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

In this conversation, Daniel Belkin and Mitch Belkin speak with Sekar Kathiresan, MD, about using gene editing medications to treat cardiovascular disease. We discuss Dr. Kathiresan’s company Verve Therapeutics, which has pioneered a lipid nanoparticle delivery system of a CRISPR-based gene editing technology. We delve into the pathophysiology of cardiovascular disease, the role played by LDL and the LDL receptor in atherosclerosis, the genetics underlying monogenic and polygenic risk for myocardial infarction, CRISPR and the future of gene editing technologies, and Verve’s ongoing phase I trial of a PCSK9 gene editing medication (VERVE-101) in humans. Who is Sekar Kathiresan?Dr. Sekar Kathiresan, a cardiologist, geneticist, and the CEO and co-founder of Verve Therapeutics. Verve Therapeutics is a company pioneering a new approach to the treatment of cardiovascular disease with single-dose gene editing medications. Prior to co-founding Verve, he served as the director of the Massachusetts General Hospital Center for Genomic Medicine and was a Professor of Medicine at Harvard Medical School. References:Sekar Kathiresan’s TwitterVerve Therapeutics websiteTirzepatide for the treatment of obesity (NEJM, 2022)____________________________________ What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin speak with Joel Topf, MD, about contrast-associated nephropathy. We discuss Acute Kidney Injury (AKI), the value of creatinine as a marker for AKI, how to evaluate volume status, the evidence around contrast-induced/contrast-associated nephropathy, recommendations on fluids to prevent AKI in patients with Chronic Kidney Disease, and comparing venous and arterial contrast with respect to the risk of AKI.Who is Joel Topf?Dr. Topf is a clinical nephrologist in Detroit, who is a partner and medical director at St Clair Nephrology and an assistant professor at Oakland University William Beaumont School of Medicine. He is the co-creator of NephMadness and NephJC. He hosts multiple podcasts, blogs at pbfluids.com, and tweets @Kidney_boy. References: Joel Topf’s Blog Twitter: @Kidney_BoyJoel Topf - Grand Rounds Presentation on Contrast NephropathyThe PRESERVE trialN-Acetylcysteine and Contrast-Induced Nephropathy in Primary AngioplastyPrevention of Contrast-Induced Nephropathy With Sodium BicarbonateCraig Brater 1998 - NEJM review on DiureticsChlorthalidone for Hypertension in Advanced Chronic Kidney DiseaseEffect of Salt Substitution on Cardiovascular Events and Death______________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and Mitch Belkin speak with Professor John Cochrane about the economics of the American healthcare system. We discuss the lack of clarity around US healthcare pricing, as well as how employer-sponsored health insurance and the persistence of massive cross subsidies contribute to dysfunction in the US healthcare market. Professor Cochrane argues that the best way to solve these problems is to simplify regulation and remove regulatory hurdles which prevent innovative entrants from improving healthcare and making it more affordable.Who is John Cochrane?Professor John Cochrane is an economist specializing in finance and macroeconomics. Formerly a professor at the University of Chicago, Cochrane is now the Rose-Marie and Jack Anderson Senior Fellow at the Hoover Institution at Stanford University. He blogs regularly as The Grumpy Economist at https://johnhcochrane.blogspot.com/.References:After the ACA: Freeing the Market for Healthcare John Cochrane’s Blog, The Grumpy EconomistTwitter @JohnHCochrane______________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Daniel Belkin and  Mitch Belkin speak with Professor Christy Chapin, who is an Associate Professor of History at University of Maryland Baltimore County. We discuss how the American insurance company-based model of healthcare developed in the first half of the 20th century. Specifically, we explore the role of some of the major actors who created the fragmentary and expensive US healthcare landscape: the American Medical Association (AMA), Blue Cross and Blue Shield, as well as private insurance companies. Prefer video? Watch the  interview on Youtube.In this episode, Professor Chapin defines what she terms the “insurance company model” of healthcare. We explore various competing models at the turn of the 20th century, including prepaid physician groups, which were an early multi-specialty group practice. (This model of healthcare delivery, which