18 Episode results for "tetracycline"

GSMC Health & Wellness Podcast Episode 289: Antibiotics

GSMC Health and Wellness Podcast

1:15:45 hr | 1 year ago

GSMC Health & Wellness Podcast Episode 289: Antibiotics

"And you want to be healthier. You just don't know what to do all these shows telling you this and that but nothing seems to work will listen close. Golden state media concept has got something great for you the health and wellness podcast dedicated to work. Trent healthy eating habits die and everything about healthy. Living join us in our banters as we help you not just live life to the fullest live it to the healthiest awesome to them. Gsm podcast brought to you. Betta GSM see podcast network. I'm your host Alex Today. I want to talk about antibiotics. We're going to talk about what they are. What they treat the types of bacteria as well as antibiotic resistance side effects and even anti biotic allergies. So I sat and as usual. Let's go ahead and define what it is. We are precisely discussing. So what are antibiotics? The word antibiotics means life killing more or less and it's referring to any type of substance that stops the growth and replication of bacteria or even kills it outright so it's a type of anti microbial railing that specifically targets bacterial infections in or on your body so that makes antibiotics a little bit different from the other main types of antimicrobials like anti fungal. 's which are you guessed? It meant to treat fungal infections. So antiseptics are also an anti microbial and they're used to sterilize surfaces of living tissue like your skin when you have a high risk of infection like during surgery disinfectants on. The other hand are nonselective antimicrobials. So they can kill a whole host of microorganisms including bacteria so they are used on non living surfaces like in hospitals or for your countertop in in your kitchen or even for cleaning your bathroom while bacteria aren't the only microbes that can really hurt us. I do mostly focus on those today. Fungi and viruses can also be dangerous to humans but those are targeted by anti fumbles in antivirals. They specifically need the light killing agents. That are specific to them. You cannot really treat the cause of a fungal infection with an antibiotic nor can you treat a viral infection like Kobe. Nineteen with an antibiotic we need specifically substances that target bacteria when we are using antibiotics so the name anti microbial as just the hierarchical term that covers all of these things it covers antifungal. Antiviral et CETERA. But antibiotic is underneath this umbrella as well. A lot of antibiotics have been found in nature but many today are produced in laboratories based off of those that have been found in nature so for example some microbes specifically kill other nearby bacteria to get an advantage in competing for resources but other microbes just produce antibiotics in the laboratory. So how do these work well? There are two main ways the antibiotics target bacteria. The either prevent the bacteria from reproducing. Or they go ahead and kill. The bacteria like by stopping their mechanism for building their cell walls. They're very specific. Antibiotics that are specialized to be effective against specific bacteria and there's also broad spectrum antibiotics that attack a wide range of bacteria although that can sometimes mean that they're also attacking the ones that are beneficial to us. Antibiotics are really important for us though because they have also revolutionized medicine and the way infectious diseases are treated between nineteen forty five and nineteen seventy to the average. Human life expectancy increased by eight years because antibiotics were being used to treat infections that previously had just killed patients today. Antibiotics are very common class of drugs used in medicine and they make a lot of complex surgeries pretty routine all around the globe. If you ran out of antibiotics then modern medicine would be set back by decades even really minor surgeries like appendectomies could become life threatening because they were before antibiotics were really available to us to be used in these day to day or routine treatments. So it's really important that we have these nowadays but also sometimes antibiotics can go awry so it's important that we use them appropriately. There is sometimes used in limited numbers of patients before surgery to make sure the patients don't contract any infections from bacteria entering open cuts and without that precaution they could get a larger risk of blood poisoning and a lot of these complex surgeries. Wouldn't be possible if you've grown up in the US and you've been ill. At any point you have likely been prescribed antibiotics and it may be confusing sometimes when you go to the doctor and they give you antibiotics for what you feel is the same thing you had lost time like a sore throat. And you're like okay. This feels like strap. Can I go ahead and have antibiotics for this and they tell you know that it's not called for in this case and I get the hell that can be confusing. I have had tonsillitis strep throat viral pharyngitis and has been in those shoes before. And I'm like doc what is going on. Why is this different from last time? That usually comes down to the different causes that can result in symptoms like sore throat. It may be bacterial or viral. So for things like strep throat strep throat is caused by streptococcus bacteria and that is always what strep is caused by so you get antibiotics for strep throat. Whooping cough and urinary tract infections are also caused by bacteria so in those cases you need the antibiotics however things like the common cold the sore throat except for strength and the flu are generally caused by viruses. And you're not going to need antibiotics. That however there are some illnesses that straddle that line and they may be caused by bacteria or viruses. So if you have a sinus infection or a middle ear infection then that made the bacterial or viral. So you might need antibiotics. But your doctor might not want to prescribe those in case it is viral so that you're not contributing to the development of superbugs or creating any antibiotic resistance in your body bronchitis and chest colds and otherwise healthy folks may also be caused by bacteria or viruses. But you generally don't need antibiotics for those because they done a lot of studies and found that an otherwise healthy children and adults antibiotics for. Bronchitis won't actually help any better so a lot of times when you are sick you just WanNa feel better as quickly as possible but a lot of times the only option maybe to just ride out the symptoms or to us over the counter meds to target the specific symptoms. You can't necessarily treat the cause of the virus most of the time you just have to treat the symptoms and I know guys. It's a big cover when you have stuff nose and cough keeping you up late at night. But it's really important to not demand antibiotics doctor. If you have a viral infection it will work for one and for two it can give you some side effects. That can hurt you so. In addition to creating resistant bacteria you can also get a lot of side effects like diarrhea. It can also kill some of the good bacteria in your mouth and the rest of your body and result in the development of Candida overgrowth in your mouth and your armpits anywhere on your body that may be moist anywhere. That sweats as well. So there's a lot of your body that could be overgrowing with Canada and that's when you get those yeast infections. I know a lot of times folks into think. Okay well. It might just make some antibiotic resistant bacteria. But what does that really mean? Well it means that at least two million people a year in the US. Become infected with antibiotic resistant. Bacteria like Mersa and at least twenty three thousand die as a result of it so overuse and misuse of antibiotics can actually cause a lot of problems. And sometimes you're going to have a sinus. That's bacterial in nature. And other times it may be viral. So they're not able to tell just from having sinus infection and symptoms alone whether it's viral or bacterial doctors going to ask you questions about how long you've had the symptoms and whether the symptoms have started to improve on your own or with symptom relief medication after about five to seven days if they have the nets a good chance that it's viral but if your symptoms are occurring for ten days or longer or they're getting worse after initially improving. There's a solid chance that there may be bacterial involvement in in that case. You may need an antibiotic prescription so to help your doctor. Select which is the most likely cause of your illness. It's important to keep track of those symptoms and any fluctuations in them and communicate them accurately. You don't want to develop antibiotic Resistant Bacteria. And you don't want to be treating a virus with an antibiotic. Scientists are conducting ongoing studies to examine the way we prescribe antibiotics. The way we take them and how that is going to impact the prescribing of antibiotics in the future. We're going to go on a quick break and when we come back we're going to talk about the types of bacteria that antibiotics treat stay. Do you really can't underestimate the importance of having the right creative work for your brand or your product whether it's a logo a website book cover or an ad campaign. You really need a quality design to make that big difference pop and deliver your overall engagement and success in a competitive market. Where design crowd comes in design? Crowd has over seven hundred and fifty thousand designers from Sydney to San Francisco. Ready to help you with awesome creative ideas. They make crowd sourcing work free. Oh so if you need a logo or you're working on your creative branding you can go to design crowd dot com and post the brief describing the design you need and then within about two two seven days you'll receive up to over a hundred different designs from designers around the world. Then you pick the best design and approve payment to the designer. So you're only paying for the design that you want it takes a lot of the guesswork out of freelancing an out of crowd sourcing and you don't have to be a huge company like Harvard business school to use design crowd although they have used it as well you can start a project on design crowd for as little as ninety nine dollars and if you go right now to design crowd dot com forward slash health and wellness where enter the Promo Code Health and wellness on their website. Our health and wellness listeners will receive up to one hundred fifty dollars off of your design. Project designed crowd dot com forward slash health and wellness. We're entering that Promo Code Health and wellness. Are you looking to learn more about the latest trends from the fitness world? Are you confused by all the different trends that are out there the GS MC fitness? Podcast is the place for you. The MC fitness podcast is the place to come for people of all skill and interest levels. Join us as we explore the latest trends in the fitness world. Does that new exercise really work. Should I try yoga? Whatever your question. Chances are good. You'll find an answer on the GMC fitness podcast before the break we were introducing the topic of antibiotics. What they are and when they're needed now we're going to talk a little bit about the types of bacteria. Antibiotics act against as well as how antibiotics act so I up there. Too broad classes of bacteria those are termed gram positive and gram negative. So they get their names from something called the Graham tests and that's where you introduce violent colored die to the bacteria gram positive. Bacteria are going to keep the color of the die when you put it through the bath but the gram negative bacteria. Don's so they will instead be colored red or pink. Now why do we care about this? And why are we dying of bacteria? Well gram negative. Bacteria are more resistant to antibodies and anti-biotics then gram positive backtra. And that's because gram negative. Bacteria have a largely impermeable cell wall so the bacteria are really resistant to the antibiotics getting through already. They essentially have really solid castle walls and kind of a moat around them. At that point it's an impenetrable fortress for the most part the bacteria responsible for Mersa an acne are gram positive bacteria. Those are more capable of being penetrated but those responsible for lime disease and pneumonia are gram negative bacteria those ones with the fortresses with the gram positive bacteria it has a really thick wall. It's a layer called Pepsi Guy. Ken and its poorest though. So think of essentially having a castle walls or a fortress that you have set up but it has a lot of sewer passages to the outside so a lot of different substances or humans could infiltrate it at that point. You could crawl through the sewer tunnels and get into the fortress. It has a lot of entry points in this. Chorus glide can layer gram negative bacteria however have a thinner? Pepco glacken layer and they also have a second outer membrane so that porous pets. Gleich and layer is a lot smaller in the gram negative bacteria. That's a lot stronger. And it's protected by an outer wall so you do also have that same layer but there is an additional layer protection beyond that that it can't get into so that stronger less porous outer membrane of gram negative. Bacteria is a really solid barrier. Eight helps prevent the passage of large molecules into the cell including antibiotics gram positive tirrenia on the other hand gives greater access to the antibiotics so since it has a more permeable or a more porous membrane. It's easier for the antibiotics to penetrate the cell or even interact with the pets liken itself because it's on the outside of the gram positive bacteria whereas it's protected by the outer membrane in gram negative one so those very specific types of antibiotics that are geared to act words. Specific type of bacteria are effective against either gram positive or gram negative bacteria. They're called narrow spectrum antibiotics because they're targeting a very specific type whereas broad spectrum antibiotics can be used for both so not all gram positive or gram negative. Bacteria are affected by a single antibiotic. And that's because the antibiotic bacterial target interaction has to be specific. We need to know whether the bacterial species has the target in question and whether the bacteria are resistant to that particular antibiotic as we mentioned in our first segment. There are two main mechanisms by which antibiotics really impact bacteria. One way is to kill the bacteria and that's called being bacteriocidal so just like homicidal it means to kill but homicide all means to kill humans whereas bacteriocidal means to kill bacteria so we just outright kills them whereas the bacteria static. Antibiotics are the ones that? Stop them from reproducing. So it gets to a certain point. And then the bacteria can't reproduce anymore and they live out their lives and then die without having any to take their place and in that way it kills out the population just by inhibiting reproductive growth. Most antibiotics have a consistent antibacterial effect so by that. I mean they are normally either bacteriocidal. Bacteria static like Beta LAXMAN'S. Those are almost always back to recital. And that is the class that includes like penicillin and stuff however the activity of classes of antibiotics can depend on the dose prescribed. And how long the treatment lasts so for certain types of antibiotics. They may be bactericide normally but instead if you use them at a low concentration they may just be. Bacteria static and that can still effectively remove the bacterial infection from your body. It just depends on what does and how long of a treatment your doctor determines that you need. That's also why it's important to follow your doctor's instructions regarding the course of antibiotics that you're taking and how they tell you that even if you're feeling better you should continue taking your antibiotics now. Some doctors disagree at this point as to whether that is truly necessary or not and really it may come down to a case by case basis but for example. If you're using a bacteria Saddik antibiotic and so you had those bacteria multiplying reproducing in your body and then you added that antibiotic in and they plateaued so. They're not reproducing anymore. There are no additional bacteria and the old ones are just dying off and not being replaced. Then you may start feeling better however if you go ahead and stop taking your antibiotic at that point and you still have the bacteria in there then. They may start reproducing again. Once the agent the antibiotic that was preventing their reproduction is removed. Because you're no longer taking it. That's because these bacteria static. Antibiotics are also working in tandem with your immune system so the antibiotics are stopping the growth reproduction of the bacteria but the cells are still actually able to reproduce if they should need to so. If you take the antibiotic away then they can go ahead and reproduce again. Really what it's doing is just halting the course of the reproduction. So that your immune system has time to really be activated and target the bacterial pathogen to be removed from the body. As we discussed in our episode on the lymphatic system. Bactericide antibiotics on the other hand. Kill any susceptible bacteria while they are exponentially growing and therefore cure the infection. In that way. It's not acting so much as a tag team with your lymphatic. Immune system components. It's rather interesting how it works and for a long time. We've mostly been using microscopic studies in order to examine how this really works in microbiology. Labs but now we also can use machine learning which is pretty cool so most antibiotics work by interfering with critical functions like DNA replication for reproduction or constructing the bacterial cell wall but those mechanisms are really only part of the full picture of how Antibiotics Act a recent study with MIT developed. A machine learning mechanism to discover additional ways that help antibiotics kill bacteria so this new mechanism involves activating the bacterial metabolism of nucleotides that the cells need to replicate their DNA so nucleotides are those building blocks of DNA this activation of the bacterial metabolism of nucleotides is very similar to how the processing of alcohol works in the body so when your liver processes alcohol it creates that ass ital- to hide and that can be toxic as it builds up in the body. But it's part of that process very similarly win. The bacteria are exposed to the stress caused by the antibiotics. It causes a lot of energy demands and win that metabolic response occurs some of those metabolic by products are toxic and also build up and contribute to killing the cells similar to how the asset aldehydes itself can be sometimes more toxic than the alcohol. That's initially introduce and how amyloid Beta builds up in your brain and can cause a lot of problems as those fragments clump together and aggregate in a toxic way building up until neuro. Communication is impeded. So we've really seen this process before as we have discussed hangovers in. How alcohol is processed in your liver. And in our discussion on the lymphatic system specifically in the component on the lymphocytic system within our brains so this machine learning application to microbiology is really important because it tells us that if we can make these bacterial cells more energetically stressed out then we can also in turn cause more metabolic activity and effectively make the bacteria poison itself and subsequently make antibiotics as they are more effective so they use this method of machine learning for E. Coli and antibiotics initially but they're also hoping to use it in the future to study. How different types of drugs affect diseases? Like cancer diabetes or neurodegenerative diseases they are using a similar approach right now to study how to. Berko survives antibiotic treatment and becomes resistant to antibiotics. It's very promising in the medical field. We're GONNA go in a quick break and when we come back. You're going to discuss antibiotic resistance how it happens. And some mechanisms in which it may happen in different types of antibiotics stay to. You really. Can't underestimate the importance of having the right creative work for your brand or product whether it's a logo a website a book cover for an ad campaign you really need a quality designed to make that big difference pop and deliver your overall engagement and success in a competitive market. That's where design crowd comes in design. Crowd has over seven hundred and fifty thousand designers from Sydney to San Francisco. Ready to help you awesome creative ideas. They make crowd sourcing work for you. So if you need a logo or you're working on your creative branding you can go to design crowd dot Com and post them wreath describing designing and then within about two seven days you'll receive up to over a hundred different designs from designers around the world. Then you pick the best design and approve payment to the designer. So you're only paying for the design that you want it takes a lot of the guesswork out of freelancing and out of crowd sourcing and you don't have to be a huge company like Harvard Business School Use designcrowd although they have as well you can start a project on design crowd for as little as ninety nine dollars and if you go right now. Senior design crowd dot com forward slash health and wellness for enter the Promo Code Health and wellness on their website. Then our health and wellness listeners will receive up to one hundred fifty dollars off design project. That's designed crowd dot com forward slash health and wellness or entering that Promo Code Health and wellness. Tired of searching the vast jungle of podcasts. Now listen close here this out. There's a podcast network that covers just about everything that you've been searching. The golden state media concepts podcast network is here nothing less than podcast bliss with endless hours of podcast cupboards from news sports music fashion looking entertainment fantasy football and so much more so stop lurking around and go straight out to the Golden State Media. Podcast network guaranteed build. That podcast is whatever it may be visit us at. Www DOT g MC PODCAST DOT COM. Follow us on facebook and twitter and download on itunes soundcloud and Google play. Not before the break we were discussing. How gram positive and gram negative. Bacteria react differently to antibiotics and specifically how bacteria Seidel am bacteria static. Antibiotics tend to provoke reactions in bacteria as well as some recent studies performed by. Mit regarding new ways that antibiotics may actually act on bacteria. Now we're going to go ahead and talk about antibiotic resistance how it happens and different ways that it may work so antibiotics are medicines that are used to kill bacteria and over time. Some of those germs can adapt to them remember. Antibiotic NEEDS TO ESSENTIALLY KILL LIES. So bacteria are considered to be lifeforms and they are able to grow and reproduce so that means that they can also adapt so that's part of what's required to be considered alive or to be considered a life form. There are about seven main characteristics that living organisms share to be determined to be living organisms. One they have to respond to their environment to they have to be able to grow and change three. They have to be able to reproduce and have offspring four. They have to have complex chemistry five. They have to be able to maintain homeostasis six. They need to be built structures called cells and seven. They need to be able as a species to pass their traits onto their offspring so humans are able to do all of those things and we're living organisms but so are bacteria. We talked earlier about the complexity of gram negative bacteria in how they have kind of a fortress around them. There's definitely a complexity to them. They're able to reproduce. That's why we attack them with bacteria static types of antibiotics to stop their reproduction. That's why we also treated with. Bacteria seidel types of antibiotics so we can stop their growth and changes so they can't create their cell walls. They are built of cells. Which is how they have cell walls and they're able to respond to their environment and pass their genes or traits onto their offspring. So that's really what antibiotic resistance comes down to just like humans can mutate in our genetic structure and pass our genetic traits onto our offspring so can bacteria but bacteria have much briefer wife spans than we do and so they're able to cycle through a lot of genetic change on a much quicker scale than we are able to for humans. Evolution takes millions of years but for something like bacteria these genetic mutations can rapidly occur to put this in perspective bacteria divide about once every twelve minutes to once every twenty four hours depending on the specific type of bacteria so that means that the average life span of a single bacterium just one back Tiriac organism as about twelve hours or so so our life span is about seventy five years or so in the US the average life span but was bacteria their life. Span is only about twelve hours so they are living their entire lives growing reproducing passing on those genes in twelve hours think about how exponentially quicker their growth and development and therefore evolution may be so they're able to evolve at a much more rapid rate than we are able to and that means that they're able to mutate a lot more frequently and they are able to replicate a lot more frequently. They're able to pass on a lot of jeans. And anytime cells defied mutations may occur and since they can respond to their environment. That means that these mutations may also occur in response to their environment meaning exposure to antibiotics so most microbes are harmless or even helpful to humans but some can cause these infections and when we treat them with antimicrobials like antibiotics in a manner that is not correct so it's either overuse or misuse of these antibiotics. Then you normally. You're on antibiotics for about a week or so a week to ten days. Think about how. Many bacterial cells are in your body replicating at that point. I don't WanNA freak you out. I just think it's very remarkable as to how long we are supposed to be on these antibiotics and how long a lot of people actually are on them when they just start feeling better in so stop taking them against doctor's orders so that is how these antibiotic resistant bacteria can develop. They're just responding to their environment. Like we are but their time scale is exponentially quicker than ours in any if you become resistant or rather. The bacteria become resistant to some types of antibiotics. Then you're going to have to try to find another antibiotic that can treat that specific type of bacteria. Antibiotics also tend to kill good bacteria in your body that can protect you from other types of infections. Look Cantina infections. We discussed earlier antibiotic resistant. Germs can also multiply so that means that they can also pass down there antibiotic resistant genetic components to other germs. And in once those antibiotic resistance genes really emerge. It can spread to new settings it can spread to new countries. You never know who you're coming in contact with who may contract what you have in. Take it to someone else. Very similar to what we're experiencing with Kobe. Nineteen although that is a virus. The same principle applies as they both will replicate and they are essentially invisible since they are microscopic. They're invisible to the naked eye and we don't all walk around with microscopes on her is so in order to deal with this antibiotic resistance we need to understand the underlying mechanisms which is why folks like the MIT researchers were examining the way the antibiotics actually works. If we understand the why then we can develop better ways to utilize the tools at our disposal so there are a few different resistance. Mechanisms or defense strategies get antibiotic resistant. Bacteria will use so these germs might change their entryways or limit. The number of entryways and for example gram negative bacteria have the outer layer called that membrane that protects them from their environment and they can use that membrane to selectively keep antibiotics from entering through that barrier. They can also get rid of the antibiotic it. Sounds wild. But they're living organisms. They're able to do that so they can use pumps and their cell walls to remove antibiotic drugs that are in the south so some types of pseudomonas bacteria can produce pumps to get rid of a bunch of different types of antibiotic drugs including some Beta lacked. Like what penicillin is as well as Corum cynical and Trimester Prim? Other ways are changing or destroying the antibiotic with enzymes remember. Enzymes ARE PROTEINS. That breakdown other types materials. They can also bypass the effects of the antibiotic by developing new cell processes that avoid using the antibiotics target so some strains of the bacteria staphylococcus aureus can bypass drug effects of tra- method prim. And the last time is by changing. The target for the antibiotic so a lot of antibiotics are designed to seek and destroy specific parts targets of a bacterium but the bacteria can change the antibiotics target. So that the antibiotics can no longer fit and no longer do its job. So the E. coli bacteria for example that has the MC are one gene can actually add a component to the outside of the cell wall so that the drug can't attached to it. It's wild the different mechanisms that bacteria have developed in response to their environment including antibiotics at the end of the day. They're really just defense. Strategies as these other living organisms are trying to stay alive even as we are trying to kill them. We're going to go on a quick break. And when we come back we are going to talk about how this works in specific types of antibiotics and continuing this discussion about antibiotic resistance including at risk for it stay tube. Gsm Seen Life Than Happiness. Podcast takes you. On a journey of exploration we'll discuss tried. And true methods alongside the latest Rennes of how to death. Live your life to its fullest happiest from psychology meditation science to self help books the GS MC. Live in happiness podcast. We'll help you to discover what makes you happy and how you can live live being the best possible. Download the GMC life and happiness. Podcast on Itunes Stitcher soundcloud. Google play or anywhere. You find podcast just tie. Gmc in the search bar and chorus embrace. We were discussing the mechanisms by which bacteria can become resistant to antibiotics now. We're going to discuss how this happens in specific types of antibiotics so as we discussed earlier Beta lack. Dems are a type of antibiotic. It's the type that penicillin falls under so all Beta lack. Some antibiotics have something called a Beta lacked him ring so penicillin mock Cephalosporin. 's those all have. Beta lacked and rings but bacteria can develop resistance to Beta lack dems in a few different ways including producing enzymes to break down that ring. Amino Gleich asides tend to work by stopping bacteria from synthesizing proteins. And that eventually leads to the cell dying in treating regularises streptomycin and Gleich aside was one of the first drugs that was effective but because of issues of toxicity with Amino glauca sides. They don't use them a lot today anymore. So we're having to try different types of antibiotics and go from there. But we're having a lot of antibiotic resistant issues with Similarly so found him is used to be used. But we're no longer able to really use those partly because they developed bacterial resistance but also because they damaged patients livers so both far nights and amino acids don't really get used a lot today because they are more likely to harm you as a side effect tetracyclene on the other hand are broad spectrum antibiotics and are useful against both gram positive and gram negative bacteria and it's one of the more common types of antibiotics however we're having to decrease using them now because more and more bacteria are becoming resistant to tetracycline. They are still using them to treat. Acne. Ut is in respiratory infections as well as Columbia infections. Chloramphenicol-free is another broad spectrum antibiotic and it tends to act by stopping protein synthesis as well and that therefore inhibits the growth in reproduction of the bacteria but there are possible serious toxic side effects. And they don't use this now unless the infections are deemed to be more life threatening really than the actual medication but it is considered a more common antibiotic in developing countries because it is low cost and more widely available. So it's also used when socio economic concerns are an issue macro lives are also very commonly use and their effectiveness is a little bit broader than that of the penicillins and macaroni and have been shown to be effective against several different species of bacteria that penicillin is ineffective against so some bacterial species have developed resistance macro lines but they are the second. Most commonly prescribed antibiotics with Arith- reminding being one of the most commonly prescribed in that class of macro lives. There are many other types of antibiotics with varying bacterial resistance. But those are some of the big ones I wanted to touch on today with you guys to give you an idea of how effective certain types of antibiotics are in different mechanisms. This does not mean that you should go to your doctor and say hey. I don't want Beta lack soms because they all have a battle-axe reading and bacteria can develop resistance to them. Give me a MAC relied and said that's not what I'm getting at. I just want you to understand why your doctor might prescribe a certain type of antibiotic and how antibiotic resistance comes about in general and therefore the importance of taking them as prescribed by your doctor. I also now go ahead and talk about who is at risk for antibiotic resistance. Show with antibiotic resistance the more people who use antibiotics. The more likely that resistance is going to occur in the population. Sometimes folks use them when they don't need them. You definitely don't need them. If you have a virus. They do not work that way. So like bacteria viruses can invade your body and causing infection but treating. A virus with an antibiotic isn't going to fix it anymore than treating a bacterial infection with cold and flu medication. Like trying to treat strep throat with cold and flu medication. That's not going to work either and it can actually raise your risk for antibiotic resistance if you take antibiotics when you don't need them now not taking all of your antibiotics also raises your risk. If you stop taking it too early you might not kill all bacteria and the rest of the germs may become resistant. Which means you can't pick it back up again later on a lot of these drugs work by making sure that you have them in your body at the same time each day so that you're maintaining a baseline of this type of pharmaceutical to keep combating the bacteria so if you give them a break remember. Their life cycle is only twelve hours long on average. Some are even shorter than that and therefore are reproducing at an even more rapid rate. So it's important to make sure that you keep taking it as your doctor prescribes if you are feeling better in like you might not need to take it anymore. Concert doctor and ask if it's okay to quit that particular type of antibiotic it that point or if they feel that you can continue taking it. Antibiotic Resistant Infections. Also tend to spread in the same ways as non resistant bacteria so even though they are now tucker they are not having any trouble spreading somebody who's infected with the bacteria or may just be a carrier they may just have it on the skin could touch an object remember from our previous discussions on disinfectants. We call those non living objects foam lights so like a door handle or a cut. And then when you touch that object the germs can into your body either through a cut in your skin or with you touch your face. And then he's infections can also spread win you sneeze or cough respiratory droplets. Other types of bacteria can spread through sharing food with an infected person or having sexual contact with them so to help prevent the spread of any bacterial infection. You should always wash your hands thoroughly with soap and water. Remember for that at least twenty seconds. Don't share food or beverages with others. I know that's not practical especially for all of you. Parents out there little ones are always gonna go and sneak up from Your Cup as soon as you turn around because it's yours when they feel that you have something nice because they are not allowed to have it so I get that your kids are GonNa Wanna eat your food and stuff. There's no getting around that. That's how they get a sick. It's just what it is. Do your best. Though in that regard when I was an Undergrad almost the entire anthropology department got mono because most of us were eating after each other and we were in close quarters all of the time just studying in the lab. It was a mess. You guys I had mono strap and the flu all at the same time. That was kind of a nightmare. You should have seen my lymph nodes. They were the size of eggs. The doctor literally touched my neck in their hand back. They were so freaked out. It compromises their bedside manner so it was not great. Sir Try not to share food beverages with people. You're not already intimately associated with whether that the nuclear family members or your partner also practice safe sex. Make sure that you are being safe. Because bacteria can spread in many different ways. Cover your mouth with a tissue or with your elbow when sneezing or coughing. Don't touch other people's wounds without gloves and don't share personal items like razors towels brushes. If you're going to wash your hands and shared services said go ahead. Use Plain soap soaps with antibacterial ingredients. Don't really help. Stop the spread of infection in a home setting and it can also contribute to antibiotic resistance if you think you have an antibiotic resistant infection than you should. Go talk to your doctor. They may take a sample of the infected tissue and send it to a lab to figure out what specific type of infection you have. They can also perform tests like those gram staining tests to determine whether it's gram positive gram negative bacteria and indicate which type of antibiotics can kill the germs. They may also perform that type of phenol. Tash I discussed with you guys. In previous episode where they're determining the female factor to see what all is effective against this new antibiotic resistant bacteria and Biwott Measure. There are a ton of tests that they may run but those are some examples of some things that they're looking for so you might have an antibiotic resistant infection if you don't get better after treatment with standard antibiotics as well so go ahead and talk to your doctor after antibiotic treatment has been taken correctly consistently and you took the course all the way through but you are still sick even if you messed up and you didn't take it appropriately and you still have the infection. Go talk to your doctor. You can get that handle before it gets worse. If you haven't antibiotic resistant infection. The treatment for that can vary. You might get prescribed another antibiotic to fight it but you might have more side effects or more of a risk of promoting resistance. In some cases your healthcare provider might not have another option. But they may you never know until you ask to prevent antibiotic Resistant Infections. Don't take antibiotics for things. That are the result of viruses. Don't save an antibiotic for the next time you get sick. Take your antibiotics exactly as they're prescribed. Don't skip any doses complete the full course of treatment unless your doctor says otherwise. Don't take an antibiotic prescribed for someone else. It won't necessarily treat specific issue that you have you also want to make sure that you only take antibiotics as prescribed so talk to your doctor about it. Make sure you're following along with recommendations if they do tell you that it's bacterial and that you need an antibiotic do go ahead. And take that before. The bacteria reproduces and spreads more. You want to target that medicine as soon as possible to the specific type of Victoria involved. All right we're GONNA go on a quick break and when we come back. We're going to talk about intense Side effects. Are you tired of the same old news or are you sick of the seemingly endless political spin negatively the Diaz? Empty America's still beautiful. Podcast is a weekly news. Podcast covering all the top positive and uplifting you stories we cover stories that will inspire uplift and remind you love the good in the world tune into the golden state media concept. Americans don't beautiful podcast to get all the great and positive news stories of today. Download the GS empty. America's dill beautiful podcast on. Itunes stitcher soundcloud Google. Play or anywhere. Podcast just tight just MC in the search bar stuck in the of fewer talking about antibiotic resistance some ways that bacteria become resistant to specific types of antibiotics as well as issues. That may make you more likely to develop an antibiotic resistant infection and how to prevent and treat those now. We're going to talk about antibiotics side effects. So the most common side effects in antibiotics tend to affect your gastro intestinal system your digestive system in about one in ten people. Get these side effects. These side effects may include vomiting nausea diarrhea bloating and or indigestion loss of appetite and even abdominal pain so those side effects are usually mild. And Pass once you finish your course of treatment but if you get extreme amounts of these symptoms so you're having debilitating stomach cramps. Abdominal pain or diarrhoea. That's just not stopping. You definitely need to contact your doctor to ask for advice if you get any additional side effects. Talk to your doctor about it. Some of these side effects can also be prevented by taking probiotics whether you take those in capsule form or you get them naturally through something like unsweetened Greek yogurt. You can go ahead and get some probiotics to help you out with that. And they helped the natural bacteria in your body to flourish. And that's part of the reason that you get. The diarrhea sometimes is because the natural bacteria. Your body are also being killed by these broad spectrum antibiotics and when that happens you are having an imbalance in your body's microbiome in your body's ecosystem and so it's really important to restore that because there are good bacteria that keep Candida and other types of microorganisms in your body in check so if they are eliminated from the body it can cause gastro intestinal distress. Remember that most of the bacteria in your body are in the lower quadrant of your intestines. So that means that if you're having diarrhea your washing most of that good bacteria out of your body as well medications like Tetris. Cycling's can make you sensitive to light and by that I mean your skin so I have gotten a sunburn before from taking Tetra cycling. I didn't really think it was going to happen. It seems so strange. I was just driving from work to my house but I don't have tended windows in my car and so the Tetra cycling's made my skin more sensitive to sunlight. It can also make it sensitive to artificial sources of light like Sun Lamps and Sun. So if you are on tetracyclene do not go to tanning bed. It's really dangerous for you and you should also not lay out. It can really hurt body. It was very unpleasant and unexpected even though it was on the label. So you think it won't happen to you. But sometimes it does other types of antibiotics leg. Fluoroquinolone can also cause severe aches and pains can include disabling long-lasting or even permanent side effects that affect your joints muscles and nervous system. But those are in very rare cases. However if you are on fluoroquinolone 's and you are starting to get tendon muscle or joint pain typically in your knee shoulder or elbow or if you're getting tingling numbness that pins and needles feeling in your body stopped taking those right away and go see your doctor that is what the national health services in the UK recommends. Make sure that you are seeing a doctor. I am not a doctor. I am just here to give you some information and make sure that empowering people with information you should still see your doctor because I am not an expert. Antibiotics can also sometimes interact with different types of medicines and substances. What that means is that its effect as perhaps different from what you expected. So if you are getting prescribe antibiotics man. Sure you talk to your doctor about the other medications you're on including supplements in any vitamins that she may be on or talk to your local pharmacist. Or both I always think that it's good to talk to the person who is prescribing. It to you to begin with but also pharmacists are very knowledgeable. It can be good to follow up. Some antibiotics needs to be taken with food and others needs to be taken on an empty stomach so they're not always just recommendations they are real instructions so make sure you're following along with the label. It is best to avoid while taking certain types of antibiotics and avoid it completely and four forty eight hours after finishing your antibiotic course that includes Metronidazole and tonight as all that Combo can cause really unpleasant side effects like stealing nauseous and vomiting stomach pain hot flashes and headaches so they recommend general that you don't drink while you take antibiotics however the NHS says it as long as you drink in moderation alcohol is unlikely to interact significantly with your medicine. I encourage you to speak with your doctor. Though before you decide how much is going to be moderation for accompanying your antibiotics. Should you choose to drink? While on antibiotics. Additionally some antibiotics like revamp. A`sun can also reduce the effectiveness of contraceptive pills. So if you are on birth control pills and you prescribed that particular antibiotic or any antibiotic you really need to talk to your doctor about whether it is one of the types that can affect your contraceptive pills because there are multiple types of antibiotics. That can do this. You may also want to disuse. Contraception like condoms while you were taking antibiotics and speak to your GP nurse or pharmacist and regards to getting advice for that and how long you need to be using additional contraception. Just also want to be careful when nixing any medicines. That's why we run it by the doctor hers. Because you don't want to take things like penicillin at the same time as methotrexate and that's used to treat psoriasis. Rheumatoid Arthritis in some forms of cancer penicillin seems pretty. Innocuous a lot of us have been taking it since we were kids but if you combine those medications it can cause some really unpleasant even serious side effects. Some forms of penicillin like Amoxicillin though can be used in combination with methotrexate. So talk to your doctor about that if you were on these medications ask if there's an alternative to the type of medication they're trying to prescribe you and what to do. In the meantime you may also experience skin rash if you take penicillin with Aloe Purnell and that is used to treat gout so just keep an eye on your body. Listen to what your body has the same and go from there. You also want to be careful with Cephalosporin so they can increase the chance of bleeding. If you're on blood thinners anticoagulant like Heparin and warfare in. If you need treatment with Cephalosporin you might need to talk to your doctor about adjusting your dose of your anti-coagulants or performing additional blood monitoring so sometimes the answer isn't that you can't have this thing at all. Sometimes that's what is necessary. But your doctor can explore other avenues and recourses for you. We're GONNA go on a quick break and when we come back we are going to wrap up by talking about antibiotic allergies and some more of these medicine. Interactions stated emcee beauty tips. Podcast his advice from everything from heritage into skin care products. We'll talk about the latest trends and makeup. Here's styles and anti aging remedies animal. Cover all of the newest fashion trends if you have an interest in or questions about the beauty trends that might work best for you. The Golden State media concept duty tip. Saad past has got you covered. Download the GS MVP beauty tips. Podcast on Itunes stitcher. Soundcloud Google play or anywhere findbaugh. Gas just type JAZZ MC in the search bar back before the break we were talking about medical interactions and side effects of antibiotics. So we're GONNA continue with some of those medical interactions now and then wrap up with antibiotic allergies first tetracycline. It's one of the most common types of prescribed antibiotics. But these are really illustrative of why. We need to make sure we're telling doctors. The supplements that were on so vitamin A supplements can interact with tetracycline. So can retinoids which are like vitamin A. So Asa Trenton eiser Trenton Wayne Trenton. Knowing all of those are used to treat severe acne. So you're taking medication. Could interact with your tetracycline blood. Thinners diuretics medicines used to treat diarrhea or diabetes such as Insulin. Medicines used to treat pneumonia antacids. So if you have heartburn and you're taking antacids you need to let your doctor know that just because you get it over. The counter doesn't mean that it's entirely innocuous when taken in combination with other types of medications. You should also let your doctor know if you are using lithium to treat bipolar disorder found or severe depression so tetracyclene can interact with lithium too so mental health is also important to mention. Even if you're seeing a different doctor for this your doctor who is prescribing. You something always know what other medications you're on in either direction Tetra. Cycling's can also interact with methotrexate strontium Ranna late which is used to treat osteoporosis. And also some migraine medications and high cholesterol medications can interact with Tetra. Cycling's for the massacre lives. You need to make sure that you do not take back relates with any of the following medications unless you're directly instructed to buy your doctor because the Combo can result in heart problems that includes antihistamines used to treat allergic conditions like Hay fever certain medications that are used to treat psychosis episodes. Medications used to treat urinary incontinence and high cholesterol medications as well for fluoroquinolone. Need to talk to your doctor. Pharmacists before taking chloroquine alone. If you are already taking certain types of asthma treatments insides so is non steroidal anti inflammatory drugs. Like ibuprofen medicines gout schizophrenia. Medicines used to treat Parkinson's disease muscle spasms diabetes indigestion heartburn nausea vomiting and certain types of steroids like corticosteroids. You may also need to talk them about in acids zinc supplements in some types of multi vitamin supplements and it's not always particularly because of an interaction between the two per se. But sometimes if you're taking medications that contain high levels of minerals or iron or certain types of other materials it can walk the beneficial effects of your medication and it may not be that you can't take them at all but your doctor main struck you to take them a certain amount of time. Apart in order to make sure you are getting all of the benefits and none of the negative consequences from them. It really just comes down to being open with them and having those conversations. Now we're GONNA TALK ABOUT ALLERGIC REACTIONS TO ANTIBIOTICS. So with antibiotics allergic. Reactions can be a severe form of side effect. If you're allergic to them then you can get certain types of symptoms like a rash or swelling in your face or even difficulty breathing if it's very severe it's known as an F. Alexis or NFL lactic shock and it occurs. Usually within an hour of taking antibiotic some signs at all. Axes are difficult breathing or noisy breathing if your tongue starts swelling if your throat starts swelling or filling tight if your voice starts sounding horse or you're having difficult talking if you start wheezing or coughing or if you start feeling dizzy or collapse or if you get pale and floppy as they turn it so if you are pale and you're not really being able to move very well. You may be having an allergic reaction. I have seen this floppiness in a cat before. Who was allergic to a new fleet caller and it was kind of frightening. That cat was normally pretty grumpy even for cat but we put the new flea collar on him and he went and lay down. Amnuay to pick him up he was just limp absolutely limp at that point and I couldn't tell me he pale because he was a cat but he was not doing very well. He wasn't really waking up no matter how much jiggled him so? I had to take that caller off of him in Washington and get him some medical attention. So that's really what they're meaning when they are saying floppy being pale. And maybe a little bit listless and kind of limp in that way you can get less dangerous symptoms before. Nfl Alexis sometimes as maybe a warning. Mike swelling of your face lips is hives or welts. Abdominal pain or vomiting. So think of a lot of the reactions that will Smith gets in the movie hitch when he has the allergic reaction to. I believe it was shellfish. So if you're having any of those types of symptoms you need to speak to Dr a sap if you're allergic to antibiotics than you may be instructed by Dr on how to avoid those triggers and if your allergies are severe they might instruct you in how to use an EPI pen or another type of self administered adrenaline injection. Your Doctor Walls. Record your allergy and the type of reaction in your notes and electronic health records and give you an NFL axis action plan so I am allergic to a couple types of antibiotics. I'm not even allergic to all of them in the same family but I have very serious stomach cramps and rashes in chef from those are in mine medical history and whenever I go to a new doctor I make sure that I tell them all of that and get all of that in the books because if I take certain types it could be worse next time. Next time I take them. It could result in an AFL axis so you have to make sure that you are paying attention to your body and differentiating that abdominal pain or vomiting from any of your other symptoms and any other types of rashes may be having and when in doubt always call your doctor. Most allergies are caused by penicillin or antibiotics that are closely related to penicillin or by another type of antibiotic called Safa'a Mites so we spoke about both of those types earlier in another segment and they can be prescribed pretty frequently penicillin ATAS. This'll fauna is not so much today. Largely due to side effects in antibiotic resistance if you feel nauseous and vomiting after you take antibiotics. That's generally a side effect rather than an allergic reaction but your doctor can usually diagnose whether or not it's an allergic reaction versus a side effect by speaking with you. They may in some cases. Refer you to an allergy specialist and you may end up getting skin allergy and or blood tests so it can go either way. It just depends on your personal doctor and your symptoms as they relate to the antibiotics if you have any concerns about your antibiotics including possible side effects. It's always important to reach out to your doctor. You can also speak with your pharmacist. But if you are already experiencing side effects definitely see your doctor and talked to them about what is going on with your body. See only one. We've got our nets all I have say today. Thank you for listening to the GMC health and wellness podcast brought to you by the GMC. Podcast network. I'd like to ask that you please subscribe to the show and writing. A Nice Review always really helps us. Also if you could please follow us on facebook twitter and Instagram at appreciated. Thank you and have a good night. You've been listening to the golden state media concepts have and wellness podcast part of the golden state media concepts podcast network. You can find this show and others like it at. Www DOT g s MC podcast DOT COM or download. Our podcast on Itunes stitcher soundcloud. Google play exists type. Billy G. S. GS MC to find all the shows from the golden state media concepts podcast network from movies to music from Sports Entertainment. And even three us. You can also follow us on twitter and on facebook. Thank you and we hope you have enjoyed today's program.

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Invention Playlist 4: Penicillin

The Best of Stuff

53:05 min | 1 year ago

Invention Playlist 4: Penicillin

"Today's episode is brought to you by IBM smart is open open is smart IBM's combining their industry expertise with open source leadership of Red Hat. Let's unlock the world's potential. Let's put smart to work. Learn more at IBM DOT com slash red hat. Guys it's bobby bones I host the bobby bones show and I'm pretty much always sleep because I wake up with three o'clock in the morning a couple of hours later I get all my friends together, and we get into a room and we do a radio show. Wish you're alive. We tell our stories. We try to find as much in the world. Possibly can, and we looked through the news of the day that you'll care about also your favorite country artists are always stopping by to hang out and share their lives and music, too, so wake up with a bunch of my friends on ninety eight point seven W. MC in Washington, DC, or wherever the rotates you on the iheartradio APP. Welcome to invention a production of iheartradio. Hey Welcome to invention. My name is Robert. Lamb and I'm Joe. McCormick and Robert I know you WanNa talk about dnd before we get to the real subject. Well I don't know I was thinking about doing it last. We can go ahead and talk about it up front. Yeah. We'll in dungeons and dragons. These various Demon Lords, and they they rule over various sort of portions of the of the fiend population in the game, and they're to demon lords in particular that I was thinking about in regards to today's episode, and that that would be. An jubilee. So Saag Moi is the. Demon Lord of Fungi. The Queen Fun Guy, the master of decay and then opposing her. Ever at odds with her is jubilee, the faceless Lord God uses slimes and blobs all the losing nasty creatures of Dungeons and dragons, and yeah there they oppose each other their constant war with each other and some. Campaigns like their forces, and even there there in embodied forms do battle with one another, and it actually ties in a bit with this subject. We're talking about today of penicillin. Okay, so penicillin, the fungus that fights! I don't know. Would you call diseases slimes? Well I feel like jubilee being the demon. Lord of Oozes, and slimes kind of makes it the demon, Lord of of microbiology, as well and you know my groves and microbial illnesses so okay well so today we're going to be talking about penicillin. Maybe one of the great real weapons of Tavoy. Yes, but this this came up I. Think because we'd been talking about fungus on or other podcasts on stuff to blow your mind where we just finished recording a five part series on psychedelics, yeah, yeah, looking at Fungal psychedelics and ongoing research into how these substances could enhance our mental. Mental wellbeing in helping the treatment of psychological issues and one of our big take home that these guys could help save lives and improve the quality of human life, but it would not be the first or only fungi to do so because we can certainly look to various interactions between human health, the different fungi species and their use in traditional medicine we can point to various products including products of fermentation for instance including alcohol but there's an even better example of better living through fungi in that's penicillin. Right so today we're going briefly explored the invention of penicillin, which is often cited as. The first true antibiotic technology of course antibiotics are medications that treat infections by killing injuring or slowing the growth of bacteria and the body. Antibiotics are a class of what you would generally call antimicrobial drugs medicines that kill microbes that present a threat to the body of course and antibiotics generally fight bacterial infections, whereas you could have others like Antifungal that Fungal infections or antivirals that fight viral infections now, antimicrobials antibiotics are gigantic subject area that we're. We're of course not going to be able to get into every nook and cranny of the subjects, but we hope we can have a an interesting introductory introductory discussion. Maybe come back to antibiotic sometime again in the future because it's it's a broad invention that has lots of little invention tributaries throughout history. Yeah, but it is such a fascinating case to look at it and I think should make for a great episode of invention here because. For starters it's it's a twentieth century invention. Slash discovery off, and of course, the line between ambition discovery is a little bit gray. But we we can pinpoint it to nineteen twenty eight, and ultimately like rolled out by nineteen forty or so but so we can, we can look to it. We can look at the world before we can look at the world after with with the sort of clarity that we always have with the certainly older or more ancient inventions, exactly because we always like to ask the question on the show what came before the invention what what changed when this invention came on the scene and what became before widespread modern antibiotics was stupendous amounts of death and misery from infectious disease in blood poisoning I I was wondering like. Is it even possible? To get stats on what the world of infectious disease looked like before we had antibiotics around the mid twentieth century. Yeah I mean to a certain extent, a lot of the suffering is just incalculable you know especially, if you go back and sort of consider all of human history up to that point in the various factors that that influenced infectious disease and injury, you know the the eventually the rise of germ theory, but. This things like that the rise of cities and so forth, but but luckily yes, since it was such a reason invention, we have some pretty incredible stats on the matter. Suddenly. Thanks to this new miracle drug diseases that it simply ravage. The global population like syphilis could be cured. The shadow of lethal infection no longer hung at least as heavily over every scrape, injury and war wound. And with wounds, where often talking about Sepsis, which is a term that was used by hippocrates back in the fourth century, BC meaning blood, rod or blood poisoning. And he was referring more in generally I think to decay, but the term came to be applied to blood poisoning, which arises when the body's response to infection causes. Injury to its own tissue and organs. But just prior to the twentieth century, infectious diseases accounted for high morbidity and mortality rates around the world, even in the industrialized world, according to w a Adedeji in the treasurer called antibiotics from two thousand sixteen, the average life expectancy at birth was forty seven years forty, six forty eight years for men and women respectively, and this was due to the dangers of smallpox cholera. Diptheria pneumonia typhoid fever plague Turkey Laos's typhus, syphilis and host of other ailments that could afflict you. endearingly antibiotic Era that follow again a rising in the middle of the twentieth century, the the leading cause of death in the United States change from communicable diseases to noncommunicable diseases like Carter, cardiovascular disease, cancer and stroke, and the average life expectancy at birth rose to seventy eight point eight years, so the elderly were no longer a mere four percent of the population, but grow to become a whopping thirteen percent of the population. So we're talking about you know profound changes. Demographics based on this new this new invention. Yeah, the changes huge. We live in a world now where if you have access to high quality, modern medicine and a lot of people don't. Mind, but if you have access to high quality, modern science based medicine, and you can get antibiotics and and can get to a hospital or see a doctor. You very likely have a good chance to beat most of the Common Infectious Diseases that people get unless you have some kind of you know like another condition that exacerbates it or something before antibiotics. This was just not the people just died from diseases that you catch like diseases that are common for people to catch all the time, yeah or certain. Certain diseases like syphilis that were virtually uncurable you know, and and some of the the cures that were attempted were were pretty horrendous. You know in and had an generally did not work. You know talking about using mercury and so forth and do you mentioned before contamination of wounds? I mean this is just a huge thing. Just like a you know you might you might cut yourself while gardening, and you die from it. Yeah, heaven, forbid you undergo, say Medieval Gallstone, surgery or something like that yeah? By the way, I think tuberculosis has a you. Know is a good example to look at for some of these stats as well according to the CDC. TB was a leading cause of death in the US in nineteen, forty, prior to the rollout of antibiotic therapy in Nineteen, hundred, one, hundred, ninety, four of every hundred thousand us. Residents died from deep TB. Most residents of urban areas in nineteen hundred, the three leading causes of death in the US were pneumonia, tuberculosis and diarrhea, and interrupt us, which together with Diptheria caused one third of all deaths, and of these deaths, forty percent were among children aged less than five years old. Now to your point in not everybody has. Access to antibiotics that say and people enjoy in say Europe and the United States. Yet TB remains a the leading cause of death from an infectious disease in many parts of the world, particularly the developing world and some antibiotic treatments or antibiotic assisted treatments are more complicated and more difficult than others I mean I know the treatment for TB is not as say easy is around of just orally administered antibiotics that you might get for a standard bacterial infection right, but it suddenly was just a heralded rightfully so is is a miracle invention. When it came about you, I saw an image of a of a sign on a garbage. Can or mailbox from the Mid Twentieth Century Advertising that now you can get gonorrhea cured in in like four hours. Thanks to the you know these new developments in antibiotics you know. It can be difficult to put ourselves in that mindset, having grown up in the wake of antibiotics, or at least most of most people listening to this show I was just thinking about how many like us. Presidents died of infections of various kinds. That seems like that would be a very unusual thing to happen now, but like in the eighteen hundreds James Garfield got shot, but it wasn't the initial gunshot that killed him. He lived for like think weeks afterwards he got an infection in the wound. I think because they were digging around with dirty hands to try to get the bullet out of him, and he and they didn't have antibiotics of course when he got an infection, so he died. I think another. A US was William. Henry Harrison who I think. They think Dow died from probably like drinking, fecal contaminated water, and the White House yes, so many different injuries and infections were. Far More likely to be lethal with you know without modern antibiotics to step in and and aid in the fight. Now there were some things that were kind of like versions of antibiotics or antimicrobials from before the discovery of Penicillin in nineteen twenty eight, yeah, the best example from the period, just immediate immediately prior to penicillin would be the Safa'a, miser or the soulful drugs, and these were the first antibacterial used systematically, and they were synthesized in nineteen. Nineteen thirty two in the German laboratories of Bear AG. Now you might be thinking about the time line like wait a minute. Didn't we just say that penicillin was discovered in twenty eight, but it took a long time after the discovery of penicillins antibacterial properties for it to be made as a useful medical dry like it was one thousand, nine, hundred forty. Generally, that's the date you see for. When penicillin actually became a yeah, an actionable thing in Madison. So, yeah, before that we had the SOFA drugs and it they had a rocky start, but they did prove very effective in preventing wound infections during the second world, war they were used on both sides in the in the form of soulful pills and also sotho powders that would be sprinkled over wound so if you've ever watched A. some sort of a period piece, especially a war piece of the twentieth century, and you see somebody, sprinkling powder mover injury. That is what that's supposed to be soft drugs are they're not as effective as true antibiotics like penicillin. And there are a number of possible side effects that. Can take place, and it also can't be used to treat syphilis an and it also can't treat SOFA resistant infections now, of course, this is also a twentieth century invention so I was wondering. Did anybody come up with any version of antibiotics or Proto antibiotics? Before the Twentieth Century? We know that penicillin hadn't been discovered and isolated and made stable as a useful medicine, but were there any things like antibiotics are sort of precursors. Precursors of antibiotic, because in game of thrones right, they have penicillin. Don't they? Or they have some sort of fantasy penicillin I've never heard of that, don't they? Have something the the the the the masters would mention having to do with with Brad in mold or something, didn't they? I? Don't remember that I just remember people get cuts, and then they get infected indic-. Give him milk of the poppy I mean they have milk the poppy maybe. Our game of thrones our our our George. Martin readers left to right in on that, but I vaguely remember there being like allusion to something like some sort of mole based. Medicine that they were using. Let could be wrong. Well. I can't see that being something that's thrown in there as a little aside, but like isn't widely recognized for us. And it's interesting how that kind of parallels. Some interesting pieces of evidence for Proto Antibiotic Technology in the real world, even going back to ancient times so I won't look at the work of the emory university bio archaeologists George. Jr Mela goes. Who is now deceased I think he died in twenty fourteen but he's interest eight interesting scholar, and he discovered something very curious back in nineteen eighty, so the subject he was looking at was a set of human bones from ancient Nubia dating. Dating from between three fifty and five fifty C E, and so the the bones came from Nubia, which is a region of Africa along the Nile, river, but south of Egypt in what would be modern day Sudan, and what these bones showed was evidence that the people they belong to had been taking tetracycline now. Tetracyclene is not the same as penicillin, but it is an antibiotic. It can be used to treat all kinds of infections for minor problems like acne concert with some other drugs. Drugs two major diseases like play or to leukemia, or even syphilis and tetracycline works primarily binding to the Ribe, assumes of bacterial cells, ribes, zones or sort of the cellular factories they build proteins that are needed in order for organisms to live and grow, and by binding to the Ri-. Zome tetracycline makes it difficult for the bacterium to create new proteins. It was patented in the nineteen fifties and became widely used in the second half of the Twentieth Century So, what was it? It doing in the bones of Nubian. People who live like seventeen hundred years ago, well Arm Lago sin colleagues followed archaeological clues to identify the source of the tetracycline, which was beer of course, beer is another one of Ultimately, it falls under zagged Moi's domain. Oh. Yeah, though this is different. Because tetracycline is not made from a fungus, it is actually an antibacterial. That is a byproduct of some bacteria. Oh, okay, so it's bacterial byproduct, but essentially okay, so technically it's duplex. Point to jubilee this jubilee versus Gibb Lakes Right. I mean that's going to happen with your demon. Lord I introduced lean warfare so beer is made from fermented grain of course and the fermented grain in this ancient. Beer apparently contained the bacteria streptomycetes, which creates Tetra cycling as a byproduct, but a question of course so like were these traces of tetracycline in Nubian mummy bones, a sign of like a bad batch of beer, got contaminated by accident, or were these people deliberately culturing their beer with antibiotic producing bacteria, and so to look at a study from the American Journal of Physical Anthropology from twenty. Ten of which are Malaga's was one of the authors the authors examined tetracycline in skeletal remains from throughout this period, and the evidence indicates that the ancient Nubians were consuming these antibiotics on a regular basis in the authors suggest that these ancient people. People were intentionally producing this medicine and this links up with some evidence from other ancient peoples, nearby such as the Egyptians that sometimes apparently used beer as a treatment for conditions like gum, disease, and other types of infections in the author, even found evidence of a four year old child, whose skull contained lots of tetracycline from this beer, suggesting that the child had been fed high doses of this like antibiotic beer, perhaps in an attempt to cure an illness, maybe the illness that killed him, and so the levels of tetracycline residue found in the bones. These mummies is only explicable. If they were repeatedly consuming this antibiotic in their diet. And there are actually other archaeological remains that show evidence of antibiotic use in the ancient world for example samples taken from the Famara of skeletons from the Dock Leo ACIS in Egypt from people who live sometime in the late Roman period, also showed evidence of the same thing of tetracycline and the Diet and this consumption of tetracyclene is consistent with other evidence, showing a relatively rate of infectious disease in Sudanese Nubia during that time period. And a lack of bone infections apparent in these remains from the this acis in Egypt so. It really does look like people in ancient Africa discovered a somewhat effective form of antibiotics centuries before the discovery of penicillin and the isolation and mass production of focused anti-microbial medicines now to be clear. I think like a beer that had tetracycline content from from being cultured with bacteria, like this probably would not be as potent and focused and effective as like the isolated compounds in the drugs you take orally or through injection would be today right, but it would have some effect and. And it appeared that it probably was somewhat effective in fighting infectious disease right, and of course they wouldn't know exactly what they had here, but they knew they had some sort of beer that seemed to some sort of holy liquid that that that had some sort of curative property to it exactly fascinating discovery from the ancient world, another interesting fact tetracyclene is relatively unique in that it leaves clear signatures in the bones that can be discovered long after the person has died so. Don't leave these clear markers like this that make it easy for archaeologists to detect, so you have to wonder like, are they? Were there other cases of ancient peoples in various places in times using some kind of antibiotics or bacterial or fungal cultures to treat diseases like these ancient Nubian people were but that we don't have evidence of because it doesn't show up in the bones. tetracycline does yeah, you could have just been lost to history. I was reading an interesting paper from frontiers in microbiology in two thousand, ten by a Rostom on Minova called a brief history of the antibiotic Era Lessons Learned and challenges for the future, and Aminov points out this unique quality of tetracycline. tetracycline and notes just what I was basically just saying like how easy it would be for evidence of other uses of antibiotics in the ancient world to be lost to us, though he he also mentioned that there are other anecdotes from history about like cultural traditions that show Proto antibiotic technologies in these other examples would include red soils found in Jordan that are used for treating skin infections. It's been discovered that these soils contain some antibiotic producing organisms. I'd guess they're probably also some major risks in applying soil to wounds, and then also plants used in traditional Chinese medicine that actually do have some antimicrobial properties. Yeah, because one thing we have to remember is like the Modern Anti. Effort is ultimately based in going out into the natural world in finding these weapons that already exist. Yeah, and then reusing them in adapting them of for Human Madison and you know this is essentially what is going on in traditional medicines as well, and it also means that are weapons out there that either have not been discovered all especially in particularly vibrant ecosystem, some of which of course of are threatened all the more reason to. US to not decimate say the rain forests or the deep ocean right? But then there are also things that may have been discovered to some degree in the past, but have been forgotten will yeah that that does seem possible, because despite all evidence of ancient sort of Proto antibiotic technologies, the worldwide rates of death from infectious disease in the periods, for which we have data right before the invention of modern antibiotics shows that humans generally did not have effective antimicrobials in that period, so maybe some of this knowledge was lost over time all right well on that note, we're GonNa take our first break, but when we come back, we're going to return to the mold research, the nineteenth century, and ultimately to our key inventor here Alexander Fleming. This episode is brought to you by IBM Today. The world looks pretty different, but already new problems are being met with new thinking. Researchers are using supercomputers to discover treatments faster retailers are turning to the cloud restock shelves more quickly. Teachers are working with ai to rethink the classroom. It's not everything, but it's a start. Let's put smart to work. See how IBM is helping IBM dot com slash cove nineteen this. This. Episode is brought to you by IBM Today the world looks pretty different, but already new problems are being met with new thinking. Researchers are using supercomputers to discover treatments faster. Retailers are turning to the cloud to restock shelves more quickly. Teachers are working with ai to rethink the classroom. It's not everything, but it's a start. Let's put smart to work. See how IBM is helping IBM, dot. com slash cove nineteen. We're back now. We'll get to Alexander Fleming in a minute with the discovery of penicillin, but Alexander. Fleming was not the first person to notice that there might be some anti microbial properties of certain fungi. That's right. There was there was work going on in this area of prior to Fleming Fleming was was You know picking up on some of it, and and really just overall. Just our understanding of a fungi in general was was advancing as we mentioned era, psychedelics episodes There was a time where we did not recognize fun guy as being separate from the realm of plants right before we realized that it was a kingdom, unto itself in the Kingdom that has a little more in common with the Animal Kingdom than it does with the plant kingdom. And little a lot of talented folks working in this area, but one of them. Might come as a prize to a lot of people and that's because her name was beatrix potter. The bunny rabbit, a bunny rabbits. Yes, okay off the Bunny Rabbit fame. It was kind of a curious coincidence, because I was reading about all this, and then just randomly on the stuff to blow your mind discussion module, which is the facebook group for people listening to the show to discuss episode, someone brought up the trix potter in regards to something to do with squirrels because there's a lot of squirrel. Squirrel content in the discussion module, and yeah, they brought a Beatrix Potter and Beatrix. Potter actually ties in to this episode a little bit, because in addition to being the author and illustrator of the you know the tale of Peter Rabbit and associated British animal tales. She was also a naturalist with a great deal of interest in astronomy, and most importantly of all my college. So she produced a lot of beautiful scientific watercolor. Illustrations of various fun guy in her neck of the British would. As part of her studies, and if you studied a lot of local molds as well and did illustrations of them. She's ultimately very interesting character. That was Unfortunately she lives in time in which the sexism of the day prevented her from reaching the heights of in the natural sciences that she would have been afforded later on, but in a lot of her work is also just being I think rediscovered and appreciated for the first time. you know in recent decades, but the yeah, the next. Next time someone busts out some the trix Potter A. Remember. This is not just a an individual who wrote some fanciful tales, and illustrated them like she was just she was out there, studying the natural world, and in Crete in in advancing our understanding of my college, she was sort of a looking into the hidden life of nature in multiple ways, yeah. I, see some sources that are asking the question. Okay was Beatrix Potter who she a true naturalist, a true natural scientists over she just to. An amateur, that was just very interested in these things, and it's kind of a couple of question. Ask when you consider the limitations. In the Victorian era for women but I think undoubtedly she she I would side with the fact that she was a natural scientist I, mean she? Or co-authored one paper. If I remember correctly so I'm I'm gonNA give her giver. Full credit was about fungi. It was a mushroom. In particular I, forget was one of those related to the Russillo Mushrooms, but I forget which species. But. Basically, she was you know she was kind of up against the the Patriarchy for the most part though. We'll. Is it time to turn to penicillin itself yes? Let's turn to this. The key discovery here and our inventor are discover Alexander Fleming. Okay So, who was Alexander Fleming? Fleming was born in eighteen, eighty. One died in nineteen, fifty five, and he was a Scottish biologist physician, microbiologist and pharmacologist. He was the son of a farmer, and he observed and studied a great deal of death from Sepsis in World War One. He observed that while antiseptics worked well at the surface, a deeper wounds, a sheltered bacteria from the effects of things like sulfur drugs right so if you have the kind of superficial wound, you could clean it off pretty good, and that might help protect you from from bacterial infection, but if you have a deep wound and say like dirty stuff, bits of soil and other you know just crud gets lodged deep in there. You might not be able to clean the wound out very well right and that's exactly the kind of stuff that's going to get lodged in there especially with your war wounds where there is a. Stab or or a deep cut or a bullet entering the body. We'll makes me think about The when we were reading about the idea of Stegosaurus, perhaps weapon I. I mean not consciously, but stegosaurus perhaps Having an adaptation to weaponize infection against its enemies by dragging its Dagga miser spikes through the Dung right exactly yeah, having dirty Bagga miser spikes, and then when it wax the T. rex in the crotch with the that gets infected later, and eliminates a Predator from the area and the the the the predators of the day would not have had access to antibiotics, certainly not or even that beer from the. We mentioned earlier so. Flip Fleming was devoted himself to research he Prior to penicillin. He discovered a lifetime naturally occurring enzyme and mucus in other parts of the body than inhibits bacteria, so he was already. You know in this area looking for for new new breakthroughs new discoveries. But then his biggest breakthrough, all is this discovery of penicillin, and it's truly one of the more amazing invention slash discovery moments from history, because while he was exactly the right person to make the discovery, and then deserves all the credit he was given. The key moment comes down really too pure luck, and we simply don't know if anyone else would have made the discovery if he had not been there to observe it, okay, so what happened with this discovery so around nineteen twenty seven, or so he had engaged himself in studying STAPHYLOCOCCI or Or staff, and he had stacks of Petri. DISHES DISH SPECIMENS IN HIS LAB, which I've seen described as being kind of an untidy lab, so imagine all these likes Petri dishes, full staff all over the place notes, and so forth, and so the key moment comes in September of one, thousand, nine, hundred, twenty eight right right, so he has these staff petri dishes out, and then he leaves them for the weekend. Go on holiday with his family any when he comes back, he expects you just see how they've progressed. See how they've grown. But he finds that they haven't grown. In fact, they have died. Something has ravaged his specimens. Yeah, now it's this is one of those stories where it gets very narrative is so you do have to wonder if some details of it or embellish to and how the story may have changed over time, but this is the way the story has been passed down and and I think it seems to be largely basically true the way that I've seen. The story often told us that. He comes in. There's a blob of mold growing in one of the plates and all around the mold. There's this halo of nothingness where you normally what you would see is that if you got a plate for culturing bacteria, there would be these little dots and blobs on the on the plate. But instead there's this halo where there's no bacteria bacterial deadzone zone now, of course we know staphylococcus is is a bacterium group linked to all kinds of human disease and misery. staph infections right if this mold could kill staff that seems medically relevant. So what happened here well? He He. He realized that he was dealing with some sort of a fungi. So he luckily, there was an ecologist with a lab just below. Fleming on the floor below his lab. Man by the name of CJ La Touche and in fact it's also been suspected that the mold and question that killed. Fleming's staff might have drifted up from a Lotta Shays lab, adding an extra element of weird chance to this whole situation. Okay, so perhaps his samples were contaminated by stuff from the lab next door down a floor, right? That's one that's not. That's not a theory that's presented in every source does pop up fairly frequently so specifically. This mold was what would later be identified as a strain of penicillin, no Tottenham and it was obvious that it's secreted something that prevented staph bacteria from growing and so fleming followed up in studying the secretion. This mold juice says I've seen it called. He he found that it didn't only prevent the growth of staphylococcus. It worked against common bacteria like streptococcus or Meningococcus, and and the back also against the bacterium that causes diptheria interestingly while Fleming did see applications for penicillin and curing disease. He mentioned them briefly in the paper he published in Nineteen, twenty nine about this discovery about a the the antibacterial properties of Penicillin he primarily thought of this secretion of penicillin as a tool for bacteriologist to sort strains of bacteria, independent, sensitive versus non penicillin, sensitive species, and the that that could be useful in the lab. Yeah, so he sometimes criticised is is really not understanding completely what he had here not. Not Having the vision to see where it could go well. I don't think he completely understood, but he did indicate that this could possibly have uses in medicine right so fleming and his assistance, Stewart, crowder and Frederick. Ridley tried for years to turn this accidental discovery into a stable isolated compound that would be useful and this. This was a problem because like you've got this secretion from the mold molds making some juice. It's getting stuff wet with this this stuff that that that fights bacterial growth, but they couldn't isolate the compound that was causing the effect and stabilize it and make it make it generally useful so to quote from. Paper that I mentioned earlier quote for twelve years after his initial observation Alexander Fleming was trying to get chemists interested in resolving persisting problems with the purification and stability of the active substance and supplied the penicillin strain to anyone requesting it, but he really he could never cracked the nut ultimately, and he didn't finally make this discovery of the process for for stabilizing and isolating the compound, and by Nineteen Forty Aminov writes that Fleming finally abandoned quest, but fortunately it was right about that time that they capable team at purdue university, including the researchers Howard. Howard, Florey and Ernst, chain or Chine. They picked up on this research and they. They kicked off the research project that would eventually breakthrough on this and there are all these interesting story so of course this while World War. Two is going on right so research conditions are not ideal and They're all these stories about how they turn to their lab at Oxford into this giant incubation center, or sort of factory for mold like employed all these lab assistants who were these women who had been referred to in some sources as the penicillin girls. And they would work to T-. They would work to grow the penicillin in buckets and tubs, and basically every container that they could And eventually they did. They were able to isolate and stabilize this compound so to quote from an Article from the American Chemical Society. In nineteen forty fluorine that'd be Howard Florey carried out vital experiments, showing that penicillin could protect mice against infection from deadly. STREPTOCOCCI, then, on February, twelfth, Nineteen, forty, one, a forty three year old policeman Albert. Alexander became the first recipient of the Oxford Penicillin. He'd scratched the side of his mouth while pruning roses, and developed a life, threatening infection with huge abscesses, affecting his eyes face in lungs, penicillin was injected, and within days he made a remarkable recovery well, but unfortunately, despite this recovery which lasted for a few days, they ran out of the drug and. and Alexander eventually got worse again, and he died, and I was reading that they were so desperate to cure him that after Alexander urinated while on his antibiotic course, they would collect the urine and try to extract the penicillin. He excreted again so that they could be re administered to him. and I should mention also that the the process that the Oxford team relied on to extract purify the penicillin and the mold juice was led by another important biochemist guy named Norman Heatley, but this case of Albert Alexander shows an obvious early problem they. which was the problem of scale? They simply lacked the ability to make penicillin at the scale. It that would be needed to treat even one person let alone. The whole world the strain of mold that they were using didn't make enough of it, and this led to the search for other species of the same fungal genus penicillin, which would maybe they thought produced higher concentrations of the penicillin filtration, and I was reading an interesting article. Article by the University of Michigan Physician and Medical Historian Howard Markel that tells a really interesting story I'd never heard about this so the story goes like this. Apparently, one of the assistants at the Oxford lab showed up for work one day in nineteen, forty, one with a cantaloupe that she bought at the market, because it was covered in a weird looking golden mold, which is great because this would be the one case where somebody. Somebody is picking over the fresh produce produce to like find the moldy one but the mold on this cantaloupe turned out to be a strain of penicillin called concilium Chris, ogsm which Markle says naturally produced at least about two hundred times as much penicillin as the original strain that they've been studying and then later, markel writes the same strain was subjected to mutagenic processes in the lab, so like bombarding with x rays and stuff to. To produce a mutated strain that would make up two thousand times as much penicillin as the old school fleming mold so by nineteen forty one penicillin is on its way to becoming viable medicine all right on that note we're GonNa. Take a quick break when we come back. We're going to look at the impact of penicillin and we're GONNA. Look at it, you know and I think a fun way by considering really interesting. What if? 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What was possible like clearly there were there were other individuals in the world working on this someone would have cracked if Rontgen had not discovered rays in eighteen ninety whatever year it was, somebody else would have discovered them pretty soon right, but when it comes to penicillin potentially, it's a little more complicated than that. I I ran across a cool article on the topic titled What Filming had not discovered penicillin, and this was a published in the Saudi Journal of biological sciences by all Harvey at all. The authors admit that that certainly if Fleming had made the discovery, someone else might have in the years to follow. Probably you know in the early nineteen forties. They estimate so we could still well have have arrived in antibacterial age. However, they also explore the possibility that we might have simply not made the discovery at all, and it's an interesting argument, so I wonder I. WanNa read a quote from the paper here. Quote of course penicillin could have been discovered. The day after Fleming missed the opportunity, but in reality there was no parallel discovery. The took place as a result anyone taking an interest in penicillin during the nineteen thirties did so in the knowledge of Fleming's work. In particular, the seems no reason to believe that Florey and chain would have discovered penicillin since their work depended on Fleming's famous paper and their access to one of. Of his penicillin, producing cultures, so that's referring to the thing I mentioned about how how a Fleming in his assistance were just like sharing the penicillin strain out with everybody like hey, can you figure out what's going on with this? Can you isolate secretion or the compound in the secretion? Yeah, so think about there was there was so far as these researchers can determine you know other effort out there that would have. In struck paydirt in the absence of Fleming's research, the Oxford. Group wouldn't have been looking for it. Someone Walks Walkman. The father of modern and Botox sometimes called as we made several key discoveries later was also inspired by Fleming so. He has one of these cases where like he seems to be the epicenter. Not only him, but just then the the the the seemingly chance encounter in his lab that day that that we're suddenly, this halo appears in the Petri dish, and that gives birth to a to a whole class of other discoveries right because not all antibiotics are derived from penicillin penicillin, class of antibiotics become sort of like one sort of grandfather class, but then there are all these other classes that are discovered during this golden age of antibiotics that takes place over the next few decades. Just additional medical breakthroughs that would not have occurred without penicillin such as organ transplant. But then there's also the question like what would've what would have happened in the the wider world because again, penicillin comes online during the Second World War, and so that you can easily ask what would have happened if allied troops had not benefited from access to antibiotics at D Day I've never thought about that in fact I. before looking at this episode, I probably would not have known the answer to whether or not. They had accessed antibiotics well. Penicillin production was actually swiftly scaled up just to make sure that allied soldiers had access to it at d day. So, there is a legitimate question to be asked. Might the allies not have won the Second World War without penicillin? Factors consider there I. Don't think it's quite a Gotcha question, but it's it's worth thinking about. The authors argue that without flemming's discovery would have had to depend on the SOFA drugs. An imperfect alternative to a true antibiotics and these. These were described in the nineteen thirties and Fleming worked with him prior to his discovery. But without penicillin in play, the authors argue that sulphur drugs might have become the standard and even push the discovery of true. Antibiotics well beyond the nineteen sixties, and this is also true of the Axis powers had risen in victorious in World War Two because the access powers depended on sulphur drugs and their their key treatment Point out. Quote, despite the fact that the Germans and their allies where at a considerable disadvantage the drugs did a relatively good job at reducing battle casualties, so not to just completely cast, aside the effectiveness of soft drugs, but still they were not as effective as true antibiotics. It's weird to think about the political implications of specific medical technologies. Yeah, and then when you get down to the curious cases of individuals. Yeah, it also gets. Gets interesting where he touched on presidents who died that would have lived potentially if there had been penicillin around right, and so they point out that that soft drugs saved Churchill's life in nineteen, forty three, when he was suffering from pneumonia as well as FDR's life a, but there's also evidence by the way that actual penicillin may have saved Hitler's life following the stuff Enberg assassination attempt of July twentieth nineteen forty, four. This was the plot that tried to kill Hitler with a briefcase bomb. Right like where the some of the officers conspired against him, and they put briefcase bomb in the room with him, and it did explode, but he was protected by a heavy table that prevented it from killing him. He was obviously injured I think he had like nerve damage after. So be the idea here is that perhaps his injuries were treated by by penicillin. Yeah, that's it. At least an argument has been made that they had access to penicillin. I'm unclear on how they would have obtained it. You know through. Maybe there's a spy story. There I don't know. But the the idea being well, if he had if he had didn't have access to penicillin, then perhaps he would have died, and that arguably ended the war in a different manner forcing us to re. An entirely different postwar world. So again we're playing with with what ifs here and also we my understanding is. We don't know for sure that Hitler had access to penicillin following that assassination attempt, but there is the overall scenario of the allies having penicillin and having this ramped up penicillin production leading today. Yeah, that is really interesting. I. I'd never contemplated that before. now something that we do often have to think about, and we should probably acknowledge at the end here before we move on. Maybe this'll be something to come back in. Doing the future with A. New Invention episode is the idea of a possible end of the antibiotics I mean this is kind of scary thing to imagine like what if the antibiotics age is essentially a period in history that has a beginning in an end. Because as we you've. You've probably heard about this. Many disease, causing bacteria and other disease, causing microbes are overtime evolving antibiotic resistance are evolving to to be powerful enough to survive are antimicrobial drugs and I think specifically one thing that's exacerbating. This is overuse of antibiotics and people, not taking the entire course of antibiotics when they're given them. Yeah, because again to come back to the Zagged Moya Jubilee. War Scenario you know it is an ongoing battle, and the the forces evolve. To to better deal with the threats on each side and so. We're we're we're? We're seeing this occur. We're seeing the the overuse of antibiotics producing. Strains that are that are resistant, and it's reversing some of the therapeutic miracles of the last fifty years, and and underscores the importance of disease prevention in addition to treatment, and that means not not abandoning some of our other vital tools for human health like vaccination. We should come back and revisit vaccination. Maybe even various different vaccinations in the future. Yeah, another thing to keep in mind that. I don't think we mentioned earlier. was that the nine hundred forty nine hundred seventy s? Are are considered like the Golden, age of antibiotic, Research Yeah, and we haven't seen at least if you haven't seen any new classes of antibiotics emerged since that time period right now there have been new developments in antibiotics, but I think the way I've read. It is that they're generally modification. Houses of Antibiotics Sorta like we. We haven't. We haven't found anything radically new. Since then. Basically, we reached out into the natural war between. Between Fungi, and the microbial legions and we, we stole some of the tools. We stole some of that Promethean fire. We day we keep adapting that fire to our own purposes, but we haven't. We haven't found any new weapon from that world, and and then they're ongoing war continues. To Change. I'd be interested A. Do you out there? You the listener you work in medical research, or are you working on areas involved in antibiotic resistance, the future of anti-microbials I please get in touch with us. I would like to hear about that. What what are you doing in your work? And what does the future like to you on the inside? Absolutely we would We would love to hear from you again. We've only scratched the surface here. Though thanks to antibiotics, hopefully that scratch will not. Get the life threatening infection. There's a lot more history here, but but hopefully what we've done here. Today is of course, highlight just a very very cool story from the history of inventions and discoveries in human history, and outlined the impact of of one of the greatest inventions or discoveries again. However, you want to classify it from the twentieth century yeah totally. In the meantime. If you WANNA check out other episodes of invention, you can check out our homepage invention pod dot com, and that will have all the episode right there. If you want to support the show and we would appreciate it. If you did support the show, there are a few simple things you can do. Tell friends about it, you know. Tell Tell Your family members about invention and. And, then if you have the ability to do so rate and review US wherever you got this podcast huge thanks as always to are excellent audio producer Maya Coal. If you'd like to get in touch with us to let us know feedback on this episode or any other to suggest a topic for the future just to say hello, you can email us at contact at invention pod dot com. Invention is production iheartradio radio for more podcasts from iheartradio. The iheartradio APP apple podcasts wherever you listen to your favorite shows. Here's something. Good is a new show from the Seneca. Women podcast network and iheartradio each day. We aspire to bring the good news. The silver lining the glass half full because there is good happy the world everywhere every day. We just need to look for and share it. Here's something. Good is a short daily show. That offers positive stories, helpful suggestions and shared experiences to inform and inspire you every day. Listen to hear something good on the iheartradio, APP apple podcasts or wherever you listen to your favorite shows subscribe now. October sixteenth, Nineteen seventy-two to Congressman Vanish on small plane in Alaska. Despite a massive search. They're never found. The case goes cold. That is until I. Start Researching it. I'm standing right. Portage Pass and Alaska my name is John. Wall Zach and what I found is one of the strangest stories you've never heard. Did he indicate what was in the suitcase? He said it was a bomb. So join me as I travel from. To the Arctic Circle trying to crack this case. Listen to missing in Alaska on the iheartradio. APP Apple podcasts or wherever you find your favorite shows.

