At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, May 23, 2026, through your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on May 25, 2026.

How Music Heals

Dr.Elizabeth Margulis directs the Music Cognition Laboratory at Princeton University. This scientific endeavor is devoted to understanding how our brains react to music. One discovery is that music has a lot in common with infant-directed speech. It is highly repetitive with exaggerated pitch modulation. When people talk to babies, they may slow their words down a bit and raise the pitch of their voices. All of these properties make infant-directed speech a lot more like music than the rest of our everyday utterances. Caregivers around the world adopt this sort of “baby-talk” because babies pay attention longer when they do. Is music tapping into the same primal brain responses?

Another characteristic of music is that it can trigger emotional responses. These are culturally conditioned; bagpipes do not have the same effects as Tibetan singing bowls. Howe er, the reminiscence triggered by music can be remarkably complete, putting us back in time not only to the place where we heard it before, but even to the bodily sensations that we experienced at that moment. Musical memories are exceptionally persistent. Older people with dementia who can no longer remember important facts about their own lives can often join in singing a popular song from their youth.

The Downsides of Music

Music may have social and political ramifications. Just imagine a chorus singing “We shall overcome,” and you will probably make assumptions about the singers and their values. As a result, we should not be surprised to learn that people may fight over music. Frequently entire generations have genre preferences such as hip hop or rock that are not shared by adjacent generations. How do we approach the music we love to hate? Can we understand how music heals even if we don’t like it very much or at all?

Musical Daydreams Help Us Understand How Music Heals

Dr. Margulis has studied and written about musical daydreams. What does she mean by this?

As you watch a movie, you may appreciate the score. But even if you don’t notice it at all, the sound track influences how you understand the action on the screen. Likewise, when most people listen to a piece of music, they may create a visual to go with it. Dr. Margulis offers us an example of a snippet of music by Liszt that evokes for many people an image of a cartoon cat chasing a cartoon mouse. Needless to say, that is not what Liszt was thinking when he composed it, since cartoons did not exist at the time.

Choosing Music for Healing

Joe mentioned the unobtrusive but soothing music playing in the background when he has an acupuncture treatment. Dr. Margulis suggested that music activates motor areas of the brain, and that might help explain the benefit in this setting. We are still learning more about how music heals. This research may some day guide healthcare professionals in choosing music for their practices, even in the hospital.

This Week’s Guest

Elizabeth Margulis,PhD, is Professor and Acting Chair in the Department of Music, with affiliations in Psychology and Neuroscience. Dr. Margulis directs the Music Cognition Lab at Princeton University. Her research pursues questions that lie at the intersection of the humanities and the sciences. She was also trained as a pianist. Her most recent book is Transported: The Everyday Magic of Musical Daydreams.  Her website is https://www.elizabethmargulis.com/about

This link takes you to the publisher’s page.

Elizabeth Margulis, PhD, Princeton University

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Listen to the Podcast

The podcast of this program will be available Monday, May 25, 2026, after broadcast on May 23. You can stream the show from this site and download the podcast for free.

Download the mp3 or listen to the podcast on Apple Podcasts or Spotify.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream Saturday, May 16, 2026, at 7 am EDT on your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on May 18, 2026. (This show originally aired April 25, 2025.)

The Power of the Unconscious Brain

Our senses feed us a tremendous amount of information all the time, but we don’t have the bandwidth to pay attention to more than a small fraction of it. That’s where the unconscious brain is so valuable, juggling millions of bits of information while we focus our conscious attention on what seems important.

One surprising outcome of the research on how our brains function is a re-assessment of what is going on when people are unconscious. For centuries, doctors thought there was really no brain activity while a person was comatose. Then, a few decades ago, a scientist was recording the brain waves of a patient in a coma. The activity was very peculiar, as if the person were watching a ball being lobbed back and forth across a tennis court. In actuality, a television set in the room was broadcasting a world championship match between Roger Federer and Rafael Nadal. The neuroscientist recognized that this individual was following the match and was not nearly as deeply unconscious as had been thought. Further research showed that this kind of unconscious brain activity is not uncommon. It may hold keys to determining who has the best potential for recovering from their coma.

Freud and the Unconscious Brain

If you hear the term the unconscious mind, you may think of Sigmund Freud. He really popularized the concept that some very important brain activity takes place outside of our conscious awareness. It still has a powerful influence on our behavior.

By the way, if we recognize that our conscious attention is indeed a limited resource (200 bps, remember), we won’t try to multitask. Humans actually aren’t very good at multitasking; instead, we switch our attention from one thing to another. Some people can do that fairly easily, but for most of us, it is less effective than staying focused.

Three Stages of Brain Development

Evolution likes to build on what it’s already got in place, so it shouldn’t surprise us that we can track three different evolutionary stages to our human brains. The reptilian brain came first, of course, and is there as a base, operating mostly on reflex. It’s definitely an important part of the unconscious brain.

The mammalian brain brings in emotions. The hormone oxytocin is relevant for this discussion. It is critical for birthing and nursing young. As it turns out, oxytocin can also be put to other uses, such as bonding mates together and creating friends.

Finally, we have the primate part of our brain. We humans, like other primates, can exercise empathy because our mirror neurons allow us to relate to another creature’s experience. In fact, mirror neurons were discovered by scientists studying macaques and eating gelato. Listen for a great story!

Speaking of empathy, we wondered about empathy fatigue. We started hearing about empathy fatigue during the COVID pandemic, when healthcare providers were overwhelmed by extreme demands with inadequate support. Research shows that “constant, repetitive exposure to the pain of others leads to empathy fatigue.” Lack of empathy can lead people to do terrible things.

Wonders of the Unconscious Brain

Our brains are full of clocks. To some extent, these are shaped by how we use them. Musicians who play percussion instruments can perceive time differences of just a few hundredths of a second. All of us are entrained to a 24-hour a day cycle, whether we observe sunrise and sunset or not. But if we are deprived of connection with that cycle, our internal clocks can’t keep good time, and our brains may get far off track.

What About Premonitions?

Some people think premonitions are a fantasy. Yet this is another area where our unconscious brain may be more capable than we imagine. Dr. Hamilton describes an experience in the Swiss Alps where he and his wife had a choice of which path to take down from the summit. One appeared to be a shortcut, and they did have some time constraints. But as soon as they had taken a few steps that direction, he had a premonition of something terrible. They took the other path and learned later that there had been a landslide on the shortcut that would have swept them helplessly down the mountain.

According to Dr. Hamilton, some people have the ability to influence the output of random number generators. Those of us who can’t may wish to reject that idea, but it has been documented. The Princeton Engineering Anomalies Research lab has run many studies demonstrating an impact on random number generations, not to mention remote viewing. In this way, some of the hidden power of the unconscious brain appear as cerebral entanglements, analogous to quantum entanglements at the sub-atomic level of matter.

This Week’s Guest

Dr. Allan Hamilton, MD, FACS, is a neurosurgeon who has specialized in treating brain tumors. His extraordinary journey from janitor to Harvard-trained neurosurgeon is just the beginning of his remarkable story. A decorated Army veteran, he now holds four professorships at the University of Arizona and has been recognized as “One of the Leading Intellects of the Twenty-First Century.” As the only American honored with the Lars Leksell Award for pioneering scientific discovery in stereotactic neurosurgery, Dr. Hamilton’s groundbreaking work has revolutionized the field. He has had a life-long interest in the application of computer technologies to enhance surgical care and reduce avoidable medical adverse events. In addition, he has served on two White House Advisory Committees under two presidential administrations.

Allan Hamilton, MD, FACS

His expertise extends beyond medicine, having studied creative writing under Rod Serling and serving as a senior medical consultant for Grey’s Anatomy for nearly two decades. Dr. Hamilton’s seven non-fiction books have garnered numerous awards and international translations, offering insights that have inspired leaders across various fields. Dr. Hamilton’s 7th non-fiction book is Cerebral Entanglements: How the Brain Shapes Our Public and Private Lives.

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Listen to the Podcast:

The podcast of this program will be available Monday, April 28, 2025, after broadcast on April 26. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, May 9, 2026, through your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on May 11, 2026.

You can watch us interviewing Dr. Breitschwerdt on YouTube.

The Hazards of Flea and Tick Bites

Ticks can transmit a dizzying number of pathogens, including viruses, bacteria and protozoa. Rocky Mountain Spotted Fever, for example, occurs when a tick injects Rickettsia rickettsii into a person through a bite. If not treated properly, it can be fatal. Fortunately, however, it usually responds to doxycycline. The NCSU laboratory has developed a reliable diagnostic test that picks it up quickly.

Another tick-borne disease that has become familiar over the last few decades is Lyme disease. It is carried by deer ticks infected with Borrelia burgdorferi. If treated promptly, most people clear the disease, but sometimes it morphs into a stealth infection that is quite controversial.

You may not think much about flea bites, but they too could be the source of a stealth infection. Fleas transmit Bartonella (and so do body lice, ants, pigeon mites, rat mites and sand flies). Cats can be infected (with three different species of Bartonella) and so can dogs (only two species). When people develop bartonellosis, it can cause liver disease and neurological problems such as headaches and memory loss. In some cases, infected people suffer seizures.

Preventing Flea and Tick Bites

Once Bartonella get into the body, it likes to hide. The bacteria can enter virtually any cell in the body and make itself at home. As a consequence, the immune system may have difficulty tracking it down and eliminating it. Antibiotics don’t always get to it, either. Treatments of entrenched infections need to be very intensive.

So it is better to prevent flea and tick bites. One way is to make sure that pets are protected. Veterinarians can prescribe preventive medicine for them, either oral or topical. Another important step is to protect yourself. Wear effective insect repellent when outside or cover your long pants with permethrin-treated gaiters. And absolutely do not skip the tick check when you come inside. If you find a tick that has bitten you, remove it with tweezers, seal it in a plastic bag, date the bag and put it in the refrigerator. That could provide useful identification if you begin to feel ill over the next several days. When the type of tick is identified, it helps to point the infectious disease expert in the correct direction for what condition you may have.

This Week’s Guest

Dr. Edward B. Breitschwerdt is a professor of medicine and infectious diseases at North Carolina State University College of Veterinary Medicine. He is also an adjunct professor of medicine at Duke University Medical Center, and a Diplomate, American College of Veterinary Internal Medicine (ACVIM). Dr. Breitschwerdt directs the Intracellular Pathogens Research Laboratory in the Institute for Comparative Medicine at North Carolina State University. He also co-directs the Vector Borne Diseases Diagnostic Laboratory and is the director of the NCSU-CVM Biosafety Level 3 Laboratory. Dr. Breitschwerdt’s clinical interests include infectious diseases, immunology, and nephrology.

https://www.galaxydx.com/about-us/meet-the-team/edward-breitschwerdt-dvm-dacvim-saim/

Dr. Ed Breitschwerdt, NCSU College of Veterinary Medicine

Listen to the Podcast

The podcast of this program will be available Monday, May 11, 2026, after broadcast on May 9. In this week’s podcast, we talk about developing treatments for these challenging conditions. A major focus for Dr. Breitschwerdt is prevention, so he and his colleagues are working on a vaccine that could prevent Bartonellosis. We also discuss the possibility that Bartonella might contribute to arthritis. Find out about the complications of another vector-borne infection, Babesiosis. You can stream the show from this site and download the podcast for free.