Professor Chapin argues, could have become the dominant model of US healthcare, was effectively banned by the American Medical Association in 1938). We discuss the organizational history of the AMA, its rise to prominence, and how it influenced the development of American healthcare. While the AMA attempted to maintain physician autonomy in the 1920s, concerns of government involvement prompted a 1938 deal with insurance companies that produced our current model of 3rd party financed healthcare. By insisting on a fee-for-service payment structure, this led to vast increases in the cost of care. Overtime, increasing insurance company regulation and government involvement (Medicare, the ACA, etc.) have attempted to reduce costs with limited success.Professor Chapin argues that the US healthcare system is not a free market. Rather, it is a product of warped incentives brought about by historical negotiations between insurance companies, hospitals, government agencies, and special interest groups. Cost containment measures instituted by insurance companies to reduce costs have led insurers to effectively control the practice of medicine.Who is Christy Chapin?In addition to being an Associate Professor of History at UMBC, Professor Chapin is a visiting scholar at Johns Hopkins. Her professional interests include 20th century U.S. political, business, and economic history. She’s also the author of Ensuring America’s Health: The Public Creation of the Corporate Health Care System, which was published in 2015.______________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Mitch Belkin and Daniel Belkin speak with Dr. Jason Ryan, the creator of Boards and Beyond. We discuss how he started Boards and Beyond, what aspects of medical education are in need of reform, and why he is bullish on med ed entrepreneurship. In this episode, we cover Dr. Ryan's background, his roots in chemical engineering, and how he decided on internal medicine and cardiology. We delve into how Dr. Ryan started Boards and Beyond, as his first entrepreneurial venture in 2014. He discusses why and how he began the medical education company, how he incorporates feedback into the product, as well as the difficulties he has encountered running the business. We touch on problems with standardized testing, how residency programs evaluate applicants, and why attendings struggle to evaluate medical students. Finally, we discuss how to reduce costs in medical school and the difficulties medical schools have in finding medical preceptors.Who is Jason Ryan?Dr. Jason Ryan is a general cardiologist and an Associate Professor of Medicine at the University of Connecticut. He received his MD and MPH from University of Connecticut before completing his postdoctoral training at Harvard’s Beth Israel Deaconess Medical Center in Boston. Dr. Ryan is a gifted medical educator and the creator of Boards and Beyond, a video subscription service that provides a comprehensive review of USMLE Board topics. References:Boards and BeyondTwitter @jasonryanmd ______________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Mitch Belkin and Daniel Belkin speak with Rick Johnson, MD, about how his views on fructose metabolism have evolved over the past decade. If you haven’t checked out Episode 9 with Dr.  Johnson, check that out for more background.In this episode, Dr. Rick Johnson talks about endogenous fructose metabolism, the thrifty gene hypothesis, fat as a source of metabolic water, dehydration and how it stimulates fat production, as well as the relationship between uric acid and bipolar disorder. He also talks about how alcohol-induced liver disease is actually mediated by fructose. Finally, he argues that fructose metabolism is a significant contributor to Alzheimer’s disease.Who is Rick Johnson?Dr. Johnson is a Professor of Nephrology at the University of Colorado School of Medicine. He is one of the world’s leading experts on fructose. His research focuses on the role of fructose and uric acid in obesity, diabetes, hypertension, and kidney disease. He is the author of over 700 academic papers as well as three books for a general audience: The Fat Switch, The Sugar Fix, and most recently Nature Wants Us To Be Fat.References:Dr. Johnson’s websiteMost recent book: Nature Wants Us To Be FatUric acid metabolism in Manic Depressive Illness with Lithium Therapy (The Lancet, 1968)History of Lithium Therapy (Bipolar disorder, 2009)Double blind, placebo controlled study on allopurinol as an adjuvant therapy in treating bipolar disorder (Eur