penicillin Alexander Fleming IBM United States Oxford Penicillin Sepsis zagged Moi syphilis tetracycline Albert Alexander Red Hat IBM smart bobby Oxford Lamb tuberculosis James Garfield Robert I
These bacteria wear chicken shoes

Future Perfect

24:55 min | 6 months ago

These bacteria wear chicken shoes

"With the wildfires burning in the west and a high stakes election on the horizon taking on an active role in protecting the earth, we all share has never been more urgent. That's why all birds is on a mission to leave the planet in better shape than they found it. Everything they make is built with the planet's health in mind including their all new will papers a cool ecoconscious twist on the classic lace up sneaker. With all birds feel confident knowing you're wearing a product that's doing right by your feet in the planet. Learn more about their sustainable practices and find your pair of wool pipers at all birds DOT com today. I'm really bad at having fun. This is Cindy Lou. In she's kind of being hard on herself, she has a lot of fun when she works as a public health researcher. And Fortunately Cindy. Married another dedicated public health researcher named Lance Price. In fact, our honeymoon is a scientific conference. He decided there was this conference that was really important that he must attend I mean that was that was the first one on this topic the conference was about antibiotic resistance in factory farming. And that wound up being fitting. because. Factory farming became a theme not just in their honeymoon but also later on in their research together. It all started when Lance and Cindy got talking about some research findings around factory farmed meat. But I looked at Turkey products when I looked at chicken products eighty, ninety percent of them were contaminated with E-coli. Which indicates that nine hundred, ninety percent work avenue with feces. So. That obviously is gross but it gets worse equal I comes in many forms inland. Cindy? Were worried that the meat contain one particularly scary group of E coli. This is not the kind of coli. We're about on the news the kind that causes gut problems. These. E. Coli are actually find when they're in your gut. But when they move out of your body, they can get into your urinary tract. They can set up an infection that can be deadly actually so it can I can go from your bladder and you're Canadian. And they were especially worried about one particular strain called S. T. One, three, one, it's resistant to a lot of antibiotics which makes it hard to treat. So all round the world it's responsible for many. Of the more severe E. coli infections like the blood infections like. This kills probably ten thousand people a year in the United States but bacteria just don't get the attention they deserve. So Linson Cindy started to wonder what if you could get these deadly coli from the Meat Yui From the VOX media podcast network this is future perfect. I'm doing matthews. This season we're looking at how the meat we eat affects us all. We want to understand what it means for animals and for workers for the environment. But also what it means for our health. To end the show Land Cindy conduct a study that raises a troubling question. Is the way we raise our meat making us sick. And is it ruining our best tools for treating that sickness? Bird Pinkerton reported the story for us. Land Cindy wanted to figure out two things. I if the dangerous equally were on meet in the first place, and then if there was a clear link between the dangerous E. coli on meat and the same equality in people. There were some broad studies that suggested a connection, but Lanson Cindy wanted something more concrete. So they set off on something even more fun than a honeymoon at a scientific conference, an ambitious year long study of meat bacteria. At the time they lived in flagstaff, Arizona which it turns out is kind of a perfect goldilocks city for experiments. Yeah. So the good thing about it is that it's not too big or too small. It's like a baby bear you know and it's kind of isolated a couple of hours from other cities nearby. So you have this captive population if you will meaning that if someone got to ut. They probably got it locally. So. Winston Cindy had their perfect study setting a next. They needed their raw materials. They got UTA samples from the big hospital in town and for the meat. They want to get samples from all the big companies over time. So they put together a detailed list of all the Turkey and the chicken and the pork cuts in all the supermarkets in the area. And every two weeks for a year their research assistants would take that list and drive to one store after another to buy a whole lot of. People just probably thought they were on the Caveman Diet or something. Okay. Fair warning things get a little gross here but they would bring these stacks and stacks of package meet back the lab than they would cut off little pieces and they would put them in a heated brought. So the bacteria could grow, and then the next day we'd come and get the soup bag and the super gone bad overnight, and then when you open that up. Is What we call the smell of success which is. Like I don't know do you have a sibling? D- Any of them are ever hold you down in your face. This is just like that. When they analyzed the results they got their first taste of success. Right off the bat. They found that dangerous strain of E. coli that had them so worried. This was a breakthrough. People hadn't been totally sure. This strain was present on meat samples. But. It was only the first step in Lanson Cindy's quest because now they had an even more fun task they had to figure out. was there a link between these dangerous musical I and the? In their UTI samples could people have gotten their UTA infections from the meat. Linson, he had a plan for tracing that connection. They thought that he might change changeling all depending on what host they were in almost like changing in and out of a uniform. It kind of reminds me of the scene from forrest gump when he's sitting on the bench next to the nurse right and he looks down, he goes goes most become Bush shoes and says, he quotes his mom right says. Molly said there's an awful lot you could tell by a person by the shoes. Where they go where they've been. This is what we're trying to do is we're trying to find what shoes E. coli wearing. So we can figure out where they've been where they're going. So did you find? Is there you call I chicken Chiu? We found the chicken shoes. More specifically, the coli from the chicken meat had special extra piece of DNA known as a plasma. So for talking about where plasmids or like nurse shoes when a bacterium goes into a chicken, Gut all slip these plasmids on. And the plasmids give the area tools to get their in the hostile taking gut dislike a nurse's shoes help them stay on their feet for long hours and protect their toes from dangerous objects but if you move them in a different host. A mouse and presumably human. That's the equivalent of our nurse deciding to go for a hike or something. It's a different environment. So now the bulk nurse shoes aren't as helpful anymore serve heavy and awkward and goofy looking. So, after a while, they're going to check out they're gonNA CHUCK OUT THAT PLASMA CHECKOUT? Chuck Up. going. GonNa. Kick. Out. That plasma. Checking kicking whatever the point is that lance and Cindy's Uti samples came from humans. which. Means if the equalizer in the samples were wearing chicken shoes, then those equalised must have been in chickens really recently. Otherwise. They would have taken off third awkward chicken nurse shoes swap them out for shoes that were good for hiking through the Human Gut. So, this was the moment of truth after months and months of work Lanston Cindy. Samples and. So, yeah. We found E-coli from people had these these chicken shoes right so they had these plasmids this piece of DNA that clearly is associated with. E. Coli adapting to chicken. This result was a big deal wired magazine described it as a smoking gun because the narrative until this point was that you could only get this dangerous strain from other people. But here's this year long indepth study suggesting the no, you could also get it from factory meet. Lanston Cindy think it's probably a matter of like touching raw meat and then touching some other food. So when you eat that other food. Bam you just ate dangerous e-coli. You have an infection and you can pass it onto others. So flagstaff a small town and we found a handful of these cases. But. When you scale that to the country scale, we're talking about thirty thousand plus infections food-borne infections just from this one strain and remember this strain can lead to more than just a urinary tract infection. It can lead to terrible complications and even death. So when you find all of this, are you all like horrified? What are you thinking I think. Really. Seeing it in front of you with actual data after a year more than a year. Worth of hard work. It's scary. But the that we can get this dangerous bacterial infection from factory farm meets. That's actually not the only thing that has cindy scared. There's something else something that's scary. Not just for meters but for everyone for me, this is actually what keeps me up at night. More on that after the break. It's hard not to feel like the planet is a really bad spot these days because climate change is at our front door. But the good news is that there are choices we can make to lower our impact on the planet. That's why Aubert's makes shoes from premium natural materials and uses sustainable practices like offsetting their carbon emissions to leave a better kind of footprint. I recently got my own pair of wool papers and I have worn them on a whole bunch of adventures. On the psych hiking trail that runs around in aviation field is Ryan them on this muddy walk. Right in them on this trip to apartment Queens Oh there's like. How many chickens are industry like? One two three and also wearing them on this trip to the beach. Kinda regret getting my shoes full of sand but. Survive. Out Not only are the WO papers made with certified Merino Wool and Albert signature sugarcane, sweet foam souls, the papers carbon footprint is printed right on the shoe. That way you have all the Info, you need to make a better purchase for the planet with Albert's feel competent knowing you're wearing your product doing right by your feet and the planet learn more about their sustainable practices and find your pair of will papers at Aubert's DOT com today. Bugging. Back. Linson Cindy is study is actually part of a much longer history, the history of antibiotics. In the early nineteen hundreds when scientists in the US and abroad I figured out how antibiotics worked. They were very excited about them clinical tests of spiritual. Muslim, indicate amazing effectiveness against a wide range of disease producing bacteria in the nineteen forties fifties. There were television specials and promotional video like this one they were all about meeting new drugs like streptomycin tetracycline how much human suffering Because of streptomycin and the other antibiotics, which among them have drastically altered the world's public health picture in a single decade he's drags helped us fight tons of infections like Tibur Closys, syphilis infections that were once totally devastated, which of them will be the next to fall before well organized fundamental research. But at the same time as these antibiotic tools or being used to fight infections in humans, another revolution was also happening. A poultry revolution the chicken of tomorrow race was on to develop better fatter birds broad breasted bird with bigger drumsticks, bumper thighs, and layers of white meat. And chicken feed was a big part of that race not so long ago chickens lived on a few handfuls of grain table scraps and whatever else they could scratch from the ground. Today we've learned that we can't take out of a bird what has not been fed into it. and. This is where to scientific revolutions collide because poultry growers started feeding chickens, careful diets, and those diet started doing glued some of these amazing new antibiotics. So in addition to fighting human infections are being used to keep poultry healthy and cramped crowded space to the commercial mixed feeds are scientifically compounded promoting maximum performance and profit through improved growth and production. And nowadays, the US is still using antibiotics our feed, not just for chickens, but for beef and pork to. Its millions and millions of pounds of antibiotics every single year for the billions of animals that we raise for meat. And the biggest issue here is we're not just using these antibiotics to treat animals that are sick. We're giving them to help the animals. So using antibiotics to keep sickness from happening in the first place. Next look at antibiotic Resistant Infections. In the last few decades, we've started to hear a lot of news like this. Global health alert tonight warning minor infections could become deadly if people continue to overuse antibiotics, the world is entering an antibiotic crisis that could make routine operations impossible and scratch knee potentially fatal overuse in human medicine is a key part of this crisis. But it turns out that overuse in factory farming also plays a role. It goes like. The bacteria living in the factory farmed animals become antibiotic-resistant, which means the bacteria on the meet bacteria like E. Coli also has a lot of antibiotic resistance. And that brings us back to Lance and Cindy study and why the results of that study keeps the up at night because. They showed that we can get infections from E coli honor meet. But one of the bacteria on that meet these activities that can infect us. What if they're also resistant to antibiotics? Them were especially to antibiotics that are commonly used in raising chickens, for example. So we saw a lot of resistance to antibiotics like John Thomason and tetracycline so if you're using Catcher cycling's and antibiotics in large quantities like we do in the United States. Then equal argon become resistant to antibiotics and when e-coli move from poultry to people. And people get a bladder infection with. Equal you can't use tetracycline to treat that infection. If you did treated with tetracycline, the treatment would likely fail and bladder infection could progress to kidney infection. Well, once it's in your kidneys, it has access to your blood and a blood infection with E. can kill you. Right. So a bladder infection because of antibiotic resistance can go from a painful annoyance to a deadly infection, and that's what we're seeing is that people are getting these drug resistant bladder infections then progress to what we call sepsis. So really serious blood infections. Lands Cindy is definitely not the first time that people have raised the alarm about factory farming and antibiotic resistant bacteria. and to a certain extent, we got more careful in us, but we're still giving animals antibiotics that we need to treat dangerous human diseases. And in the meantime, we've also exported our model of raising animals all over the world and bacteria. They do not respect boundaries, which means that this isn't just an American problem. It's a global problem. Take for example, the story of Collison. Carlson is an old antibiotic that had been long abandoned because it was toxic and some new antibiotics come along that we're more effective and less dangerous but as bacteria have become more resistant to the antibiotics, we have in heavy rotation. Doctors have started using collison again. It's like a break glass in case of emergency backup option. Our. Last resort antibiotic. But we may not have that option for long. Because it turns out that factory farmed pigs in China. We're getting collison in their feed have a colleague that's working in China, and he's looking at the coli better in their animal populations there and in their food supply any fines E. Coli that are resistant to call us in this last drug and it turns out that this equal I is not only really good at resisting Holliston. It's also really good at teaching other bacteria to Resist Colston. It passes on key pieces of genetic information, right? So this is just it's just. Everybody's worst nightmare when it comes to the abolition of untreatable. E.. COLI BACTERIA DEVELOPED ANTIBIOTIC RESISTANCE IN FACTORY FARMS IN. One. country. They. Don't stay there. They spread to other countries. And as Lance Andy showed, the bacteria don't stay on meet either they hop to humans spread around some more. And as they spread, they make it that much harder for us to fight back diseases. My sister had bone cancer just two years ago. The first four rounds of chemo she had three bacterial infections if any of those had been. super-resistant. She could have died a twenty dollar prescription. A failure of a twenty dollar prescription. So there. Thankfully, she survived and none of those infections were supervision. But as bacteria become resistant to all of our antibiotics because of our overuse animal production and in human medicine. We are not going to be able to save people. The way we have in the past, which is by just giving them an oral antibiotics earn really extreme cases giving them an and DJ action of antibiotics or drip of antibiotics. Last year the CDC put out a report saying that every fifteen minutes someone in the US dies of an infection that can no longer be treated effectively using antibiotics. You've been listening to this episode for at least fifteen minutes. We're a long way from the days of those early promotional film. And quite likely. Then in time with my actually be able to control most of the infectious, the plague mankind with them. Those days are. I shouldn't say those days are over but I can just tell you that. We are entering a period where. More and more infections are resistant to almost all of our antibiotics. What what do we do? What do we do? Yeah, that's a great question. I I. Don't have a simple answer, but but just so we don't end this on a total downer. We. Do have some options. We could learn from Denmark. For example, it is a leading producer o'clock in the world it has very big industrial farms but in Denmark, they have successfully brought antibiotic use way down. They focused on treating sick animals instead of just feeding antibiotics to all their animals all the time and they're pig populations have not gotten terribly sick as a result you can use botox responsibly and still. Run, a profitable business we also look to. Quebec. Chicken producers there used to inject eggs with antibiotics. And then the government approached them and said, essentially, please stop doing this and and please as more effective in Canada I guess when the? Stopped injecting eggs, it brought resistance to that particular antibiotic way down in Region. So a direct positive impact. So if we stop doing this. We can reverse this and a lot of cases and some cases, the cats out of the bag, right? We've released these bacteria and there's no getting them back. But in some cases, if we decrease substantially unnecessary antibiotics in animals and we decrease unnecessary antibiotics people. We could turn this around something really has to be done. Poverty Hunger. And disease this episode was reported and produced by birth. Pinkerton and edited by Amy Drift off Scott are hustlers Seagal Samuel, knee? Don. Matthews three ancient animism man the still stoke hand in hand. Of the three. Disease can be said to be the most deadly Jillian Weinberger is the senior producer of the show and jared Paul. Mixes it. Liliana Mitch. Elena fact check this episode enlists Nelson is the executive producer for Vox podcasts. This is the story of how one of the mightiest happens against disease was forged. It is the story of Pencil. The fest of the Modern Wonder Drugs Known as Antibiotics Vivek Amores from the Yale Law Ethics and animals program advised US Things also to Laura Rogers, enshrine, Avaz Ramamurthi for their help. Music in this episode from APM Jared Paul in Chris the brisky. We're grateful to lowering cats for her social media work into daily for all your help. In, this podcast is made possible. Thanks to support from animal charity evaluators the research, and promote the most effective ways to help animals. Many things to. For sponsoring the show, we've all had that pair of Lisa that looks awesome. Feels awful on your feet with Albert's new wallpapers. You don't have to sacrifice comfort for that. Cool vintage inspired book. You know the one casual but put together low key but ready for anything. and. Since they're made with premium natural materials like certified Marino. Albert's signature cushy souls. You can hit the streets in your wallpapers knowing you look good and are making the right choice for the environment with Auburn feel confident knowing you're wearing a product that's doing right by your feet and the planet learn more about their sustainable practices and find your pair of wallpapers at all birds DOT com today.

Winston Cindy Cindy Lou United States Lance Turkey tetracycline flagstaff Albert Collison matthews Lanson Cindy urinary tract infection Bird Pinkerton Lance Price Aubert producer researcher
The Story of Jane

Radio Diaries

12:10 min | 2 years ago

The Story of Jane

"Radio. Ex from pure Xs radio topa, this is radio diaries. I'm Joe Richmond. Good evening tonight. The subject of abortion, the legal termination of pregnancy has reached epidemic proportions in this country. Walter Cronkite on CBS nineteen sixty five that time abortion was illegal everywhere in the United States that didn't mean that women didn't have them conflict between the law and reality has resulted in a national dilemma abortion will continue to be a critical problem. And for those involved may call for desperate decisions that result in dangerous medical complications, hundreds of women were dying each year in botched abortions in eighteen sixty five and underground network formed in Chicago to help women who wanted to have abortions and medically Safeway, they call themselves. Jane at first, they connected women with doctors willing to break the law to perform the procedure, but eventually women the collective train to perform abortions. Themselves today in the radio podcast, the story of Jane and heads up the story includes graphic descriptions that may not be appropriate for all listeners. My name is when net Willis when I was twenty three years old. I was a single mom and advocate pregnant it terrified me the thought of having another kid that myself. I think I was kind of desperate actually. I remember being on an L on the train platform in seeing a sign in the signs it pregnant a question. Mark don't wanna be question. Mark call Jane in a phone number. So I called. My name's Heather booth. I started Jane in nineteen sixty five when a friend of mine was looking for a doctor to perform an abortion. I made the arrangements then someone else called while by the third call. I realized I couldn't manage it on my own. I thought I better set up a system. My name is Martha Scott I joined the group in nineteen sixty nine I had four children under the age of five. Many of us were stay at home. Moms a bunch of housewives, I'm gene galaxy Levy I was a member of Jane. I was twenty years old. I hadn't had so much speeding ticket but abortion really was the front line. It was where women are dying. That was all kinds of stories out there, you know, people who had used a hanger to stick in themselves to kind of stimulate abortions. But I wasn't going to do that. So that's why I went to Jane women would call an answering machine we're asked to give their phone number their name and the data. They're less period. We met someone before they were going to do this. We gave them a chance to talk about it. And we told them what was going to happen. There were lots of points along the way where they could have said, no change my mind because you do think about it a lot. I don't think anyone chooses to have an abortion lightly. I remember the day of out took public transportation to this apartment in high park. There was like seven or eight people in there. And we waited that the appointed time we were put into a car, and we would take in to a second location with abortion was performed. If felt very underground. You know, I remember looking at the people who perform the surgery, and I felt relief. That's was gonna help me. Good evening. The facts are astonishing hundreds of thousands of pregnant women unmindful of what may happen to them secretly abortions for them. There is a wide Gulf between what the law commands and what they feel. They must do. My name is Ted O'Connor. I was a young homicide detective on the south side of Chicago. This is a Catholic city abortion wasn't even discussed, and I knew nothing about Jane, the whole operation was totally under our reader, Jane was very organized, and very clandestine and secretive. My name is Lesley Regan and the professor of history and author of the book when abortion was crime the thing that ultimately made Jane so unique was they took the practice of abortion into their own hands. They decided to learn and perform abortions from selves and that was a stunning decision. We told them up front. We were not doctors, you know, doctors charged five hundred dollars a pop so we would say we charge a hundred dollars, but we will take which you can pay. We were doing four days a week. And we were typically doing ten women day, we would rent parts all over the city, we set up in two bedrooms and put linens on the bed and sterilized our instruments. So the person who is having the abortion would, you know, stretch out and the person who's assisting would sit with them while it was happening. You know, hold hands. And you know, and then I would insert the spectrum administer the anesthesia that was delivered by four shots to the cervix. And then the service would be dilated, and then the instrument would be inserted into the uterus to remove the material. So that was the procedure. We gave every woman a little pillbox with erga trait to help prevent bleeding and tetracycline which is an antibiotic by and large we were dealing with healthy women, pregnancies. I mean, we were not qu-. Defied to deal with somebody with real medical problems. I probably did hundreds of abortions. I mean, the fact is abortion is pretty easy procedure. But still you messing around inside somebody else's body. It's not necessarily given that you won't do harm. There were problems. There were people who ended up in the emergency room. You know, did it's wasn't always perfect by any means. You know, we felt it was the right thing to do. But that doesn't mean anything when the police are actually at your door. It was spring of nineteen seventy two and two female Spanish walked into the police station. And they told us that they're sister-in-law was going to have an abortion. Of course, these women were Catholic and to them was a sin and to they didn't want to a child killed. That's how they felt. And so with two Mark Suad cars, we managed to follow our target drove into the south shore neighborhood pulled up in front of one of the apartment buildings road up on the elevator. And we saw a young woman late twenties. Extremely well. Dressed, and she stopped momentarily and braced herself. She was pale looks like the blood and drained out of her face, and my partner took her by the arm, and a very stern voice said did you just have an abortion? She said he s and he said where and. She let us to the door. I really didn't know what to expect. When I walked in their living room was filled with young women waiting for an abortion and was shocked to see it. And of course, they were very surprised when we came in. They were such a cog. Oh, cops. You know? They were they were burly. They spoke with southside accents, they came in and looked around and said, where's the doctor? Looking for the guy. But there wasn't any guy. You know, it was just us. I remember one of the women asked me what I thought these women were supposed to do if they couldn't get an abortion. You know, what did I think was the right thing? And the I told her listen, I don't have any opinions about what they should do. But you're breaking the law. That's all. I know. That's why I'm here. So we are rested everybody I remember being handcuffed to somebody. And we were all taken down to women's lockup. We were charged with eleven counts of abortion and conspiracy to commit abortion. I remember thinking at the time, I can see both sides of this. It's it's tough issue. In on my side is I don't wanna see a life destroyed that life is helpless. It has no choice in this. And that's that angers me. On the other hand, I've never been pregnant. This is the CBS evening news with Walter Cronkite. Good evening in a landmark ruling the supreme court today, legalized abortions, the majority in cases after the arrests the supreme court decided versus way. Ultimately that charges. The had been brought against Jane are dropped antiabortion laws of Forty-six states for rendered unconstitutional. More. We'll be weighed brought an end to shave because now there were legal providers. But the controversy didn't just disappear perhaps more than any other issue in American life today, the abortion question is noted with the emotional arguments of life, death and morality, not the kinds of issues of court can finally Senate. Throw v. Wade made such an enormous difference. It was very important victory. At that point. We all kind of scattered went onto other things. I mean, we really thought the fact that it was legal would change things that this wouldn't be as political anymore that it would fade a lot as any kind of a social issue. But we were wrong. We were wrong. The Jane collective performed approximately eleven thousand first and second trimester abortions before Roe v. Wade legalized abortion in nineteen Seventy-three. No deaths of women were ever reported in connection with the service. Today abortion remains one of the most politically divisive issues in the United States since Roe v. Wade individual states have enacted more than twelve hundred anti abortion laws and over the next few years. It's likely that the battle over abortion will be waged once again and the US supreme court. The story was bruised by Nelly Gillis of radio diaries with myself. Joe Richmond, and Sarah, Kramer and edited by Deborah, George and Ben Shapiro ex-al-arqam. Flynn author of the story of Jane raided ariza's part of radio Topi from Rex could radio Topi dot FM to check out all the podcasts in the network. I'm Joe Richmond. Thanks for listening.

Jane Mark Suad United States Walter Cronkite Chicago Joe Richmond CBS Willis Martha Scott Wade Safeway Lesley Regan erga Heather booth Senate dilated Ted O'Connor Roe Nelly Gillis tetracycline
314: Why We Need Meat (& So Does the Planet) With Anya Fernald

The Wellness Mama Podcast

55:37 min | 1 year ago

314: Why We Need Meat (& So Does the Planet) With Anya Fernald

"Bobby podcast this. Podcast is sponsored by blue blocks that's B. L. U. B. L. O. X. They create stylish effective blue light blocking glasses that are used for any time of day. So there's several different options there. Blue Light Lens is clear. Lend that's designed for people who work under artificial light during the day but they don't WanNa look like they're wearing orange glasses. This one is designed to target the light that creates digital ice ice train migraines headaches and more but it's the most gentle easy inconspicuous lent their summer glow lens steps it up a notch and this is great for people who are exposed to intense artificial light all day or who as a result suffer from migraines anxiety depression or seasonal affective disorder and this blocks the light spectrums of light that contribute to those conditions and even further step up for better sleep. Their Sleep Lens is a complete blue green light blocking full red lines and the idea is to use this after the sun goes down to when the sun goes down the right glasses go on and the studies are showing that by blocking Lula. You can increase your Melatonin production and improve sleep. And I know I've seen this change in my sleep tracking as have many other people who have made that adjustment. And lastly if you aren't able to create a perfectly dark sleep environment their blackout. Sleep mask is the next best thing it blocks one hundred percent of light whilst and comfortable easy to sleep it as a listener of this podcast. You can save fifteen percent on any blue locks products by using the code wellness. Mama so to get that deal to blue blocks dot com forward slash wellness Mama. That's B. L. U. E. L. O. X. dot com forward slash wellness Mama and use the Code Wellness Mama to save fifteen percent. This podcast is brought to by Guy Herbs and in particular their black elderberry syrup. I have been a big fan of elderberry Syrup for years. And there's is the best pre made one I have ever found so unless you want to make your own. I highly recommend using guys formula. You can experience yourself. Why is America's favorite black ELDERBERRY SYRUP? It is the number one selling like Mary in the US and this time of year. It's a medicine cabinet staple and immune season essential. Elderberry will Family feel well and this delicious Elixir. Kids in children both like the guy. A formula certified organic and contains fourteen point five grams of elderberry and a single teaspoon to it's highly potent. It's made with only four clean whole food ingredients and of course vegan dairy free Clinton frigging sway free making safe for most people. Lack elderberry syrup is considered safe for the whole family and it's formulated to be safe for adults and children. One Year of agent older. You can save big enough herbs as a listener of this podcast by going to guy herbs website and using the Code Wellness Mama. All one word at checkout to save twenty percent so again guy herbs com forward slash wellness. Mama make sure to use the code while Neshama to save forty percent. Hello welcome to the Wellness Mama podcast. I'M KATIE FROM ALL ISLAMIC DOT COM. And this episode is all about why we need meat and how it can actually be good for the planet as well. It'll be maybe a little bit controversial but I think you'll really enjoy this. One Anya Fernald. I'm hoping say her name. Right is the CO founder and CEO of Bell Campo Bell Cambo operates a twenty seven thousand Acre organic farm land in California and processes its own livestock for sale in. Its own butcher shops and restaurants on your has two decades of leadership entrepreneur experience in high quality organic premium foods and her list of accomplishments is long and impressive. She's been recognized as one of INC magazine's one hundred female founders one of the forty under forty by food and wine she was named a nifty fifty by the New York Times and has been profiled in the New Yorker served as a regular judge on iron chef America since two thousand nine and has a cookbook called home-cooked which released in two thousand sixteen. And we're GONNA go really deep on this topic today and talk about how the human body needs meet and how it can regenerate our planet when it's grown and cared for properly so let's jump into this episode Anya. Welcome thanks for being here. Thank you probably me. I am so excited a chat with you today because I think you have such amazing and unique set of knowledge around topic that is increasingly important right now and that is the role of meat in animal wellness environmental wellness and human wellness. And I know we can go deep on so many areas related to this but to start. I WanNa give people just Abroad level of just how important this is and how animal wellness and Human. Laws are so connected. You know I think about it as these are animals that we share ninety nine percent of our DNA with right tone of genetic level were very aligned. So it's intuitive to me that any kind of environmental impacts that make animals gain weight extremely rapidly that then we eat. We'd want to be extra cautious about right the way that animals are raised right now with affectively an Abi Genyk Environment. So they're put in a place where they're under stress. They're fed a maladaptive diet that causes to be inflamed and Gain. Weight really quickly. And it's actually basically an extreme inflammatory and heightened cortisol response so they're put in areas without access to natural light no social connection competition for resources and then Really given a Lotta innocent you. Their bodies response of sickness to these inflammatory conditions. And I actually create the Beastie so it you know chicken growing in that environment can reach the optima weight of two and a half pound that in in just over two weeks Compared to the natural environment like at our farm and that's Eight to ten weeks right to gain weight gain at four times the speed so just thinking the human connection. It's like well. We share a lot in there with this animal. He also functionally are the same. You know it's not like an earthworm where you're digest decisions actually quite different. You know the way that a chicken digest is quite similar. They needed microbiome. They you know they have circadian clock but there's a lot of similarities to how we function. I think there's a need for people. Do the extra attentive to the conditions of the animals are raised and simply because our our whole body and digestive system is it aligned with how they function so for us to be well. It makes sense that we're gonNA WANNA eat. Animals that have been raised in a way that well and healthy with normal weight gain in normal functioning National Environment. That makes perfect sense. And I think that's something pretty much. Everybody across the board can agree on. I think it's really important in the nutrition world because it can get so controversial. In so polarizing people tend to focus on the little things we disagree on but I think most people would agree that we should treat animals well and in line with their natural biology whether we eat near we. Don't I think that's a really important point and I don't think anybody's in favor of treating animals poorly or a lot of the feed lot situations but I think also people maybe don't realize just how drastically the way that we raise. Animals has changed even only in the last few decades from what I understand. Is that right? Have we really changed supply so quickly radically and and you know Katie? If it doesn't say something very specific about how dribbed raised or have the actual name of farm you can Google and is the name of a farm not just like a packing house or you know facility. They cut that meeting wraps it. It's call the farm right unless it's really very different and cost. More has a lot of different claims on it. It is absolutely commodity need. That's raising a feed lot that's the biggest takeaway you're right. People understand intuitively animal wellness and Human. Wellness are connected. I mean sense right. That's just like a no brainer. Not only for putting your body but also people living near animal confinement. Feeding operations have heightened risk of low-birth-weight higher miscarriage rate higher indicating related disorders including cancers right. So there's the no brainer in a wellness. Hyun wellness connected. But then people say oh you know well. I buy a really good grocery store. Well that means nothing right I buy from or I go to. I go to arrest like I only eat meat at expensive restaurants also means nothing so you have to be extremely activist as a consumer to ensure that you're getting meet that's not the status quo if it's not stated very clearly. I can guarantee it's not just happening that supermarket or that restaurant is buying better. Baldini it's not that makes sense and I have so many follow up questions we're GONNA go deep on but first of all if people are trying to be conscious consumers here are there. Is there any regulation on these labels? So I think that's great tip of look it make sure it's a verifiable farm that you can find out the practices but do any of these other labels actually mean anything labeled means something. Words mean nothing. So you know we're every word is regulated Campo for my company anytime. We put any word on a package. Kito friendly or free reign or anything. I have to write a letter to the government that explains why but that letter to the government. I mean Tyson has natural on all of their products and they're absolutely feed. I mean can find the worst of the confinement. Operators Pasta farmers also a large-scale confinement. Operation has natural all of their products. So the regulation of the words they can say. I don't know what case they're making but it's like hey we're not being in plastic praises natural. You know so. The the most of the words are totally unregulated. And that's the problem consumers. You know. Keep in mind that they. Usda's run by an extra executive from perdue made from purdue. Massive massive agribusiness Definitely not animal wellness company right so there's just vested interest in keeping consumers in the dark and to make consumers settle and that's what you're being asked to do in America. It's like settle for unsafe meat K. Guys Hey mom settled for a product. We have to cook to the point of killing all the pathogens on it. That's what they're asking you to do. Settle for product. That probably dirty. But we're gonNA tell you could do one hundred sixty five degrees so your kids. Actually I kind of feel like well. I don't really like this right. 'cause overcooked and dry and he needs to settle for that though because we're not going to guaranteed clean product. That's what you're being asked to do. So do you think the labeling I it's it's a really It's a situation that stacked against the consumer so when you're looking for a label you need to look beyond or like natural free range and eating to look beyond You know what I consider. Claims and look for real certification certified. Organic good places are but it doesn't have anything to do with free range for free range. That's where I say you need to look for an actual name of a farm. You can verify Or of a group of farms that you can verify So that would be any national players beyond our company that the immune but it's probably some some specifics in like lamb and poultry that do ship nationwide but in your local grocery store you will find that many grocers are trying to stop at least one option of that like actual from a farm In integrion level traceability and a greater commitment to a wellness that makes sense and I think people if maybe the idea of hormones being in meat and dairy products for instance is that a concern to actually worry about like. Are these not our animals that are not raised? Well do they have different levels of either artificial or natural hormones that we should be worried about who great question about hormone in the US. It's actually illegal to use hormones in production of chicken or pork so when you see a pork chop for sale it says no hormones that just means are complying with the Basic Law in the US. The question of why. Don't they allow the use of Hormone? Isn't that the? Usda and being particularly health conscious. It's just that the hormones do not create as effective and rapid weight gain of antibiotics. Do Antibiotics do a better job at causing rapid weight gain then hormone doing pigs or chickens so we don't use hormones in the US in those two products simply because antibodies tetracycline amoxicillin or more efficient in beef beef. Do not respond as well to Antibiotics for weight gain as they do to hormones so be are allowed. Tease homeless producers these hormones because rapid weight gain and beef. So they get. I feel like the hormones are kind of like a red herring or a lot of producers are getting away with saying. Oh it's it's no more no growth hormones and no prophylactic antibiotics right that claim easy analog mass market pretty by using the grocery store no hormones. No extra antibiotics but the truth is hormone aren't allowed because they're not efficient and you might say you're only using antibiotics when the animals are sick. Well guess what if you're in a Hoop House with you know that. That's three hundred feet long with nineteen thousand other chickens. You're at risk of dying of sickness every day because of the toxicity of the environment that you're in so give animals antibiotics in. That is actually necessary for them to stay alive. So the claim that they're not using antibiotics. They only when the animals are sick. Well there's veterinarians on payroll that are able to say constantly. Yes all. These animals are sick or at risk of getting sick because of the environment. So that where those claims of antibiotic and hormone free. They're both meaningless. And that's why you know the thing that kills me. It's like as consumers if you see a math market meet brand all of a sudden have a bunch of new claims but the price is the same and the product was saying. You better call bs on that right. It's actually not any meaningful change. Changes in the production system of animals are typically caused pride to grow more slowly and therefore become much more costly. So when you see it hyphen or in a big player. Changing their claim but the price points as the same. You're getting ripped off. I mean you really actually being sold a false good while I think that's an important point too. You brought up about antibiotics because it really makes me wonder. We've seen all these news stories about overuse of antibiotics in humans and how this is leading to superbug superbugs and antibiotic resistant bugs. And then you mentioned that these antibiotics help animals gain weight. So is there any concern with this transferring to humans this gonNA cause humans to gain weight and have resisted Katie? That's right yeah. I mean the the Antibiotic Resistance Free Right. 'cause I mean you can die of staff right? These are serious serious illnesses and now people are getting the heavy antibiotics for pretty minor sicknesses because antibiotics are so prevalent in animal agriculture. And then they get into the water I mean they find tetracycline in the drinking water Three to five miles away from us in the drinking water right because there's so much antibiotics in those animal farms. Now for your own. This is definitely. I'm not a nutrition expert or a But I know from animal. Agriculture that antibiotics increased wade crane gained by factor to at least and this has been shown in humans as well and some very interesting studies that were done in the military In right after World War. Two a bunch of say that showed that Just regular prescription Amoxicillin tetracycline in low doses made The young men gain weight more quickly. So it's got the same effect on human then. It has something to do what I've heard from. People know more than me but I encourage you to do your own research on this and it's something to do with suppressing your microbiome so effectively you become less efficient at your food right So you're without a complex microbiome Which suppressed by antibiotics You actually Convert convert your data host issue. More quickly gained more fat and many more weight. So that's the that's the short story but it's actually got a similar a similar effect on humans. Right I mean it's been shown in humans in the nineteen forties in the studies as As a mom I'd say if you can avoid antibiotics for your kids absolutely do because it's definitely connected to human weight gain and it also has a three months tail so even regular like you've got a sinus infection. You get a dose of whatever little thing they give you sixty day package. That's what a three months. Pale on your microbiome In terms of how long your system the minimum of your system is going to be suppressed through the antibiotic of course that makes sense and okay. So there's two things I wanNA make sure that we cover we're going to get to the environmental side of this so if you guys are interested in that definitely keep listening but I wanNA talk about the role of meat in human health. Because I think a lot of people realizing all these problems with feedlots and realizing how horribly animals are treated understandably think okay. Well maybe I should just not eat meat. And then that's going to be better for me But I think in doing that. We absolutely throw the baby out with the bathwater. So let's talk about the role of meat and why it is so important especially for a lot of listeners who are moms who are pregnant or nursing or have small children. Yeah I mean there's a meeting data about the actual the number one thing as a for me as a mom. That just blew my mind. Was that a mother's access to animal protein. Too High Quality. Animal Protein is a higher indicator of her child. I chew then the country that she lives in Economic Index. That doesn't stunning Santa Barbara. So a mother is accessed. Jared Dj Omega Three Rich high-quality proteins in a greater indicated a child's performance on standardized tests than the country they limit why in Sweden versus Ethiopia that crazy Right so what's what's important for your house. The things that were stunning to me are just around. You know for for women If you are a vegetarian from age Early puberty from twelve. Till when you have children in your thirties you will actually pass essential amino acids that you can only get from me onto your fetus. Your body has evolved to hold on to those from Early Childhood for Eventual Child Berry. So I mean that doesn't seem to me L. Who Amazing I mean the on the mother at things I'll send you the study. It's an incredible or it can give it to you to link for your listeners again. From from this Gentleman you Santa Barbara who showed again major intelligence correlation with young children and the quality of their mother's breast milk With hot being Haina Mega threes. Dj's these are really impressive. Amazing data that connects primarily around Essential Aspects of animal proteins then contribute to brain growth and brain health. And that's really for you as a mom right and for for us as mothers thinking about. How do we facilitate healthy? Happy Balanced Smart Kit and animal. Protein appears to be a really crucial part of that. I mean and really the essential The essential and fatty acids from animal protein. That's like data is locked down on that subject that you're you're going to be doing disfavor to your child by being a Vegan Vegetarian Around your childbearing years in terms of your own nutrition. I mean for me. It just kind of basic that. That animal protein is extremely healthy It's very nutrient dense. And it gives you a wide range of essential amino acids and that's all I can say on it you know. It's also demonstrated that there's animal protein. That's good for you and the not so good for you. And the better and slower. The animals are growing and by slower. I mean just like the natural rate of growth of muscle mass healthier that muscle mass is going to be for you as a consumer. I'M NOT I'M ATTRITION S. I'm an active avid You Know Cook and mom and all those good things so I encourage you to do research on the people who know more me. We're discussing Chris Presser as a great resource on this as well but Animal protein is a really high quality at for sources. Lots of different attrition for you absolutely and my background is nutrition and just realizing especially like you said in those childbearing years Your body's going to do everything in its power to pass on the nutrients that your growing baby needs even at the expense of your own body. So you're not getting those nutrients you're also putting yourself at risk and I think this is like this topic that you bring awareness to such an important one for our time because it is very much about quality and amount and sourcing. It's not just about getting the meat and getting the protein and like I said in the beginning. I think we can all agree that we don't want to treat animals poorly. We don't want animals and be lots nor do we WANNA feedback kind of meat to ourselves or to our children but realizing there is a biological need for these amino acids and it's extremely difficult. Maybe nearly impossible but extremely difficult to get enough of those proteins during pregnancy and during nursing and developing child. And you have to be extremely extremely careful if you're even trying to do that whereas it's so much easier if you can just find high-quality. Oh Yeah I mean. The number of women who I've talked to who were vegetarian couldn't conceive and then third eating meat and got pregnant a month later. I mean like I've heard that story now so many times just like that's your body's saying you don't have the micronutrient base to make this happen. Lady you know and and then they start eating meat even dismantle month like bone Bra right and we conceive so there around the the the Mojo around your fertility your ability to to raising healthy children without completely you bring up a good point. Katie. There's no way to do it with. We got your own body. Lose your teeth lose your hair right but to do that With the way that you stay healthy and sound inital proteins appear to be crucial in another piece. I WANNA call out. It's not just protein period right something I learned recently which is just amazing to me. Is your ability to extract glutathione. Which is you know the bodies master amino acid. You probably know a lot more about this than me. Katie but who super crucial for wellness and health and essential. And it's one of the reasons we eat meat right now your ability to to to metabolize an in your lean muscle that you eat is actually the. There's a rate limiting component in in That in your ability to digest which has to do with the availability of collagen protein. So you're just eating lean muscle and not eating connective tissue like stews and raises and bone. Broth you're not actually going to be able to extract the nutrition right so there's another type of like I call it almost like it's a former vegetarianism where you're like. I'm suffering. I'M GOING TO START EATING. Just like boneless skinless chicken breasts. Well that's actually not doing your body any favors so we're talking about eating meat. We're talking about also getting access to the other Mojo in meat which is bone broth braces connective tissue. I'm not sure Mero and liver are your jam. But it'd be amazing if they could be right but I think the basis at least getting some Collagen rich connective tissue rich foods that you can take collagen powder which is typically made from animal hides to. Collagen powder available commercially extracted from. Hides you know it's an animal. I product in general stuff that you're eating in. Its natural form and easier for your body to integrate metabolize. So I would absolutely recommend you know. Mix if you're looking especially infertility childbearing like collagen bridge bone broth or soups. Plus your chicken breast or your New York steak or your pork Loin or whatever you're GonNa have which classic like Lean Stride Muscle for me to after my second child. I went on a much more intense bone broth regimen than I'd ever done before Because we actually opened up a Bell Camp Restaurant next to my office and I started to drink about a core of bone broth because I've policy and my company. Every employee gets become boombox free every day from white one sign up for that so. I had been producing it for my audience. Let's for myself served to drinking a quarter day and massive changes in terms of like my Breast tissue coming back after breastfeeding to kids in four years I had gone down two cup sizes and they just that Collagen rich within a month and a half. I was back to my pre baby. One Cup size Despite you know that usual kind of like weight loss weight fluctuation your whole body is moving around but I also started to get just much more Much greater improvements. My skin tone You know a nice like pumped in my face that despite you know fully losing the baby weight so that Collagen well I think of it as like a beauty juice to it kind of gets. It's great for your hair. Skin nails breasts Especially with all the kind of like the body wrecking that happens through childbirth and breastfeeding absolutely. And I think that's another important distinction that we don't talk about enough in the modern world is that for most of history. We ate all of the animal we used every bit that we made bone broth. Like you talked about and that's being this change. We didn't for most of history eat just ground beef and chicken breasts I love the book. Nutrition she really talks about this and just how important getting that variety and especially those different types of amino acids that are in broth are to balancing out the muscle meats. And I think that is your another piece that people really really miss and also on the note of quality is important when people start quoting these studies about why might not be good for health or people seeing these changes. These studies are not separating at all based on quality of meat and they're almost always using conventional meat. Which would explain has all of these bad things in it. That people tend to think like Oh will. I can't see the hormones. I can't see the antibiotics so I'm not gonNA worry about it and it always kind of boggles my mind because people will take a Motrin. Which is this tiny pill and expect it to have this huge effect on them and then ignore the same amount of something in meat and then think it's going to be totally fine and so I think that quality is the the missing key when it comes to that to shift gears a little bit though. I think it's really important that we get into the environmental side as well. Because I'm sure you're even more than I am all the press and publicity lately Blaming meet practices for climate change and for a lot of things going on in the world and saying that Raising animals for food is really bad for the climate and bad for the environment and I personally take a much different view knowing a little bit. I know about regenerative agriculture in the role of animals in permaculture in our entire ecosystem. But I know you can speak to this much more from a first hand perspective and from a place of knowledge so let's talk about the role of raising animals in environmental stewardship. So the data that companies like impossible foods and beyond meat are putting out about carbon impact of beef is a hundred percent correct right. Conventional beef is terrible for the environment. I want to be clear that I'm not contradicting their data. What they're not telling you consumer is that there's a different way of producing beef and cheese in all types of livestock that is carbon impact positive and it is the way that beef and other women have been produced for Millennia and that is raising them with regenerative practices. So our farm bill Campbell. We farm twenty seven thousand acres in northern California and our firm has been there documented as carbon impact positive which means that our practices actually increase the density of carbon in the soil. And get too how that's different from conventional symbols. It's kind of a long story but I'll say insurance conventional beef your feeding animals crops. You raised by tilling the soil to digging it up planting very nutrient dense food like corn or wheat and then using a lot of nitrogen and how it's raised and harvesting it and telling it up bringing it to account that's on cement in great density like you know hundreds of animals feedlots and then feeding it to in confinement along with a lot of other honest crap like skittles candy thought. Us and plastic shavings are all used in conventional caffeine. You can do all that stuff and see about it. So that's the conventional system. They're not on graph near grass eating grass for most of their life although they the half right when it's born some many of those cow calf operations are on Under graphs for the for the first six months might be outdoors but then for the remainder of their life in confinement in this fast. Paced animal waking context that Is is based off of a really Nigerian intensive and resource intensive crop. The only reason why it makes sense to feed such a costly food to cows is because of the subsidy system so these processes subsidized so effectively way able to feed expensive food to cheat me. That's a total fake economy are says them along with many other. Regenerative small-scale farms in in in America and around the world we're raising beef on on perennial pastures. So we've got grasslands with hundreds of species of grass. We don't tell them we never disrupt the soil. These grasses have root systems that are thirty feet K. That's how they question carbon animals are low density And there are moved from pastor pastures. They don't spend a whole season on one pastor getting muddy right and and turning it into basically just kind of dirt. We moved them from Bachelor Pastor. They eat a little bit. They moved to another pastor and then animals are brought back to that. I pastor after a break of two or three weeks to recover. So that's more like mimicking typical migratory pattern of how ruminants evolved. They would evolve by walking through a field and eating some south keep moving they drop a little bit of their manure. They kill the earth with their homes. But you're not talking about a thousand beef all dumping manure onto an Acre and then it being left kind of devastated right. You're talking about a loan entities. So we make a natural migratory pattern for the animal and we do it on perennial passers and we're not the only ones doing this. I mean literally. There's hundreds of regenerative Livestock ranches around the US. And they're all practice and they're all carbon positive. There's not very many of them. Were less than one percent of the D. supply system. But we're actually we've been tracking carbon in our own farm using a third party Research Group for five years now and then that five year period meet increased the carbon density in our own soil which is just beyond beyond product. That's amazing that has long term environmental positive effect as well and I think that's another important correlation for people to understand is just like the quality of the meat matters so much when we were going to consume it also really really matters for the planet and to compare regenerative agriculture and how beef has raised in that environment with It's like you're hearing entirely separate like they're not even on the same playing field at Katie. Like it's like saying. Oh for me to get to work. is X. Pounds apartment sometimes. Take a helicopter to work. And then I walked to work. But it's ex- carbon like that's how it's like inflating two totally different things with totally different impacts helicopter versus walking that's the feedlots versus conventional versus. You know that regenerative and it Kinda kills me when I see stats and I see people bashing you know. Meet your killing the environment and then all those pictures of the gallons of water and I'm like damn we don't use one gallon of water like we have like rain at fills cashman ponds. I mean there's some stock water but you know you're it's so minimal There's actually not even software. Usually the animals are just freaking out of puddles. Were out there in the fields and streams right. So it's such a different environment. It drives me crazy but I'm happy. I'm happy because I see people. Starting to pay attention. I feel like the whole movement of of the alternative. The fake needs the highly processed vegetable. Meets those guys are are pulling aside the curtain a little bit and they're showing consumers just how bad things are so. I feel super grateful for those products existing. I feel like we're kind of fighting the same fight in some ways you know but I think that many of those considered for the first time have there like the light push gets flipped on where they're like. Wait what the heck is going on what I'm eating you know. And they just really hadn't thought 'cause like I shop at X. Grocery store it's not the worst grocery store so they probably you'd better stop and they don't realize that it's all bad unless it's really expensive and really different. You know so that that it's been useful. I think in the broader education. It's really not true about all beef however such distinction and I'm glad you brought up the alternative meets that have gotten so popular and certainly have been extremely highly funded and publicized because to me that brings up two things right. It's shedding light on some really important stuff that we definitely all need to be aware of and to kind of unite around fixing both for ourselves and for the planet but also it always is ironic to me of like if humans didn't have a need for meat. If we were supposed to be vegetarian. Why do we need to spend so much time and money trying to make plants tastes exactly like meet? If we don't have a need for that I think you know it's an indicator that we actually are hardwired to need these kind of proteins especially at certain phases of life like we talked about or for kids when they're growing and like I said Multiple Times it goes back to at the end of the day for both the planet for ourselves for all of it for the animal. Certainly it's all about the quality and how they're raised and I love that. There are practices like you. Guys that are really revolutionizing and getting back to kind of how. It's always supposed to have been done when it comes to that yet that's a great perspective that the that the beyond me impossible exist because there is that kind of craving I two. I'm really perplexed by the need to make vegetables look like me and kind of genetically modified complicated processes that go into them. It seems like every time there's kind of like radical innovation and something that is sort of too good to be true in fake and magical. It's like well merger in especially in my lots of like. Oh what was that crazy fat that you couldn't digest and so you go chip? She wanted those things they tend to. They tend to have a pre short life cycle But it is. It is interesting the amount of like its appeal to a almost like it's captured the popular imagination in certain ways. Because the idea as well then you can kind of have limitless me kind of for free with no need for processing an animal or the responsibility of an animal dying. You know those are. That's kind of A. That would be an amazing Lucien. Were it not as As fraught with challenges. That really is exactly this. Podcast is sponsored by blue blocks that's B. L. U. B. L. O. Excellent Day create stylish effective blue light blocking glasses that are used for any time of day. So there's several different options. They're blue light. Lens is a clear Lens. 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All one word at checkout to save twenty percents again guy herbs dot com forward slash wellness. Mama make sure to use the Code Wellness Mama to save twenty percent and I want to talk about the kid aspect a little bit more as well because like from nutritionally kids have higher protein demand to per pound of body weight than adults do and especially during phases like when they're puberty or any kind of growth spurt. They need a certain amount of protein. And that's really really vital for them to function optimally I also know as a mom and I'm sure you can probably relate to this Kids don't always necessarily want to eat what you want them to eat. And so realizing this realizing that like this is really important for our kids. Do you have any tricks mom or as a business owner in this industry for helping kids be introduced to these kinds of things and getting them to like it because like in my house. For instance bone broth is pretty much the first food for all my babies with the understanding that babies naturally have a semi permeable gut. And this is really important. Actually because when babies are feeding that's how a lot of stuff can transfer through and they can develop their immune system this way and it's a wonderful design but because of that you may be don't WanNa put some foods that can be slightly inflammatory as the first food they get in there and so I always start with bone broth because of its ability to suit the gut But I'm curious how you have integrated win meat products with your kids and if you have any tips for that so I'm pretty radical on this front. I mean I I meet with actually my both my kids for sued along with Bone Broth and my kids to this day. Love from me in love marrow and love liver and heart and it has to do with availability but I also think Katie had has to do with it tasting. Really good you know. I don't think my kids would like liver if they were eating. I don't know where what kind of liberty you can buy a standard American grocery store but it can't be very good. He's probably older frozen so getting really delicious. Fresh product is the first thing. I think that the kids have a natural ability to taste. Hell you know there are more in touch. I think in pregnancy we as women have a little bit of that that tastes where we start to taste. What what we need you know craving talk about sort of crazy thing but crazy we actually. If we're really in eating intuitively. We should have them all the time. And they're very healthy for us. You know and kids have those cravings to And they actually listen to the more you know like that demand they have where they like leary now. I really want to get a lot of that one thing. They're more in touch with that. So my approach with my kids has been to really make them delicious food in Super High Quality Proteins. And you know my daughter at seven can eat like six drumsticks. We will go. We eat a lot of me and she's loud. My son had a little bit more of a carb lover But and he he but also we'll just eat every type of meat and I. I don't have a good. It's so it's it's such a battlefield on on this you know you don't want to judge other people's choices and also there's just. I live in in a very Like luxurious contact for. I have access to this really high quality protein. You know so. I don't know what I would do if I didn't have that. But my in my own home for my kids My major goals as a mom or to cook them breakfast every day and cooking dinner instead of most days and had their lunch be homemade leftovers. That's what I tried to get to And I see that you know. We have like three things that we make for breakfast and then and it's always from scratch. dinners. We do a lot of different things. I also have no refined carbohydrates snacks around my house at all and I I found and I also don't this is going to tell them we'll crazy but I don't carry Max for my kids. You know in the German or an apple and a bag. You know all that but I don't carry boxes of raisins or by a goldfish or any or back. Cheerios or anything. And that's in part because we don't do any refine carbs But it's it's also just by doing that. I find that they're I think a lot of the reason that kids are picky is that they don't durians being hungry And so I'd like to be sitting down for dinner and the kids are like. Oh my God i WanNa eat dinner. If I've been feeding them snacks all day they. They're they're not gonNA enjoy dinner in the same way. So I I really believe in very minimal. We always have big bowls of fruit around They can always have milk and water. There's no snacks for them. But I don't make snacking available and I find that. Then they eat a lot more enthusiasm and they're more open to try and more things stand on those days when they've been played throughout you know the Little Light Daycare Center that drama sometimes where they get paid for dinner. I am hundred in alignment with you on that. I think I always said hunger. Incredible teacher and I think your kids are much more likely to try new foods when they have natural hunger and it's great for kids to experience hunger to learn to eat when they're hungry. We're the same way we have refined carbs or sugar in our house because there's no biological for those men carbohydrates certainly eat some fruit some sweet potatoes but we don't have a need refined food at all or for refined sugar at all. So I know that sounds extreme to a lot of people But like you. I'm not the mom who's like Uber. Controlling my kids diets when they're not in my house if they go to a friend's house and they want make a choice. It's one hundred percent their choice to make but in our house where I'm responsible for the food I'm going to have really high quality nutrient dense food. And that's what I'm going to feed them and I think that's an important metric that you don't have to take like it's not that the you're never gonNA eat these foods but in my house. I'm certainly not going to have them. I also find too when we do make cookies. I Mike you'll you want. You know like I never want to have their be guidelines around things are like have they're always like when there's the only cookies like once a month you know twice a month maybe we'll make it with coconut sugar and really good chocolate and like so diligent but if my kids want to eat ten they will but the thing is that now that they're they self-regulate well they'll have to and then they'll want one the next day you know so it's like. I really try to be like when we do have something. That's like a little bit different or sweeter. Knock yourself out you know and and go crazy and I just never wanna have the sense of like you know I. I think you have a big bucket of pretzels. Big Bucket of Gulf. I've seen as in friends places. And it's like this constant thing and like not now and you're constantly regulating it and it's actually a source of anxiety and stress in the home. You know to have like these sort of like limitless. Bad Foods available And the thing that goes Halloween candy. I'm like get it all. Eat all you want make yourself sick and then a day later. I'm talking like it's like go crazy while you love there so I don't WanNa have to be the PL- The food you know. I WANNA I WANNA teach my kids in natural agitate another another thing that I've Noted the two is that the the whole act of preparing foods with my kid has helped them appreciate home cooking more you know so involving them like they make the painting batter in this morning. We made waffles in mice. They do it to get like they actually. They really enjoy sort of a no brainer but they wanted to. Outside of cooking from scratch is that it's more fun for the kids you know there's more parts and pieces and What we do in our houses. I have everything organized like in basket. So like the little basket was baking and baking powder and then the flowers in the tub so easy for them to get the parts and to participate in that which they really enjoy But it's it's it's hard to you know I I was so afraid. Katie when I when I had my first it was like my terror that is going to have a picky child and then my daughter eight. Everything was amazing and when she was three. I did my first. Like mom date within within her best friends at the time her mom and we went to a pizza restaurant and I got the pizzas. And then there's mom brought out like four containers and one had watermelon chunks in one had goldfish and one had cheese sticks and one had like apple slices and I wonder what's going on here and she said Oh you know so this child really sh- she's really picky and so I had to bring. That's where else she won't eat. And I'm like okay. I'm filling. I felt so empty for her but I also felt so relieved. Because I realize I'm never gonNA have picky eater. Isn't I completely get that? There are some picky eaters that are born that way. Or maybe allergy related but I think by giving our children limitless choice. I mean. Imagine if you went to work every day and sitting on your desk was like all of your favorite foods that were prepared for you with love and they were there all day long twenty pounds in a week you know so would you It's not feasible to have people offering us our favorite most highly processed delicious things all the time that we want to get. The MOM was doing your best job and brought things that were pretty pretty healthy and fresh but it still meant that the the daughter wasn't didn't have to eat the pizza and try something new to try this pasta and she could go on and say. I I. Don't you know I only watermelon cubes. You know I it. It can be a choice and I just encourage people to let the Child Experience. A little hunger let them experience a little delight enjoy with finding something that they do like and that that hunger also teaches cravings and teaches the conversation. You know exactly. Yeah I think you nailed it. I think that's such an important point and such a great point to start and I can't believe our time is flying by so quickly but I wanna make sure we talk about a little bit more about your farm and also all your restaurants and just all the amazing innovative stuff you guys are doing so kind of give us a roundup of what the farms are like how many cattle you have and then what. The restaurants are like absolutely so our firm is a thirty thousand acres in northern California. It's all organic certified. We have three thousand beef about two thousand lambs. Two thousand pigs and produce about fifty thousand chickens every year along with Goose Duck and Turkey in smaller quantities. All of our meetings are sold through our own channels which we have six restaurant. But you're shops one in New York and five in California. We also sell through select retail partners. So currently we're selling through air one which is a great grocery store in southern California. Where expanding right now with grocery partners in northern California and New York. So we're looking at being probably a hundred doors by this time next year. Was Oliver meets as well. We also sell on BELL CAMPO DOT COM direct from our own slaughterhouse. We have our own USB FATHER JASON. To our firm that certified humane certified organic meat processing plant and so we saw Bo. Kenema DOT COM. You can go online. And it gets shipped directly from our plant from Army plant and why Rica California or you can go to Williams Sonoma dot com and they sell some really awesome gifting. Bundles evolved Ocampo but our claim to fame is they. I think we're the first and only truly vertically integrated farm-to-table meet operation with animal wellness as its core. I consider about Campo fundamentally an animal. Wellness Company providing optimally healthy mead in support of optimal human nutrition. And really you know the why of it and all this complexity man. We've built something insanely complex. That's also fun. You know like this Christmas. I'm watching a line of animal. Fat Face Moisturizer And Beard Ball and things that are just like actually developed this line. When I was pregnant with my second and got kind of freaked out by they creams and things that I use Is to make my own easing animal fat. And now we're selling them but like so we can do neat. Little Line extensions like that Because of having the whole animal But we we started from a ranch In twenty twelve and the idea was like great. How do we get this product to the consumer in a way that honors it through the whole supply chain and you can ship it to a massive consolidated slaughterhouse where thousands of animals are killed in an hour? There's no traceability There's animal handling processes are inhumane. So that was okay until the former house and then how do we get into retail? And it's the restaurant. Philip give people a completely owned supply chain so they can have absolute known for in the fall of this product. And it's been so cool to we're best burger in La from La Magazine Best Aspirin Asset magazine like we get. We've been winning on taste for years And that's sort of been the knee upside. You know. We started around wellness and doing the right thing. And then. Wow you do the right thing for the environment for people for animals and it takes a heck of a lot better so the nice kind of like positive upside of it that our army is consistently reknowned for just pacing really awesome. I can vouch for that. I've been to the La Restaurant in the Burger is amazing so Definitely GonNa get back and try a lot more things but I'll make sure that links to all of your websites are in the show notes. If you guys are in or near any of those places you can find the restaurants or you can find. Yeah hope you up with a discount code for your audience is amazing. So yeah you guys check the show notes Wellness Mama Dot. Fm for that Discount Code and also post on social media but Yeah I can definitely vouch for the quality. It's amazing and delicious and I loved that it's run by a female founder and mom who is just really pioneering in this world. I think it's incredible selfishly. There's another question I loved asked for the end of interviews because I'm always looking for new book ideas and that is if there's a book or number of books that have really impacted Your Life. If so. What are the vertical? Could be on food and cooking by Harold. Mcgee it's an Oldie but Goodie publishing the eighties and it was the first book that really got me thinking about the science of food and then microbiology of nutrition and food on food and cooking by her d. and then Fergus. Henderson book Meet the river. Cottage meet. Book is amazing in talking about this graph ED operations and how different they are That that's that's really amazing Introduction to free range everything on the other side. There's an incredible book called the Meech Racquet Racket tennis racket NEAT reckitt. And that's about the whole environmental and economic system around how Tyson farms. It's chicken and what I learned from that it's just how involved the. Usda from financing perspective with all these firms and also that these confinement operations are are almost exclusively now run by South East Asian immigrants. Who are really locked in to lose lose situation from an economic perspective with you know in over. Their heads is debt Owing Money Tyson and only having one client has also Tyson. So it's amazing to me just thinking about the kind of the the bad tentacles of the conventional operations Just gave me a sense of wow. This isn't just about animals. This is human wellness in any human ability is being threatened by the confinement system so if anybody wanted a real. Downer recommended me racket. It's pretty depressing but also just like kind of blew my mind to read about how the system actually works. I will make sure all of those Arlington show notes as well I think this has been such a fun episode in such an important topic and I love like I said Multiple Times. I love that you are providing such quality products in education. I think this is a really important topic especially for MOMS and children and I love that you are leading the way for us so thank you so much for all your work in figure time and being here today you know it all depends like you making a different choice you know. I can offer from choice but people have to make the choice so. I'm just really grateful that you're using your popcorn to support me being able to share my story more trying to do. I love it. Thank you again for your time and thanks to all of you for listening and sharing one of your most valuable resources your time with us today. We're both so grateful that you did. And I hope that you will join me again on the next episode of the Wellness Mama. Podcast if you're enjoying these interviews would you please take two minutes to leave a rating or review on Itunes for me? Doing this helps more people to find the podcast which means even more moms and families can benefit from the information. I really appreciate your time and thanks for listening.

