A review found that spironolactone is an effective and safe treatment option for hair loss” (). Besides boosting scalp hair growth, however, it can also cause itchy scalp, facial hair growth and menstrual problems. Another approach that actually works for hair loss is minoxidil (Rogaine). Most people are familiar with this as a topical product to be applied twice daily. That might get old after a while. Also, some people react to the product with contact dermatitis, irritation or itching. Low-dose oral minoxidil seems to work as well as topical minoxidil without the irritation. Another possible option which is better than placebo but not as potent as full strength topical minoxidil is rosemary oil. It is less likely to cause itching, however. This Week's Guest Chris G. Adigun, MD, FAAD, is a board-certified dermatologist and the President and Medical Director of the Dermatology & Laser Center of Chapel Hill, which she founded in 2016. Dr. Adigun practices both general and cosmetic dermatology, with a strong emphasis on minimally invasive treatments that deliver natural, impactful results. She has devoted much of her career to increasing public awareness of skin cancer and the harmful effects of UV exposure—both medical and cosmetic—and maintains an academic specialty in nail disorders. Chris G. Adigun, MD, FAAD, Dermatology & Laser Center of Chapel Hill
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Show 1486: Sprains, Strains and Tears: The New Science of Healing Faster
09/12/2026
Show 1486: Sprains, Strains and Tears: The New Science of Healing Faster
For years, anyone who sprained an ankle or twisted a knee got some standard advice: ice it, rest it, wrap it with compression tape and keep it elevated. The acronym for Rest, Ice, Compress and Elevate is RICE. New research shows that following this advice alleviates the pain from the injury in the short term, but it may actually slow healing. What can help you in healing faster from this type of problem? You can hear it directly from a scientist applying cutting-edge research with tendons and rats to getting NBA players back on the court sooner. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Healing Faster from Injuries Sports medicine expert Dr. Gabe Mirkin coined the acronym RICE in the 1970s. At the time, many physicians and physical therapists embraced this approach to treating injuries. It helped reduce the pain in the immediate term, and it doesn’t seem to do any harm over the longer term. It can take quite a while to heal damaged tendons and ligaments, however. Sometimes, that takes even longer than for broken bones to knit. Eventually, Dr. Mirkin reversed his RICE recommendation. But very few professionals took note. Is there a happy medium between applying RICE and toughing it out by trying to walk a sprained ankle off? Our guest on this episode has been studying the topic of healing faster from injuries and has some concrete advice to offer. Trying to Fool Mother Nature Many of the precautions that amateur athletes take are designed to undermine the body’s inflammatory response. Yet acute inflammation is exactly how the body tries to heal itself from injury. Ice and ibuprofen are anti-inflammatory, so taking ibuprofen before exercise or icing a sore knee afterwards might be counterproductive. What Is a Better Approach to Healing Faster? According to Dr. Keith Baar, immobilizing a joint (“rest”) leads quickly to loss of muscle and force. When he put rats on bed rest (listen to learn how), they lost strength rapidly. On the other hand, moving a joint gently helps to reduce swelling by pumping fluid out. This, in turn, is an early step in healing faster. How do you move a joint gently? Dr. Baar has developed his own acronym: 3LD isometrics. How Do You Practice 3LD Isometrics? First of all, what does 3LD even mean? It stands for low-load, long-duration isometrics. During isometric exercise, instead of moving a muscle quickly, you hold it in position until it fatigues. Physical therapists recommend isometrics, such as planks or wall squats, to strengthen the muscles around joints. In low-load long-duration exercises, you provide some support so you are not putting your entire body weight on the joint. In other words, you lessen the load. Rather than moving quickly through the motion, you find the point at which you can feel the tension in the muscle but it doesn’t actually hurt. Dr. Baar describes this as ooh instead of ouch. Then you hold that position (with the support, remember) for 30 seconds or so. This is a relatively long duration. Healing Faster from Sports Injuries Dr. Baar describes how he helped his nephew, a college-team football linebacker, heal an injured shoulder. Sports injuries are not the only joint problems that could benefit from healing faster with 3LD isometrics. Other common complaints are carpal tunnel syndrome in the wrist or plantar fasciitis in the foot. Changing the Culture of Treating Injury Dr. Baar describes his work with a rugby player who injured his hamstring tendon and was able to resume playing much earlier than the surgeon initially anticipated. Baar’s team has also worked with a basketball player who ruptured an Achilles tendon last year. Healing faster with 3LD isometric work got him back on the court last year–the only NBA player with such an injury to manage that. As elite athletes learn the advantages of 3LD isometrics, physical therapists will begin offering it to ordinary people who simply want to resume their usual activities sooner. This Week's Guest Keith Baar, PhD, is a professor of molecular exercise physiology at the University of California, Davis who leads the Functional Molecular Biology Laboratory. Dr. Baar is a leading expert in musculoskeletal health, studying how muscles, tendons, and ligaments respond to mechanical loading and nutrition. His websites are r and
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Show 1421: Is Lp(a) the Heart Risk No One Talks About? (Archive)
09/05/2026
Show 1421: Is Lp(a) the Heart Risk No One Talks About? (Archive)
This week, we get in-depth information on Lp(a), the heart risk no one talks about. You have heard of cholesterol, and you may even know what your cholesterol level is. The compound lipoprotein a may be equally dangerous when it is elevated, but you have probably heard very little about it. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Is Lp(a)? Lipoprotein a, or L-P-little a for short, circulates in the bloodstream, where it picks up and carries cholesterol and oxidized phospholipids. Scientists believe that blood levels are determined mostly by genetics and change very little over the course of our lives. Roughly 20 percent of people have high levels of Lp(a), above 30 ng/dL or 75 nmol/L. The two different figures are because tests use different units to measure the blood concentration, either nanograms per deciliter or nanomols per liter. While we don’t know if Lp(a) has or perhaps once had some important functions, we do know that elevated levels of this chemical is associated with heart disease. People with higher levels are more likely to suffer blood clots and inflammation. That puts them at risk for heart attacks or even strokes. So why hasn’t your doctor ordered a blood test to learn your level? Is Lp(a) the Heart Risk Doctors Can’t Treat? Perhaps doctors have been reluctant to measure or discuss lipoprotein a because they don’t have good interventions. That is beginning to change with the development of antisense oligonucleotides, a new category of prescription drugs that can cut levels sharply. The FDA has not yet approved any of these new medications, though. The first of these, pelacarsen, is still in Phase 3 trials needed before the agency can consider the evidence. However, it can bring down lipoprotein a by an estimated 80 percent. Cardiologists’ favorite drugs, statins, do not help Lp(a) levels. In fact, Lp(a) the heart risk rises when people are taking statins to lower their cholesterol. Other cholesterol-lowering drugs such as evolocumab (Repatha) and alirocumab (Praluent) can bring Lp(a) levels down modestly. One really old cholesterol-lowering drug, high-dose niacin, also helps moderate Lp(a). Some people do not tolerate it, however, as it can cause very uncomfortable flushing. So far as we know, no scientists have run studies to see whether niacin reduces the risk of heart attacks and other complications because of its effects on Lp(a). Other Complications of Lp(a): Our guest, Dr. Sam Tsimikas, is among the country’s leading experts on lipoprotein a. We asked him whether Lp(a) the heart risk factor causes other problems as well. Dr. Tsimikas described heart failure, potentially resulting from a heart attack, as well as peripheral artery disease (PAD), which can make it painful to walk. Lp(a) seems to cause plaque in arteries throughout the body. As a result, it can increase the chance of a stroke. In addition, it contributes to calcification of the heart valves. This condition interferes with their ability to function properly. What Can We Do If Lp(a) Is Too High? Dr. Tsimikas runs a unique clinic for cardiology patients with high levels of Lp(a). We asked him how he helps them. One approach is to collect additional information about their level of risk. A coronary calcium score can be a useful indicator. If it is high, he and his patients work to control all the potential risk factors that they can. He discusses the potential benefit of aspirin with them. Because Lp(a) the heart risk factor increases the chance of dangerous blood clots, the anti-clotting activity of aspirin can sometimes be helpful. Offering dietary advice can be tricky if a patient has high cholesterol as well as elevated Lp(a), since the ideal diets for each are nearly opposite each other. A ketogenic diet tends to raise LDL cholesterol, for example, while it may modestly lower Lp(a). We think by the end of this episode, you’ll join us in hoping that scientists can learn a lot more about Lp(a) in the next few years. This Week's Guest: Sotirios (Sam) Tsimikas, MD, FACC, FAHA, FSCAI, is Professor of Medicine/Cardiology and Director of Vascular Medicine at the Sulpizio Cardiovascular Center. That is part of the Division of Cardiovascular Medicine at the University of California, San Diego. His website is Sotirios (Sam) Tsimikas, MD, FACC, FAHA, FSCAI, UCSD
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Show 1485: What Are We Still Getting Wrong About ADHD?
08/29/2026
Show 1485: What Are We Still Getting Wrong About ADHD?
A new school year is about to start in many parts of the country. Going back to school can be exciting, but some students may dread it. Perhaps they are struggling with attention deficit hyperactivity disorder, abbreviated ADHD. How can you recognize the symptoms of this problem? What are the most common misconceptions? In short, what are we still getting wrong about ADHD? When we talk about distractibility, trouble missing deadlines, forgetting where you left your keys, it is easy to relate. Likewise, when we look at kids with wiggles and short attention spans, do we see a child with ADHD or just a normal youngster? What constitutes ADHD? Does everyone have it, or is it an all-or-nothing condition? Expert John Mitchell explains that many people have some symptoms from time to time, but once a person is suffering from enough that it is affecting their ability to function, that is when a yes-or-no ADHD diagnosis is made. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How You Can Listen You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, August 29, 2026, through your computer or smart phone (). so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on August 31, 2026. What We Get Wrong About ADHD One of the most common misconceptions about ADHD is that it primarily affects little boys who can’t sit still. While hyperactivity can certainly make a parent or a teacher uncomfortable, the inattention aspect of ADHD could be more disabling in many instances. Moreover, girls too may suffer with ADHD. Though they are less likely to be hyperactive, they can often have difficulty focusing. Another popular myth about ADHD is that it is a pediatric condition. People think kids grow out of it. What we are beginning to see with more research into ADHD is that some people learn effective coping skills they can use as adults. Nonetheless, many older people who were not recognized as having ADHD when they were children may discover that their impulsivity and lack of follow-through, accompanied by anxiety, depression or migraines perhaps, could be a manifestation of this disorder. Failing to recognize the suffering of neurodivergent adults is another thing we get wrong about ADHD. How Do You Treat ADHD? A third misunderstanding about ADHD is that prescribing a stimulant medication is the only treatment necessary. While drugs such as methylphenidate (Concerta, Ritalin) or mixed amphetamines (Adderall) can be really helpful, there is a saying in the ADHD community: the pills don’t teach skills. They do allow a person to focus well enough to learn some new skills they will need. Nonpharmacological approaches are important in conjunction with prescription medicine. However, adolescents with ADHD are much less likely to turn to drugs of abuse if they are taking properly prescribed stimulant medicines in the context of a thoughtful treatment plan. What Is the Role of Emotional Regulation in ADHD? Pediatric ADHD expert Paul Rosen describes another assumption that we can get wrong about ADHD. A child may appear to be doing fine, bringing home As, getting along well in school. But he describes “duck syndrome,” in which you see a duck gliding along the surface of the water. The motion looks effortless, but the duck is paddling like crazy. If it gets into an eddy or a current that’s too strong, it can’t keep up. These students are working much harder than is apparent and at some point, they encounter demands they can’t meet. How will they respond to that frustration? Trouble with emotional regulation is not always part of the ADHD picture, but it isn’t unusual, either. Some kids with ADHD respond pretty much as other youngsters do, but some seem like a super bouncy ball. Their emotions go very high and very low quickly, but they bounce back quickly as well. Still other children may be more like volcanoes. When faced with frustration, they explode, and it may take them many hours to return to baseline. Focusing on Warm and Fuzzies Parents sometimes assume that impulsive or explosive behavior is willful, but that is another thing we often get wrong about ADHD. Most of the time, such behavior is emotional. The child wants to be a “good kid” but may not know how to deal with these extreme emotions. Dr. Rosen recommends unconditional positive attention. He suggests that when parents tuck their ADHD children into bed at night, they appreciate one thing the child has done that day and one aspect of the child, separate from the behavior, that is wonderful. This kind of affirmation can help a youngster keep striving for the skills they will need. (In fact, it sounds like a helpful idea for any parent and child, regardless of whether either of them has ADHD.) This Week's Guests [caption id="attachment_141257" align="alignnone" width="768"] John T. Mitchell, PhD Dr. John Mitchell is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University. His research and clinical work are focused on ADHD across the lifespan. He has published peer-reviewed articles and chapters on longitudinal outcomes and the treatment of ADHD, as well as recently co-authoring . The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). [caption id="attachment_141258" align="alignnone" width="500"] Dr. Paul Rosen Dr. Paul Rosen is an Associate Professor of Pediatrics at the University of Louisville School of Medicine, affiliated with Norton Children’s Medical Group. He currently serves as the Director of the ADHD Evaluation Services in the Division of Behavioral and Mental Health with Norton Children’s Medical Group.