This episode of our podcast was sponsored in part by MUD\WTR. Start your new morning ritual & get up to 43% off your @MUDWTR with code PPOD at mudwtr.com/PPOD

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, May 2, 2026, through your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on May 4, 2026.

Why We Pay Twice as Much for Health Care

One reason Americans pay twice as much is the complexity of our health care services. We often call it a health care “system,” but it often doesn’t feel as coordinated as a system ought to be. Many other countries have universal health insurance coverage in one form or another (and there are many). That means the government has an incentive for keeping costs down. With so many different payers and players in the US, the incentives frequently go in the other direction.

You may notice this if you examine an explanation of benefits from Medicare or a private insurance company. There may be a sizable gap between what the provider charged and what insurance approved. Who pays the retail price? Only people who don’t have insurance, who are usually those least able to manage a big bill. If you find yourself faced with a hospital bill and no insurance coverage, it is important to talk with the billing department. Nonprofit hospitals should have a mechanism for patients without coverage to negotiate a lower total or a longer time frame in which to pay. Even some for-profit hospitals and medical practices are open to negotiation, but starting the negotiation as early as possible is key.

How Much Does an Emergency Cost?

Nobody plans for a medical emergency. That is the nature of emergencies–they are unexpected. If you need an ambulance to get you there, if you have to be transferred to another hospital with a better ability to care for your problem, if the doctors must do multiple tests to make a diagnosis will all influence your bill. As a result, emergency visits could cost from tens of thousands of dollars to a million or so. With high-deductible health insurance, a person or their family could end up owing more than they can pay. That is how some cases of bankruptcy are rooted in high healthcare bills.

We Pay Twice as Much Because Providers Make More

In the US, doctors were once in the same category of professionals as teachers or firefighters. Those days are long gone. Healthcare providers here are compensated more generously than providers in many other places, such as Canada, Japan or Israel. Moreover, just as there are middlemen in the prescription insurance business (called pharmacy benefit managers, PBMs), health insurance has its own middlemen. The result is a great deal of complexity, very little transparency, and a lot of parties trying to make money on each transaction. That also leads to a great deal of administration, which further increases the cost.

Why Don’t Market Forces Control Costs?

Some analysts suggest that the free market should be able to control costs. But for market forces to work, you need competition and transparency. Over the last decade or so, there has been increasing consolidation in every sector of health care. Competition is limited in most areas. Moreover, transparency is in very short supply in health care. For years we have been talking about how hard it is to do comparison shopping for health services like MRI scans or colonoscopies. If consumers cannot compare costs or value, they cannot make the rational decisions that would help moderate prices.

How Administrative Costs Increase Bills

Part of every insurance premium goes to paying administrative costs. Insurers pay people to review claims (and deny some). Preauthorization also adds to administrative costs.

Manage the Hospital Bill So You Don’t Pay Twice as Much as You Should

Years ago, we interviewed Marshall Allen, who titled his book Never Pay the First Bill.  Our guest for the current episode counters always request an itemized bill. That way you can check it to make sure that simple items such as names, dates and insurance policy numbers are correct. Then look at whether the services billed are actually the services received. An estimated nine of ten hospital bills contain mistakes. The sooner you catch them and contest them, the less likely you are to have to pay them. To determine what you must pay, you may need to review the summary of benefits on your insurance policy. That lays out in detail exactly what the insurance will cover.

What Can Patients Do So They Don’t Pay Twice as Much?

• Ask for an itemized bill and check it carefully in every detail.
• If you find a mistake, contest it. Sooner is better, even though you may be trying to recover from a serious illness.
• Ask the billing office about patient assistance or a negotiated payment plan.
• Check with the Patient Advocate Foundation. They may be able to help in an individual case.
• Find out if your state has a consumer assistance program in the department of insurance.
• Notify an intractable billing department that your story will appear in your social media feed. This should probably be the last step if the previous ideas don’t work. But hospitals really don’t like bad publicity, so it might give you leverage you wouldn’t have otherwise.

This Week’s Guest

Linda J. Blumberg, PhD, is a research professor at Georgetown University’s McCourt School of Public Policy. She is an expert on private health insurance (employer and nongroup), health care financing, and health system reform.

Linda J. Blumberg, PhD, describes why we pay twice as much for healthcare

Listen to the Podcast

he podcast of this program will be available Monday, May 4, 2026, after broadcast on May 2. On this episode, Dr. Blumberg discusses the importance of the summary of benefits in your insurance policy in greater detail. You’ll hear about a situation in which an emergency department overcharged a patient egregiously; the summary of benefits was key in resolving the problem. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1471:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy.

Joe

00:06-00:27

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com.

Medical bills can be mysterious or infuriating. How can you make sense of the complexity and pay a fair price? This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34

Here in the United States, we pay more for our health care than people in any other comparable country. Despite this, our longevity statistics are worse.

Joe

00:46

We’ll talk with an expert about how we got ourselves into this mess and what we might be able to do about it.

Terry

00:54

She’ll help us better understand medical billing and how to challenge mistakes.

Joe

00:59

Coming up on The People’s Pharmacy, why Americans pay twice as much for less care.

Terry

01:15

In The People’s Pharmacy Health Headlines: An estimated two-thirds of American adults drink coffee every day. Now scientists have an idea why coffee is so popular.

Researchers recruited 31 coffee drinkers and 31 people who do not drink coffee for a detailed study. They compared the composition of their gut microbiota and found some striking differences. Then the coffee drinkers abstained from coffee for two weeks. During this time, the investigators noticed changes in their gut microbiota. After two weeks, coffee drinkers were once again provided with their beverage. Half the volunteers got regular caffeinated coffee, the other half got decaf. Neither researchers nor participants knew who got which beverage. Non-coffee drinkers did not participate in this part of the experiment.

Coffee-drinking volunteers reported less stress and depression whether the coffee had caffeine in it or not. People drinking decaf had improvements in learning and memory, possibly due to the polyphenols. Those getting caffeine in their mugs reported less anxiety but better attention and vigilance.

The scientists note that coffee is much more than a caffeine delivery mechanism. Coffee consumption also has an effect on the immune response.

Joe

02:37

Vertigo can be a disorienting and disturbing symptom. A recent overview published in JAMA describes one of the most common forms, benign paroxysmal positional vertigo, abbreviated BPPV. It’s caused when calcium carbonate crystals inside the ear move out of position.

A sensation of non-spinning dizziness or lightheadedness occurs when people lie down or change position. The diagnosis of BPPV relies on observing eye movements called nystagmus that occur when the head moves. It can be treated with a set of prescribed head movements called the Epley maneuver.

Although physicians often prescribe the antihistamine meclizine for vertigo, this drug is not effective for treating BPPV. Patients can also self-treat this condition by performing the Epley maneuver at home with good results.

Terry

03:34

Levothyroxine is one of the most prescribed drugs in America. That’s because millions of people have a sluggish thyroid gland. The condition is called hypothyroidism. Medical experts have worried that it is being over-diagnosed, especially in older people, based solely on thyroid function blood tests.

The investigators set out to examine whether de-prescribing levothyroxine is feasible. Study participants were all 60 or older and had been taking levothyroxine at the same dose for at least a year. The doctors began gradual dose reductions. Over the course of a year, 25% of the 370 volunteers were able to get off levothyroxine without having TSH or T4 levels go out of range.

Joe

04:24

One of the most contentious issues among nutrition experts in recent years has revolved around fat, in particular, the benefits and risks of omega-6 polyunsaturated fatty acids, or PUFAs. The AHA has long promoted PUFAs found in vegetable oils because they’re heart-healthy. Critics suggest that an imbalance with excessive omega-6 fatty acids could be harmful. Nutrition scientists distinguished between one specific omega-6 fat, linoleic acid, and all the others.

Researchers used data from nearly 274,000 volunteers registered with the UK Biobank. These middle-aged, healthy people had no dementia when the study began. Blood tests revealed the balance between linoleic acid and other omega-6 fatty acids.

Over the next 15 years, 5,800 individuals developed dementia. Those with the highest levels of linoleic acid were almost 20% less likely to come down with dementia. In contrast, those with the highest levels of other omega-6 fats were about 20% more likely to have a dementia diagnosis.

The scientists call for research on whether increasing dietary linoleic acid might help protect people from dementia.

And that’s the health news from The People’s Pharmacy this week.

Terry

06:15

Welcome to The People’s Pharmacy. I’m Terry Graedon.

Joe

06:18

And I’m Joe Graedon. Have you ever received a confusing medical bill? Actually, let me correct myself. Have you ever received a bill from a hospital that was not confusing?

Terry

06:30

Most of us have had, oh, maybe a moment of alarm when we’ve had to try and decode a complicated medical bill. Why is the American system so hard to navigate and so difficult to afford? We pay far more for our health care than people in any other comparable country, and we have much less to show for it.

Joe

06:53

To learn more about health care in America and how it compares to other countries, we turn to Dr. Linda Blumberg. She is a research professor at Georgetown University’s McCourt School of Public Policy. Dr. Blumberg’s expertise is in private health insurance, health care financing, and health system reform.

Terry

07:17

Welcome to The People’s Pharmacy, Dr. Linda Blumberg.

Dr. Linda Blumberg

07:20

Thank you so much for inviting me today.

Joe

07:23

We are delighted to be able to talk to you about, I think, one of the most challenging issues facing health care in America, and that has to do with our system for paying. So perhaps you can explain briefly how our payment system in the U.S. compares to most other advanced countries.

Dr. Linda Blumberg

07:47

Well, it is much more complicated than in most other advanced countries, probably in all other advanced countries. And that’s because we have so many payers and so many different sets of prices that are used for providers, for insurers, for different plans, et cetera, and how employer plans work. So the variation is enormous, which causes a lot of confusion for consumers.

And frankly, it often causes confusion for the providers as well.

Terry

08:17

I wonder if you would explain, Dr. Blumberg, you say so many different prices, which implies that if I were to go in for a CT scan of something, I might get one price and somebody else who has the exact same procedure done maybe charge something completely different. How does that work?

Dr. Linda Blumberg

08:39

That’s absolutely correct. And it all boils down to what type of insurance you have and what plan you have.

So if you are somebody who is enrolled in Medicare, the program in the U.S. for those who are 65 and over or who have particular disabilities that qualify them, there are prices that are regulated by the federal government in terms of what a provider can charge for each service.

If you have private health insurance, however, there is no regulation on the prices. And so a lot of it depends on what the market will bear for the particular provider that you happen to be using and the negotiations that they have completed with the particular insurance plan you have.

And so you may have a United Health Insurance Plan and somebody else may have a United Health Insurance Plan, but they’re two different plans and those would pay different prices for the same procedure.

Joe

09:34

Well, we’ll talk about billing in a minute, but what has always confused me is the idea that if you have insurance and you have to go into the hospital for some sort of a procedure, you would get bill X if you have insurance company Y.

But if you have no insurance and have to pay out of pocket, it can be substantially greater. I mean, like dramatically more expensive, which seems like it’s just [bleep]-backwards. Pardon my language. I mean, it just seems upside down.

How do they figure out these crazy prices?

Dr. Linda Blumberg

10:20

Well, first of all, we do not have a rational basis for deciding the prices that an insurer is paying to a particular provider or what a particular provider is going to charge to someone who’s uninsured. And you’re right. If you walk in the door without any insurance coverage, you are likely to be charged the highest price of anybody that’s walking in the front door of a hospital.