Katie US America California Code Wellness Mama New York tetracycline Lula Clinton Melatonin B. L. U. B. L. O. Mary Guy Herbs apple amoxicillin INC magazine Anya Fernald Bobby Neshama
Invention Classic: Penicillin

Invention

52:36 min | 1 year ago

Invention Classic: Penicillin

"Support for invention comes from T. mobile for business five G. will revolutionize the way we work but it only matters. See Your Business if it works where you do T. Mobile has invested nearly thirty billion dollars in their advanced network to drive. True workforce mobility no matter the size of your business t mobile for businesses. Here to change the way your business moves businesses changing. Are you with us? More at T. MOBILE FOR BUSINESS DOT COM. I'm Hugh Atchison. I'm a chef for restaurant traveler. And now I'm the host of the passenger people. Ask me all the time. What's that list of places to go in this city in that city and this show is dedicated to that idea? Immersing yourself in that culture and finding out what's intriguing and what resound and what we think about the future of that place as a visitor as a passenger subscribe now on the iheartradio APP apple podcasts. Or wherever you date your guests. Hey Welcome to invention. My name is Robert Lamb. And I'm Joe McCormick and we are bringing you a classic episode of Invention Today. This is an episode on penicillin that originally published July Fifteenth Two Thousand Nineteen. Yes a fungal accident. In the early twentieth century that opened the door for the Medical Wonders of the Antibiotic Age. So yeah this was a pretty fun one and an important one so we'll just dive right in. Welcome to invention a production of iheartradio. Hey Welcome to invention. My name is Robert Lamb. And I'm Joe McCormick and Robert I know you WanNa talk about. Dnd before we get to the real subject well. I don't know I was thinking about doing. It lasts but we can go ahead and talk about it up front. Yeah we'll in dungeons and dragons various Demon Lords And they rule over various portions of the of the fiend population in the game and there are two demon lords in particular that I was thinking about in regards to today's episode And that that would be boy and jubilo x. So zagged Moi is the the demon Lord of Fungi. The Queen of fungi the master of decay and then opposing her Ever at odds with their is jubilee the faceless Lord which is a god of loses and slimes and blobs all the losing nasty creatures of Dungeons and dragons and there. They oppose each other. There are constant war with each other and in some campaigns like their forces. And even there there you know in bodied forms do battle with one another and it. It actually ties in a bit with this subject. We're talking about today of penicillin. Okay so penicillin. The fungus that fights. I don't know. Would you call diseases slimes a well? I feel like jubilee. Being the demon Lord of uses in slimes kind of makes it the the Demon Lord of of microbiology as well and You know Mike Groves and And microbial illnesses so okay. We'll so today we're going to be talking about penicillin. I guess maybe one of the Great Real Weapons of Soaked Moi yes But this this came up. I think because we'd been talking about fungus on our other podcasts. On stuff to blow your mind where we just finished recording a five part series on psychedelics. Yeah yeah looking at Fungal psychedelics and ongoing research into how these substances could enhance our mental wellbeing and helping the treatment of psychological issues and one of our big take home was these guy could help save lives and improve the quality of human life but it would not be the first or only fungi to do so because we can certainly look to. Various interactions between human. Hell's the different fungal species. In their use in traditional medicine we can point to various products include products of fermentation for instance including alcohol. But there's an even better example of better living through fungi in that's penicillin right so today we're going to briefly explored the invention of penicillin which is often cited as the first true antibiotic technology. Of course antibiotics are medications that treat infections by killing injuring or slowing the growth of bacteria in the body. Antibiotics are a class of what you would generally call antimicrobial drugs. Medicines that kill microbes that present a threat to the body of course antibiotics generally fight bacterial infections whereas you could have others like Antifungal. 's THAT FIGHT. Fungal infections or antivirals that fight viral infections now. Antimicrobials and antibiotics are gigantic subject. Area that we're of course not going to be able to get into every nook and cranny of the subjects but we hope we could have An interesting introductory introductory discussion. Maybe come back to antibiotics sometime again in the future. Because it's a it's a broad invention that has lots of little invention tributaries throughout history but it is such a fascinating case to look at and I think should make for a great episode of invention here because for starters it's it's a twentieth century Inventions slash discovery off. Of course the line between innovation. Discovery is a little bit gray But we can. We can pinpoint the nineteen twenty eight and ultimately like rolled out by nineteen forty or so But so we can. We can look to it. We can look at the world before we can look at the world after with sort of clarity that we don't always have with certain late older or more ancient invention exactly because we always like to ask the question on the show what came before the invention what what changed when this invention came on the scene And what became before widespread? Modern antibiotics was stupendous amounts of death and misery from infectious disease. In blood poisoning. I I was wondering like is it even possible to get stats on what the world of infectious disease looked like before we had antibiotics around the mid twentieth century. Yeah I mean to a certain extent of the suffering is just incalculable Especially if you go back and sort of consider all of human history up to that point in the various factors that that influenced Infectious Disease and injury eventually the rise of germ theory but also things like the rise of cities and so forth but but luckily yes. Since it was such a a reason invention we have some pretty incredible stats on the matter. Suddenly thanks to this new Miracle Drug Diseases. It simply ravaged. The global population like syphilis could be cured. The shadow of lethal infection. No longer hung least as heavily over every scrape injury and war wound and with wounds. Where often talking about sepsis which is a term that was used by hippocrates back in the fourth century BC meaning blood rod or blood poisoning and he was referring more generally I think to decay but the term came to be applied to blood poisoning which arises when the body's response to infection causes causes injury to its own tissue and organs but just prior to the twentieth century infectious diseases accounted for high morbidity and mortality rates around the world even in the industrialized world according to w a Adedeji in the treasurer called antibiotics from two thousand sixteen. The average life expectancy at birth was forty seven years forty six and forty eight years for men and women respectively and this was due to the dangerous smallpox cholera diphtheria pneumonia typhoid fever plague tuberculosis typhus syphilis and a host of other ailments that could Affleck and endearingly antibiotic era They follow again arising in the middle of the twentieth century. The leading cause of death in the United States change from communicable diseases to noncommunicable diseases like Carter cardiovascular disease cancer and stroke and the average life expectancy at birth rose to seventy eight point eight years so the elderly were no longer a mere four percent of the population. But grow to become a whopping thirteen percent of the population. So we're talking about profound changes distant demographics based on this new this new invention. Yeah the changes huge. I mean we live in a world. Now where if you have access to high quality. Modern medicine and a lot of people don't mind but if you have access to high-quality modern science based medicine and you can get antibiotics and And get to a hospital or see a doctor. You very likely have a good chance to beat most of the Common Infectious Diseases. That that people get unless you have some kind of you know like another condition that exacerbates it or something. Before antibiotics. This was just not the people just died from diseases that you catch like diseases that are common for people to catch all the time. Yeah or you had certain diseases like syphilis. That were virtually uncurable. Yeah you know. And and some of the. The cures that were attempted were pretty horrendous. And had an generally did not work. You know talking about using mercury and so forth And you mentioned before contamination of wounds. I mean just a huge thing just like a you know you might You might cut yourself all gardening and you die from it. Yeah Heaven Forbid you undergo a say medieval Gallstone surgery or something like that. Yeah a by the way I think. Turkey loaf has you know is a good example to look at for some of these stats as well according to the CDC TB was a leading cause of death in the US in nineteen forty prior to the roll out of antibiotic therapy in one thousand nine hundred one hundred ninety four of every one hundred thousand. Us residents died from deep tb most residents of urban areas in nineteen hundred the three leading causes of death in the US were pneumonia tuberculosis and diarrhea and interrupt us which together with Diptheria caused one third of all deaths and of these deaths forty percent were among children aged less than five years old. Now to your point in not everybody has access to Antibiotics that Say people enjoy in Europe and the United States? Yeah TB remains a the leading cause of death from an infectious disease in many parts of the world? Particularly the developing world and some antibiotic treatments are in about assisted treatments are more complicated and more difficult than others. I mean I know the treatment for TB is not as say easy is the round of just orally administered antibiotics that you might get for a standard bacterial infection right but it suddenly was just a heralded rightfully so is Is a miracle invention when it came about. I saw an image of a of a sign on a garbage can or mailbox from the Mid Twentieth Century Advertising. That now you can get gonorrhea cured in in like four hours and thanks to the you know these new developments in antibiotics You know it's just a a it can be difficult to put ourselves in that mindset having grown up in the wake of antibiotics or at least most of us most people listening to this show. I was just thinking about how many like. Us presidents died of infections of various kinds l. Yeah that that seems like it would be very unusual thing to happen now but like in the eighteen. Hundreds James Garfield got shot but it wasn't the initial gunshot that killed him. He lived for like two weeks afterwards. he got an infection in the wound. Think because they were digging around with dirty hands to try to get the bullet out of him and he and they didn't have antibiotics of course when he got an infection so he died. I think another a US. Was IT William Henry Harrison who? I think they think Dow died from probably like drinking fecal contaminated water in the White House. Yeah so many. Different Injuries and infections were just far more likely to be lethal with You know without modern antibiotics to step in and And aid in the fight. Now there were some things that were kinda versions of antibiotics or antimicrobials from before the discovery of Penicillin in nineteen twenty eight. The best example from the the period just immediate immediately prior to penicillin would be the Sultana miser the sulfur drugs in these. Were the first antibacterial to be used. Systematically they were synthesized in nineteen thirty two in the German laboratories of Bayer a G. Now you might be thinking about the time line like wait a minute. Didn't we just say that penicillin was discovered in twenty eight but it took a long time after the discovery of penicillin antibacterial properties for it to be made as a useful medical drive like it was nineteen forty generally. That's the date you see for went. Penicillin actually became an actionable thing in medicine. So before that we had The the sulfur drugs and it had. They had a rocky start but they did prove very effective in preventing wound infections during the World War they were used on both sides in the in the form of Sulfur. Pills and also SOFA POWDERS. That would be sprinkled over a wound. So if you've ever watched the some sort of a period piece oh especially a war peace from the twentieth century and you see somebody sprinkling powder mover an injury. That is what that's supposed to be self drugs. They're not as effective is true. Antibiotics like penicillin in. There are a number of possible side effects that one that can take place and it also can't be used to treat syphilis and it also can't treat Sulfur resistant infections. Now of course. This is also a twentieth century invention so I was wondering. Did anybody come up with any version of antibiotics or Proto? Antibiotics before the twentieth century. We know the penicillin hadn't been discovered and isolated and made stable as a useful medicine. But were there any things like antibiotics are sort of precursors of antibiotics? Because then game of thrones? They have penicillin don't they? Or they have some sort of fantasy versus penicillin. I've never heard of that. Don't they have something that the the the old masters would mention having to do with Brad and mold or something didn't they. I don't remember that I just remember. People get cuts and then they get infected and die. Give him milk of the poppy. I mean they have milk in the poppy. Maybe our game of thrones Our our George Martin. Readers left to right and on that but I vaguely remember there being like allusion to something like some sort of mole based medicine that they were using lead could be wrong. Well I can't see that being something that's thrown in there as a little aside but like isn't widely recognized or use GONNA be And it's interesting how that kind of parallels some interesting pieces of evidence for Pro Antibiotic Technology in the real world even going back to ancient times. So I want to look at the work of the emory university bio archaeologists George. Jr Mela goes. Who is now deceased? I think he died in two thousand fourteen But he's interesting interesting scholar and he discovered something very curious back in nineteen eighty so the subject he was looking at was a set of human bones from ancient Nubia dating from between three fifty five c e and so the bones came from Nubia which is a region of Africa along the Nile River but south of Egypt in what would be modern day Sudan and what these bones showed was evidence that the people they belong to had been taking tetracycline Now tetracycline is not the same as penicillin but it is an antibiotic it can be used to treat all kinds of infections for minor problems like acne. I think in concert with some other drugs Two major diseases like plague or to leukemia or even syphilis and tetracycline works primarily by binding to the Riva's oems of bacterial cells. Ribes oems or sort of the cellular factories. They build proteins that are needed in order for organisms to live and grow and by binding to the Rybeck. Zome tetracycline makes it difficult for the bacterium to create new proteins? It was patented in the nineteen fifties became widely used in the second half of the Twentieth Century So what was it doing in the bones of Nubian people who live like seventeen hundred years ago? Well Arm Lago sin colleagues followed archaeological clues to identify the source of the tetracycline which was beer Of course beer is another one of Ultimately it falls under zagged noise domain. Oh yeah though. This is different. Because recycling is not made from fungus. It is actually. An antibacterial is a byproduct of some bacteria. Oh okay so. It's a bacterial byproduct but essentially so technically it's duplex okay point to jubilee this jubilee versus Jubilee Right. Oh Yeah I mean that's going to happen with your Demon Lawrence intriguing warfare yeah So beer is made. From fermented grain of course and the fermented grain in this ancient Nubian beer apparently contained the bacteria streptomyces which creates tetracycline as a byproduct but a question of course were these traces of tetracycline in Nubian mummy bones. A sign of like a bad batch of beer the got contaminated by accident or were these people deliberately culturing their beer with antibiotic producing bacteria and so to look at a study from the American Journal of Physical Anthropology from twenty. Ten of which are Malaga's was one of the authors of the author is examined Tetracyclene in skeletal remains from throughout this period and the evidence indicates that the ancient Nubians were consuming these antibiotics on a regular basis and the author suggest that these ancient people were intentionally producing this medicine and this links up with some evidence from other ancient peoples nearby such as the Egyptians that sometimes apparently used beer as a treatment for conditions like gum disease and other types of infections and the authors even found evidence of a four year old child whose skull contained lots of tetracycline from this beer suggesting that the child had been fed high doses of of this like antibiotic beer perhaps in an attempt to cure an illness. Maybe the illness that killed him and so the levels of tetracycline residue found in the bones. These mummies is only explicable if they were repeatedly consuming this antibiotic in their diet. And they're actually other. Archaeological remains that show evidence of antibiotic use in the ancient world for example samples taken from the Famara of skeletons from the Wastes in Egypt From people who live sometime in the late Roman period also showed evidence of the same thing of tetracycline and the Diet and this consumption of tetracyclene is consistent with other evidence showing a relatively low rate of infectious disease in Sudanese Nubia during that time period And a lack of bone infections apparent in these remains from the this oasis in Egypt so it really does look like people in ancient Africa discovered a somewhat effective form of antibiotics centuries before the discovery of penicillin and the isolation and mass production of focused anti microbial medicines. Now to be clear. I think like a beer that had tetracycline content from from being cultured bacteria. Like this probably would not be as potent and focused ineffective as like the isolated compounds in the drugs you take orally or through injection would be today right but it would have some effect and it appeared that it probably was somewhat effective in fighting infectious disease. Right and of course. They wouldn't know exactly what they had here but they knew they had some sort of beer that seemed to Some sort of of holy liquid that that that had some sort of curative property to it exactly fascinating discovery from the ancient world Another interesting fact. Tetracyclene is relatively unique in that it leaves clear signatures in the bones that can be discovered long after the person has died so other antibiotics. Don't leave these clear markers like this that. Make it easy for archaeologists to detect. So you have to wonder like are were there other cases of ancient peoples in various places and times using some kind of antibiotics or bacterial or Fungal Cultures To treat diseases like these ancient Nubian people were But that we don't have evidence of because it doesn't show up in the bones like tetracycline. Does it could've just been lost. A history I was reading an interesting paper from frontiers. Microbiology in two thousand and ten by a reuss domino called a brief history of the antibiotic Era Lessons. Learned and challenges for the future and Aminov points out this unique quality of tetracycline and notes. Just what I was. Basically just saying how easy it would be for evidence of other uses of antibiotics in the ancient world to be lost to us though he he also mentioned that. There are other anecdotes from history about cultural traditions. That show Proto antibiotic technologies in these other. Examples include red soils found in Jordan. That are used for treating skin infections. It's been discovered that these soils contain some antibiotic producing organisms. I'd guess they're probably also some major risks in applying soil to wounds and then also plants used in traditional Chinese medicine that actually do have some antimicrobial properties. Yeah because one thing we have to remember is like the modern Anti effort is ultimately based in going out into the natural world in finding these weapons that already exist. Yeah and then you re using them And adapting them of for Human Madison. And you know this is essentially what is going on in traditional medicines as well and it also means that there are weapons out there that either have not been discovered at all especially and particularly vibrant ecosystem. Some of which of course are threatened. All the more reason to for us to not decimate Say The rain forests or the deep ocean right but then they're also things that may have been discovered to some degree in the past but have been forgotten will. Yeah that that does seem possible because despite all all this evidence of ancient sort of Proto antibiotic technologies the worldwide rates of death from infectious disease in the periods for which we have data right before the invention of modern antibiotics shows that humans generally did not have effective antimicrobials in that period. So maybe some of this knowledge was lost over time. All right well on that note. We're GONNA take our first break when we come back we're going to return to The mold research of the nineteenth century and ultimately to our key inventor here Alexander Fleming. Here's the thing saving money with. Geico is almost better than playing pickup basketball. Because there's always that guy who joins your game. He never passes the rock. He constantly bricks threes. And who completely hack you? And then put his hands up and say no foul no foul with GEICO. It's easy to switch and save on car insurance. No need to fake. An ANKLE SPRAIN. Because you're absolutely exhausted. So switch and save with GYCO. It's almost better than sports. Hey guys it's bobby bones host Bobby Jones show and I'm pretty much always sleepy because I wake up at three o'clock in the morning a couple hours later. I get all my friends together. We get into a room and we do a radio show our allies we tell our stories we try to find as much good in the world possibly can and we looked through the news of the day that you'll care about also your favorite country. Artists are always stopping by to hang out and share their lives and music to wake up with a bunch of my friends. I Ninety eight point. Seven W M Z Q in Washington DC or wherever the rotates you on the iheartradio APP. All right we're back now. We'll get to Alexander Fleming in a minute With the discovery of penicillin but Alexander Fleming was not the first person to notice that there might be some anti microbial. Properties of certain fungi. That's right there was there was work going on in this area of prior to Fleming Fleming was was picking up On some of it and and really just overall our understanding of fungi in general was advancing as we mentioned in our psychedelics episodes. You know there was a time where we did not recognize fun guy as being separate from the realm of plants right Before we realize that it was a kingdom unto itself in all ultimately kingdom. That has a little more in common with the the animal kingdom than it does with the plant kingdom and a lot of talented folks working in this area but one of them might come us as opposed to a lot of people in this because her name was Beatrix Potter the Bunny Rabbit. A bunny rabbits yes. Okay off the bunny rabbit fame. I was kind of a curious coincidence because I was reading about all this and then just randomly on the stuff to blow your mind discussion module. Which is the FACEBOOK Group for people? Listen to the show to discuss episodes. Someone brought up trix Potter in regards to something to do with squirrels. Because there's a lot of squirrel squirrel content in the discussion module and they brought a beatrix potter and Beatrix Potter actually ties in to this episode. A little bit because in addition to being the author and illustrator of the the tale of Peter Rabbit and associated British animal tales. She was also a naturalist with a great deal of interest in astronomy and most importantly of all my college ready so she produced a lot of just beautiful scientific watercolor illustrations. Various fungi in her neck of the British would part of her studies. And if you studied a lot of a local mold as well and did illustrations of them. She's she's a legitimately a very interesting character. That was you know. Unfortunately she lives in a time in which the sexism of the day prevented her from. I think reaching the heights of in the natural sciences that she would have been afforded later on But in a lot of her work is also just being. I think rediscovered in appreciated for the first time You know in recent decades but the yeah the next time someone busts out some the trix Potter A. Remember this is not just an individual who wrote some fanciful tales and illustrated them. She was also just issues out there. Studying the natural world and create a in in advancing our understanding of the my college. She was sort of looking into the hidden life of nature in multiple ways. Yeah you know I see some sources that are asking the question. Okay was Beatrix Potter. Sheer true naturalist a true natural scientists over she just a an amateur. That was just very interested in these things. And I don't know it's kind of complicated question to ask when you consider the limitations In the Victorian era for women but I think undoubtedly she she D- I would side with the fact that she was a natural scientist I mean she authored or co authored one paper if I remember correctly so I'm I'm GonNa give her giver full credit. Was it about a guy it was a it was a mushroom in particular I forget it was one of those related to the Russillo mushrooms but I forget which species but Basically she was she was kind of up against the Patriarchy for the most part though. Yeah well is it. Time to turn to penicillin itself. Yes let's turn to this the key discovery here and our inventor are discover Alexander Fleming. Okay so who was Alexander Fleming? Okay so Fleming was born in eighteen. Eighty one died in nineteen fifty five and he was a Scottish biologist. Physician microbiologist and pharmacologist. He was the son of a farmer and he observed and studied a great deal of death from Sepsis in World War One. He observed that while antiseptics worked well at the surface deeper wounds sheltered bacteria from the effects of things like sulfur. Drugs right so if you have the kind of superficial wound you could clean it off pretty good and that might help protect you from From bacterial infection. But if you have a deep wound and say like dirty stuff it's of soil and other crud gets lodged deep in there. You might not be able to clean the wound out very well right. And it's exactly the kind of stuff that's going to get lodged in there especially with your war wounds where there is a stab or or or deep cutoff or a bullet entering the body. We'll makes me think about The when we were reading about the idea of stegosaurus perhaps weaponized. I mean not consciously stegosaurus perhaps Having an adaptation to weaponize infection against its enemies oh by dragging its dagga demise or spikes through the Dung right exactly yeah having dirty. Bagga miser spikes and then when it wax the T. rex in the crotch with them that That gets infected later and eliminates a Predator from the area and The the the predators of the day would not have had access antibiotics certainly not or even that beer from and we mentioned earlier so Fleming was devoted himself to research and he Prior to penicillin he discovered license. Ximen naturally occurring enzyme mucus and other parts of the body than inhibits bacteria. So you know. He was already in this area. You know looking for for new New Breakthroughs new discoveries but then his biggest breakthrough of all is this discovery of penicillin. And it's truly one of the more amazing invention slash discovery moments from history because while he was exactly the right person to make the discovery and then deserves all the credit he was given the key. Moment comes down really to pure luck and we simply don't know if anyone else would have made the discovery if he had not been there to observe it. Okay so what happened with this discovery so around? Nineteen twenty seven or so. He had engaged himself in studying STAPHYLOCOCCI or staff and he had stacks of Petri dishes dish specimens in his lab which I've seen described as being kind of an untidy lab a- petri dishes full staff all over the place notes and so forth and so the key moment comes in September of Nineteen. Twenty eight right right so he has these staff petri dishes out and then he leaves them for the weekend to go on holiday with his family. Any when he comes back he expects to just see how they've progressed. See how they've grown but he finds that they haven't grown in fact they have died. Something has ravaged his specimens. Yeah now it's this is one of those stories where he gets very narrative is so you do have to wonder if some details of it or embellish to how how the story may have changed over time but is the way the story has been passed down and I think it seems to be largely basically true The way that I've seen the story often told us that he comes in. There's a blob of mold growing in one of the plates and all around the mold. There's this halo of nothingness. Swear you know normally what you would see is that if you've got a plate for culturing bacteria they would be these little dots and blobs on the on the plate but instead there's this halo where there's no bacteria bacterial dead zone now. Of course we know. Staphylococcus is a bacterium group linked to all kinds of human disease and misery. Staph infections right. If this mold could kill staff that seems medically relevant. So what happened here? Well He? He realized that he was dealing with some sort of a fungi. Luckily there was a my college est with a lab just below Fleming on the floor below his lab a man by the name of cj La Touche and in fact it's also been suspected that the mold and question that killed Fleming's the staff might have drifted up from a low shays lab adding extra element of weird chance to this whole situation. Okay so perhaps. His samples were contaminated by stuff from the lab next door or down a floor right. That's one that's not. That's not a theory that's presented in every source but it does pop up fairly frequently so specifically this mold was what would later be identified. As a strain of penicillin no tottenham and. It was obvious that it's secreted something that prevented staph bacteria from growing and so fleming followed up in studying the secretion. This this mold juice says I've seen it called he. He found that it didn't only prevent the growth of staphylococcus. It WORKED AGAINST COMMON. Bacteria like streptococcus or meningococcus and and the back and also against the bacterium that Causes Diptheria. Interestingly while Fleming did see applications for penicillin curing disease and he mentioned them briefly in the paper he published in nineteen twenty nine about this discovery about The antibacterial properties of concilium He primarily thought of this secretion of penicillin as a tool for bacteriologist to sort strains of bacteria basically into penicillin sensitive versus non penicillin sensitive species and that could be useful in the lab. Yes so he. Sometimes criticised is really not understanding completely what he had here not having the vision to see where could go well. I don't think he completely understood. He did indicate that this could possibly have uses in medicine right Fleming and his assistance Stewart. Craddock in Frederick Row Ridley tried for years to turn this accidental discovery into a stable isolated compound that would be useful and this. This was a problem because like so. You've got the secretion from the mold molds making some juice it's Kinda getting stuff wet with this stuff that that That fights bacterial growth. But they couldn't isolate the compound that was causing the effect and stabilize it and make it make it generally useful So to quote from Aminov Paper Aminov that I mentioned earlier quote for twelve years after his initial observation Alexander Fleming was trying to get chemists interested in resolving persisting problems with the purification and stability of the active substance and supplied the penicillin strain to anyone requesting it. But he really he he. He could never crack the nut ultimately and he didn't finally make this discovery of the process for For stabilizing and isolating the compound and by nineteen forty off rights that Fleming finally abandoned quest but fortunately it was right about that time that a capable team at Oxford University including the researchers Howard Florey and Ernst chain or Chine they Picked up on this research. And they they kicked off the research project. That would eventually break through on this And they're all these interesting story so of course this is wild World War Two is going on right so research conditions are not ideal and then there are all these stories about how they turned their lab at Oxford into this giant incubation center or sort of factory for mold like they employed all these lab assistants were these women who had been referred to in some sources as the penicillin girls and they would work too like they would work to grow the penicillin and buckets and tubs and basically every container that they could and Eventually they did they were able to isolate and stabilize this compound so to quote from an article From the American Chemical Society in Nineteen forty. Flory that'd be Howard. Florey carried out. Vital experiments showing penicillin could protect mice against infection from deadly STREPTOCOCCI then on February Twelfth Nineteen Forty One. A forty three year old policeman. Albert Alexander became the first recipient of the Oxford Penicillin. He'd scratched the side of his mouth while pruning roses and a developed a life threatening infection with huge abscesses affecting his is facing lungs. Penicillin was injected and within days. He made a remarkable recovery. But unfortunately despite this recovery which lasted for a few days they ran out of the drug and Alexander eventually got worse again and he died and I was reading that they were so desperate to cure him. That after Alexander urinated while on his antibiotic course they would collect the urine and tried to extract the penicillin. He excreted again so that it could be re administered to him And I should mention also that the the process that the Oxford team relied on to extract and purify the penicillin and the mold juice was led by another Important biochemist a guy named number nine Heatley but this case of Albert Alexander shows and obvious early problem. They had which was the problem of scale. They simply lacked the ability to make penicillin at the scale it. That would be needed to treat. Even one person let alone the whole world The strain of mold that they were using didn't make enough of it and this led to the search for other species of the same fungal genus penicillin. Which would maybe they thought produced higher concentrations of the penicillin filter rate and. I was reading an interesting article by the University of Michigan Physician and medical historian Howard Markel. That tells a really interesting story. I'd never heard about this So the story goes like this. Apparently one of the assistance at the Oxford lab showed up for work one day in nineteen forty one with a cantaloupe that she'd bought at the market because it was covered in a weird looking golden mold which is great. Because this would be the one case where somebody is picking over the fresh produce to like find the moldy one The mold on this cantaloupe turned out to be a strain of concilium called Penicillin Chris. Gm which Markle says naturally produced at least about two hundred times as much penicillin as the original strain that they've been studying and then later markel writes that the same strain was subjected to mutagenic processes in the lab so bombarding with X. Rays and stuff to produce a mutated strain. That would make two thousand times as much penicillin as the old school fleming. Mold so by Nineteen Forty. One Penicillin is on its way to becoming a viable medicine. All right on that note. We're GONNA take a quick break and when we come back we're going to look at the impact of penicillin and we're GONNA look at it in a fun way by Considering a really interesting what if the only way is through a new podcast in partnership with iheartradio underarm. Join us as we hear from the world's greatest athletes coaches and trainers. They discuss how they utilize training competition and recovery improve their performance and push through hall of fame. Women's basketball coach Muffin. Mcgraw has established a culture of winning through our historic thirty five season career Notre Dame but this season. Coaching team are trying. Everything is there flow against losing record? Here's coach McGraw. I've never been in this situation before of having lost five. Starters and I was just thinking the other day you know how when you're going through and the stress of being number one being the team to beat being every game knowing you're supposed to win. That really weighs heavy on your shoulders than I think I said at one point. Wouldn't it be great to be the underdog again and my husband said be careful what you wish for and here we are? Listen to the only way through available now on the iheartradio APP wherever you get your podcast all right. We're back so we often don't don't do a lot of what if on invention doubt. I thought we. We can't do certain extent but I mean a lot of times. It's harder case to be made like what if this had not been invention or discovered because in most cases you can you. Can you can look at the data you can look at other individuals where like if the Wright brothers had not invented the airplane not created that That FIRST PROTOTYPE. That release showed what was possible like clearly there were. There were other individuals in the world. Working on this someone would have cracked it. If if front getting had not discovered x rays in eighteen ninety one whatever year it was somebody else would have discovered them pretty soon right but when it comes to penicillin Potentially gets a little more complicated than that. I ran across a cool article on the topic. Titled What He Fleming had not discovered penicillin and this was published in the Saudi Journal of Biological Sciences by al-Harbi at all the authors. Admit that that certainly. Fleming had made the discovery someone else might have in the years to follow probably in the early nineteen forties. They they estimate so we could still well have have arrived in the antibacterial age however they also explore the possibility that we might have simply not made the discovery at all. Well it's an interesting argument so I WANNA. I WanNa read a quote from the paper here. Quote of course penicillin could have been discovered the day after Fleming missed the opportunity but in reality there was no parallel discovery. That took place as a result. Anyone taking an interest in penicillin during the nineteen thirties did so in the knowledge of Fleming's work in particular. The seems no reason to believe that. Flory and chain would have discovered penicillin since their work depended on Fleming's famous paper and their access to one of his penicillin producing cultures. Okay so that's referring to the thing I mentioned about how Fleming in his assistance. Were just like sharing the penicillin. Strain out with everybody like. Hey can you figure out what's going on with this? Can you isolate secretion or the compound in the station? Yeah so think about that. There was there was so far as these. Researchers can determine no other effort out there that would have struck Peter. In the absence of Fleming's research the Oxford Group would have been looking for it Selman Walkman. The father of modern antibiotics sometimes called as we made several key. Discoveries later was also inspired by Fleming So it's yeah it's one of these cases where like. He seems to be the epicenter. Not only him. But just the the the the these seemingly chance encounter in his lab that day That that We're suddenly this halo appears in the Petri dish and that gives birth to a to a whole class of other discoveries right because not all Antibiotics are derived from penicillin penicillin. Class of antibiotics become sort of like one sort of grandfather class but then there are all these other classes that are discovered during this golden age of Antibiotics. The takes place over the next few decades. Yeah and there are various. Just additional medical breakthroughs. That would not have occurred without penicillin such as organ transplant. But then there's also the question like what would what would have happened in the wider world because again penicillin comes online during the second world. War and So you can easily ask what would have happened if allied troops had not benefited from access to antibiotics at D Day. I've never thought about that. In fact I before looking at this episode I probably would not have known the answer to whether or not. They had access antibiotics well. Penicillin production was actually swiftly. Scaled up Just to make sure that allied soldiers had access to at D Day. Well so there's a legitimate question to be asked might. The allies not have won the Second World War without penicillin. I think there are a lot of factors to consider there. I don't think there is quite a Gotcha question. But it's it's worth thinking about the authors argue that without flemming's discovery would have had to depend on the SOFA drugs. You know an imperfect native to to antibiotics in these You know these were described in the nineteen thirties and Fleming worked with him prior to his discovery but without penicillin in play the authors argue that sulfur drugs might have become the standard and even push the discovery of true antibiotics well beyond the nineteen sixties and this is also true of the Axis powers had risen in victorious in World War because they're the access powers depended on sulfur drugs and their their key treatment. They do point out. The you know quote. Despite the fact that the Germans and their allies where considerable the sulfur drugs did a relatively good job at reducing battle casualties so not to just completely You know cast aside the effectiveness of soft drugs but still. They're not as effective as true. Antibiotics it's weird to think about the political implications of specific medical technologies. Yeah and then when you get down to the curious cases of individuals it also gets interesting. Where he touched on presidents who died that would have lived potentially if there had been penicillin around right and so they point out that That Sotho drugs saved Churchill's life in nineteen forty three when he was suffering from pneumonia. I as well as FDR's life but there's also evidence by the way that actual penicillin may have saved Hitler's life following the Stauffenberg assassination attempt of July twentieth nineteen forty four. This was the plot that tried to kill Hitler with a briefcase bomb right like where the some of the officers conspired against him and they put a briefcase bomb in the room with him and it did explode but he was protected by like a heavy table that prevented from killing him. He was obviously injured. I think he had like nerve damage after I'd so the idea here is that perhaps his injuries were treated by by penicillin. Yeah that's at least. An argument has been made that they had access to penicillin I'm unclear on how they would have obtained it. You know maybe there's a spy story there. I don't know but the idea being well if he had it had didn't have access to Penicillin. Then perhaps he would have died and that would have arguably ended the war. You know in a different manner forcing us to re imagine an entirely different postwar world so again playing with with what if series and in also we minor standings. We don't know for sure that Hitler had accessed penicillin following that assassination attempt but there is the overall scenario of the allies having penicillin and having this ramped up penicillin production leading into D day. Yeah that is really interesting. I never contemplated that before Now something that I we do often have to think about. We should probably acknowledged at the end here before we move on. Maybe this'll be something to come back and do in the future with a recent invention episode is the idea of a possible end of the antibiotics age. I mean this is a kind of a scary thing to imagine like what if the antibiotics age is essentially a period in history. That has a beginning an end. Because as we. You've you've probably heard about this. Many disease causing bacteria and other disease causing microbes are over time evolving Antibiotic Resistance are evolving to powerful enough to survive are antimicrobial drugs and I think specifically one thing that's exacerbating this is overuse of antibiotics and people not taking the entire course of antibiotics when they're giving them. Yeah because Again to come back to the Zagged Moi Jubilee War a scenario you know it is an ongoing battle and the the forces evolve to better deal with the threats on each side. Yeah and so You know we're we're we're we're seeing this occur we're seeing the overuse of antibiotics producing strains that are that are resistant. And it's reversing some of the therapeutic miracles of the last fifty years and underscores the importance of disease prevention in addition to treatment and that means not not abandoning some of our other vital tools for human health like vaccination. Oh Yeah we should come back and revisit vaccination yes or maybe even various different vaccinations in the future. Yeah another thing to keep in mind that I don't think we've mentioned earlier. That the nineteen forties through the nineteen seventies are are considered the golden age of Antibiotic Research. Yeah and we haven't seen we haven't seen any new classes of antibiotics emerged. Since that time period right now there have been new developments in antibiotics. But I think the way I've read it is that they're generally modifications on existing classes of antibiotics. Sorta like we. We haven't we haven't found anything radically new since then basically you. We reached out into the natural war between Between Fungi and microbial legions and we stole some of the tools we stole some of that prometheus fire We keep adapting that fire to our own purposes. But we haven't we haven't found any new weapon from that world and And then their ongoing war continues to change. I'd be interested Do you out there you the listener dee work in medical research or are you working on areas involved in antibiotic resistance the future of anti-microbials? I please get in touch with us. I would like to hear about that. What what are you doing in your work? And what does the future look like to you on the inside absolutely we would. We would love to hear from you again. We've only scratched the surface here though. Thanks to antibiotics. Hopefully that scratch will not life threatening infection but yeah there's a lot more history here but but hopefully what we've done here. Today is of course highlight just a very very cool story from the history of inventions and discoveries in human history and outlined the impact of of one of the greatest inventions or discoveries. Again however you want to classify it from the twentieth century. Yeah totally in the meantime. If you want to check out other episodes of invention you can check out our homepage. Invention POD DOT COM and. That'll have all the episode right there if you want to support the show and we would appreciate it. If did sports show. There are few simple things you can do. Tell friends about it. You know. Tell Tell Your family members about invention and then if you have the ability to do so rate in reviews wherever you got this podcast huge. Thanks as always to our excellent Audio Maya Coal. If you'd like to get in touch with us to let us know feedback on this episode or any other suggested topic for the future just to say hello you can email us at contact at invention pod dot com. 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penicillin Alexander Fleming Infectious Disease Nineteen Forty Penicillin pneumonia Oxford Penicillin United States Beatrix Potter apple syphilis Mike Groves zagged Moi Oxford T. Mobile Robert Lamb tetracycline Hugh Atchison
Episode 116 -- August 15, 2020 AFP: American Family Physician