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Show 1484: Change Your Diet, Heal Your Mind
08/22/2026
Show 1484: Change Your Diet, Heal Your Mind
Do you suffer with anxiety, depression, or another mental illness? Millions of people do. The usual treatment is a prescription medication. If that doesn’t work, the healthcare provider may offer a different one. Diet is certainly not the first topic on the provider’s mind. But what if, in addition to appropriate pharmacological treatment, you were able to nourish, protect and energize your brain with your diet? Our guest offers evidence that you can heal your mind with a ketogenic approach to eating. We need to acknowledge that this approach is quite different from the plant-rich eating pattern advocated by last week’s guest, Dr. Will Bulsiewicz. Humans around the world have adopted a wide range of dietary regimens that support health. Listen to Dr. Georgia Ede explain why she thinks a paleo or ketogenic diet is helpful for bolstering brain health. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Can You Heal Your Brain with Food? We live in stressful times. More than 50 million Americans take prescription antidepressants, and millions more are on anti-anxiety medication. Unfortunately, while these drugs can be life savers, they don’t always work as well as we would like. In some cases, antidepressants are only about 10 percent more effective than a placebo. Dr. Georgia Ede is a psychiatrist who began her investigation into how food affects mental health serendipitously. She was experimenting with her own diet to address some physical health issues. She used a food and symptom journal to discover the best dietary choices for her own health. To her surprise, the “upside-down” diet that helped her feel better physically also improved her sleep and her ability to focus. She started looking into evidence that a paleo or ketogenic diet could benefit people with mental health challenges. What Is Metabolic Psychiatry? There is evidence that people consuming unhealthy diets full of fast food or ultra-processed products are more susceptible to symptoms of anxiety (). On the other hand, people participating in a supervised weight-loss program using either a low-carbohydrate ketogenic diet or a low-fat diet reported improvements in mood (). Those on the ketogenic (Atkins) diet reported less hunger and fewer unpleasant symptoms. Researchers have also tested a ketogenic diet in people with schizophrenia or bipolar disorder (). These volunteers also had metabolic disorders, including obesity, which is often an unwanted effect of the ant-psychotic drugs they take to treat their condition. This four-month pilot study saw participants lose weight, reduce insulin resistance and lower their triglycerides. Even more impressive, they had a 32 percent reduction in the Brief Psychiatric Rating Scale. They also reported better sleep and improved life satisfaction. You may find this recent article from National Geographic of interest: . Unfortunately, it might be behind a paywall. How Does Food Affect Our Brains? Most of our body tissues are accustomed to getting energy from glucose, with the help of insulin. However, years of exposure to high levels of these compounds often makes the tissues less sensitive to the effects of insulin. The consequence is that the body–and therefore also the brain–is flooded with high levels of glucose. This exposure can result in the formation of advanced glycation end products in the brain, which can be harmful. The brain evolved to use either glucose or a flexible mix of glucose and ketones. These are the result of burning fat rather than sugar. A paleo diet will naturally provide more ketones and less glucose. Dr. Ede and colleagues have found that a ketogenic diet can be very helpful even for people with relatively serious mental problems. In one study (which was not placebo-controlled), patients hospitalized with severe persistent mental illness were given a ketogenic diet. Most did well and had significant improvements in their depression and psychosis symptoms (). Is Ketosis Dangerous? Ketosis itself simply means that you are burning fat as fuel rather than sugar. This can be achieved by following a diet that is high in animal fat, with moderate amounts of animal protein and low amounts of carbohydrate derived from plant foods. Ketosis is not inherently dangerous. However, Dr. Ede urges anyone who wants to heal their brain with diet to ask a healthcare provider to monitor and supervise the process. Prescription drug doses may require adjustment, and people may need support as they adopt a paleo or ketogenic diet. That is why this is not a do-it-yourself approach. Is Coconut Oil Helpful to Heal Your Brain? Dr. Ede described the benefits of medium-chain fatty acids produced in digesting fat. You may recall a video from a few years back in which a doctor described helping her husband recover from Alzheimer disease, at least partially, by giving him coconut oil. Some researchers consider Alzheimer disease to be a form of diabetes because the AD brain does not metabolize sugar effectively. Dr. Ede suggested that the benefits may be real, but getting medium-chain fatty acids from the diet rather than be taking coconut oil might be preferable. After Dr. Ede told us about Fran, who overcame significant memory problems by changing to a ketogenic diet, we hope there will be trials on this. Future Trials on Diet to Heal Your Brain Dietary trials are notoriously difficult to conduct. People often don’t stick to the prescribed diet, and it can be difficult to find an appropriate placebo for comparison. Nonetheless, Dr. Ede is looking forward to results from a large trial of the keto diet for people with schizophrenia or bipolar disorder. This study is being conducted in Australia. This Week’s Guest Dr. Georgia Ede is a globally recognized expert in nutritional and metabolic psychiatry. Her 25+ years of clinical experience include 7 years at Harvard University, where she was the first psychiatrist to offer nutrition-based approaches to mental health conditions. Dr. Ede co-authored the first inpatient study of the ketogenic diet for serious mental illness, developed the first medically accredited course in ketogenic diets for mental health, and is a recipient of the Baszucki Metabolic Mind Award. Current research collaborations include pilot studies in pediatric bipolar disorder, adult ADHD, and PTSD. Her internationally bestselling book is being translated into 11 languages and is recommended by the New York Times Book Review. The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Dr. Georgia Ede, author of Change Your Diet, Change Your Mind Citations Shafiee A et al, "Association between unhealthy dietary patterns and anxiety symptoms: a systematic review and meta-analysis." Nutrition Neuroscience, May 19, 2026. DOI: 10.1080/1028415X.2026.2667465 McClernon FJ et al, "The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms." Obesity, Jan. 2007. DOI: 10.1038/oby.2007.516 Sethi S et al, "Ketogenic diet intervention on metabolic and psychiatric health in bipolar and schizophrenia: A pilot trial." Psychiatry Research, May 2024. DOI: 10.1016/j.psychres.2024.115866 Danan A et al, "The ketogenic diet for refractory mental illness: A retrospective analysis of 31 inpatients." Frontiers in Psychiatry, July 6, 2022. DOI: 10.3389/fpsyt.2022.951376
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Show 1483: The Gut Immune Solution
08/15/2026
Show 1483: The Gut Immune Solution
When you decide to grab a bite to eat, do you think about how to feed your gut microbes? Most of us don’t. Even if we did, their only means of stating their preferences is somewhat after the fact. Do you end up feeling less than well? Perhaps the denizens of your gut aren’t happy. In this episode, we consider how to support your microbiota and whether that can reduce the inflammation that seems to accompany modern life. At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Feed Your Gut Right to Fight Inflammation Dr. Will Bulsiewicz is a gastroenterologist who urges all of us to focus on a healthful fiber-rich plant-strong diet to maintain our microbiome in good shape. He has described his own evolution from a busy medical student relying heavily on processed food products to a whole-food plant-based enthusiast. Eating a wide variety of plants is one of the easiest ways to make sure we are getting the nutrients our gut microbes need. Why are the trillions of microbes in our large intestine so important? Dr. Bulsiewicz (aka Dr. B.) shares the story of a patient who was overwhelmed by a serious C. diff infection. A course of clindamycin for a skin infection had decimated her normal microbiome and left an open field for C. diff to flourish. Instead of treating her with surgery and even more potent antibiotics, Dr. B. and his colleagues utilized a fecal transplant. She got poop from a healthy person into her colon and left the hospital a few days later in good health herself. What Is the Link Between the Microbiome and the Immune System? Inflammation is one of the primary signs that the immune system has gone into action to fight off a perceived foe. There is a close relationship between the gut microbes, the gut barrier and the cells of the immune system. Between 70 and 80 percent of immune system cells are present in the gut (). There is just one layer of cells in the gut barrier, firmly attached to each other through tight junctions. If those tight junctions break down, pathogens and toxins can get from the gut into the bloodstream and activate the immune system into creating inflammation Medicines That Harm the Intestinal Barrier Diets that are high in salt have a negative impact on the integrity of the intestinal barrier (). In fact, a diet high in salt can reduce the number of Lactobacilli in the gut by 90%. This also affects the permeability of the gut barrier, which can contribute to auto-immune conditions. When we asked about inflammatory bowel disorders such as Crohn disease or ulcerative colitis, Dr. B. told us he thinks it’s a mistake to classify them as auto-immune conditions. Instead, he suggests we should consider these conditions as due to the immune system rejecting the microbiome. Some of them might be initiated and perpetuated by failures in the gut barrier that allow certain organisms or their toxins into systemic circulation. A number of medications can also harm it, most notably the nonsteroidal anti-inflammatory drugs (NSAIDs). Agents like ibuprofen, naproxen, celecoxib and meloxicam may disrupt the tight junctions that keep the intestinal barrier intact (). In some cases, they may also upset the balance of microbes. Four Keys to an Anti-Inflammatory Diet There are several different dietary patterns that allow you to feed your gut and fight inflammation. Good evidence supports a DASH diet, a Mediterranean diet, pescatarian, flexitarian, vegetarian and some vegan diets. We asked Dr. B. to summarize the four features healthful eating patterns share. They include adequate fiber, plenty of polyphenols, healthy fat and fermented foods (think of sauerkraut or kimchi). Fiber and Flatulence One drawback of a high-fiber diet is that when microbes in the colon ferment the fiber we can’t digest, they produce gases. It has to go somewhere, or it will cause sensations of cramping and bloating. Consequently, fiber is often associated with flatulence. Dr. B. suggests that there may be more gas, and it may be loud, but it shouldn’t be stinky. Smelly farts are born of sulfur, which is more common in a diet containing garlic, onions, crucifers like broccoli or cabbage, fish, eggs or meat. Plant-Powered Plus We wondered what might be included in the “plus” category when you feed your gut and fight inflammation. Dr. B. offers a few things that you might not expect in a book about diet, but they are related to reducing inflammation. One is to go outside early in the day, every day, to get your circadian rhythm in sync. Another is to maintain your emotional connections with family and friends. Still another, just as important, is to nurture your spiritual core. This Week’s Guest Dr. Will Bulsiewicz describes how a plant-powered diet can fight inflammation Will Bulsiewicz, MD, is a New York Times bestselling author, award-winning gastroenterologist and internationally recognized health expert. Dr. Bulsiewicz directs the Gut & Microbiome Center for Excellence, a physician-led executive medicine and telemedicine practice based in Mount Pleasant, SC. Dr. Bulsiewicz is the author of several books, including his latest book, . His website is The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). In this week’s podcast, you get to peek into Dr. B’s shopping cart. Are you buying the same vegetables he does? We also get insights on his favorite recipes for grains like farro. And we discuss the effect of coffee on the gut microbes. If you want to feed your gut to encourage certain microbes, remember that consistency is crucial. You can’t eat a specific food once and expect it to make a difference. But consuming it several times a week will ultimately add up. We also discuss antidotes for flatulence, if you are interested in that. Citations Wiertsema SP et al, "The interplay between the gut microbiome and the immune system in the context of infectious diseases throughout life and the role of nutrition in optimizing treatment strategies." Nutrients, March 9, 2021. DOI: 10.3390/nu13030886 Si W et al, "High-salt diets, intestinal barrier, and hypertension: A mechanistic review and the promise of dietary therapy." Nutrients, Nov. 25, 2025. DOI: 10.3390/nu17233688 Bjarnason I et al. "Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs." Gastroenterology, Feb. 2018. DOI: 10.1053/j.gastro.2017.10.049
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Show 1482: Are Your Kidneys in Trouble? Two Tests Could Tell You
08/08/2026
Show 1482: Are Your Kidneys in Trouble? Two Tests Could Tell You
Our kidneys do an incredible job filtering our blood every hour of every day. Most of us have two kidneys, and each one has about a million microscopic filters called glomeruli. Unlike the filters in our HVAC system, though, these filters cannot be replaced. But they do their work so well and unobtrusively that most of us don’t even think about our kidney function. Although 37 million Americans have kidney trouble, the majority are unaware of their situation. Two tests could reveal how well the kidneys are working. What are they, and how often should you ask about them? At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Are the Two Tests That Reveal Kidney Trouble? Chronic conditions like high blood pressure and diabetes put a strain on the kidneys. They are very common problems that signal the need for kidney function monitoring. Our guest expert, Dr. Samir Parikh, suggests that all of us should know our numbers. One is derived from the level of creatinine in the blood. This is normally part of a basic metabolic panel. Usually, the panel results will include a number for the estimated glomerular filtration rate (EGFR) calculated from the value for blood creatinine. The other crucial test is a urine test for protein. Keeping Kidneys Healthy by Staying Properly Hydrated One of the simplest tactics to keep kidneys healthy is to provide them with enough liquid. We get some fluid from the food we eat, which may be one reason eating fruits and vegetables seems to be good for us. They are full of water! We also need to drink fluid, and plain water is probably the best choice. It would be smart to use thirst as a guideline and make sure to drink when thirsty. We do avoid overdoing water consumption, though, as overloading the kidneys with more fluid than they can handle is dangerous as well. Medicines That Are Hard on the Kidneys We mentioned to Dr. Parikh the experience of an older friend, a devoted runner, who discovered that taking ibuprofen after a run reduced the likelihood of having to get up overnight to urinate. He reminded us and our listeners that nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, celecoxib or meloxicam can be hard on the kidneys. That doesn’t mean we shouldn’t ever take such pain relievers, but perhaps we should try not to make it a habit. When we asked about other medicines that might be tough on the kidneys, he mentioned PPIs. Proton pump inhibitors such as omeprazole (Prilosec) or esomeprazole (Nexium) are often used to treat heartburn or other digestive symptoms. Regular use can put a strain on the kidneys, although the gastroenterologist recommending the medicine might not warn you of that side effect. We asked about environmental toxins and learned that heavy metals such as lead or arsenic can harm the kidneys along with other organs. We should make sure that the food we eat and the water we drink are not contaminated with such compounds. The Possible Benefits of Vitamin B Dr. Parikh has been studying how the kidneys respond to the B vitamin nicotinamide. The preliminary work he and his colleagues have done so far is promising. However, they have not conducted clinical trials to find out whether the vitamin could help people with early kidney disease. Because kidneys work so hard, they need a lot of energy to be produced by the mitochondria in their cells. Those mitochondria need NAD+ (nicotinamide adenine dinucleotide) to function at their best. Providing additional nicotinamide appears to help (). One to three grams a day appears to be safe and may be beneficial. Medications That Can Promote Kidney Health Some medicines initially developed for other conditions are proving to be helpful in treating kidney disease. In particular, these include diabetes drugs known as SGLT2 inhibitors like dapagliflozin (Farxiga) or empagliflozin (Jardiance). They help slow the decline of kidney function (). GLP-1 agonists may also be familiar because they too are used to treat diabetes. Medications such as semaglutide (Ozempic, Rybelsus, Wegovy) and tirzepatide (Mounjaro, Zepbound) have made headlines as weight loss and diabetes meds, but they also can reduce the risk of kidney failure and other bad outcomes (). The benefits of these types of drugs should give us hope that we can go from slowing the progression of kidney disease to stopping it in its tracks Taking Care of Your Kidneys We asked Dr. Parikh what we should be doing to care for our kidneys and keep them healthy. He urged us once again to know our numbers: most importantly, the numbers from the two tests we discussed, blood creatinine and urine protein. Other numbers that are important for kidney are our blood pressure and, for those with diabetes, HbA1c. In addition to paying attention to all those numbers, we need to embrace a lifestyle that will help keep them where they belong. That means following a heart-healthy diet, staying physically active and getting adequate sleep. This Week’s Guest Samir M. Parikh, M.D., FASN, is Professor of Internal Medicine and Pharmacology and Chair of Internal Medicine at the University of Texas Southwestern. He holds the Donald W. Seldin Distinguished Chair in Internal Medicine and the Ruth W. and Milton P. Levy, Sr., Chair in Molecular Nephrology. Dr. Samir Parikh, University of Texas Southwestern Citations Ralto KM et al, "NAD+ homeostasis in renal health and disease." Nature Reviews. Nephrology, Feb. 2020. DOI: 10.1038/s41581-019-0216-6 EMPA-KIDNEY Collaborative Group, "Empagliflozin in patients with chronic kidney disease." New England Journal of Medicine, Nov. 4, 2022. DOI: 10.1056/NEJMoa2204233 Badve SV et al, "Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: a meta-analysis of randomised controlled trials." Lancet. Diabetes & Endocrinology, Jan. 2025. DOI: 10.1016/S2213-8587(24)00271-7
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Show 1481: Flip-Flops, Fungus and Foot Pain: What Are Your Feet Trying to Tell You?
