Author: Mitch Belkin

I am a radiology resident at University of Maryland Medical Center. Outside of medicine, I am excited about Brazilian Jiujitsu, meditation, and podcasts on financial independence.

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9. Fructose and Fat Storage: An Evolutionary Perspective with Rick Johnson, MD

Rick Johnson, MD

In this interview, Mitch Belkin and Daniel Belkin speak with Dr. Rick Johnson about fructose and its relationship to fat storage. They discuss uric acid as a cause of kidney inflammation and essential hypertension, how glucose intake can trigger endogenous fructose production, and the relationship between salt and obesity. Finally, they touch on the evolutionary history of uric acid metabolism and the potential role for fructokinase inhibitors in treating metabolic disease. This conversation was recorded on June 24th, 2021.

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Who is Rick Johnson?

Dr. Johnson is a Professor of Nephrology at the University of Colorado School of Medicine. He is one of the world’s leading experts on fructose. His research focuses on the role of fructose and uric acid in obesity, diabetes, hypertension, and kidney disease. He has over 700 publications, in journals including JAMA and the NEJM. He is also the author of two books for a general audience, The Fat Switch and The Sugar Fix.

References

Books:

1. The Fat Switch

2. The Sugar Fix

 

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8. John Mandrola, MD: Medical Conservatism, Myocarditis, and Physician Advocacy

John Mandrola

In this interview, Daniel Belkin and Mitch Belkin speak with Dr. John Mandrola about a 2019 article he co-authored entitled The Case for Being a Medical Conservative. They discuss concerns about vaccine-induced myocarditis in children, vaccine mandates, and whether the AMA and other physician organizations should take sides on controversial political issues. This conversation with Dr. Mandrola was recorded on July 11th, 2021.

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Who is John Mandrola?

Dr. John Mandrola is a practicing cardiac electrophysiologist and a regular columnist for theheart.org on Medscape. He hosts the fantastic “This Week in Cardiology” podcast and is a blogger at drjohnm.org. He completed his medical training in Internal Medicine, Cardiology and Electrophysiology at Indiana University. 

References:

The CAST trial 

RECOVERY Trial

Medscape – Cardiology

Medscape – General Medicine

Blog

Substack

This Week In Cardiology Podcast

Twitter: @drjohnm

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Podcast

7. The Epigenetics of Aging & Dispelling mRNA Vaccine Myths with Yuri Deigin

Yuri Deigin

In this External Medicine Podcast interview, Daniel Belkin and Mitch Belkin speak with Yuri Deigin about aging, which he argues is fundamentally an epigenetic phenomenon. They discuss partial reprogramming using Yamanaka factors, evolutionary explanations of aging, and recent in vivo experiments which suggest that aging is partially reversible. They also touch on mRNA vaccines, specifically to address allegations about the cytotoxicity of the spike protein and concerns about infertility discussed on Bret Weinstein’s Dark Horse Podcast with Steve Kirsch and Robert Malone, MD, recorded on June 11th 2021. This conversation with Yuri Deigin was recorded on June 25th, 2021.

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Who is Yuri Deigin?

Yuri Deigin is a biotech entrepreneur with a background in pharmaceutical development. He received degrees in computer science and mathematics from the University of Toronto and an MBA from Columbia University. He is the CEO of Youthereum Genetics, a company which aims to translate epigenetic rejuvenation therapies to humans. 

Yuri was an early proponent of the SARS-CoV-2 lab leak hypothesis, the idea that the virus may have inadvertently escaped from a lab. In April 2020, he published a detailed genomic analysis of SARS-CoV-2. In that article, Yuri discusses the virus’s furin cleavage site, genetic similarities and differences with its closest relative (RaTG13), and the similarities between the virus’s receptor binding motif and that of a pangolin respiratory virus. He also explores the gain-of-function research program at the Wuhan Institute of Virology. Unfortunately, we did not have time in this conversation to delve into this hotly debated topic.

References:

Universal methylation age across mammalian species

Partial reprogramming of Progeria mice

David Sinclair paper on restoring vision in mice

Uri Manor Lab spike protein paper 

Large doses of Spike Protein Induce Acute Lung Injury in Mice

Pfizer ADME study (translated from Japanese) 

Vaccine Adverse Event Reporting System (VAERS) FAQ re: requirement to report deaths, other serious adverse events

How frequently are side effects reported to VAERS?