AFP: American Family Physician Podcast

24:03 min | 8 months ago

Episode 116 -- August 15, 2020 AFP: American Family Physician

"The AFC PODCAST is supported by the American Academy of Family Physicians and by Pediatrics on call the new podcast from the American Academy of Pediatrics each week family physicians can learn the latest news and research on Children's health to help make them better doctors new episodes weekly at AARP dot org slash on. Welcome to the American family physician podcast for the August Fifteenth Twenty Twenty issue I'm jake. I'm Krista, I'm meredith. And we are residents and faculty mostly residents of the University of Arizona, College of Medicine Phoenix family. Medicine. Residency today, on the PODCAST, we're GonNa Talk About Sarah Seiken Iga Vascular. Also, Tama Vir. paget disease of the bone will have practice guidelines on colorectal cancer screening, and we'll wrap things up with a poem about daily Colchicine Use Post. The opinions expressed in the podcast our own Internet represent the opinions of the American Academy of Family Physicians. The editor of American, family physician or banner health do not use this podcast for medical advice. Instead see your own family doctor medical care. The. First Up, we have my personal favorite steps remember step stands for safety tolerability efficacy price in simplicity. This steps looks at Sarah Cycling for the treatment of Acne and it comes to us from Doctors Rupert and Hughes from the Nellis Air. Force Base Family Medicine Residency in Las Vegas Nevada Syra cycling brand names. Sarah. It tetracycline class medication labeled for the treatment of Acne. Specifically inflammatory lesions of non modular moderate to severe acne ages nine and up. Let's start with the I S and steps which stands for safety. What are you remember about Tetracycline Class Drugs From Med school jake well, meredith I remember him by remember I mean you told me in the script that they're Terada genetic and they cost skeletal deformities in offspring. So avoid these pregnant patients. Likewise, they should be avoided in breastfeeding patients because they can cause changes the infant like problems with bone and tooth development, and like other antibiotics, they can cause C. difficile diarrhea. Cycle has some significant drug interactions. So I'm GonNa Listen Drugs and you tell me the interactions who fund. All right ready I one tennis silicon. Decrease, bacterial seidel action of the penicillin right precisely. how `bout and acids. Decrease absorption. So take them at different times of the day right again. What about retinoids? I'm GONNA guess that they were too well together in your skin becomes too perfect. Flow not exactly. This Combo can cause increase inter cranial pressure. What about anti-coagulants decreased plasma proof trombone activity. So you may have to decrease the antiquarian dosing thinking you're both winners in my book. All right. Well, let's move on T- houses drug tolerated. Actually pretty well, the most common side effect is nausea which less than three percent of people have. It can increase the risk of sunburn. So you should minimize sun exposure and tanning beds. You also do that in general, but especially with this drug. True. All right. So what about the how effective is it? In studies one in five had treatment success compared to one in ten for placebo. It has similar effectiveness doxycycline a minute cycle in which are two other tetracycline us for acne. However, it is much more expensive than doxycycline Minnesota Quinn. These drugs only cost about twenty to thirty dollars for a thirty day supply. One against the P. which price for a month, the Sarah cycline ooh, I'm going to guess. Sixty cents are. One million, one, million, Bob Alright terminal. General Tremble. All right, the price for a month of cycling is seven, hundred, forty dollars. Close. Yes and that's not even covered by Medicare Part D. so if you're playing prices rights, I, guess KRISTA would get rb. That's right and finally simplicity it's simple. It's once daily dosing. All right. So KRISTA can give online. Sarah. Cycling is a once daily oral medication for moderate to severe non modular acne Jude wits lack of clear benefit over less expensive medications. It should be reserved for patients who have not responded to other conventional treatments. Let's move onto a main topic. He knocked shown perpere or Igt vascular is rapid evidence review, and this comes to us from doctors REIMI survey in Williams from uniform. University of Health Sciences in Bethesda. Formerly, known, as he knocks shown perpere I, J vascular us is the most common vascular and children. Honestly, we aren't mad about the name change given it's a systemic immune complex. Vessel, Leukocyte Oh classic basket elitest with non thrombosis peanich, palpable perpere, abdominal pain, and arthritis, which is enough to remember twel out for. The clinical questions here are how do we diagnose g vascular disease and once diagnosed? What's the recommended treatment and up? So back. Well Fun for me. I. Guess My sister actually had this disease growing up when she was about six years old which in fact is the mean disease. However, this disease is more likely to affect males. And although this is predominantly a pediatric disease about ninety percent of the cases, this can occur in adults as well. Mr Still Mad at me for making fun of her Purple Pills for we took her to a doctor to get diagnosed her core. I achieve vascular disease, a small vessel disease with immune complex deposition in the joints, skin kidneys and gastrointestinal track. It is thought to be triggered by infection such as streptococcus, Para Influenza, and Parvo virus be nineteen. This vascular also has an association with H. L. A. Genes that can be tied to morbidity and long term. Complications. There are some good diagnostic criteria from the European League against. Slash Pediatric rheumatology European society. They have a League Yeah Yup and they're coming after you for making fun of your sister. We'll hey now. Okay. All right. Didn't have the opportunity to be a family doc yet I was only nine the time and you have to poke fun your siblings. Yeah. Fair enough. But back to the criteria, the criteria has one hundred percent sensitivity an eighty seven percent specificity in children and is almost as good in adults. The mandatory criterion is as you would suspect per hour or PTA with Lynn predominance this should be accompanied by a minimum of one out of the following four. So arthritis or acute onset are thrall. Diffuse, acute of domino pain renal involvement with protein area or he materia and histopathology showing Lugosi Classic Basket RJ depositions in the areas. Usually symptoms develop over days to week in fatigue and fever are common. The rash can start is an era simitis PAP. You'll that crops into petite guy or perpere that's palpable. Usually this fades ten days in Kiddos are more likely to have joint an abdominal pain. I remember my sister's ankles hurt so bad one day I had to carry her at after school care and she was luckily pretty skinny. So it wasn't too bad. Laver Arthur Joe's are typically in the larger joints like knees and ankles and doesn't cause long-term damage thankfully. It is concerning hovers abdominal pain, and that can mimic acute abdomen where Gi bleeding and insists can occur in up to one third of cases. I think another concerning finding is the renal disease that can affect fifty percent of patients that may cause long-term damage. There are few random symptoms that are far less common but no joke. Yeah. The include or Kadish. Pulmonary. Hemorrhage CNS involvement with headaches, behavioral changes, seizures, and hemorrhage, and general. Meredith. Is there a specific test we can use to identify the disease? Yeah. It's a laugh at your sister test. Getting. Actually no test is necessary for diagnosis, the best data supports a clinical diagnosis with criteria mentioned a bit ago I j vacillated spontaneously resolves and ninety four percent children and eighty nine percent of adults. So what is our primary treatment goodall and saids unless there's real involvement in that case, don't use end saids, but Acetaminophen is available. So. This is a vacillates can't we use steroids? No. Actually sturridge really should only be used in patients with severe abdominal pain who do not improve with support of this will only reduce the symptoms by about one point two days very specific used to be thought that steroids were helpful in preventing renal damage but the evidence including Cochran reviews says note. What complications may prompt hospitalization. So these are issues like our KAIEDA's said, the domino pain or of course, inability to ambulant or tolerate Po. We haven't talked a lot about adults and that's because nobody cares about adults. No. But actually, their progression is less well understood. They have about an eleven percent risk of in stage renal disease in thirteen percent risk of severe renal failure follow up after recovery should happen at least six months from diagnosis with urinalysis lip pressure in Craton and measurement that the frequency remains unclear and as largely patient defendant. Alright in short suspect vascular disease in children less than ten with palpable perpere Ab- domino pain and arthritis. And use the diagnostic criteria from the European league against rheumatism slash pediatric. Rheumatology European. Society. So there you have it I, G vascular disease. The segment is dedicated to my sister Lauren I'm glad those weird purple spots in your legs went away and I no longer have to carry you around. For Lauren. You guys ready for Poem Yeah Let's do it. Remember poem stands for patient or evidence matters and this one. Comes to us from Dr. Henry Berry in. It's titled Also Tama Beer of uncertain benefit in patients with flu like illness. The clinical question here is is also Tama Beer name-brand Tamiflu better than usual care in shortening the duration of symptoms and patient with flu like symptoms in primary care settings. To answer this question, Dr Berry looked to a study that took place in the primary care setting over three consecutive winners. Patients were at least one year old in had flu like symptoms for less than three days just over thirty two hundred patients were included with about half being randomized receive five days. ozil. Time of year and half to their primary care clinicians. Usual care. Everyone was tested for influenza and everyone was asked to keep a daily symptom diary those from received. Also, Tam Veer recovered faster than those receiving usual care with an average symptom duration of one less day. Older patients those with co Morbid conditions in those with longer symptom duration at baseline tended to recover two three days faster if they took also tampier. Importantly, six to seven percent of participants from each group dropped out or discontinued the MED but were not included in the analysis. So this wasn't done by intention to treat also about half the patients tested positive for influenza in tragically only ten percent had been vaccinated against influenza. So once again, also, Tama Aveer doesn't hit home run. The continued story for Tamiflu is modest benefit in some shadiness when it comes to the methods. All right. We're bringing the listeners another main topic paget disease of the bone for primary care and this comes to us from doctors ran on and day sport us from the University of Texas McGovern medical, school in Houston. Patchett diseases a benign skeletal disorder characterized by focal areas of increased bone resorption in disorganized both formation. These lesions called pathogenic lesions that sounds fancy. Can Be. Confined to one site called Mono- static or several states called police. Dodig. The most common sites are the pelvis Femur Lumbar, enthusiastic spine school in. It's rarely diagnosed in people younger than forty and men are one point five times more likely to get the disease up to twenty percent of people have a positive family history most patients are Ason. And diagnosis is made from elevated alkaline phosphates levels on routine blood work or abnormalities on radiography or bone scans for other indications. The diseases considered metabolic. We active when there's high turnover and thus the elevated biochemical markers. If the patients are you gonNa be symptomatic pain is often the first symptom occurring. Late in the disease process, the pain is typically mild to moderate relieved by Timothy and often were set nighttime. What are some of the other clinical presentations of paget disease meredith? Okay. Well, your bonus going Haywire and as organized I guess you could get deformities like Boeing. Anterior, Boeing of the Tibia and anterior lateral bowing of the FEMUR typical, there's fancy-sounding skull deformity called Osteoporosis circumscription cranial. You can see an x rays to so brittle bones how about fractures particularly with minimal trauma and I've heard of people going death from Coakley. Involvement Bony. Can. Lead to cranial nerve entrapment and spinal involvement can lead to ridicule up the spinal stenosis court compression paralysis and altered gait. You may see increased urinary calcium in rarely hyperglycemia particularly with large burden of bone disease or with. Or fracture also rarely, you can have so much blood flow going to the bone lesions you can develop high output cardiac failure. Oh, man that sounds like a lot and although is a benign condition less than one percent of cases can transform into bone tumors such as Osteo, Sarcomas, Congress, Sarcoma, and giant cell tumor. But remember most people are a symptomatic with an isolated elevated alkaline phosphates or only have pain as their initial presentation. So diagnosis requires a high degree of suspicion. Start with x xrays of the suspected painful site or if you're going off just an elevated alkaline phosphates consider abdominal skull facial bones or Tibia. Because you might see an obvious deformity here or more subtle finding an x Ray. If you do find anything x ray to diagnose paget's disease gear radionuclide scanned to see just how much padded disease they have. So let's say you've been the excellent doctors that you are. You listened to your patient with some mild pain who also have been have an elevated alkaline phosphate tastes on labs. You think got xrays that confirmed paget disease followed by radionuclide scan. What do you do for? I would say nitrogen containing the spas fascinates our first line antibiotic agents. So like Alendronate and rescinded Nate, you can take Peo- those can be used but only if zola drunk acid brand name class is contra indicated are not tolerated. Zone undrawn acid is the first line. Med is a single five milligram dose given IV contraindications to all this phosphates. Disease hypoglycemia and pregnancy. I've you Besiktas Vinnie fancy and of course, treat any pain in Jesus such as. Anti near Pathak pain agents if it needed, there are some numbers to remember for follow three months and twelve months three to six months for an alkaline fos face to assess response to initial treatment, and then every twelve to twenty four months after that. Repeat rays twelve months after treatment to assess for improvement versus deterioration. If they have relapse either by symptoms or biochemical markers, they may be offered retreatment. If no response is seen within six months in as a reminder, treatment will not cure paget disease, but the hope is to prevent progression. Next up, we're going to wade through some practice guidelines looking at colorectal cancer screening. This issue of the AF has a couple of practice recommendation updates for colorectal cancer screening one from the American College of Physicians Are Internal Medicine Colleagues, and one from the B. M. J. Magic Group Wu Magic. I feel like there are so many varying recommendations when it comes to colorectal cancer screening of greed as they point out in article unfortunately, the underlying evidence for colorectal cancer screening is low quality with few screening methods evaluated by a randomized trials. This in turn has led to many slightly different takes on what we should be doing as a reminder. The AFP continues to endorse the two thousand sixteen US Preventive Services, Task Force recommendations, screen patients between fifty and seventy five years of age with fit flexible coin toss copy or colonoscopy and way screening risks and benefits for patients. Seventy six to eighty, five years of age. What is the ACP sang guys the American. College of Physicians reviewed six independent guidelines and the evidence behind them and developed a consensus statement for colorectal cancer screening in average risk adults. The highlights from our internal medicine colleagues include they recommend four different options for screening. All, right. So newer Ono colonoscopy every ten years newer dose flexible Seguin Auspey every ten years, plus fit every two years numerous. Fit every two years or numerous. Quattro. Kwak fecal occult blood testing every two years WHO's not judge my Spanish. It is deficit quish. Another highlight is that neither ct call inaugural or fit with stool DNA are recommended screening test due to limited evidence of benefit and increased harms. Lastly, they do not recommend screening after seventy, five years of age or when life expectancy is less than ten years. So those are the highlights from the ACP is guidance statement. But like I said, we also have an update from the B.. M. J. Magic Group listeners should, of course, check out the Journal for the full story. But we wanted to highlight one interesting component of the recommendation. The B. M. J. Magic group recommends calculating estimated colorectal cancer risk and avoiding screening in those with an estimated fifteen year risk. Less than three percent because the risk of colorectal cancer mortality approximates risks associated with screening did highlight the Q. Cancer Calculator based on proven accuracy and its use of routinely available information. Importantly, this calculator was designed for British patients and hasn't been studied in the US. Again, the American Academy of Family Physicians Endorses the 2016 USPS screening guidelines but these are definitely some interesting developments here by these two groups agree. Let's wrap up episode with a Poem Daily Culture Zine Post in my reduces strokes and recurrent hospitalizations for Angina in this poem comes to us from Dr. Kulkarni. The thought process is at there is inflammation post myocardial infarction in this may increase risk of recurrent cardiovascular events. If this is true are their interventions that can decrease inflammation to decrease risk future cardiovascular events the inflammation. Yeah insteps the Anti Inflammatory Medicine Culture Zine. To answer this clinical question this poem look at a trial that brought out the big guns we like to hear in evidence based medicine. It was double blinded. randomized. And controlled no way. Yup Culture Sane which is fairly inexpensive was given at eight zero point five milligram daily dosing bursts placebo. Tummy war. Oh I'll tell you more. About twenty three, hundred patients for each group and the patients were pretty similar to hit. All had an MRI within the past thirty days and completed vascular of any kind. All had been treated with dual. Anti Platelet therapy plus staten. The median age was sixty one years. Nineteen percent were women thirty percent were smokers and twenty percent had diabetes. They excluded patients with severe renal or hypnotic disease recent stroke recent bypass procedure, and those with severe heart failure. Most patients receive treatment for nineteen months and followed up at twenty three months in outpatient setting. The primary endpoint was a composite included death from cardiovascular causes resuscitated cardiac arrest, 'em I stroke, and urgent hospitalization for Angina leading to coronary masculinization. So what did they find? I'll tell you the number needed to treat for primary endpoint event was actually sixty three and a large part of this was driven by a decrease in stroke with a number needed to treat of one, hundred, sixty, seven, and decrease in urgent hospitalizations for anche now leading to basket. With, a number needed to treat of one hundred. The closest group did report more nausea and flatulence, which seems to be a small price to pay. They also had a slightly higher rate of pneumonia, but the incidence was low at less than one percent that brings us to the bottom line in patients using guideline directed therapy. With recent M I, they should be considered for daily colchicine use as it reduced cardiovascular events, specifically, strokes and rehospitalizations for Angina. This could be very important for patients. Please email us at AFP podcast at AF DOT ORG or tweet at AFC podcast please rate and comment on Apple podcasts or podcast team has J. Anderson Jocelyn both Steve. Brown circles Coles Spinoza Crista Russo Genevieve Lambert on Wilson Illinois in Coney in married Rosenthal are sound technical guru is Tyler Coles. Our theme song is written and recorded by Family Physicians Bill dabs Ryan Evans and Justin Jenkins. This podcast is brought to you by the residents and Faculty of the University of Arizona College of Medicine Phoenix Family Medicine residency. We'll talk to you soon for the next edition of the American family physician podcast.

abdominal pain paget disease American Academy of Family Phy Influenza American family physician meredith Acne tetracycline Krista Angina Sarah European League Colchicine Sarah Seiken Iga Vascular Tama Vir. paget Base Family Medicine Residency bone disease doxycycline Dr. Henry Berry
Penicillin

Invention

51:07 min | 1 year ago

Penicillin

"Hey Joe we talk a lot of a lot of game changing technologies on the show <hes> why don't we talk about a great product from one of our sponsors that has only recently started to change the game. Okay I am intrigued. We're talking about see by a new player in the smart lighting and smart technology space if you're hesitant about making the transition into a smart home you're not alone but thankfully see by G._e.. Was designed for you okay. So what's the deal. Tell me about it all right. We're talking about voice in APP control bulbs that can be set to your schedule. We're talking about smart switches that can turn any traditional bulb into a smart one in short your one stop solution for smarter lighting. <hes> that's interesting we can learn more about Jeez amazing new suite of C. BY SMART lighting products at sea by DOT com that C. B. Y.. G. Dot com welcome to invention production of iheartradio. Hey Welcome to invention. My name is Robert Lamb and I'm Joe McCormack and Robert. I know you WanNa Talk About D._N._D.. Indeed before we get to the real subject well. I don't know I was thinking about doing it last but we can go ahead and talk about it up front yeah we'll in dungeons and dragons these various Demon Lords and uh they they rule over various portions of the of the fiend population in the game and their two demon lords in particular that I was thinking about in regards to today's episode <hes> and that that would be boy and Jubilee Eulex so zagged Moi is the demon Lord of fungi the Queen of fungi the master of decay and then opposing her ever at odds with their is jubilee the faceless as Lord which is a god of loses and slimes and blobs you know all the losing nasty creatures of Dungeons and dragons and yeah there they oppose each other their constant war with each other and in some campaigns like their forces and even they're they're in embodied forms do battle with one another and it it actually ties in a bit with this subject. We're talking about today of penicillin okay so penicillin the fungus that fights I don't know would you call diseases diseases slimes well I feel like jubilee being the Demon Lord of Oozes and slimes kind of makes it the the Demon Lord of of microbiology as well and <hes> you know microbes and <hes> and microbial illnesses so okay well so today we're going to be talking about penicillin. I guess maybe one of the the great real weapons of spoke to Moi yes <hes> but this this came up I think because we'd been talking about fungus on our other podcasts on stuff to blow your mind where we just finished recording a five part series on psychedelics yeah yeah looking at <hes> Fungal psychedelics and ongoing research into how these substances could enhance our mental wellbeing and helping the treatment of psychological issues and one of our big take home was these fungi could help save lives improve the quality of human life but it would not be the first or only fungi to do so because we can certainly look to various interactions between human. Hell's the different fungi species and their use in traditional medicine. We can point to various various products including <hes> products of fermentation for instance including alcohol but there's an even better example of better living through fungi in that's penicillin right so today we're going to briefly explore the invention of penicillin which is often cited as the first true antibiotic technology of course antibiotics are medications that treat infections by killing injuring or slowing the growth of bacteria in the body and antibiotics are a class of what you would generally call whole antimicrobial drugs medicines that kill microbes that presents a threat to the body of course antibiotics generally fight bacterial infections whereas you could have others like Antifungal that fight Fungal infections or antivirals that fight viral infections and now antimicrobials antibiotics are a gigantic subject area that we're of course not going to be able to get into every nook and cranny of the subjects but we hope we could have an interesting introductory introductory discussion may become back to antibiotics sometime sometime again in the future because it's it's a broad invention that has lots of little invention tributaries throughout history yeah but it is such a fascinating case to look at and I think should make for a great episode of invention here because for starters it's it's a twentieth century century invention slash discovery off and of course the line between invasion of discovery is a little bit gray but we we can pinpoint it to nineteen twenty eight and ultimately like rolled out by nineteen forty or so <hes> but we can we can look to it we can look at the world before we can look at the world after with with the sort of clarity that we don't always have with <hes> certainly <hes> older or more ancient inventions exactly because we always like to ask the question on the show what came before the invention what what changed when this invention mentioned came on the scene <hes> and what became before widespread modern antibiotics was stupendous amounts of death and misery from infectious disease in blood poisoning. I I was wondering like is it even possible to to get stats on what the world of infectious disease looked like before we had antibiotics around the Mid Twentieth Century Yeah I mean to a certain extent. A lot of the suffering is just incalculable. <hes> you know especially if you go back and sort of consider all of human history up to that point in the various factors that that influenced infectious disease and injury you know the the eventually the rise of germ theory but also this things like that the rise of cities and so forth but but luckily yeah since it was such a reason invention we have some pretty incredible stats on the matter. Suddenly thanks to this new miracle drug diseases that simply ravaged the global population like syphilis could be cured the shadow of lethal lethem infection no longer hung at least as heavily over every scrape injury and war wound and with wounds were often talking about sepsis which is a term that was used a by hippocrates back in the fourth century B._C.. Meaning blood rod or blood poisoning and he was referring more in generally. I think to decay but the term came to be applied to blood poisoning which arises when the body's response to infection causes causes injury to its own tissue and organs but just prior to the twentieth century infectious diseases accounted for high morbidity and mortality rates around the world even in the industrialized world according to w. a. g. in the treasure called antibiotics from two thousand sixteen. The average life life expectancy at birth was forty seven years forty six forty eight years for men and women respectively and this was due to the dangers of smallpox cholera diptheria pneumonia typhoid fever plague tuberculosis closest typhus syphilis and host of other ailments that could afflict you and then during the antibiotic era <hes> they follow again a rising in the middle of the twentieth century. The leading cause of death in the United States change from communicable diseases uses to noncommunicable diseases like cardio cardiovascular disease cancer and stroke and the average life expectancy at birth rose to seventy eight point eight years so the elderly were no longer a mere four percent of the population violation but grow to become a whopping thirteen percent of the population so we're talking about profound changes demographics based on this new this new invention yeah the change is huge. I mean we live in a world now. Where if you have have access to high quality modern medicine and a lot of people don't necessarily mind but if you have access to high quality modern science based medicine and you can get antibiotics and <hes> and get to a hospital or or see a doctor you very likely likely have a good chance to beat most of the common infectious diseases that that people get unless you have some kind of you know like another condition that exacerbates it or something before antibiotics? This was just not the people just died from diseases that. You catch like diseases that are common for people to catch all the time yeah or you had certain diseases like syphilis that were virtually uncurable yeah you know and and some of the the cures that were attempted were were pretty horrendous in in and had an generally did not work you know talking about using mercury and so forth and you mentioned before contamination of wounds. I mean just a huge thing just like a you know you might <hes> you might cut yourself while gardening and you die from it it yeah heaven forbid you undergo say Medieval Gallstone surgery or something like that yeah by the way I think <hes> tuberculosis has you know is a good example to look at for some of these stats as well according to the C._D._C.. It's <hes> was a leading cause of death in the U._S.. In one thousand nine hundred forty prior to the roll out of antibiotic therapy in nineteen hundred one hundred ninety four of every one hundred thousand U._S.. Residents died from deep T._B.. Most were residents of urban in areas in one thousand nine hundred three leading causes of death in the U._S.. where pneumonia tuberculosis and diarrhea and into rightous which together with Diptheria caused one third of all deaths and of these deaths forty percent were among children aged less than five years old now to your point in not everybody has the access to <hes> antibiotics that <hes> say people enjoy and say Europe and the United States Yeah T._b.? Remains a the leading cause of death from an infectious disease in many parts of the world particularly the developing world and some antibiotic treatments or antibiotic assisted treatments are more complicated and more difficult than others. I mean I know the treatment for T._B.. Is Not as say easy is the round of just orally administered antibiotics that you might get for a standard bacterial infection right but it suddenly it was just a heralded rightfully so is <hes> as a miracle invention when it came about I saw an image each of a of a sign on garbage can or mailbox from the Mid Twentieth Century advertising that now you can get gonorrhea cured in in like four hours thanks to the these new developments in antibiotics. It's just a it can be difficult to put ourselves in that mindset having grown up in the wake of antibiotics or at least most of us most people listening to this show. I was just thinking about how many like U._S.. Presidents died of infections ends of various kinds. That seems like that would be a very unusual thing to happen now but like in the eighteen hundreds James Garfield got shot but it wasn't the initial gunshot that killed him he lived for like weeks afterwards. <hes> he got an infection in the wound I think because they were digging around with dirty hands to try to get the bullet out of him and he and they didn't have antibiotics of course when he got an infection so he died. I think another U._S. was William Henry Harrison. I think they think Dow died from probably like drinking fecal contaminated water in the White House yeah so many different <hes> <hes> injuries and infections were just far more likely to be lethal with <hes> you know without modern antibiotics to step in and aid in the fight now there were some things that were kind of like versions of antibiotics or antimicrobials from before the discovery of Penicillin in nineteen twenty eight he had the best example from the period. Just immediate <hes> immediately prior to penicillin would be the demise the sulfur drugs and these were the first antibacterial to be used <hes> systematically and they were synthesized in nineteen thirty two in the German laboratories of bear a g now you might be thinking about the time line like wait a minute. Didn't we just say that penicillin was discovered in twenty eight but it took a long time after the discovery of penicillins antibacterial properties for it to be made as a useful medical dry like it was nineteen forty generally. That's the date you see for when penicillin actually became an actionable <hes> thing in Madison so yeah before that we had <hes> the the sulfur drugs and it had they had a rocky start but they did prove very effective in preventing wound infections during the Second World War they were used on both sides in the in the form of soulful pills and also sofa powders that would be sprinkled over a wound so if you've ever watched <hes> you know <hes> some sort of a period piece so especially a war piece of the twentieth century and he sees somebody sprinkling powder mover an injury that is what that's supposed to be sulfur drugs. They're not as effective is true. Antibiotics like penicillin and there are a number of possible side effects that one that can take place and it also can't be used to treat syphilis a- and it also can't treat <hes> <hes> Sofa resistant infections now of course this is also a twentieth century invention so I was wondering did anybody come up with any version of antibiotics or Proto Antibiotics before the twentieth century we you know the penicillin hadn't been discovered and isolated and made stable as a useful medicine but were there any things like antibiotics are sort of precursors of antibiotic because in game of thrones right. They have penicillin don't they they have some sort of fantasy version. I've never heard of that. Don't they have something that the the old naysayers would mention having to do with with Brad and mold or something didn't they. I don't remember that I just remember people get cuts and then they get infected and die. Give give him milk. They have milk poppy our game of thrones <hes> our our George Martin readers left or right in on that but I vaguely remember there being illusion to something like <hes> some sort of mole based <hes> medicine that they were using <hes> could be wrong well. I can't see that being something that's thrown in there as a little aside but like isn't widely recognized or used to be and it's interesting how that kind of parallels goals some interesting pieces of evidence for Proto Antibiotic Technology in the real world even going back to ancient times so <hes> I want to look at the work of the emory university bio archaeologist George J._R. Mela goes who is now deceased. I think he died in two thousand fourteen <hes> but he's interest- interesting scholar and he discovered something very curious back in nineteen eighty so the subject he was looking at was a set of human bones from ancient Nubia dating from between three fifty and five fifty c e and so the bones came from Nubia which is a region of Africa along the Nile River but south of Egypt in what would be modern day Sudan and what these bones orlands showed was evidence that the people they belong to had been taking tetracycline. Now tetracyclene is not the same as penicillin but it is an antibiotic it can be used to treat all kinds of infections for minor problems like acne. I think in concert with some other drugs <hes> two major diseases like plague or to leukemia or even syphilis and tetracycline works primarily by binding to the ribe `ISMs of bacterial cells ribes oems or sort of the cellular factories stories they build proteins that are needed in order for organisms to live and grow and by binding to the Ri- Zome tetracycline makes it difficult for the bacterium to create new proteins it was patented in the nineteen fifties and became widely used in in the second half of the Twentieth Century <hes> so what was it doing in the bones of Nubian people who live like seventeen hundred years ago well <hes> Armagh Logos and colleagues followed archaeological clues to identify the source of the tetracycline which was Bashir. <hes> of course beer is another one of <hes> ultimately it falls under Doug Moi's domain. Oh yeah though this is different because tetracycline is not made from fungus it is actually an antibacterial that is a byproduct of some bacteria arterial. Oh okay so it's a bacterial byproduct but essentially okay so technically it's duplex okay point to jubilee this jubilee versus Jubilee Right. I mean that's going to happen with your demon. Lords introducing warfare so so beer is made from fermented grain of course and the fermented grain in this ancient Nubian beer apparently contained the bacteria streptomycetes which creates tetracycline as a byproduct but a question of course. So like were these traces of tetracycline in Nubian mummy bones a sign of like a bad batch of beer. The got contaminated by accident or were these people deliberately culturing their beer with antibiotic producing bacteria and so to look at a study from the American Journal of Physical Anthropology from twenty ten of which <hes> Armagh Logos was one of the authors <hes> the authors examined tetracycline in skeletal remains from throughout this period and the evidence indicates that the ancient Nubians were consuming these antibiotics on a regular basis and the authors suggest that these ancient people were intentionally producing this medicine and this links up with some evidence from other ancient peoples nearby such as the Egyptians that sometimes apparently apparently used beer as a treatment for conditions like gum disease and other types of infections in the authors even found evidence of a four year old child whose skull contained lots of tetracycline from this beer suggesting that the child had been fed high doses of of this like antibiotic beer. Perhaps in an attempt to cure an illness. Maybe the illness that killed him and so the levels of tetracycline residue found in the bones of these mummies is only explicable if they were repeatedly consuming assuming this antibiotic in their Diet and there are actually other archaeological remains that show evidence of antibiotic use in the ancient world for example samples taken from the era of skeletons from the Dock Co.. ACIS in Egypt <hes> from people bull who lives sometime in the late Roman period also showed evidence of the same thing of tetracycline and the Diet and this consumption of tetracyclene is consistent with other evidence showing a relatively low rate of infectious disease in Sudanese. He's Nubia during that time period and a lack of bone infections apparent in these remains from the this oasis in Egypt so it really does look like people in ancient Africa discovered a somewhat effective form of antibiotics attics centuries before the discovery of penicillin and the isolation and mass production of focused anti microbial medicines now to be clear. I think like a beer that had tetracycline content from from being cultured with bacteria like this probably would not be the as potent and focused ineffective as like the isolated compounds in the drugs you take orally or through injection would be today right but it would have some effect and it appeared that it probably was somewhat effective in fighting infectious disease right and of course they they wouldn't know exactly what they had here but they knew they had some sort of beer that seemed to <hes> some sort of holy liquid that that that had some sort of curative property to it exactly I mean if fascinating discovery from the ancient world <hes> another interesting in fact tetracycline is relatively unique in that it leaves clear signatures in the bones that can be discovered long after the person has died so other antibiotics. Don't leave these clear markers like this that make it easy for archaeologists us to detect so you have to wonder like are they were there other cases of ancient peoples in various places in times using some kind of antibiotics or bacterial or fungal cultures <hes> to treat diseases like these ancient Nubian people were <hes> but that we don't have evidence of because it doesn't show up in the bones like tetracycline does yeah it could've just been lost to history. <hes> I was reading an interesting paper from frontiers in microbiology in two thousand intend by Rustam Domino called a brief history of the antibiotic Era Lessons Learned and challenges for the future and Aminov points out this unique quality of tetracycline and notes just what I was basically just saying how easy it would be for evidence in other uses of antibiotics in the ancient world to be lost to us though he he also mentioned that there are other anecdotes from history about cultural traditions that show Proto antibiotic technologies in these other examples would include red soils els found in Jordan that are used for treating skin infections. It's been discovered these soils contain some antibiotic producing organisms though I guess they're probably also some major risks in applying soil to wounds <hes> and then also plants used it in traditional Chinese medicine that actually do have some antimicrobial properties yeah because one thing we have to remember as like the modern anti biotic effort is ultimately based in going out into the natural world in finding these weapons that already exist I yeah and then you re using them in adapting them of for Human Madison and you know this is essentially what is going on in traditional medicines as well and it also means that there are weapons out there that either have not been discovered at all especially in particularly vibrant ecosystem some of which of course of threatened all the more reason to <hes> for us to <hes> not decimate <hes> say the rain forests or the deep ocean right <hes> but then there are also things that may have been discovered to some degree in the past but have been forgotten will yeah that that does seem possible because despite all all this evidence of ancient sort of Proto antibiotic technologies the worldwide rates of death from infectious disease in the period for which we have data right before the invention of modern antibiotics shows that humans generally did not have effective antimicrobials in that period so maybe some of this knowledge was lost over time all right well on that note. We're GONNA take our first break AAC but when we come back we're going to return to the mold research the nineteenth century and ultimately to our key inventor here Alexander Fleming all right so of course our sponsor today is C.. G. Lighting. I have not made the smart homes which yet Robert. I'm wondering if you can sell me on it <hes> yeah I can give it a shot. I mean you're definitely not alone but once you realize just how insanely simple it can make your life is almost hard to justify not switching it allows you to connect control and automate your lighting with a full suite of smart products. We're talking the ability to set lights to your schedule so you never have to come home to a dark house for example ability to set in turn on automatically to the perfect brightness every morning ability ability to control your lights and appliances remotely through your phone and the ability to set the perfect scene with the touch of a button and this can all be a reality with C. by G._e.. SMART home products to learn more about transitioning your home quickly and easily into a smartphone visit C by DOT com. That's C. B. Y.. G. E. DOT com all right. We're back now. We'll get to Alexander Fleming in a minute <hes> with the discovery of penicillin but Alexander Fleming was not the first person to notice that there might be some anti microbial properties of certain fungi. That's right there was there was work going on in this area of prior to Fleming Fleming was was picking up on some of it and <hes> and really just overall our understanding of a fun Guy <hes> in general was was advancing as we mentioned in our psychedelics episodes. You know there was a time where we did not recognize fun guy as being separate from the realm of plants right before we realized that it was a kingdom unto itself in all ultimately kingdom that has a little more in common with the Animal Kingdom than it does with the plant kingdom and a lot of talented folks working in this area but one of them might come as surprise to a lot of people <hes> and that's because her name was Beatrix Potter the Bunny Rabbit a bunny rabbits. Yes okay off the bunny rabbit fame. I was kind of a curious coincidence because I was reading about all this and then just randomly on the stuff to your discussion module. Which is the facebook group for people listen to the show to discuss episodes? Someone brought up Beatrice Potter in regards to something to do with squirrels because there's a lot of squirrel squirrel content tint in the discussion module and they brought up Beatrix Potter and Beatrix Potter actually ties in to this episode a little bit because in addition to being the author and illustrator of the you know the tale of Peter Rabbit and associated British animal tales she was also a naturalist with a great deal of interest in astronomy and most importantly of all my college so she produced a lot of beautiful scientific watercolor illustrations of various fungi in her neck of the British would. And you know as part of her studies and if you studied a lot of local molds as well and did illustrations of them you know she's ultimately a very interesting character that was you know unfortunately she lives in a time in which you know the sexism of the day prevented her from reaching the heights of in the natural sciences that she would have been afforded later on but in a lot of her work is also just being I think rediscovered in appreciated for the first time <hes> <hes> you know in recent decades but yeah the next time someone busts out some metrics potter A. Remember this is not just a an individual who wrote some fanciful tales and illustrated them. She was also just she was out there. Studying the natural the world and create in in advancing our understanding of psychology she was sort of a looking into the hidden life of nature in multiple ways. Yeah I see some sources that are asking the question. Okay was Beatrix Potter hotter a true naturalist true natural scientists over she just a you know an amateur. There was just very interested in these things and I don't know it's kind of a complicated question. Ask when you consider the limitations in the Victorian era for women but I I think undoubtedly she she I I would side with the fact that she was a natural scientist. <hes> I mean she authored or co authored one paper if I remember correctly so <hes> I'm I'm GonNa give her giver. Full credit was about a fungi mushroom in particular I forget it was one of those related to the Russillo mushrooms but I forget which species but basically she was. She was kind of up against the the Patriarchy Eh for the most part though well is it time to turn to penicillin itself. Yes let's turn to this key discovery here and our inventor are discover Alexander Fleming okay so who was Alexander Fleming okay so Fleming was born born in eighteen eighty one died in nineteen fifty five and he was a Scottish biologist physician microbiologist and pharmacologist. He was the son of a farmer and he observed and studied a great deal of death from Sepsis in World War One uh-huh he observed that while <hes> antiseptics worked well at the surface <hes> a deeper wounds sheltered bacteria from the effects of things like sulfur drugs right so if you have the kind of superficial wound you could clean it off pretty good Gordon and that might help protect you from <hes> from bacterial infection but if you have a deep wound and say like dirty stuff bits of soil and other you know just crud gets lodged deep in there you might not be able to clean the wound out very well right and that's exactly the kind of stuff that's going to get lodged in there especially with your war wounds where there is a stab or or deep cut or a bullet entering the body. We'll makes me think about <hes> the when we were reading about the idea of Stegosaurus US perhaps weapon I mean not consciously stegosaurus perhaps <hes> having an adaptation to weaponize infection against its enemies oh by dragging its <hes> Dagga misers spikes through the Dung right exactly yeah having dirty Bagga miser spikes aches and then when it wax the T. rex in the crotch with them that <hes> that gets infected later and eliminates a Predator from the area and <hes> the the the predators of the day would not have had access to antibiotics certainly not or even that beer from the we mentioned earlier so a full Fleming devoted himself to research and he <hes> prior to penicillin he discovered a license. I'm a naturally occurring enzyme in mucus and other parts of the body than inhibits bacteria so you know he was already you know in this area you know looking for for new <hes> new breakthroughs new discoveries but then his biggest breakthrough of all is this discovery of penicillin and it's truly one of the more amazing invention slash discovery moments moments from history because while he was exactly the right person to make discovery and then deserves all the credit he was given the key moment comes down really to pure luck and we simply don't know if anyone else would have made the discovery if he had not been there to observe it okay so what happened with this discovery so around nineteen twenty seven or so he had engaged himself in studying <hes> STAPHYLOCOCCI the or staff and he had stacks of Petri dishes dish specimens ends in his lab which I've seen described as being kind of untidy lab so you're imagining all these like Petri dishes full staff all over the place notes and so forth and so the key moment comes in September of Nineteen Twenty eight right right so we ha- has these staff Petri dishes out any leaves them for the weekend to go on holiday with his family any when he comes back he expects you just see how they've progressed see how they've grown but he finds that they haven't grown in fact they have died. Something has ravaged his specimens specimens yeah now. This is one of those stories where he gets very narrative is so you do have to wonder if some details of it or embellish how the story may have changed over time but this is the way the story has been passed down and and I think it seems to be largely largely basically true <hes> the way that I've seen the story often told us that he comes in. There's a blob of mold growing in one of the plates and all around the mold. There's this halo of nothingness. Where normally what you would see is that if you got a plate for culturing bacteria there would be these little dots in blobs on the on the plate but instead? There's this halo where there's no bacteria bacterial dead zone now of course we know staphylococcus is is a bacterium group linked linked to all kinds of human disease and misery staph infections right if this mold could kill staff that seems medically relevant so what happened here well he he. He realized that he was dealing with some sort of a fun guy so he luckily there was a microbiologist with lab. Just below Fleming on the floor below his lab a man by the name of C._J.. La Touche and in fact it's also been suspected that the mold and question that killed flemings the staff might have drifted up from Latouche as lab adding an extra element of weird chance to this whole situation okay so perhaps his samples were contaminated by stuff from the lab next door or down a floor. You're right that's not that's not a theory. That's presented in every source does pop up fairly frequently so specifically this mold was what would later be identified as a strain of penicillin no tottenham and it was obvious it's the it's secreted something that prevented staph bacteria from growing and so fleming followed up in studying the secretion this this mold juice says I've seen it called he found that it didn't only prevent the growth of staphylococcus it worked against common bacteria like streptococcus or meningococcus and and the back also against the bacterium that Causes Diptheria interestingly while Fleming did see applications for penicillin in curing disease and he mentioned them briefly briefly in the paper he published in nineteen twenty nine about this discovery about the antibacterial properties of concilium <hes> he primarily thought of this secretion of penicillin as a tool for bacteriologist logist to sort strains of bacteria basically into penicillin sensitive versus non penicillin sensitive species and that that could be useful in the lab yes so he sometimes criticised as is really not understanding completely what he had adhere not having the vision to see where it could go well. I don't think he completely understood but he did indicate that this could possibly have uses in medicine right <hes> so Fleming and his assistance Stewart craddock in Frederick Ridley tried for years eight years to turn this accidental discovery into a stable isolated compound that would be useful and this this was a problem because like so you've got the secretion from the mold molds making some juice it's kind of getting stuff wet with this this stuff that that <hes> that fights bacterial growth but they couldn't isolate the compound that was causing the effect and stabilize it and make it make it generally useful <hes> so to quote from Aminov Paper Aminov that I mentioned earlier quote. For twelve years after his initial observation Alexander Fleming was trying to get chemists interested in resolving persisting problems with the purification and stability of the active substance and supplied the penicillin acilia strain to anyone requesting it but he really he he could never cracked the nut ultimately and he didn't finally make this discovery of the process for <hes> for <hes> stabilizing and isolating the compound and by Nineteen Forty Aminov writes that <hes> Fleming finally abandoned his quest but fortunately it was right about that time that a capable team at Oxford University including the researchers Howard Florey and Ernst chain or Chine they <hes> picked up on this research and they they kicked off the research project that would eventually break through on this <hes> and they're all these interesting story. So of course this is while World War Two is going on right so research conditions are not ideal and <hes> they're they're all all these stories about how they turned their lab at Oxford into this giant incubation center or sort of factory for mold like they employed all these lab assistants who were these women who had been referred to in some sources as the penicillin girls half and they would work too like they would work to grow the penicillin and buckets and tubs and basically every container that they could <hes> and eventually they did they were able to isolate and stabilize allies this compound so to quote from an Article <hes> from the American Chemical Society in Nineteen Forty Flory and that would be Howard Florey carried out vital experiments showing that penicillin could protect mice against infection from deadly STREPTOCOCCI then on February twelfth nineteen forty one a forty three year old policeman Albert Alexander became the first recipient of the Oxford penicillin he'd scratched the side of his mouth while pruning roses and developed a life <unk> threatening infection with huge abscesses affecting his is facing lungs penicillin was injected and within days he made a remarkable recovery well but unfortunately despite this recovery which lasted for a few days they ran out of the drug and Alexander eventually got worse again and he died and I was reading that they were so desperate to cure him that after Alexander urinated while on his antibiotic course they would collect the urine and try to extract the penicillin he he excreted again so that it could be re administered to him <hes> and I should mention also that the process that the Oxford team relied on to extract and purify the penicillin and the mold juice was led by another important biochemist a guy named Norman Heatley ugly but this case of Albert Alexander shows an obvious early problem they had which was the problem of scale they simply lacked the ability to make penicillin at the scale it that would be needed to treat even one person let alone the whole world <hes> the strain of mold that they were using didn't make enough of it and this led to the search for other species of the same fungal genus penicillin which would maybe they thought produced higher concentrations of the penicillin filter eight and I was reading an interesting article by the University of Michigan physician and Medical Historian Howard Markel that tells a really interesting story. I'd never heard about this. <hes> so the story goes like this apparently one of the assistance at the Oxford lab showed up for work one day in nineteen forty one with a cantaloupe that she'd bought at the market because it was covered in a weird looking golden mold which is great because this would be the one case where somebody is picking over the fresh produce to like find the moldy one <hes> the mold on this cantaloupe turned out to be a strain of penicillin called Penicillin Chris O._G._S._M.. Which markle says naturally produced at least about two hundred times as much penicillin as the original strain that they've been studying and <hes> then later markel writes the the same strain was subjected to mutagenic processes in the lab so like bombarding it with x rays and stuff to produce a mutated strain that would make up to a thousand times as much penicillin as the old school fleming mold so by nineteen forty one penicillin is on its way to becoming a viable medicine all right on that note? We're GONNA take a quick break. When we come back? We're going to look at the impact of penicillin and we're GONNA look at it <hes> in and I think a fun way by considering really interesting arresting. What if everybody we love a good food documentary around here and now there's so many wonderful culinary podcasts to turn to as well in the latest is food three sixty st with Mark Murphy? He's a celebrity chef and restaurant tour. He's been cooking in some of the world's most esteemed kitchens for over thirty years and on this show he's joined by impressive roster of his close friends in the industry. It's food three sixty and he's he's GonNa look at the world of food bringing history science culture and more through the lens of the stuff we eat season one will be eight episodes topics include in no special order flavor at the art of Cookbook and recipe writing ice cream coffee menus in and outs of opening a restaurant pizza and breakfast so tune into food three sixty a brand new podcast that airs every Friday listen and subscribe at Apple podcasts on the iheartradio APP or wherever you listen to podcasts all right we're back so we often don't don't do a lot of what ifs on Invention don't I thought we to certain extent but I mean a lot of times. It's harder case to be made like what if this had not been invention united right bill bill or discovered because in most cases you can you can you can look at the data you can look at other individuals where like if the Wright brothers had not invented the airplane had not created that <hes> that first prototype that really showed what was possible <hes> like clearly there were there were other individuals in the world working on this someone would have cracked it. If Roentgen had not discovered x-rays in eighteen ninety whatever year it was somebody else would have discovered them pretty soon right but <hes> when he comes to penicillin <hes> potentially it's a little more complicated than that I ran across a cool article on the topic titled What He Fleming had not discovered penicillin and this was published in the Saudi Journal. <hes> of biological sciences is by Al Harbi at all the authors admit that that certainly Fleming had made the discovery someone else might have in the years to follow. Probably you know in the early nineteen forties they estimate so we could still well have have arrived saved antibacterial age however they also explore the possibility that we might have simply not made the discovery at all well and it's an interesting argument so I wanna I wanna read a quote from the paper here. Quote of course penicillin could have been discovered the day after Fleming missed the opportunity but in reality there was no parallel discovery that took place as a result anyone taking an interest in penicillin during the nineteen thirties did so in the knowledge of Fleming's work in particular the seems no no reason to believe that flory chain would have discovered penicillin since their work depended on Fleming's famous paper and their access to one of his penicillin producing cultures okay so that's referring to the thing I mentioned about how <hes> how so <hes> Fleming in his assistance were just like sharing the penicillin strain out with everybody like hey. Can you figure out what's going on with this. Can you isolate secretion the compound in the secretion yeah so think about it there was there was so far as these researchers could determine you know no other effort out there that would have in struck paydirt in the absence of Fleming's research. The Oxford Group wouldn't have been looking for it. Someone walks men. The father of modern antibiotics sometimes called who made several key discoveries discoveries later was also inspired by Fleming <hes> so it's it's one of these cases where like he seems to be the epicenter not not only him but just then the the the seemingly chance encounter in his lab that day that that <hes> we're suddenly this halo appears in the Petri dish and that gives birth to a to a whole class of other discoveries right because not all <hes> antibiotics are derived from penicillin the penicillin class of antibiotics. Antibiotics become sort of like one sort of grandfather class but then there are all these other classes that are discovered during this golden age of antibiotics that takes place over the next few decades yeah and there are various just additional medical breakthroughs that would not not have occurred without penicillin such as organ transplant but then there's also the question like what would what would have happened in the wider world because again penicillin comes online during the Second World War and so you can easily really ask well what would have happened if allied troops had not benefited from access to antibiotics at D Day. I've never thought about that. In fact I before looking at this episode I probably would not have known the answer to whether or not they had access to antibiotics well. Penicillin film production was actually swiftly scaled up just to make sure that allied soldiers had access to it at d day so there is a legitimate question to be asked might the allies not have won the Second World War without penicillin <hes>. I think there are a lot of factors to consider there. I don't think it's quite a Gotcha question but it's it's worth thinking about the authors argue that without flemming's discovery would have had to depend on the SOFA drugs an imperfect alternative negative to <hes> true antibiotics and these these were described in the nineteen thirties and Fleming worked with him prior to his discovery but without penicillin in play the authors argue that Sofa drugs might have become the standard and even push rush the discovery of true antibiotics well beyond the nineteen sixties and this is also true of the Axis powers had risen in victorious in World War Two because they're the access powers depended on sulfur drugs and their their key treatment <hes> point out that you know quote despite the fact that the Germans and their allies where at a considerable disadvantage the soft drugs did a relatively good job at reducing battle casualties so not to just completely <hes> you know cast aside the effectiveness of soft drugs but they were not as effective as true antibiotics. It's weird to think about the political implications of specific medical technologies yeah and then when you get down to the curious cases of individuals yeah it also gets interesting where he touched on presidents who died died <hes> that would have lived potentially if there had been penicillin around right and so they point out that <hes> that sofa drugs saved Churchill's life in nineteen forty three when he was suffering from pneumonia I as well as F._D._R.'s life a but there's also evidence by the way <hes> that actual penicillin may have saved Hitler's life following the Stauffenberg assassination attempt of July twentieth nineteen forty four this was the plot that tried to kill Hitler with a briefcase I bom right like where the some of the officers conspired against him and they put up briefcase bomb in the room with him and it did explode but he was protected by a heavy table that prevented it from killing him. He was obviously injured and I think he had like nerve damage after I'd so so the idea here is that perhaps his injuries were treated by by penicillin yeah that's at least an argument has been made that they had access to penicillin <hes>. I'm unclear on how they would have obtained it. You know through. Maybe there's a spy story there I I don't know but the the idea being well if he had if he didn access to penicillin then perhaps he would have died and that would have arguably ended the war in a different manner forcing us to re imagine an entirely different postwar world so again again. We're playing with with what ifs here and in also we my understanding is we don't know for sure that Hitler had access to penicillin following that assassination attempt but there is the overall scenario of the allies having penicillin and having this ramped up penicillin production leading into d day yeah that is really interesting. I never contemplated that before. <hes> now something that we do often have to think about and we should probably acknowledge at the end here before we move on. Maybe this'll be something to come back and do in the future with a recent invention episode is the idea of <hes> a possible end of the antibiotics edge. I mean this is a kind of scary thing to imagine like what if the antibiotics age is essentially a period in history that has a beginning winning in an end because as we you've you've probably heard about this many disease causing bacteria and other disease causing microbes are overtime evolving. <hes> antibiotic resistance are evolving to to to be powerful enough to survive are antimicrobial drugs and I think specifically one thing that's exacerbating this overuse of antibiotics and people not taking the entire course of antibiotics when they're giving them yeah because again to come back to the Doug Moi jubilee war scenario you know it is an ongoing battle and the the forces evolve to better deal with the threats on each side yeah and so we're we're we're seeing this occur. We're seeing the the overuse of antibiotics producing strains that are that are resistant and it's reversing some of the therapeutic miracles of the last fifty years and underscores the importance of disease prevention in addition to treatment and that means not not abandoning some of our other vital tools for human health like vaccination. Oh Yeah we should come back and revisit vaccination or maybe even various different vaccinations in the future yeah another thing to keep in mind that I don't think we've you mentioned earlier was that the nineteen forties through the nineteen seventies are considered like the Golden Age of Antibiotic Research Yeah and we haven't seen at least we haven't seen any new classes of antibiotics emerged since that time period right now there have have been new developments in antibiotics but I think the way I've read it is that they're generally modifications zone existing classes of antibiotics sorta like we we haven't we haven't found anything radically new since then basically we reached out into the natural a war between <hes> between fungi and the microbial legions and we we stole some of the tools we stole some of that premium fire we day we keep adapting that fire to our own purposes but we haven't we haven't found any new weapon happen from that world and and then they're ongoing war continues <hes> to change. I'd be interested <hes> do you out there you the listener. Do you work in medical research. Are you working on areas involved in antibiotic resistance the Future Future of anti-microbials please get in touch with us. I would like to hear about that. What what are you doing in your work? And what does the future look like to you on the inside absolutely we would we would love to hear from you <hes> again. We've only scratched the surface surface here though thanks to antibiotics hopefully that scratch will not get life threatening infection but yeah there's a lot more history here but but hopefully what we've done here today is of course highlight just a very very cool story from the history of inventions inventions and discoveries in human history and outlined the impact of of one of the greatest inventions or discoveries again how we want to classify it from the Twentieth Century Yeah totally in the meantime. If you WANNA check out other episodes of invention you can check out our homepage invention pod dot com and that'll have all the episodes right there. If you want to support the show and we would appreciate it. If you did support the show there are a few simple things you can do. Tell friends about it. You know tell I'll tell your family members about invention and then if you have the ability to do so rate in review as wherever you got this podcast huge thanks as always to our excellent audio producer Maya coal if you'd like to get in touch with us to let us know feedback on on this episode or any other suggested topic for the future just to say hello you can email us at contact at invention pod Dot com invention is production of iheartradio for more podcasts from IHEART radio the iheartradio APP apple podcasts or wherever you listen to your favorite shows so joe. Are you sold on the life changing technology of C. BY G. I am not sure yet. I'm still still I'm still mulling it over. 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penicillin Alexander Fleming Doug Moi tetracycline United States syphilis Robert Lamb Egypt Nubia typhus James Garfield Proto Antibiotic Technology William Henry Harrison Jubilee Eulex Mid Twentieth Century facebook Joe McCormack diarrhea
Invention Playlist 4: Penicillin