08/01/2026
Show 1481: Flip-Flops, Fungus and Foot Pain: What Are Your Feet Trying to Tell You?
Millions of people suffer with foot trouble. Some have heel pain when they first get out of bed. Others complain of flat feet or bunions. Athlete’s foot is very common, though it doesn’t always respond as expected to antifungal medications. Speaking of fungus, toenail fungus can be extremely stubborn. What are your feet trying to tell you about what they need? How can you keep them healthy, especially in the summertime? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Are Your Feet Trying to Tell You? Most everyone looks forward to summer vacation, but that special time away from the usual routine may pose challenges for your feet. Whether you are hiking in the mountains or running on the beach, you may need to pay attention to your tootsies. Time at the Beach Beach time can inspire long walks on the sand, but soft sand could really put a strain on foot muscles that aren’t accustomed to it. Our expert guest, podiatrist Jane Andersen DPM, recommends wearing good running shoes for walking long distances on sand. Choosing to walk where the sand is hard-packed when the tide is low can also be helpful. Possibly the most important but easily overlooked step to protect feet at the beach is to apply sunscreen. The tops of the feet are easily overlooked, but they can burn pretty readily. And if you are planning to spend time sunbathing prone, you might even want to apply sunscreen to the bottoms of your feet. They never see the sun, and walking on sunburned soles could be quite painful. Protecting Bare Feet Another consideration at the beach is how you will get from the parking lot or boardwalk to the water. How hot is the sand? If it is hot enough to burn the soles of your feet, you might consider using water sandals. In general, going barefoot can be risky. Whether you’re at the beach, at a campground, in your own backyard or even inside your home, there are potential hazards underfoot. Bits of glass shards, little pieces of wire, tiny pebbles or nails could all cause havoc if they end up embedded in a sole. Protecting your soles by wearing good flip-flops makes a lot of sense. To find a list of flip-flops that provide appropriate arch support as well as sole protection, consult . Treating Black Toenails During this episode, Joe describes a trip to the beach with a long walk. By the time he removed his shoes, his longest toe had a black toenail that was rather painful. Although the pain faded before too long, it took about a year for the dark color to disappear from the nail. Dr. Andersen suggests that it often takes at least nine months to regrow a toenail. She emphasizes that if the nail turns black due to sudden trauma (like dropping something heavy on the toe), a podiatrist should check it out. Sometimes there is a fracture under that discolored nail that requires medical attention for proper healing. What Is the Story on Flat Feet? Joe has always had flat feet. Perhaps your feet are flat, too. The condition is pretty common. If Joe gets out of a bathtub or swimming pool and leaves footprints, they are almost oval. There is very little indentation in the center. Other people with higher arches may leave footprints that are nearly C-shaped. Flat feet can benefit from arch support such as orthotic inserts for shoes. High arches can also cause trouble, especially if they are linked to a genetic condition called Charcot-Marie-Tooth. It is a nerve disorder that can also lead to muscle weakness. Consequently, people with high arches may also need podiatric care for their feet to stay comfortable and healthy. Plantar Fasciitis Is a Pain The bottoms of your feet have thick connective tissue called fascia that run from the heel to the ball of the foot. Inflammation of this tissue causes pain, typically at the heel but sometimes along the arch. Often, more supportive footgear or special orthotics can help. Getting a shoe with the correct heel drop is important. That is the difference between the height of the shoe at the heel and at the toe. A podiatrist can recommend the most appropriate heel drop for your feet. Stretching is also useful, particularly pulling the toes toward the knee or stretching the calf in a runner’s stretch pose and holding for 30 seconds or so. Rolling the bottom of the foot on a frozen water bottle helps with the stretch at the same time that the cold eases the inflammation. Plantar fasciitis is common and treatable. If left untreated, it may last a long time. What Can You Do About Stinky Feet? A couple of listeners shared their experiences with smelly feet, and we asked Dr. Andersen for her opinion. Jan described using a topical erythromycin antibiotic prescription that came as a roll-on. She also got rid of all her stinky shoes and is careful to wear socks that will wick sweat away. Dr. Andersen noted that erythromycin is very effective against a bacterial infection with Corynebacterium minutissimum. This organism glows coral under ultraviolet light and can definitely raise a stink. Sophia wrote about developing smelly feet after walking around in wet shoes. She finally solved the problem by treating her feet with rubbing alcohol. Dr. Andersen agreed that rubbing alcohol could be helpful. So can soaking the feet in a strong solution of tea. Other tips include cleaning the floor of the shower stall frequently and always wearing socks that wick–not cotton, which absorbs sweat but traps the moisture. Acrylic or wool work better. Another tactic is to alternate shoes; don’t wear the same shoes day after day but give them at least a day to dry out. How Should You Treat a Sprained Ankle? There has been controversy lately about the standard RICE protocol for a sprain: rest, ice, compression and elevation. Some experts now recommend warmth instead of ice and gentle motion rather than rest immediately after a sprain. Of course, the first step is to ascertain that it is really a sprain and not a fracture. The treatment for those two injuries is completely different and the person suffering the problem may not be able to tell just from the way it feels. An X-ray is prudent. Bunions and Hammer Toes If you don’t suffer from bunions, you might not know what they are. In a bunion, the bone that supports the big toe (the metatarsal) moves out of alignment and starts to point more towards the midline of the body. To compensate, the rest of the big toe ends up pointing back toward the rest of the foot. This creates a bump on the edge of the foot that might be painful. There doesn’t seem to be any clear correlation between the size of the bump and the amount of pain it causes. Bunions seem to be hereditary, at least to some extent. Conservative management entails choosing footwear with a roomy toe box, not pointy-toed shoes. Podiatrists also correct bunions surgically. They can choose from a wide range of surgical approaches. In hammer toes, one of the toes (typically the second toe) curls over so that the end that would normally face forward points downward. This too can be corrected surgically, but the recovery can be pretty lengthy. A roomy toe box is also a good bet for living with hammer toe. Taking Care of Your Feet We asked Dr. Andersen for general advice, and she suggested that one very important consideration is to buy your athletic shoes in person, preferably at a store that caters to athletes. Buy the proper shoes for your activity; in other words, don’t try to play pickleball in running shoes. One nationwide chain that does a good job fitting the shoe to the athlete is Fleet Feet. Locally, she recommends Bull City Running. This Week’s Guest Dr. Jane Andersen, Board Certified, American Board of Foot and Ankle Surgery, is in practice at Chapel Hill Foot and Ankle, part of FASMA, Foot and Ankle specialists of the Mid Atlantic, in Chapel Hill, North Carolina. Dr. Andersen specializes in Foot and ankle care for Children, Adults, Athletes and Geriatric Patients including surgery and conservative care. She is a Trustee of the American Podiatric Medical Association. January 18, 2025, Jane Andersen, DPM, was awarded the Edwin B. Martin, Jr., Award for Podiatrist of the Year. Jane Andersen, DPM, Chapel HIll Foot and Ankle
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Show 1446: The Science of Strong Bones: Lifestyle, Medication and Movement (Archive)
07/24/2026
Show 1446: The Science of Strong Bones: Lifestyle, Medication and Movement (Archive)
Are you concerned about your bone health? Do you worry about osteoporosis? According to the CDC, more than 10 million Americans have low bone density that makes them more vulnerable to fractures. For many older people, a fracture can be devastating, reducing mobility and possibly even leading to death. What does the latest medical science tell us about how you can maintain strong bones? At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Strong Bones You may have seen Halloween skeletons or even chewed the meat off a bone that you then dropped on a plate with a clatter. No wonder we usually think of bones as hard, unchanging objects. Dead bones are. But living bones are quite different. Strong bones are constantly undergoing change. Scientists call it remodeling. One set of specialized cells, osteoclasts, breaks bone tissue down and recycles it. Another set, the osteoblasts, builds bone back. Ideally, their activities are in balance. But if the osteoclasts start to get ahead, as they tend to do while we age, that can weaken bone. The result is low bone mass, known as osteopenia, or even serious bone loss called osteoporosis. This puts a person at risk for fractures. Who Gets Osteoporosis? Osteoporosis may have been less common a hundred years ago or more, when many people had to do manual labor that put stress on their bones. That helps for strong bones, so today’s sedentary lifestyles can undermine bone health. Although we think of osteoporosis as typically affecting postmenopausal women, men can lose bone mass too. Medications may contribute to the risk for bone loss. Steroids such as prednisone or methylprednisolone are especially risky if taken for a long period of time. Androgen deprivation therapy for prostate cancer is a risk factor specifically for men. Wait–MEN Can Get Osteoporosis? Q. My husband and I have two friends with significant disability largely due to spinal fractures as a result of osteoporosis. One man was always an avid exerciser, including running marathons. Both men are over six feet tall and have always appeared to be muscular. My husband is shorter and is physically active, playing tennis and going to the gym regularly. Because of our friends’ bone issues, I advised him to request a DXA scan to assess his bone health. The nurse practitioner told him that it was not recommended for men. I am still concerned that he may be at risk for osteoporosis. Are there medical studies that determine the risk factors for men? A. The nurse practitioner was mistaken. Men can develop osteoporosis, as your friends discovered. Many medical guidelines recommend that men over 70 be tested with a DXA scan to assess bone health. If your husband has low testosterone levels or has taken medications such as prednisone, he could be at increased risk for a fracture. He would be prudent to have the assessment. Diagnosing Osteoporosis Doctors assess bone mineral density with imaging called dual-energy X-ray absorptiometry, or DEXA for short. Then they compare the results on the scan to the results they would expect from a 30-year-old person. Results more than 2.5 standard deviations from that could result in a diagnosis of osteoporosis. A person who experiences a fracture without trauma, such as falling from standing height, is also suspected and often diagnosed with osteoporosis. Non-Drug Approaches to Strong Bones: People who want to keep strong bones need to focus on exercise. High intensity exercise can be helpful, but brisk walking may be enough. Tai chi and yoga are also popular. If you have been diagnosed with osteoporosis, be sure to check in with your doctor before you start a new exercise program. Building balance and core strength without increasing your risk of a fall (and thus a fracture) would be ideal. Our guest expert, Dr. Kendall Moseley, says the jury is still out on technology such as vibrating platforms, weighted vests or vibrating belts. More studies should show how valuable these could be. Following a diet that supplies adequate protein, vitamin D and calcium is also crucial. If you must take a calcium supplement, calcium citrate may be well tolerated and absorbed. How Do Doctors Treat Osteoporosis? Physicians prescribe several different types of medications to help curb bone less and perhaps even build it back. Some of the oldest and least expensive are the bisphosphonates such as alendronate (Fosamax). These slow bone break down and give the osteoblasts a chance to catch up. They can be hard on the digestive tract, though, and they have been associated with a few rare but alarming side effects: jawbone deterioration and atypical thigh bone fracture. Most people seem to do well on them. Doctors generally prescribe them for up to five years. Did You Forget Evista? Another type of osteoporosis medicine is called raloxifene (Evista). It is appropriate only for women, because it is an estrogen modulator. It acts like estrogen in the bones and reduces bone loss. In the breast and uterus, it opposes estrogen activity. Raloxifene does double duty in reducing the risk of breast cancer as well as osteoporosis. Like all drugs, though, it has some worrisome side effects. It can increase the risk of blood clots that cause deep vein thromboses and strokes. What About Prolia? Denosumab (Prolia) is a monoclonal antibody that also interferes with osteoclasts. That is how it improves bone density. One thing to keep in mind about Prolia is that stopping it requires careful planning and backup medication. Otherwise, a patient can lose all the bone that was built rather quickly and may suffer debilitating fracture. This Week's Guest Kendall F. Moseley, MD, is Associate Professor of Clinical Medicine in the Division of Diabetes, Endocrinology, and Metabolism at Johns Hopkins University School of Medicine. She is also Clinical Director of the Division of Diabetes, Endocrinology, and Metabolism at Johns Hopkins University School of Medicine. In addition, Dr. Moseley is Medical Director of the Johns Hopkins Metabolic Bone & Osteoporosis Center. Kendall F. Moseley, MD, Johns Hopkins University School of Medicine , or listen to the podcast on or .