More on Yuri:

Medium article on SARS-CoV-2 Origins

Yuri’s twitter: @ydeigin

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Podcast

6. The Case for Medical Education Reform with Bryan Carmody, MD

Bryan Carmody

This conversation with Dr. Bryan Carmody was recorded on June 21st, 2021. In this interview, Daniel Belkin and Mitch Belkin speak with Dr. Carmody about the history of the USMLEs, the value of standardized test scores, and the arms race in the residency admissions process. They touch on conflict of interest in medical education and the rising cost of medical schools among other topics.

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Who is Bryan Carmody?

Dr. Bryan Carmody is a pediatric nephrologist at Eastern Virginia Medical School. He has made a name for himself as a critic of certain aspects of medical education and the residency application process. For years, he has argued that USMLE Step 1 should go pass-fail and that Step 2 CS should be eliminated — both of these events happened in the last year and a half. 

Campbell’s law:

Campbell’s law comes from Donald Campbell, a psychologist and social scientist from the mid-20th century.

In 1976, Campbell wrote: “Achievement tests may well be valuable indicators of general school achievement under conditions of normal teaching aimed at general competence. But when test scores become the goal of the teaching process, they both lose their value as indicators of educational status and distort the educational process in undesirable ways.”

For instance, there are now entire school curricula devoted to improving test scores. This obviously wasn’t the original intention. 

References:

Radiology Journal Article: “Do residency selection factors predict radiology resident performance?” This article finds a fairly modest association between USMLE score and discordance rates between preliminary resident reads of radiologic findings and the final attending interpretation. This was for residents at UPMC. https://pubmed.ncbi.nlm.nih.gov/29239834/

Paul Graham: The podcast references his essay, The Lesson to Unlearn.

More on Dr. Carmody:

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5. Diagnostic Reasoning and Medical Overuse with Deborah Korenstein, MD

Deborah Korenstein

In this interview, we talk with Deborah Korenstein, MD, about medical overuse and overdiagnosis. We discuss her April 2021 publication in JAMA Internal Medicine, the Accuracy of Practitioner Estimates of Probability of Diagnosis Before and After Testing as well as the diagnostic process, the teachability of diagnostic reasoning, cognitive biases, and other topics. This conversation was recorded on June 7th, 2021.

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If you enjoy this discussion, you may like our conversation with Dan Morgan, MD and Paul Offit, MD

Who is Deborah Korenstein?

Dr. Deborah Korenstein is Chief of the General Internal Medicine Service at Memorial Sloan Kettering Cancer Center in New York. Her clinical work focuses on care to adult survivors of childhood and other high-risk cancers. As a researcher and an educator of physicians in training, she is interested in improving the value of care while minimizing unnecessary and potentially harmful tests and treatments.

To learn more about mitigating medical overuse, check out the ABIM Foundation’s Choosing Wisely campaign and Dr. Korenstein’s project Testing Wisely.

Factoids:

In this week’s episode, we list some factoids on the overprescription of antibiotics for viral URIs, the incidence of incidentalomas, and the detection of PE with high resolution CTA. If you’d like to read the articles from which these factoids were taken, check them out below:

1. 2019 Update on Medical Overuse: A Review in JAMA Internal Medicine

Highlights:

  • Procalcitonin does not affect antibiotic duration in patients with lower respiratory tract infection (4.2 vs 4.3 days)
  • Incidentalomas are present in 22% to 38% of common magnetic resonance imaging or computed tomography studies
  • 9% of women dying of stage IV cancer are still screened with mammography
  • Clinics commonly overprescribe antibiotics (in 39% of all visits, patients received antibiotics)
  • State medical liability reform was associated with reduced invasive testing for coronary artery disease, including 24% fewer angiograms

2. Overdiagnosis in primary care: framing the problem and finding solutions in BMJ (2018)

Highlights:

  • Overdiagnosis is defined as the diagnosis of a condition that, if unrecognized, would not cause symptoms or harm a patient during his or her lifetime
  • Overdiagnosis can harm patients by leading to overtreatment (with associated potential toxicities), diagnosis related anxiety or depression, and labeling, or through financial burden.
  • Many entrenched factors facilitate overdiagnosis, including the growing use of advanced diagnostic technology, financial incentives, a medical culture that encourages greater use of tests and treatments, limitations in the evidence that obscure the understanding of diagnostic utility, use of non-beneficial screening tests, and the broadening of disease definitions.