Stuff To Blow Your Mind

52:12 min | 1 year ago

Invention Playlist 4: Penicillin

"Today's episode is brought to you by IBM. SMART is open open is smart. IBM's combining their industry expertise with open source leadership of Red Hat. Let's unlock the world's potential. Let's put smart to work. Learn more at IBM DOT com slash red hat. A class twenty twenty. We note things have been super weird lately robbed of a graduation ceremony, so found some people to write you. Clinton speeches John Legend. He's a Hillary Clinton. She's into over twenty of your favorites from Dj College Coach K. Abby Wambach to halls. They're all here to give you the wisdom that we could all use right now, Mrs I heart radio new podcast commencement speeches drop me fifteen on iheartradio APP and Sunday may seventeenth across all IHEART. Radio stations brought to you by state farm like a good neighbor state. Pharma's they're. Welcome to invention a production of iheartradio. Hey Welcome to invention. My name is Robert. Lamb and I'm Joe. McCormack and Robert. I know you WanNa talk about dnd before we get to the real subject. Well I don't know I. I was thinking about doing it last. We can go ahead and talk about it upfront. Dragons. These various Demon Lords, and they rule over various portions of the of the fiend population in the game, and they're to demon lords in particular that I was thinking about in regards today's episode and that that would be a boy and jubilee. So zagged Moi is the the demon Lord of Fungi, the Queen Fungi the master of decay and then opposing her. Ever at odds with her is jubilant, the faceless Lord which is God of Oozes and slimes and blobs. Losing Nasty creatures of Dungeons and dragons, and yeah, they oppose each other. They're a constant war with each other and in some. Campaigns like their forces, and even their their embodied forms do battle with one another and it. It actually ties in a bit with the subject. We're talking about today of penicillin. Penicillin the fungus that fights. I don't know. Would you call diseases slimes? Well I feel like jubilee, being the Demon Lord of uses and slimes kind of makes it the the demon Lord of of microbiology, as well and microbes and and microbial illnesses. So okay we'll so today we're going to be talking about. Penicillin may be one of the the great real weapons of Zog to Moi. Yes, but this this came up I think because we'd been talking about fungus on our other podcasts on stuff to blow your mind where we just finished recording a five part series on psychedelics yeah. Yeah looking at Fungal psychedelics ongoing research into how these substances could enhance our mental wellbeing and help in the treatment of psychological issues and one of our big take homes was that these fungi could help save lives and improve the quality of human life, but it would not be the first or only fungi to do so because we can certainly look to various interactions between human hell's the different fungal species and their use in traditional medicine. We can point to various products including products of fermentation for instance including alcohol. But, there's an even better example of better living through fungi in that's penicillin. Right so today we're going to briefly explore the invention of penicillin, which is often cited as. The first true antibiotic technology of course antibiotics are medications that treat infections by killing injuring or slowing the growth of bacteria in the body and antibiotics are a class of what you would generally call antimicrobial drugs medicines that kill microbes present a threat to the body of course, antibiotics generally fight bacterial infections, whereas you could have others like Antifungal 's that Fungal infections or antivirals that fight viral infections, no antimicrobials antibiotics are gigantic subject area that we're. We're of course not going to be able to get into every nook and cranny of the subjects, but we hope we could have a an interesting introductory introductory discussion. Maybe come back to antibiotics sometime again in the future because it's it's a broad invention that has lots of little invention tributaries throughout history. Yeah, but it is such a fascinating case to look at and I think should make for a great episode of invention here because. For starters it's it's a twentieth century invention. Slash discovery off, and of course, the line between invention and discovery is a little bit gray. But. We we can pinpoint it to nineteen twenty eight, and ultimately like rolled out by nineteen forty or so. That we can, we can look to it. We can look at the world before and we can look at the world after with with the sort of clarity that we don't always have with certainly the older or more ancient inventions, exactly because we always like to ask the question on the show what came before the invention what what changed when this invention came on the scene and what came before widespread modern antibiotics was stupendous amounts of death and misery from infectious disease in blood poisoning. I I was wondering like. Is it even possible? To to get stats on WHAT THE WORLD OF INFECTIOUS DISEASE! Look like before we had antibiotics mid twentieth century. Yeah, I mean to a certain extent. A lot of the suffering is just incalculable. Especially, if you go back and sort of consider all of human history up to that point in the various factors that that influenced infectious disease injury, you know the eventually the rise of germ theory, but also this things like the rise of cities and so forth, but but luckily yes, it was such a reason invention. We have some pretty incredible stats on the matter. Suddenly. Thanks to this new miracle. Drug Diseases that simply ravaged the global population like syphilis could be cured. The shadow of lethal infection no longer hung at least as heavily over every scrape, injury and war wound, and with wounds were often talking about Sepsis, which is a term that was used a by hippocrates back in the fourth century, BC meaning, blood, Rod, or blood poisoning, and he was referring more in generally I, think to decay, but the term came to be applied to blood poisoning, which arises when the body's response to infection causes because injury to its own tissue and organs. But just prior to the twentieth century, infectious diseases accounted for high morbidity and mortality rates around the world, even in the industrialized world, according to w. a. g. in the treasure called antibiotics from two thousand sixteen, the average life expectancy at birth was forty seven years. forty-six and forty eight years for men and women respectively, and this was due to the dangers of smallpox cholera. Diphtheria pneumonia, typhoid fever plague, tuberculosis, typhus, syphilis, and a host of other ailments. That could affliction. And, enduring the antibiotic era that follow again a rising in the middle of the twentieth century, the leading cause of death in the United States change from communicable diseases, noncommunicable diseases like Carter cardiovascular disease, cancer and stroke, and the average life expectancy at birth rose to seventy eight point eight years, so the elderly were no longer a mere four percent of the population grow to become a whopping thirteen percent of the population, so we're talking about profound changes. Demographics based on this new this new invention. Yeah, the changes huge. I mean we live in a world now. Where if you have access to high quality modern medicine? Medicine and a lot of people don't I mean insure mind, but if you have access to high quality, modern science based medicine, and you can get antibiotics and and can get to a hospital or see a doctor. You very likely have good chance to beat most of the common infectious diseases that that people get unless you have some kind of you know like another condition that exacerbates ed or something before antibiotics. This was just not the people just died from diseases that you catch like diseases that are common for people to catch all the time. Yeah, or you had certain diseases like syphilis that were virtually uncurable. Some of the the cures that were attempted were were pretty horrendous. And had an generally did not work. You know talking about using mercury and so forth, and you mentioned before contamination of wounds. I mean this is just a huge thing. Just like a you know you might You might cut yourself while gardening and you die from it. Yeah, heaven, forbid you undergo, say medieval. Gallstone surgery or something like that yeah! By the way I think tuberculosis has a you know is a good example to look at for some of these stats as well according to the CDC. TB was a leading cause of death in the US in nineteen, forty prior to the rollout of antibiotic therapy in one, thousand, nine, hundred, one, hundred, ninety, four of every one hundred thousand us. Residents died from deep TB. Most were residents of urban areas in one thousand, nine, hundred three leading causes of death in the US word pneumonia to. And diarrhea and Interruptus, which together with Diptheria caused one third of all deaths and of these deaths, forty percent were among children aged less than five years old. Now to your point in not everybody has. Access to antibiotics that say people enjoy in say Europe and the United States yeah. TB remains a the leading cause of death from an infectious disease in many parts of the world, particularly the developing world and some antibiotic treatments are in about assisted treatments are more complicated more difficult than others I mean I know. The treatment for TB is not as say easy is the round. Round of just orally administered antibiotics that you might get for a standard bacterial infection right, but it suddenly was just heralded rightfully, so is a is a miracle invention. When it came about you buy. I saw an image of a of sign on a garbage. Can or Mailbox from the Mid Twentieth Century Advertising that now you can get gonorrhea cured in like four hours. Thanks to the these new developments in antibiotics. It can be difficult to put ourselves in that mindset, having grown up in the wake of antibiotics, or at least most of us, most people listening to this show I was just thinking about how many like us. Presidents died of infections of various kinds. That seems like that would be a very unusual thing to happen now, but in the eighteen hundreds James Garfield got shot, but it wasn't the initial gunshot that killed him. Live for like I think weeks afterwards. he got an infection in the wound. Think because they were digging around with dirty hands to try to get the bullet out of him, and he and they didn't have antibiotics of course when he got an infection, so he died. I think another US was William Henry. Harrison, who I think, they down died from probably drinking fecal contaminated water and the White, house. Yeah, so many different injuries and infections were just far more likely to be lethal with you know. Know without modern antibiotics to step in and and aid in the fight. Now there were some things that were kind of like versions of antibiotics or antimicrobials from before the discovery of Penicillin in nineteen, twenty, eight, the best example from the period, just immediate immediately prior to penicillin would be the Fontham is or the sulphur drugs, and these were the first antibacterial to be used systematically, and they were synthesized in one, thousand, nine, hundred, thirty, two in the German laboratories of bear a G.. Now you might be thinking about the time line like wait a minute. Didn't we just say that penicillin was discovered in twenty eight, but it took a long time after the discovery of penicillins. Antibacterial Properties for it to be made a useful medical dry like it was nineteen forty. Generally, that's the day you see for when penicillin actually became. An actionable thing in medicine. So before that we had The the SOFA drugs, and it had they had a rocky start, but they did prove very effective in preventing wound infections during the Second World War, they were used on both sides in the in the form of soulful pills, and also south powders that would be sprinkled over a wound so if you've ever watched A. Lot of the. Period piece so especially a war piece of the twentieth century and you see somebody sprinkling powder mover injury. That is what that's supposed to be sulphur drugs. They're not as effective. Is True Antibiotics like penicillin? In there are a number of possible side effects that one that can take place, and it also can't be used to treat syphilis, and it also can't treat SOFA resistant infections. Now, of course, this is also a twentieth century invention so I was wondering. Did anybody come up with any version of antibiotics or Proto antibiotics? Before the Twentieth Century? We know penicillin hadn't been discovered and isolated and made stable as a useful medicine, but were there any things like antibiotics are sort of precursors of antibiotic, because in game of thrones right? They have penicillin, don't they? Were they have some sort of fantasy version? I've never heard of that, don't they? Have something that that the the the naysayers would mention having to do with Brad and mold or something. I don't remember that I. Just remember people get cuts, and then they get infected and die. Give him milk of the poppy. They have milk in the poppy. Maybe you're at our game of thrones our. George Martin. Readers left to right in on that but I vaguely remember there being like allusion to something like some sort of mole based. Medicine that they were using. I could be wrong on that well. I can't see that being something that's thrown in there as a little aside, but the like isn't widely recognized her us. And it's interesting how that kind of parallels. Some interesting pieces of evidence for Pro Antibiotic Technology in the real world, even going back to ancient times so I wanna look at the work of the emory university bio archaeologists, George J are mellow goes. Who is now deceased? I think he died in twenty fourteen but he's interesting interesting scholar and he discovered something very curious back in nineteen eighty, so the subject he was looking at was a set of human bones from ancient. Nubia dating. Dating from between three fifty and five fifty C E, and so the bones came from Nubia, which is a region of Africa long the Nile River, but south of Egypt in what would be modern day Sudan, and what these bones showed was evidence that the people they belong to had been taking tetracycline now. Tetracyclene is not the same as penicillin, but it is an antibiotic. It can be used to treat all kinds of infections for minor problems like acne I think in concert with some. Some other drugs two major diseases like plague or to leukemia, or even syphilis and tetracycline works primarily by binding to the ribes, oems of bacterial cells, ribes, oems or sort of the cellular factories they build proteins that are needed in order for organisms to live and grow, and by binding to the Ri- Zome, tetracycline makes it difficult for the bacterium to create new proteins. It was patented in the nineteen fifties became widely used in the second half of the Twentieth Century so what? What was it doing in the bones of Nubian people who live like seventeen hundred years ago, well Arm Lago sin colleagues followed archaeological clues to identify the source of the tetracycline was beer of course beer is another one of ultimately it falls under zagged noise domain Oh. Yeah, though this is different. Because tetracyclene is not made from a fungus, it is actually an antibacterial. That is a byproduct of some bacteria. Okay, so it's a bacterial byproduct, but essentially so technically it's duplex, okay? Point to jubilee? This is looks versus jubilee. That's going to happen with your demon. Lord introducing warfare. So beer is made from fermented grain of course and the fermented grain in this ancient Nubian beer apparently contained the bacteria streptomyces, which creates tetracycline as a byproduct, but question of course were these traces of tetracycline in Nubian mummy bones. Of like a bad batch of beer, the got contaminated by accident, or were these people deliberately culturing their beer with antibiotic, producing bacteria, and so to look at a study from the American Journal of Physical Anthropology from twenty, ten of which are was one of the authors the authors examined tetracycline in skeletal remains from throughout this period, and the evidence indicates that the ancient Nubians were consuming these antibiotics on a regular basis in the authors suggest that these ancient people were intentionally producing this medicine and this links up with some evidence from other ancient. Ancient peoples nearby such as the Egyptians that sometimes apparently used beer as a treatment for conditions like gum, disease, and other types of infections in the authors even found evidence of a four year old child, whose skull contained lots of tetracycline from this beer, suggesting that the child had been fed high doses of this like antibiotic beer, perhaps in an attempt to cure illness, maybe the illness that killed him, and so the levels of tetracycline residue found in the bones of these mummies is only explicable if they were repeatedly consuming this antibiotic in their diet. And there are actually other archaeological remains that show evidence of antibiotic use in the ancient world for example samples taken from the era of skeletons from the Dock Leo ACIS in Egypt from people who live sometime in the late Roman period, also showed evidence of the same thing of tetracycline in the Diet and this consumption of tetracyclene is consistent with other evidence, showing a relatively low rate of infectious disease in Sudanese Nubia during that time period. And a lack of bone infections apparent in these remains from the basis in Egypt so. It really does look like people in ancient Africa discovered a somewhat effective form of antibiotics centuries before the discovery of penicillin and the isolation and mass production of focused anti microbial medicines now to be clear I think like a beer that had tetracycline content from from being cultured with bacteria, like this probably would not be as potent and focused ineffective as like the isolated compounds in the drugs take orally or through injection would be today right, but it would have some effect, and it appeared that it probably was somewhat effective in fighting infectious disease right, and of course they. They wouldn't know exactly what they had here, but they knew they had some sort of beer. Beer that seemed to some sort of holy liquid that that that had some sort of curative property to it exactly I mean if a fascinating discovery from the ancient world, an interesting fact tetracycline is relatively unique in that leaves clear signatures in the bones that can be discovered long after the person has died so other antibiotics don't leave these clear markers like this that make it easy for archaeologists to detect, so you have to wonder like are. Were there other cases of ancient peoples in various places in times using some kind of antibiotics, bacterial or fungal cultures to treat diseases like these ancient Nubian. People were but that we don't have evidence of. It doesn't show up in the bones like tetracycline does. Yeah, it could've just been lost to history I was reading an interesting paper from frontiers in microbiology in two thousand and ten by Reuss Domino, called a brief history of the antibiotic Era Lessons Learned and challenges for the future and Aminov points out this unique quality of tetracycline notes. Just what I was basically just saying like how easy it would be for evidence of other uses of antibiotics in the ancient world to be lost to us, though he he also mentioned that there are other anecdotes from history about cultural traditions. Traditions that show Proto antibiotic technologies in these other examples would include red soils found in Jordan that are used for treating skin infections. It's been discovered that these soils contain some antibiotic producing organisms I'd guess there are probably also some major risks in applying soil to wounds, and then also plants used in traditional Chinese medicine that actually do have some antimicrobial properties. Yeah, because one thing we have to remember the modern antibiotic effort is ultimately based in going out into the natural world in finding these weapons that already exist, and then you re using them in adapting them. For Human Madison and you know this is essentially what is going on in traditional medicines as well, and it also means that there are weapons out there that either have not been discovered at all, especially in particularly vibrant ecosystem, some of which of course, the for are threatened all the more reason to. For us to not decimate say the rain, forest, deep ocean, right but then there are also things that may have been discovered to some degree in the past, but have been forgotten well. Yeah, that that does seem possible, because despite all all this evidence of ancient sort of Proto antibiotic technologies, the worldwide rates of death from infectious disease in the periods for which we. We have data right before the invention of modern antibiotics shows that humans generally did not have effective antimicrobials in that period, so maybe some of this knowledge was lost over time all right well on that note, we're gonNA. Take our first break, but when we come back, we're going to return to the mold research, the nineteenth century, and ultimately to our key inventor here Alexander Fleming. iheartradio and the US. Census Bureau wanted to do something special for the class of twenty twenty, so we made commencement a new podcast with words of inspiration from the biggest names like John Legend, Tim Cook and cash listen to iheartradio new podcast commencement in partnership with twenty twenty census speeches drop may fifteenth on iheartradio, APP or wherever you get your podcasts, remember you can do something that will affect the next ten years so if you lived in a dorm, don't worry. Your school will count you if you didn't visit twenty twenty census dot Gov, Slash Grad to be counted. That when Lexus opened its doors, one of the first steelers made important observation. Lexus wasn't in the car business. They were in the people business. Above all they needed to be helpful, respectful and compassionate. To treat people like guest. It's what they agreed to do from the start. And rededicate themselves to every day. Today, how we all interact with each other is changing, but who we are isn't in a time of uncertainty. We are all looking for new ways to be human to connect to reach out. To respond. Now when we need each other, most lexus will continue to do what they've always done. Take care of people first then the rest will follow. VISIT LEXUS DOT com slash people I to find out what Lexus is doing for their guests. Their employees am for our communities. All right. We're back now. We'll get to Alexander Fleming in a minute with the discovery of penicillin, but. AL exander Fleming was not the first. To notice that there might be some anti microbial properties of certain fungi. That's right. There was there was work going on in this area of prior to fling was was picking up on some of it and and really just overall understanding of a fun Guy in general was was advancing as we mentioned psychedelics, episodes you know there was a time where we did not recognize guys being separate from the realm of plants right before we realized that it was a kingdom unto itself in all ultimately kingdom that has a little more in common with the Animal Kingdom. It does with the plant kingdom. And little a lot of talented folks working in this area, but one of them. MIGHT COME A- surprise to a lot of people in. That's because her name was Beatrix Potter. Who the the Bunny Rabbit Bunny rabbits, yes, okay off the Bunny Rabbit fame. It was kind of a curious coincidence because I was reading about all this, and then just randomly on the stuff to remind mind discussion module, which is the facebook group for people listen to the show to discuss episodes. Someone brought up the trix. Potter in regards to something to do with squirrels because there's a lot of squirrel. Squirrel content in the discussion module and they brought up Beatrix Potter and Beatrix Potter actually ties in to this episode a little bit, because in addition to being the author and illustrator of the the tale of Peter Rabbit and associated British animal tales, she was also a naturalist with a great deal of interest in astronomy, and most importantly of all my call Aji, so she produced a lot of beautiful scientific watercolor illustrations of various fungi in her neck of the British, woods. And you know as part of her studies, and if you studied a lot of local molds as well and did illustrations of them. She's ultimately very interesting character that was. You know unfortunately she lives in a time in which you know? The sexism of the day prevented her from I. Think reaching the heights of in the natural sciences that she would have been afforded later on, but in a lot of her work is also just being. Think rediscovered and appreciated for the first time in recent decades, but yeah the next time someone busts out some dietrich's Potter A. Remember this is not just. An individual who wrote some fanciful tales and illustrated them. She was also just she was out there, studying the natural world, and in create in in advancing our understanding of the my college, she was sort of a looking into the hidden life of nature in multiple ways. Yeah, no, and I see some sources that are asking the question. Okay was Beatrix Potter, she a true naturalist, true natural scientists over she just to. Lead an amateur. That was just very interested in things and I. Don't know it's kind of a COUPLA question. Ask when you consider like the limitations in the Victorian era for women, a but I I think undoubtedly she she i. I would side with the fact that she was a natural scientist she authored, or co authored one paper. If I remember correctly so I'm I'm gonNA give her giver. Full credit was about fungi. it was it was a mushroom. In particular I forget was one of those related to the Russillo Mushrooms, but forget which species? But Bama basically she was. She was kind of up against the. The patriarchy for the most part though yeah. Well. Is it time to turn to penicillin itself yes? Let's turn to the key discovery here and our inventor are discover. Alexander Fleming. Okay, so who was Alexander? Fleming, okay so Fleming was born in eighteen, eighty, one died in nineteen, fifty five, and he was a Scottish biologist physician, microbiologist and pharmacologist. He was the son of a farmer, and he observed and studied a great deal of death from Sepsis in World War One. he observed that while antiseptics worked well at the surface. A deeper wounds, sheltered bacteria from the effects of things like sulfur drugs right so if you have kind of superficial wound, you could clean it off pretty good, and and that might help protect you from from bacterial infection, but if you have a deep wound and say like dirty stuff, bits of soil and other you know just crud gets lodged deep in there. You might not be able to clean the wound out very well right, and that's exactly the kind of stuff that's going to get lodged in there especially with your war ones where there is a stab or or or deep cut or a bullet entering the body, we'll makes me think about the when we were reading about the idea of Stegosaurus, perhaps weapon I mean not consciously Stegosaurus, perhaps having an adaptation to weaponize infection against its enemies by dragging its Tagamet bikes through the Dung right exactly yeah, having dirty Bagga miser spikes, and then when it wax the T. rex in the crotch with them, the that gets infected later in eliminates a Predator from the area and the the the predators of the day would not have had access to antibiotics, certainly not or even that beer from the. We mentioned earlier so. Full Fling? Devoted himself to research and he it prior to penicillin, he discovered a license Zayn naturally occurring enzyme in mucus and other parts of the body than inhibits bacteria, so he was already. You know in this this area looking for for new new breakthroughs new discoveries. But, then his biggest breakthrough of all is this discovery of penicillin, and it's truly one of the more amazing inventions slash discovery moments from history, because while he was exactly the right person to make the discovery, and then deserves all the credit was given. The key moment comes down really too pure luck, and we simply don't know if anyone else would have made the discovery if he had not been there to observe it, okay, so what happened with this discovery so around like nineteen, twenty seven, or so he had engaged himself in studying STAPHYLOCOCCI the or know staff and he had stacks. Stacks of Petri dishes displacements in his lab described as kind of an untidy lab. So you know imagining all these likes like Petri dishes, full staff, all over the place notes, and so forth, and so the key moment comes in September of Nineteen Twenty eight right right so he has these staff petri dishes out, and he leaves them for the weekend to go on holiday with his family, and he when he comes back expected to see how they've progressed. See how they've grown a, but he finds that they haven't grown. In fact, they have died. Something has ravaged his specimens. Yeah, now. This is one of those stories where it gets very narrative is so you do have to wonder if some details of it or embellished and how the story may have changed over time, but this is the way the story has been passed down and I think it seems to be largely basically true the way that I've seen. The story often told us that. He comes in. There's a blob of mold growing in one of the plates and all around the mold. There's this halo of nothingness. Where normally what you would see is that if you got a plate for culturing bacteria, there would be these little dots in blobs on the on the late. But instead there's this halo where there's no bacteria bacterial dead zone now, of course we know staphylococcus is is a bacterium, grouped linked to all kinds of human disease and misery. staph infections right if this mold could kill staff that seems medically relevant. So what happened here? He he he realized that he was dealing with some sort of a fun guy. So, he Luckily there was a microbiologist with lab just below Fleming on the floor below his lab. A man by the name of CJ LA, Touche, and in fact it's also been suspected that the mold and question that killed. Fleming's staff might have drifted up from Latouche as lab adding an extra element of weird chance to this whole situation. Okay, so perhaps his samples were contaminated by stuff from the lab next door down a floor, right. That's not that's not a theory that's presented in every source does pop up fairly frequently so specifically? This mold was what would later be identified as a strain of penicillin, no Tottenham and it was obvious that it's secreted something that prevented staph bacteria from growing and so fleming followed up in studying the secretion. This this mold juices I've seen it called. He found it didn't only prevent the growth of staphylococcus. It worked against common bacteria like streptococcus or meningococcus and and the back, and also against the bacterium that Causes Diptheria, interestingly, while Fleming did see applications for penicillin and curing disease, and he mentioned briefly in the paper, he published in Nineteen, twenty nine about this discovery about the the antibacterial properties of concilium he primarily thought of this secretion of penicillin as a tool for bacteriologist to sort strains of bacteria, basically independent, sensitive versus non penicillin, sensitive species, and the that that could be useful in the lab. Yeah, so he sometimes criticised is really not. Not Understanding completely what he had here not having the vision to see where could go well I don't think he completely understood, but he he did indicate that this could possibly have uses in medicine right so Fleming and his assistance. Stewart craddock and Frederick Ridley tried for years to turn this accidental discovery into a stable isolated compound. That would be useful and this. This was a problem because like so you've got this secretion from the mold molds making some juice. It's kind of getting stuff wet with this this stuff that that that fights bacterial growth, but they couldn't isolate the compound that was causing the. The effect and stabilize it and make it make it generally useful so to quote from Aminov. Paper Aminov that I mentioned earlier quote for twelve years after his initial observation Alexander Fleming was trying to get chemists interested in resolving persisting problems with the purification and stability of the active substance and supplied the penicillin strain to anyone requesting it, but he really he, he could never cracked the nut oatmeal and he didn't finally make this discovery of the process I for stabilizing and isolating the compound and by nineteen forty. Aminov writes that fly. Ming finally abandoned his quest wood. Fortunately, it was right about that. That time that capable team at Oxford University, including the researchers Howard flurry in Ernst chain or Chine. They picked up on this research and they. They kicked off the research project that would eventually break through on this and they're all these interesting story, so of course, this is while World War Two is going on right so research conditions are not ideal, and there are all these stories about how they turned their lab, at Oxford into this giant incubation center, or factory for mold, like they employed all these lab assistants who were these women who had been referred to in some sources as the penicillin girls. And they would work too like they would work to grow the penicillin and buckets and tubs, and basically every container that they could And eventually they did. They were able to isolate and stabilize this compound so to quote from an Article from the American Chemical Society. In nineteen forty Flory, it'd be Howard Florey carried out vital experiments, showing that penicillin could protect mice against infection from deadly STREPTOCOCCI then on February. Twelfth Nineteen, forty, one, a forty three year, old policeman Albert Alexander became the first recipient of the Oxford Penicillin he'd scratched the side of his mouth while pruning roses, and developed a life threatening infection with huge abscesses affecting. Affecting his is facing lungs, penicillin was injected and within days he made a remarkable recovery while, but unfortunately despite this recovery, which lasted for a few days they ran out of the drug and Alexander, eventually got worse again, and he died and I was reading that they were so desperate to cure him that after Alexander urinated while on his antibiotic course, they would. Would collect the urine and try to extract the penicillin. He excreted again so that it could be re administered to him. and I should mention also that the the process that the Oxford team relied on to extract and purify the penicillin. The mold juice was led by another important biochemist, a guy named Norman Heatley but this case of Albert Alexander shows. Shows an obvious early problem they had which was the problem of scale. They simply lacked the ability to make penicillin scale it that would be needed to even one person. Let alone. The whole world the strain of mold that they were using didn't make enough of it, and this led to the search for other species of the same fungal genus concilium. concilium, which would maybe they thought produce higher concentrations of the Penicillin Phil Trait, and I was reading an interesting article by the University of Michigan Physician and medical historian Howard Markel. That tells a really interesting story I'd never heard about this The so the story goes like this. Apparently, one of the assistance at the Oxford lab showed up for work one day. Day In nineteen, forty, one with a cantaloupe that she'd bought at the market because it was covered in a weird looking golden mold, which is great, because this would be the one case where somebody is picking over the fresh produce to like find the moldy one but the mold on this cantaloupe turned out to be a strain of penicillin called penicillin. Chris. Chris O. GM with Markle says naturally produced at least about two hundred times as much penicillin as the original strain that they've been studying and then later, markel writes the same strain was subjected to mutagenic processes in the lab, so like bombarding it with x rays and stuff to produce a mutated strain that would make up to a thousand times as much. Much insulin as the old school fleming mold so by nineteen forty one penicillin is on its way to becoming a viable medicine. All right on that note. We're GONNA take a quick break. When we come back, we're going to look at the impact of penicillin and we're going to look at it in a fun way by considering a really interesting. What if? iheartradio and state farm. It know that the graduation stage is the first of many, and while grads may not be walking across one this year. They can get the send-off. They've always dreamed of with our new podcast commencement, featuring inspiring speeches from the biggest names like John, Legend I'm honored to have the chance to speak to to share in this special. Katie couric. You'll need. Need some very important life skills to move forward. Perhaps the most important one is resilience. Chelsea handler dare to do things that scare you. If you can embrace the unknown and fully jump into what life has to offer you, there will be much to celebrate and much. Enjoy and cash reflect on the work you've done and celebrate moving into your new face these iconic. ICONIC NAMES ALL coming together to celebrate you. The class of twenty twenty listened iheartradio's new podcast commencement brought to you by state farm speeches drop may fifteenth on the iheartradio. APP, or wherever you get your podcasts and remember state farm will be there for this stage and every stage after like a good neighbor, state farm is there. This episode is brought to you by IBM. IBM Today the world looks pretty different, but already new problems are being met with new thinking. Researchers are using supercomputers to discover treatments faster retailers are turning to the cloud restock shelves more quickly. Teachers are working with Ai to think the classroom. It's not everything, but it's a start. Let's put smart to work. See How am helping at IBM, dot com slash covid nineteen? All right. We're back. So we often don't don't do a lot of what if on invention doubt, I thought we, we can do to certain extent, but I mean a lot of times. It's harder case to be made like what if this had not been invention in? Bill or discovered because in most cases you can, you can, you can look at the data you can look at other individuals were like if the Wright brothers had not invented, the airplane had not created that that I prototype that really showed what was possible like clearly there were there were other individuals in the world working on this. Someone cracked it. If if Rontgen had not discovered x rays in eighteen ninety whatever year it was, somebody else would have discovered them pretty soon right, but when it comes to penicillin, potentially gets a little more complicated than that. I ran across a cool article on the topic titled What Fleming had not discovered penicillin, and this was published in the Saudi Journal. Of Biological Sciences by all Harby at all. The authors admit that that certainly Fleming had made the discovery. Someone else might have in the years to follow probably in the early nineteen forties. They estimate so we could still will have have arrived in the antibacterial age. However, they also explore the possibility that we might have simply not made the discovery at all, and it's an interesting argument so I wonder I. WanNa read a quote from the paper here. Quote, of course, penicillin could have been discovered the day after Fleming miss the opportunity, but in reality there was no parallel discovery that took place as a result anyone taking an interest in penicillin during the nineteen thirties did so in the knowledge of Fleming's work. In particular, the seems no reason to believe that flory and chain would have discovered penicillin since their work depended on Fleming's famous paper and their access to one of his penicillin producing cultures. Okay, so that's referring to the thing. I mentioned about how how Fleming in his. His assistance were just like sharing the penicillin strain out with everybody like hey, can you figure out what's going on with this? Can you isolate the secretion the compound in the secretion? Yeah, so think about it. There was there was so far as these researchers can determine you know no other effort out there at the would have in struck paydirt in the absence of Fleming's research, the Oxford Group wouldn't have been looking for it. Someone walks men. The father of modern antibiotics called made several key discoveries later was also inspired by Fleming. Has One of these cases where like he seems to be the epicenter. Not only him, but just the the the the seemingly chance encounter in his lab that day that that we're suddenly, this halo appears in the Petri dish, and that gives birth to a to a whole class of other discoveries right because not all antibiotics are derived from penicillin penicillin, class of antibiotics become sort of like one sorta grandfather class, but then they're all these other classes that are discovered during this golden age of antibiotics that takes place over the next few decades. Yeah, and there are various just additional medical breakthroughs that would not have occurred without penicillin such as organ transplant. But then there's also the question like what would have what would have happened in the wider world because again, penicillin comes online during the second. World War. And so you can easily ask what would have happened if allied troops had not benefited from access to antibiotics at D Day I've never thought about that. I in fact I before looking at the I, probably would not have known the answer to whether or not. They had access to antibiotics well, penicillin production was actually swiftly scaled up just to make sure that allied soldiers had access to it at d day. So. There is a legitimate question to be asked. Might the allies not have won the Second World War without penicillin? I think there are a lot of factors to consider there. I, don't think it's quite gotcha question, but it's it's worth thinking about. The authors argue that without flemming's discovery would have had to depend on the SOFA drugs. An imperfect alternative to true antibiotics and these. These are described in the nineteen thirties and Fleming worked with him prior to his discovery. But without penicillin in play, the authors argue that soft drugs might have become the standard and even push the discovery of true antibiotics beyond the nineteen sixties, and this is also true of the Axis powers had risen in victorious in world. War Two because the access powers depended on sulphur drugs and their their key treatment You know they do point out that you know quote. Despite the fact that the Germans their allies, where at a considerable disadvantage, the soft drugs did a relatively good job at reducing battle casualties, so not to just completely cast, aside the effectiveness of soft drugs, but still they were not as effective as true antibiotics. It's weird to think about the political implications of specific medical technologies. Yeah, and then when you get down to the curious cases of individuals, it also gets interesting where he touched on presidents, who died? That would have lived potentially if there had been penicillin around right, and so they point out that that soft drugs save Churchill's life in nineteen, forty three when he was suffering from pneumonia I as well as FDR's life. But there's also evidence by the way that actual penicillin may have saved Hitler's life following the Stauffenberg assassination attempt of July. Twentieth Nineteen Forty Four. This was the plot that tried to kill Hitler with a briefcase bomb. Right like where does some of the officers conspired against him? And they put briefcase bomb in the room with him, and it did explode, but he was protected by a heavy table that prevented it from killing him. He was obviously injured and I think he had like damn edge dried. So the idea here is that perhaps his injuries were treated by by penicillin. Yeah, that's at least an argument has been made that they had access to penicillin. I'm unclear on how they would have obtained it, you know. Maybe, there's a spy story there. I don't know but the idea being well. If he had it have access to penicillin, then perhaps he would have died, and that would've arguably ended the war in a different manner, forcing us to re imagine an entirely different postwar world. So again. We're playing with with what you have here and in also we understand we don't know for sure that Hitler had access to penicillin following that assassination attempt, but there is the overall scenario of the allies having penicillin having ramped up penicillin production leading into D day. Yeah, that is really interesting I never contemplated that before. now. That I we do often have to think about, and we should probably acknowledge at the end here before we move on. Maybe this'll be something to come back in. Do in the future with the recent invention episode is the idea of a possible end of the antibiotics. Thing to imagine like what if the antibiotics is essentially a period in history that has a beginning and an end. Because as we you've. You've probably heard about this. Many disease causing bacteria, other disease, causing microbes are overtime evolving antibiotic resistance are evolving to to be powerful enough to survive are antimicrobial drugs, and I think specifically one thing that's exacerbating this overuse of antibiotics and people, not the entire course of antibiotics when they're given them. Yeah, because again, come back to the zagged Malloy Jubilee. War Scenario, you know. It is an ongoing battle and the forces evolve. To. Better deal with the threats on each side and so. We're we're? We're seeing this occur. We're seeing the overuse of antibiotics producing. Strains that are that are resistant, and it's reversing some of the therapeutic miracles of the last fifty years, and and underscores the importance of disease prevention in addition to treatment, and that means not not abandoning some of our other vital tool for human health like vaccination. Oh, yeah we should come back and revisit vaccination. Maybe, even various different vaccinations in the future. Another thing to keep in mind. I don't think we've mentioned earlier. was that the nineteen forties with one thousand nine hundred seventy s? Are considered like the Golden Age of Antibiotic Research, yeah and we haven't seen at least if you haven't seen any new classes of antibiotics emerged since that time period right now there have been new developments in antibiotics, but I think the way I've read. It is that they're generally modifications zone existing classes of antibiotics sorta like we we haven't. We haven't found anything radically new. Since then basically we reached out into the natural war between between fungi and the microbial legions and we. We stole some of the tools. We stole some of that prometheus fire. Day We keep adapting that fire to our own purposes, but we haven't. We haven't found any new weapon from that world and and then their ongoing war continues to change. I'd be interested Do you out there? You the listener, Dee, work in medical research or you working on areas involved in antibiotic resistance, the future of anti-microbials I please get in touch with us. I would like to hear about that. What what are you doing in your work? And what does the future look like to you on the inside? Absolutely we would. We would love to hear from you. Again? We only really scratched the surface here. Though thanks to antibiotics, hopefully that scratch will not. Life threatening infection. But? Yeah, there's a lot more history here, but but hopefully what we've done here. Today is of course, highlight just a very very cool story from the history of inventions and discoveries in human history, and outlined the impact of of one of the greatest inventions or discoveries again how you want to classify it from the twentieth century yeah totally. In the meantime. If you want to check out other episodes of invention, you can check out our homepage invention pod dot com, and that'll have all the episodes right there. If you want to support the show and we would appreciate it if you did support show, there are a few simple things you can do. Tell friends about it, you know. Tell Tell Your family members about invention and. And then if you have the ability to do so rate and review US wherever you got this podcast, thanks as always to are excellent audio producer Maya Coal. If you'd like to get in touch with us to let us know feedback on this episode or any other to suggested topic for the future or just to say hello, you can email us at contact at invention part dot com. Invention is production of iheartradio for more podcasts. My heart radio is iheartradio APP apple podcasts or wherever you listen to your favorite shows. A twenty twenty. We know things have been super weird lately were robbed of a graduation ceremony, so we found some people to write you. Clinton speeches John Legend Pisa Clinton into over twenty of your favorites from Dj College Coach K. Abby Wambach two halls. They're all here to give you the wisdom that we could all use right now. Listen to iheartradio new podcast. Commencement speeches dropped me fifteen iheartradio APP ends. Sunday may seventeenth across all I. Heart Radio Stations brought to you by state farm like a good neighbor. State farm is there.

penicillin AL exander Fleming US Penicillin Twentieth Century John Legend IBM Oxford Penicillin Beatrix Potter Sepsis syphilis Alexander Fleming tetracycline Albert Alexander Red Hat Hillary Clinton Coach K. Abby Wambach zagged Moi Lamb
Dr Sandra Lee aka Dr Pimple Popper

The Emma Guns Show

59:46 min | 1 year ago

Dr Sandra Lee aka Dr Pimple Popper

"Believes that with the right support and resources women can transcend societal barriers and lead on their own terms and a mentor. Memo's you'll hear from twelve women Gaba out here I'll be hosting a new podcast from the girl boss Radio Network produced in partnership with trust the May called mentor memo's trust and Kovar Dot com forward slash Megan's this episode is Dr Sandra Lee who you may know as Dr Pimple Popper I I heard about Sondra on a night out first and then soon enough I really did become addicted to that Doctor Pimple Popper Feed California based Dr Sanjay is probably the most famous dermatologist playing on the screen was Dr Pimple video of an extraction a posse extraction and my first reaction was to ski Agreem- pushed Caroline's Ob- Anti brand new phone out of my face and go or something like that Hello Hi and welcome to another episode of the Emma Gun Show I am your host emigrant Wardner and my guest confidence it's why I love moisture night the world's most brilliant gem it's an ethically sound revolutionary Dr Charles and Colbert that gives more if that SPA plus they do we is made with ninety five percent recycled precious metals that I'll hundreds of beautiful styles choose from over on their website whether you're in the market which to own Skincare Line S. L. MD skincare and in this episode she takes us to Pimple Academy or school explaining the different types of spots. When to see it Fyre an eye-catching brilliance than any other gemstone in the World Charles and cold water police gems engagement bridal fashion and find joy that you can afford wants to choose from that it just makes sense to head over to Charles Kovar now learn more and get exclusive savings at Charles Kovar dot com forward slash Emma guns that's because here I didn't break the iphone can you even imagine but those are the videos that Dr famous for a big spot PAPI classic stunts statement ring or particular type of cut my personal favorite is Asher there might that oval anyway there's so clip my instant reaction is to scream but then something strange happened I started watching the video sort of with the phone at forty five degree angle in through my fingers apologist and went to address your skin issues with skin care the truth about sports related to your menstrual cycle and topical ingredient she thinks really work you know what I love my to do I love for it to sparkle to catch the eye and exudes style taste he does and you want to feel like Dr Pimple Popper then you can actually buy Dr Pimple Popper Halloween costume isn't that bad anyway she is an expert in her field and has recently and we were walking down the road towards the venue and you know what it's like when you walking along agreed protesting and Caroline's like ems do you follow pump doctor pimples how about three years ago with caroline hirings and offering Kate Lyon we on our way to a concert it was the last time they were playing they're going to be back cornea I'm in London for that reason the sound was really self and I've had to tinker with it quite a bit in post production I went back and forth about asking they watch this space for those instagram stories I do have to fess up to something though Sandra and I recorded this conversation via skype and it was not a great connection she's in for a record but I think I've managed to salvage it somewhat but mea culpa this is not the usual audio ended a no one is more annoyed about that Pump Open Papa D. Dr Pimple Rubber and she just got a brand new iphone and she throws her hand in front of my face and ver- and hasn't millions and millions of followers view is to help him popping videos the fans are instantly called politics and if you really like Dr von She just seems like a really awesome person as well as being an expert in her field so here she is on the gun show it's talked to pimple popper Dr Wanderley Dr Sandra Lee most me I apologize it wouldn't happen again but I hope that it doesn't hinder your enjoyment of the show Cassandra was a great guest I love chatting tear she was the the the heaviness of it you know I don't really think about how many people can actually be watching something or taking it in yes it's quite I don't think I really I don't really think I absorbed when she also took some time to answer this question which is really great for and perhaps most importantly she's keen to have Tequila with me and a few other friends of the show like Nadine Caroline when she's next in London Oh you are because I've just done an introduction about but also because you your somebody who has enjoyed this lovely thing of going viral but well I mean Dr Pimple Popper on social media and all over the place yes my husband does not answer to Mr Thirty four that's when I really when I finished all my schooling officially so yeah it took a while to get there doing what you doing when exactly and also you went viral for doing something professional not because of anything controversial you are air yes so just for the listeners just so they understand you a dermatologist and you have a promise in like about I think it's about fourteen years or so fourteen fifteen years and I have a private practice with my husband and so this the stakes yes in southern California been in practice for about I keep forgetting exactly and how you address that if appropriate clinic because as much as you're dealing with the skin you must also be dealing with hearts and minds right I think that imagine dealt with acne in one or more of its forms throughout their lives and I wanted before we get into the nitty gritty which you are well known for pimple popper channel I wondered if we could talk a little bit about the emotional distress that acne causes come to see us is not necessarily because something has life threatening but some the because something bothers them appearances something so dermatology more than perhaps any other specialty has the closest connection with psych another and it can leave permanent scars which can stay with you that that also affects you mentally and that stays with us throughout your life crumpled paper he does not like that so that way noted that's a good one to know everyone listening to this podcast will they don't come out feeling worse about themselves then came in I think that's very important and you know the thing is with acne is talk about today is something new that has emerged from the doctor pimple popper brand but I wanted to make this as useful as possible for my listeners and you are one of the most important knowledgeable voices in skincare right now and a lot of people listening maybe everybody listening to this podcast will have no reason why are you seeing Dr for that you know it doesn't threaten your life specifically but it definitely threatens your emotional wellbeing to really give give me a way to kind of quantitative it so so yeah I know I'm so so lucky but maybe it's good that I don't think about that too hard you know don't really think I absorbed what those numbers sort of like when you gamble and when money turns into chips anything anymore like I just I can't fathom that unless someone almost all of us have had a pupil some time in our life or certainly have had something that makes them feel embarrassed or makes them feel different than other a equally important to you know not only help to treat people acne but to help to give them some confidence back and I was in a lot of time it has to do with their skin you know don't feel or hair or nails or something and acne doesn't kill anyone I mean it doesn't threaten our lives acne is a perfect example I mean so so in other words we dermatologist to be way well aware of managing them control back that's part part of this loss of control you know oh you know it's really important to make people because that's what life is about about you know how Damato the gist you have a lot of letters after your name Sandra a yeah I was in I I studied I didn't start really working until I was what I would is there skin type and no no that you're if you're oily or that your dry on the net will help to you know really put you in the correct direction there's no specific ran that I recommend but I do think that people wanting that's very important that people should be aware of when you're just trying to figure out who you are and how you fit into the world and then to have acne and feel like you can't even present your own personality to others he took off though now known as Dr Phil Cooper since like about almost five years ago and it's been an incredible journey in one of the things we're going to I have a good life because we feel happy we feel confident we feel good about herself so it's important to do that and so you know that's just part of my how I China what makeup to use whatever products in general and also it's important to know that your best friend who swears by a makeup brand or your or your celebrity and the thing is that happens to people in a very tenuous part of their life you know being mainly teenagers that's the type uh-huh and become social is a it can really affect the development of your personality so that being said I mean I think it's very important for us as dermatologist when we have patients coming in to really know that that were on their side and trying to help them and sometimes it's not so easy to do that news but it's an umbrella when I go there I must call them spots yes yes when you come over here in additional care having to Keeler with me you're not gonNA use some really moisturizing liquid makeup foundation you know you're probably going to opt for powder so versa so don't be swayed acne certainly or high really any kind of skin condition I think a lot of us are Matala just do that and you obviously extract treat by topical and oral aide by you know celebrities or what your friends say peers listen to your own skin and that's the way of taking control to if you understand your own comfortable blanket of warmth inches on oil and this is where I'm going to thrive and that's when you get a fuel and inflammatory popul- that read the because so much of what we do has to do of the so for so many one of the primary reasons people ahead blockheads per pupils pustules nodules and cysts love pap you'll yes there's sort of like the remain kind of categories I say of acne are the building blocks where it all starts are the coma domes which are the a person as well and and making sure that they feel comfortable seeing you but at the end and that's part of gaining their trust and making sure that so then there's like there can be we also categories more severe type of acne which is not everybody gets but remains is that any makeup you recommend to your patients to help cover and conceal why that while they're working towards their clear skin can you're going to be able to find something that's going to work for you that's great advice right now let's talk about this umbrella term so I guess in the UK it would be spots and in the US it's more pimple this infiltrated by bacteria you know this bacteria that figures out that there's a poor here and goes oh my gosh this is the perfect environment I've got food I've got you know it's like someone that you idolize they have as make Brennan that's not necessarily the brand for you I mean it depends on your type of skin I mean if you really oily collect in there and that's what creates a black header whitehead and then the next category the next step up as if that four yet trump that we all know as a pimple that hurts when you press on it and a lot of times they'll be under there you'll feel them but you know they're coming in they're not quite there yet I I know you've already talked about the poor and debris and bacteria but is there a simple answer to question why do we get spots so those the thing that we are most concerned about when you have more severe acne and it can get very severe and then be call it like Acne Congo Bata or because you're live because you have hormones because you have a genetics that maybe have passed this no absolutely not and and sometimes that feeling of being feeling like your dirty 'cause people are telling you this can sometimes make your it hasn't blackadder those are the clogged pores you know you have a poor under skin and there's debris and dead skin cells and oil that kind of teenage acne hormonal teenage acne and I as a lot of people do at school you get bullied and you're not it's not an issue issues with acne but yeah no it has nothing to do with dirt I mean new made also feel a little more dirty because you're more oily when we get yeah I think that you need to be more aggressive about seeking out treatments if you have more substantial acne because again the the with those things I mean there's some other smaller things that can do to like just certain the way you may wear your hair that kind of blocks includes pours of you put product in your hair and it like and it's just really anyone listening may be feels that it is a barrier like it's real and you you see it in people every single day yeah I mean I think it's rules are cysts which are just deeper levels of that kind of path you'll just their names different because of the size of it you know the size of the depth of it own your parents may have one or the skin more prone to acne when they were teenagers they or throughout your life and so has mostly to do they were pads and the on the back and shoulders and they're back but mainly it has so much to do with hormones all to scar also if you pick at your acne you have a potential to have scarring so that's the thing to be aware of you know do you mow him in say smokes but so in this umbrella within that do we have am I right in thinking we have what spots pimples are normal when do you know when normal spots that to be expected have transitioned into something that needs tree aw than their parents bring them in to see us and say what can we do with our acne and you know it's almost always the fact that and that's what happens during our teenagers because that's when your hormones are raging kind of one thing I wanted to say here is I had really bad even door professional intervention well like I said you know ask me does not threaten our life but I certainly we have a lot of patients and I mean all of us are tall just see this well you'll have a patient who has just like a couple of black heads on their forehead and there there are nine ten that will do the least amount of damage well this is also the thing that I say you know my mantra is no one to pop no one to stop but I want to pop your head to pick squeeze or cop but if someone was going to despite all of the advice not to what might be the most efficient way worse because then you feel compelled to have to clean it and then you over washer face you know and then you have to irradiate your skin and make it more red and angry and more potential apparent had bad acne when they don't want their kids to go through that same thing and again it is all about this mental thing you you know especially when people have a Lotta oil if you feel like you want to be clean but it doesn't have to do it we all have dirt on her face so monitor than anyone else talking full Menendez are really devastating devastating acne that really can lead to scarring that is permanent and you're not gonNA create scarring because again the deeper you traumatize you squeeze your pimple and it's not ready like it's under the skin you're like and we've all done this most likely I like the idea of the redness when you have a sport being your body squeezing the spot without using your hands yeah it's like your body is trying to like that person you know when other people them it's that same kind of thing interesting now you mentioned than picking and as a dermatologist I suspect your advice would be that's pretty good tonight there are several topic of ingredients that can tweet acne and I wondered if we could discuss so would you say that they all right pimple as the the more closest to the surface it is the higher the likelihood is by popping up that you're going to resolve it completely and also that control it more and know what to do the right thing to do so the point the most important thing is again as I've spoken is that the more superficial that snow salicylic acid sulfur alpha hydroxy acids nice in the might and Benzyl Peroxide yes yeah sure I think that make worse they get bigger they hurt and then you're like now what have you know so really technically so what's happening yes you why we don't want you to pop and no one ideal timeless to pop you understand that a little bit I think that people can sort of I hope that people can Campbell's Bet I know that people are going to unfortunately and I and I I feel then it's sort of like my duty to toe unexplained modern home but it's extremely tempting plus jewel and that's actually the ideal time the best time because you have the most chance of removing there's you look in the mirror and we may not see we may not notice it that they think everybody's looking at a sort of like someone who's who's who is over weight and lost a lot of weight and he's still feel after a while you notice it turns whites right and it's very superficial on the skin that's like your body trying to push this out so eventually it will come in the United States we have a lot of we have a lot of products that have all of those really in in there are over the counter topical medications it's actually a good thing it means that your body is reacting to this and trying to get these things out so your coffee person you have a good immune system okay most important thing to know is how deep it is that the more that inflammation the deeper the acne bumps the more you have a potential decrease inflammation So all of those all of these products that you see out there that a lot of you know are available over the counter and acting medications are usually called the karate riddick where it increases turnover tries to really you know sloth your skin and encouraged healthy skin to to take its place out those pores which is where like salicylic acid would come in or under these alpha hydroxy acids right they're all exploitative then so as retinol retinal does that as well it's like a recognize that there's Macarena and trying to attack it and get rid of it you know push it out so that's why you get what's called the hustle or some people call whitehead that it's not all that purulent pus out and also use your debt you're traumatizing your skin the most superficially or the least right I know that the rules are a little bit different I think in the UK that the and then the states as to what can be available over the counter but area or make it inhabitable for the bacteria to live there so and those things to help minimize redness you know things like that well there's also the idea of suffocating and you listen to seeing this do you feel like this is breaking you out like that so much you know so I don't listen to your own skin and then there's also to school of thought in my years as a beauty editor I don't know if it's oiliness that's GonNa also make it not as great an environment for bacteria to grow but on the other hand if you are really dry at already you may not across your forehead since I've seen people that have a smattering of acne right where there lies your violinist and you get on your Chin because you know football player the type of skin we have it doesn't compensate for you know the things that you've done what you know it doesn't mean because you really wash your face multiple times now it's going to now produce more oil to make up for that in your face a lot makes you more oily and I mean that's not the case just like eating greasy pizza is not gonNa make you break out because it's not eh pustule so all these white blood cells your immune system kind of send all these cells over there to kind of fight off bacteria and it's pushing it to the surface of the skin which is why with your pimple so you got that bacteria in there it's all happy and excited and making an area of getting red because your body has that I really believe in that I think is worth mentioning this idea of oil on spots oil on spot I can't imagine why that would work technically I don't think that a proper I don't know no I would say no I mean hiring and people can put together their own skin-care regimes with a little bit more understanding of what's going on their skin have you seen an increase and they're all working sort of different ways but almost similar ways you know you're trying to prevent black as foreign we're trying to help to fully eight or clean all you've spoken about all these different variations are what we know that are available over the counter general that can help improve acne but and then also it's this idea of suffocating sorry listeners we had a little jump in the connection there but we're back online the this idea of using an oil or something quite heavy too or do you feel like you know this is making things worse if it is absolutely don't use it I mean I don't believe that I think some people may believe that lifestyle that creates a you know that includes your skin you know said like wearing your hair a certain way or maybe putting on a product that they think is but usually people are acne gets worse because they sort of men thing is that to know that a lot of these things can be drying in general because part of it is targeting oiliness on our skin we're trying to minimize I don't think I mean you can't see people that unknowingly created by doing things or having actually suffocate this sport is that something that you think is true I don't really in people coming to you because they've tried their best and perhaps they've done more harm than good and they've over stimulated over stimulated you mean they've made just like some people might eat or drink or gamble to to really there's like people pick pick their skin and that is something that can I don't know why I would add more food for the you know food for the bacteria to to want to eat you know that's I'm glad that has have been more transparency about what's in skin-care topical ingredients do and as great as this can be and it is very I know I've had that before but I will tell you I've never had like a eighty year old come in and said this spot has been coming up everyone results you know I mean thing but actually clogging your wars more you know having activities sport activity that promotes more breakout on on their body AH people may feel compelled to pick their acne bumps and it's sort of way that you deal with stress if you get the same spot in the same place every month is that anything you can do about that it's tough I and then you have things that are antibacterial you know things that are anti microbial bends approximate like sulfur like things like that we're trying to destroy some of the bacteria inflamed under the skin but it never completely comes to the surface it's never resolves like your buddy takes care of it but it calms down and yeah I know that there's a lot of creon beauty care that that the oil cleansers and things like that I think that that you know the oil there is potentially a to I mean I'm going to say this off the top of my head you know I think that that oil it's sort of like it's trying to take your oil and wash it off your washing it off you're not keeping this on your face correct do you have a big event you know coming up and you have this month the SUV. Es You know on your nose or heading you need to get rid of it that you can usually inject an active -biotics most commonly people use the tetracycline group which are really good against peac knees on which is I've had that happen to me before and you know if that happens in is the trouble I I mean I think that one thing certainly what I would do because I'm into Matala gist as they chat about navigating male dominated workspaces and learning big life lessons that they've picked up along the way subscribe to memo's wherever you get your podcasts I understand that comes up often sometimes but it will usually eventually work its way out when I mean it's sometimes I think it's because you know what I mean ingredients in medicines that you it can be used to tweet happening sure might be a little different than names in in k. but we certainly have topical all of a sudden you don't feel like I ate this pizza and all my son I feel like my skin is just starting to exude oil I think that we have Bulatova like there is you know type of acne called Acne excoriate or even neuro dermatitis or you know people sort of aligned it can be difficult to make people stop was certainly can make their acting worse okay there are breakouts that we don't that we don't predict you know you wake up Daphna worst why see people that come to me that actually done things jake at work maybe even made it worse or maybe have created it when they didn't have it in the first place it will help it go away and like within twenty four hours wow yeah but at the dermatologist's office yes it may be a little easier for me is that I would go and see dermatologists and have it injected you know with a little low potency corticosteroid that actually a great thing Bam there's a giant spot on your cheek but there were also they're also breakouts I certainly have one I can predict like clockwork and it's usually because of menstrual cycles wipe out to the UK Would you mind outlining the prescription or will oh anti biotic give you names or just give you top over talking about oral medication or medications would be obviously oral we all know bacterium acne just a particular type of bacteria that likes to cause acne but the issue is there's a lot of resistance you know there are certainly bacteria that don't don't respond to this medication that's usually one of the first line treatments we use Orly most tain them but educate them at the same time and hopefully give them information that is correct and also give them control you know like by teach them about why why this happened why you get breakouts and why these products work specifically and then they have access to something like that go variant syndrome which is when you have the nine roths on your ovaries secrete more testosterone so that is certainly something we suspect despite I have this opportunity to there's so much craziness on the Internet so many so much misinformation so I have this opportunity to did this platform that I didn't expect but it was so amazing and fascinating that I could build this and I have all these people around the world that you know seeing examining somebody asked them some questions then we might want to talk about that or check a blood test to see bad acne in Minnesota veered distribution that I said and bind with extra hair growth and and a slightly deeper voice trust my opinion I'm they're asking me questions about what they can do with their acne and they certainly can't travel to see me but I feel like severe acne because it really is the only thing that can really many people the only thing that can help to sort of here tone which is a medication that it sort of has has an anti androgen effects that's used you more specifically particularly in women products that we created that are over the counter for them to treat various medical conditions skin conditions including acne then they're probably more aw definitely practical things that you can do is the reason that this happened is because you know here I am somebody not necessarily there's only one there's really no one the one case where we would consider checking it is if you have a little bit and then we have I known which is an all medication which is really truly a fantastic medication for people especially with replaced him apologist because certainly people these are over the counter medications these are not things that can necessarily treat somebody with quite severe acne they're showing the first more interested in using it and I'm going to be more compliant and they're gonNa feel particularly proud that uses it's helped their acne. I mean this is not going to sizzled if you were in professional k. but what I have in my hands right now is S. O. MD.. Yeah so I'm Jay MD here's your skincare range so acnes a teenager all those years ago and I didn't have anything like this I used things that were very harsh and very strict increase salicylic acid cleanser BP lotion retinal ceremony facial moisturizer which contains SPF. I believe I'm glad you've gone out there pasta-roni and our body which is normal have higher levels can promote little breakouts like that listeners Sandra was just indicating on the jaw line and along with a beard distribution so to speak and then we also have like birth control or contraceptives can help because it helps to control your hormones thing and probably questionable that does you know and that would raise certainly the price of this you know we're not trying to make products that are oh these smells delicious and are sob- feel so beautiful skin I mean hopefully they do but there's no fragrances because that can irritate your skin you know that that's not something we're not trying to make a Foodie Austin science not berries bryce within the range you have actually the acne system the thirty day kit yeah we're trying to just give people options that we know yeah exactly I mean I mean I want to make this available to anybody you know we're not trying to we're trying to make things that we as dermatologists would recommend to people within my power not seeing you as well as my patients yeah understand that actually efficient ingredients sometimes don't give you that marketing advertising feel that there's not all that plum PG about the fact that they don't have any fragrance and they they all based in Iowa's say science and so I just wondered if we sell some Rear Berry that you could only find on the south side of this mountain in the Andes and that's supposed to have some potential of doing something yeah I mean I I mean I mean that's that's a lovely thing to say that means so much to me actually because that's really what I'm trying to do is if I can I'm one thing to point out to that end is that it is not I mean you could have created arranging put a price tag on it but it's actually affordable category talk about the fact that I think when I was growing up to that skin cash should feel a certain way it should feel silky it should feel soft on my face and it took me a long time this things like that because all those signs sort of indicate maybe you have a higher level of testosterone and a lot of women have this they have he c. o. s. which is stuff going on it just gets absorbed and that's IT and sometimes marketing goes the other way sometimes they're they're definitely products that are sold for on my skin it did did have a positive effect then I just thought gosh if I could go back in time and give myself this I would feel very well looked after in women who have acne breakouts are more on this distribution here because we do know we do suspect that there has to do with a little higher levels of tests that might be you know it's tough to some of the Senate across the pond I this is a thirty day kit and I was trying to think back to when I had at this opportunity in this platform but I also feel this level of responsibility that I sort of need to do good with it stab you know there's a lot of people can't see them and now they are the time and the money that often so I feel really lucky that I have their acne or make it go away if a hormonal links should you be checking your woman's purse and if you balance those might your treatment defer she percent Bonzo Peroxide Lotion those your acne fighting cornerstones yes we also have we'll see you said retinol Salicylic oh I'm just trying to see if we can't help people and help them take control of them is now and do it in a way that makes you so it's not really that it's you did just beat the pipe pup pup the Pied Piper of pimples all day right now what this is all about I'm hoping to bring something good about it you know and and help people dollar business I mean this morning we're all looking for answers and it's nice that there's always new things there's always new searches for new medication so should you be using the same topical ingredients all over or is it clever to use a more targeted approach I think that certainly no new products that can work but we also there's also something to be said about the things that have been around for generations and are tried and true until we you know you're doing it because you're getting answers for yourself that I think are going to work and you understand how things work and also I'm we've talked it's like I'm wearing socks on my face so I think yeah I think a lot of things that's why it's a multi billion prescription medications event and so you sort of fine tune it to the person now I don't have that opportunity because I can't see the person who themselves so I'm trying to the best way to get rid of acne scarring and pigmentation and does it vary depending on your skin color there's two main ways that when you see me as a patient as a patient I'm going to prescribe you a couple of products based on how you know my discussion with you and and everybody's a little acid sulfur and then the property unit Lesbians Yeah Yeah I think yes those are those are the things that I found because it's harder no no this is a great question and it was specifically asked about Asian skin but then someone came underneath and said could you discuss for all skin types but she said what this is not strict hard and fast rules now the other thing is spots and blemishes don't take up a lot of real estate on your face important things to know about this to reassure people as these are actually not scars because in my mind scarred means permanence and means US basically the things that we know work the best for the vast majority of people and but then I also try to tell them look it's not like this is set in stone very expensive that smelly stinky socks and then I'm putting on my face and it smelled like this must be spending this money in it you have to use this at night and you know this is the pattern of something irritates you leave it out for every dryness that everyday don't use it every day different you want to find you and I say look back in a month let's see if you don't like this product obviously don't keep using it but let me know because there's hundreds of different there are products that are probably better hughes all over the face and others that maybe it doesn't matter to you so much I mean I think like south like acid and retinol you see afterwards a result symbols and then you have people like

Dr Sandra Lee Dr Pimple Popper Dr Pimple Pimple Academy Dr Sanjay Kovar Dot Radio Network Dr Charles ski Sondra Megan California tetracycline Jay MD Charles Kovar Charles Kovar Agreem Asher Caroline
Episode 97: November 1, 2019 AFP: American Family Physician

AFP: American Family Physician Podcast

20:00 min | 1 year ago

Episode 97: November 1, 2019 AFP: American Family Physician

"The AFC podcast is brought to you by the American Academy of Family Physicians and by COMP health family physicians are so much more than just a white coat. They're real people with real needs. That's why compelled personalizes every aspect of a physician's job search each by providing locum tenants opportunities across the United States international local tenants and permanent placements tailored specifically for them. More information formation is available at health dot com slash. FM Career and welcome to the American family physician. Sean podcasts for the November I twenty nineteen issue. I'm Steve I'm Hillary I'm Melissa and I'm Caroline. We are residents and faculty mostly residents. It's from the University of Arizona. College Medicine Phoenix Family Medicine Residency. This time on the PODCASTS. Were going to talk about care of the military veteran oral oral antihistamines for physician burnout hydride nitis separate Tiba and telehealth consultations the opinions expressed in the podcast our own and do not represent the opinions of the American Academy family physicians the Editor of American family physician or banner health. Do not use this podcast for medical advice instead seer one family doctor for medical care IT S. Let's start with care of the military veterans selected health issues. He's from doctors yet. Linski neff and Jordan so we all know and love our local. Va but what. I was really surprised to learn from this article. Coal right off. The Bat was that more than half of military veterans actually received their care from community based primary care doctor alone. So that's US and there's some specific things we should be thinking about when we see a patient who served in the military Alyssa. Any ideas about what you might wanna be on the lookout for in these patients. How about up? PTSD Yeah Post. Traumatic stress. Disorder can be really distressing and lead to problems including unemployment family and relationship difficulties aggressive aggressive behavior poor sleep and just overall poor quality of life. How can we make sure we're not missing this? There's a screening checklist called the P. L. C. Five that is provided in the article. They recommended using this tool every year. For the first five years after discharge from the military and then every five years after that and then if you had legitimate concern based on that you would want to use the DSM five criteria to make a formal diagnosis. So how do we treat PTSD. The emphasis here is non pharmacologic interventions including cognitive processing therapy exposure therapy and stress. Inoculation training. So you would want to refer to a therapist who has experience with these as far as medications search Orlean and paroxetine are the only FDA approved ones. Benzodiazepines are not recommended and while we're on the topic of mental health issues. There's a couple more topics to mention. It's really important to assess for depression in veterans they specifically recommend screening with the P. H. Q.. Nine every year the rate of suicide among veterans compared to non veterans is one point four times higher in men and one point eight times higher in women and then sadly something that most veterans will not report while active in the military but may later disclose to their doctor is sexual trauma. It affects almost four percent of men and thirty eight point four percent of women you can let these patients know that the va does provide services for sexual. We'll trauma related issues even if the person is not otherwise eligible to receive care through the Va.. Okay moving on Hillary. What other conditions do you think of specifically really related to veterans combat injuries? Yes and no musculoskeletal. Injuries are in fact. The main reason for medical discharge from the military very in some are directly from combat but most are related to cumulative stress a repetitive activities. Think running marching parachuting wearing heavy. Abby body armor for long periods of time veterans actually have twice the incidents of osteoarthritis compared to similar age. Cohorts and as you can imagine for many this leads to chronic pain and that actually brings up another condition to look out for traumatic brain injury or TBI chronic pain has been found to be a CO morbidity for a large number of veterans following Ti. Is there anything about the treatment of these conditions. That is unique to veterans generally. No you're going to consider. That are the usual non pharmacologic approaches including physical therapy exercise and cognitive behavioral therapy. The keep in mind that if a patient has cognitive impairment airman related to a than their response rate to see bt for P. T. S. T. may be reduced by up to fifty percent and then the pharmacologic approach will be typical including anti inflammatories Acetaminophen. Gabum Penton and possibly. TCI's or Azure is depending on Co Morbidity. He's all rights. It's anyone WANNA take a guess at the last few conditions. That article mentions that we haven't talked about yet. Agent Orange hearing loss malaria. You're all alright. So regards to hearing loss. Many veterans were exposed to high caliber weapons or fought in developed areas where buildings are closer together and and this puts them at risk for noise related hearing loss and then like you mentioned malaria. Many of these patients have spent time in remote parts of the world were various diseases. There's like malaria or West Nile virus to burke yellow. Sus and many others are prevalent. So you WANNA keep that in mind especially if someone who's presenting with symptoms like fevers is fatigue persistent cough Arash and then yes environmental exposures like agent orange depleted uranium or specis have have been associated with certain diseases. That's a really nice summary. Carolyn it sounds like we should definitely be asking your patients about any history of military service and if so when where and the type of combat they were involved in. It sounds like we could really help our patients absolutely. Let's do a a Cochran. Four clinicians from doctors cocker and skill. And this Cochran for clinicians sought to answer a question where all itching to know the answer to are oral. H One antihistamines. Effective add on therapy to topical treatments for X. Amount The review included twenty five are CT's bt's with over three thousand participants and studied thirteen different oral h one antihistamines. In children and adults primary outcomes included. It'd change in patient. Assessed symptoms of Excema and patient reported adverse effect rate secondary outcomes included change in physician assessed clinical signs of Exim Zuma change in patient reported quality of life and number of Xm flare ups reviewers found no evidence demonstrating improvement in primary or secondary outcomes. SATYRICON or Laura Jean Children are notes and adverse effects did not differ among treatment and placebo groups however a small reduction in patient assist ex symptoms was noted with the use of one hundred twenty milligrams of FEC so Finnegan daily and adults compared to placebo with the number needed to treat of eleven the bottom line in children with exit. There is no evidence support adding on oral h one antihistamines to standard treatment with topical corticosteroids in adults consider adding FECSA affinity for additional national symptom. Relief next up a curbside consultation physician burnout and stress while interacting with patients. This commentary commentary by Dr Devaux from Fayetteville Georgia. We face stressors in modern medicine. That can lead us to feel disillusioned when the reality. The of practicing medicine does not match what we hoped to be doing. In our careers this is described as Bernau which is a syndrome that includes emotional fatigue so de personalization and a loss of meaning and work burnout can lead to depression and substance abuse and can lead to an increased risk of suicide. Compared to the general population physician burnout also impacts public health as it increases major medical errors and leads to attrition which further worsens access problems causes of burnout include e Char documentation perceived loss of control administrative tasks and shift from professionalism awesome to consumerism. Patients can transfer their frustrations with our dysfunctional healthcare system to the physicians at the frontline on the flip side of the coin. We hope physicians can be engaged patients of engage. Physicians are more likely to fall position recommendations. We should seek the quadruple aim in our practices improve patient experience variance improving population health reducing overall costs and maximizing healthcare professionals health and happiness. What can we do about this crisis? Dr Auto has some suggestions I. We need strong physician. Leadership and professional organizations and local health systems to play a major role in supporting important efforts for it's likely decreasing administrative burdens. Yeah there's a really nice review. In hair some health care organizations like Stanford and Nova Health have implemented wanted bold physician wellness strategies coastal medical and Providence Rhode Island held physician focus groups which led to changes to ensure physicians. We're working at the top of their licenses. A group led by family doctor. Corey Lyon at the University of Colorado showed team based documentation decreased decreased burnout rates substantially. Doctors Need Self Care. It's our ethical obligation to take care of ourselves and each other we also need processes processes and programs in place to foster and reinforce a culture of physician wellness we can build physician community and mutual accountability for wellness and remind physicians that we are together. United and we are not left to fend for ourselves and we must fix the external factors that got us here in the first place. There's a table in the article that shows resources from the Ama American Foundation for Suicide Prevention and the National Academy of Medicine and a special shout Out to friends of the pod cliff night and Mark Greenwald who have created and lead an annual American Academy of Family Physicians Physician Wellbeing Conference next ex- conferences April. Twenty twenty you can find the AFP's physician Health First Initiative Online and we'd also recommend you. Listen listen to our bonus episode where we interviewed physician wellbeing leader Dr Greenwald on bonus episode for February twenty seventeen. Okay team team. We have a rapid evidence review. Hydrogen itis separately ver from doctors. Whip Herman Brag and listener from Wichita. Kansas US let's start with a brief summary of the disease hydride night as separate eva or H S is a chronic colitis affecting enter trigeminus areas. Onset is from ages ages eighteen to thirty nine and is more common in female and African American patients obesity and cigarette smoking increase risk. Additionally it's commonly associated with a host of weather conditions including type two diabetes Crohn's arthritis and spawned Laura Thrive A-this P. C. O. S. trisomy Twenty One and Dermot Gangrene Awesome Presentation Tation Ranges From Stage One AKA single or multiple abscesses. Without sinus tracts or scarring to Stage two abscessed recurrence. With the sinus tracts and scarring to the most of your form of the Disease Stage three which is characterized by diffuse skin involvement with multiple sinus tracts and widespread abscess formation. You're defining features. Here are painful deep seated now jewels. Lasting days to months absentees with malodorous discharge open open doubled tombstone. Komi Jones and interconnecting sinus tracts based on those diagnosis clinical first and foremost treatment should start with counseling. slink patients to stop smoking where loose fitting clothes and lose weight if they can. This is A. B. Recommendation in particular fifteen percent weight loss is associated with a significant an improvement in disease severity while continued smoking is associated with a decreased response to treatment next screen for depression and the other associated conditions that we listed before like type two diabetes eighties patients with H s have lower disease related quality of life in a two point five times increased risk of suicide when it comes to pharmacologic treatment. There are a lot of options out there but only a few with high evidence ratings the key treatments you should know about our topical Clinton my sin and oral tetracycline for mild to moderate Ahs and add limb ab or brand name Humira for moderate to severe hhs in our CT with thirty patients. There was significant -nificant improvement in symptoms and APPs burden when topical Clinton mice in one percent was applied directly to active lesions twice daily for twelve weeks similarly similarly in in our CTO forty six patients when oral tetracycline five. Hundred milligrams was given twice daily for three months. Patients had fewer absentees. And now Joel's US now. This result was not superior to top Bill Clinton Mason. These treatments have a BI recommendation at a limo mob. which is given as a self administered Mr Weekly subcutaneous injection is the only medication currently approved by the FDA for the treatment of HFS to double blind are CDs of of more than three hundred patients found that patients with moderate to severe H S had significant improvement compared to placebo with the number needed to treat of three to six for at least fifty percent improvement after twelve weeks? Another study found sustained response after three weeks of continued treatment. This has an a recommendation combination at Olympia. Yeah that's what's up. Get those practice started now. Caution though according to get Iraq's each weekly dose of this medicine is at least twenty five hundred dollars. James Hillary what about surgical treatment options. The primary goal of surgical treatment is to control inflammation by removing disease. sinus tracts and debris to prevent event further progression and scarring. There's surprise a lot of surgical options too. But the main ones are as follows incision and drainage might be necessary for acutely inflamed painful abscesses. But you can expect lesions to recur. Since the procedure won't remove the root cause fully kilo pileups obey Shis unit. That being said punch biopsies at the center of the lesion are a better option since they will remove the unit and thus better treat the issue any local excisions wins should be allowed to heal by secondary intention because primary closure is associated with higher recurrence rates last but not least while local excision has fewer complications than wide excision I e less delayed healing scarring and conjecture formation. It does have high recurrence rates. Why decision is the definitive treatment for severe hss fasts with extensive involvement and scarring? That's be recommendation. Wow that's a lot for. HSA can you summarize all of that for us. My pleasure Steve like always always lifestyle changes. I your next options. For mild to moderate disease our top glenda an oral tetracycline for severe disease. Think Atalanta Bob but keep definitive surgical treatment with wide excision. And your back pocket. We're going to wrap things up with implementing arc effectiveness healthcare reviews helping clinicians. Make better our treatment choices. This review is entitled the effectiveness of outpatient telehealth consultations a practice pointer from Dr C.. Hoosen and adds ads rack every week. I feel like I hear about a new way. telehealth is being used in medicine. This review from the agency for Healthcare Research and quality the examined if the use of telehealth in the outpatient setting has been shown to improve clinical outcomes reduced cost and or increase patient satisfaction and as far as clinical outcomes various studies with moderate strength of evidence concluded that for wound. Care telehealth leads to better wound. Healing and fewer amputations for psychiatric disease decreased psychiatric symptoms and higher rates of remission as well as positive effects on chronic disease clinical go out comes for diseases including diabetes arthritis hypertension and chronic pain. What about ease of access to care? Moderate strength. Thanks evidence found that telehealth improves access in terms of comprehensiveness. Anti to service or treatment reduced. Wait times and an increase in the number of patients receiving indicated diagnostic tests or treatments. But keep in mind. This doesn't necessarily translate to improved. Clinical Outcomes telehealth was also shown to to reduce hospital visits and admissions and length of hospitalization. However this is based on low strength of evidence and Steve You'd be especially happy to know that telehealth was also shown to reduce the number of in-person sub specialist visits yes anyway to reduce unnecessary referrals? To partial lists. Did the review note any areas. That telehealth may not have been as beneficial for or areas where evidence is lacking recovery in dermatological conditions showed no significant differences in clinical outcomes. L. Comes with use of telehealth as far as complications and adverse events until a health evidence is insufficient and clinician satisfaction was the same or slightly worse I than for face to face encounters based on studies with low strength of evidence. I imagine patients might be more satisfied with telehealth. Low Strength. Evidence showed patients patients may be more satisfied with telehealth than face to face visits if it saved patience time and travel however this evidence was rarely statistically significant Elissa. What about my favorite topic reducing costs of care low quality evidence but yes most studies that looked at cost reported savings with use of telehealth? telehealth boom okay. That was the whirlwind What's the bottom line Elissa? So far the strongest evidence suggests telehealth has shown the most promised Thomas for psychiatric and wound care and in general improved access to care. Evidence is limited for patient satisfaction and cost savings. And please send us your thoughts by emailing us at eight. F P podcast at F P DOT ORG or tweeting at AF P podcast. Please subscribe and rate us in items. Are podcast team is Jake Anderson. Caroline Block Burger Steve Brown. Sarah Coles Elissa cornstarch Victoria krantz Herber Rosenbaum Michelle Summer and Hilary Tamar are sounded technical. Guru is Tyler Coles. Our theme song long

US Va American family physician tetracycline American Academy of Family Phy bt depression James Hillary Caroline Block Burger Steve Br FDA College Medicine Phoenix Famil Bill Clinton Mason Editor of American family phys CT University of Arizona Tiba Cochran American Academy of Family Phy Steve I
#001  InspirAction  Comment Transformer sa Vie en 15 min chrono !

Le Quart d'Heure d'Inspir'Action

15:49 min | 1 year ago

#001 InspirAction Comment Transformer sa Vie en 15 min chrono !