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Show 1480: The Sleep Reset: How to Fall Asleep and Stay Asleep
07/18/2026
Show 1480: The Sleep Reset: How to Fall Asleep and Stay Asleep
Do you have trouble sleeping? An occasional late night or early morning is probably not dangerous, but too many people get too little sleep on a regular basis. How does that affect their health? Even more importantly, what can they do to change the situation? You’ll want to listen to find out if you need a sleep reset. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. The podcast will be available on Monday (July 20, 2026) Do You Need a Sleep Reset? Why is sleep so important for good health? Our guest is a sleep medicine specialist who uses a metaphor of Disneyland. Crucial maintenance on the theme park happens at night, when there are no visitors. Streets are cleaned, flower beds are weeded, and rides are inspected and, if needed, repaired. None of that can happen while the park is open for business. Our bodies and brains also need time for maintenance and repair, and some of that happens while we are sleeping. When we don’t get the rest we need, we may find ourselves at increased risk for diabetes, cardiovascular problems, cancer, cognitive challenges and even premature death. Unfortunately, anxiety about not sleeping can keep people awake all on its own. How can people break that cycle? We’ll also discuss ways that people can get help avoiding screens at night. That is an important part of a sleep reset. Blue light from the screen signals the brain to be alert instead of relax. Scrolling social media can often be emotionally upsetting, which also makes it more difficult to fall asleep. Is Your Diet Keeping You Awake? Most of us recognize that a big midnight snack, á la Dagwood Bumstead of the Blondie comic, is probably not conducive to sleeping well. How does nighttime eating affect our circadian rhythm? Are there diets that we should avoid because of their impact on sleep? Dr. Seheult describes a study in which volunteers had their sleep stages monitored closely during the time they were consuming different diets (). When they followed a high-fat, high-sugar diet, it disturbed the pattern of their brain waves during what should have been restorative sleep. How Do Sleep Problems Affect Eating Habits? A lot of us are aware that when we are sleep deprived, we are more inclined to become hangry and we may be less discerning about what we eat. A recent study shows that the sleep deprivation can have an effect even if it is fairly mild and short-term. Scientists recruited people who normally sleep seven to eight hours a night and asked them to stay up an extra hour and a half (). During the six weeks of that part of the experiment, people were less active during the day. They also ate more, so they gained about a pound, on average, during those six weeks. Presumably, disrupting sleep for a longer period of time would result in greater weight gain and metabolic disruption. Would a Ketogenic Diet Help with a Sleep Reset? A ketogenic diet, in which the body relies on ketones rather than glucose for energy production, may be helpful. In particular, fasting overnight for at least 14 hours helps the body do what it must during sleep time. To figure out when you should stop eating, identify when you usually start to feel sleepy. That should be your bedtime. Having your last meal of the day about three hours before that will generally offer enough time for digestion so that you don’t experience reflux in the middle of the night. Morning Light and Afternoon Naps Your sleep reset may depend on getting your own circadian rhythm to synchronize with the rest of the world. That is where early exposure to morning light comes in. It’s beginning to feel a bit like The People’s Pharmacy is on repeat: get morning light exposure! It sets your system up for feeling awake and alert during the day and starting to feel sleepy as the light fades in the evening. Obviously, this is most helpful for people who work during daylight hours. Those working overnight shifts would have to organize their days differently. People who have trouble falling asleep may be tempted to take a nap in the afternoon to make up for the lost sleep. That could be a mistake, as it relieves the sleep pressure that helps people fall asleep without trying. Learning to Fall Asleep If you interact with parents of very young children, you may have heard of sleep training. People have strong feelings about this, both pro and con. Adults rarely need sleep training, though. What we are more likely to need is “not-sleeping un-training.” Too many people approach the bedroom as though it were a stage, and sleep is the performance. No wonder they may develop some performance anxiety about sleeping! Other individuals have learned to associate the bedroom with tossing, turning and watching the clock. Consequently, their bodies tense up instead of relaxing when they get between the sheets. There is no easy quick fix for this problem, but cognitive behavior therapy for insomnia has been proven effective for most people. How About PM Pain Relievers? Even though there isn’t an easy fix for sleep troubles, many people want one. They reach for the PM pain reliever and hope it will offer them a good night’s sleep without a prescription. The “PM” part of that pain reliever is an old-fashioned antihistamine called diphenhydramine. You might be more familiar with its brand name: Benadryl. You’ll also find it in Tylenol PM, Advil PM and all the other PM meds because it tends to make people feel drowsy. What’s wrong with that? To start with, it isn’t clear that it remains effective after a week or two. In addition, people with restless leg syndrome often find that it makes their condition worse. Other folks report that diphenhydramine can result in an unpleasant “hangover” the next day, in which they feel drowsy though not asleep for a good part of their waking hours. What Wakes You Up at Night? If your sleep problem is waking in the wee hours and having trouble getting back to sleep, you should consider the possibility that you have sleep apnea. The REM sleep of those early morning hours is not as deep as some other sleep stages. Consequently, an alarm signal from your brain saying you haven’t taken a breath for 20 or 30 seconds may be more likely to wake you. Sleep apnea may be treated by providing air so that the pressure props the collapsing airway open. We discuss this in greater detail along with a new alternative to a CPAP machine in the podcast for this week. This Week’s Guest Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine. He is also an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. His current practice is in Beaumont, California. He is a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult lectures routinely across the country at conferences and for medical, PA, and RT societies. He is the director of a sleep lab and the Medical Director for the Crafton Hills College Respiratory Care Program. He is co-founder and presenter for , a site that offers concise and easy-to-follow medical videos on a range of topics. Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside Citations Brandão LEM et al, "Exposure to a more unhealthy diet impacts sleep microstructure during normal sleep and recovery sleep: A randomized trial." Obesity, July 2023. DOI: 10.1002/oby.23787 Zuraikat FM et al, "Prolonged Short Sleep and Its Effect on Body Weight and Composition : A Pooled Analysis of Randomized Trials." Annals of Internal Medicine, July 7, 2026. DOI: 10.7326/ANNALS-25-01660
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Show 1479: Must You Shun the Sun to Save Your Skin?
07/11/2026
Show 1479: Must You Shun the Sun to Save Your Skin?
When sunny summer days come around, it makes some dermatologists shudder. They would prefer we behave like bats and hide in caves until nightfall. Failing that, they stress the importance of always applying (and re-applying) high SPF sunscreen, wearing sun-blocking clothing with long sleeves and keeping a big-brimmed hat firmly on the head. A beekeeper’s outfit might be perfect. But must you really shun the sun completely to save your skin? Our guest describes how to practice moderation safely. He also explains why some people are addicted to sunshine, while others are allergic to it. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Can You Really Be Addicted to Sunlight? Dermatologists do their best to discourage people from using tanning beds. They describe the damage that ultraviolet light can cause, ranging from wrinkles to skin cancer. For some people, though, those arguments just don’t make a difference. Our guest, Dr. Steve Feldman, conducted a study several years ago. The volunteers were accustomed to using tanning beds. In the study, there were two beds, one with the usual ultraviolet light and the other, identical in appearance and temperature, had its UV blocked. After a session in each bed, volunteers were allowed to choose their bed for the last session. They almost invariably chose the bed with the active UV. To follow up, the researchers administered naltrexone, the opioid-blocking medication. When volunteers had taken it, they were no longer able to distinguish which bed was active. It seems that, for these people, ultraviolet light activates pro-opiomelanocortin, which in turn triggers the production of natural opioids called endorphins. Further research imaging the brain during tanning sessions confirmed that the UV exposure was activating areas of the brain associated with pleasure (). Dr. Feldman and a colleague found that excessive indoor tanning is similar in pattern to substance use disorders (). Can You Save Your Skin and Still Enjoy the Outdoors? Dr. Feldman offers advice on avoiding sunburn that is tempered with this fact from epidemiology: people who go out in the sun live longer (). The goal here is not to shun the sun completely, but rather to exercise enough caution and good judgment to avoid burning your skin. (Who wants to burn, anyway? It hurts, and it looks bad.) Timing your sun exposure carefully is crucial to save your skin from sunburn. You may also be interested in the new sunscreen ingredient the FDA just approved, bemotrizinol. What Can You Do About Heat Rash? When the weather gets hot and bodies get sweaty, heat rash becomes a common complaint. Sweaty skin may develop bumps that can sometimes be very itchy. What do you do to ease the discomfort? If you can cool the skin off, it might help a lot. Of course, people may also suffer from other types of rash. Babies get diaper rash. Women sometimes experience under-breast rash, just as men may develop jock itch. Zinc oxide ointment can often be helpful for these types of rash. Managing Psoriasis Psoriasis is one of Dr. Feldman’s special research interests. The red scaly plaques of this skin condition have raised borders. They look a lot like a fungal infection, but there is no fungus present on the skin to cause them. Something else seems to trigger the skin’s immune system to react along the same pathways as if there were a fungus. Most of the time, psoriasis is mild enough to manage without costly medications. It actually responds very well to ultraviolet light exposure. UV downregulates the immune system’s over-response. While many dermatologists offer UV exposure within their office walls, in the summertime patients could get exposure to sunlight outdoors. This is practical if they avoid the middle of the day, when they might get burned. Another option? Tanning beds also offer an easy way to calibrate the appropriate amount of UV exposure to save your skin from psoriasis. (Most dermatologists don’t approve of this one, so don’t tell.) One other practical but unorthodox tip for dealing with mild psoriasis. OTC cortisone may not be strong enough to help heal up a red spot. But you could buy Flonase nasal spray or a generic version, fluticasone, over the counter. Spray it on your skin and appreciate the relief. In fact, this could work for a mild case of poison ivy or other skin irritation as well. Severe cases still need a dermatologist’s care. What to Do About Atopic Dermatitis Atopic dermatitis is the medical term for eczema. People with allergies or asthma also appear to be more vulnerable to eczema. Dysregulation of the immune mediators interleukin 4 (IL4) or IL13 may be responsible. This condition may appear in a mild form, which can be readily managed, or a more severe form that might require prescription medication. A topical corticosteroid such as triamcinolone will often clear it up. Or you could try spraying on some Flonase nasal spray for a cost-effective low-key approach. Those will actually help the majority of people with mild eczema. Using mild soap rather than detergent-based body wash, moisturizing well and following an anti-inflammatory diet are the pillars of home management. People with more severe atopic dermatitis covering a large portion of the body may need powerful prescription medication rather than topical steroids. Trying to cover so much skin with steroid would probably result in side effects from the cream. Dupixent (dupilumab) is a relatively new self-injectable medication that blocks IL4 and IL13. It works well for most people with atopic dermatitis and has a good safety profile. Certain other drugs in this category, such as Skyrizi (risankizumab), are also pretty safe but very pricey. Stelara (ustekinumab), has been around longer. Biosimilars for Stelara have been approved and are more affordable. Ustekinumab blocks IL12 and IL23. TV ads tout other medicines for this condition as well. Rinvoq (upadacitinib) is three or four times more effective than Dupixent, but it is also super expensive. It is a Janus-kinase (JAK) inhibitor. Xeljanz (tofacitinib) is another potent prescription JAK inhibitor, but it carries an elevated risk of heart attack. Beware of Bug Bites Another summer skin hazard is bug bites. Here unquestionably the best approach to save your skin is avoidance. Appropriate clothing is key. (That beekeeper’s suit will come in handy here again.) Dr. Feldman recommends spraying DEET on your pants legs, socks and sleeves rather than directly on your skin. If there are grasses or brush where you have walked, run or played, a tick check immediately upon coming inside is critical. Can AI Help Patients with Skin Problems? It doesn’t make sense to tell people to stay off the internet. Some searches can be quite helpful and guide patients in asking their dermatologist the right questions. Dr. Feldman is enthusiastic about a New Zealand dermatology website. https://dermnetnz.org Joe and Terry recommend . This Week’s Guest Steven R. Feldman, MD, PhD, is Professor of Dermatology, Pathology, and Social Sciences & Health Policy, at the Wake Forest University School of Medicine. His research has been published in over 1,000 peer reviewed, Medline-referenced articles. ranks Feldman among the top experts in the world on psoriasis, acne, dermatology, and treatment adherence. Steve Feldman, MD, in Dermatology clinic, Country Club Commons Citations Aubert PM et al, "Dopamine efflux in response to ultraviolet radiation in addicted sunbed users." Psychiatry Research. Neuroimaging, May 30, 2016. DOI: 10.1016/j.pscychresns.2016.04.001 LaMonte OC & Feldman SR, "Indoor tanning addiction: Biological mechanisms and association with other disorders." Journal of Cutaneous Medicine and Surgery, May-June 2025. DOI: 10.1177/12034754241303135 Alfredsson L et al, "Insufficient sun exposure has become a real public health problem." International Journal of Environmental Research and Public Health, July 13, 2020. DOI: 10.3390/ijerph17145014
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Show 1412: Beyond Amyloid: The Science That Could Change the Course of Alzheimer Disease (Archive)
07/04/2026
Show 1412: Beyond Amyloid: The Science That Could Change the Course of Alzheimer Disease (Archive)
This week, we look at the new pharmaceuticals that the FDA has approved for treating Alzheimer disease. Although they are effective at removing amyloid plaques from the brain, they don’t seem to help patients function better. Is it time to turn away from an exclusive focus on amyloid to consider other factors that might affect cognitive decline and change the course of Alzheimer disease? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Changing the Course of Alzheimer Disease Even though pharmaceutical firms have spent billions of dollars developing drugs to reduce amyloid in the brain, they haven’t changed the course of Alzheimer disease. Perhaps we need to be looking beyond amyloid at other risk factors. Dr. Dale Bredesen says he and his colleagues have identified more than 36 risk factors. He asserts that when these these are addressed, people can slow or sometimes even reverse their cognitive decline. According to Dr. Bredesen, Alzheimer disease is multi-factorial and it needs a multi-pronged approach. Considering Physiology Instead of Pathology The plaques and tangles that are characteristic of the brain disease first identified by Alois Alzheimer more than 100 years ago only show up in pathology slides. Past studies have hinted that some individuals who have plaques or tangles in their brains don’t have serious cognitive difficulties. Dr. Bredesen urges us to look beyond amyloid pathology and use a physiology lens. What are the main drivers of problems? Energetics Our bodies need to make, use and transfer energy efficiently. That involves the mitochondria, the energy factories within the cells. Nutrition is also critical here, as missing vitamins can block appropriate metabolism. The cardiovascular system is also crucial for the transfer of energy within the body and to the brain. Sleep apnea, which interferes with oxygen uptake overnight, is another big culprit. Inflammation Inflammation in the brain or even elsewhere in the body puts a huge strain on the neurons. Identifying and removing the sources of inflammation is important in treating someone struggling with cognitive problems. Where is the inflammation coming from? It might be an infection. Treatment can make a difference there. It might be dietary, in part. Changing the diet could change the course of Alzheimer disease. Wouldn’t that be worth the effort? Toxicity Heavy metals such as lead or mercury are definitely neurotoxic. However, other substances can also put neurons at risk. Toxins produced by mold are common and very difficult to treat. Additional Factors to Consider There are at least three additional categories that should be considered. Do we have the essential ingredients to create the neurotransmitters we need? One example would be choline for acetylcholine, an essential neurotransmitter that may be in short supply in Alzheimer disease. Most American diets are not rich in choline. Second, how are the neurotrophins doing? These are substances such as BDNF, brain-derived neurotrophic factor. It supports the growth and differentiation of neurons. Third, and possibly most common, is chronic stress. Occasional acute stress is expected and shouldn’t be considered harmful. But chronic stress can damage neurons and make it harder to think even if your neurons are not damaged. High cortisol levels are associated with brain atrophy, which is a clear indication of damage. Fixing the Leaks Dr. Bredesen uses a metaphor of the brain as a house with a leaky roof. If you have a lot of places where the roof leaks, you need to fix all of them to stay dry. But your roof may leak in different places from your neighbor’s roof. Finding the weaknesses and addressing them with personalized medicine is key to changing the course of Alzheimer disease, in Dr. Bredesen’s opinion. It may require attention to diet, exercise, sleep (with adequate oxygen saturation), stress management, brain training, detoxification and possibly supplements such as omega-3 fats or vitamin D. You can learn more from his books and his recent publication in ). This Week’s Guest Dale Bredesen, MD, is an internationally recognized expert in aging and neurodegenerative diseases. He is the Senior Director of Precision Brain Health at Pacific Neuroscience Institute, and former Professor of Molecular and Medical Pharmacology at UCLA. Dr. Bredesen is also the founding President and CEO of the Buck Institute for Research on Aging and the Co-founder of MPI Cognition. Dr. Bredesen is the author of the New York Time’s best seller and . The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Listen to the Podcast The podcast of this program will be available Monday, July 6, 2026, after rebroadcast on July 4. You can stream the show from this site and download the podcast for free.