And that is because there is no insurer or third-party administrator that is negotiating any prices on your behalf. So you’re basically being charged the, you know, the retail rate, which is the highest that there is.

What a lot… as you say, it makes no sense because usually people without insurance are the people with the lowest incomes, right? And they have the least ability to pay for these services.

And oftentimes the hospitals, in particular, the nonprofit hospitals are required to have programs that lower prices for people with modest incomes that are coming in without insurance. However, they often don’t even advertise that these programs exist. They’re hard to find even on their websites.

And so people who are walking in without insurance are being charged huge prices, and they have to know to say, “Listen, well, I have low income and I need to have access to someone who’s going to help me with whatever program you have for low income people walking in the door.”

So it is a lot of hit and miss in terms of what people understand about what might be available to them and what negotiated deals a particular hospital has made with a particular health insurance plan. And it’s often a function of how much market power the insurer and the health care providers, the health system have in that particular area is going to drive whether the prices are lower or higher.

Terry

12:22

Dr. Blumberg, you mentioned the retail price of a procedure or a hospitalization. And you also mentioned that Medicare prices are regulated, even though all these other prices are not. I’m going to mention, as a Medicare patient, I occasionally look at my explanation of benefits and I find them very confusing and/or alarming because what I see is that my provider, for example, might charge $355 for something. So that’s the retail price. And Medicare approves, let’s say, $128, you know, as that’s the approved payment, but it doesn’t pay that full amount. And then the supplemental, I happen to have Blue Cross, picks up usually most of what Medicare doesn’t pay on the amount that Medicare has approved. But there’s such a mismatch between that retail price and that approved price. How does that work?

Dr. Linda Blumberg

13:40

Well, that shows you that when somebody who walks in the door to get the retail price is being charged much more than somebody who’s coming in with Medicare. And that is by federal government law, is that physicians who take payments from Medicare, who participate in Medicare, have to agree to take the rates that are set out in federal law.

And these providers know they’ve made this agreement with the federal government. That’s why they’re participating. So this is customary for them. It’s not surprising to them that there is a disconnect between those prices. In fact, very few people end up paying the actual retail price.

But if you’re walking in with private health insurance, you’re likely to pay considerably more than or your insurer is going to be paying more and you are likely to pay some more also compared to the Medicare prices. So on average, and this is just on average, hospital payments under private insurance are in the neighborhood of two and a half times what Medicare pays. And for physicians, for clinicians, it’s more on average about 25% above what Medicare pays. So the variation is large even around that.

You know, for some procedures and for some clinicians, they may be getting 600% of Medicare or 900% of Medicare. It varies enormously through the system. And that’s why I say we’re not paying privately on any rational set of prices.

Joe

15:17

So what has really boggled my mind is that if, for example, you need a hip replacement, as I have had, or a cataract surgery, the provider may charge thousands of dollars. Let’s just make up a number and say, you know, $3,500 for this particular cataract surgery. But Medicare may only pay a few hundred dollars.

It’s like the discrepancy is so dramatic. It would be as if the sticker price for your car is $25,000, but you actually only have to pay $18,000. I mean, people are so shocked by these numbers. They seem to make no sense whatsoever.

And you kind of wonder, well, how can this system function if these billable numbers are two, three, four times more than the doctor actually gets paid? It seems insane.

Dr. Linda Blumberg

16:19

Except for the doctor doesn’t really expect to get paid the amount that they’re showing on the bill, they have negotiated particular rates of payment with insurance plans, and they have accepted the federal government fee schedule, which is public information.

So the retail prices that you see are really pretty meaningless because the real prices are the ones that have been negotiated with whoever the insurance company is, whether it’s public or private.

Joe

16:50

Unless you don’t have insurance, unless you’re not eligible for Medicare, in which case you’re on the hook for an unbelievable amount of money that you can’t possibly afford.

Dr. Linda Blumberg

17:02

Absolutely. But then, you know, I always suggest to consumers when they’re in that situation, first of all, if it’s with the hospital, to explore what programs they have for uninsured people with modest incomes. Because if it’s a nonprofit hospital, they’re required by law to have some kind of program. Whether a particular individual is going to qualify for it is up to what that program looks like. But you always explore that.

And absent that, or if you’re talking about care you’ve received from an individual physician, I always suggest that the consumer talk to the physician, talk to the financial manager for the practice and see if there’s some way to negotiate that rate down. Because as you said, it doesn’t make any sense and nobody with private insurance is paying for it.

Terry

17:51

You’re listening to Dr. Linda Blumberg, research professor at Georgetown University’s McCourt School of Public Policy. Dr. Blumberg’s expertise is in private health insurance, health care financing, and health system reform. She has analyzed the Affordable Care Act and studied strategies to address remaining health insurance coverage issues.

Joe

18:14

After the break, we’ll ask Dr. Blumberg how much an emergency might cost.

Terry

18:18

Are we getting any bang for our buck compared to other countries? How do health insurance middlemen affect the cost of care? Some people suggest that the free market should take care of the pricing problems.

Joe

18:29

Why haven’t market forces brought health care prices down?

Terry

18:43

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Terry

20:45

Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

20:48

And I’m Joe Graedon.

Joe

21:17

We’re talking about the high cost of health care in the United States. Are we getting our money’s worth? We pay far more than people in most other countries, but our health statistics are abysmal.

Terry

21:31

Many families in America go into debt because of huge medical bills. In some cases, people have lost their life savings and their homes because of a health care crisis.

Joe

21:42

Will cuts to Medicaid make this situation more challenging? Will hospitals close because of reduced financial stability?

Terry

21:52

Our guest is Dr. Linda Blumberg. She’s a research professor at Georgetown University’s McCourt School of Public Policy. Dr. Blumberg’s expertise is in private health insurance, health care financing, and health system reform.

Joe

22:10

Dr. Blumberg, in the event that you had an emergency, and let’s say you had to have an ambulance and then you had to go to the emergency department, maybe you thought you were having a stroke or a heart attack, and then you’ve seen multiple specialists and you have a whole bunch of tests, CT scans and goodness knows what else. And then you have to stay in the hospital with maybe a couple of procedures for, let’s say, three to five days. How much might your bill be at the end of this hospital stay?

Dr. Linda Blumberg

22:43

Well, a total bill for a hospital stay can be enormous. It depends upon the services you’ve received, how long you’re staying. But, you know, it can often be in the tens of thousands of dollars. But, you know, there are people who have inpatient stays in a hospital for a length of time in serious conditions that could be a million dollars, right?

So it all varies a lot, but an emergency department is a particularly expensive place to obtain care, and hospital stays are the most expensive costs that we face in our healthcare system.

Joe

23:17

I’d like to ask you about how much bang we’re getting for our bucks in the United States compared to other advanced countries, because, you know, we have done an amazing job at getting smoking down. I mean, turn back the clock about 40 or 50 years and like half of Americans, especially men, smoked. And today it’s down around 12 or 15 percent or lower, maybe around 10 percent. So we’ve made some real progress in terms of health behaviors. But that aside, our life expectancy has not improved dramatically.

Other countries, for example, Japan, South Korea, Sweden, and France are all about 83 to 84 years of age. In the U.S., our life expectancy is around 78 years. We spend annually over $12,000 a year per capita per person. In Germany, it’s 8,000. In France, it’s $6,600. And in Sweden, it’s $6,400.

So almost half of what we spend. And yet their longevity is much greater. I mean, substantially better. How? I mean, what?

Terry

24:37

What gives?

Joe

24:36

What is going on? How can it be that we’re paying so much more for so much less?

Dr. Linda Blumberg

24:45

Really good question. Part of what’s going on and probably the biggest difference in terms of what we spend compared to other countries, developed countries on health care, is the prices that are paid to the health care providers from, you know, who we’re receiving our care from.

So a hospital stay for the same services in the United States is typically going to cost considerably more than if those services were obtained in Canada or in Japan or in Germany or in Israel. So those are systems that… where all of the… There is regulation of the prices that are paid, are paid for medical procedures, regardless of the type of insurance coverage you have. And some of them have, you know, different plans, et cetera, not as much variation as we have here, but some variation.

But all of those prices are limited in those countries by government dictate. And we are, as I said, we’re only limiting the prices that we pay for medical care if you’re in a public insurance program like Medicaid or Medicare. If you have private insurance, which most people below age 65 have a private health insurance, those prices are not regulated.

In addition, when you think about longevity, we do have a more diverse population in a lot of respects than is the case in most other developed countries.

But in addition, we have the issue here of still having a significant number of U.S. residents without any health insurance coverage at all, which is not the case in these other developed countries where they have at least some level of universal health insurance coverage. And sometimes it’s considerably more comprehensive than the types of coverage we have here.

And so when you have a significant share of the population, even if it’s only at this point under 10%, about 10% of the population under age 65, you still have a considerable number of people who are not getting access to medical care when they need it. And that is going to affect longevity.

Other things like diet and pollution and, you know, various other different issues. We have a lot of gun violence here, which is not the case in the vast majority of other countries. So all of those things go into the difference. But the difference in our spending is completely on the prices that we’re paying to our health care providers on the commercial side.

Terry

27:25

Dr. Blumberg, you’ve written about health insurance middlemen. I wonder if you could explain what that is and how it affects the prices we pay.

Dr. Linda Blumberg

27:35

Sure. So when we are obtaining medical care in this country, we are paying for the particular services, right? And money is going to the providers who are providing these services to us. But we’re also paying administrative costs. And those administrative costs are built into the prices that we’re paying to hospitals and doctors and other providers. And it’s also built into the premiums that we’re paying for our health insurance coverage.

And increasingly in this country, we have moved our healthcare economy into a space where huge numbers of dollars are going for administrative fees that are associated with what I refer to as middlemen. People have heard a lot about prescription drug benefit managers.

But the same is true on the medical side. So a hospital is spending large amounts of money on a revenue cycle management company that is trying to figure out how to send in bills and code the services delivered to increase the revenue of the hospital. Same on the physician side. You have various different types of entities that are contracting with insurance companies to do particular types of tasks that the insurance company or the third-party administrator either doesn’t want to do themselves or finds more profitable to contract out to their subsidiaries.

So there is a lot of dollars that are going into making the prices higher on the claim side, on the medical service price side, and that are also being built into our insurance premiums through higher claims and through higher administrative loads that are attached by the insurer. So, I mean, we’re talking about an industry that is hundreds of billions of dollars every year that is really extractive, that’s pulling dollars out of every one of the transactions. And there’s billions of transactions that go through our system every year.

And so these entities, these administrative and financial entities have figured out how to extract dollars from the healthcare economy by adding some administrative costs to every single transaction that is being processed through the system.

Joe

30:07

Dr. Blumberg, I think most people have a real hard time dealing in billions and dealing with middlemen and all the other stuff, but they can relate to an office visit. So for example, if you had to go see a specialist in this country, maybe a gastroenterologist or a dermatologist or a cardiologist, those bills for just a quote unquote ‘regular visit’ could be in the hundreds of dollars.

In Sweden, it’s 40 bucks. That’s the maximum a specialist can charge in Sweden. Kids are free in Sweden. I think most parents know that a pediatrician’s visit can be pricey. They have no health care premiums in Sweden. It comes off their tax bill. The average hospital bill in Sweden for a day, this, you know, being in the hospital for a day, is $11. In this country, it can be thousands. And the maximum that a person would pay for all medical appointments annually in Sweden, everything lumped together would be $160. It can cost us $160 for just one visit in this country.