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1337 Mastering Periodontology with Dr. Homa Zadeh : Dentistry Uncensored with Howard Farran

Dentistry Uncensored with Howard Farran

1:28:23 hr | 1 year ago

1337 Mastering Periodontology with Dr. Homa Zadeh : Dentistry Uncensored with Howard Farran

"Patients family finances. You've got a lot on your plate. Get the tools you need to keep it. All balanced with members only resources and discounts from the American Dental Association Association. Joined today at eight dot org slash join now it. It is just a huge huge honor. Today I cannot believe I'm podcasts. Interviewing one of my idols. He's your idol. He's the parried carried on us for us. Dr Homa is a day my Gosh D. D. S. PhD. He is a diplomat of the American board appeared on technology and implant surgery. He has served as tenured associate. Professor Director of the Postdoctoral Parrot on policy as well as chair a parrot oncology a section at USC ostrow school of Dentistry. He graduated from the University of California Los Angeles with a Degree BS degree followed by Dr Dental Surgery From University. USC Ostro he completed postdoctoral. Clinical training impaired on as well as a Ph d degree agree and immunology at the University of Connecticut. All known as that's Yukon right you con- School of Dental Medicine Doctors a day has lectured nationally and internationally in over thirty countries at prestigious conferences on topics range from aesthetics to minimally invasive per donald implant surgery as well as tissue engineering He served as president of the Western society. A period on Tall Aji which is the largest regional? Parrot oncology all g societies spanning the sixteen Western states and Canadian provinces. He's the innovator of the Vista Technique recognized around the world is one of the most effective methods for the treatment gum recession. He's also innovative. MINI CON substance devices which have been patented and developed into products and clinical use in in many countries doctors as director of the laboratory for Immuno regulation and tissue engineering called L.. It USC. I was going to do it but I was busy that day. And I forgot my. PhD enemy -nology which is a science? I mean this guy I mean his his resume. It goes on for forty pages. He has an extensive publication track including over sixty publications in peer reviewed journals and numerous book chapters. He serves as editorial reviewer reviewer for many scientific journals he served as a chartered scientific viewer to the National Institutes of Health and shared a scientific panel at the NIH Center for Scientific Interview He served as director of USC international period algae implant symposium. I mean I got anything you haven't done meeting eating Howard for an I met you so my gosh complete now if you just if you just drop ends a day Z.. A. D. H.. Smells like today. I'm fact I need my today's dental. I didn't name is dazed dental because I knew he'd Sumi so I a cold. Today's dental But you just drop his name in dental town and you have questions are I mean this is a common for you Someone's posting about tunnel tunnel graph. I post doctors today. Do I mean that's just what they I mean you say they. You're the you're the Perry on us at the Perry on us. Listen to your your so so first of all. Thank you so much for coming in an honor to see you. I have to say at of all. All the ten specialties I got to school in eighty seven. I mean what's really changed in pediatric dentistry over Demean Floride. What's really changed in? I I mean so. Many of the professions haven't really changed much periodontics. I mean my God. It's it's crazy. When I get out of school it was all these donald surgeries as it was taken for -cations and doing route this and that and all that and then about one hundred five ten years out of school people said you know how you Nutri- perio with forceps? Let's just pull them out and place it with titanium after ten years of that like that didn't really work like I thought it would. And now the pendulum's all the way back to being buried on us again I would have to say I think your specialty change more than all the others. Would you agree agree or disagree first of all. Thank you Howard for having me here. It's an honor to be here and a pleasure to join you. I applaud what you're doing. Yeah I think it's a great service to the profession. You're right that Perry Don told her. She has had the most amount of innovations. Just because I think there are more periodontics who are doing research and I think keep an open mind and adapting into a knowledge as comes along and you're absolutely captured. It encapsulated very well that the pendulum has swung. And I look at the way I treated payroll disease. We started out with parallel therapy and then we became so enthralled with dental implants and then discovered all the problems that go along with that so that really taught us a lesson that we shouldn't jump on the bandwagon again. We shouldn't abandon the tried and true type of procedures that we have known for many years. So I think for me as a parent on US my passion today. Saving teeth is really We have discovered that teeth. Have something that you we have not been able to capture chair in dental implants yet. They ability to you know he'll themselves the ability to maintain themselves. I think that's There's no replacement for teeth at the present time. So you know you gotta remember quarter of my viewers or still in dental kindergarten school and the restaurant under thirty. I mean people our age. They're not into podcast or instagram or snapchat. They're you know they're so you're talking to kids and it's very stressful for them. They only became a dentist. She only beekeeping Dennis because her mom's at us and she comes out of school She's read chapters. And how many books have you written. I mean she's read all this stuff now. She's working with her mom and her and it's stressful. Because her mom started to treat Perria with extractions and implants and she's looking at him and five years later you you know. A third of them have peri implant titus around there and the mom sane were well frank or you have a problem is I know I can eat a bacon cheeseburger. You know. I no problems no pain and then her mom says no problems no pain and there's these people talking about the oral health continuum and some people are saying well you know they're finding Perry Donald Pathogens and now Zimmer's deliver they all this like that and she's she's talked Dr She. She doesn't know what to do. It's it's her mom. The patients on having pain. Some people say well you know every morning when I turn on my coffee pot. The Sun comes up up but I didn't 'cause it. It's a correlation and a lot of these diseases that you're saying or associated payrolls are correlations. They're not cause-effect and she stressed what would you. What would you say to her? She's twenty five working with their mom's on careful. You're absolutely right that we shouldn't jump into conclusion. Always I think we have to be very careful in how we interpret information formation. You're right that when we're looking at many associations they don't always pan out into 'cause -ality and I think Their tendency for people to draw conclusions too quickly so yes we have a great deal of evidence to look at the correlation between paranormal disease. Many systemic diseases and perhaps we will find at some point correlation relation between Peri implant diseases and systemic diseases and not not all of it has really panned out in the form of a causality. Not some of them have have more evidence for the reality is that inflammation and infection or key aspect of many many different disease processes. So there's no question that regardless of any of that we as then as our main job is to control infection inflammation toy mation and we're going to be dealing with that whether we're dealing with paranormal disease whether we're dealing with Peri implant diseases where whether we're dealing with carries we have to put that as is a center of what we do in dentistry when you're talking about causality. Do you know the Dennis out there by you. Paul o'malley Molly. Yeah Paulie from university o Paulo Malo from power o'malley. When I I was a freshman at Creighton I went over to the dental school? And he was a freshman at Creighton dental somebody and I had eight sticks on my Aclu's -als and Molars and he did eight ACLU's amalgams and by the end of the year. All my hair started falling out and I was wondering can I still go back and sue him because look at it right now. Look at all of his hair. He's got them. How come you made me go bald thirty years later? Sporting His hair so they come out of school and a lot of people are saying The people who represent dental schools they're lying with statistics. They always put on their website that the average dental student has two hundred eighty four thousand dollars in loans. Come on you run a dental school. Why are the lion an average twenty percent of those kids? Their Dad's paid for dental school. Another five ten percent. Somebody paid them the military military Something else when you look at just the kids who have student loans. It's more like four hundred thousand dollars and then they come out of school. They're four hundred thousand one dollars in student loans but And they're told you WANNA BE WANNA be honest you need to buy a hundred and thirty five thousand dollars NAPA laser You'RE GONNA need one hundred thousand dollars. CBC T- You'RE GONNA need one hundred thousand dollar chair side can't Cam and she's like dude if I make three purchases I double my student loans. So this is dentistry and censor. We don't talk about what everybody agrees on. So I'm going to hit you hard. I because I know it's it's channel conflict with these guys. When these guys are prestigious gauges period honest? They don't want to have people come up to me and say why did you trash talk something on Howard's dentistry incentives. But I'm going to ask you the point blank. Do I need one hundred and thirty five thousand dollars nap laser to be a married honest like you let me ask you. If you WANNA be coby Bryan you go by Kobe Susan. You become Kobe Brian so just because you find some tools is not always going to improve outcomes. That's the number one thing I think the most important aspect for a dentist is the decision making skills. I think today that is wife are the most important thing that you can do for your practice is to improve your decision making skills by acquiring information so I think if we are focusing more on information and how to make decisions. We're going to be much better. Dennis than buying tools and gadgets to improve our outcomes. Not all of those gadgets and tools are going to improve the outcome of our patients. The first question we have to ask. Is this going to improve what we're doing for. Our patients is going to improve outcome of our treatment. If it does then we pursue that unfortunately many people will look at. How can amortize this particular piece of equipment over the course of the treatment man to make more money for that means from a business standpoint? That's one way to look at it. But I think as looking as clinicians I I think that may not be the most effective way to look at how we can be better. Healthcare professionals healthcare I think is a bad business to go into because when I went to Creighton at Omaha with Paulo Molly who went to Creighton. the My Gosh Warren Buffett. The Oracle Omaha was in there and he'd come over and he talked to the business class and he'd never go into a business that needs big capital investment. And someone. What else such your your price never going to have business? So what do we do. We go into expensive healthcare and insurance companies set the price so you really wanted to be a dentist bad to intentionally walk into that storm and one of the things that I can get my mind around is the. I'm the oral surgeons when you go in with four Byzantine. They put all four once When I I don't know when I'M GONNA get my quadruple bypass but I'm sure it sooner rather than later? I don't think they're GONNA do one. Bypass a month. They're going to do all four at once so someone comes into my office and they have a mouthful of gum disease. I always think for me. I want to treat you like I would. I wouldn't have all four quadrants and spend two three three hours and do the whole mouth. 'cause I'm trying to I mean I don't I I don't know how to flush half the toilet but the insurance company said No. No no you can only do. You can only bill us for one quarter and at a time or two quadrants at a time. You can't bill for all quadrants at a time and say God I I I to me. Does this have but you would know the research. You would know the immunology you you got to your double doctor. I'm actually about half the doctor. Would it be a better outcome if I did. Full mouth. Replaying Cure Taj to flush out today and and or is insurance company. Right I should do right side left side two weeks apart were there. There is some level of evidence that has done a full mouth disinfection type of treatment man. There's a research done in Leuven university by Mar Cronyn who has shown that format disinfection is the more effective form of treatment. You're correct that if we're dealing with an infectious disease it doesn't improve the situation if we're doing one the area and at the time and we leaving part of the infection behind as we're cleaning up so It's just like if you're going to be doing there You know clearing roach infestation. House you cannot do one bedroom at a time and then have all of the infestations sins remained in other areas so I think we have to look at one. Aspect is a insurance but I think insurance is still a choice in us. I think we still do have a choice because we can inform our patient what is in their best interest. We still have an Opportunity to give them what the best way of treating that and it will be up to the patient to make the decision in some other countries is not always. There's a choice I know. I have some friends in France that even as private Dennis. They don't get to decide the government actually gets would set prices and they have to buy you. Don't have the option of opting out of these insurances because the government actually decides is how the prices will before implants and other types of procedures. So I think we still have a choice here in this country. I think we still have the opportunity tune into these present or patients what is in their best interests and if they want to utilize their insurance that would be one way to look at it but at least they should know what is in the best interest which is basically one time treatment usually my patients. I appreciate it when you try to do. All of the war in one session whether it's scaling gala route. Planning where they're doing surgery and they don't WanNa go through it multiple times. Yeah when I had my only one surgery. I told him do both at the same time. I did not want to come back again but I'm so so let's see on the debris deal I'm I'm I'm old school. I graduated in eighty seven. I still got a lot of my seniors and you still got there. But it's it's a wig beat. Let's be honest. It's a week and I had plenty of Malcolm so that this is that molly. I'M STILL GONNA Sue Paul He's in southern cal by you so you can deliver the lawsuit for running but there's a lot of boys lot of my friends which you know local alcoholic. Dennis that Drink too much That after every four quadrants of replaying your Taj they still say I give them around around. Attach cycling because cycling show up and the curricular tissues seven times weren't concentrated than penicillins and Blah Blah Blah Blah Blah. And then and then the guy drink next to him and say well you know what I do at the end. If it's a deep pocket I put in a Pero chipper. I put in this or that. How much of that? So so succinctly distinctly after four quadrupling here Taj all at once. Is there a need for an antibiotic or is that silly and do you ever put local perio chips and and do using that stuff whether tetracyclene type a class of medications. They've pretty much lost. Is there anti microbial effectiveness. Because of the overuse by especially by the colleagues in dermatology they put patients on many the months or years. So there's so much tetracycline resistant as antimicrobials than not so affected. They there. There were some efforts to try to take advantage of tetracycline other ability which is to inhibit the enzyme. colledge anees to prevent tissue degradation. So that's the other side of tetracycline medication where you can use low doses of them to reduce their tissue breakdown and that also Seemed to be a nice therapeutic. There people were put on these sub anti microbial doses of tetracycline class medication but they also did not seem to pan out in the long term. We're enthusiastic ask you about it. But it didn't work out so the answer. The question about anti microbial therapy do we really need to have anti microbial therapy on top of mechanical called the Brightman not in most cases in in most cases where we have an abundance of local factors we have mineralized realized biofilm Calculus and plaque and and there's abundance of that by just eliminating the massive The buyer film we we can usually be very successful in patients which have not a lot of calculus they have pretty good hygiene but they still. You'll have had a lot of breakdown. They those are patients that we used to call aggressive paragon titus now the terminology change. These patients can benefit benefit from that because a lot of these bacteria can get into the tissues so adding on top of that anti microbial therapy. Systemic can be helpful in conjunction sanctioned with with with the full Martha's infection so one way is to do bacterial testing to figure out but but most of those bacteria respond to a combination of Amoxicillin Metronidazole in patients. Who are not allergic to that so that could be a a therapy to to combine adjunctive? Systemic antibiotics with formats disinfections in younger are individuals who have had severe form of attachment loss but have not don't have a lot of local factors like plaque and calculus and and that we can address with planning so those are the patients that we give systemic antibiotics that question to bring up a nightmare in my life. So you said the antibiotic plus Metronidazole. I took my four boys scuba diving one time right and we came back and something was wrong with her. Gi So we had go to the bathroom. Senator lab in Minnesota back and said you all have a parasite and put us all on Penn B. K. Metronidazole. Aw pretend days and curious up but I'm is there. Are you doing salivary. Testing is that an partier protocol colder. Because you're not getting the easy perio cases I mean we like the pediatric dentist. So or is that oral saliva. Testing is that part of your arm or not really. It is for select number of patients. Vast majority of patients do very well just by Scaling Route Planning inning and mechanical Brightman for select cases. It's Putin to also take a saliva sample to look look for their bacterial composition. It's a very simplified form of diagnosis. Because most of those bacteria we don't even know who which there are there are hundreds of different type of bacteria that could be president any time their DNA testing will only check for a handful of them. So I would only use that instead. In certain cases where the patient has aggressive forms appeared on titus titus have a have a great deal of of attachment loss and we wanna Kinda monitor the bacteria. Make sure that we can see at least the known pathogens and track them before and after treatment to make sure that we've suppressed the numbers with our treatment so I would say maybe less than five percent of cases we use microbial sampling. So when you and I got out of school school the there were improving implants like putting. Ha Coatings on it. You know they thought that would be better. And so the question is Perry Plan Titus. How real is it and does any implant surface better for preventing than others? Yeah I mean I notice all the Ha coatings are gone so does does the does the Does the Name Brand Nike Reebok Puma implant implant have less period titus than the one made that I buy I buy mine at Home Depot you know is there any do aquarium plant titus could have prevalence depending on who you ask and who you Believe the Perry implying. Dan Diseases come into two varieties. One is Perry implying because ciders which is the equivalent of Ginger Vitus and Peri implant height. Data's which is a period on Titus O.. Peri implant MECO seitis could be as in as much as eighty percent of the implants. That's just inflammation parent macos pair implant titus which also bone loss. It depends on what are your criteria for defining bone loss. How much won't last you accept? Their threshold has been anywhere from half half a millimeter of bone loss to define plan titus up to three millimeters or more so currently depending on what classification vacation. You agree on. I would say that the most reputable percentages that are out. There is about ten percent of the implant the have the severe form apparent titus. That's about the global warming by changing from Fahrenheit to Celsius. Yeah no I like it so so yeah because everyone likes to light was so you're so you're saying true period. Donald disease around around implants implant. Titus is probably ten percent about ten percents. That's actually any length of time. Are you talking about like after. That's that's actually very similar to Perry Don Titus. We know that about half of the population has period titus but this severe forms of period on Titus isn't about ten ten percent of the population very similar to Perry the Peri implant titus that maybe about forty percent of the implant have some form of pair implant titus but the severe form that could affect the function about so we're talking about prevalence at any given time not not incident so usually pair implant titus starts somewhere around year three to seven years so somewhere in that time ranges stars and then it can progress over time but the key is early diagnosis and don't think about implants as you know as the final treatment that we don't need to follow them up dislike are are are Ed Perry the Titus patients that we have to follow them up pairing plan. Titus patients need to be followed up on a regular basis. And I see peri implant. Titus I see this two words one word Perry Hyphen Implant Titus. What's the USC? I mean I know we're hillbillies out here in Phoenix. What how would you see? Do perio IMOs dead hyphen or to the definition. The most reputable definition right now is by American candidate Paragon Tolliday European Federation period period tells you they had the most recent classification definition. Anybody who wants to look up the diagnosis all that Scott American Academy may appeared on that. Yes they can go to Harry Dot Org and undercover you dot org you'll find the latest classification and the latest data's You know back actually. There's some very good papers in there that you would see that. Define practical way of diagnosis apparent. Param Param Plan Titus in clinical practice. Also they have Perry done titus diagnosis clinical day to day diagnosis. So go to period dot Org Org. You'll find their classification. A parallel diseases period implant diseases. And you'll see a series of papers in there that have very clear definition of these diseases and some guidelines for diagnosis and treatment. Could I'm still just trying to get out. The hyphenated is is the proper way. So Perry's you said all that just to say hyphen but I just want to give colleagues an opportunity to Areola. Areo Dodson formation. Yes Barrio dot org and let's also great. You know what I love about period dot. Org the most is You know the Women Women in Phoenix. They're all on Pinterest they are. The moms are on pinterest and so on pinchers. I'm at Howard for an and so many of the homecare instructions so many of those things are all means from perrow dot org and I just tell I I just plot my iphone right the chair and I say what are you on our because like pinchers easiest because you can separate your picture albums buy Perio Areola and Boys newborn mother So that was going to be my next question so Perry Donald sees again. She's twenty only five. She's hearing all this about parallels associated heart disease Alzheimer's relationship. I love the way you cleaned up Perry and plan titus to in bone loss. Severe whatever Do you think there's when somebody has this severe gum disease. Do you think there's any diseases that are you got yes. This is causing that disease. Do you think at twenty twenty. We just don't know their correlations are causal. We're just not sure well. The reality is that that period all diseases very multifactorial disease. There are many different forms appeared diseases. There's not just one disease and and same is true with many other systemic diseases. They have many factors you take cardiovascular disease you know many people know the you know. Let's say cholesterol as one of the risk factors but you cannot have cardiovascular disease just with high cholesterol you need on top of that inflammation so inflammation goes at the heart of many diseases including cardiovascular disease these including the diabetes type two diabetes you cannot have just diabetes by high a sugar you need inflammation at the heart of it. So inflammation can come from many sources in the body one of them is oral cavity and buried buried. All Diseases are one form of contributing that inflammation to the systemic overall health. So I think The keyword in in many of the long-term Stat Diseases Inflammation and and period. All this is going to be one of them so yes Cardiovascular good diseases diabetes. These are ones that very highly correlated with period on diseases and I think if we want to control any of these longterm diseases controlling inflammation is really key and one aspect of it is controlling oral infections including parallels. I am so glad you came here today because this morning my mom email me and she wants to come out in February and she's the only thing that inflames me. So so it's so you're saying to stop op inflammation. Tell mom no. I just saw you over Christmas. You're not coming out here causing more another but back back-back to implants is there is there. Is there some implants that are better than others. Regarding future her plan titus the surface yes absolutely. So there's quite a bit of information on that. The short answer is at every single implant. Surface Service is amenable to implant titus every individual implant surface so many people has amenable to peri implant titus. That was the that wasn't the mucus. Il No this. You can have Perry embiid. You could have developed bone loss okay. In relationship to the impact so they mindset has been that with machine implants which were original implants that we had these machine implants plants there have smoother surface. They didn't attract bacteria as much so we did not have as as as higher peri implant titus with those that is true that machine implants have about ten percent lower percentage of Perrin Pant Hiatus but the reality is that they have you know less integration in the up front as well so you can take your pick you wanna have more complications initially lower chance of integration. You can use machine implants but if you WANNA have better integration use any of the rough surfaces but down the line if you have exposed rough surpluses that predisposed to pay Pun Titus so out of all the rough surfaces every implant company penny wants to make their surface the best that there is but the reality is that what appeals to the host to to attached to the implants and US integrate. The same factor appeals to the bacteria bacterial love to attached to the same surfaces so by making Dr Implants rough to attach to the bone. They also makes it more rough and the bacteria love to so that increases the chance apparent plan titus now now we do know that specific surfaces have more propensity for Param plan. Titus are some specific studies studies that have identified very specific implant surface. You know modes of of Ruffling happening to higher incidents of implant tight so out of so maybe we don't mention there by name but yeah well you look at the literature and you can look at the literature. I Need Vegas drinks decisions. We need to start making cocktails. Just needless to say that I will say that there are different ways of making implants rougher there there if you look at some of the systematic reviews have compared they have identified the implants that have been roughened by their You know annotations system okay to have higher incidence of paramount titus so analyze surface. This is one way of making the implant surfaces rough and that's what has been an associate with higher incidents of parent plant bowl loss. I Want I want to ask you. Okay can I say now. The new thing is to say okay. Let's forget about titanium. Let's go to a Konia because their own is not amenable to paramount titus. You know we don't have evidence for that. Many of the manufacturers are we're trying to make that as the main point and there's not enough evidence to say forget about titanium now with zirconium. You won't have as a problem. The reality is that we don't know enough about their Konia to make a widespread recommendation to everyone now to switch to the Konia and we can't say that we're going to have less complication. We need much more evidence before making that recommendation to people so my recommendation to stay with what we know about what rather than going with the more unknown well. Dentistry is an art and a science and the oral surgeons tell me. They hate glass zirconium. AM implants. They don't like working with them. I mean are you hearing. You don't love them well. You know. the zirconium has some some pluses and minuses. As cornea isn't ice surface. Their reality is at many people will say well. If you are concerned Cernan about metal lesko with a metal free Za Konia if you look at the periodic table you have titanium right below titanium when you have Zakho neom which is basically a right below that in the periodic table so So Zico NEOM is also metal. So so to say the corneas metal free. I think that's a little bit of a stretch so It is a cornea has some benefits benefits. But also there is a possibility higher possibility of fracture. And I think we don't know enough about long term studies Colonia to know that you're gonNA use it on a large number of our patients. I'm sorry I'm on Google so I clicked the periodic table. The first three were ads. I'm still trying to find so titanium was eighty one or show me is rob right below then. The periodic table is eighty one titanium. And that's that's not take him He's right here is twenty two twenty two what was i. The word is. Ti Hea L. S. O. T.. Okay so so the same titanium is one Roy Moore tonight on him so they that's right there in the periodic table so exact same thing right so you see next to that as vanadium and these are all us in some of the and you're they're trying to develop for US integration and and I see that with people that I'm a big water fluoridation guy and They don't like the floride but it's like okay. Well you know right underneath flooring is chlorine if if we take that out now your kid dies of color and And now the swimming pool. They're all coming by and they go down one more they saying. Well you need to get rid of the chlorine. It's all toxic. Let's replaced with Birmingham. We're in this. We're in the same column of number seventeen trying to say metals a bad but just to say every metal is good or every metal is bad. You know there's clearly a difference between titanium as a metal versus mercury as a metal or chromium as a metal Nicole's they're different metals that have different by reactivity so we have to not love it when they add in there on people though because they come in they say I want metal free. It's a well I. At least they're honest because they're driving metal free cars or flying the metal free airplanes There's no other metal in their house there. There is is like when you went to the global warming summit. It was so interesting to see all the movie. Stars was flying in their in their jets. Bring ten thousand gallons of Carrozza hour on the way to the global warming and what they want to talk about To use a metal a metal Straw Straw. Okay so get back in your learjet. So up this pet peeve of mine. Tell me if I'm if you tell Ma'am absolutely wrong. I'm wrong but it doesn't make sense for me When I see I'm a dental office and they've seen grandma every the three months for for ten years and they've never seen dad and I always say well what if you saw every three months for an S. T. D.? And they had it every three months for ten originally say. Hey we need to check grandpa we can you treat someone for personals is every three months for ten years with ever seeing their spouse when they're sleeping with them right so they're this. There is clearly a some kind of familiar. gration appeared on diseases partly because of genetics. Partly because of exposure so exposure poser doesn't always equal disease. So if you're exposed to the disease you have to have the genetic susceptibility on top of that to be predisposed disposed to that so yes. There is a higher in communication of that so there's horizontal vertical communication of some the payroll pathogens. But you need also the the host susceptibility to go along with that. So yes the answer is that you do. We need to examine all members especially if you have a younger individuals who has paired all diseases and is it's likely that they have familiar aggregation of that. There's a genetic predisposition for that so other members of the Family should definitely be examined so this could also be a practice builder to bring in more members of the family to examine to look for that. I think the low hanging fruit of whether it's opportunity as a you know every dentist four years of college four years of dental school they all got as and Math Calculus Calculus physics. I mean the Denison V.. They're the only ones in Phoenix. You know the difference retain assign Aniko sign. I mean they're they're so smart and they yes so I look for. Where's the big? They're not into agreement dentistry incentives. So explain to me this you twenty five dentist. Five dentists refer patients routinely for crown lengthening. Or maybe and do it themselves. And they've done their whole life and the next twenty they've never they've never referred anybody for crown. Thank you very honest and they don't do it themselves to me there's gotta be something wrong. Have you noticed that phenomena. Of course what. Well you don't know won't hurt you. So yes absolutely. There are many Basically undiagnosed Purnell all disease in the practices. So you know when you see their patients who have had All these restorations that are either sub changeable changeable and causing increased bone loss because the crown limiting was not done or because you have recurrent caries because because the margin was so sub Ginger Ale that they couldn't capture a good impression so Kremlin and it could be a very important but if the dentist is is not pursuing that you know they wouldn't know why the case failed. Why did they end up with a recurrent caries is just because they were unable able to capture the impression because there were always into the biologic with and they were unable to capture the good impression so I think a lot of that goes on one but people don't realize while the cases are not lasting as long as they should be because they didn't really set up the cases properly I'm I think it's hilarious out here. PHOENIX Where they're now they're advertising that that colgate now has a toothbrush that connected to your APP and we're just trying to get him to not smoke math while drinking mountain dew but the million the dollar question is that Dennis ask is is? Do I treat carried on these better with an ultrasonic toothbrush connected to an APP versus my the old oral B. Manual tooth. Brace with with crust toothless. Well the reality is that there's no evidence that one form of tooth brushing improves outcomes. In terms of whether you use the power brush versus a manual brushes any differences differences. However if you can have some kind of a motivation or behavioral modification by using an APP and just like your Apple Apple Watch candidate reminds you to get up an exercise? I don't know if re actually translate into people exercising more but if there is some benefit in that I think there's nothing wrong with that you know what got me to start going to the gym regularly and I'm not even kidding right there on a millstream by Asu. They opened up a bar called the JIM felder. I G I am and it's like I am now going to the gym. So so there's there's a A lot of people talking about some of these procedures and they have named almost like Nike or reeboks The pinhole technique. And you see there and there you actually see a trademark and then someone else was saying they were doing a pinhole technique and I. It was like well. You can't say that that's trademark so so explain the pinhole technique. Why is it trademark? Does it go by other names What what what is that all about? Because I'm just I'm just asking you the most common questions I see on social media I see so there are different modalities for treating ginger or recession defects okay and their most common way is reflective reflective flap place graft and coralie advanced the flap. Then you have the tunneling techniques where you don't make make the surface incision on a flop incense you create a tunnel so one way to create a tunnel is to go through Saugus of the teeth. Another way is to go. Oh through the vestibule now there are different techniques to go through the vestibule of the of the teeth one is to use the pinhole which basically Sokaia uses instruments for puncture through the vestibule to create a movement of the tissue the technique that I've been working with this call vista that's also vestibular incision that creates a tunnel for Carl Roll advancement so I'm obviously biased about the technique in terms of benefits of that for being able to currently only advanced the tissues and achieving Ruth Coverage. The reality is that we haven't had side by side comparison of these techniques to decide the effectiveness of of these different techniques. But I can tell you that this definitely as a completely biased. Individual has many advantages for treating ginger recession in the sense that we create a small incision in the vestibule gives us more maneuverability to be able to loosen up the tissues to correlate advance but also a key aspect of it is this is a rigid fixation of the ginger margin. By bonding the ginger margins with suture two teeth. So that's really Goes at the heart of this procedure to corey advance and bond each sutures. The teeth so then it creates a very stable GINGERBREAD position during the healing so the ginger will attach us to the new location. Now if you contrast contrast that with Pinhole pinhole basically If you look at the publications there that was was in two thousand twelve They showed that it's a procedure that does not utilize sutures for me. Personally I think I think Having the suture is very important aspect because if you don't stabilize ginger margin with some specific sutures. There's there's more chance of the movement of the tissue during the healing and more chance of relapse so this this that's what that's The means and Talion word means site or view in Spanish means literally until I see you or more simply sealer so so talk about. What is the Vista? Oh It's Vista Institute for Therapeutic Innovations. That's okay okay. This the institute is my institute where we teach various continue education courses but this as a procedure is an acronym for vestibular incision superiore. You'll tunnel axes. So that was my next guest right. That was very next guest. So that's just their acronym. Okay so you're gonNA remember speaks ally. So Vista stands for what vestibular incision should buehler. You're incision sub periosteum tunnel. Incision sub Perry allsteel tunnel. Yes access so access. So that's a so that's kind of like. Is that kind of okay. But ad describes each gingele recession so we use vista for many different types of use it for plastic surgery procedures including treating Ginger Recession you can use Vista for treating Peri implant a recession. We can use vista for tooth extraction to manage the the hisense around those areas. We can use this stuff. During immediate implant placement to monitor the facial official area for soft tissue augmentation or argumentation we can use Vista for. Gb are for bone argumentation For irredentist site there are many different applications of Vista but the most common is to treat gingele recession around teeth or an close to recession around implant so to that so your website is learn this to dot com. Yes so the websites learned this dot com and I want to tell you what this means because I mean I already knew. The titular incision sub periods of steel tunnel access. That I say right you you may get and who who are is going so go to learn visa dot com and. What are the problem with Dennis is? They're they're. They're practicing low. When I started the goal was no deaths whatever act practice solo again so? She's on our commute to work. I hope she's driving you work because I if she's on the hour treadmill just get off and it's just just stop it. It's hard for me to focus when I know you're on a treadmill who but she doesn't know who's going to your courses and what are they learning because I know they're successful and by the way I got a hand to you're southern. California consensus opposed is February. Six and eight. I mean you have the Two four six eight ten twelve fourteen sixteen eighteen twenty twenty th those are like the twenty four biggest names in parallel or in dentistry. I mean that's a That's amazing mazing. Twenty four speakers from seven countries. So so I wanna be your first art with them because don't tell no one brexit alone Why I wipe are her home? He's flying out to southern cal to go to vista learning. As I mentioned the beginning the the most important aspect of improving our outcomes is not to buy piece of equipment or gadgets. The most important is improve improve information so I think that's the most effective way is to get information from reputable sources. I think you anything that we can do to improve our inflammation. I think that's the most important so at our institute we have courses that use a blended learning where we have half of the material online. But the but you still need to be in person there to do some simulated exercises sizes to give some feedback to make sense of procedures to meet face to face to discuss the clinical procedure so we have many courses with hands on component life surgery so colleagues come from all over the United States and some also from foreign countries is to basically hone their information and their skills about some of the importance of inflammation and procedures in dentistry Of course Vista is the technique that a lot of people come to learn but we have many courses in conjunction with with other colleagues with other buried on US and other colleagues on that. But I thank you for mentioning about the southern California Consensus Symposium that's coming up in a couple of weeks and February six to eight just as a way of For your followers for for the town is I have a promotion code if they want to go to that website LEARN FISA DOT COM if they want to What what's the promotion Townie so if they if they use a promotion Kohn a code of Townie they get two hundred dollars off of the registration and we're in they register at learn Visa Dot Com. That's correct okay. So I'm Lauren visa so I go to registration so I go to registration. Yes so then. When you put into Promo Code hold townie you get two hundred dollars off of the registration and fifty dollars off of each of their hands on workshops so ties just I just typed in town running? Said if you're Italian you need proof that you're still a licensed dentist so so so the we're is that it's going to be Woodland Hills California. It's it's the symposium is in downtown at the La live right across from Staples Center. Oh so that's at the J W Marriott in La live that's where the symposium is located SC larger event and so so that's in Los Angeles nine hundred West Olympic Boulevard. That's downtown L. S. downtown La Right at the staple center at La live You know I know that many colleagues like to get the education from online and I think that's that's good but still we need to be have in-person major events like this to to see our colleagues network. Listen to some of the top speakers in the world for me. I attend a lot of these. I give lecture in many of these type of events but also attend them for me. The most important is that when I attend an event like that I get inspired. I get energized is GONNA go back to my office and treat my patients with a renewed energy because you see some of the people with their you know that are the top educators hitters in the world and you definitely can be inspired by what they're showing in terms of the outcome. So what would you say is the theme of of your symposium. Our team is trends in clinical dentistry. So we have some of the people who are the trendsetters thought art leaders who are coming in to give their presentation and the format for us is is a bit different that we have the lectures from these speakers coming from all over. US speakers several of them come from Europe and Asia and when they come to this they they partic- they give their lecture. But we have these prolong panel discussions where we put pose important questions to them and we we really put them to challenge because we want them to just say how as how it is and and we actually put people with the opposing and Philosophy's just so that they can kind of clarify it for the participants about the point of view so i. This is the first year that I do this. As a southern California consensus symposium prior to that I ran the UC a parallel implants symposium Up and for sixteen years. So this is a new venture for me to do it as a a non university but private events because that really allows us to rethink and reimagined not have some of the restrictions actions and and to be able to do a world class educational event. So I'm going to. My job is to get you to make the most dentists mad. I'M GONNA I'M GONNA I'm GonNa ask you the ones that I'm so we'd Curl Mishaan here and and Carl Mesh really loved him because he he would he would always tell you what he thought he never. He never pulled any punches if he didn't but he said that the drawing blood there is no research and he said that was our was necessary. I got friends that said that the the way they draw make the putty they just love it So some people are saying. There's no research for while we learned from the New York Times I share. There's no research for floss member making so do I need to draw blood and spin it and all that stuff or do I not well one of the individuals who will be at the symposium is Professor Ganapati who's coming from Gertie University in Frankfurt. He's one of the originators haters of the protocol is done. Probably some of the most significant research into the biology of the platelet. Concentrate and concentrate the traits in this area. Yes there's a lot of poor research in this area but there's also a lot of great research which has demonstrated clearly early the importance of blood concentrates on what it can do for us in any kind of surgical therapy. So you're saying Karl Mesh on this show was spreading. MISH information did was Carl Information. Did you catch Michigan. There were many different kinds of AH blood concentrates the first generation of blood concentrates where Carl Mitch was talking. Can about the P. R. P. and platelet rich plasma that was the first generation that required you to use an anticoagulant and then draw the blood and then it was a very cumbersome multi step procedure that required you to argue late it using `thrombin so it was very complex procedure and many of the research that was that was platelet. Rich Plasma so P. R. P. STANDS DANCE FOR PLATELET rich plasma so that was the first generation of that basically a lot of the research done by Robert marks marks and In in University of Florida and and he did a lot of great work in that. So I think doc it's not fair to Poo Poo all of that research because they did find a lot of benefits for PRP but when and they put it into specific tasks for example. Would it make bolt more bone in the sinus. They didn't find it because it doesn't do miracles. Calls when you expect things from it we know that it does when we use these platelet. Concentrate you can find many different benefits office. First of all you have improved control of inflammation so I use it for routine and I can tell you just aside from the research. There's far less inflammation far less Dima. I think the bruising that we were seeing with the major surgical cope procedures is almost gone away when we're using these acceleration of healing and You know reduce inflammation. These are things that have definitely be found. Do you find more bone not all these researchers found that consistently do you to find more Perry Dont`a regeneration there's some evidence that actually shows that yes. There is some additional clinical benefits of using it for for parallel defect. You find a faster healing. Yes that we can say conclusively. There is faster healing of the macossa. When when we're using it? Is there less pain. Yes there's a lot of good researchers show that when we using the platelet rich isolates the we see a lot of Improved and pain experienced from the patients. So anybody WHO's interested in that Professor Gennadi spending a whole day of going over and all of the biology of this and the clinical benefits of using it in the regenerative environment and he can actually distill their importan evidence that we have from some of the Rick evidence because there's a lot of poor research evidence in this area as well. Now this I'm GonNa ask you a softball question. This can get you in trouble for anything. Who pleases is if you're a general dentist who plays the implant? Better World Surgeons Generalization. I think that You know the the you know what whoever has the best information I think actually ends up with better outcomes. I think the decision making is the most important aspect of it. The actually technical aspect is not as hard as the decision Jim Making of when to treat how to treat what what material to select how to sequence at so whoever has the best information. We'll have the best outcome and he. You may not be any specific specialty. As a general rule. I think whoever and also has better maintenance S. program afterwards to maintain these patients over time will actually have better long term results so I think that's what you want to going. So that's February seventh and eighth. Yes every seven days. That's just a one two three weeks. Who who is your target market For this symposium is it Who who which one of my homies? That is. The best this is for is anybody who wants to have up-to-date information. Because we believe that you know you you have to get information to every you know discipline and every clinic clinician there. So we have some restorative `presentation Shannon. We have some surgical presentation some scientific presentation and we have a hygiene day so anyone in clinical dentistry could benefit from. I'm this How crazy am I that because you have a piece of knowledge I mean I I think that got it? So darn cool but I see these on fours and I get the business side of it because Americans want instant gratification. I mean when I pull into McDonald's and and there's three cars in front of me so mad sometimes I flip turning go across Burger King just despite them right and I'm looking at that it's like okay they got a full mouth of gum. uh-huh Z's they all the teeth place the implant to me. I'm thinking well. Shouldn't you pull all the teeth and put them on Arendt and some antibiotics at least give it a day for all the p Jinja vowels to die and then I've read papers say now Howard because that that that PG to be living in your tonsils. It'd be living in your mouth. But I I don't know I see the the worst gum disease cases and you know I know I know everybody who talks about all on four but remember clear choice doesn't even do eighteen thousand arches of all in four for a year. The most common procedure is not on four. It's all on none. It's a full denture and you see how many full dentures are done for a real on forward America. What would you say one hundred to one so but when you see those people with full mouth gums and you pull those teeth two weeks later? It's fresh pink carpet everything's beautiful. It's the miracle healing. I tell people all the time when they're sick and they're like You know I don't know if if Oliver get over. I say you know for thirty years. I pulled out a tooth. You leave this big hole pass infection. Whatever and they come back to later brand new pink carpet? Everything's things are but it seems to me it Peri implant tight is is a problem. Wouldn't why would you wanNA pull do all the teeth and place. Implants a same day. Wouldn't it be better if you just waited two weeks. Let the new pink carpet come in with no gum disease or my mind. So treatment treatment in general is about risk assessment. We have to do risk assessment on our patients to find out who are at highest risk and assign treatment according to their risk and decide the protocol. The problem is that when you know all we have is a hammer everything looks like a nail. And that's really the approach that I think is the wrong headed approach when it comes to some some of their senators who are treating this who basically look at every patient who comes in and say okay. I learned this particular modality. Everybody everybody who comes in. I use a cookie cutter approach on everyone so I think in general to what you treat referring to. I prefer prefer not to name all on four. I think that's a really terrible name because it emphasizes one thing which is four. I think the general concept of that is using a combination of axial implant straight implants and in conjunction with tilted implants. I think that's a valid concept that can work very well the concept of immediate loading. That's a concept that works very well but we should do risk assessment our patients. And I. That's your you actually hit the hammer the nail. Because what happens is that many times. We have a patient who his hated to go to. The Dennis is been phobic in and sometimes I have patients. I have some friends who work in some of these clinics are working as a male to do this kind of treatment on everyone who walks through a door. The problem is that these people come in. They think that they they hate to go to Dennis. And they're led to believe that if they extract the teeth. That's the end of their problems. Once they place implants and they will never have problems again and that's really the misinformation that they're that they're giving to these patients so the concept of you know immediate immediate loading on even patients who've had history period disease is valid. But you're correct. We don't need to do that on every individual if if somebody has a very poor hygiene if somebody who has demonstrated that they're capable of doing something better to jump into a treatment men of extracting all the teeth and do this complex treatment on them and not go through the effort of disharmony whether or not be able to maintain ED. I think that's a you know really am not doing doing a disservice to their patients. So you're correct that maybe those patients we need to step it back a little bit. Go through some Some oral health In Health instruct oral hygiene instructions. Make sure that they're capable physically three to maintain these if they're not able to maintain they're GONNA lose them. We have. I think we're opening up a future epidemic mic of of these large constructions. That are going to fail. And we're GONNA have a lot of disappointed patients because of the fact that they're not properly treated a followed so what's the difference between She's listening to you now. She's saying well. Should I go to your visa institute where it's classes with you. Or should I go to. The southern Californian consensus oppose him favoring six say on your website five reasons to come to the Vista Institute World Renowned Faculty with Passion for Teaching Number to updated evidence based knowledge on important clinical topics picks number three cutting edge practical techniques guidelines and protocols number four simulated exercises to elevate clinical skills and provide feedback back number five live surgery demonstration to allow observation of clinical inflammation and number six free beer. Free Beer Free Beer. So what would be the difference between going. Would it ever seen the Visa Institute and going to Your Day. Southern California's consensus oppose him. What would be the difference there and To the thirty thousand dentists who are members the FA Academy of General Dentistry Five hundred hours of clinic but to get your masters ship it six hundred more hours and four hundred hours hours of that has to be hands on what percent of your Vista Institute courses qualify for. MADD hands on to to get your madd okay. So the difference between a symposium the symposium is when we have these twenty four experts were coming from all over the world the top experts in the world. You have them in one place in a two day format that they're sharing big concept ideas us so when you hear about these big concepts they basically open your mind to things that we may not be thinking about. We see what they're doing. We can get inspired by them. We also have an opportunity to see a large number of our colleagues network so it's a different setting where we look at the big picture ideas but we're really looking at them more in general form to kind of You know get us started but then when you come to the Vista Institute you coming for more in depth information on specific treatments for example if you WANNA learn the vista technique you will come in this Basically one day of the material online so it's basically available would would on demand access and the other day is is is Basically more clinical descriptions and hands on and live surgery so this is a much more indepth training. which gets you prepared to be able to implement those things in your private practice? So that's year tord clinician. So all of the courses that we have at this institute will include at least two to three hours of of simulated exercise hands on workshops day but they also have a lot of inflammation clinically relevant. So you can implement them in your clinical practice. So those are geared toward people who want to have much more indepth information to be able to implement the full protocol and the practice How would ucla let someone How did you see someone in from? Ucla I still can't figure aren't those like oil and water. I mean I think anybody I didn't think anybody from USC like anybody from Ucla. Sheila but there are they working together now. You promised me our your life our fifteen minutes. I'm so grateful. Do you need to run run run or can I do any more overtime. It's up to you and it's up to you. The honor is all mine. Have some. You've asked some great questions. You open the a lot of important fourth topics in our clinical field. I think you're doing great service for their profession. I think you'll really am bringing some important information formation to light and and keeping a lot of the colleagues you up to date with information so i WanNa thank you for that. Well thanks thanks. It's only the only thing I do is for some reason. People like you to come on the show but Sinus list I just real quick. I'm when I got out of school. The best implant was the longest one I mean. They they wanted to go all the way out the top of the head around the moon three times back down and now the implants I like them better. Because they're getting shorter and fatter. And I like anything. Shorter and fatter is sinus. Lifts going away because the shorter fatter. Implants you're not GONNA have to go into the sinuses much or is that more dream name voting okay so nothing is going away. I think the key is that as doctors. We should be using being a decision tree to decide the best treatment for a given individual. So I know that. That's the approach. Many he called Who Love to do sinus augmentation? Every patient walks into the door gets a sinus augmentation. Those who love short implants every patient patient guests at the reality is that we should have an expanded armament Taurean so in our toolbox. We should have many different tools that we can utilize based on the specific needs of the patient. You are correct that the the evidence has clearly demonstrated that there's there's no difference in the length of the implants so short and long implants performed very well. One of my areas of research has been to compare pair in clinical trials randomized studies of of Short versus long implants. We actually found that the short implants have a little bit. I'm less bone loss around them. Yeah the so you're saying short and fat is better short. Works very well not not fad necessarily early because we used to think maximum titanium volume so rethinking actually shorter and narrower. Because we don't want to take more bone out to put could more titanium in but that's why they're confused There's two dental schools and the valley. Here we got. At Still Mesa and and we have mid western and both. When I walk into either one of those schools? They say they go the buried on his. They don't make sense. I say why Oh do anything to save bone and then over here on the all on four there shaving down the bone. They said well we need room for inter how do you. How do you worship bone and then shave it all offer on so there's a time and place for all of them? Each of those receptive therapy to respect the bone to place the implant into base. It's a great treatment but for the right patient saving. The bone is also great treatment for the right patient so rather than saying this or the other. We have to have a decision tree you to side. When would be the best way to use that? What are you sounds like an online course? You should make town we. We had today actually addresses society period. Exactly that we went to the whole decision tree to talk about exactly the all of those points but well I'm happy. I think it'd be the the best marketing because What paint he did is they? End the Dawson Institute. They said okay. We have five one week courses. That's that's a big jump to go from from an ad in a magazine or a flyers or tweet on twitter to a week so they made a one hour course for each one of their weeks and said it it was the best marketing. They did So many people when they do a one hour we put up four hundred course on Donald Time. They've been viewed over a a million times so I only want your course on there just because seriously would add so much for stage To of course I'm just just a couple more questions Now the big thing is natural paths natural medicine natural everything. Would you say to the holistic. Dentist I who are treating panels Z's with with probiotics I'm Pro Bio Geisha Cultured. CARE probiotic gum in private or fly revived and do you think Do you think that's bleeding edge leauge here now and why is there no Olivera I. I don't understand. How could you be a natural path out aloe vera? Integrative medicine is really great branch of medicine because integrates greats many areas and and looks at some of the traditional medicine along with complementary medicine and by comparison an integrative dentistry is also a great when we are integrating different aspects of what we know from the traditional dentistry but also also we're bringing some alternative treatments but we have to be very careful and you know there's a difference between utilizing some of the naturopathic information that we have and that may have health versus doing boo dentistry overdue practice. So I think there's a fine line between that so I'm all for complementary medicine complementary dentistry many areas a two years ago we did research on hypnosis to show how hypnosis can actually change physiology it changed your immune system it actually can change so there are many areas where we can find information that that these could be useful but also there's a lot of unfortunate where people are using Treatment without evidence. I someone showed me that. They're taking people to take all of their titanium implants and they're doing all of this other stuff and they're putting their cornea implants in them. I I think this could really get out of hand. If it's motivated by something other than what is in the patient's best interest so out of hand wouldn't it be out of mouth just gone just to be clear are you are you. The man are are doctor is a day are using any laser in your office as Picasso lightly any soft tissue. Do you have any need for a laser. Laser is also a tool that can have some benefits. There are definite benefits. If using laser you can have better visualization Zeh Shen to perform scaling roots. Planning you can There some limited evidence that you can have better outcomes on your implants now laser. What does not do magic right so there are some people who are basically over in now promising? What laser is capable of doing? So I I have no problem with laser as a modality as a tool but you you know unfortunately again some people are abusing laser and and Using it for something other than improving outcomes for patients two more questions and all that you guys wearing we're down to the deal As a period honest not as an implant implant implant surgeon as as a period on us is there any advantage to bone grafting extracted socket You know you pull the tooth Yea Your Naser advantage of that that also comes to risk assessment yes. There's clear evidence that by placing bone on graft in the extraction sock socket grafting you can minimize or reduce the magnitude of the dimensional loss. That comes after tooth extraction distraction. So that part is very clear but what comes along with. It is a delay of healing anytime. You put any bio materials in extraction distraction socket. You've got a delay the healing so there's a pro side of reducing that the shrinkage of the of the ridge but there's a downside site of delaying the healing. So you have to weigh the pros and cons to say. Would you benefit more from reduction of the volume uh-huh volume loss or would you know gain more by having faster healing by not putting a graph material in there. So what comes down to the the most important decision aspect is measuring the thickness of the buckle if Bucko bone is less than a millimeter. EITHER STICK YOU'RE GONNA lose tremendous amount of bone so I would advise those cases to graph the sockets because if because if you don't you can have as much as fifty to seventy percent shrinkage of the bone bone versus if you have a thick bone which is more than a millimeter either of the buckle bone thickness. Those ridges are very stable. And they don't need to be grafted so that's one thing that you can use as a decision making process to decide whether to graft or not and I had the best bone grafting technique in the world minds mine's better than them. All us for the bone graft mother-in-law bone and it worked so it was a what is the. What would again Dan? You know you go to McDonald's for a big Mac. Frantic coke If I if wouldn't her colleagues go to your Visa Institute stew for therapeutic. Innovations would be the hamburger prego what what are the three most reasons you see students going there. Wh why are they going. They're number one reason if they want. They want the come because they wanted to vista technique. I think that's where is used for most of the treatment and I've gingerbread recession and treating mucosal recession around implants. So that's the number one reason people come courses. Kindergarten right is it only knows that right. So that's so people who WANNA learn to treat injured recession or treat them mucosal recession around implants. Those the most common reasons why people come. But they're also the second type of courses that we have our or treatment of dentists patients for immediate immediate loading kind of cases that you said I hate to use the word all on four but it's basically a treatment of immediate loading on those but also people come to learn regenerative therapies regenerating bone augmentation in different areas of the mouth. So those are the the three types of courses that we have. Let me tell you something. It's in two weeks it's February sixth and eighth. It's in Los Angeles my God but I can assure are you. I've been in this business thirty two years. Those are the twenty four most amazing speakers from seven countries all in La. I mean that is a Helluva deal and how much how much is the course. Well for. It's six hundred ninety five dollars but if you use the Promo Code Townie you save two hundred dollars on the registration and by the way. There's no commercials did you. Did you give me any money for this. He will come later. No one no one's ever they don't no one's ever given me money to be on this show and I I've I've been trying to get you on this show for four years and this was a dream. Come True Mike say my My parried on us every pairing on a Sino This is their man. And if you're a dentist and you don't know that worships this man Go because if you don't know this is the man you might not know some of these speakers coming here but My God you're a legend in my mind. Your legend Emmy View. Google your name on dental town like say I started this program with this is this is the most common way I see your name on dental town. someone's talking coronal tunnel graft and it's just like what is what is today's say. Say Your first name homers is a day Thank you so much. It was just an honor to podcast. You today live in the studio. Thank you so much. Thank you very much for being anti eh inviting me here and thank you for everything you do for the profession same backyard.

Ed Perry Dennis bone loss Howard Perry Donald Los Angeles Perry Don Titus USC Phoenix United States California Pun Titus president USC Brightman University of Connecticut
Ancient Egyptian Mysteries