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Show 1478: The Outdoor Prescription for Fighting Dementia, Depression and Heart Disease
06/27/2026
Show 1478: The Outdoor Prescription for Fighting Dementia, Depression and Heart Disease
Too many of us are spending our days staring at screens. Little screens on our phones, big screens on the television, medium-size screens on our computers at work. Our modern lifestyles mean that we spend the vast majority of our time indoors–93%, on average. What is the time inside doing to our health? Is there an outdoor prescription to reverse dementia and depression? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Is Our Indoor Time Doing to Us? Humans used to spend a lot of time outside and had their circadian rhythms synchronized with sunlight. Living indoors as most of us do can disrupt that natural rhythm. Bright indoor lighting as well as our favorite screens in the evening can make sleep more elusive. Another consequence of focusing on screens rather than on a distant horizon of land, sea or sky is an increased risk of nearsightedness. Beyond that, screen exposure can increase the chance of brain fog, insulin resistance and immune system abnormalities. If you are spending all your time inside, your body may process that as captivity and begin to rebel. The Outdoor Prescription Dr. John La Puma pioneered culinary medicine, making the connection between what we eat and the state of our health. His analysis of the research indicates that spending just 17 mindful minutes outside each day can help reverse the damage we suffer from living indoors. He offers seven types of outdoor prescription, starting with morning light. Greeting the Sun as the Day Begins Dr. La Puma encourages us all to start our day by stepping outside for at least a few minutes under the open sky. Before coffee, before screens, morning light gets us off to the right start and helps us sleep better at the end of the day. That light exposure, even on an overcast day, helps us with deeper sleep at night. Deep sleep is critical for maintaining the brain with the glymphatic system as well as for bolstering the immune response. Before checking your email or your social media, perhaps while the coffee is brewing, make it a point to step outside for a few minutes. If that is too difficult, standing in the doorway or just looking outside through a window screen (not glass) may be enough. Bright morning light exposure is helpful in treating major depressive disorder (). Although the study utilized standardized indoor lights, natural light outside is brighter, even on a cloudy day. New research shows that bright light during the day reduces the risk of dementia among older people (). The benefit was especially clear for those who spent more time in brighter light (at least 5,000 lux) such as one would get on an overcast day. It was even able to mitigate some of the risk associated with APOE4 genes. What Is Forest Bathing? Another practice in Dr. La Puma’s outdoor prescription pad is forest bathing. This idea comes from Japan. Spending time outdoors in a forest environment is extremely healing. It can help modulate the immune system, lower blood pressure and counteract stress. Forest bathing does not require a huge investment of time, either. One Japanese study found that spending just two hours a month in a forested environment can lead to lower blood pressure and reduce techno-stress. A review has found forest bathing beneficial against stress and burnout (International Journal of Environmental Research and Public Health, July 28, 2017). https://pubmed.ncbi.nlm.nih.gov/28788101/ No Forest? No Problem Many people do not have an actual forest handy. Dr. La Puma describes his outdoor prescription for Sarah, who felt stuck inside her city apartment all the time while she cared for her elderly mother. What he prescribed for her was mindful time in the courtyard of her building, starting with very short periods of five to ten minutes. Gradually her heart rate slowed and blood pressure lowered and she began to recover from some of the chronic problems she had been suffering. Forest-bathing doesn’t really require a forest. One tree, or in a pinch, a shrub, can be pressed into service. Meet Your Friends Outdoors There are few things better than spending time outdoors. One outdoor prescription that improves on spending time in nature by yourself is spending some of that outside time with friends. Walking, playing tennis, going for a picnic all help your system recalibrate. Human friends are important, but animals such as dogs or horses can also contribute to our well-being (as we contribute to theirs) when we spend time with them in a natural space. Taking Your Physical Activity Outside We all have heard how important it is for us to stay active if we want to maintain good cardiometabolic health, diminish our risk of depression and enhance our chances of staying cognitively sharp. There are advantages to outdoor activity that include but go beyond the benefits of exercise. You can accomplish the same amount of exercise with less perceived effort. In addition to light, and possibly horizons, you also get beneficial microbial exposure and a lot of joy. Gardening as an Outdoor Prescription A healthful diet begins with healthy organic soil. Gardening is a great way to experience this for yourself. We asked about people who do not have space for a backyard garden and heard about Greg, who learned to garden starting with a single basil plant indoors. Minimum Effective Dose for the Outdoor Prescription Dr. La Puma tells us that the minimum dose to get the benefits of being outdoors is just 17 minutes a day. That’s not very much compared to all the time we spend inside. This Week’s Guest Dr. John La Puma is a board-certified internist, trained chef, and regenerative farmer who pioneered the Culinary Medicine movement. He is now leading the charge behind Outdoor Rx, the evidence-based response to the indoor epidemic. Dr. La Puma’s latest book is The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Get his free 7-Day Outdoor Reset at His book is featured in the from the New York Times. John La Puma, MD, advocates for the Outdoor Rx Citations Lam RW et al, "Efficacy of bright light treatment, Ffuoxetine, and the combination in patients with nonseasonal major depressive disorder: A randomized clinical trial." JAMA Psychiatry, Jan. 2016. DOI: 10.1001/jamapsychiatry.2015.2235 Zheng N et al, "Associations between wearable-device-measured daytime and nighttime light exposures and dementia risk: A prospective cohort study." General Psychiatry, June 24, 2026. https://doi.org/10.1002/gps3.70039
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Show 1477: Answering Your Questions About Vision Problems
06/20/2026
Show 1477: Answering Your Questions About Vision Problems
Humans have five senses, but for most of us, sight dominates. That’s why vision problems are so distressing. Have you been dealing with difficulties with your eyes? During this broadcast episode, our guest expert is ready to answer your questions about vision problems. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Are More People Nearsighted? Myopia, the technical term for nearsightedness, is increasing at a rapid rate. Globally, 23 percent of the world’s population had myopia in 2000. By 2020, that rate had risen to 34 percent. Some experts estimate that it could reach 50 percent by 2050. Rates among children and adolescents are even higher in some places, reaching 70 percent among East Asians and an alarming 86 percent among Singaporean Chinese youth 15 and under (). Why are so many people, including young people, myopic? Are there implications beyond a need for corrective lenses (glasses or contacts)? Can we reverse this trend by limiting screen time or encouraging more time outdoors? Are there treatments that can help children and adolescents improve their vision? Which Vision Specialist Should You See? Eyes are complicated, and caring for vision problems has become increasingly specialized and technically sophisticated. As a result, ophthalmologists (eye doctors) now often treat just one part of the eye, such as the retina or the cornea. Some surgeons specialize in removing cataracts. Others, like Dr. Sharon Fekrat, are expert in retinal surgery. There are also pediatric ophthalmologists who treat children. In addition, some people need to consult a neuro-ophthalmologist or someone who specializes in inherited retinal degenerations, uveitis or ocular oncology. How can you determine which type of eye doctor you should see to address your particular problem most effectively? What Is in a Complete Eye Examination? Dr. Fekrat will describe the elements of a complete eye examination. Why is each one included? What further steps are needed if trouble is detected? This will give you an idea of how vision problems are assessed and where to turn for treatment. Managing Dry Eyes One of the most common complaints is dry eyes. This condition is uncomfortable as well as common, affecting up to half of adults in the US. What are the causes? Are there treatments? People often use eye drops to alleviate the discomfort. Which ones work best? What can a person do if they have severe dry eye problems and are referred to a dry eye specialist with an appointment months in advance? Is it dangerous to postpone dry eye care? What to Do About Blepharitis When the problem is more the eyelid than the eye itself, doctors call it blepharitis. One typical symptom is crust on the lids, which may feel itchy or scratchy. Some people find that applying warm compresses morning and evening is helpful. Others need medication. You may have seen ads for Xdemvy, which is aimed at reducing the population of Demodex mites living in the follicles of the eyelashes. Mites are not the only problem, however. Sometimes bacterial infections are the underlying cause of blepharitis. Rosacea and seborrheic dermatitis that affect skin elsewhere on the face may also show up with the same symptoms. Demodex mites can also be treated effectively with ivermectin cream. How Will the Doctor Diagnose Glaucoma? Glaucoma is generally understood as a condition in which pressure inside the eye rises and damages the optic nerve. This disease can lead to vision loss. That’s why intraocular pressure measurement should always be part of the eye exam. But this simple diagnostic technique alone may be incomplete. We’ll ask Dr. Fekrat about additional approaches that might pick up normal-pressure glaucoma. How is it treated? Age-Related Macular Degeneration Deserves Treatment Another of the vision problems that can cause serious impairment is age-related macular degeneration. In this disorder, the central part of the retina, the macula, loses its ability to focus. Patients may notice that the central part of the vision is blurry, and it may be harder to see under low light conditions. Ophthalmologists now have a range of medications to inject to slow the progression of macular degeneration. Dr. Fekrat can describe the difference between “dry” and “wet” macular degeneration and the drugs used to treat them. What Other Vision Problems Are Troubling You? This is a chance to ask questions and get answers about vision problems from an expert. You can send email to [email protected] or call in your questions to 888-472-3366 between 7 and 8 am EDT on Saturday, June 20, 2026. This Week’s Guest Sharon Fekrat, MD, is a retina surgeon at the Duke Eye Center of the Duke Health Integrated Practice and vice chair of faculty affairs and the Robert Machemer MD Distinguished Professor of Ophthalmology at the Duke University School of Medicine. She is associate chief of staff at the Durham VA Healthcare System and past interim chief of surgery there. She is Director of Duke iMIND Research Group and Chief Editor of the book as well as the . Dr. Fekrat is past President of the NC Society of Eye Physicians and Surgeons. The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Sharon Fekrat, MD, FASRS, Duke Eye Center Listen to the Podcast The podcast of this program will be available Monday, June 22, 2026, after broadcast on June 20. You can stream the show from this site and download the podcast for free. Citations Rudnicka AR et al, "Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention." British Journal of Ophthalmology,, July 2016. DOI: 10.1136/bjophthalmol-2015-307724
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Show 1476: Tell Me Where It Hurts: A Roadmap for Managing Chronic Pain
06/13/2026
Show 1476: Tell Me Where It Hurts: A Roadmap for Managing Chronic Pain
Pain is an important warning signal, helping you protect your body from damage. That’s why we can view acute pain as an asset. Chronic pain, though, can be debilitating. In this episode, a pain psychologist offers a roadmap for managing chronic pain. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Managing Chronic Pain Nobody likes feeling pain. Joe remembers that as a child, he would ask the doctors and nurses if the procedure was going to hurt. They always lied and told him it would not. As a result, he ended up not trusting them. We often think of pain as located in the body part that hurts (hence, tell me where it hurts). In actuality, though, pain is a complex phenomenon the brain and its interpretation of the situation at least as much as the body. That is why Dr. Rachel Zoffness maintains that pain is biopsychosocial–the result of three overlapping circles in a Venn diagram: biological, psychological and sociological. The biological circle includes our genetics, tissue damage, diet, sleep and movement. Psychological factors are never just psychological. The brain uses the same limbic system to process emotions and pain, so our feelings about our situation have a major impact on our pain experience. In the sociological realm, we find access to care, a history of trauma, and factors like racism or poverty. One result is that pain is incredibly subjective, varying from one individual to another and even from day to day. Another example of the power of the brain to generate pain is phantom limb pain. You may have heard of someone whose foot hurts even though the leg was amputated. Dr. Zoffness tells us about a boy with hand pain after a fireworks accident that resulted in his arm being amputated. The hand wasn’t there, but the pain was real. What Is Your Pain Recipe? In managing chronic pain, it helps to know what your pain recipe is. What factors contribute to a bad pain day? A few common ones are poor sleep, too much junk in the diet, lots of stress, too little movement. Once you have the recipe for a bad pain day, you may be able to turn that around to find the recipe for a low pain day. If you get enough sleep, does that turn down the pain dial? How about diet? We also discuss the power of self-hypnosis and biofeedback. If you can practice warming your hands up, as Dr. Zoffness has learned to do, you can also practice making yourself more comfortable. She shares another story of a teenager who suffered from crippling migraines, social anxiety and generalized body pain. He had not been to school in years, but taking very small steps at first–just standing in the sun on his front porch–he was gradually able to build himself a low-pain recipe. Taking the dog to the dog park helped him move his body and his brain started producing chemicals like dopamine and serotonin. Eventually Sam was able to return to high school, even graduating. Using Pain Medicines in Managing Chronic Pain Physicians have often learned that managing chronic pain is something of a prescription puzzle. Which drug will work best for this patient? A decade or more ago, the answer was frequently opioids. That’s no longer the case. As a result of the overdose epidemic, doctors usually try to prescribe some other type of medication. Two of the most popular are gabapentin and tramadol. When our listeners tell us about their experience with gabapentin, the results range widely. For some people, it seems to be a life-changing medication. For many others, it is lackluster at best, and for some, the side effects of brain fog, dizziness, breathing problems, edema and an increased risk of dementia are too much. Dr. Zoffness has heard similar reports about gabapentin. Her guideline for pain medicine is to try it for three months and see if it makes a (positive) difference. If not, ask the prescriber to help you taper off. Stopping any pain medicine suddenly could be a mistake. For managing chronic pain, people need a healthcare professional who can help them create a personalized pain management plan. For improving sleep, which is often a key ingredient in the pain recipe, she recommends cognitive behavioral therapy for insomnia (CBTI). The sleep hygiene protocol she suggests can also be helpful, dimming lights and gearing down as the day comes to a close. The Roadmap for Managing Chronic Pain The last section of Dr. Zoffness’s book is a detailed pain protocol. She reminds us that there is no quick hack for pain. If trauma is part of the pain recipe, addressing the trauma will be useful. Medications are important tools, but they are not a permanent fix for chronic pain. She wants us all to remember that if the brain can change, pain can change. It is in our power. This Week’s Guest Dr. Rachel Zoffness is a leading global pain expert, pain psychologist, speaker, author, and thought leader in pain medicine. She is faculty at the UCSF School of Medicine, teaches pain science at Stanford, and is a winner of the prestigious Mayday Fellowship. Dr. Zoffness is the author of . Her website is Dr. Rachel Zoffness, pain expert at UCSF The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).