Neuropsychopharmacol, 2014) ______________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this conversation, Mitch Belkin and Daniel Belkin speak with Nikhil Krishnan about his healthcare newsletter (OutofPocket), why he’s optimistic about healthcare startups, and what he’s learned from investing in health tech companies. He talks about his preferred business models and gives advice to healthcare entrepreneurs on the zero-to-one phase of startups. They also discuss direct-to-physician and direct-to-consumer advertising of pharmaceuticals, digital therapeutics, unbundling of the hospital, and touch on medical education.Who is Nikhil Krishnan?Nikhil Krishnan is a prolific blogger and masterful meme-maker who writes about healthcare. He’s the author of a free newsletter (outofpocket.health) on which he tries to make healthcare and changes in the industry accessible. Previously, he worked at TrialSpark, building a new way to run clinical trials faster and cheaper, and CB Insights creating data driven research trends in healthcare. He is the author of a children’s book and a Medical Bankruptcy Game.References:Outofpocket.healthtwitter @nikillinitMedical Bankruptcy: The GameIf You Give a Mouse Metformin______________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this episode, Mitch Belkin and Daniel Belkin speak with Robert Montgomery, MD, DPhil, about his background, family history of cardiomyopathy, as well as his work in immunology and transplantation. They discuss the 3 types of organ rejection, how to manage and prevent rejection, porcine endogenous viruses, as well as Dr. Montgomery's work on xenotransplantation. This podcast was recorded on February 4th, 2022.Who is Robert Montgomery?Dr. Robert Montgomery is a Professor of Surgery and the chair of the Department of Surgery at NYU Langone as well as the director of the NYU Langone Transplant Institute. He received his MD from the University of Rochester School of Medicine and completed his surgical residency, multi-organ transplant fellowship, and post-doctoral fellowship in Human Genetics at Johns Hopkins. He also received a Doctorate of Philosophy in molecular immunology from the University of Oxford. He’s been the recipient of many awards including the Johns Hopkins Clinician Scientist Award, the Champion of Hope Award from the National Kidney Foundation of Maryland, and the Terasaki Medical Innovation Award from the National Kidney Registry.Dr. Montgomery developed the first laparoscopic kidney procurement technique for transplants as well as the first “domino paired donation” -- which is when two or more donors and recipients are paired in a kidney swap. He helped develop a protocol combining kidney and bone marrow transplants to prevent rejection of donor organs in immune-incompatible patients which has eliminated the need for immunosuppressive therapy in some patients. In September 2021, Dr. Montgomery performed the first xenotransplantation of a nonhuman kidney to a deceased human donor.References:Robert Montgomery - Wikipedia pageNYU article on Dr. Montgomery Dr. Montgomery - Review of HLA in transplantationWashington Post article on UMD xenotransplant patient (2022)Carmen - Full Opera - with English Subtitles______________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon

In this episode, Mitch Belkin and Daniel Belkin speak with Ben White about his background and reasons for selecting radiology. They discuss ways to improve radiology residency training and medical school education. They briefly touch on physician shortages, Dr. White’s blogging at BenWhite.com, and his nano-fiction project (Nanoism).Who is Ben White?Dr. Ben White is a practicing neuroradiologist and an Associate Program Director at Baylor University Medical Center. Dr. White obtained his Medical Degree from University of Texas Medical School at San Antonio before completing a radiology residency and neuroradiology fellowship at UT Southwestern Medical Center. He’s a prominent blogger at BenWhite.com, the editor of a nano-fiction website, and the author of three books, including a free book on student loans.  References:Personal Blog: http://benwhite.com/Twitter: @benwhitemdNano Fiction Project: ​​https://nanoism.net/Free Book on Student Loans______________________What is the External Medicine Podcast?The External Medicine Podcast explores some of the most exciting ideas in medicine. Co-hosted by Daniel Belkin, MD, and Mitch Belkin, MD.Support the showFollow us at @ExMedPod Subscribe to our Youtube channelConsider supporting us on Patreon