The Naked Scientists

1:00:49 hr | Last month

Ancient Egyptian Mysteries

"This episode is supported by inside the breakthrough. And you history of science podcast full of. Did you know stuff like electric cars. And not just a twenty-first-century idea best friends henry. Ford thomas. edison tried to make one but saudi failed. A mary. curie wasn't as he's wadi thought french. She was actually polish and her father was part of the resistance against the russians. That ruled poland back in the day. He taught physics in secret in the basement of their house. Inside the breakthrough explores the idea of a eureka moment. It's historical wisdom mixed with modern insights. A mashup between a history show and assign show we quite a few laughs along the way to hosted by dan riskin. Each episode has a theme with that light bulb. Moments and scientific history is made to twenty twenty one being the one hundredth anniversary of the discovery of insulin. I've had a sneak peek of inside the breakthrough. And it's great informative fan. So search inside the breakthrough. Anyway you listen to your pocus. And we'll also include lincoln show notes. Now thanks to inside the breakthrough for their support. This episode of the naked scientists is supported by. Now what's next the newly relaunched ideas. Podcast from morgan stanley. The helps make sense of life. After the pandemic it tells the unexpected stories of the businesses citizen individuals that are rethinking age-old assumptions and seeking out new opportunities in the wake of covid. I listened to the now. What's next episode working together remotely. In which astronaut jessica recounts her experiences of living aboard the international space station for six months somewhat surprisingly. She says she felt isolated up there than she does. Now here back on earth in lockdown you can hear what else she had to say by looking up now next wherever you get your us will also include details in show notes. Meanwhile thank you to now. What's next for their support this week. Welcome to the show where we bring the science. He means discovery statue. Unbelievable this is the naked scientists. Hello welcome to the show where we bring you. The latest breakthroughs in science technology and medicine. With me chris. Smith either higginbotham. Coming up the fireball. That shot across the uk guy. A new device protects women from hiv and the carbon footprint of cultivating cannabis plus solving the mysteries of ancient egypt. We delve into the discovery of secret chambers hidden inside the pyramids and two glowing bones reveal antibiotic use going on thousands of years ago the naked scientists podcast is powered by uk. Fast dot coach uk on the final day of february people in some parts of the uk were treated to a celestial light show as a meteor streaked in from space hundreds of videos viable have since been posted online by amateur photographers. We'll see even more special by analyzing the footage multiple networks of cameras for the first time in three decades in the uk the coporate and as it turns out very rare space rock the caused all this was successfully tracked down and recovered from someone's driveway. Phil sansom spoke to the uk meteo observation networks. Mary mcintyre to hear how it happened. There was a really bright fireball picked up across multiple networks. A week ago on sunday and later in the week we found out the in meteorite fight being recovered and this is an incredibly thing to happen in the uk actually even in the world to recover meteorite that's been seen as a fireball quite ready then we found out that it's one of an extremely rag kind of meteorite just so many special things and we just haven't been able to sleep because we're just so excited such a huge win for citizen science. It really was. Wow and you didn't even know what was coming. Did you just sort of appeared as a flash right. Yeah these things. You can't predict them. They're entirely random pieces of space debris and this one was really unusual because it was captured by so many cameras across the because we had a clear sky across the country. What does it look like. Is it just a bright. The whole sky lynx up or is there like an angle you can see and that's how you figure out where he's going. It depends way you see it from our camera so it was heading straight for us so actually on our camera was just an enormous flash and it was really difficult. Get any data from it. Because she couldn't see a flight path but there's a guy called rigid fleet down in wiltshire. Who caught it side on is the most phenomenal bright thing. Streaking across the sky just resulted in this enormous kind of explosion and it fragmented. We could see that there were multiple fragments there and won't she kind of do the calculations behind the scenes. They can figure out the speed. It was moving the angle through the atmosphere. It's exact path before it been up and once you do all that they can also figure out the mass. And once she know the mashed you can then calculate whether something may have survived and landed the normally something like that would be kind of kept quiet for fear of contamination but because of covid and the fact that the area that they think it landed was basically lots of farmland in the cox worlds. None of us are thought for a second that this would get recovered and if it was recovered not for many days when it been rained on all that stuff so it was. It was just incredible. It could have gone in a stream. I'm guessing it could have gone a sheep's trough and cheap eight it. Many fables in the k. Are thought to survive but the end up in the sea because the small island so who actually found dead and how one of the homeowners at actually heard third on their drives the previous your house and they just didn't think anything of it but once the natural history museum per hour video to local saint. If you see anything please have a look and they went out and there was a fragment some dust and kind of black raise on driveway. And i think a fragment bounced over the the walter. Next door's garden wants. People arrived on the scene from wednesday onwards. There was like a fingertip search of the area remote fragments being found in. We've now found about hundred grams of this. Which is just extraordinary. You said that not only was it. Amazing space rock. It's also a very special kind of space rock. It is it's it's a type of meteorite called a carbonaceous conned right and they're really important because most of them originate from the asteroid belt asteroids themselves the old because that leftover material from when the solar system formed four point five billion years ago. But what's amazing about carbonaceous conroy's they have these tiny little of material that actually predates our solar system some of them have organic materials amino acids in them and to get a sample that is really pristine like this is incredibly rare and so important for scientists to kind of analyze the material and find out the origins of our solar system and before also system. It's just being one of the most amazing stories of the decade and the hasn't been a full that's been found for thirty s in the uk. So it's amazing and what's funny as well as aren't their missions. Going on right now. Sending probes up to asteroids way out in space desperate to try and get any sort of sample from them. And we've just had one line right at our doorstep. It is well. There was actually a mission to the asteroid a writer and the quality of the some police comparible without sample return mission from right and they brought by lake tiny amounts of asteroids. And we've got four hundred grams of this. I mean you can't rely on them landing as a way of analyzing them because it just doesn't happen very often. I take me found all the time. But they've been led on the ground. Who knows how long. And still quite believe israel i just honestly when i found out i just cried because such an amazing story. Wow astronomy gets light up but the homeowners were glad. They didn't leave their car in the drive that night when they that was a very emotional mary mcintosh she's in the uk metoo observation again. If that story has picture interest you can get in touch with that group. Look them up online. And they'll tell you how you can set up your own. Meet your camera. And then who knows mobile. Be catching the next amazing bit of space. Dos raining now. Around the world close to forty million people are living with hiv most of them in poorer countries but encouraging results from a drug impregnated ring. That's inserted into the female genital tract. Show that it can cut. Hiv infection rates by fifty percent so staggering. Difference isn't it. It's made of a soft silicone material which is designed to remain in place for up to ninety days at a time and then steadily as it goes along. Release a cargo of the anti-aids drug to peer evine. Now this could make a very big difference to the autonomy of women who live in third world countries which have been previously very hard hit by hiv public health research. Albert blue has just presented the latest performance results of the at a conference. Women make up more than half of all people living with hiv and they need a range of strategies to prevent hiv infections. One promising approach to hiv. Prevention is the use of vaginal rings which are really exciting because they offer long acting prevention approach to preventing hiv. Now when you said that women make up more than half of cases while they disproportionately impacted by hiv then in saharan africa it may be unequal relationships with men as well as some women engage in sex work and may have less economic opportunities and there may also be some biological differences that make women more susceptible to hiv and the approach. That you'll testing here. Tell us how it actually works. And what does he do. And how does it protect the user. The doctoral ring that we have been studying was developed by a nonprofit group. The international partnership for microbicides. They've developed a ring that contains a medication called the differing. It's an anti hiv medication that is dispersed into the ring and releases the drug slowly into vagina. This medication prevents infection taking place in the body. And does it actually work. Is that what you'll finding. There were two large studies and over forty five hundred women in africa and they found that the ring was both safe and effective in reducing. Hiv infections the latest studies. That were done suggest that the ring reduced hiv infections by about fifty percents wise. This better though than just popping a pill because we could give this same drug in pill form which arguably might be even easier to distribute. Yes the pill. Form of prevention also known as crapper pre exposure prophylaxis is a really important and exciting option for hiv prevention. But what we've seen across a number of studies is that oral. Prep is not for everyone. There may be number of reasons why women may prefer not to take A daily pill can be challenging for people to remember to take the pill every day. Also the pills needs to be kept private on that can sometimes be a challenge so there needs to be a range of options for women to be able to choose different options that will work the best for them and is the strategy then the women insert these rings and keep them inside for the full lifetime of that ring or do they take it in and put it out on a daily basis. How does it work. The ring is designed to be inserted and remain in place through the duration of use. And so for the monthly ring. That's or a whole monthly period. You've go to ring here. Which is just one drug in it. Is that not a risk though that. We're going to end up with the next scourge of hiv being resistant to that drug and it will just therefore cement. The protection conferred by these rings. And people are gonna catch hiv anyway. That was a look at in several of the earlier studies a looked Women who became hiv positive in the studies and they did not see element of hiv resistance as a result of use of the ring. How is this going down with the uses. Women have reported that the ring very easy to use and also neither they nor the partners could peel the ring during sex and they liked this option as a prevention strategy and impact on fertility. Is there any impact on likelihood of conception of these drugs considered completely safe if a person does full pregnant while they all using this particular method. There isn't evidence that these rings Affect fertility the are currently doing a study of ring us during pregnancy is a really important study because women during pregnancy are particularly vulnerable to acquiring hiv. Albert live from the san francisco department of public health. World is worried about a number of new corona virus variants. But are they going to be a problem for the vacc- biologist pay young. She is working on exactly down. We think as i've seen steel works quite well. Here's the issue quite well sometimes means not as well and we don't know whether that is good enough that minimum bob has not been defined that and more on febreeze episode of naked genetics. Wherever you get your podcasts. Coming up the carbon footprint of cannabis production and unraveling how novel technologies are helping. Scientists uncovered the secrets of ancient egypt. First though researchers using the large hadron collider the hcf sern so they've recently discovered a new exotic form of subatomic particles called tetra. Quarks they exist just fractions of a second so the very hard to spot there even harder to study but luckily with us now is. The university of cambridge is cliff is a physicist working on the experiment that discovered them and he does. I'm pleased to say. Harry have slightly longer to tell us about them than they hang around for also tetra quote then very simply a tetra. Walk is a particle made of two quarks and to antique walk so the full objects inside basically hints the tetra. a requires a bit of unpacking because you might Well every atom has a new kiss you probably know that the new cases made of protons and neutrons we've known more than half a century now protons neutrons amid a three quarks each bound together until recently we only knew of combinations of quarks that came in threes or pez so tetra. Quarks are holding you close of particle that we didn't know about until relatively recently is funny. Isn't it because the reason we call atoms. Atoms is the greek word. Tomas means cut an eight-hour moss. Means can't be cut down further. So initially scientists thought atoms were the smallest possible things and then people realize that atoms have got things inside them. Protons and neutrons anthem they with the smallest things and then people used started smashing things together very high energies and realize that those tiny things inside atoms have actually got tiny things inside those. Those are the quarks yet. That's exactly right. I mean there was this big mystery. In the nineteen forties and fifties when in particle collider in astrophysics experiments. People would discover all these news. Subatomic particles middle strange names. Used with concrete letters like delta's ann landers and it was called the particle zoo. No one really understood what these particles were. It was eventually realized you could explain this. Huge number of different particles is being combinations of basically six different types of even smaller particles called quarks so that's almost up-to-date understanding of the basic ingredients of matter today. Why don't these things hang around for very long though basically has to do with the forces. That bonding together. So actually. there's only one possible. Made of quarks as far as we know completely stable and that's the proton so that's the thing that's inside every atom and that is a good thing to the proton stable. 'cause if it wasn't well you know every disintegrate but anything apart from the proton basically is unstable. It can always collapse in either break apart or nine late with itself into other particles so these things because they're bound together but not in a way that allows them to exist. I don't have time. And they very quickly disintegrate into other sets of particles which we then detect in our experiments are they therefore real an important part of physics or do you think that just an artifact of the fact that you have in a natural way slammed particles together you can detect these things trendy but because they disappear. They play no part in january physics. Or do you think they really do have a role to play in the way that the universe works. Well they tell us something about one of the forces of nature so we know about four forces gravity the electromagnetic force sokoll the weak force and the strong force in the strong force is the full holds. The nucleus together holds walks together but the strong force is really mysterious despite being at full speed known about for ages really hard to understand and it's very hard to make predictions using all theory of the strong force. So we call walk out in advance. How quarks come together in what combinations are allowed which aren't allowed so discovering new pasta was like these tetra kwok tells us something about the way too strong false interacts and as one of the four basic forces in nature. That's a really important thing to get a deeper. Understanding often has impacts on the rest of our understanding of particle physics as well and hopefully. That's going to keep you busy for dental on your case. Thanks very much harry. That is harry cliff a physicist at the university of cambridge. You can see why it was called the particle zoo. Quarks and quacks and all sorts now. Although the use sale and possession of cannabis is still illegal in the usa. Countrywide level in two thousand and twelve. The states of colorado and washington became the first legalize for recreational use. And by the end of last year. Twelve more states had followed. Suit with thirty. Six states having legalized for medicinal purposes. Least this has taken. What was an underground black market cannabis. Production into the mainstream with legal cannabis sales projected to reach twenty two billion dollars by next year. So the law. Isn't it but coach averting cannabis all missile scale is very energy intensive. The plants grown indoors using very powerful lights and they also pumping additional. Co two to maximize the yields louis got colorado state university research haiti summa's wondering about the potential carbon footprint of all of this homegrown produce. It's a windowless warehouse. The smell hits you right away. And there's just a canopy of green and then you've got these really high intensity lights that almost feel like you're getting a vernon side and then there's a a suite of dehumidifiers around the room and there's usually simple office fans mounted to the walls that are circulating air. And then there's a number of climate control systems on the wall because most growers really care about the environment. These plants are being grown and so they control it heavily to make the best product possible in our study. The primary intent was to quantify the greenhouse gas emissions from growing cannabis plants indoors. Why would someone choose to grow cannabis indoors where they have to provide things like light as opposed to growing outdoors when the sun's just that. Yeah there's a number of reasons. A big one is being able to control the product. When you grow artificially indoors you can keep your indoor climate your temperatures in your humidity's very regulated so that allows you to make the best product possible. There's also some security or theft issues an indoor warehouses a very secure environment. Also it allows you to get multiple harvests per year because you can create an artificial environment and grow year round. You're not limited to just the weather outside right. If we were to grow cannabis is in colorado. For example purely outdoors we would probably only be able to achieve one harvest per year whereas indoors you can get about six harvests per year. We'll kind of factors. Did you have to consider so. We investigated two primary inputs. And that would be your energy inputs and then any material inputs needed the energy inputs primarily breakdown to either electricity or natural gas and then the material inputs. We consider it. Include things like water or fertilizers or carbon dioxide. And so we looked at basically all of the quantities of those inputs needed and then we acquainted those inputs to greenhouse gas emissions using a standard methodology called life cycle assessment. And what did you find. The total amount of greenhouse gas emissions was pretty so we analyzed over thousand locations across the us and we account for variations in weather and electric grid mix. And so those play a pretty big role in determining your overall greenhouse gas emissions in colorado. We were able to obtain the amount of cannabis being produced and that translates to about one point. Seven percent of colorado's annual greenhouse gas emissions. How big of an impact is this. Intensive growing of cannabis having in paris into the industries that we know release a lot of greenhouse gases to in the past few years on the previous study came out and said that about four percent of denver's electricity is coming straight from these grow facilities so that's a pretty big portion of our electricity use and to put this into context. There's a couple other sectors that i can compare that to one would be coal mining operations. Those in the in the state of colorado are about one point five percent of the state's annual total a little bit less if we just switched to renewable energy resources which is hopefully on the horizon in lots of parts of the world coming up. Would we solve the problem of this energy intensive farming i think that growing indoors in the state that we are is probably the worst it will be as we clean up the greatest certainly going to help. But they're still some of these material inputs. Such is the carbon dioxide supply that are not directly associated to the grid. If it's so hard to grow cannabis in colorado where it is called. why don't we just grow it. All outside in california where the weather is ideal for growing cannabis. So there's a couple of reasons why we can't do that in the current state on. The biggest one is legalization so currently for states. That are either medicinally or recreationally legalized. You would have to grow that cannabis in the state that it's legal in so right now. We can't grow in a state in the transport across state lines if federal legalization was to lift. We could probably come up with a centralized location to grow the majority of cannabis and then distribute from their fifth. Oh heidi psalmist. The study just published in the journal nature sustainability now two slugs and a new video game simulation is being published by a company could slug disco. It multiples the evolution of life in a realistic underwater world. You put basic starting creatures into this water and then you create the environment in which the going to live you then watch as they evolve and a debt to the environment and each other just as darwin described as called ecosystem and the naked gaming podcast. Chris berrow caught up with creator. Tom johnson inspired by some research that was done in the ninety s ads. Mit by carlson. He was sort of working with virtual evolution. The ideas that you kind of have these features that are actually a bunch of boxes jointed together basically and they have a virtual brains that are basically pipeline computers so they take in like visual input auditorium point stuff like that do a bunch of processes and then as an output they apply talks at the various joints. So they kind of move around just like we do so unlike a normal game that creatures aren't necessarily playing like an animation that like an artist made their actually contracting joints at each joint that they have and so the idea. Is that if you take a bunch of these creatures just like totally random ones with random brains and bodies and you throw them in the ocean most of them will just kind of feel around but a few will probably get a little bit and if you let the ones that move the furthest have the most children then after an of generations you will actually have teachers. That can actually swim so that sense. It's like a true evolution game because the physiology is driven by the function and so the premise of the game is basically that you kind of shape this environment and then you sort of throw him these creatures and they adapt to all the different lake. Mitch's that you create. How g model something like that. Because i know that there are existing models for evolution. But how do you actually designed that into a game context because strikes me as probably the nice difficult thing. Yeah it took a lot of work. In fact when i first started would actually take a full day just to get an evolution just to get a creature that could swim. It was a very sort of experimental process because it doesn't matter quite cleanly existing game. There's not like some well established tradition that kind of and copied so to some extent. There's a big element of creativity to it that you kind of have this fish tank except that the fish are morphing team to your tank. What are some of the other factors that are at play here. There's a couple other ones. One that i recently was like creature vision system dishes like their physical body shape their skin. Coloration and pattern and stuff like that also involves many sort of encoded in their dna and so when creatures are preying on each other. They have a vision simulation order to a creature if it's green against a green background. It's it's harder to make that out. The better fits to that harder. That preacher is to see for example. A bunch of forager's that had no predators anywhere don't actually really need camouflage and so they may end up more like the birds of paradise right because it's better for mating right whereas if there's too few sharks swimming around looking for you then suddenly you don't want to be the most ornate beautiful purple fish but you wanna be the one that looks just like the dirt i'm presuming if you were to in real life create environment that exactly. The same thing wouldn't happen every time like you might suddenly find the actually some creatures with shining wings or whatever would start to become very providence. But then if he ran again in real life might find the actually camouflage became the the way to go just for. No reason just because. That's what happens evolution. Does that happening the game as well or is it very much if you were to shut the same thing in the same environment happens the same way. There's quite a bit of variation. So i would say very much is the case that just because of random features and even how creatures are reacting to part of their environment easily other creatures in a sense. There's a decent chance at least if you cut the pressures just right that you know you could probably get camouflage to statistically occur more frequently. One of the main goals for the game was that i wanted to make sure that could actually reproduce the as much as code like method variety that you see in life so i think i would have been a little disappointed if like you always got the same handful of things at that often tend to come out looking like little monsters sort of very alien looking things but there's probably a decent chance that if you through some microbes into the ocean earth you may not necessarily get fish again. You might not get things that look exactly like the fish thing where he used to so give it a go. If you tom. Johnson talking to chris bury now. It is time for our mailbox. And this week. We've had this poetic question from listeners. O. b. cells t. cells. She sells seashells. Please explain what these cells do. All they equally important chris. Can you answer this for us. Thank you so we'll obviously. This is a question very person at the moment. We're hearing a a lot about the immune system because of headlines around corona virus to put it simply these both types of white blood cell that are important components of your immune system b. cells make antibodies or involved in the production of antibodies which sticky molecules that go round in the bloodstream and komo pop things. That shouldn't be there and they take a while to make once you've seen a threat for the first time and they can protect you. Should you re encounter that threat into the future. T. cells are different kind of white blood cell and they are actually in a number of categories. One could help a- cells and they actually helped to boost the response of other parts of the immune system there are also very important class of t. cells cytotoxic t. cells and their programmed to go and inspect all the cells in the body. They drift around in the bloodstream. And find out what though sales are doing and if there are signs that they are harboring a virus or producing viruses. They can nuke the cells and destroy them so together. These things all your adaptive immune system b. cells make antibodies which defend you against encountering a threat again in the future and t. Cells can help the immune system. Do what it does an also get rid of cells that harboring ours is right now. Thank you chris. And if you'd like to get in touch with us with a comment or question for the show. The email address is chris at the naked. Scientists dot com. Abc's done just that and asked us to wish josh. We gather is a very big fan of very happy birthday this week. So happy beth they josh. Meanwhile if you're interested in the current covid nineteen situation. You might like to listen to this week's naked reflections podcast which explores the role. Obesity and diabetes are playing in the outbreak and health in general and why we need to tackle this urgently the naked scientists podcast is produced in association with spitfire cost-effective voice internet and ip engineering services uk businesses. Find out how spitfire can impel your company at spitfire dot coach. Uk music and the program is sponsored by epidemic sound perfect music for audio and video productions for the rest of the program and not going to step back in time in fact to the time of ancient egypt to hear how sciences solving some of the mysteries that archaeologists have been turning up over the years now ancient egyptian civilization dates from around three thousand and it lasted almost thirty centuries a really long time. These people made such a big impact on the landscape and on the archaeological record that the world has been fascinated ever since with the ancient pyramid's hieroglyphs artifacts and mummies that left behind but many of these wrapped up in mysteries that only now with the help of modern science. We're beginning to solve on the first of those mysteries. Look at our the faeroes the kings and queens of egypt. we've reasonably good records for the later periods of ancient egypt. But as you go farther back in time the records more murky this is my worst by the fact that new era had a habit of making their mark by demolishing the paintings and monuments of their predecessors. Tom higham is an archaeological scientists. The university of oxford and he's also author of the new book. The world before us is revealing a new story of human origins. He's been involved in a project to figure all this out. Why though tom would they actually destroy would come before. Was this really just to establish their presence or to achieve some kind of dominance. Absolutely what we quite often this that nefarious came to power by virtue of plotting or coups and they overthrew their predecessors and once they've done that in the temple to establish their legitimacy that we go back and rub out evidence for their predecessors in the form of temple inscriptions prepari- and someone and in fact we see the to this day i mean hosni mubarak's image was and of. His wife was systematically removed by court order in cairo following the spring. So it's something that we see again and again and this presumably create something of a puzzle because although they wrote things down and we knew who lived when in relation to whom. If we haven't got physically things to tether to particular eras or people it makes actually understanding that time. Line that much more difficult indeed and this is part of the problem. I mean we often think about ancient egyptian. Chronologies is being absolutely precise and robust. But as you say there are gaps in the record and there are periods where ferries tried to rewrite history for themselves and eliminates the evidence for the people and when you visit egypt and you see the wolves of temples and so on you can see where often there has been destruction and people have subsequently picked out evidence for katusha identifying different rules ferries. So as you go back in time we have problems identifying precisely who will win how long how are you trying to get underneath this then and basically right history the right way rather than the wrong way that people have sought to manipulate the record. One thing that we can do is we can use radiocarbon. Dating and radiocarbon is a method that was developed in the late nineteen forties so it's a long established tool and it basically revolves around the fact that all of the carbon that we all living organisms uptake has a tiny proportion of radioactive carbon or carbon fourteen and this radioactive carbon is constantly replenished until death. When an organism dies the amount of radiocarbon slowly begins to degrade away and disappear and what we know is the rate at which disappearance occurs. We know the every five and a half thousand years. Half of the amount of radiocarbon disappears and so by measuring the remaining radiocarbon in archaeological bone piece of wood. We can get a date for it but people must have done that. Give him this. Technique is coming up for his hundredth birthday. As you'll say they must have already done that with artifacts from ancient egypt. They did but what we found was that there was a sort of mistrust radiocarbon methods because it hasn't properly been applied in the pasta instead. People that just david anything really. They dated old pieces of charcoal wood from temple complexes which often predated the use of that would in those complexes of temples and graves and so on and this is a really key point and radiocarbon. We have to select good material that dates as closely as we can to the data of the archaeological event. We seek to understand. I see so if for instance i wanted to know how old my wheelbarrow was. But i'd inherited it from my granddad. I would get a false date because it's not a new barra go for something which can't be inherited or can't be recycled as you potentially if rain if you'll excuse the pun because i was thinking cereal grains and they absolutely what we did was. We went back to these burial. Contexts that contained independent has evidence from the egyptian chronology. For example we found evidence in the form of inscriptions on the side of the grave in which that person died. During the seventh year of the reign of king joseph for example and then in that grave we would find short lived pieces of grain and floral wreaths in the funeral materials. And so on. Those are the things we focused on deicing in order to kind of crap the problem of when these things happened in the past that would give you a nice neat time line for that murky period back in history. When when you symbol that timeline. Did you discover that in fact things that we thought we understood. Well were in fact wrong and we had it wrong all. We didn't find in the recent because of the fact that we have pretty good understanding that historical record that was one of the things that gave us confidence that we were getting things right but as we move back through time back through the middle kingdom and especially into the old kingdom we found that our data estimates much earlier than we thought previously and they were about a century earlier than previous estimates had out sort of put forward so that was quite an important conclusions reach also we found that the period before the domestic period the period of the egyptian state and its formation. We found that this happened much more quickly than had happened. In similar cases of state formation in places like the middle east and africa and so that was also a very interesting thing because it showed that the egyptian state began very quickly from pastoralists and people that were moving around the landscape from period with they then started to grow crops and to be more century live in the same place and shortly after that state formation happened and we get farrow's get institutions. We get writing and so on and so forth isn't science and amazing thing. Tom thanks very much for joining us to tell us about it as tom. Hi i'm from the university of oxford now. Arguably one of the most iconic legacies of ancient egypt are the pyramids which were built as tombs for pharaohs and other high ranking officials and hundreds still stunned today thousands of years later explorers and scientists have found way inside many of them and uncovered rich archeological treasure troves within but could the ancient egyptians have crafty concealed. More insight there pyramids than we realize at one hundred and forty meters high and two hundred and thirty meters long. One of the largest pyramids has been very well explored and studied in the chambers inside have been thoroughly mapped out. Also we thought because now he's radiation streaming in from space to see through the pyramid. Researchers have found something very exciting. The great pyramid of giza is to be the tomb of one of the earliest fascists of egypt. King who food more than four thousand years after its construction. It's still receiving visitors. Smears dust shitty surprisingly. It's it's quite you meet because there are many tourists visiting the place they even my security We had some some issues with therese coast because mice were visiting them eating some cables based on the life inside. That's sebastian procure her. He's a physicist on a project called scan pyramids launched in two thousand fifteen scan. Pyramid is a collaboration between institutions in egypt. France and japan. All trying to gain a deeper understanding of the great pyramid was to check for internal structure of government. We've done city measurement we've yet to check with surveys new room. Cavities hold corridor. Whatever which could be be inside the perez but we're still not found inside the pyramid. There are three main chambers that we know about the king's chamber the queen's chamber and an underground chamber the appears unfinished. There's also a forty seven meter long corridor leading to the king's chamber called the grand gallery to investigate whether there were any other chambers inside the pyramid the scan pyramids team used an imaging technique called cosmic muo griffey in for the use photon which israelite to make an image of an object. But of course you have a need the external image of subject. You don't see inside mammography and the other hand us party kurds and the advantages but it can really see inside of structures. It works by the detection of elemental particles produced by the interaction between the atmosphere and other particles called cosmic rays the moons. Make it down to earth and are highly penetrating. They can go through tens or hundreds of meters of solid rock. Depending on their energy scientists can use the variable penetration of nuance to figure out the density of a structure. It's like a race at the start of a race. You know how many people are taking part and by looking at how many people make it to the finish line just making ratio of easter number. You have an estimate of the difficulty of arrays we've announced it's exactly the same not some of the moons. We'd the permits but some of us would stop just because vision have enough energy to crawford the world so just by counting the number of meals crossing the means know given the option. You have an estimate of the difficulty of race. Vote is an estimate of sickness and under density. The team set up muan detectors inside and outside the pyramid at different locations. And by taking what are essentially cosmic muan on photographs at different angles. They built up a picture of what the internal structure is like including wasim conspicuously empty areas. Were in what should have been solid rock. We've amir coffey means. Were able to buy three different. So i guarantee you was found on the office age cavity was found the just on the face just behind with corvo chevron zone and affair cavity which is the biggest was founded bova gregory so it was called a big vote. The length is estimated to be about fifty meters between thirty and forty meters long. So seven hundred cubic meters intern. Sebastian and the team are confident. That what they found is not just a defamation. In the rock all smaller stones that have crumbled due to the careful way that they image the pyramid from multiple locations. They used simulations to help guide where they should put the detectors and it turned out with a position that the simulation gets base position was listen. Let's go for the restroom of governors. So so we had to discuss with and this other evidence that what they found is a real secret chamber. What is also very intriguing and can be considered as a coincidence always structures. I was talking about so order. Whose and they are placed in the same plane in the pyramid. So it's a north-south plane which is slightly shifted with respect to its center also of a plane caesar seven meters in the east division. And he does. I would bet this big void is also placed in special plane so all these says that it cannot be incidence inveighs. Radio big significant void at this place. I also sebastian. If he thought it might be something. Inside the big void. You tom as Some objects of any kind even goldwater imagine an extra already. Several theories of what visible void can beat one fairies. Vet it may be the real. Tom of how that it was used as a storage place versus interesting failures which say that it made us and this is gwen. Gatty was used to put the grenade stones of the king chamber may be a greta was required to the highest tone of the king chander. So it may be that. The big void was created as a necessary. Part of the construction of the pyramid and sebastian is confident that future scans with even new techniques will help reveal more details of how this great pyramid was built. Also one of the long-standing curiosities of khufu pyramid is that unlike most other pyramids which are richly decorated with images and inscriptions telling stories about the life of the person buried there. There is virtually nothing on the walls of coup food pyramid on top of that. It's completely empty. The objects we know people were often buried with things like pottery and gold. They would need in the afterlife. This is no surprise really as tomb robbery was absolutely rampant in ancient times but still perhaps the big void and the other spaces they found represent untouched undisturbed challenges which themselves could hold the key to understanding. More about the mysterious cuckoo's rain. How amazing that was sebastian procure. We are looking at how modern science is helping. Scientists solve some of the mysteries of ancient egypt. And one of those mysteries concerns a long lost city called punt which was hugely significant as a trading partner with ancient egyptian civilization unfortunately while they wrote a lot about punt including poems and songs the egyptians didn't say exactly where it was so archaeologists have hit a bit of a dead end trying to understand how the ancient trading route operated. Now that might be about to change. Thanks to a breakthrough involving animals. The egyptians kept as pets and went to punt especially to purchase bobbins. They also mummified them. Meaning specimens off those pet baboon in museums and critically still carry a chemical fingerprint of where they came from. Originally putting dartmouth colleges nate dominy on the scent of punt. Might have been there. Are two mysteries. Mystery wrapped in a mystery and the first involves babboons because babboons have a very large distribution across sub saharan africa and generally across africa. Baboons are disliked new. Rarely boone's any kind of statuary or carving or any kind of handicraft egypt however is the big exception because when you look at the entire arc of egyptian history you see that boons have been revered. They've even been deified. Have been elevated into the pantheon of egyptian gods so it's really quite a striking reversal to the general patterns across sub saharan. Africa the puzzle for someone like me who studies. Primates is that bob moon never lived in egypt. The holocene fossil record which is the period of time of modern human habitation and agriculture and complex societies is entirely devoid of any evidence of any primate whatsoever. Let alone babboons have we go physical specimens of boone's from that geography nevertheless they must have encountered them because they deified them. That's right so we find babboons buried in human context. They were deliberately buried the oldest evidence Looks like it might have been zoo. One young boone is buried with a young person about twelve or thirteen suggesting status as a pet and then at later periods. We royal mummification. Where the animals were actually wrapped linens and interred in royal tombs in the valley of the kings and then still later period during the roman greek period. We get the period of animal. Colts were an babboons and many other animals were mummified on practically industrial scale. You get tens of thousands of animals being mummified during that period. So they're fool if you've got evidence of these animals being deified in that particular geography you've got evidence of specimens of them being brought to that geography. But there's no evidence that they were naturally there. This argues that any baboons that all there were brought there by human activity and therefore that the question must be from where precisely and they have written records of importing bevan's into egypt they have a paintings and reliefs on the temple walls and tombs showing the importation baboon from a distant place. And they tell us that place. The place was punt. And that's the other mysteries was punt. Oh so there's lots of references to place but but that place does not exist and we don't know where it is right Historians of argued about punt because it was terribly important because egyptians typically when they wanted resources they might Might go to war to get those resources we know. The egyptians went to war with the nubians. They went to war with the hittites. But with the pun tights they sent emissaries they sent ambassadors sent diplomats. This was a very important trading partner for the ancient egyptians primarily because the tides produced very valuable incense that the egyptians used for religious purposes so the egyptians were highly motivated to travel great distances to go to punt for these exotic luxury goods including bobbins can use our knowledgeable boons to workout wear panties. Then babboons are a really great animals system for this question because babboons drank water every day and the water in your environment reflects the rainfall and the chemical composition of water evaporates at different different rates. And so when animals are drinking water on the landscape they incorporate those chemical signatures the oxygen stable isotopes in the water and the incorporates the bones in their teeth and in their hair. And so you get this geographic fingerprint. Were animals been living based on the kind of water and food. It's been ingesting but what about if you do what you said. Which is that. There's evidence that they were animals being held in captivity in egypt you not then see the signature of egypt's rather than the signature of where the animal came from written into those ratios. Yes that was. A great risk of the project is that long term captivity would produce a geographic signature associated with living in captivity in egypt. And so we use different tissues hair bone teeth which integrate drinking water and food for different intervals of the animals life and a large number of animals for example the bobbins that we studied that were at the petri museum in london. Those animals uniformly showed us a signature that was consistent with a lifetime living in egypt and so we think the egyptians may have been They may have had a husbandry program. I they may have been breeding them in captivity. But we got very lucky. There was one animal at the british museum that showed us signature in the teeth. That showed us a distinctly foreign signatures unambiguously non-egyptian so would it to workout. Where punt must have been a you reasoning than that if you triangulate the origins as written down in the teeth and other specimens of these boons. That must be somewhere. Relatively equidistant from these places all close to where a lot of these animals were originating from that that would give you a narrowed geography for web. Punt was likely to be exactly so the egyptians tell us that punt was east and south of egypt and they tell us that you could reach it by land or sea problem is that eastern south of egypt still a lot of open possibilities and so what we can do is we can take bobbins. Living in all of those competing areas somalia. eritrea ethiopia yemen sudan uganda. We can take balloons living in those areas now and we can look at their chemical signatures and create a chemical map. If you will of that region and so then we can match the mummified specimens that are present at the british museum to populations in those areas and the great thing about our announces. We could definitively rule out some places and we showed very strong match to animals living in eritrea and somalia. Today that would be there for the most likely place with the animals were sourced from but do not just think that it could just be. That was a good hunting ground. And they were transported from there to wherever punt bulls. that's right punt was both a kingdom and a in an emporium on the coast so there was a market town or port. And so we think the egyptians would have pulled their ships up to the port and they may have purchased or traded for animals. That were there in the port city But the animals may have been sourced from farther inland. And that makes sense. We think the punt heights new there. They knew their market. They knew their consumers and so they would have gathered animals from farther inland and brought them to the central entrepot for For trade with the egyptians. So how much narrow is the search for punt now in the wake of what you've done much narrower one hundred fifty years scholars have been debating about the possibility of the arabian peninsula. Yemen has always been a strong contender for the location of punt. Some authors have put it in mozambique. Or uganda we can rule those places out and we can say definitively that it was somewhere in africa on the horn of africa. Probably an era and somalia those two places. We can't distinguish between those two places. Which are the two contending places that most scholars agree on and is there any way to nile it. Well and truly. Yes i think so i think if we can turn to ancient dna Turn to some of the other tissues that were coming out of punt if they all start point in the same place and corroborate each other then Then we'll really have something in and obviously archaeology is where we need to go. It would be nice to dig in some of those areas. And if we can find the remains of these ancient places that would be That'd be the clincher. It's like an episode of indiana jones. Isn't it that was nice. Domini on the trail of the lost city of punt which we now know thanks to him. Somewhere south of egypt and he recently published those results in the journal life. Also south of ancient egypt was a land called nubia and archaeologists have made a surprising finding their to signs that the nubians were being exposed to antibiotics human bones recovered from the area glow. Green under uv. Light which is due to tetracycline antibiotic we use today embedded in the bone. The university of cambridge's thomson macconnell is an archaeological scientist. And she's with us to explain the story so thompson. First of all where on earth were ancient nubians getting tetracycline from well. Either they were getting it from things that they were eating drinking. And we think it's an accidental product that gets in and so if they're consuming something like bill o'brien made from grain. That might have site can in it. Then that gets incorporated into their buy ins and the longtime later we get to see glowing under uv light. Why might that be tapped to cycling. Ingrains tetracycline to naturally occurring product of funky and it occurs naturally in funky grow under certain conditions and that can be when grain is stored in slightly damp environment. So if they're having a wheat harvest in putting it in a big grain storage area and you have water that's coming up and going down into the ground than that could make the grain at the bottom. Go slightly moldy. It would still be good enough to eat but it might contain trace levels off tetracycline. I see if they then use that tweet to make biro bread than they're going to be accidentally eating tetracycline. So then how does it take to get from being eaten as bread to being incorporated into bone so tetracycline. It's quite a big molecule and is gonna ring structure in a carbon chains and it structured loves to bond to calcium. And there's a lot of calcium in your bones and so as burns growing as this calcium phosphate which is in your benz is being laid down. If there's something in your bloodstream that likes to bond to it. Then it will just be close stuck in there and it will hang around forever so does not mean that you've ever taken tetracycline. Then you have some glowing bones. Yes pretty well said the bits of your bones that were being remade remodelled day. That when you were taking tetracycline or any similar sorts of antibiotic includes things like doxycycline which is an antimalarial. Those bits of your bones will blow if you could get them out and look at them on. Dvd light so maybe try to avoid that fennell. Then how do we know that. The tetracycline got into the bone because it was incorporated by the bono throughout their lifetime rather than it got into the bone through some sort of contamination because it has been thousands of years. That is a really good question whenever we find anything in archaeological samples. We have to question whether or not it's naturally occurring. It came in during the individual's lifetime or if it came in later on and the shape of the glowing lines within the bones tells us that it looks like it's sort of on the face of a bone cell being formed rather than percolating in contamination. Later on i see so sort of just in the right place to mean or i got in there because it was being incorporated officially as part of bone robin randomly slapped on afterwards. Yes it's worth saying. That tetris can is used as a label in modern day. Studies of bone turnover bone remodeling. So we know an awful lot about what it should look like when it's being taken out by living in growing bone and comparing the archaeological bones. The passing we see there with what we know. We see in modern bones when tetracycline is being used as a label gives us confidence that it is being laid down when these people were alive and do you think that it could have had some sort of health benefits. Is there enough tetracycline in there that it could have had a benefit to the person consuming it so having low grade antibiotics in your diet could have some benefits if people were having a bacterial infections but we really can't say they knew that it was a health benefit to them although we do know from texts the via dregs are often included as ingredient in medical prescriptions for a roundabout. It's time for thousand years ago and so it's possible that they knew it was some good things. They accidentally getting in beer and bread. So do we have any other evidence of eight and addictions or other civilizations taking antibiotics possibly on purpose. Not that they're taking it on purpose but we can see tetracycline in burns from other populations so it's been founded people who were living in herculaneum. The tom eruption of the serious. I would speculate that any population where grain has been stored and could have got moldy. We'd be able to see some tetracycline in that. Sounds vaguely disgusting. Thing called stick with the regular pill form for now but thanks very much. That was thomson. O'connell thanks to our other guests. This week. Tom higham sebastian. Procurer and nate dominy. And let's finish this week with an electrifying question of the week. Can katie hayler is leading the charge on this one for michael. Why batteries such as aa or aaa size be recharged. What's the difference between regular batteries. Rechargeable 's especially lithium ones. Is this a big battery conspiracy to sell more about trees or valid reasons. Big battery conspiracy her well hair. Three scientists who can root out this recharging riddle. Garreth hines from the national physical laboratory and david hall and dd wrinkle from cambridge university. Gareth fist there are two types of battery primary cells which are designed for single use and secondary cells which are rechargeable. Every single battery in the world consists of two electrodes. One we call the positive. The other is the negative separated by some sort of an electrolyte solution. That is a salt dissolved. In a solvent when a battery is discharged electric Reactions occur at each electrode converting chemical reactions to products on generating electricity. However there are many choices for the electrodes and for the salts and solvents only some of these choices can be recharged which scientists call secondary cells but for others like most aa and aaa batteries. Using the stored. Energy is a one way street. By the battery's rechargeable. depends on what the positive and negative electrodes and made of the most common a and aaa after. He is a cold alkaline. Batteries and these have zinc metro and manganese dioxide electrodes when you use the battery zinc methodist up any form zinc oxide and fortunately this reactions irreversible which means that you can get metal back if you recharge the battery in a secondary cell. The electrochemical reactions are reversible for example in a lithium ion battery. The very small lithium ions can easily insert into both electrode usually graphite and mixed metal oxide so the electric chemical reactions work equally. Well in both directions. This means that the battery can be charged and discharged many times. They're also rechargeable. Al aaa batteries. Such as the nickel metal hydride battery the reactions in this type of battery offer of us with me that you can recharge the battery and use it again so this is not a conspiracy by battery. Manufacturers primary cells are inherently limited to a single discharge while secondary cells are not ultimately when choosing a battery to use one has to consider the energy needs of the device for example. A cordless drill needs lots of power in short bursts which takes a higher voltage battery but a smoke detector uses very small amounts of energy over long period of time and so it needs low voltage batteries such as your standard double or triple as i just need to remember to check which batteries offering chargeable ones before. I put them in the charging station. Thanks garris dd and david from batteries to boredom now because next time. We're boring into this question from douglas. Good eating the same thing all the time like sheep. Do they get bored of one type of grass. Well that's certainly food for thought and if you can help. Come join the debate on our forum. Naked scientists dot com forward slash form. Or if you'd like to ask us a question we're on chris. At the naked scientist dot com or use the web form the naked scientists dot com for. Its last question and there. We must leave it for this week on the naked scientists. Thanks to put the program together and do be sure to tune in at the same time next week. Because years on from the earthquake that triggered the fukushima disaster will looking at the science of soon armies and earthquakes the naked scientists comes from the university of cambridge's institute of continuing education. It's supported by rolls royce until next time goodbye.

uk egypt hiv colorado dan riskin Phil sansom Mary mcintyre saharan africa mary mcintosh Albert blue san francisco department of pu university of cambridge vacc chris tetra kwok harry cliff higginbotham
How to Grow the Whitening Component of Your Practice

The Thriving Dentist Show with Gary Takacs

52:16 min | 5 months ago

How to Grow the Whitening Component of Your Practice

"Yes is the thriving. Dentist show with gary tax where we help you develop your ideal dental practice. One that provides personal professional and financial satisfaction. Welcome to another episode of the thriving. Neta show i'm gary tacking podcast co host of very excited to bring an episode to you. That is going to be very useful in your practice. It's titled how to grow the whitening component of your practice in the coaching action section. We're gonna talk about why it's important to grow the whitening component your practice along with how to think you're gonna find this very useful Hey we have another thriving. Dentists financial tip. This is going to be a regular segment of the thriving. Dentist show podcast odd. If you've listened to previous episodes you've heard the first one of those done by. Kate wilford today. We have by longtime friend. Art liederman at art is going to talk about the types of retirement plans that are available to dennis and how to determine when to use each type of plant. This is very important because those of you that know me that one of our goals one of my goals with my clients is to help you. Achieve financial independence from your practice. Financial independence and financial independence. Is the day that you can go to work because you want to not because you have to and having the appropriate retirement plan is going to be one of the tools that you can use To help you achieve financial independence you really going to enjoy this thriving. Dennis financial tip from art wiediman. And that's going to be about the middle of this episode so after the coaching and segment. You're gonna hear from art So you're going to want to hear that you're to want to take action that you know. I've listened to arch tip. You're going to want to listen to it. Multiple times. It's that useful. Will now will go the coaching and atkins segment for this episode. How to grow the whitening component. Your practice hello. Everyone welcome to the thriving. Dentist coaching in action segment. The topic today is how to grow the whitening component of your practice. This is your co host of the thriving. Dentist show many of you. Who have been following gary for years. No that getty has talked about growing the whitening component of your practice internationally. Getty let me jump in. Why is it important for dentists to grow the whitening component of their practice. And i'm so happy that you started there with that question because i think whitening from any dentist. Many dentists think that all whitening. That's old news. You know that was something that was hot in the early two thousands and and now it's kind of passe but there's two reasons why white dennis should be interesting growing the whitening component. Let me let me list those number one. There was a survey done laugh. Steer last within the last year of six thousand people on the street corner in chicago. They're walking the street and the question was if there was something you could do to improve your smile. What would that be in. Marin you won't be surprised to hear this but eighty five percent of the people surveyed said. They would like whiter teeth. They would like whiter teeth. Eighty five percent. Now that's not everybody but that's almost everybody so almost everybody wants whiter teeth. Now narron in a marketing sense. Doesn't it make sense to give people what they want. Absolutely so that's reasonable and give people what they want. Eighty five percent of the people and let me just kind of personalized to our listeners. Eighty five percent of your patients in your practice want whiter teeth. Let's give them what they want. Now the second reason why it's important to grow the whitening component your practices whitening can be a gateway service a gateway service. We whiten the peach. Patient's teeth and very often. They become way more interested in their teeth than they've ever been before and whitening can lead you to all kinds of restorative and elective services. Want some teeth. Maybe six months later for hygiene appointment and the patient says dr. Love the color of my teeth. But what about this. What about that. What about this. And they're interested in other areas that they can improve their smile so think of it as a gateway service so whitening gives them what they want which is whiter teeth and whitening can be a gateway service to express greater interest in other services within your practice so clearly. There's a ton of potential for any of our listeners. To grow the whitening component of their practice near. I have four very specific tips so we talked about why we shared the reasons. Why let's talk about how now so let me go through these tip number one. This is very very important. Doctors choose a whitening system that works for you works for you. We teach our clients to offer three forms of lightning. And ideally. i think it'd be useful for all of our listeners. To adopt that same approach to three forms of lightning one form would be chair side. Widening chairs whitey. A we zoom in my own office the light based system and so owned by philips and we've chair side so so for a patient that wants to do whitening for them. A chaired side solution works very well. A second option is to offer custom trays to make custom trays and provide the patient with whitening material. So they can whiten at home so a system for whitening There's any number of products out there. I like the ultra dent products. The opel lessons products from ultra didn't work very well for the take home lightning and that i like to offer a third option as well and the third option that we recommend to our clients also available for. It's called go. Geo and go are prefabricated trays. It's a dual trae system. That's preloaded with gel. So patients simply pops. The pre of the prefabricated trait into their mouth. they take out the outer trae. It leaves an inner trade. that's preloaded with gel and the patient lightly affixed that to their teeth and it becomes a very inexpensive way for the patient to whiten their teeth very very cool products. That's what we recommend to our clients but there are other whitening products available The key here is to to find what works for you in your practice and their let me explain why that's so important This happened about two years ago with with one of my clients and we talked about winding. Everyone was excited to work on growing their whitening component. And then nothing happened. And i'm sure that will resonate with any of our listeners. I mean doctors. How many times have have you spoken with your team and provided some training and you get excited about it but all of a sudden it just fizzles out i mean. I'm sure that's happened offer. Let's try this is what was happening in this practice. Nothing was happening and noticing that. Nothing's happening and i just didn't want this to die because i know how important it is to grow the whitening component. So i put my detective cap on the sherlock holmes detective cap. I started to say i wonder what the real issues and let me tell you what i discovered as i started talking to our dental systems in this practice as i started to talk to i can't really see why we can't really get traction whitening and I had developed trust and confidence with the with the assistance. They trusted me. I i I valued them and one of the assistants said to me who carry. I don't really like talking about whitening the practice because to be perfectly honest. We don't see really good results with our patients. Have you see. That was a key point. The team was gonna talk about whitening with their patients because they weren't getting good results. I mean you don't want to talk to a patient getting excited about something and then the results aren't what the patients expecting. So what's the human reaction to that not presented in the first place. And so i said oh. Wow that's that's i'm so glad i learned that whatever system they were using they just weren't saying good result with with with their patients. So i said a team meeting that i had with him i said. Hey let's come up. Why don't we do a little bit of research and come up with the whitening options that you guys feel. Good about ensure enough The assistance the hygienist some research and they came up with a lightning system they really liked and once they believed in it they could properly promoted to their patients. If they didn't believe in it every other technique we use is gonna fall flat. Make sense near absolutely. I want to go back to the uae getty. So one reason is eighty percent of people wanted that includes the patients in your practice. The second reason is it's a stepping stone to create the mindset. Where they start thinking about cosmetic is that correct not just cosmetic restored like for example. Let's say the patient has old amalgam fillings in their mouth and now with the whiten their teeth and now the the dark fillings are even greater contrast to their white teeth so the patients say hey doc. I noticed when i smile really wide. You know those dark filling show. Can i do anything about that. So it's not. And i guess you could call that a customer service as well but it's not just smiles and veneers but they become more interested. Another example would be Gotta love the color of my teeth. Doc but i didn't realize my lower teeth have so much crowding. Can we do anything about that and so it really becomes a gateway for the patient to show interest in other services in your practice. Perfect can show us some data either from your practice off from one of your clients about the impact of this. Oh yeah you know so What we strive for. Clients is on a monthly basis We wanna do about fifteen procedure. Fifteen whitening procedures a month a fifteen a month So thinking about four or to achieve that fifty or let me give you some data on this. Not every office offers whitening believe it or not even in two thousand and twenty two thousand twenty not every office offers white but those that do achieve an average of one point two y you procedures a month one point two a month wu anyone here my sarcastic tone associated with that for the one patient that begged you for it. Now is it. But what is that was to be fifteen x fifty white procedures in my think about it for me. After six months. There's ninety people have whiter teeth. Ninety patients doctor. What would you rather have at the end of six months. Would you rather have six patients more interested in their mouth or ninety. Take as long as you like. I want ninety ninety. This absolutely drives interest in the in their mouth in their teeth. And i'd rather have ninety at the end of six months. I'd rather have a hundred and twenty people more interested in their mouth than twelve at the end of the year for doing one way procedure that kind of puts it in perspective that. Let me give you another statistic. Doctors and i really want you to have some fun with this. A let's just say hypothetically you see an average of twenty patients a day. I i'm simply making a number your your. Your mileage may vary. You may see more or fewer than but let's say you see twenty rember. Eighty five percent of the people in the world. What whiter teeth that means that every day seventeen of your patients whiter teeth. Seventeen and if you're doing one a month how are we doing at meeting. The needs and interests of our patient at one month. I'd say we're flat out. Failing that is one out of one out of three hundred and forty people. That's like less than one third of one percent. Wow when you put it that way to steal worse and even fifteen downstairs to sound early mousy doesn't it fifteen at the end of the month out of three hundred and forty people can see put in that context. How realistic it is to do. Fifteen a month do fifteen a month. I mean you know people love letter and let me share a demographic information data with you. Nerine millennials millennials are People that were born from one thousand nine hundred eighty two the year. Two thousand millennials and many of our practices by the way millennials are the largest demographic group in in in our inner population today millennials that just this year. The number of millennials became greater than the number of baby boomers so think about how powerful millennials are among millennials near. Will you be surprised if i tell you this. Among millennials who are on instagram and many millennials use. Instagram is a social media channel. Sixty seven percent of them. Sixty seven percent have photoshop. Their smiles their instagram votes. So they look better. Six to three millennials and instagram have photoshop. Don't wanna emphasizes photoshop narran. It's not just filter through a photo. I mean that's easy but actually ghanaian it photoshop. To improve their smile. What does that tell us. They're not happy that smile. That'd be what they're snails. And i know many practices that are starting to do a lot of smile design cases on millennial patients for this very trend right here. So there's data that. I hope help help l. june this but let's go back to these four jets tip number one Find a system that works for you and and make sure that you all believe in it If you're trying a new system a one of the things you might do is a white in yourself you know wyden the doctrine team members and see about your experience with it but you should be thrilled about the resolve. That shouldn't be you know at the end of the whitening. Want to go through a discussion like this narran smile for me. Let me see. I think it's better Not sure but you see again I think it's it's good. No we want to say. Wow near let me show you the before. And after his look at the difference. Look at the difference. So make sure you have a system that you all believe in if you don't believe in it you're not going to get any traction tip number two. This is This is powerful. I want your hygienist tarp. Start to take a shade match at the beginning of the hygiene appointment for your patience for your dole patients. And here's how that might sound Near let's say i'm Hygienist and you're my patient pay narrowed. i'm going to do something a little bit. Different the beginning of this appointment. I'm going to start by taking a shade match of your current tooth color. And they're and the reason why we're going to do that is we now know that tooth color changes over time to ten dark with age. I'd like to go ahead and take shade mad so we have it for a records so now take shade match. It takes fifteen seconds to take shade nuts and now i'm going to display the a part of this tip. I'm going to display that shade on evita's shade guide that's organized chromatic -ly from dark to light from darkest to lightest so the patient can see a chromatic gut and then i'm going to show the patient bear current to color sharon the average north american Who has not had their teeth whitened. Their shade on evita shade gut adult north. American is a three point. Five now eight three point. Five is two thirds of the way down the chromatic shade guide toward dark. So you can. Visualize what i just described right. No i show the patient near. Let me show you where you are. Organized from dark on the right side to to white on the left side. You're about right here and now imagine that you're seeing two thirds of the way down the shade guide toward dr. What are most people going to say. I on the other side i do. I get over here and A nice icebreaker narran just so you know We've got three great whitening options in practice. We can do a chair side for you. We can make custom trays and you can do it at home. Or we have a simple inexpensive counter product That works very well. If you have any interest it now if the patient just flat out says nagy no interests. I don't care mike. Two colors fine may connote your records and don't bring it up again right square peg in the round you know but but guess what eighty five percent of the people are going to say. I'm gonna sign. I run a get here by the way on that. Third option to go option the prefabricated trace. I call it an over the counter product but technically it's only available in dental offices Altered doesn't sell that retail so in other words is not available at grocery stores. Not available at drugstores. It's only available in the dental office. A dan fisher the that founded alternate. I think did a did our profession a very noble decision. He wants to make sure. Whitening is supervised by professionals. He could've made a lot more money going to walgreens and walmart and and selling go a retail direct to consumers but you can only get that Through a dental practice. Which is one of the reasons why i like that product accents near absolutely i think so. This kind of keeps the customers even close ride. Because imagine if you don't offer the second is still go and get it from the pharmacy anyways. And they are not having the conversation about the whiter teeth right. They can't get go. That way which. I was very noble decision for duck fisher to make regrettable tip number three consider value pricing whitening. Now near just hear me out on this in our listeners. Just hear me. It's no secret that if you make waiting more affordable you'll do more way and remember. I wanted to be profitable. I don't want anything to be lost. Her wanted to be profitable but our real economic benefit. Is that restored. Elective treatment did comes from the whitening that we do. That's why i want ninety white knee procedures in six months instead of six. So you can set your fees or whenever you want. But i'm going to share what we often recommend to our clients for chair side whitening like like zoo. I think it appropriate fee is slightly less than three hundred homes so to ninety seven to ninety nine. Something like that and that would include a set of custom drapes now. Clearly you can charge more for that. There's many offices Dental offices in my and phoenix charging five hundred dollars. There's even an office in our building that charges six hundred now. She doesn't do anyway but she charges six hundred foot but doesn't do so as to ninety nine to ninety seven including the set accustom traits the second option will be just take home trays. The opal essence product recommended. I like a fee of slightly less than two hundred dollars. One ninety seven ninety nine something like that and for a box of go. They come in boxes of ten A fee of forty dollars for a box You buy the box for thirty two. We sell it for for forty minor. Profit there but really. Where's the opportunity whereas the profit come from this from the treatment that comes as a result of the gateway service. Now tip number four so considerate. You won't hurt my feelings if you choose not to value price but i think i can safely say you'll do a lot more of it if you do if you do value price tip number four and this is something. I'm very proud of. Because i actually made this up in seeing great results from this. Consider offering lifetime whitening lifetime weight. Now what's lifetime so. This only applies if we have a permanent set of custom trace. It doesn't apply to go because those trays are disposable. Be thrown away after the us. But with a zoom custom trays and with blessed with custom praise patient has a set of concentrates we provide them with free whitening gel We buy those alternate syringes And we'll give them one or two syringes during their hygiene appointments at no cost as long as they keep the recommended hygiene appointments so long as they keep the recommended hygiene points. We call it lifetime. Whitey narrow whitening isn't permanent not permanent. The color of someone's tepe will be affected by their Food products beverage products. So if they're drinking a lot of coffee. After drinking a lot of t- whitening will degrade over time. What what causes teat to darken often asked that question and we could give a very sophisticated answer that but here's an easy way to answer it. Hit narain anything that you would spill on a white shirt and costing shirt gonna stain your teeth. An easy way for people to think of it so now by offering lifetime whitening and all they have to do is keep the recommended hygiene appointments. So we're going to give them one or two syringes if they're relatively light on the use of a food and beverage products that causes standing. We'll one syringe. That's good for four applications Drink more coffee. drink not eat more. You know spaghetti sauce than were we. Damn two syringes. We pay about three dollars a syringe. And you could pay about three dollars a syringe to if you buy them enough in volume from alternate so basically look at. What i'm doing. I am going to give give them a gift. Free whitening spreads as long as they keep the recommended hygiene appointments. And what that does is it. Motivates people such a great value. So now that to ninety seven for zoo did include. It was already a great value at two ninety seven house the value if it includes lifetime widening. I mean from from my point of view. It's huge right. Because i get to have whiter teeth as long as i'm a patient of yours and it shows me that you care about what's good for me what i cared about. So they're gonna keep coming. Yeah the property. One of the things we learned about. This snaring is You know we're in an area where people move around you know. They upgrade their house and they moved to another neighborhood and phoenix's very horizontal city. It's very spread out so we'll have patients that move forty five minutes away but they have lifetime winter now. Where does lifetime whitening apply. Only one place our practice all right so now. They've moved forty five minutes away but they still stay patients in our practice. They drive past thousand dental offices to come to our office because of lifetime. Wendy by the way carleen tells me that. She saves a number of hygiene cancellations. A week you know in the patient calls and says hey a i i'm gonna have to reschedule hygiene employment and add carling will say you know. Gary i see you have lifetime whitening remember. How lifetime whitening works as long as you keep your recommended hygiene appointments. We provide you with free whitening gel during your dry deployment appointment. I hate to see a lose that benefit. Is there anything you can do to rearrange your schedule. Keep today's appointment at we save hygiene cancellations because of its just and we're and we're saving it with a carrot. Instead of a stick the stick would be punishing them with a broken appointment. Feet right you can do to. But i'd rather work with a carrot. You know then then. Punish him with a stick. Let me review those. Let me recap here. The reason to do whitening and to grow the whitening business. Your practice eighty five percent of the people in the world won't later teeth and secondly it's a brilliant gateway service so now you know why how to do it. Consider the four tips number one start with a system that you and your team members believe it number to have your high jets take a shade match to the beginning of hygiene appointment and show it to the patient on vita shade guide organiz chromatic from to light number three consider value pricing whitening and number four consider offering lifetime whitening As an incentive to keep people coming in on a regular basis in your practice nearing we've got some great questions From our listeners. But before we get to that We have this great Financial tip from our liederman About the different types of retirement plans how to determine what retirement plan is best for you. Here's that financial tip from weaver. Hi this is art liederman. I'm dental director at the cpa firm of daily. We're located in southern california in orange county in the city of testing and my financial tip today has to do with retirement plans. So we're gonna talk about the three types of retirement plans. The dentist should be looking at setting up. But before i do that. I wanna give you some rules of the road number one contributions to a retirement plan in your practice or tax deductible that means you get a full tax write off for every dollar you put an end. The money at earns is going to be tax deferred. Second thing you should do before you start thinking about our retirement plan is to figure out. How much money can you afford to put away. It might be thirty thousand dollars a year. It might be three hundred thousand dollars a year. But you really need to figure that out. So let's go through the three types of plans number one a simple ira. If you're just getting started you can put away up to thirteen thousand five hundred dollars a year. as a deferral similar to a 401k and you can do a match up three percent and that usually runs about three to seven thousand dollars a year and and you have to match up to three percents for your employees but only your employees that have deferred so nobody participate each other than you and you don't have to put any money in for your employees and there's no irs compliance with a simple. So for those of you who have up to about thirty five. Maybe forty thousand dollars to contribute a simple. Ira is a great way to go. The second type of a plan that you can have is called a profit sharing plan and a profit sharing plan allows you to put away a maximum If you're under the age of fifty of fifty seven thousand dollars per year as well as You can put away sixty five hundred dollars per year as a An additional match if you have a 401k component if you're over the age of fifty so sixty three thousand five hundred if you're over fifty fifty seven thousand if you're below for two thousand and twenty and if you have a spouse on the payroll your spouse can do the 401k. Same thing nineteen thousand. Five hundred for your spouse under fifty and Another sixty five hundred for your spouse if he or she is over fifty and so you can put in as much as probably about ninety thousand dollars between the two of you and most times depending on the size of your staff and their ages They are generally going to get somewhere in the neighborhood of five to fifteen thousand dollars. So if you can put away say Ninety thousand dollars a year in a retirement plan You might be able to put away seventy five thousand for yourself and fifteen thousand for your employees. It's a nice benefit for your employees And you get a tax write off so that ninety thousand is going to be paid for in most cases somewhere between a third and forty five percent by the government. So it's gonna cost you about two thirds or maybe as little as one half Because the government is giving you a tax deduction for that contribution the final plan is for someone who's got somewhere in the neighborhood of one hundred thousand dollars or more to contribute because if you don't have one hundred thousand doesn't make sense and this is called a defined benefit pension plan and with the new cash balance rules. We can have you get started with a defined benefit plan as early as the age of forty two forty five. This is for doctors who are a little older who have a little less time for retirement because the calculation is done in such a way that you figure out. How much do. I have to put in each year to get to a pot of money. When i'm sixty-five that will allow me to take out about one hundred eighty thousand dollars a year now defined benefit plan. You can put away. There's no limit like with the defined contribution or the simple. You can put away up to name your number two hundred three hundred four hundred thousand dollars a year If you have a younger staff that's even better. Because they're going to get less of the contribution you can also use a defined benefit plan in combination with a profit sharing plan where we can segregate where the employees are put into each plan and make it to best advantage and my favorite strategy with this is. If you're about three or four years from retirement set up a defined benefits funded at a lower level for your last years of practice and then maybe in the fourth year go ahead and really really put a lot of money away and by the way that happens to be the your that you sell your practice and you have a big money so my advice is start saving early. Save as much as you can. Make it a monthly bill in your practice and enjoy your saving and enjoy your retirement. Have a great day in today's trading dentist segment. I have questions from across the us and canada and one question from australia. The very first question to you is getty noticed that some patients respond much better to wiping than others. Why is that. What a great question. And one of the things that i think is Disconcerting to all of us is that whitening is an inexact. Science is a little bit. Inexact can respond differently But i've done a lot of research on this and i've had a chance to talk to You know some of the chemists involved in the materials and understand the science behind whitening. And here's your some things that might help you with this If if an adult has not had their teeth white another as they have the natural tooth color if you look at their teeth you're gonna see underlying shade every time if you look close enough and the underlying shade is. It's either going to be yellow brown yellow brown others when your tape. You see a slight yellow brown tint or green gray green gray narrowed. Have you ever noticed that when you look at some teeth. They actually have if not whitened. They have a slightly green gray tint. Have you ever noticed that. Yes i have so. Basically those are the two underlying shades of yellow brown green gray yellow brown ring right. Yellow brown almost always responded brilliantly to whitening. They're the ones that you wanna put in your before and after albums you'll your digital before. Because they really respond. Well yellow yellow brown green gray. It's a little bit of a roll the dice But typically you have to work with those teeth longer. So you have to apply the white gel longer and oftentimes. It's simply takes more applications to get a similar result. So that's one of the things. I've learned so look at that as a team. You might wanna do an in service training with your team on this and teach them to see the yellow brown of the green grape yellow. Now it's not that you can't whiten when it's great great but it usually takes a little bit more work but that's why we often see differences in how they look but i'll bet the doctor that asset question is some respond much better than others. It's almost always the yellow brown bay shape that responds and pops when you when you apply waiting to those patients thank you gotta let me ask the next question. How long does whitening typically last. It really depends on their food habits. Remember the coaching action section we talked about the staining food beverage It really depends on their food of prize for example. Near if someone's an occasional coffee drinker they go to starbucks once a day versus. the coffee. addict is at starbucks. Four times a day which one you think is experienced more degradation in their color. The four times a day the starbucks patient right really depends on their food products. Vine red wine absolutely red wines. The same thing you know if they have an occasional glass of red wine once a month. You're going gonna see much degradation on that but if it's something. They enjoy with their meal every night. It's going to be different. You know it's going to be very different and You know again. I like to tell the patient and that would stain a white shirt or white blouse female patient it is likely to cost It's all the good stuff narran you know it's chocolate spaghetti sauce. It's east indian curry dishes served. You know all the good stuff is gonna is gonna cause staining but yeah. The point is with whitening There it's not permanent if we white and someone's teeth now there actually is a permanent solution and that's not whitening what would be the permanent solution. Veneers yes because that's porcelain at that won't be subjected to the staining permanence lotion But more often than not if we're doing whitening experience. Some degradation based on their food or beverage a consumption habits. I have a technical question can tetracycline stain. Td whiten can tetracycline stained teeth whitened. you're tetracycline staining. Is very common. An awful lot in practice i've to share a case with you You know. I taught it at pack. Live with dr david hornbeck. Great years and it was a aesthetic course where we talk taught doctors how to do smile designs. And each case was attended upright. Jared parcel veneers case and i remember one case intimately and this one. I'll never forget this case. A patient was forty two years old female very very attractive woman and her teeth were very great. They actually looked great in color like they had a coat of grey paint under teeth and when the doctor propped into her teeth to prep the teeth for veneers the stump shade narron was as dark as your hair down there word. Do this on audio Would you describe the color of your hair to our listeners. Unites talk black. It is is raven black. Yes it's a full head of hair to let her bay. Shade was lack actually charcoal black and the immediately brought dr hamburg over and said homer tick look at this and i said no worries and he. He has his very cool technique. In order to mask. The baishak has been ears are fairly thin and if he didn't mass that they shade than it was the dark base was going to show through the veneers and she was to have a darker smile. Anyway the end result was fabulous. The end result was unbelievable that this was very attractive. prior to veneers was stunningly attractive. When the veneers were completed she was so happy. It was literally life changing. There were tears rolling down her cheeks just when she saw the temporaries underneath and when she saw her final restorations literally there were tears of joy streaming down her face. So let me answer. Your question can tie tetracycline State light the answer is sometimes same. Thing that we noticed with hyper calcification spots. You know. i'm sure you've all had patients with hyper calcification spots and when you apply whitening to a patient that has hyper Spots one of two things happened either. The whitening eliminates the spots. And now we have a uniform color. Which is what we're hoping for or guess what the whitening candu amplify. The spots amplified the spots. Same thing with tetracycline. Sometimes we get a great result with whitening and other times literally nothing literally. Nothing happened so the answer is can sit tip cycling. Saint he'd be whiten sometimes. I think it's always worth doing whitening. Let's see let's see if it works. But i would. I would try to set the patient up for expectations and say you know linda. We can try whitening. It's possible that it's not gonna work. So i can really damage but but it's possible that it doesn't work and if it does work i would refund what the invested in whitening and let her know that we can still helper get whitening require veneers. You know instead of a widening. But that's how i would handle a tetracycline case. Thank you gotta shed it the next one i really like. We seem to run hot and cold on whitening. Sometimes we are very busy whitening other times. We hardly do any any suggestions on how to be more consistent. That is my favorite question narrow because it doesn't just apply to whitening We could substitute another word in there. We go ahead and do it We seem to go. Hot and cold on google reviews in my practice sometimes. It seems like we're going gangbusters. We're getting tons of reviews and other times were not. That's human nature by the way that's human nature you know ed. What happens is were easily distracted. Squirrel squirrel squirrel squirrel so multiple widening. We're talking about widening. We're talking about waiting all of a sudden we're over here on embezzling you know Or next rover here on veneers or were over here on implants and whitening becomes yesterday's old news so the best way to keep it front and center is to a designate one of your team members as your whitening champion. You're whiting champion now. That doesn't mean that she has to do all the whitening that means. She is just the quarterback in charge of whitening in your practice. So she's the one that brings it to the morning huddle. She's the one that said. Hey guys we did three whiny procedures last week. We're right on track to do our five fifteen for the mets. Or she's the one to say. Hey let me show everyone the before. And after his of real last week look at this. She was as happy as can or conversely. She's one to say guys. We haven't done a whitening in a while. let's get back on. Are we taking the shade match at the beginning of hygiene appointments so waiting champion and that way that person can be in charge of keeping it front front and center keeping a top of mind so the whitening doesn't become the project is you're all of a sudden just slips away from our memory very important actually. This is one of the things that your clients really appreciate about you because you are team works with these champions to make sure that on top of things because you know dentists get busy with dentistry. So you know you and your team. Kind of in a provides that silent partner who's behind the scenes in managing in supporting them. That's awesome it really does work I always use the analogy. Some of us are familiar with that. It was the circus act Where the circus performer comes into the three ring. Barnum bailey circus and and he's got a stick stick is about About three feet long and he takes a plate dinner plate and start spinning it on the stick. And i remember when i saw that as a kid. I remember thinking So we'll let i could do that. And my dad just said just keep watching. Just keep watching an next thing. I know the guy had a second stick in a second plate and you know a minute later. He had fifteen sticks and fifteen plates spinning. It was literally like wow. How could you do that. But what i mean by that. Is you know we got one stick. And we're spending plate. The plate is whitening there were spending. It's been a spin it and then all of a sudden it's like want to focus more on implants so we're over here and implants what happens to the plate. It comes crashing down to the floor and shatters into thousand. That's what i went home. I embarrassed tell you this. I i got in trouble on this narrow go. You know what i'm doing. I was about a ten years old. And i had In our garage. I had a a stick that was about two feet long From craft set. And i took the stick and i took one of my mom's good and i started spending the plate. It's about about fifteen seconds. Came crashing down on the floor. That was the end of my career as a circus performer. Darren but that's what they have a waiting champion because that person can be the one that keeps it front and center on top of mind for your team and what your team does and you do is making all. These plates are spinning in other words. The different champions are doing what they're supposed to and they love it. They love the challenge. They loved the celebration Sometimes they're monetize for it. They they love the the performance incentive for as well it just it solves a lot of problems. Let me ask the last question. I'm concerned about patients experiencing sensitivity after whiting. How can i reduce the sensitivity. Yeah science is really helped us with this year Any of us that have been doing chair side waiting for a long time as as as as i have. No the history of this. A zoom was originally created by discus dental and there was Phillips bought discus dental it was a discus product in developed and it was awesome and there was a zoom one and end zone one Worked really well narran. With one exception there was a high incident of sensitivity after whitening. And near and i'm not talking about little zingers like little zinger shots in your teeth. I'm talking about driving home after your dental appointment. Feeling like you get struck by a bolt of lightning in the middle of your head. So that wasn't working. So they went back to the chemists and then they created zoom too and so imagine a pendulum swinging like this near where the pendulum is too hot to call to a lot to call well so if it was too much sensitivity there swinging the pendulum the other way to reduce the sensitivity and unsuited to date they virtually eliminated the sensitivity but in the process of eliminating the sensitivity. Guess what else. They eliminated the whitening certain. And i can't tell you how many times i'd be my client offices and and the assistant would call another near the patient. You're sitting in a chair and the assistant would call another assistant and she'd say karen would you do me a favor and look at neurons tears to before photo Do they look any whiter. Do you a little. They're both now looking your mouse in. Think so. I don't think to send wider Think so it wasn't working is back to the chemist and they developed the zoom. Three and zoomed three became kind of the secret sauce where they found the sweet spot of a great lightning result and minimize sensitivity. So here's one of the things you can do. We always ask the patient near. Do you have any history of tooth sensitivity. Do you have any history. And if the patients look like. I don't know what you're talking about. Guess what the answer is no they've never had sensitivity but they said well you know sometimes in cold water or warm water. Give me some sensitivity. Sometimes if there's some history of sensitivity we can pre treat the patient with sensitivity gel That they used before we do the whitening that radically reduces if not eliminate sensitivity the other thing we can do on the zoom zoom is now owned by philips and they re engineered the light so it has three different settings on the lamp high medium low and so if the patient doesn't have any sense to but we start out at medium and then we dial it up too high through still not experienced says jodi if they have a history of sensitive who started low. So it's just a lot of things we can do. These days to reduce sensitive to what we've found in my practice in eric lane offices is sensitivity is very manageable issued. Today it's not pick the crisis that it was in the early days of wiping when the science wasn't quite there so if maybe you have flashbacks to early days of whitening it's probably because the science wasn't there and in fact patients were experiencing extreme says. Did we just don't see that today at all. We can manage very easily through the different options that we have available. Yeah you know. I i hope our listeners. A take action on this episode and really get serious about growing the whitening voter their practice Emphasize that second benefit because it is a gateway service and doctors. I know you're gonna love it when patients ask you instead of. You haven't asked them if patients ask you. Doctor love the color of my teeth. But i notice my lower teeth are kind of crowded can do anything about that. Don't you think every dentist on the planet would love it if patients ask those kind of questions absolutely and i what i really really like about us about. This is like you said. Eighty five percent of the people wanted so you know even if you do value pricing. Now you are now flipping the whole relationship into. I already gave you what you wanted now. Starting to ask the question which is brilliant you. You're like a professor. You are like you go to the teacher and ask for help. As opposed to your the sky. It's a recipe for happy patients recipe for for happy patients. Hey as we're bringing this episode to a conclusion I'd like to make a final announcement. coming up we have our very last thriving dentist. Nba workshop of the year It saturday december fifth and during that nba works eight hours online. All in livestream. It's eight hours. A cover the ten elements with thriving the twenty four systems of a thriving. Practice six very specific goals that we want all of you to embrace After after the workshop we go through eleven different exercises and the exercise. It is a workshop even though we do a livestreamed so workshop and in the exercises allow us to do is help you apply all this information your practice. Hey if you wanna make twenty twenty one your best year yet. A really good thing to do to come to that Nba workshop on saturday december fifth. And get all the information you need to make sure that twenty twenty one is your very best year yet. We do limit attendance. And they do sell out. So i would encourage you to go to thriving dennis dot com forward slash. Nba If their seats available it'll say it right there you'll notice. Jewish is very affordable Come join us on that Nba workshop on saturday december. First on that note. I wanna take a minute and thank you nerine. Thanks for all the things you and your team do At equa marketing to provide us with a quality flow of new patients. I also want to take minute. Thank our listeners. We appreciate each and every one of you There's some things you can do to support our work You can share Thriving dentist show with your colleagues We would appreciate if you do that. A secondly you can jump on i tunes and rights review a review on items helps more dentist us. Third thing you can do is you could hit the subscribe button you can do i tunes google play a spotify or whatever your podcast rectory of choices hit subscribed emmys every wednesday. It'll be automatically uploaded for your listening convenience on that note. Let me thank you for the privilege of your time and tell you. We'll look forward to connect with you on the next when you sure when you smile. Smile y and don't let them know they have one guy off. Because bain was soon be go when you train a as big as o. She revenue dream by trump shoe revenue train.