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Show 1475: Your Allergy Survival Guide: What Works, What Doesn’t, What’s Risky
06/06/2026
Show 1475: Your Allergy Survival Guide: What Works, What Doesn’t, What’s Risky
You may think of allergies as causing sniffly noses and congestion in the spring or fall. But allergies can go far beyond that. As Dr. Kari Nadeau points out in this episode, allergies can affect us from head to toe, including eyes, nose, throat, lungs, sinuses, skin and gut. In the most dangerous instances, the whole body is threatened with an anaphylactic reaction. That’s a medical emergency! One in three Americans will develop allergies at some point in our lives, so it’s important to know what works to control them. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Are Allergies? We begin our discussion of your allergy survival guide with an explanation of what is happening during an allergic reaction. The immune system perceives some foreign compound, usually a protein, as dangerous even though normally it would not be. So it reacts by trying to flush the invader out by producing extra mucus. The turbinate sinuses can make one to two gallons of mucus a day, and naturally, it has to go somewhere. That’s why you might be congested. Having all that mucus in the sinuses can also encourage bacterial growth, so if the allergic reaction persists, some people have to deal with sinus infections. Emergency Treatment In determining what works, you need to know the nature of the reaction. If you have two or more organs involved, if you are having trouble breathing or if you feel dizzy, you may be in the midst of an anaphylactic reaction. What works for that is an epinephrine injection and immediate medical attention. This is potentially life-threatening, so you will want to figure out what triggered the reaction so you can avoid it in the future. Once someone has suffered one anaphylactic reaction, they should keep epinephrine with them at all times in case of another episode. Epinephrine comes as a self-injector pen or a nasal spray (). Can You Spot Drug Allergies? In the warnings that are rattled off as part of a TV ad for a pricey new drug, we often hear viewers cautioned not to take the medicine if they are allergic to it. That sounds like simple common sense, but it also has a Catch 22 quality. How do you know you are allergic to a medication unless you take it–and experience an allergic reaction for which you might need treatment. Most of these presumably are immune system-mediated reactions, in which the body produces IgE. That is how allergies to penicillin or sulfa drugs work. Some drugs cause a different type of reaction, not IgE-mediated but dangerous nonetheless. Lisinopril is the most commonly prescribed blood pressure medicine in this country. Like other ACE (ACE is short for angiotensin-converting enzyme) inhibitor medications, lisinopril can trigger . This swelling can affect the face, lips, tongue and throat, where it can compromise breathing. The most insidious aspect of this reaction is that it can occur after the person has been taking the drug without problems for weeks, months or even years. “Red man syndrome” or infusion reactions in people taking vancomycin can likewise occur without warning. The last type of drug reaction is not actually an allergy at all, although people occasionally use that terminology. It is better described as sensitivity. For example, a stomachache is a common reaction to the antibiotic erythromycin. Some people are disabled by this abdominal pain and try to limit their exposure to erythromycin thereafter. What Works and What Doesn’t? Since the immune system is acting inappropriately to cause allergic reactions, treatment should involve immunotherapy. Eye drops can help eyes feel less itchy and irritated. Likewise, OTC nose drops or nasal sprays can often help the nose. The corticosteroid Flonase (fluticasone) and the antihistamine Astepro (azelastine) are good examples. During allergy season, some people find that a daily nasal wash (with a neti pot or NeilMed device) can help reduce the mucus and remove the allergens such as pollen causing the reaction. There are also oral antihistamines and inhalers for asthma. For decades now, allergists have offered their patients shots to help desensitize them to the allergen causing their trouble. Joe had these as a child and teenager and has been largely free of allergies since. Not everyone gets such lasting relief. Complications from Current Therapies Medications have side effects, and that is true of allergy medicines as with other drugs. Antihistamines, especially the older ones like Benadryl (diphenhydramine), are notorious for causing drowsiness. That’s one reason it is often included in nighttime pain relievers as the “PM” in drugs like Advil PM. We worry about regular use of such antihistamines because it has been linked to a greater risk for dementia. A second-generation antihistamine such as Allegra (fexofenadine) is much less likely to make someone feel sleepy. However, Dr. Nadeau has seen patients on antihistamines suffer worse allergies if they stop suddenly. The People’s Pharmacy has received hundreds of reports from people who experienced unbearable itching upon discontinuing Zyrtec (cetirizine) or Xyzal (levocetirizine). This can last for weeks. Doctors don’t usually worry much about steroid nasal sprays like Flonase because they are topical. Presumably, nasal tissues pick up most of the dose. Just the same, using such a nose spray day after day for a long time could result in systemic steroid exposure that is not trivial. Stronger Medicine Dr. Nadeau is enthusiastic about the benefits of two potent prescription medicines. One is Xolair (omalizumab). It was originally developed to prevent asthma, but is now approved for chronic sinusitis, food allergies and chronic hives. Paradoxically, Xolair is one of those medicines that could cause a severe allergic reaction even on the first dose, so the FDA warns that the initial injection should be given in a healthcare setting prepared to treat anaphylaxis. This is uncommon, though, occurring in 0.1 to 0.2% of patients. The other medication Dr. Nadeau is prescribing for allergy patients who don’t respond well to other treatments is Dupixent (dupilumab). The FDA has approved this medicine to treat a wide range of conditions, including eczema, asthma, chronic sinusitis, allergic reactions affecting the esophagus and chronic hives, among other things. Most insurance companies will not cover this pricey injection unless the patient has failed all other therapies. Fighting Air Pollution: What Works Air pollution makes allergy symptoms worse, so using an effective air filter inside the home is a good step. A HEPA (high-efficiency particulate-arresting) filter is ideal, especially as part of the air-handling system. If that’s not possible, utilizing a MERV 13 in the part of the home where you spend the most time is a good second choice. Sonu One new option for treating allergies is acoustic resonance therapy with the SoundHealth Sonu headband. It uses vibration from sound to loosen mucus from the sinuses so that they can clear. The FDA has approved its use for children as well as adults. New research was just published demonstrating its helpfulness in treating children with nasal congestion (). SoundHealth has underwritten The People’s Pharmacy podcast. Dr. Nadeau has also been compensated for her role in conducting studies of this device (). Since it does not employ medications, there are no drug side effects. This Week’s Guest Kari C. Nadeau, M.D., Ph.D., is Dean of the UCLA Fielding School of Public Health ( starting July 1 2026). Until then, she holds many other positions. At Harvard T. H. Chan School of Public Health she is: John Rock Professor of Climate and Population Studies; Chair of the Department of Environmental Health; and Director of the Allergy, Extreme Weather, and Exposomics Lab. Dr. Nadeau is Professor of Medicine at Harvard Medical School and serves in the Division of Allergy and Inflammation at Beth Israel Deaconess Medical Center. She is an Adjunct Professor at Stanford Medical School. Dr. Nadeau is also the co-author of The End of Food Allergy, which provides strategies for treating and preventing food allergies in children. to the research underway in her Harvard laboratory. PHOTO CREDIT: STACY GEIKEN Taken in April 2017 at Kari Nadeau’s professorship dinner The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Citations Khanwalkar AR et al, "Acoustic vibrational therapy for the treatment of pediatric rhinitis." Oto-Open, April-June 2026. https://doi.org/10.1002/oto2.70247 Levi L et al, "The influence of nasal cavity dimensions on frequency of treatment for rhinitis symptoms." International Forum of Allergy & Rhinology, Dec. 2025. DOI: 10.1002/alr.70060
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Show 1474: Treating the Cause, Not Just the Symptoms, with Functional Medicine
05/30/2026
Show 1474: Treating the Cause, Not Just the Symptoms, with Functional Medicine
Over the years, we have spoken with scores of healthcare experts about chronic illness. Many of them attribute the problems to inflammation, which is after all a natural response to infection or injury. But not everyone has a system for locating and addressing the source of the inflammation. If you want to treat the cause, not just the symptoms of your disease, you might want to consider functional medicine. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. What Is Functional Medicine? Many people have heard of integrative medicine. We asked our guest, Dr. Susan Payrovi, how this differs from functional medicine. (She practices both.) According to Dr. Payrovi, while both approaches embrace lifestyle therapies, integrative medicine may focus on individual organ systems, just as conventional medicine does. Functional medicine, on the other hand, is more likely to focus on how the body works. What functional systems are involved when a person experiences fatigue, for example? If there is a problem with the way the body produces energy, how could that be resolved? If you are dealing with a problem caused by underlying inflammation, you could prescribe a potent anti-inflammatory or even a medicine that counteracts the immune system’s response to danger by blocking interleukins, for example. Or you could search upstream for the disturbance that is causing the immune system to overreact. Going upstream to find the cause is the functional medicine approach. Sending the Body Safety Signals If inflammation is a response to a danger signal, how can we let the immune system know that the body is safe? Lifestyle therapies offer some powerful interventions, even though they may sound very ordinary. Getting adequate sleep can make a huge difference for the immune system and lower inflammation dramatically. Stress management is another potent non-pharmaceutical approach. Consuming a diet rich in anti-inflammatory foods or even medicinal herbs could also contribute to a sense of safety and reduced inflammation. The Silo Problem of Modern Medicine We have spoken with many people who have struggled with a disease that manifests in multiple symptoms. They end up seeing a variety of specialists who don’t seem to communicate with each other. NO tool manages every condition. Too often, specialists pay attention only to the specific organ that they are assigned, and as a result, nobody puts the big picture together for a long time. The hope is that functional medicine would do a much better job for such patients, including those whose suffering has an emotional, psychological or spiritual aspect. Functional Medicine and Chronic Fatigue Syndrome One example where patients are demanding more of their medical care is chronic fatigue syndrome. Conventional medicine has a notoriously difficult time treating such patients. Coaching patients on small but important lifestyle changes is one approach that functional medicine can offer. Pacing and learning to prioritize are vital skills for such patients. Dr. Payrovi learned a lot about the value of such approaches in dealing with her own illness, multiple sclerosis. Finding a Functional Medicine Practitioner People looking for a functional medicine practitioner can consult the Institute for Functional Medicine. The organization lists practitioners on its website, . So does the Academy of Integrative Health and Medicine, . This Week’s Guest Susan Payrovi, MD, is a physician practicing Integrative and Functional Medicine at Stanford’s Center for Integrative Medicine. Dr. Payrovi is board certified in Anesthesiology, Hospice and Palliative Medicine, as well as Integrative Medicine. She has additional training in Functional Medicine and acupuncture. . Her website is . Susan Payrovi, MD
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Show 1473: How Music Heals: The Neuroscience Behind an Ancient Medicine
05/23/2026
Show 1473: How Music Heals: The Neuroscience Behind an Ancient Medicine
What do you conjure up when you think of music? Perhaps you imagine a singer-songwriter telling her story. On the other hand, you might imagine a parade with a marching band, an orchestra playing an outdoor concert or a mother singing her baby to sleep with a lullaby. Regardless of the format, music acts on the brain in unique ways. Neuroscientists are learning how music heals and why healers around the world have integrated music into their rituals for millennia. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How Music Heals Dr.Elizabeth Margulis directs the Music Cognition Laboratory at Princeton University. This scientific endeavor is devoted to understanding how our brains react to music. One discovery is that music has a lot in common with infant-directed speech. It is highly repetitive with exaggerated pitch modulation. When people talk to babies, they may slow their words down a bit and raise the pitch of their voices. All of these properties make infant-directed speech a lot more like music than the rest of our everyday utterances. Caregivers around the world adopt this sort of “baby-talk” because babies pay attention longer when they do. Is music tapping into the same primal brain responses? Another characteristic of music is that it can trigger emotional responses. These are culturally conditioned; bagpipes do not have the same effects as Tibetan singing bowls. Howe er, the reminiscence triggered by music can be remarkably complete, putting us back in time not only to the place where we heard it before, but even to the bodily sensations that we experienced at that moment. Musical memories are exceptionally persistent. Older people with dementia who can no longer remember important facts about their own lives can often join in singing a popular song from their youth. The Downsides of Music Music may have social and political ramifications. Just imagine a chorus singing “We shall overcome,” and you will probably make assumptions about the singers and their values. As a result, we should not be surprised to learn that people may fight over music. Frequently entire generations have genre preferences such as hip hop or rock that are not shared by adjacent generations. How do we approach the music we love to hate? Can we understand how music heals even if we don’t like it very much or at all? Musical Daydreams Help Us Understand How Music Heals Dr. Margulis has studied and written about musical daydreams. What does she mean by this? As you watch a movie, you may appreciate the score. But even if you don’t notice it at all, the sound track influences how you understand the action on the screen. Likewise, when most people listen to a piece of music, they may create a visual to go with it. Dr. Margulis offers us an example of a snippet of music by Liszt that evokes for many people an image of a cartoon cat chasing a cartoon mouse. Needless to say, that is not what Liszt was thinking when he composed it, since cartoons did not exist at the time. Choosing Music for Healing Joe mentioned the unobtrusive but soothing music playing in the background when he has an acupuncture treatment. Dr. Margulis suggested that music activates motor areas of the brain, and that might help explain the benefit in this setting. We are still learning more about how music heals. This research may some day guide healthcare professionals in choosing music for their practices, even in the hospital. This Week’s Guest Elizabeth Margulis,PhD, is Professor and Acting Chair in the Department of Music, with affiliations in Psychology and Neuroscience. Dr. Margulis directs the at Princeton University. Her research pursues questions that lie at the intersection of the humanities and the sciences. She was also trained as a pianist. Her most recent book is s. Her website is takes you to the publisher’s page. Elizabeth Margulis, PhD, Princeton University The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Listen to the Podcast The podcast of this program will be available Monday, May 25, 2026, after broadcast on May 23. You can stream the show from this site and download the podcast for free.