So I’m just wondering, when will the American public say enough is enough?

Dr. Linda Blumberg

31:38

So I think one important thing to remember is that, yes, when somebody is taking their kid to a pediatrician in Sweden, they’re not paying anything out of pocket. But their taxes are higher, right? Because those providers still have to be paid for the services they’re providing. It’s a matter of how the prices are, how they’re being paid. And in those countries, much more of the dollars are flowing through their national health system, which is funded by tax dollars.

And so the tax rates in Sweden, for example, are typically quite a bit higher than we face in the United States. But they, at the same time, obviously the country is regulating how much the providers can earn for providing the services that they’re provided. So there are some limits that lower the incomes, the revenue that the providers receive, but much more of the dollars are flowing through the government and from tax dollars than is the case here.

We have always struggled here in the United States with balancing, number one, regulation. How much do we want to regulate prices instead of letting the market decide what a private sector person like a health care provider or hospital is going to receive? And we also struggle with increasing our taxes, right? And so we could create a system where we have greater regulation of the prices and limits on prices that are paid to health care providers to lower our total spending. We can also finance more coverage through the federal government or through state government for more people.

But it is a real political struggle to convince people that while they feel like their… that health care is too expensive, they’re afraid of oftentimes of putting limits on what their particular doctor is going to make or their particular hospital is going to make. Because the hospitals and the physicians will let them will tell them whether it’s accurate or not, that their access and their quality of care is going to suffer if they do that.

And there are also people in this country are very much resistant to significant increases in their taxes, even if you tell them it’s going to lower other out-of-pocket expenses because they don’t really believe it, right? Or they think they’re going to end up paying more for somebody else to have lower prices. So it is a very complicated political balance here.

I think people are getting more and more frustrated with the way that the system works and the increase in the denials and the red tape and the complexity people have to jump through to obtain their medical care. But the political challenge is real in terms of more government regulation of prices and/or financing more care through the tax system.

Terry

34:43

Well, you’re absolutely right. It is very complicated politically. And you mentioned that one of the alternatives that is sometimes posited is: let market forces regulate prices, which is, I think, where we are, except that market forces are only making prices higher, not lower.

Why doesn’t health care in America work like a market should?

Dr. Linda Blumberg

35:12

We have had a tremendous amount of consolidation in our healthcare industries. And so when we talk about hospitals being bought, you know, buying other hospitals and creating hospital systems and, you know, sometimes often now buying medical practices, insurance companies, UnitedHealthcare is now the biggest employer of physicians in this country, right?

The insurers and the healthcare systems are buying up these middlemen that are making more money off of, you know, as I was saying, extracting dollars from the claims that are being processed. So there’s been a tremendous amount of complexity added in the financial relationships between all of these stakeholders, the providers, the insurers, the middlemen.

Very few of them are independent at this time. Very many of them have conflicts of interest, all directed in the direction of increasing prices on the commercial side and increasing spending.

Terry

36:15

Right. Lots of complexity, not much transparency.

Dr. Linda Blumberg

36:18

Right. It is basically capitalism run amok. And you’re talking about a product in health care that was already from the beginning of time, much more complicated to shop for than a refrigerator, right? You know, you don’t know necessarily what you’re going to need in terms of services or what it’s going to cost before you walk in the door at the doctor’s office or in the hospital.

It is not something that is easy to shop for, whereas I can, you know, spend 20 minutes and figure out what the best price I can get on the refrigerator I want is. That’s just not the way medical care works. And then when you take the consolidation and the hidden fees and the conflicts of interest that have arisen both between co-ownership in the healthcare industry and these financial deals that are being made between the insurers and the middlemen and the providers at this point, you have a situation where there is no competition in these markets or where there is, it’s extraordinarily limited.

And so you’re not going to… the more this is allowed to fester and expand, which is what it is doing year in and year out, the worse it’s going to get. You’re not going to have competition driving prices down. You’re going to have greater financialization of the system continuing to drive prices up.

And really the only way to interfere with that is for government to put limits on both what prices can be charged for particular services and to eliminate the financial dealings that are interconnecting all of these stakeholders with each other and encouraging higher intensity coding and hidden financial fees that are passing between different entities that are driving costs up for consumers and employers.

Terry

38:14

You’re listening to Dr. Linda Blumberg. She’s a research professor at Georgetown University’s McCourt School of Public Policy, and she is an expert on private health insurance, health care financing, and health system reform. Dr. Blumberg has provided technical assistance to states in their efforts to analyze and implement federal reforms and examine the implications of private equity companies’ movement into health care.

Joe

38:43

After the break, we’ll discuss why you need to examine your hospital bill extra carefully and with skepticism.

Terry

38:52

Hospital bills are complex and they often contain errors. To really figure out the charges, you need to request an itemized bill.

Joe

39:01

Surprisingly, your insurance company might not behave like an ally.

Terry

39:09

How do you contest a bill that is obviously wrong?

Joe

39:12

Sometimes media exposure of outrageous bills can make a big difference. Most hospitals hate bad publicity.

Terry

39:31

You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

39:46

And I’m Joe Graedon.

Joe

40:16

Are you the kind of person who pays bills as soon as you get them? Nothing wrong with that. But when it comes to hospital bills, you may need to slow down. It turns out they often contain errors that can be tough to track down.

Terry

40:33

Medical bills, especially hospital bills, can be extremely complex. And hospitals make mistakes all the time. You’ll need to scrutinize every charge.

Joe

40:44

We’re talking today with Dr. Linda Blumberg, research professor at Georgetown University’s McCourt School of Public Policy. Dr. Blumberg’s expertise is in private health insurance, health care financing, and health system reform. She has analyzed the Affordable Care Act and studied strategies to address remaining health insurance coverage issues. Dr. Blumberg has also analyzed approaches for setting standards of affordability for insurance coverage.

Terry

41:14

Dr. Blumberg, some years ago, we spoke with a fellow, I think his name is Marshall Allen, who wrote a book. He titled it: “Never Pay the First Bill.” And we found our conversation with him quite interesting. I’m wondering what you think of that advice.

Dr. Linda Blumberg

41:34

Well, I think my advice is always be skeptical and look carefully at a bill. Don’t just pay it, because the vast majority of them, whether they’re coming from a hospital, much more likely from a physician, also reasonably likely there’s mistakes in them. And so you do want to approach them with some skepticism and caution.

Joe

41:58

Well, actually, that’s not enough. And the reason I say that’s not enough is because most of us, when we look at a hospital bill or a clinic bill, we don’t know what to make of it. I mean, it is really confusing. And as you said, there’s like the bill that the doctor presents and the bill that the clinic presents or the hospital presents.

And then there’s what Medicare might pay or might not pay or your insurance. It’s like, how in the world do we make sense of our medical bills? How do we even get started?

Dr. Linda Blumberg

42:38

It’s rough and it takes a good deal of patience and time, unfortunately. Hospital bills in particular, I’ve heard estimates that nine out of 10 of them have errors. I’ve heard others say that there’s never a hospital bill that doesn’t have an error in it, right? And they’re the most complex of the bills that an individual is going to receive.

My advice is always the first thing you do is request an itemized bill from the hospital, because by and large, what the hospital will send out is a summary bill, not an itemized bill. And you can’t figure out what the errors are in general from a summary.

So request an itemized bill. If they don’t send it, you got to ask again, because sometimes they’re a little pokey about it because they just want you to pay. They don’t want you to look at the itemized bill.

Joe

43:26

Well, let me ask you this: let’s say you get an itemized bill and it says that you had an ultrasound done on such and such a date of, you know, such and such a part of your body and you go, “No way. I did not have an ultrasound at all.”

How did that happen? And then how do you contest something that’s obviously wrong?

Dr. Linda Blumberg

43:53

The first stop from my perspective is to call the billing department, to call the physician’s office of the physician that you’ve seen and contest it and say, there’s a mistake. I’m being charged for a service that I never received. An insurance company, if you have an insurer, can also often be helpful when you’re talking about something you’ve been charged for that is something you have not received. But it sometimes will take multiple calls and multiple interactions to resolve a problem like that.

You know, one of the most common errors that people see in hospital bills is being billed twice for the same thing or the number of, you know, something that was charged for, you know, some supply or something is, you know, somebody added a zero to it by mistake, you know, assumedly. And that needs to be corrected, and so engaging with the physician who you’ve received services from with your insurer and trying to contact the billing department directly at the hospital…

Joe

44:59

Let me ask you one follow-up to that, because you would think that since the insurance company, if you’re fortunate enough to have insurance, would be an ally, would be joining you in fighting an incorrect bill or a bill that was overcharged for some reason or a service that was never provided or a medication that you never got.

We’ve heard that insurance companies, they’re not as likely to be enthusiastic about challenging these bills because after all, they’re just going to pass those charges on to their customers and consumers. It’s like, well, why waste our time? Because you, you know, you, you were charged for aspirin, but you didn’t get aspirin. So how do we get the insurance companies fired up to actually challenge mistakes?

Dr. Linda Blumberg

45:55

It is sometimes a struggle for sure. One of the things that people should be aware of, and what I talk about when I talk about this complex web of interconnected financial interests across stakeholders in the healthcare industry, is that insurance companies, they can make greater profit the higher the claims. Under the law, they are limited in terms of what percentage of a premium can go to administrative costs, including profit. So since that’s limited as a percentage, the higher the total spend on claims, the bigger the amount of money they have left over for their administrative costs and their profit.

And so in a lot of ways, they’re disincentivized to hold down spending, which is contrary to what many people who are using, buying health insurance coverage expect of their insurer. They think their insurer is trying to get the best deal for them. That is not always the case.

And so you can talk to the consumer reps with the insurer, but sometimes you’ve really got to go directly to the provider and dispute. And there’s a nonprofit called the Patient Advocate Foundation that is particularly created to help people with chronic illnesses contest incorrect bills and deal with billing issues. There are others who will do it for a fee as a percentage of what savings created.

But it becomes sometimes a situation where the consumer themselves needs to do repeated calls and contacts and filing complaints in order to get a bill resolved. But I still always say contact the insurance company as well. They may be in a mindset to help out.

Terry

47:52

Dr. Blumberg, you’ve mentioned that patients can and probably should negotiate with whether it’s the physician’s office billing or the hospital billing, especially if they don’t have insurance, but even if they do. Can you tell us about a time when somebody did that? What was the outcome?

Dr. Linda Blumberg

48:17

Well, sure. I mean, I think it depends greatly on the health care provider, right? And if you have had a primary care physician for many years and then you’ve lost health insurance coverage or for some reason you have a gap or et cetera, you know, there are ways in which, you know, in circumstances where these providers will either set up a payment plan for you, or they’ll say, “Listen, you know, you’ve been a great patient and I want to help you through this rough spot.” And they’ll negotiate down, you know, hopefully to what at least at a minimum that the private insurer would have paid, right?

But it is very much [an] ad hoc kind of decision that’s being made by these providers. Now, in the situation of a hospital, particularly for people who have modest incomes, there are programs that nonprofit hospitals have, as I mentioned before, that are there to help people in financial straits. And those programs, sometimes they’re programs that are funded by state government dollars. Sometimes it’s… parts of it, the hospital themselves, but those are programs that exist explicitly for people in tough situations. And some… but some… The problem is you have to really push to get the information about them to figure out whether you’re eligible.