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Mon. 04/12 - Is An Art Movement Happening On TikTok?

Kottke Ride Home

21:01 min | 4 d ago

Mon. 04/12 - Is An Art Movement Happening On TikTok?

"Now is the chance to use reliable energy to grow your money. With the dominion reliability investment our new investment product offers competitive returns no maintenance fees and flexible online access to your money. You make the reliable investment in reliable energy. The dominion energy reliability investment to find out more go online to reliability invesment dot com that's reliability investment dot com. Well the key ride home for monday. April twelfth twenty twenty one. I'm jackson bird. Genetically modified mosquitos are set to be released in florida but will locals thwart the project. A new technology that can three d. print bones directly inside of patients bodies and tiktok our latest great art movements. No really stay with me on this one. Here are some of the cool things from the news today. Genetically modified mosquitos are officially being let loose in florida. Well almost maybe. Biotech company tech will be releasing the genetically modified or g. m. mosquitoes in the florida keys in an effort to combat mosquito borne viruses. Like zepa and dungy mosquitoes in the area are increasingly resistant to other forms of control like insecticide. So other options like gm. Mosquitoes have been long explored quoting dark. Oxyde tech's o x five zero three four. Mosquitoes are programmed to combat the transmission of mosquito borne illnesses. By suppressing local artist aegypti populations occidente. Which is us owned and based in the united kingdom describes their mosquitoes as friendly because they will only release males which unlike females do not bite humans or transmit disease at architects laboratory in the uk. The company genetically engineered the mosquitoes giving the insects. These self limiting gene. That makes the females dependent on the antibiotic tetracycline without the drug. They will die eggs from these genetically altered. Mosquitoes which will hatch both male and female insects will be shipped to the keys. Mosquitoes will require water to mature from an egg to an adult and when architects team adds water to the boxes the mosquitoes will be deployed in both gm males and gm females will hatch with no tetracycline present in the box the gm females are expected to die in larval stages the male mosquitoes will survive and carry the gene and when they leave the boxes the insects will hypothetically flyway to mate with wild females to pass the gene to the next wild generation according to nathan rose head of regulatory affairs at oxford tech. Kevin gorman the company's chief development officer says the local female mosquito population will be increasingly reduced which will also reduce the number of wild male mosquitoes in the treatment areas and quotes but a number of scientists are skeptical of this plan. Jennifer kuzma co founder and co director of the genetic engineering and society center north carolina. State university says that tetracycline antibiotic the females are genetically modified to be dependent on and then deprived of is actually commonly used in florida both at sewage plants in agriculture so the females may still find it and survive. Architect seems to have a long history of not handling the legal and outreach side of things too well even if the science might hold up. Many local residents physicians in environmental activists are concerned on a number of points including oxidants stating of their trial success a lack of transparency on their part and the disregard for the local public opinion for example when oxygen was seeking epa approval and open to the public forum. There were thirty one thousand one hundred seventy four comments in opposition and only fifty six support quoting again. Oxidized has released more than a billion there. Oh x five one three eight mosquitoes over the past ten years. According to independent scientists some of experiments do not go well for example researchers at yale university and collaborators from brazil analyzed oxygen two thousand fifteen release of the olympics five one three in brazil. The scientists confirmed that some offspring of the genetically modified mosquitos which were supposed to die and not pass new genes to the wild population survived to adulthood and made it with their native counterparts. Between ten and sixty percent of the native mosquitoes contain genes from tech. According to yale study which was published in nature in two thousand nineteen the paper's authors concluded. They do not know what impacts these mixed. Mosquitoes have on disease control or transmission but added that their findings underscore the importance of monitoring the genetics of the insects. Oxyde tech disagreed with the findings and responded on the journal's website oxyde told gizmodo that yale's study includes numerous false speculative and unsubstantiated claims and statements about ox text- mosquito technology and quotes ultimately. I think natalie koffler molecular biologist and bioethicist and advocate for inclusive decision. Making with regards to genetic technology sums it up best quote. One of the most upsetting is that the very people who are going to be most impacted both by the benefits or the risks of such decision have like the smallest voice in how these choices are made. I think that's a really big issue. If oxidative doesn't do this right. We could have impacts on delaying the use of other beneficial technologies like that in the future and quotes because yeah the tech here is very cool and sounds quite promising. But if it's not handled well in these early runs could sour public opinion on it in the long run and that would be very disappointing. Three d. printing is a frontier that is just endlessly cool. And here's the latest one a new technique that would enable doctors to create new bone tissue directly inside a patient's body so the three d. printing of bone material is not new. But it's always been done outside. The body requiring the patient to go into the lab and using extremely hot furnaces and toxic chemicals to craft the bone like material being able to print the tissue inside the body would substantially reduce pain in speed up recovery time for patients like those with bone cancer or who experienced accidents that require a lot of bone repairs. The technique was developed by scientists at the university of new south wales in sydney and quoting the university of new south. Wales newsroom using a three d. printer that deploys special ink made up of calcium phosphate. The scientists developed a new technique known as ceramic omni directional bio printing suspensions or kobe enabling them to print bone like structures that will harden in a matter minutes when placed in water. This is the first time. Such material can be created at room temperature complete with living cells and without harsh chemicals or radiation says. Dr mon- ruhani from us w school of chemistry and associate professor. Christopher kilian co-developed breakthrough technology. With dr hani says the cool thing about our technique. Is you can just extruded directly into a place where there are cells like a cavity. In a patient's bone we can go directly into the bone where there are cells blood vessels and fat and print a bone like structure that already contains living cells right in that area and quotes one of the key elements of the process is a special inc. They developed in a micro gel matrix with living cells. Dr hani describes it in layman's terms for us. Quote it forms structure. That is chemically similar to bone building blocks. The ink is formulated. In such a way that the conversion is quick nontoxic in a biological environment and it only initiates when inc is exposed to to the body fluids providing ample working time for the end user for example surgeons and quotes and quitting further from you and s w he says when the ink is combined with collision substance containing living cells it enables in situ fabrication of bone like tissues which may be suitable for bone tissue engineering applications disease modeling drug screening an institute reconstruction of bone and osteochondrosis effects and quotes. The team is moving onto animal tests next to see how the bone like constructs continue to grow and they're hopeful about the potential of this technology. Saying it could perhaps one day be used for dental restoration in addition to disease model lean and bone reconstruction quoting professor killian. This has the potential to radically change current practice reducing patients suffering and ultimately saving lives. End quote did you know. There's a one stop shop for hiring indeed now offers you everything you need in one place get instantly match with quality candidates whose resumes on fit your job description then schedule interviews. Top picks all in your indeed dashboard. Indeed is the job site that makes hiring as easy as one two three post screen and interview all on indeed. Get your quality short list of candidates whose resumes on indeed match your job description faster only pay for the candidates that meet must have qualifications and schedule. Incomplete complete video interviews in. You're indeed dashboard. 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Is there some skill you've always wanted to learn or take to the next level maybe music theory or how to build a website or even how to take care of house plants with today's sponsor skill share. You can learn all of that and more skill. Share is an online learning community for creatives where millions come together to take the next step in their creative journey. They offer thousands of inspiring classes for creative and curious people on topics including music. Web design animation video editing leadership productivity. And yes even house plants. I personally love the creative writing classes because they get some pretty awesome authors to teach them roxanne. Gay's class crafting. Personal essays with impact was amazing skill. Share takes the intimidation out of achieving. Your goals. they have plenty of classes to fit your skill level. And your schedule. Most classes are under sixty minutes. So whether you're looking to amp new skills or find a new creative outlet skill share has so much to choose from explore your creativity skill share dot com slash khadki and get a free trial of premium membership again for listeners of the key ride home. That's a three trial of premium membership at share dot com slash cot key. You might be familiar with the exquisite corpse. Either as a game you've played before or as a surrealist art concept it's basically when you get a group of people together the foreign concept to our ears nowadays. I know but you get a group of people together and one person draws something on a piece of paper or they write a word or half the sentence and then they pass it to the next person that person adds their contribution. If it's writing. They add writing if the group is drawing. They'll add the drawing and then before they pass it they fold over the first person's contribution and so it continues so when each new person contributes they can only see what the person right before them had written or drawn not the whole peace altogether it usually produces something pretty funny in a mad lib kinda way and fun way to pass the time the game itself originated among the surrealists folks including marcel duchamp and andreessen ton as well as free to kalo once when the french surrealists played it produced the sentence look cadavre wallet levin nouveau or the exquisite corpse will drink the new wine. So that's how it got. Its name exquisite corpse though. It had all the markings of a parlor game and was likely enjoyed such at least by some at the time the surrealists also considered it. Serious arts brittan wrote about how it was something that could not be created by one brain alone but their critics disagreed as brittan described it critics quote reproached us for delighting in such childish distractions and quotes. Angela watercolor writing in wired. Says some now might be reproaching. Tiktok as a childish distraction when it to a pretty brilliant platform yielding some outstanding art. Susan laxed in a professor of art history at uc riverside and the author of surrealism at play told water quote. I think andre britain were living. Today he would turn on tiktok in. Be blown away with the mechanical aspect. The idea that there is a system for generating these images so that it's done automatically which could have some kind of resonance with automatic writing and therefore tapping pure thought then. Preconceived conventional ideas and quotes. I talked before about the sea shanties and the radically musical to trends on tiktok that heavily relied on the platforms duet and stitch functions whereby users can build off of each other's videos creating new videos either responding to the original or building off of it and you can layer several on top of each other. Which is how you got total strangers from around the world harmonizing sea shanties and quarantined theater kids writing designing and performing an entire musical together without ever meeting side. Note here this is probably complaint exclusive to people who are active on youtube in the early days. Many of us have long felt the youtube decision to end the video. Reply feature where you could not just comment textually. But upload a video response that would show up alongside. The original was a real turning of the tide moment and one that disappointed. A lot of us who were on the platform for community building in creative collaboration and i would argue that the amazing creations popularity of tiktok is proof positive. That killing that feature was a mistake on youtube parts and there are a lot of things that tiktok is doing that. Make king over youtube right now if you want to argue. They're competing in the same race. Which is a whole other debates but back to tiktok in the surrealists water points out that the comparison to the exquisite corpse is not exact tiktokers. Know what they're responding to and not every tiktok is a duet or response but the same spirit. Is there. Spontaneous collaboration pushing the envelope having fun like the surrealists. Some might be very serious about having fun but the spirit of it is fun nonetheless and it's not just the surrealist that some of tiktok videos hearken quoting watercolor in wired the most bizarre collaborative techniques laxton notes echo other creative movements in the nineteen fifties the american artist. Alan caprio brought together. Poetry dance theater music painting and other disciplines into single performances. He called happenings. Which often encouraged audience participation tiktok does the same just digitally real time but not live performance public art but on a platform and quotes daniel mertz left to created the grocery store musical on tiktok which ended up laying the foundation for the radha to musical. Says that tiktok has a lot of improv elements to it. He told watercolor it's like gen z. Yes and and for generation that's coming age in the middle of a pandemic more as they might say a panorama or a pan pizza not to mention having grown up online. Already creating a new digital type of improv makes perfect sense. According again my general take on tiktok arts and social media and art in general. Is that it really bears. A lot of resemblance to street art and street performance says on gemina author of means to movements how the world's most viral media is changing social protests. Power especially during the pandemic. Social media is where we do public right. Now there is meena notes something guerrilla about what's being created on tiktok. It's often made on the fly. And designed to be infinitely remix -able and quotes and watercolor points to a number of examples from the second half of the twentieth century of forms of creative expression that were rarely regarded as art at the time and water could points to a number of examples from the second half of the twentieth century of forms of creative expression that were rarely regarded as art of the time and sure some still when it call them that but they were presented in galleries and there studied in universities. Now if that counts for anything like zeman's in other arts sent through the mail or video art which got even wackier with the advent of consumer grade camcorders. The art was shaped by the platforms available. Of course one of the thorny exceptions here is that tiktok creations are exclusive to a particular branded platform to go briefly back to my youtube soapbox moment a lot of media type folks. These days criticize youtube for not having an easily accessible built video editor. It does have a built in editor. But it's clunky and reminiscent of a full video editing suite. Nothing like the intuitive interface of tiktok or any stories app which just require a few taps and have plenty of effects filters to make your video looks slick in a way that would have required hours of work with a traditional camcorder and editing software. Critics say this barrier of entry will be tubes downfall and they may be right from a certain user perspective but videos uploaded on youtube can be posted anywhere except for the occasional very niche use of their particular features. That video could live anywhere and have been made anywhere videos. That could only have been made on tiktok using those duet or stitch features. Sure they can be uploaded elsewhere after the fact but part of their production is dependent on proprietary technology. If we want to start talking about taking talks off of tiktok to be displayed in a gallery or something. We run into an issue. That hasn't really been relevant. Before the fact that there is such a creative movement and body of work blossoming on. The app is awesome. But we can't forget that it is one single app owned by a corporation. That's one complication. another is a question of authorship. Will you can sometimes find your way back to the origin of a particular trend on tiktok. That original creator doesn't always get all the credit and yeah. Predictably it's usually creators of color. Who miss out on the late night. Talk show appearances and record. Deals scholars have written endlessly for a couple of decades. Now how the web is a new era of remix culture and tiktok has turned up the dial on that exponentially building on the corpses of lessons learned in earlier internet two point. Oh days where will it go from. Here how will this spirit live on. Innovate on other platforms. And isn't art. Meena the meme author who compared social media to street art says she hopes the curator's in archivists are paying attention. So this moment can be documented in the archiving of content is a whole other topic but hopefully the ones who work on that are not overlooking this moment of innovation on tiktok. Because it's just a childish distraction. As watercolor says we live in an age. Where an nfc of a piece of art has value simply because it represents creative work a thing gains meaning in value once people are able to label it but the time tiktok creators were done with grocery store. New musical mertz lifts original tiktok was almost unrecognizable underneath. All the additions and modifications exquisite corpse is a fitting description for the process even if the tools and methods have changed since the nineteen twenty s. The collaboration absurdity are the same besides no new movement is considered art until someone gives it a moniker. Culturally history has proven art is infinitely mutable in exquisite body without a name and quote tolerate. That is quite enough from me for today. As always this show was produced by raido media and khadki dot org. I am jetson bird. And i will talk to you again tomorrow.

tiktok gm florida mosquito borne illnesses nathan rose oxford tech Kevin gorman Jennifer kuzma genetic engineering and societ brittan Oxyde tech natalie koffler yale university of new south Dr mon ruhani us w school of chemistry Christopher kilian dr hani
120 - When it Rains it Pours: A Succinct Clinical Review of Hyponatremia due to SIADH

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

41:08 min | 6 months ago

120 - When it Rains it Pours: A Succinct Clinical Review of Hyponatremia due to SIADH

"Welcome to helix and educational podcast for healthcare students providers covering real life clinical pearls professional pharmacy topics that drug therapy discussions. His odd cast is provided by pharmacists and faculty members at rosalind. Franklin university college of pharmacy is podcast contains general information for educational purposes. Only this is not professional advice and should not be used in lieu of obtaining advice from a qualified healthcare provider now onto the show. Welcome to helix episode one hundred and twenty. I'm your host actor kane and i'm dr patel and intrude. Twenty twenty fashion. The title of today's episode is when it rains it pours a succinct clinical review of hypo nutri mia due to sad h today. We're focusing on the syndrome of inappropriate anti diabetic hormone which is a form of hypoglycemia called. Sad h. and dr kane. I think for our audience. It would make the most sense if you have a some sort of clinical case associated with this. This topic is not commonly seen unless you work in practice setting so what what is our case today. are cases h end. She's a seventy four year old female. She came in the er after a she had a witness follow at home. She did not hit her head. She's not complaining of any pain But the husband says she's more confused than normal. She's nauseated and has been complaining of a headache for the past several days. Not related to her fault. The do a c. T. of her head that's normal. No bleeds in her brain that you some x rays to make sure she has no broken bones. Everything is fine except for her altered mental status. The do some lab work and it turns out that she has serum sodium of one hundred nineteen which is quite low normal would be one thirty five to one forty five so on the basis of hypoglycemia they consult a nephrologist and that nephrologist does a bunch of lab work including a seven is morality which confirms that. The patient has hypo tonic. Hypo nutri mia sermons. Morality is two hundred and fifty anything. Less than two eighty is a little bit low. They do some urine chemistries in her urine. As morality is high at four hundred in her your sodium is also a little bit high fifty milligrams per liter on physical exam. She's you've lameck and on the basis of all of these lab findings which will discuss in a little bit. The diagnosis is made for sad. Hr syndrome of inappropriate anti direct hormone upon further questioning in terms of trying to figure out why she has this new diagnosis. It turns out that the husband report said the patient started taking Pram or selects recently for anxiety again because of twenty twenty and. That's a very typical patient. Scenario for someone with sad hey. In recent years there's been transition in this acronym instead of syndrome of inappropriate antibiotic hormone as they age. It's also known as s. I a d sya syndrome of inappropriate anti diarrhea. So if you're looking for literature you know you might see a combination of both for the purposes of this podcast. We're gonna stick with sad. H i'll be honest with you. I feel like it just makes things more complicated when we start renaming things. But you'll definitely see both in literature so laying. The foundation of the hormone. That's at the center of this is the anti diuretic hormone. And it's appropriate that we talk about its physiology and pathophysiology i eighty anti-democratic hormone is released from the hypothalamus in the pituitary gland. It has another name to so ages also called a vp. Arginine vasil precedent. It's the same vasil press in that we have. Iv for septic shock and basically the role of adhd is that it maintains tennessee in the blood. So if the brain detects that your blood is to hyper smoller to concentrated need more water in your blood it will release eighty h anti-diabetic. Means that it will hold onto water. That water will then be reabsorbed in the kidney. And then your blood will be diluted out by that water that you're not paying out but retaining in your blood instead. You may wonder well. How does it actually work in the kidneys for this water reabsorption. And so i love these cool receptor names. The buzzer prison too as well as akwa foreign to the prison to the v. two receptors are located in the kidneys late Bulan collecting basically at this receptor. It causes increase in akwa foreign to expression in the south and basically the app before and two channels than would allow the water to be reabsorbed into the blood and so essentially like you said dr cain it will go ahead and do the the blood but at the same time then there is little water in the urine so the urine is going to be more concentrated in. You know we won't get too much into the physiology of this process. You really need how activation of that vizo preston. V two receptor causes the ecuadoran to to be expressed on the cell membrane. Basically is sitting in the cell ready to be put onto the cell membrane in. Does that win. As a present to receptors activated. So there's so many pathways going on that. We don't have time to talk about today but it is a really cool example of a fairly simplistic pathway. In terms of getting this case a water channel to the surface of cellular membrane there is other reasons by age would be released so when the other example is low. Blood pressure Whenever there is low blood pressure the ages released lower concentration though the job of ages to just reabsorb. Water as we talked about earlier at higher concentration. Adhd can act as vasil constrictive agent. And so that basil constriction that results in to increase blood pressure. As you mentioned earlier the two receptors in the kidney so clearly we must have a v one receptor right in that the one receptors in vascular smooth muscle your vascular. So when we hit the v one receptor when we agonize that be one receptor using arjun bazo press center eighty h in that causes of vasil. Constrictive property your blood pressure goes up and this is actually different than some of our vasil pressures that we use in the icu. So norepinephrine epinephrine they primarily work by alpha. One mediated vasil constriction precedent not. I mean it's not working on the alpha. One receptor is not part of the sympathetic nervous system. So one potential advantage here is that this is a different modality caused basil constriction in patients especially in septic shock patients. This is a receptor the to know about because we actually use it quite commonly in septic shock patients and so what happens when the ages not balanced meeting. You know the pathophysiology. That's where we call it the syndrome of inappropriate anti-democratic hormone that sad age. It could be that there is too much eighty h. So basically the blood gets diluted as we talked about earlier there is more reabsorption of the water than the water should have been paid out in some cases you may get to see this as not a hyperbole mack but more of a you've elite picture unlike our patient is kind of coming up with and these patients don't have that profile dima and the reason is because there are other competent satory mechanism going on The body says that there is too much volume we have other paths. that would go ahead and You know increase it. Salt water excretion But may be the this compensation is just not enough in the sodium is still dropping in you know on a an exam. Question for example dr patel. The classic thing is going to be that this is a form of you've lee mc hypo nutri mya meaning that. The patients aren't fluid positive that they're not very democrats in actual clinical practice. It's usually not clear-cut definitely usually only maker. Not many of these patients will have commodities it. Can confound the picture even clinically sometimes. It's not always straightforward in terms of for seventy plus year old person. Oftentimes they have the dima a little bit in their ankles anyway. Whether that constitutes being usually make or hyper volume it can sometimes be difficult to discern. Hundred percent agree with you. Sometimes the way it's taught in the books versus what you actually clinically get to see different so we appreciate you kind of highlighting that difference. You might be wondering okay. So s h is that you have too much eighty h. What are some typical causes of. Why your body would make too much. H well what are the example is certain cancers especially that small cell lung cancer can do that This age is secreted in in the brain basically and so the cnn's disorders like stroke meningitis and head trauma could result into inappropriate. Eight secretion is ball we can also see patients have surgeries especially if they're in a lot of pain. Pain can be a trigger to have more eight's released and of course that can propel pharmacist. We have to talk about drugs in there are plenty of drug induced causes of s. H will absolutely talk more about that later. That's gonna be the emphasis of the ideology of most of the patients. That we're gonna talk about but drugs are definitely a common cause here right. And then on the flip side and you know if there is not enough age involved than it could lead to hyper a trivia by not obviously having enough d. h. and so this would result in two large amount of water into the urine and not enough in the in the basically so the other way around and these patients present bit. We call it either. Central diabetes in separatists or nefer. Jonah diabetes This is not sad anymore. It's actually the opposite but it's relevant. Because in these cases these patients produced tons of urine very water urine and the cases. That i've seen dr patel. Most of these are central diabetes and separatists type patients where they have a brain injury in the herniation in their sodium. Go from one forty five to one sixty within the matter of several hours because they're producing like a leader plus of urine per hour and the never genetic diabetes in separatist is relevant. Because later on we'll talk about how we don't really do it but a textbook answer of a kind of third line therapy for. Sad is to give drugs that caused diabetes epidemic to offset s. h. Again if this is the opposite of. Sad h there's some drugs that can cause diabetes epidemic s. h. So dr king. You mentioned earlier that the normal value of serum sodium is hundred thirty five hundred five our patient at hundred nineteen. Monday's a normal time where patients actually start to show some of these symptoms. You know for the most part. Most symptoms will start when you get to less than one thirty. So that one thirty to one thirty five typically a symptomatic numerically not normal clinically. Not that relevant once you get below like one twenty five you'll definitely start having symptoms so round thirty you're gonna start seeing things like nausea. Malays had as start going down and getting more severe hypoglycemia. You're going to see certain things like neurologic impairment. So this could be balance problems Problems will often see falls especially elderly patients and then finally when it gets really severe. Were talking like one. Twenty and below. That's when we start seeing seizures and it can progress to patient being completely comatose having respiratory arrest were the respiratory drive completely shuts down in the brain and people can die from. This is absolutely a very dangerous thing that they have very low. Sodium like less than one twenty. They need to be in an icu. With very close monitoring because of the drugs that we're using the frequency of monitoring both neurologic monitoring but also laboratory monitoring and so basically the bottom line is whenever you have sodium of less than one twenty. You wanna take it very seriously because the outcomes could be very grave absolutely and going back to our discussion about drugs causing this issue. I always as pharmacists loved to pinpoint drugs as differential diagnoses for any trouble. That patient is having and so. It's prudent that we talked about drug induced causes. Most common one is s arise Causes about one third of all all the as To name some of these agents are search aline prance walks teen paroxetine as became. Go back to our patient case. Chen remember the husband kind of double the that she is started aunts pram. She sorta taking it for some anxiety a few weeks back again thinking about typical textbook type questions. I would assume that most nap flex board review type questions or even nap flex questions. They're probably gonna trigger esa the The cause of s h. It's such a common link between the two but there are other medications out there that are worth talking about so carbamazepine in acts carbamazepine. These patients actually have to have routine serum sodium monitoring because of the concern of sad h. Not my neck of the woods because it's chemotherapy but high dose cyclophosphamide apparently the higher dose is associated with sad h and then there are a ton of other drugs that are implicated in. If you were to put a list it's not as bad as cutesy prolonging drug lists but it's pretty extensive just to name a few really any antidepressant in anti convulsant in the typical anti psychotics. These are all. Cns acting medications so generally speaking. You're probably pretty safe to assume that it may be implicated if it's a cns oriented medication. That kind of makes sense too because it each is secreted from a part of the brain. So if drugs are accumulating in the brain in interacting with receptors in the brain crossing the blood brain barrier they're more likely to potentially interact with the hypothalamus and potentially alter eighty h secretion and so deprecating. You mention that these patients will need rigorous lab monitoring to. What kind of left do we usually go for. And what are we going to find in this labs so the first thing that needs to happen is checking the ceremonies morality and the reason for that is if you go back to like a hypo nutri. Me lecture gets really confusing here but we need to know the tenacity of the blood to distinguish from hypo. Tonic versus hyper tonic. Blood and in this case in sad h we want to see hypo tennessee. We wanna see a plasma oz. Morality below two hundred eighty. And if you think about it the things in your blood that give you tenacity. Sodium is one of the most predominant things that gives you. Tenacity so intuitively. You would say well if sodium is low. I would expect my tenacity to be low. Why would it ever be low. And the reason that we check tennessee. Is that if you have a low sodium value but your tennis city is not low. It means that something else is going on. It's probably not it's actually a pseudo. Hypo natrium yo where. The lab values falsely low. Because of other things going on common examples would be really high triglycerides thousands a lot of proteins in your blood like abnormally high amount of protein. And also probably the most common example at least in the icu is decay a h. adjust whether glucose are many hundreds oftentimes more than eight hundred or nine hundred. In all of these cases the actual serum sodium is not low is actually normal. That's where we caught a pseudo hypothermia but it's a lab air because of these other components in the blood that are altering the lab itself as we discussed earlier. This patients could not have hold on to vima going on so they would appear as their you believe Although as we discussed earlier. Dr cain that this is not very easy to classify because patients may have other underlying abilities. That could muddy this picture of it yet and then the other thing would be your urine studies. So i think it's important to note that there are literally like eight guidelines for sad h that are out there in the literature so in terms of specific thresholds for diagnosis. There is some variability here but generally speaking the urine is morality should be inappropriately high or too concentrated in someone with sad. H typically. this is gonna be the many hundreds millions per cagey but a typical threshold. So we might see as you're not morality being four hundred five hundred something like that in these patients then also will see inappropriately high amounts of sodium in the urine as well. If if you think about it if you're a kidney and you know that your serum sodium is one nineteen your as a kidney. You're going to do whatever it takes to hold onto as much sodium as possible so really there's more than twenty or forty milligrams per liter sodium in the urine. That's not appropriate. You should be holding onto more of that. Sodium so again with urine chemistries. We're looking at odds. Morality more than one hundred urine sodium more than twenty to forty but oftentimes these will be even much higher than those values and so this is a pretty good background of what's considered normal and whatnot and you know what should be looking out on in terms of clinical evaluating the patient as well as you know laboratory Evaluating the patients to but let's dive into the treatment and so the overview of the treatment the bigger picture over here is the Identify secondary cause for sad aged and try to remove that cause or you know tried to alleviate that cause so for our patients for example it would be appropriate to stop the newly started. Sri the number two is going to be more of a critical care. Type topic is decide whether this is a cute hypothermia where they have neurologic manifestations of hypoglycemia. Or if it's severe hypothermia where they're starting is less than one hundred and twenty which is danger zone for seizures and other really life threatening complications so they have altered mental status seizures sodium Less than one twenty than in the first several. Your management is actually focused on Rapidly correcting their sodium by up to six local vince per liter. So that you can avoid those neurologic complications that may arise from that acute or severe hypoglycemia wants to deal with that then obviously transition over to the more chronic management of slowly getting back to a fairly normal sodium value over a period of several days and so from huron can probably talk about the treatment in terms of that acute severe version versus. Kind of like what happens after that acute treatment is done in patient is not in danger zone participant and so starting out with the acute or severe presentation as you mentioned dr cain This is berg. Patients would have neurologic changes. Maybe they're having seizures or their sodium is less than one. Twenty kind of relate this back to our patient. Her sodium was one nineteen and she did have altered mental status and she did have a fall. We know that that's probably caused her hypochondria in addition to her being on obviously the premise new therapy and so again. The indepth discussion about this treatment is probably beyond the podcast scope. But the bottom line is that we treat this acute Trina with the concentrated sodium. Chloride a three percent hyper tonic. Ceiling solution for this typical doses. Going to be a one hundred m l. bolles of three percent hypersonic. Sailing in this is going to be given over ten to twenty minutes and then basically give a dose and then you wait a little bit and assess for neurologic. Changes in terms of them improving. You'll likely get a follow up lab value an hour or two and Depending on what you see against beyond the scope of today's podcast by you may give up to three total doses. So three hundred miles of this three percent. Hypersonic sailing bolles with the overall goal. In the first six hours we want to correct that serum sodium in terms of increase that sodium by about four to six mclovin per leader in that first six hour period usually changing it that small amounts of there at one nineteen getting them. No more than one. Twenty five is kind of our therapeutic goal and that typically is enough to avoid the really serious complications of hyper nutria like seizures. Herniation things like that. We don't want to correct it too quickly but we want to move them up enough that we can avoid some of these acute problems that happened with severe hypoglycemia and of the drew mentioned dr king. This patients will be under icu. Care they're going to get frequent sodium checks for at least i or to model therapy is going in while they are getting stable. Exactly in during that time really. That's it for the acute. Management is not going to fix all of the patient's symptoms and it won't certainly won't fix their serum starting back to a normal level but it gets the ball rolling and then really after that comes the still hospital but non acute management of their hypo nutrient getting back to normal in terms of their. Sad h right so again going back to what discussed about identifying the secondary causes and removing it or alleviating it. It'd be better something that you mentioned earlier. Dr cain about the acute treatment that we don't want to raise the sodium too quickly. What happens if we do that. Why can't we just load them up. But the three percent Hepatic sailing yesterday. What happens is the your brain cells. Because of the blood brain barrier are slower to react to acute changes of really any electrolyte including sodium. So if we dramatically change your serum sodium make it higher. What will happen is the brain sodium. Let's say that your blood and bremer are at one. Nineteen we dramatically. Change your serum to go one thirty now. All of the water in your brain cells are gonna leave the brain in. Go into your blood to help. Dilute down that higher sodium levels through asmus but it turns out your brain cells. Need that water and we have a problem with that in that problem is called central ponti license or pm. And basically what happens. Is those brain cells damaged by because they don't have the water that they need. Because it's gone out back into your blood because of that asthmatic gradient so this sounds like a really big deal that we make sure we don't increase the serum concentration of sodium more than six million quivalent part of the first six hours. Yeah and then beyond that it really depends on what guideline you look at the historic textbook. Answer here is that you don't change some sodium more than eight to twelve milk events per liter per day in the first day in the no more than eighteen over a two day period. Depend on who you talk to. There are some sources that are a little bit more conservative suggest in closer to no more than six to eight mclovin per day of change period. No more than that. And so let's say a patient came in the serum. Sodium was hundred and twenty three. You know they weren't having this acute or severe presentation but they do have what we call it. Sad h won't be that first line therapy in that scenario so again the first line is going to be figure out why they have it and stop the 'cause especially if it's a drug induced 'cause obviously if they have lung cancer there is not a lot you can do about that but if they recently started taking a new drug especially like a. You're gonna stop that even though you could potentially be worried about withdrawal syndrome in this case the risks of continuing the esa sarai are almost always going to outweigh. The benefits of that. Drug is giving you. And as far as therapy. Therapy goes after removing that underlying cause would be fluid restriction and for that reason. Sounds really exciting dr kane so one thing is when you think about. Sad learn this really neat pathophysiology and you're kind of waiting for this miracle drug and it turns out that we just make the patients not drink as much. Fluid honestly is the mainstay of therapy for the vast majority of patients. There's no rule equation in terms of how much they're gonna drink or not on. There's no cool drug really. That is the first line therapy patients. Don't really like this at much to be honest with you. So we're going to restrict them to about one to one point five liters per day of both oral and iv fluid intake or. We can also look at the different wayne state that we want the patient to pee out five hundred miles more than whatever they took in and unfortunately patients don't like this because they get thirsty in we don't let them drink water and it takes several days really i sodium to approach normal levels using the strategy. So nobody's excited to do this. It's not comfortable but it is the safest and most effective therapy that we offer for these patients. Can i put it in perspective to those who have heart failure. You know john really. I mean it's individualized but generally we look out for like that two liter per day restriction. And so this one to one point five liter per day sounds little too extreme and so i can tell by patients. Don't like it absolutely and really the next therapy. Dr patel is actually. I think to not do in the thing to not do an sad each patients as you do not give them point nine percent sodium chloride or normal saline. The reason is it can actually make their hypo nutri. Mio worse. This actually counterintuitive because normal sailing has a hundred and fifty four Leader sodium in it. So you know when you give this most patients that actually makes them height bernie mac. Which is why intuitively. Think that this would be a good idea but it can actually worsen there. S h in. Why why does that really happened. Because i mean it just makes sense that. Hey there's water a has sodium. Minute organizers supplement. This you know today so turns out the sad h. They have a problem managing water but they don't have a problem managing salt so at the kidney level. What happens is they will be out most of the sodium from that bag but they will retain a lot of the water so the net effect is that they pay out more sodium than the amount of water that they took in so the the the net is that they have more free water that they retained because they got rid of the sodium that you just gave them so that is why they're hypoglycemia worsens is that they don't get that much sodium and they get some free water to go along with it. Really the key here is that these patients need to have an id fluid. That has an oz. Morality is exceeding whatever their urine is. Morality is so normal saline house moralities around three hundred and typically sad. We're looking at as morality. Four hundred five hundred something like that and so we're gonna probably resort to three percent. You know hyper tonic solution. Which has the odds morality of you know about one thousand one thousand two hundred twenty seven. That would probably help fix the problem exactly. So if looters friction working and we have to go to the next step the next step would be giving them three percent sodium chloride typical doses around point five to two milliliters per kilogram per hour. That's a pretty big range. Another way to look at. It is four three percent. The math would be different if you're using a different concentration but if you take their body weight in kilograms times the amount of change per hour that you want their sodium to change by that's gonna tell you the rate that you want so for example for eighty kilo patient if you want their serum sodium to change by zero point five eighty ten zero point. Five is forty milliliters per hour. So if you hang that three percents sodium chlorate at forty miles an hour on eighty kilo patient that means that every hour their serum sodium will increase by zero point five and in these patients in our sometimes. They'll they'll need that ivy loop diuretic if they start to have been a hyper. Lean out so the diuretic like rosa. Mind it's going to help. Patients get rid of that fluid volume and this. This really is not needed for most patients but if they have underlying conditions like heart failure or cirrhosis which we know are conditions that increase that dima to begin with than that might be necessary. Node actor toll earlier we talked about how fluid restriction is our first line therapy. And isn't this sexy awesome really targeted therapy for. Sad h we actually do have that sexy awesome targeted therapy nsh. But we don't use it very often in that. Drug class is called the app pens and the vast vast vast majority of patients will not need vapin instead. They'll do fine with food restriction stopping the drug induced 'cause in maybe three percent sodium chloride and as we dive more into what these are all big a more clear through wine. Most patients don't need to go on this but in general of app pens are we to receptor antagonists. Remember h goes through the kidney and that lay diesel fuel and collecting dot and agonizes. V two receptor map tons are basically doing the opposite of that and producing Accurate suspect Pure water loss is induced into the urine and unlike our fluid restriction. This takes effect within hours in. It lasts all day. You only have to dose the oral therapy once a day so in theory these vat ten sound like the perfect therapy for sad. H there are two tins on the market. We have told vapin or samsung. That's a once-daily tablet or early and we also have a continuous. Iv infusion called combat of at ten or rapper. All so we have iv we have. We have a perfect mechanism that links directly back to our pathophysiology dr patel. What is not to love about the vaccine drug class. Well so because they worked so well. There is a box warning for them. Causing the opposite. Which is the hyper nutri mia. And as we know there is the the consequences of causing the cpn mcphee over correct the sodium to yet so again when you initiate of app ten just like with three percent you're going to be very frequently monitoring serum sodium probably every four to six hours. If not more often at least in the first day or two in the after that you know several times a day because these vaccines are so potent. You really should not use them immediately. After giving percents chloride you wanna see what the effect of that. Hypersonic saline is then. Probably the most important counseling point with. This is when you see a patient. Receiving a new start bap ten. They should not be fluid restricted for the first day or two days. You should allow them to drink as much as they want. In the reason for that is that if you fluid restrict them plus give them the baptism the amount of change they will have will almost certainly exceed what you want them to to have an again. You're at risk for too rapidly correcting the sodium and so defecate. I don't deal bap. Dan's in a conic practice and disease management area. But in the hospital setting if you were to use the let's po holdback damn. The samsa was kind of dozing Do we consider if they work really really well so if you look at the package insert says fifteen milligrams a day on day one then it can go all the way up to sixty milligrams in my experience usually will actually give half of initial dose. Which would be seven point. Five milligrams in kind of reassess at that point. You can always give more. But what you don't want to have happened is that Overly cracks in. They have to start something like giving them extra water or even five. W iv infusion because you overcorrected non play catch-up avoid some of those complications of over correction make sense and so as we would expect. These drugs are going to cause more thurbers. Dry mouth and urination and so these are kind of like the common side effects. Patients will report in another thing about these in terms of side effects is actually patak's society so again usually for s h were giving several doses in the hospital setting. But these do have a warning that you should not exceed thirty days because of the risk of have had attacks the city in addition to that these are also dragging her actors. These are three a. four substrate so they're susceptible drug interactions but also they are three or four inhibitors so that caused regular actions as well so we do have some issues in terms of wide. These are not core. First line therapies for city h and in addition to that you know. They're they're expensive. The average wholesale price is about six hundred dollars for one tablet Actual cost lower. But that kind of goes back to the use of just half the does dr kane as you mentioned that that helps to cut down the cost of little bit. Exactly i mean again. Most patients are not going to be taking this for very long. So it makes sense that this would be pricier per tablet. 'cause it's not a chronic med that a patient would take indefinitely but six hundred dollars tablet. That's pretty pricey and something that really should be taken seriously in terms of who is going to initiate therapy basically. It's not for everyone that just and then there are some other therapies. That are not for everyone to so what we talked about up until now are kind of like the common. It's more like a streamlined Prime line therapies. But you may hear a read textbooks or literature additional drugs that have been used to correct. Sad age so some examples of that and again this this textbook. This is almost never done. In clinical practice. There is a tetracycline. Derivative antibiotic called domecq clean and about two thirds of patients that causes diabetes and separatists. Where the kidney does not respond to age. But that means that about a third of patients. Don't respond to it. It has a fairly delayed onset of action. so it's not even close to the onset of our vaccines. It takes about two weeks for sodium levels to get back to normal. And it's the tetracycline derivates you have to worry about. Photos sensitivity in compared to other tetracycline also causes a little bit more nefer taxes city as well so generally this is not used. But you'll definitely see textbooks and the other drug that you may hear is lithium. Yes i let them. It also causes. Genetic diabetes ends in about thirty percent of the patients that you can think about seventy percent of the patient. It may not work to do what we intended to do. But give all the lithium related side effects so again now for a tax subsidy thyroid and hello. I mean who wants to caused mood imbalances by giving lithium to patients just to correct there. S h that. Sounds like a bad idea that you're giving a drug for side effect without really considering all of the other side effects that the patient has to deal with because of that lithium that you're giving them and this threatened doctor. Cain was really surprising. We're talking about taking urea urea in your p yeah pretty much taking it orally bell. Okay so yeah with urea. The the mechanism here is that you're giving you load to the patient so they have to out the urea that you give them out. Water comes along with it so it causes this salyut racist because the water's following that urea. There's also a secondary mechanism related to reducing the amount of sodium loss in the kidney as well but its primary mechanism is that saw diaries. Something tells me that this does not taste good. No so it's available as a powder for solutions you have to mix it with a liquid is actually medical food not an fda approved drug in it tastes apparently terrible and nobody likes drinking it on top of that. You're literally giving these patients. You're eso via. When levels usually increase. They should increase typically. Were looking at be when doubling when you take this medication so generally this is not well tolerated mostly because of palatability issues but all of the other side effects in things like that Really relegate all of these therapies that tetracycline derivative lithium urea almost. No one uses these. But you're still gonna see them in a textbook potentially exam questions and things like that but not commonly done we will probably just leave them in the textbook. We won't you. I agree how about that. Well why don't we go back to our patient case in kind of wrap things up in terms of won't be a typical clinical course for that patient so again each end was seventy four year old female. Sad where the of eighteen with some neuro changes. What are typical therapies. That are gonna happen for her. Dr patel so as we laid out i think for the goal of therapy is to identify underlying causes. Remove it right. We know she started her satala pram because of anxiety we covered that they are causing. Sad age in one of the cases. That's most likely the cause and so we're probably going to stop her. Ssi i obviously. We're going to look for other options to help control during ninety but for now we're going to stop this one in because she did have neuro changes in she would be classified as severe highpoint treatment with the city in less than one twenty. She will get at least one hundred miles of three percent. Sodium chloride or hypersonic sailing in the emergency department again. We don't want to change her certain by more than about six within the for six hours potentially even within the first day of she clinically improves with that. If her sodium isn't improving her. Clinical symptoms are not improving. We could potentially give up to three total doses of the one hundred miles hypersonic sailing and once that's done than the gold. Standard therapy of fluid restriction is. What will come in play. So we're talking about one to one point five per day of food. Obviously if fluid restriction doesn't work then we can repeat the three percent sodium chloride infusion one more time in the again the ten sound like a great drug category but because of costs side effects. Things like that really the only scenario where she could potentially receive of ap tan is if she's refractory to fluid restriction in more three percents of chloride that would be a very rare circumstance where she would qualify for that so i think that wraps up the episode of adhd Dr cain we have a few points to kind of lay out as a key concept and so just understanding the pathophysiology you know as i h causes hypo nutri ya It causes it by making the body to reabsorb too much water and so leads to too little water in the urine and leads the urine concentrated. And the you know the pathophysiology. The core issue is not really a sodium issue but the water issue that leads to a sodium issue. Number two is going to be the The most common cause of sad h there are a number of other seen as acting medications by esera. We're going to be the textbook. Example here in india cuter severe cases where you have very low levels in patients presenting with Status three percent. Sodium chloride the tonic. Is going to be the quickest way to increase the sodium. We may not make sure we don't do this too quickly and our goal will be about six quibble quibble per liter even within the first six hours potentially within that first twenty four hours to avoid any kind of acute neurologic complications then finally fluid restriction. Is our first line therapy for these patients. It's going to take several days for him to get back to normal range so have to be patient and typically around one to one point five liters per day is what we're looking at for that fluid restriction so. I think that wraps up. Today's episode nicely. We do have a couple of references that are review articles. If you're interested those are available at our website. Helix talked dot com again. This is episode one hundred twenty. Were also on twitter at helix talk and we love the five star reviews itunes so that we can climb the rankings and other clinicians are more likely to find the podcast so with that dr king. And i'm dr patel in his elevates. Study hard if you enjoyed the show. Please help us climb the tunes. Rankings for medical podcasts. Like giving us a five star review in the store. Search for helix. Talk and place your review there to suggest an episode or contact us were online. He looks dot com. Thank you for listening to this. Episode of helix talk. This is an educational production. Copyright rosalind franklin university of medicine and science.

dr patel hypoglycemia vasil diabetes dr kane dr cain dr king Dr cain Franklin university college of diabetic hormone lameck hypothermia foundation of the hormone Arginine vasil akwa vizo preston tennessee lee mc
Spare the Rodrigo: Philippine elections

The Economist: The Intelligence

21:53 min | 2 years ago

Spare the Rodrigo: Philippine elections

"This economists podcast is sponsored by linked in jobs. Hello and welcome to the intelligence on economist radio. I'm your host. Jason Palmer every weekday. We provide a fresh perspective on the events shaping your world. Overuse of antibiotics has driven the evolution of microbes that are resistant to them. So new drugs are constantly needed. But pharmaceutical companies lack the incentive to develop them market prices are dirt cheap and doctors are trying to prescribe the less. And the treasures of antiquity that are dotted around. Greece are jealously protected by the state. That's why a new art exhibition on dealers smack in the middle of the tiny islands. Ancient sites is both surprising and intriguing. But I. Today, Philippine voters will head to the polls for mid-term legislative elections. More than eighteen thousand government positions are up for grabs including around three hundred seats in the house of representatives and twelve slots in the Senate in a political system where personality Trump's party some see the ballot as a popularity test for the country's firebrand leader Rodrigo Detaille if his loyalists do well, the president will be able to consolidate his power. Mr. deter take was elected in two thousand sixteen. I win so press crime group the. Nothing. Anti-establishment populist. He promised hardline policies. Three years into his term. He's delivered. He launched a bloody war on drug crime. Dead bodies are being recovered from the streets in Manila. And in one notorious speech even likened himself to Hitler. Loss of third three million. Is three million three million. That'd be happy to slot. Person. Do say is an abrasive character whose son some international opprobrium for all his campaign against drugs, which is turned into a RAV murderous free for all that's killed thousands of people John MacLean reports for the economist from nila, he's less well-known for determined efforts to to peace with was than separatists of south of the Philippines, while at the same time being tough on those who get together with Islamic state and also for his efforts to dial down the confrontation with China over territory in the South China Sea and today Filipinos will go to vote in midterm elections. Why are those elections important for Mr. dude? Jose miss deters has three years left of his single six-year term, and like go presidency needs support of congress to keep governing effectively. Now, he has been quite covering his first year. Years in office in getting most of the legislation he needed urge of the these tax reform program of infrastructure building, which will help keep the economy growing fast. So he has less need of congress in the second half is too, but it's still useful to have to govern affected. Well, I mean, what's sort of changes are in prospect for the second half of his term. Watching needs to do is congress positive the second half of tax reform measure, which will do the economy a world of good Congress's help is also needed in his project to also the constitutions were placed the unitary state with a federal system. Why did Mr. detach? They want to change the nature of governance, essentially, he wants to make sure that the peace plan for the Muslim areas of the Philippines will stand up to the scrutiny of the supreme court. Now, there is a chance the supreme court will declare that these unconstitutional simple answer to that problem. Of course, it's the change in the constitution. Back is the main reason for Mr. turkeys eagerness for federal system. And how popular is he with this program of tax reform and infrastructure and an ambitious peace plan. How's he doing in? The polls wish to do. He has had consistently high ratings in all kinds of England polls satisfaction with his government popularity everything and he's not so much. He's policies that making popular, but he's personality. And I mean, the thing that's we often hear most outside the Philippines is about this brutal crackdown on drug dealers. And the like is that a popular policy is that contributing to his popularity. Well, there are certainly misgivings on many Filipinos about how this campaign is conducted. But in general is perception the crime on seats who's fallen so yes, he's policy has public approval. But it's very qualified public approval. Is there truth to that is crime genuinely down or is it? The very public very visible nature of this crackdown. Kind of contributing to the sense that crime is down crime figures in of the crime figures and many other parts of the world. They say what the police want them to say if he's a section that the streets are safer on the other hand, the campaign against drugs is a very bloody. It said it's so it was not so much a case if these, nurses the criminals, but it's more of a war on drug dealers and predictors of the drug dealers among the police, so it's a free for all where no one knows exactly where they stand and in the event that Mr. Tetteh and his allies are triumphant in this election. We'll vet get worse. You think certainty that will be next affective criticism of the campaign against drugs, but it will carry on anyway. And in that election. I mean who are the credible threats then to Mr. detained and his allies opposition coalition. Who's made the mistake of painting? This election is a referendum on Mr. do. Tessie? Now, the opinion polls show them that the president is popular. That's only one of the senatorial candidates in the opposition is likely to win a seat. Bam Aquino who belongs to the Aquino clan. But is provided to presidents Philippines. Now, political dynasties are big factor in Philippine politics. And another interesting character to watch we'll be Mr. do Turkey's own daughter who is the man of his hometown. She's only session to attain a post. But whether we're seeing him start of a new let's go on the national stage remains to be seen. I think it's highly unlikely that tattoo tech table. We'll step onto the national stage anytime soon, so what do you think? Then we'll we'll have it in this election will Mr. Detaille and his loyalists keep their majorities. Yes. Mr. if you touch there will retain a degree of control of congress. How long that control will lust though is another matter OE politics in the? Philippines is transactional. The president. Is the phones will patronage congress gives the president's support in return for government spending in that constituencies that loyalty to the president's can change quickly. Suddenly when the president tends to become a lame duck is he does towards the end of his term. But for now, you think Mr. Detaille is is safe for the next year or two years. Yes. He's sake towards the end of his term. He will suddenly become laying as it would be. John. Thank you very much for joining us. Antibiotics are so widely used that it's easy to forget what a miracle drug. They seemed when they were new before penicillin even simple wounds could result in fatal infections during the second. World War, the production capacity for the drug was limited. It wasn't used much because a single shot could cost around six hundred dollars today's money, but better manufacturing methods cut that price down to just twenty cents to make the Pontes needed. It was decided to seek help in the United States here. Scientists devised better ways of countering penicillin, which could give much bigger yields. This film produced by the British government in the nineteen sixties hinted at the extrordinary need the world would develop for the drugs today, the penicillins early one group of antibiotics among many butter. I didn't know Bartos throughout the world. The such goes on for more. Big pharma companies are finding it very hard to make money on these drugs because the margins have historically been very slim. They obviously have more lucrative opportunity such as drugs for cancer, rare. Diseases Slovakia Czech about is the economists healthcare. Correspondent the development of antibiotics is an expensive business molecules are harder to discover the development Coster quite high. It takes about ten years or even more to bring a drug from the lab to the patient it costs somewhere around a billion dollars. So obviously, if you target your research and development investment, the particular product, you want to pick one that can bring you money, and I presume that the the the rise of antibiotic resistance and this roof growing awareness of that also kind of puts pressure on people are actively trying to use fewer of these things. Absolutely. That's that's the main problem with the business model for anti-biotics, so antibody cheers. Which is the concept of doctors reserving, the newest antibiotics as a last resort in order to preserve them to make sure that resistance doesn't develop to them means that sales volumes are very small. So if you have a new antibody on the market, not only you can't get a lot of money for it. You can't tell much of it either. When why is it so expensive too to find to make new ones? Some researchers say that the low hanging fruit has been picked traditionally the way anti-biotics have been discovered his being too literally just dig in the samples of soil brought from anywhere in the world and try to find a compound that works on certain, Victoria. So that model is getting more difficult because resistance is so widespread now with overuse of antibiotics all over the world on the other hand developing new drugs is expensive as ever bringing them from the lab to the patient requires expensive clinical trial. Els and in the case of antibiotics for new superbugs. It's particularly difficult because the number of patients when he'd dumb is quite small resistance develops over time. So the number of these patients will grow. But at the beginning there are so few of them that for clinical trials, it's a lot of work to find his patients and run the trial, which makes it very expensive and difficult to do it in reasonable time. And so the these drugs than look kind of like a bad bet for pharmaceutical companies to to pursue. Yes. That's right. And that's why big pharma companies have largely left this line of business on the three of them still have antibiotics in clinical research. So the pipeline of new antibiotics has really dried up so kind of a cross the board the the incentives to to develop these things have have been reduces or any way to address that or to to bring down development costs or raise the incentives and some other way bringing down development costs is really. Not not an option because you do need to run the clinical trials the development costs are what they are. It's difficult to to bring them down on the other hand paying for the drugs. Could be changed at the moment. Antibiotics in America are paid for as part of bundles for hospitalized patients, which means the companies can charge a lot of money for them. So changing how antibiotics are reimbursed could make a difference. There are some interesting models that are being considered the British government. For example, is trying out a model whereby the pay for antibiotics in bulk. So it's sort of a subscription fee to have access to certain antibiotic, regardless of how much the us if that subscription fees large enough that could make business sense for some new anti-biotics, and is anybody sort of stepping into the breach. Yes, they're a small by technology companies which in the last five to ten years. Have tried to few in the scab? Some of them have come up with anti-biotics for some of the really scary superbugs kill half of the patients. They infect however is they're bringing their products to market. They're running into the same problem of not being able to make money at the beginning. When when there are so few patients around for that drug and another interesting idea that has been discussed quite a bit is giving an award to someone who develops an antibiotic for a particularly scary superbug and the amount that has been discussed is about a billion dollars, which is the development costs for a new drug that seems like a lot of money, but by some estimates, antibiotic resistance could cost the world a lot more by twenty fifty the World Bank estimates that the cost of anti-microbial resistance could rival that of the two thousand seven finance crisis begin the mechanism. That's brought us to this point with growing resistance than and the need to find drugs. I mean, isn't this a problem that will? Of continue in indeed magnify if it's so hard to find new drugs. Oh, absolutely. We've been able to keep infections on their control. Exactly because there have been new antibiotics pain developed to replace those which microbes have become resistant. And now the process is slowing down. We are in real danger of being unable to fight common infections. If there are no new antibiotics to replace those that are rapidly becoming useless. Is there a chance that will will reach a stage where there are simply no more molecules to be to be found to do this job. I don't know anyone knows the answer to that question molecules are still being found which means they're out there. It may be more difficult to discover them. But the real problem is really once the molecules discovered how it will be brought to drag the goes on the market, and is commercially sustainable, and so it's all about getting the incentives right at this stage. Yes. That's right. Your thank you very much for your time. Thank you. And if you'd like to hear more on antimicrobial resistance, you can listen to the economists podcast the world ahead when the drugs don't work, we speak to Maryn McKenna, the author of the new book plucked. She reveals just how much antibiotics are overused in the cultural industry, we are spraying as streptomycin an Oxy tetracycline. Hundreds of thousands of kilograms on citrus grows to save the orange industry of Florida and California, no matter how we have misused antibiotics in all of these settings the central problem is that we are not using them for the thing that they were invented for which is to cure infections. Every summer tourists flock to the Mediterranean and board ferries to the Greek islands. In between basking in the sun and eating moussaka many. Visit the ruins of ancient Greeks of Liz Asian imagining an era when people worshipped a pantheon of gods and thought terrible wars, but also nurtured early democracy science drama an architecture. Dellis is an island in the middle of the GM small Little Rock sounded by many other large ones. Amaryllis party is a tour guide who shows people around the tiny place with its huge ancient city. I believe that one of the most beautiful sites of losses that bypassing the sea to get the you're literally having a catharsis of our times and you travel back into time with the boat. And you get the Opal -tunities to walk through history with no traffic, no buses. No shops not much reminding us of our times, but it's just yourself history nature and the surrounding light. She's worked for years on the island showing people around the site where pilgrims once came to worship Artemis and Apollo and to trade, but like most ancient sites in Greece. The authorities have never allowed anything modern on the ruins until now. Now these cultures that made of iron, their obviously contemporary sculptures, and they make an extraordinary impression in this very antique and beautiful landscape. Bruce, Clark writes about faith for the economist and visited deals earlier this month, you've got a small and very numerous Greek island with the low hill of the top with a lovely competent flowers and grass because it's springtime and we've had lots of rain. And so the injection of these sculptures into the landscape is something very powerful. It really catches the eye. So, Bruce, what's what's going on who who made these cultures? And what are they doing on the island? These cultures were made by one of Britain's most popular public artists. So Antony Gormley now he's famous in England for placing sculptures in important public places, and the common theme of all his sculptures is that they explore the relationship of the human being with his environment. And they were brought to Greece at the initiative of a private autistic foundation by the name of Nalen, and they were working in close collaboration with the Greek ministry of culture. And did you get a chance to ask serenity about why he chose this site? Well after seeing next edition I had the chance to sit down with Ronnie Gormley in a hotel and talk to him about the show. It's difficult. Not to kind of go into magical thinking, oh, MRs them in saying the qualities of dealers are extraordinary. But it is something to do with the in a way. The smallness of the island is it's it's rockiness. And it's light it's lack of water. And yet this feeling of of somehow in spite of the smallness of the island somehow being extended into into space at large. I mean, he's spent the last several months fine tuning the installation of his sculptures in this landscape. It's been a very complex operation putting the sculptures in place. Some of them had to be dropped in by helicopter. Well, quite with with helicopters and everything I mean, it's not common for for Greece to allow that this kind of kind of intrusion into action sites. Right. Why why did they permit? This one is. What is to stop with the first point is certainly true that the Greek authorities are very sensitive to anything that seems to disturb the integrity of an ancient site. Now, I think what was special in. This case is that the was already a very harmful bond of collaboration between the private sector and the public sector as it were the private foundation now and the Greek ministry of culture, and they jointly made the application to the Greek ecological counsel to use the landscape of dealers and on certain conditions. It was accepted. And so what did you make of it? Did you did you like it? Well, seven the ones that were placed with the sea in the background. I found extraordinarily moving, and it is just a stunning landscape anyway and the site of these sculptures against the scudding waves is very very powerful and moving the ones that are extremely abstract will appeal to some people not to others to me. It was almost. Votive that they've put a rather solid. Heavy piece of iron in the middle of the ancient theatre, which is a place that would have hosted lovely flexible, nimble, movements and Odin times. So there was a great contrast between the heaviness and the solidity of this piece of on with the kind of performance that once would have been seen in this lovely environment. But it was let's say a provocation almost playful statement, which I found acceptable and didn't ruin the environment from and that's the main thing the environment is so powerful that it really can't be shattered by anything, Bruce. Thank you very much for your time. Thank you. That's all for this episode of the intelligence if you like us give us a rating on apple podcasts, and you can subscribe to the economist at the communist dot com slash radio offer, twelve issues for twelve dollars twelve pounds Seebeck your tomorrow.

president Philippines congress Greece Rodrigo Detaille Bruce Greek ministry of culture British government John MacLean England Jason Palmer penicillin Manila Bam Aquino supreme court Turkey United States World Bank Hitler