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Show 1428: The Hidden Power of the Unconscious Brain (Archive)
05/16/2026
Show 1428: The Hidden Power of the Unconscious Brain (Archive)
In this episode, a renowned neurosurgeon shares what he has learned in decades of working to restore ailing brains. His new book covers a vast range of neuroscience. Our dilemma was what to pay attention to in all those options. In a sense, that is always the human situation. We are capable of conscious processing of approximately 200 bits per second (bps) of information. Our unconscious brain deals with as much as 11 million bps. At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. The Power of the Unconscious Brain Our senses feed us a tremendous amount of information all the time, but we don’t have the bandwidth to pay attention to more than a small fraction of it. That’s where the unconscious brain is so valuable, juggling millions of bits of information while we focus our conscious attention on what seems important. One surprising outcome of the research on how our brains function is a re-assessment of what is going on when people are unconscious. For centuries, doctors thought there was really no brain activity while a person was comatose. Then, a few decades ago, a scientist was recording the brain waves of a patient in a coma. The activity was very peculiar, as if the person were watching a ball being lobbed back and forth across a tennis court. In actuality, a television set in the room was broadcasting a world championship match between Roger Federer and Rafael Nadal. The neuroscientist recognized that this individual was following the match and was not nearly as deeply unconscious as had been thought. Further research showed that this kind of unconscious brain activity is not uncommon. It may hold keys to determining who has the best potential for recovering from their coma. Freud and the Unconscious Brain If you hear the term the unconscious mind, you may think of Sigmund Freud. He really popularized the concept that some very important brain activity takes place outside of our conscious awareness. It still has a powerful influence on our behavior. By the way, if we recognize that our conscious attention is indeed a limited resource (200 bps, remember), we won’t try to multitask. Humans actually aren’t very good at multitasking; instead, we switch our attention from one thing to another. Some people can do that fairly easily, but for most of us, it is less effective than staying focused. Three Stages of Brain Development Evolution likes to build on what it’s already got in place, so it shouldn’t surprise us that we can track three different evolutionary stages to our human brains. The reptilian brain came first, of course, and is there as a base, operating mostly on reflex. It’s definitely an important part of the unconscious brain. The mammalian brain brings in emotions. The hormone oxytocin is relevant for this discussion. It is critical for birthing and nursing young. As it turns out, oxytocin can also be put to other uses, such as bonding mates together and creating friends. Finally, we have the primate part of our brain. We humans, like other primates, can exercise empathy because our mirror neurons allow us to relate to another creature’s experience. In fact, mirror neurons were discovered by scientists studying macaques and eating gelato. Listen for a great story! Speaking of empathy, we wondered about empathy fatigue. We started hearing about empathy fatigue during the COVID pandemic, when healthcare providers were overwhelmed by extreme demands with inadequate support. Research shows that “constant, repetitive exposure to the pain of others leads to empathy fatigue.” Lack of empathy can lead people to do terrible things. Wonders of the Unconscious Brain Our brains are full of clocks. To some extent, these are shaped by how we use them. Musicians who play percussion instruments can perceive time differences of just a few hundredths of a second. All of us are entrained to a 24-hour a day cycle, whether we observe sunrise and sunset or not. But if we are deprived of connection with that cycle, our internal clocks can’t keep good time, and our brains may get far off track. What About Premonitions? Some people think premonitions are a fantasy. Yet this is another area where our unconscious brain may be more capable than we imagine. Dr. Hamilton describes an experience in the Swiss Alps where he and his wife had a choice of which path to take down from the summit. One appeared to be a shortcut, and they did have some time constraints. But as soon as they had taken a few steps that direction, he had a premonition of something terrible. They took the other path and learned later that there had been a landslide on the shortcut that would have swept them helplessly down the mountain. According to Dr. Hamilton, some people have the ability to influence the output of random number generators. Those of us who can’t may wish to reject that idea, but it has been documented. The Princeton Engineering Anomalies Research lab has run many studies demonstrating an impact on random number generations, not to mention remote viewing. In this way, some of the hidden power of the unconscious brain appear as cerebral entanglements, analogous to quantum entanglements at the sub-atomic level of matter. This Week’s Guest Dr. Allan Hamilton, MD, FACS, is a neurosurgeon who has specialized in treating brain tumors. His extraordinary journey from janitor to Harvard-trained neurosurgeon is just the beginning of his remarkable story. A decorated Army veteran, he now holds four professorships at the University of Arizona and has been recognized as “One of the Leading Intellects of the Twenty-First Century.” As the only American honored with the Lars Leksell Award for pioneering scientific discovery in stereotactic neurosurgery, Dr. Hamilton’s groundbreaking work has revolutionized the field. He has had a life-long interest in the application of computer technologies to enhance surgical care and reduce avoidable medical adverse events. In addition, he has served on two White House Advisory Committees under two presidential administrations. Allan Hamilton, MD, FACS His expertise extends beyond medicine, having studied creative writing under Rod Serling and serving as a senior medical consultant for Grey’s Anatomy for nearly two decades. Dr. Hamilton’s seven non-fiction books have garnered numerous awards and international translations, offering insights that have inspired leaders across various fields. Dr. Hamilton’s 7th non-fiction book is The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).
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Show 1472: Beyond Lyme: Stealth Infections from Flea and Tick Bites
05/09/2026
Show 1472: Beyond Lyme: Stealth Infections from Flea and Tick Bites
Tick season is well underway in many parts of the country. It seems that a mild winter and a warm spring have brought the nymphs out seeking blood. If that blood is yours, you may be exposed to a range of pathogens. What’s more, ticks are not the only creatures ready to bite you. Fleas are an even bigger problem when it comes to transmitting bacteria called Bartonella. That genus is responsible for cat scratch disease and trench fever. When the infection goes chronic, it’s called bartonellosis. What are the dangers of flea and tick bites? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. The Hazards of Flea and Tick Bites Ticks can transmit a dizzying number of pathogens, including viruses, bacteria and protozoa. Rocky Mountain Spotted Fever, for example, occurs when a tick injects Rickettsia rickettsii into a person through a bite. If not treated properly, it can be fatal. Fortunately, however, it usually responds to doxycycline. The NCSU laboratory has developed a reliable diagnostic test that picks it up quickly. Another tick-borne disease that has become familiar over the last few decades is Lyme disease. It is carried by deer ticks infected with Borrelia burgdorferi. If treated promptly, most people clear the disease, but sometimes it morphs into a stealth infection that is quite controversial. You may not think much about flea bites, but they too could be the source of a stealth infection. Fleas transmit Bartonella (and so do body lice, ants, pigeon mites, rat mites and sand flies). Cats can be infected (with three different species of Bartonella) and so can dogs (only two species). When people develop bartonellosis, it can cause liver disease and neurological problems such as headaches and memory loss. In some cases, infected people suffer seizures. Preventing Flea and Tick Bites Once Bartonella get into the body, it likes to hide. The bacteria can enter virtually any cell in the body and make itself at home. As a consequence, the immune system may have difficulty tracking it down and eliminating it. Antibiotics don’t always get to it, either. Treatments of entrenched infections need to be very intensive. So it is better to prevent flea and tick bites. One way is to make sure that pets are protected. Veterinarians can prescribe preventive medicine for them, either oral or topical. Another important step is to protect yourself. Wear effective insect repellent when outside or cover your long pants with permethrin-treated gaiters. And absolutely do not skip the tick check when you come inside. If you find a tick that has bitten you, remove it with tweezers, seal it in a plastic bag, date the bag and put it in the refrigerator. That could provide useful identification if you begin to feel ill over the next several days. When the type of tick is identified, it helps to point the infectious disease expert in the correct direction for what condition you may have. This Week’s Guest Dr. Edward B. Breitschwerdt is a professor of medicine and infectious diseases at North Carolina State University College of Veterinary Medicine. He is also an adjunct professor of medicine at Duke University Medical Center, and a Diplomate, American College of Veterinary Internal Medicine (ACVIM). Dr. Breitschwerdt directs the Intracellular Pathogens Research Laboratory in the Institute for Comparative Medicine at North Carolina State University. He also co-directs the Vector Borne Diseases Diagnostic Laboratory and is the director of the NCSU-CVM Biosafety Level 3 Laboratory. Dr. Breitschwerdt’s clinical interests include infectious diseases, immunology, and nephrology. Dr. Ed Breitschwerdt, NCSU College of Veterinary Medicine Listen to the Podcast The podcast of this program will be available Monday, May 11, 2026, after broadcast on May 9. In this week’s podcast, we talk about developing treatments for these challenging conditions. A major focus for Dr. Breitschwerdt is prevention, so he and his colleagues are working on a vaccine that could prevent Bartonellosis. We also discuss the possibility that Bartonella might contribute to arthritis. Find out about the complications of another vector-borne infection, Babesiosis. You can stream the show from this site and download the podcast for free. This episode of our podcast was sponsored in part by MUD\WTR. Start your new morning ritual & get up to 43% off your @MUDWTR with code PPOD at
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Show 1471: Broken Bills: Why Americans Pay Twice as Much for Less Care
05/02/2026
Show 1471: Broken Bills: Why Americans Pay Twice as Much for Less Care
Americans often boast of having the best health care in the world. It is certainly the most expensive health care. We pay twice as much as people in many other industrialized nations. Are we getting our money’s worth? Some population statistics, such as life expectancy, suggest we could be doing much better. How can we make sense of the complexity of American health care? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Why We Pay Twice as Much for Health Care One reason Americans pay twice as much is the complexity of our health care services. We often call it a health care “system,” but it often doesn’t feel as coordinated as a system ought to be. Many other countries have universal health insurance coverage in one form or another (and there are many). That means the government has an incentive for keeping costs down. With so many different payers and players in the US, the incentives frequently go in the other direction. You may notice this if you examine an explanation of benefits from Medicare or a private insurance company. There may be a sizable gap between what the provider charged and what insurance approved. Who pays the retail price? Only people who don’t have insurance, who are usually those least able to manage a big bill. If you find yourself faced with a hospital bill and no insurance coverage, it is important to talk with the billing department. Nonprofit hospitals should have a mechanism for patients without coverage to negotiate a lower total or a longer time frame in which to pay. Even some for-profit hospitals and medical practices are open to negotiation, but starting the negotiation as early as possible is key. How Much Does an Emergency Cost? Nobody plans for a medical emergency. That is the nature of emergencies–they are unexpected. If you need an ambulance to get you there, if you have to be transferred to another hospital with a better ability to care for your problem, if the doctors must do multiple tests to make a diagnosis will all influence your bill. As a result, emergency visits could cost from tens of thousands of dollars to a million or so. With high-deductible health insurance, a person or their family could end up owing more than they can pay. That is how some cases of bankruptcy are rooted in high healthcare bills. We Pay Twice as Much Because Providers Make More In the US, doctors were once in the same category of professionals as teachers or firefighters. Those days are long gone. Healthcare providers here are compensated more generously than providers in many other places, such as Canada, Japan or Israel. Moreover, just as there are middlemen in the prescription insurance business (called pharmacy benefit managers, PBMs), health insurance has its own middlemen. The result is a great deal of complexity, very little transparency, and a lot of parties trying to make money on each transaction. That also leads to a great deal of administration, which further increases the cost. Why Don’t Market Forces Control Costs? Some analysts suggest that the free market should be able to control costs. But for market forces to work, you need competition and transparency. Over the last decade or so, there has been increasing consolidation in every sector of health care. Competition is limited in most areas. Moreover, transparency is in very short supply in health care. For years we have been talking about how hard it is to do comparison shopping for health services like MRI scans or colonoscopies. If consumers cannot compare costs or value, they cannot make the rational decisions that would help moderate prices. How Administrative Costs Increase Bills Part of every insurance premium goes to paying administrative costs. Insurers pay people to review claims (). Preauthorization also adds to administrative costs. Manage the Hospital Bill So You Don’t Pay Twice as Much as You Should Years ago, , who titled his book Never Pay the First Bill. Our guest for the current episode counters always request an itemized bill. That way you can check it to make sure that simple items such as names, dates and insurance policy numbers are correct. Then look at whether the services billed are actually the services received. An estimated nine of ten hospital bills contain mistakes. The sooner you catch them and contest them, the less likely you are to have to pay them. To determine what you must pay, you may need to review the summary of benefits on your insurance policy. That lays out in detail exactly what the insurance will cover. What Can Patients Do So They Don’t Pay Twice as Much? Ask for an itemized bill and check it carefully in every detail. If you find a mistake, contest it. Sooner is better, even though you may be trying to recover from a serious illness. Ask the billing office about patient assistance or a negotiated payment plan. Check with the Patient Advocate Foundation. They may be able to help in an individual case. Find out if your state has a consumer assistance program in the department of insurance. Notify an intractable billing department that your story will appear in your social media feed. This should probably be the last step if the previous ideas don’t work. But hospitals really don’t like bad publicity, so it might give you leverage you wouldn’t have otherwise. This Week's Guest Linda J. Blumberg, PhD, is a research professor at Georgetown University’s McCourt School of Public Policy. She is an expert on private health insurance (employer and nongroup), health care financing, and health system reform. [caption id="attachment_139784" align="alignnone" width="768"] Linda J. Blumberg, PhD, describes why we pay twice as much for healthcare[/caption]