Joe

49:41

Dr. Blumberg, what about media exposure? I mean, every once in a while, somebody sort of blows the whistle on an outrageous bill that just blows everybody’s mind. It’s like, that’s ridiculous. And they contact their, their local TV station or their newspaper, and all of a sudden, you know, it goes, you know, wild on the internet, and it affects the hospital in such a way they say, “Oh, never mind, let’s negotiate a better bill.”

Is that something that people can actually do successfully?

Dr. Linda Blumberg

50:15

Yes, people have done it successfully. And there’s, you know, ‘bill of the day’ kinds of newspaper reporting, et cetera, where some experienced reporters are doing this repeatedly on behalf of people in particularly egregious circumstances. And it can be really effective at cutting through to the right people at the right moment to get a better deal created. And so, listen, if I was in that situation, I would use whatever options I had at my disposal.

You know, in some states, unfortunately, it’s not all states, but in some states, state governments have what are called consumer assistance programs. They were originally funded by the federal government across the country, but that funding has not been reappropriated in many years now. But those consumer assistance programs, if you’re lucky enough to live in a state that has one, can sometimes also be helpful if you contact them, file a complaint with the state. If it’s a problem with the insurance company and it’s a fully insured product, not a self-funded plan from the employer, you can file complaints with the Department of Insurance, et cetera.

So there are opportunities for going higher. And I always suggest to people, even if you’re contacting someone at the hospital, if you’re not getting any kind of satisfaction from a consumer rep, you want to escalate to a manager, to whoever. You want to just go as high as you can in the pecking order to try to get some resolution.

Joe

51:50

We are concerned about pharmaceutical prices, as you can very well imagine here on The People’s Pharmacy. And we have seen pharmacies disappearing in this country at an extraordinary rate, in part because private equity firms have bought up large chains, and those large chains are now closing not dozens but hundreds of pharmacies. And so the idea of a mom-and-pop pharmacy where the pharmacist was a sole operator seems to be disappearing very quickly. And drug prices, as everybody knows, are way higher in this country than any place in the world.

What do you suggest when it comes to the costs of medicine in this country, especially for people who have life-threatening conditions and their bills may be in the tens of thousands of dollars?

Dr. Linda Blumberg

52:43

It’s really, really difficult. And I wish I had a good answer for you. I know some people are trying to obtain medications at more affordable prices outside of the country. That’s always challenging and a little bit risky depending upon where you’re going to get the medications. But there are some programs that particular pharmaceutical companies have that lower prices for people with modest incomes or people who do not have health insurance coverage for brand-name types of drugs that they need.

And so, you know, I usually suggest to people, first stop if you can’t get satisfaction or help from your insurance company. And sometimes if it’s not on their formulary, you can get evidence from your… help from your physician about why that particular drug is so necessary to try to appeal and get coverage from your insurance company. If you’re without insurance or without good enough insurance to cover costs, I would suggest to people go to the website for the company that makes your drug and see if they have some programs that might be able to help.

There are also some states [that] have particular programs for providing financial support for prescription drugs.

Joe

54:04

Dr. Blumberg, we only have about two minutes left. If we were to put you in charge of the entire health care system, how would you change things?

Dr. Linda Blumberg

54:15

Well, first of all, I would put back a number of the coverage cutbacks that this administration has put in place or that they will be putting in place in the near future in the Medicaid program because every person in this country should have access to affordable, adequate health insurance coverage for their medical needs.

Beyond that, I would put limits in place on the prices that are charged by providers, and I would do it broadly across all prices, and hospital level, physician level. I would include prescription drug controls in that as well. I would then make sure that we are monitoring a system to make sure that everybody has the access that they need.

And I would do a lot to break up the kinds of integrated financial incentives from co-owned entities in the healthcare system to separate those financial incentives, create more competition and clarity in terms of what people are paying when they obtain care.

And I think we’ve also got to go a ways to your point about the prescription drug issues on the private equity side. There’s a lot of practices that private equity typically uses in the healthcare space that are extractive and damaging both to prices, quality, and sometimes the stability of the healthcare providers themselves. And we have to prohibit those kinds of high debt financing and other extractive practices that are often in place there.

Terry

55:50

Dr. Blumberg, did we miss anything that we should have asked you?

Dr. Linda Blumberg

55:54

No, I think we covered a lot. So, yeah, I think, you know, when people get their bills, they should always make sure that the names, the dates, you know, the insurance information is all correct. Sometimes that stops insurance companies from paying appropriately from like little minor like typo errors in addition to the kinds of things we talked about.

And everybody who has a health insurance policy by law has access to what’s called a summary of benefits and coverage or an SBC. This is part of the Affordable Care Act law. It’s an English-language summary of your benefits. And so I always suggest to people to have that in hand so you can make sure that when you get the bill that says this is what your insurance company pays, this is what you owe, that you’re clear that that is really what you owe.

So, for example, I had a situation where I was helping somebody and they had gone into the emergency room for urgent care that the doctor told them to go to the ER. And the hospital charged them $2,000 up front on a credit card when they walked in the door. Their summary of benefits and coverage very explicitly said that the only charge they should be charged when they walk into an emergency room for a real emergency is $200.

It took me about an hour and a half or two hours and maybe three or four different telephone calls to resolve that. But it was really clear from that summary of benefits and coverage that that person was overcharged. So, you know, knowing, being really on top of what your health insurance plan is supposed to cover and comparing that to what you’re being charged is a really important line of defense.

Joe

57:47

Dr. Blumberg, whenever we talk to healthcare professionals, they often complain these days. They complain that they have to see way too many patients in way too little time. They complain about the cost of their education, whether it’s a nursing school or pharmacy school or medical school, that it’s very expensive and that they had to go into debt. And then they complain about the whole fee structure and all the bureaucracy and all the time they have to spend sometimes arm wrestling insurance companies, and it’s not actually practicing medicine the way they would like to.

But at the same time, we hear that people earn rather extraordinary incomes. So a, for example, orthopedic surgeon is often making $500,000, $600,000, $800,000 a year. A family practice physician may be only making $150,000 to $200,000 a year.

How do the payments to healthcare professionals in this country compare to the healthcare professionals in, let’s just say, the UK or Germany or Sweden?

Dr. Linda Blumberg

59:20

We are paying our specialists in particular a lot more than are being paid in those other countries. I don’t have the statistics at hand on those specific salaries, but, you know, I’m not sure we’re paying our primary care physicians, you know, any more or not significantly more than they are paid in other countries. But, you know, those are at the highest levels, you know, as you said, the orthopedic surgeons, the interventional radiologists, the folks that are being paid for procedures at really high levels are paid much more than we see in other countries.

And I think my understanding is, and I’d have to look at this more carefully, but my understanding is that education in general, including education for medical professionals, is much more highly subsidized in most of these countries than we do here.

And so if you’re going to pay considerably less, then we also have to think about subsidizing the education for some more medical professionals than we do. And that should be part of the thinking if we’re going to put a lot of limits on what these providers can make.

Joe

01:00:38

And finally, our listeners learn from stories. And quite honestly, so do doctors. They call them case reports. But it makes the topic that we’re discussing come alive in ways that just talking in a more academic way [does not]. Have you had any experience over your career in which a patient or a family or some situation where the billing was so outrageous that it came to your attention and it was able to be modified?

You mentioned spending a couple of hours on the phone because the person was billed so much on their credit card when they entered the emergency department. Is there any other story you could share about billing that would be how I would describe it as helpful for our listeners to comprehend the scope of the problem?

Dr. Linda Blumberg

01:01:40

Well, you know, I am an academic researcher, right, and a policy researcher. And so I do not generally work as an advocate for patients. Every once in a while, a family member or a friend or somebody who sees a program that I’ve been speaking on will contact me and ask for help and I’ll do what I can. But that’s the most…

The situation with the $2,000 bill instead of the $200 bill is my most recent case of that. But, you know, the other thing that I’ve seen a lot in terms of what’s been in the media is stories of people who go in for an emergency room visit, and it’s a reasonably modest kind of situation. They’re not in there long. Maybe it’s for a child and they were worried, but it’s really not a big medical problem. And the intensity with which that bill is coded is way out of whack with the services that were provided because emergency room visits are coded by the intensity of the situation and the services needed.

And so those are situations where people can get bills in the huge range, tens of thousands of dollars for something that should have been a much more low-cost price. And seeing that and having to go back and appeal that is something that is becoming more common, I think, in emergency departments over time. So I don’t have a lot of individual stories where I have particularly intervened because that’s, you know, I’m a data and analytic person more than I am, you know, I’m not really a consumer advocate.

Terry

01:03:26

Dr. Linda Blumberg, thank you so much for talking with us on The People’s Pharmacy today.

Dr. Linda Blumberg

01:03:32

My pleasure. Thanks for having me on.

Terry

01:03:34

You’ve been listening to Dr. Linda Blumberg, research professor at Georgetown University’s McCourt School of Public Policy. She’s an expert on private health insurance, health care financing, and health system reform. Dr. Blumberg has provided technical assistance to states in their efforts to analyze and implement federal reforms. She’s also examined the implication of private equity companies’ movement into health care.

Joe

01:04:05

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

01:04:14

This show is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy.

Joe

01:04:23

Today’s show is number 1,471. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. We’d love to hear your reports about hospital bills, interactions with the medical system. Please, you can reach us through email, radio at peoplespharmacy.com.

We’re also trying to enhance our YouTube channel with videos of our interviews. If you’d like to watch our interactions with guests you hear each week on The People’s Pharmacy, why not go to YouTube and search for People’s Pharmacy?

Terry

01:05:01

Our interviews are always available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning. In this week’s podcast, we also discuss how easy it is for errors to creep into the bill, even through simple typos. The summary of benefits for the insurance coverage is a crucial document. It lays out exactly what the hospital can and can’t charge you for. One reason health care costs so much in the U.S. is the high cost of specialized medical professionals. How does compensation in other countries compare to what health care professionals make here? You’ll also hear about emergency room coding errors.

Joe

01:05:48

At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We would be so grateful if you would write a review of The People’s Pharmacy and post it to the podcast platform you prefer. If you find our topics thought-provoking, please share them with friends and family. In Durham, North Carolina, I’m Joe Graedon.

Terry

01:06:18

And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to The People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

01:06:55

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

01:07:04

All you have to do is go to peoplespharmacy.com/donate.

Joe

01:07:10

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, April 25, 2026, through your computer or smart phone (wvtf.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on April 27, 2026.

Would Your Doctor Prescribe Exercise for Depression?

Earlier this year, the Cochrane Collaboration published a review of 73 randomized clinical trials of exercise as a treatment for depression (Cochrane Database of Systematic Reviews, Jan. 8, 2026).  Most of these compared physical activity to antidepressants or to psychological therapy for depressed patients. Some of them compared the exercise prescription to no treatment or wait list.

Comparing exercise to no treatment revealed an advantage for exercise, although the quality of the trials left something to be desired. Ten trials compared exercise to psychological therapy. In addition, five trials weighed exercise against antidepressant medication. Neither comparison showed a clear tilt for or against exercise as a superior intervention against depression.

Exercise in the Cancer Center

Dr. Claudio Battaglini of the University of North Carolina at Chapel Hill was not surprised by this finding. The exercise program he oversees for cancer patients often results in lifting their spirits as well as improving their health. That may help explain the very high adherence in his program.

Will Physical Activity Reduce the Risk of Cancer?

