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Fabulous episode, as always. Love the camaraderie. You’re building a great community of sorts. Subscription is worth logarithmically more than a journal subscription. I’d say get us some T-shirts so we can spread the word!

Minor quibble about the health advice, Mandrola: Key piece here is, VP is of Asian Indian ancestry and has a BMI of 21.7. He is doing excellent watching weight, exercising. Bet his LDL is great. Not worth checking a lipid panel. However, if things were to change, BMI going up to 23.1 for instance, I would instantly check lipids and connect him with a trainer, lifestyle coach :). (BMI cut-off is lower for Asians)

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Have the price of admission cover the cost of the conferences.

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I’ve been to a number of big scientific meetings at NIH, where there are no pharmaceutical ads. Clearly they’re not unbiased though.

I’ve also been to an interesting range of medical society conferences. The one where the marketing really jumped out at me was psychiatry (also the anti-psychiatry protestors outside). In Preventive Medicine and Public Health, we don’t really have a ton of industry sponsorships so that aspect of it was more muted. Most of the booths were academic or government. We still somehow found the money to be in downtown New Orleans this year (though I’ve heard criticisms of the college leadership’s extravagance). Addiction Medicine was a good show; probably not super fancy the way that oncology or cardiology would be, but a majestic venue near DC. And there are only a few drugs so again a lot of the booths were academic, government, potential employers. I’m not sure where the money for some of these less moneybagged specialties comes from.

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Who is benefiting from trials? Who is benefiting from deepest dive studies? If trials and studies are skewed, presented in numbers and graphs which require specialists to study the numbers' true percentages, and misrepresented why do they continue? Why are they so heavily relied upon?

Scud work. If medicine is in such disarray, is part of it because we've left to bedside to fall into EPIC? Why take away the work that brings us closer to the bedside? Shouldn't doctors empty bedpans, start an IV, work a 12 shift on an MS floor? Shouldn't nurses give baths, tidy rooms and bathrooms, feed patients, T&P Q2hr?

I know it's not as simple as that, but the more we rely on AI, numbers, graphs, percentages the less we factor in the human element. Harlow's monkeys all grew and showed s/s of being nourished but the monkey's with only the wire mother did not fare as well emotionally and mentally. You can put data into a machine, it will define the best regimen: medication+dose+frequency+length of treatment, until you treat the entire being, you end up just spitting out factoids.

Is anyone reaching back and studying medicine as it was in the mid 1800s to the early 1900s? What were the number of deaths from TB before Florence Nightingale opened the hospital windows to after she started opening the windows? We basically got close to that during the covid pandemic. People outside w/ or w/o masks were less likely to contract the airborne virus. Isolation for communicable diseases. Hydration. Handwashing. (Ok, so blood-letting turned out to be not such a good idea)

We are relying heavily on the new and upcoming, the next big breakthrough, how can we make the wheel rounder. Modern medicine has mind-blowing assets, MRI/PET/ABT/etc. We should take advantage of all of it, we should continue to look forward to betterment, but leaving behind the humanness leaves it all a little too sterile.

The shopkeeper who comes out from behind the counter holding 4 lollipops, bends down and says to the youngster, pick one. The colorful machine that requires a coin, a twist of the knob, plopping out a gum-ball already chosen for you.

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I like that phrase, 'Sensible Medicine Headquarters'. I am listening to the 64-minute podcast show, "Mandrola Gives VP Health Advice" while driving in my Mobile Command Post here on the interstate.

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