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Show 1470: Why Your Doctor Should Prescribe Exercise to Treat Depression, Cancer & Aging
04/25/2026
Show 1470: Why Your Doctor Should Prescribe Exercise to Treat Depression, Cancer & Aging
If you had to name one thing that could contribute to better health throughout the lifespan, what would it be? We think exercise, or at least physical activity deserves the top spot. Yet in 2025, fewer than half of adults met the guidelines for aerobic physical activity. And less than one-quarter were doing both aerobic and muscle-strengthening exercises on a regular basis. Perhaps your doctor should prescribe exercise. What could we expect as the benefits? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. Would Your Doctor Prescribe Exercise for Depression? Earlier this year, the Cochrane Collaboration published a review of 73 randomized clinical trials of exercise as a treatment for depression (). Most of these compared physical activity to antidepressants or to psychological therapy for depressed patients. Some of them compared the exercise prescription to no treatment or wait list. Comparing exercise to no treatment revealed an advantage for exercise, although the quality of the trials left something to be desired. Ten trials compared exercise to psychological therapy. In addition, five trials weighed exercise against antidepressant medication. Neither comparison showed a clear tilt for or against exercise as a superior intervention against depression. Exercise in the Cancer Center Dr. Claudio Battaglini of the University of North Carolina at Chapel Hill was not surprised by this finding. The exercise program he oversees for cancer patients often results in lifting their spirits as well as improving their health. That may help explain the very high adherence in his program. Will Physical Activity Reduce the Risk of Cancer? According to a review of the evidence, regular physical activity can reduce the number of people who die prematurely. In addition, it helps with weight control, quality of life and bone health. Older people are less likely to fall or experience declining cognition if they exercise regularly. The review found that physical activity improves quality of life and promotes emotional benefits (). If oncologists should prescribe exercise, don’t cancer patients deserve to have their insurance company cover the cost? Insurers rarely blink twice at cardiac rehab. Although cancer rehab is also super-helpful, insurance companies often don’t choose to pay for it. What Role Could Coaching Play in Guiding Physical Activity? Lots of doctors tell their patients to get more exercise. The patient wants to and intends to, but perhaps they just don’t know how. What activity should they choose? What is the proper technique? How often and how much do you need to move? All these questions can be answered by a coach. The coach will take into account your objectives and preferences as well as your prior experience. What do you love doing? Are there any moves you should avoid to reduce the risk of injury? That’s why when doctors prescribe exercise, they should include coaching to provide this sort of guidance. If Doctors Prescribe Exercise, Will That Help Motivation? Many of us know we should be active, but we don’t always follow through. How can we get motivated to move? According to Dr. Jordan Metzl, the first step is to find something you love doing. For Joe, for instance, having the doctor prescribe exercise of runniing a mile a day is not going to work. But he’ll cover much more than a mile–and quickly–if he is playing a competitive game of tennis. Joe loves tennis. Terry is not a runner either. On the other hand, karate club is a highlight of her week, and she has worked to achieve some skill in it. Dr. Metzl advocates for finding the activity that gets you excited and making it a priority in your life. If you are having fun, that is a great motivation. Reducing the Cost to Act Another thing to consider is overcoming the cost to act. If your activity requires a lot of preparation that feels like a chore, the cost to act is high. If you can make it easier and break down that barrier, you are much more likely to accomplish your exercise. External rewards can also play a role. Joe loves winning, so he likes to play with guys at about his same level of skill. That way, he has a chance to win if he tries. For Terry, there was a progression through belt levels in karate, from yellow to green to blue, and so on. Now, she looks forward to closing the rings in the fitness app on her watch. When Doctors Prescribe Exercise, Does That Give You a Push? For Dr. Metzl, the idea of pushing yourself and maybe your friends is a positive notion. We asked him about people who dig in their heels when pushed. What approach do they need to perceive and pursue their goals? He summarized the three ingredients of healthy motivation as knowledge, emotion and belief. That’s knowledge of the benefits of activity, an emotional response of appreciating and enjoying activity and a belief that you can achieve your goal. This Week’s Guests Claudio Battaglini, PhD., FACSM, is Professor in the Dept. of Exercise and Sport Science at The University of North Carolina at Chapel Hill. He is also Director Emeritus of the Get REAL & HEEL Breast Cancer Research Program and Co-Director of the Exercise Oncology Research Laboratory. Jordan D. Metzl, MD is an internationally recognized sports medicine physician, bestselling author, and fitness instructor who practices at the Hospital for Special Surgery in New York City. He lectures around the world and founded the first physician-led online fitness community, IronStrength, with more than 50,000 members. He created the Ironstrength Workout, a functional fitness program for improved performance and injury prevention that he teaches in fitness venues throughout the country. An elite athlete himself, Dr. Metzl is also a 40-time marathon runner and 14-time Ironman finisher. Dr. Jordan Metzl, author of Push, runs the New York City Marathon 2025 Dr.Metzl’s latest book is The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you). Listen to the Podcast The podcast of this program will be available Monday, April 27, 2026, after broadcast on April 25. On this episode, Dr. Metzl talks about the joy of teaching medical students to offer an exercise prescription and the challenge of getting specialties other than cardiology to integrate physical activity into their rehab process. Dr. Battaglini discusses the contrast between cardiac rehab, which is covered by insurance, and cancer rehab, which is not. He also describes the value of swimming, especially for older people with sore joints. Walking is good exercise and easy for most people. What if the weather is bad? Perhaps an indoor walk around the mall would be a good alternative, and if you can recruit some friends to join you, so much the better. You can stream the show from this site and download the podcast for free. Citations Clegg AJ et al, "Exercise for depression." Cochrane Database of Systematic Reviews, Jan. 8, 2026. https://doi.org/10.1002/14651858.CD004366.pub7 Albini A et al, "Physical activity and exercise health benefits: cancer prevention, interception, and survival." European Journal of Cancer Prevention, Jan. 1, 2025. DOI: 10.1097/CEJ.0000000000000898
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Show 1469: Fresh Air & Sunlight: How Some Hospitals Are Rediscovering This Healing Secret
04/18/2026
Show 1469: Fresh Air & Sunlight: How Some Hospitals Are Rediscovering This Healing Secret
Hospitals can be pretty overwhelming. Sometimes you may feel like you need a map to find your way around the maze, not to mention a trusty guide to get you to the department or health professional that could actually help you overcome illness. In addition, being hospitalized often means being deprived of fresh air & sunlight. Could that be a mistake for proper healing? At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment. How You Can Listen: You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, April 18, 2026, through your computer or smart phone (). so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on April 20, 2026. Striving for Person-Centered Care Wouldn’t it be great if healthcare facilities were specifically designed around the individuals they are supposed to serve? Fifty years ago, a group of physicians and former patients started Planetree to do exactly that. At first, Planetree provided information at a time when patients were rarely told what was wrong or how it could be addressed. There was also a Planetree ward in a hospital in the Bay Area that operated on principles of transparency and person-centered care. Over the next several decades, Planetree developed as a network of more than 300 health care facilities in 30 countries that strive to provide a home-like environment for healing. The main value is person-centered care, in which they strive to treat the whole person as well as that individual’s family or significant others. We invited Planetree President Michael Giuliano to tell us about it. He mentioned that one feature is getting your care summary in real time, so you can ask questions and correct errors before you leave the clinic or office. Fresh Air & Sunlight Built In One of the things that sets a Planetree hospital apart from other facilities is the way the values are visible in the architecture. Planetree planners put a premium on access to nature and outdoor space, though of course each facility does it a bit differently, according to its own plan. Rooms are set up so that people have access to fresh air & sunlight. That makes them feel more comfortable, certainly. Might it also promote healing? How Do Fresh Air & Sunlight Promote Healing? More than 150 years ago, Florence Nightingale set standards based on what she observed of soldiers healing from battle wounds and horrible infections during the Crimean War. This was, of course, before the development of antibiotics, so nursing care was paramount. Nurse Nightingale insisted on the primacy of fresh air & sunlight for her patients. Was this just a quaint old-fashioned idea, or is there modern scientific support? The Power of Near-Infrared For more information on the science of fresh air & sunlight (yes, there is science), we turn to Dr. Roger Seheult of MedCram.com. https://www.medcram.com/ He began by describing the brand new Footscray Hospital in West Melbourne. The design is something of a modern take on Florence Nightingale’s hospital plan, since the architects figured out how to get natural light and real ventilation in every room. They prioritized fresh air & sunlight in this $1.5 billion hospital because of their healing properties. People exposed to sunlight leave the hospital sooner because they recover more quickly. So the patient gets better and goes home faster, the hospital has a better bottom line and the insurance company pays less. Everybody wins! Probably a good part of the credit goes to near-infrared light. We can’t see it, but it penetrates our bodies and they react. Exposure to near-infrared at 850 nanometers improves mitochondrial function. You could get this from a device, but it is cheaper and arguably more pleasant simply to go outside and allow sunlight to fall on your skin soon after sunrise (or before 10 am) or just before sunset (probably after 4 pm). An Amazing Story About Fresh Air & Sunlight We’d be tempted to call this an unbelievable story, but Dr. Seheult provided all the details and checked the medical records himself, so we believe it. He told us about a 15-year-old boy with a serious blood cancer, acute lymphoblastic leukemia, ALL. This type of cancer undermines the immune response, and this young man had come down with a terrible fungal infection, mucormycosis. The fungus did not respond to medication, and it rampaged through his left lung. Ultimately, his doctors proposed removing the lung as a last-ditch method of controlling the infection. Unfortunately, when they found that the fungus had invaded his right lung, they were out of options. They figured he probably couldn’t survive much more than two days, so they asked him his last wishes. All he wanted was to go outside; at this point, he’d been cooped up in the hospital for two months. They fixed up a wheelchair to hold all his drips and took him outside. The next day, they did it again. The youth didn’t die as expected. Instead, he recovered completely, over time. We can’t put sunlight in a bottle, but perhaps oncologists and other doctors should consider writing prescriptions to cover it. This Week’s Guests Michael Giuliano is the President of Planetree International, a mission-driven non-profit organization setting the global standard for person- centered excellence across the continuum of care. Michael joined Planetree in 2022 as Chief Operating Officer (COO) following a decade of leadership roles in Australia’s public and private healthcare sectors. Michael Giuliano, President of Planetree International Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine. He is also an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. His current practice is in Beaumont, California. He is a critical care physician, pulmonologist, and sleep physician at Optum California. Dr. Seheult lectures routinely across the country at conferences and for medical, PA, and RT societies. He is the director of a sleep lab and the Medical Director for the Crafton Hills College Respiratory Care Program. He is co-founder and presenter for , a site that offers concise and easy-to-follow medical videos on a range of topics. Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside
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