According to a review of the evidence, regular physical activity can reduce the number of people who die prematurely. In addition, it helps with weight control, quality of life and bone health. Older people are less likely to fall or experience declining cognition if they exercise regularly. The review found that physical activity improves quality of life and promotes emotional benefits (European Journal of Cancer Prevention, Jan. 1, 2025).

If oncologists should prescribe exercise, don’t cancer patients deserve to have their insurance company cover the cost? Insurers rarely blink twice at cardiac rehab. Although cancer rehab is also super-helpful, insurance companies often don’t choose to pay for it.

What Role Could Coaching Play in Guiding Physical Activity?

Lots of doctors tell their patients to get more exercise. The patient wants to and intends to, but perhaps they just don’t know how. What activity should they choose? What is the proper technique? How often and how much do you need to move? All these questions can be answered by a coach. The coach will take into account your objectives and preferences as well as your prior experience. What do you love doing? Are there any moves you should avoid to reduce the risk of injury? That’s why when doctors prescribe exercise, they should include coaching to provide this sort of guidance.

If Doctors Prescribe Exercise, Will That Help Motivation?

Many of us know we should be active, but we don’t always follow through. How can we get motivated to move? According to Dr. Jordan Metzl, the first step is to find something you love doing. For Joe, for instance, having the doctor prescribe exercise of runniing a mile a day is not going to work. But he’ll cover much more than a mile–and quickly–if he is playing a competitive game of tennis. Joe loves tennis.

Terry is not a runner either. On the other hand, karate club is a highlight of her week, and she has worked to achieve some skill in it. Dr. Metzl advocates for finding the activity that gets you excited and making it a priority in your life. If you are having fun, that is a great motivation.

Reducing the Cost to Act

Another thing to consider is overcoming the cost to act. If your activity requires a lot of preparation that feels like a chore, the cost to act is high. If you can make it easier and break down that barrier, you are much more likely to accomplish your exercise.

External rewards can also play a role. Joe loves winning, so he likes to play with guys at about his same level of skill. That way, he has a chance to win if he tries. For Terry, there was a progression through belt levels in karate, from yellow to green to blue, and so on. Now, she looks forward to closing the rings in the fitness app on her watch.

When Doctors Prescribe Exercise, Does That Give You a Push?

For Dr. Metzl, the idea of pushing yourself and maybe your friends is a positive notion. We asked him about people who dig in their heels when pushed. What approach do they need to perceive and pursue their goals? He summarized the three ingredients of healthy motivation as knowledge, emotion and belief. That’s knowledge of the benefits of activity, an emotional response of appreciating and enjoying activity and a belief that you can achieve your goal.

This Week’s Guests

Claudio Battaglini, PhD., FACSM, is Professor in the Dept. of Exercise and Sport Science at The University of North Carolina at Chapel Hill. He is also Director Emeritus of the Get REAL & HEEL Breast Cancer Research Program and Co-Director of the Exercise Oncology Research Laboratory.

Jordan D. Metzl, MD is an internationally recognized sports medicine physician, bestselling author, and fitness instructor who practices at the Hospital for Special Surgery in New York City. He lectures around the world and founded the first physician-led online fitness community, IronStrength, with more than 50,000 members. He created the Ironstrength Workout, a functional fitness program for improved performance and injury prevention that he teaches in fitness venues throughout the country. An elite athlete himself, Dr. Metzl is also a 40-time marathon runner and 14-time Ironman finisher.

Dr. Jordan Metzl, author of Push, runs the New York City Marathon 2025

Dr.Metzl’s latest book is Push: Unlock the Science of Fitness Motivation to Embrace Health and Longevity

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Listen to the Podcast

The podcast of this program will be available Monday, April 27, 2026, after broadcast on April 25. On this episode, Dr. Metzl talks about the joy of teaching medical students to offer an exercise prescription and the challenge of getting specialties other than cardiology to integrate physical activity into their rehab process. Dr. Battaglini discusses the contrast between cardiac rehab, which is covered by insurance, and cancer rehab, which is not. He also describes the value of swimming, especially for older people with sore joints. Walking is good exercise and easy for most people. What if the weather is bad? Perhaps an indoor walk around the mall would be a good alternative, and if you can recruit some friends to join you, so much the better. You can stream the show from this site and download the podcast for free.

A personal note: I worked in the Neuropharmacology Laboratory at the New Jersey Neuropsychiatric Institute from 1967 to 1969. My mentors were Dr. Carl Pfeiffer and Dr. Leonide Goldstein. Both were actively involved in basic research into psychedelic compounds such as LSD and psilocybin. Dr. Pfeiffer’s first paper on the topic was published on March 14, 1957 in the Annals of the New York Academy of Sciences.

I tested these hallucinogenic compounds in rabbits and rats using a quantitative EEG technology that Dr. Goldstein brought to the US from France. One of our papers was published in the Proceedings of the National Academy of Sciences (Oct. 1969). I share this in an effort to provide full transparency so that you will understand I was involved in basic psychedelic research before it was unacceptable to conduct such investigations.

What Scared the FDA and the NIH?

After 1970, if a researcher wanted to perform research on psilocybin or LSD, the FDA was not supportive. Neither were funders such as the NIH or private foundations. The memory of the 1960s with the slogan sex, drugs and rock and roll created a no-fly zone for scientific investigation after 1970. That was when the federal government passed the Controlled Substances Act (CSA).

The CSA made LSD and related compounds Schedule 1. The meant that LSD and related hallucinogens were categorized like heroin with “no currently accepted medical use and a high potential for abuse.” This made scientific research virtually impossible.

But over the last decade or so, there has been increasing interest in the use of such compounds to ease the anguish of post traumatic stress disorder, the existential crisis of a cancer diagnosis, drug dependency or even schizophrenia. But the hallucinatory potential of such drugs continues to discourage many researchers from studying such compounds.

President Donald Trump Signs the Psychedelic Drugs Executive Order

On April 18, 2026, President Trump signed an executive order titled:

“Accelerating Medical Treatments for Serious Mental Illness“

For the first time in decades, investigators will be encouraged to conduct research into the therapeutic potential of hallucinogens such as psilocybin, MDMA and ibogaine. Health and Human Services (HHS) will be encouraged to fund research into psychedelic programs. And eligible patients will able to access such compounds for therapeutic purposes under the “Right to Try Act.”

Here is the dramatic reversal:

“The FDA and Drug Enforcement Administration shall facilitate and establish a pathway for eligible patients to access psychedelic drugs, including ibogaine compounds, under the Right to Try Act (21 U.S.C. 360bbb-0a), including any necessary Schedule I handling authorizations for treating physicians and researchers, consistent with 21 U.S.C. 823, and any applicable waiver authority under the Controlled Substances Act.”

What Does This Mean?

First and foremost, it means that psychedelic drugs can now be studied without fear by researchers at prestigious medical institutions. Agencies can now fund such research. The head of the Food and Drug Administration, Dr. Marty Makary, is on the record encouraging the FDA to accelerate review of such compounds.

There is growing evidence that psychedelic compounds may help people dealing with severe mental health conditions. You will see research and have access to interviews with investigators that have been studying these drugs for years. Yes, there has been research, even if it was not sanctioned by federal agencies.

Current Research on Psychedelic Drugs

Over the past decade or so, investigators have been conducting research on the healing potential of psychedelic drugs. Dr. David Nichols, an international authority on these compounds, describes the history of this research. His son Charles Nichols, a pharmacologist, studies the molecular and behavioral effects of hallucinogens in animal models.

The Healing Potential of Mystical Experience

Dr. Matthew Johnson, associate director of the Center for Psychedelic and Consciousness Research at Johns Hopkins School of Medicine, has conducted a number of clinical trials utilizing psilocybin. He and his colleagues have been exploring the possible uses of psychedelic drugs as medicines for people with life-threatening cancer. They have also examined the possible benefits of a single dose of psilocybin for smoking cessation and overcoming alcohol misuse. Their research was highlighted in an episode of the CBS television show “60 Minutes.”

How Psychedelic Drugs Affect Existential Crises

When people are diagnosed with terminal cancer or other life-threatening conditions, many become extremely anxious or depressed. While this reaction may seem rational in the face of a frightening diagnosis and foreshortened life expectancy, it can interfere with people actually appreciating the days, weeks or months they have left.

Dr. Johnson and other scientists have found that a session with psilocybin that results in a mystical experience can alter people’s lives dramatically. They have far less anxiety and depression and seem to find more purpose in their lives, along with other positive changes. How does this work? Dr. Johnson’s most recent publication (with colleagues) explores the nature of these mystical experiences (PLoS One, April 23, 2019).

Our Radio Show Guests

David Nichols, PhD, is an adjunct professor at the Eshelman School of Pharmacy at the University of North Carolina, Chapel Hill. David Nichols had an active research program at Purdue University for 38 years prior to his retirement in June 2012. His research interests focused in two areas: the study of hallucinogens (psychedelics), where he was recognized as an international authority, and also discovery of novel D1 dopamine receptor full agonists, which showed efficacy comparable to levodopa in both animal models of Parkinson disease, and in human Parkinson patients.

In 1993 he founded the Heffter Research Institute, which has encouraged and supported modern clinical studies of the psychedelic agent psilocybin (from “magic mushrooms”) for treatment of depression, anxiety, and various addictions. His general interests continue in the medicinal chemistry and pharmacology of CNS-active agents.

Charles Nichols, PhD, is Professor of Pharmacology at Louisiana State University Health Sciences Center in New Orleans. As David Nichols’ son, he did not begin his career with the intention of studying hallucinogens. However, his current research interests include the molecular and behavioral effects of such compounds on the brain.

Matthew W. Johnson, PhD, is Associate Professor of Psychiatry and Associate Center Director of the Center for Psychedelic and Consciousness Research at Johns Hopkins School of Medicine. The photograph of Dr. Johnson is courtesy of Johns Hopkins Magazine. The website is https://hopkinspsychedelic.org

Listen to the Podcast:

The podcast of this program is available for free. The show can be streamed online from this site and podcasts can be downloaded for free.

Download the mp3

Want More?

Here is our radio show # 1317: Psychedelic Compounds for Healing

You can listen by clicking on the arrow inside the green circle under the photograph of Bryan Roth, MD, PhD at the top of the page. It’s super easy!

You will learn about conditions that may respond to psychedelic compounds:

• Cluster Headaches
• Substance Use Disorders
• Depression and Distress

Would You Consider LSD If There Were No Hallucinations?

Investigators at University of California, Davis have modified LSD so that it does not cause hallucinations. The new compound, called JRT, appears to have some therapeutic benefit, however. That’s because it increases neuroplasticity.

So far, the drug has only been tested in animals, but the initial responses appear promising. The hope is that JRT will have fast-acting antidepressant activity and may even be helpful against schizophrenia (Proceedings of the National Academy of Sciences, April 14, 2025).

The authors of this research point out that current treatments of schizophrenia leave a lot to be desired.

They don’t work very well:

“…for addressing the negative and cognitive symptoms, and evidence suggests that they are unlikely to rescue morphological or synaptic deficits.”

One of the negative symptoms of schizophrenia often includes the term anhedonia, which is described as an inability to feel pleasure or joy. It is also characteristic of depression. Another negative symptom of schizophrenia is avolition. It means an inability to get motivated to participate in goal-directed activities. That’s psych talk for profoundly disturbing blahs. People just cannot mobilized to get going or stay going. Social activities are just overwhelming.

Then there are the “impairments in attention and working memory.” It is hard to function when you have brain fog, little to no motivation, and few, if any, feelings of joy or happiness.

JRT and Neuroplasticity:

The researchers who helped create the new compound called JRT suggest that this nonhallucinogenic compound promotes “neuroplasticity” in the brain. So does LSD. What is neuroplasticity, you ask.

It is, according to Wikipedia:

“…the ability of neural networks in the brainto change through growth and reorganization. Neuroplasticity refers to the brain’s ability to reorganize and rewire its neural connections, enabling it to adapt and function in ways that differ from its prior state. This process can occur in response to learning new skills, experiencing environmental changes, recovering from injuries, or adapting to sensory or cognitive deficits. Such adaptability highlights the dynamic and ever-evolving nature of the brain, even into adulthood.”

The researchers who helped create JRT note that:

“Effective treatments for complex neuropsychiatric diseases like depression, substance use disorders, and SCZ [schizophrenia] are likely to involve multiple targets rather than a single site of action. However, the polypharmacology of such agents must be carefully tuned to maximize benefit while minimizing unwanted side effects. The unique polypharmacology of (+)-JRT might endow it with specific advantages compared to compounds currently in use.”

“Despite its lower hallucinogenic potential, (+)-JRT has demonstrated profound therapeutic effects.”

It’s a long and winding road before JRT could become available as a medication to treat challenging conditions such as PTSD or schizophrenia. In the meantime, there is a lot of new and intriguing research involving drugs that do induce hallucinations.

The Future of Psychedelic Drugs?

There is no good answer to that question. No one should undertake treatment with a psychedelic compound on their own. This approach requires well-trained healthcare professionals who actually know what they are doing. It requires a therapeutic setting with experienced therapists. Some people should not undergo such an experience.

Despite the fact that I worked in a laboratory that had one of the world’s largest collections of LSD and other psychedelic compounds, I was never interested in a hallucinogenic experience. Some people may not be helped and might be harmed by such a “trip.”

That said, I am pleased that the research doors (and funding) are beginning to open. After research was halted because of the “war on drugs,” we could now be entering a psychedelic renaissance. Let’s see what the research produces.

Please share your thoughts in the comment section below. If you think friends or family might be interested in this article, please send it along. Thank you for supporting our work.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, April 18, 2026, through your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on April 20, 2026.

Striving for Person-Centered Care

Wouldn’t it be great if healthcare facilities were specifically designed around the individuals they are supposed to serve? Fifty years ago, a group of physicians and former patients started Planetree to do exactly that. At first, Planetree provided information at a time when patients were rarely told what was wrong or how it could be addressed. There was also a Planetree ward in a hospital in the Bay Area that operated on principles of transparency and person-centered care.

Over the next several decades, Planetree developed as a network of more than 300 health care facilities in 30 countries that strive to provide a home-like environment for healing. The main value is person-centered care, in which they strive to treat the whole person as well as that individual’s family or significant others. We invited Planetree President Michael Giuliano to tell us about it. He mentioned that one feature is getting your care summary in real time, so you can ask questions and correct errors before you leave the clinic or office.

Fresh Air & Sunlight Built In

One of the things that sets a Planetree hospital apart from other facilities is the way the values are visible in the architecture. Planetree planners put a premium on access to nature and outdoor space, though of course each facility does it a bit differently, according to its own plan. Rooms are set up so that people have access to fresh air & sunlight. That makes them feel more comfortable, certainly. Might it also promote healing?

How Do Fresh Air & Sunlight Promote Healing?

More than 150 years ago, Florence Nightingale set standards based on what she observed of soldiers healing from battle wounds and horrible infections during the Crimean War. This was, of course, before the development of antibiotics, so nursing care was paramount. Nurse Nightingale insisted on the primacy of fresh air & sunlight for her patients. Was this just a quaint old-fashioned idea, or is there modern scientific support?

The Power of Near-Infrared

For more information on the science of fresh air & sunlight (yes, there is science), we turn to Dr. Roger Seheult of MedCram.com. https://www.medcram.com/ He began by describing the brand new Footscray Hospital in West Melbourne. The design is something of a modern take on Florence Nightingale’s hospital plan, since the architects figured out how to get natural light and real ventilation in every room. They prioritized fresh air & sunlight in this $1.5 billion hospital because of their healing properties. People exposed to sunlight leave the hospital sooner because they recover more quickly. So the patient gets better and goes home faster, the hospital has a better bottom line and the insurance company pays less. Everybody wins!

Probably a good part of the credit goes to near-infrared light. We can’t see it, but it penetrates our bodies and they react. Exposure to near-infrared at 850 nanometers improves mitochondrial function. You could get this from a device, but it is cheaper and arguably more pleasant simply to go outside and allow sunlight to fall on your skin soon after sunrise (or before 10 am) or just before sunset (probably after 4 pm).

An Amazing Story About Fresh Air & Sunlight

We’d be tempted to call this an unbelievable story, but Dr. Seheult provided all the details and checked the medical records himself, so we believe it. He told us about a 15-year-old boy with a serious blood cancer, acute lymphoblastic leukemia, ALL. This type of cancer undermines the immune response, and this young man had come down with a terrible fungal infection, mucormycosis. The fungus did not respond to medication, and it rampaged through his left lung. Ultimately, his doctors proposed removing the lung as a last-ditch method of controlling the infection.

Unfortunately, when they found that the fungus had invaded his right lung, they were out of options. They figured he probably couldn’t survive much more than two days, so they asked him his last wishes. All he wanted was to go outside; at this point, he’d been cooped up in the hospital for two months. They fixed up a wheelchair to hold all his drips and took him outside. The next day, they did it again. The youth didn’t die as expected. Instead, he recovered completely, over time. We can’t put sunlight in a bottle, but perhaps oncologists and other doctors should consider writing prescriptions to cover it.

This Week’s Guests

Michael Giuliano is the President of Planetree International, a mission-driven non-profit organization setting the global standard for person- centered excellence across the continuum of care. Michael joined Planetree in 2022 as Chief Operating Officer (COO) following a decade of leadership roles in Australia’s public and private healthcare sectors.
https://www.planetree.org/team-member/michael-giuliano

Michael Giuliano, President of Planetree International

Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine. He is also an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. His current practice is in Beaumont, California. He is a critical care physician, pulmonologist, and sleep physician at Optum California.

Dr. Seheult lectures routinely across the country at conferences and for medical, PA, and RT societies. He is the director of a sleep lab and the Medical Director for the Crafton Hills College Respiratory Care Program. He is co-founder and presenter for MedCram.com, a site that offers concise and easy-to-follow medical videos on a range of topics.

Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside

Listen to the Podcast

The podcast of this program will be available Monday, April 20, 2026, after broadcast on April 18. On this episode, Dr. Giuliano discusses billing as part of person-centered care. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen:

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, April 11, 2026, through your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on April 13, 2026.

You can also watch Dr. Buchheit talking with us on YouTube.

The New Science of Regenerative Therapies

What is the price of pain relief for aching, arthritic joints? We’re not talking about the drugstore sticker on a bottle of ibuprofen. Instead, we are referring to the potential negative consequences of utilizing such medicines for temporary symptomatic relief when the joint continues to hurt for weeks, months or years. Even more powerful treatments, such as corticosteroid injections into the sore joint, don’t heal the cartilage. In fact, they may contribute to further deterioration as they suppress the immune system. Our guest offers other ways to treat joint pain with regenerative therapies.

Immune Mechanisms That Resolve Inflammation

Dr. Tom Buchheit is a pain management specialist who has worked with elite athletes as well as seniors to get them moving well again after an injury. One of the reasons exercise can be so helpful is that the right kind and amount of movement creates good inflammation. Unlike chronic inflammation that causes further harm, good inflammation helps the immune system switch to a different phase, one in which destructive pathways are resolved. The three pillars of exercise are aerobic exercise, muscle building exercise and exercise to improve balance. Together, these types of exercise help recovery and healing and can even help heal damaged nerves. NSAIDs like naproxen, celecoxib or ibuprofen can interfere with the good inflammation exercise creates. Rather than taking such a pill before a game or workout, it makes sense to wait and take it afterwards if you need it.

Will Exercise Wear Out Your Joints?

Injury can damage the joints, but the idea of osteoarthritis as a consequence of wear and tear seems to be a medical myth. Instead, we might think of osteoarthritis as a chronic wound that may need regenerative therapies to heal properly. Immune system building blocks like omega-3 fats in the diet and a wide palette of colorful produce can help with the healing. Movement itself is part of the healing process.

What Are the Regenerative Therapies?

PRP

Some of the therapies we think of as “new” have actually been in use for several decades. One of these is platelet-rich plasma, which was initially developed to help wounds heal. In this treatment, the doctor uses the patient’s own blood. The plasma with as many platelets as possible concentrated in it is then carefully injected into the painful joint. The idea, again, is to cause “good inflammation,” alerting the immune system that healing is needed here and encouraging it to flip into inflammation resolution mode. Not all studies of platelet-rich plasma (PRP) have shown benefit, but some of that may be due to using plasma that is not truly rich in platelets. Properly prepared PRP works especially well for ligaments and tendons, according to Dr. Buchheit.

MSC

If you hear someone talk of getting a “stem cell” injection, they are talking about MSC. They were originally misnamed mesenchymal stem cells, but would be better termed medicinal signaling cells. They too are derived from the patient’s own body. Rather than rebuilding cartilage, they also signal the immune system to switch from long-term damaging inflammation to short-term healing inflammation. This is also the idea behind prolotherapy, in which the therapist injects sugar water into the joint. That may sound like a placebo, but it can be effective at easing pain and helping healing.

Autologous Conditioned Serum

Dr. Buchheit describes another of the regenerative therapies, autologous conditioned serum. Blood is drawn and encouraged to clot; then the serum is injected into the troublesome joint. Clotting helps create powerful signals that healing is needed. This therapy is not widely available, as only about ten places in the US have the dedicated laboratories required to prepare ACS properly.

Hydrodissection

Dr. Buchheit also describes how to use injections to free up trapped nerves in a process called “hydrodissection.” This is often very helpful in alleviating chronic neuropathy. We conclude the episode with a brief reminder of how to stay healthy once you get nerves and joints feeling good again.

This Week’s Guest

Thomas Buchheit, MD, served as Chief of Pain Medicine at Duke from 2013-2019 and led several NIH- and DoD-funded research studies. His focus is on immune mechanisms that resolve inflammation and pain.
In 2025, Dr. Buchheit completed his book, Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies, and founded Triangle Regen Medicine and Biologics Center. His overarching goal is to help patients understand and use regenerative therapies to activate their own healing and repair mechanisms. He continues to serve as adjunct associate professor at Duke and collaborates with colleagues at the Center for Translational Pain Medicine.

His website is https://triregenmed.com/

Dr. Tom Buchheit

The People’s Pharmacy is supported by readers and listeners. When you buy through a link on this site, we may receive a small commission, at no additional cost to you.

Listen to the Podcast

The podcast of this program will be available Monday, April 13, 2026, after broadcast on April 11. The podcast has additional information about how to use MSC as well as the cost of regenerative therapies. We also discuss the pros and cons of pharmaceutical pain relievers. You can stream the show from this site and download the podcast for free.

Download the show on mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript of Show 1468:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of the People’s Pharmacy.

Joe

00:06-00:27

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com.

Exercise is critical for good health, but when your joints or nerves hurt, it’s hard to keep moving. What can you do? This is the People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:49

Most people rely on non-steroidal anti-inflammatory drugs. Millions take over-the-counter ibuprofen or naproxen every day. Others rely on prescription medicines such as celecoxib or meloxicam. What are the downsides?

Joe

00:50-00:54

Our guest today is an expert in regenerative medicine.

Terry

00:55-01:00

What does that mean? And how does it differ from the usual way to manage pain and speed recovery?

Joe

01:01-01:06

Coming up on The People’s Pharmacy, the new science of regenerative therapies.

Terry

01:14-02:05

In The People’s Pharmacy Health Headlines: flu season is pretty much over, but every year it takes a toll, especially among frail elderly people in nursing homes.

A new study published in JAMA Internal Medicine asked whether using Tamiflu preventively could reduce hospitalizations and death. Researchers reviewed records covering 404 flu outbreaks in 318 nursing homes. More than 35,000 residents were covered by the study.

When Tamiflu was given to at least 70 percent of the residents within two days of the first flu cases, there were dramatically fewer hospitalizations needed within the next two weeks. That’s in comparison to situations where Tamiflu was not provided as a preventive medicine.

Joe

02:05-03:06

If you ask most cardiologists what causes heart disease, the answer is likely to be LDL cholesterol. They might also mention triglycerides, lipoprotein A, and high blood pressure.

They probably won’t consider lead, but a study of over 42,000 American adults who participated in the National Health and Nutrition Examination Survey tracked lead levels over many years. Those with the highest levels of lead in their bones were more likely to die from heart disease or stroke.

People born in the 1930s and 1940s, before lead was removed from gasoline and paint, have the highest lifetime lead exposures. Further reduction in lead exposure should lead to lower rates of cardiovascular mortality. An editorial in the journal suggests that coronary heart disease is in part attributable to lead and other environmental exposures.

Terry

03:07-04:00

What is the cause of memory loss as people age? A recent study of mice suggests it might begin in the gut. Specifically, the scientists tracked microbiome aging throughout the lifespan. They found that gut bacteria producing medium-chain fatty acids accumulate with aging and drive inflammation. This, in turn, weakens the signal from the vagus nerve to the brain, with the result that the hippocampus falters. The hippocampus is critical to memory.

In this study, the scientists introduced phage viruses to target the parabacteroides, gut microbes, causing the trouble. They suggest such interventions might counteract age-associated cognitive decline, although, of course, mice are different from humans. We look forward to research that might demonstrate its feasibility in people.

Joe

04:02-05:08

Fibromyalgia is a painful and chronic condition that affects soft tissue. It also causes fatigue, brain fog, and sleep problems. Millions of Americans are affected by this somewhat mysterious condition.

A study published in JAMA Network Open reports that the combination of physical therapy and transcutaneous electrical nerve stimulation, also known as TENS, can reduce pain. Over 380 patients participated in the trial. Volunteers were randomized to receive PT plus TENS or physical therapy alone. After two months, those getting physical therapy plus electrical stimulation reported significantly less pain than those in the PT-only group.

The authors note that the findings demonstrate effectiveness of this non-pharmacological intervention in reducing movement-evoked pain and suggest that the benefits of TENS are clinically meaningful in this population.

Terry

05:09-06:17

With warmer weather, tick season is right around the corner. In fact, it’s already here in many parts of the country. Most people have heard of Rocky Mountain spotted fever and Lyme disease, but ticks can transmit over a dozen different diseases, from anaplasmosis and babesiosis to ehrlichiosis and alpha-gal syndrome. It’s estimated that more than 500,000 people could be treated for Lyme disease between now and the first freeze this fall.

But there is potentially good news on the horizon. Pfizer is teaming up with a French company to produce a vaccine against Lyme disease. It triggers your body to make antibodies to a protein on the surface of the Borrelia bacterium. These antibodies keep the Lyme-causing bacteria from infecting you and causing disease.

And that’s the health news from the People’s Pharmacy this week.

Welcome to the People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:27

And I’m Joe Graedon. You’ve heard us praise the power of exercise for good health. But it can be hard to keep moving when your joints hurt.

Terry

06:27-06:44

The usual approach is to take a non-steroidal anti-inflammatory drug, such as ibuprofen or naproxen. That is a short-term solution, and it comes with a handful of side effects. What else could we do to alleviate joint pain?

Joe

06:44-07:11

To help us understand some new options, we are talking with Dr. Tom Buchheit. He’s done research on immune mechanisms that resolve inflammation and pain. He serves as an adjunct associate professor at Duke University and collaborates with colleagues at the Center for Translational Pain Medicine.

His new book is “Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies.”

Terry

07:13-07:16

Welcome to the People’s Pharmacy, Dr. Tom Buchheit.

Dr. Tom Buchheit

07:17-07:27

Thank you, Terry, Joe. It’s wonderful to be here.

I have to say, I’ve been listening to your show since 1998 when my wife and I moved to North Carolina, and it’s just a delight to be here. So thank you.

Joe

07:27-08:36

Well, thank you so much for joining us. You know, Dr. Buchheit, I’d have to say that if people ask us, and they occasionally do, what’s the one most important thing we should do for good health?

The answer is simple. We say exercise. Exercise is absolutely critical. Move your body. Even if it’s just for a walk every day, if you can. And if you can do more, so much the better. Terry is a black belt in karate. I love to play tennis. We love to move our bodies.

There’s only one problem. What interferes with exercise? Pain. Injuries. You know, when you exercise a lot, you sometimes hurt yourself, and then you have to take a break. And for people who really enjoy exercising and want to do it, that can be both psychologically and physically very challenging.

So help us understand your field and how to help people get back moving again once they hurt themselves.

Dr. Tom Buchheit

08:37-10:02

Well, Joe, you brought up a really good point. Exercise plays a very important part of health for all of us. And I think we increasingly know the reasons why. One of the core topics that I talk about and like to focus on is the importance of healing and our body’s innate ability to heal. We turn those healing mechanisms on by stimulating certain immune cells, and one of the most powerful ways of doing so is exercise.

Exercise does it. Good inflammation does it. Some other regenerative therapies do it. And these are all bound together by the same healing mechanisms. But you’re right, exercise is core to that.

The challenge a lot of people run into is that they have an injury. They have arthritis, a problem in a joint. They’re unable to do that. And their question is, how do they get back to that activity? What I use, I use the phrase orthopedic limbo. That individual is in orthopedic limbo. They have an issue that prevents them from pursuing their tennis or their karate or just walking the dog or spending time with friends. And they’re trying to figure out how to get beyond that and move again, but they’re not necessarily a surgical candidate.

So what can they do? And that’s one of the reasons I like to focus on these things that stimulate a healing response and stimulate recovery to function.

Joe

10:02-10:11

And we’ll talk a little bit more about some of those strategies because they’re really intriguing. But first, why is exercise so important?

Dr. Tom Buchheit

10:13-10:16

Exercise is important because it produces good inflammation.

Terry

10:18-10:21

Whoa, whoa, whoa, wait. Inflammation is good?

Dr. Tom Buchheit

10:23-11:23

That’s an important topic, right? I think a lot of people hear inflammation, they think immediately inflammation is always bad. We have to get rid of it. We have to suppress it. We have to drive it down.

And there are, and I think you’ve talked about this in your show before as well, but there are good components of inflammation. We have to be careful we don’t throw the wheat out with the chaff with that. So chronic inflammation is always bad, right? It damages tissues. It drives arthritis. It drives chronic pain.

But short-term, brief, and fairly strong inflammation is how we heal. If I had an ankle sprain and I bled into that ankle sprain, that injury, that inflammation is what heals that ligament eventually. You bleed, you release growth factors, you turn on these immune systems.

Exercise does that same thing, but it’s good inflammation. So I think of good inflammation as short, reasonably strong, and able to flip an immune switch that begins a healing cascade.

Terry

11:24-11:33

Dr. Buchheit, in “Healing Joints and Nerves,” you talk about the three pillars of exercise. What are the three pillars and why do we need three of them?

Dr. Tom Buchheit

11:35-12:23

Well, great question. There are certain tremendous advantages of aerobic exercise. We know that people who have a high aerobic capacity and who can exercise at high levels, it doesn’t matter if it’s running, swimming, playing tennis, that’s linked to longevity. We also know that muscle mass, and increasingly people talk about muscle mass being very important and strength being very important to strengthen joints. And we see this with studies of even arthritis patients who have less joint pain if they can strengthen the support structures of that joint.

And then, of course, balance is such a wonderful thing, whether it’s through balance exercises or yoga or tai chi, just such wonderful exercises that brings all this together of strength, stability, and the ability to stay on two feet without falling down.

Joe

12:24-12:52

I want to know how exercise helps recovery, because that’s, you know, we often hear, “Oh, ice and rest and, you know, just don’t do anything for a week or two,” because a lot of tennis players, they want to get back on the court as fast as possible, and they’re told, “No, no, no, no, no, no, you got to rest those joints, that you pulled a muscle, you better let it rest.” And you’re suggesting that exercise actually helps with healing.

Dr. Tom Buchheit

12:53-13:52

It absolutely does. And it helps with healing because it flips that immune switch and turns on this healing cascade. There was a study that I think showed this well. It was patients who had ankle injuries and they were immobilized in crutches after an ankle injury and they measured the cartilage in their knees as a marker after immobilization.

And they found out that those who were in crutches for long enough actually had less cartilage in their knees. Their knees were never injured, but it was the lack of exercise that decreased the health of their joint cartilage. So our bodies need this. They need intermittent stress.

And I think this… we have kind of fallen into this trap where we think all inflammation is bad. I would push back on that. I think we need to stress ourselves, whether it’s studying for an exam, whether it is playing a tennis match, whether it’s going for a brisk walk. Our bodies use stress and use these intermittent bouts of exercise to strengthen.

Terry

13:54-13:57

I’m assuming we stress ourselves appropriately.

Dr. Tom Buchheit

13:57-14:30

Exactly. And that’s the Goldilocks phenomenon, right? If you want enough stress. So to look at it kind of biochemically, if you look, there are a lot of inflammatory proteins that a muscle will release if it’s been exercised.

Matter of fact, some of those will go up a hundred fold and they cause some of the aches that we’re familiar with after a strong workout. But those same inflammatory proteins will then flip and help our bodies to produce some of the anabolic proteins and things that rebuild tissues and strengthen tissues.

Terry

14:31-14:35

How does exercise help nerves regrow? You’ve said it does.

Dr. Tom Buchheit

14:35-16:00

That’s a great question. And that came as a bit of a surprise to me when I started doing research on this a bunch of years ago. We all thought of, and I think a lot of the medical profession thinks of, well, once you have neuropathy, it’s just a done deal. You’re never going to recover from it. Your nerves are gone. And neuropathy is nerve pain. Right, nerve pain and nerve dysfunction from the nerve pain.

And it can be different kinds. There can be sciatica somebody experiences after a disc herniation in the spine. There can be dying back of the nerves somebody experiences because of diabetes or they’ve had chemotherapy in the past. Those nerves can recover. And exercise is actually one of the important tools to help those nerves recover.

It does a few… through a few things. Some of the growth factors I talked about that exercise releases. It also does it through these very small immune particles called exosomes that we researched in lab that I’ve researched and looked at for a long time now. And they also help nerves recover.

[If] we think about it, nerves are energy hogs. And anything we can do to improve their energy supply through mitochondria, mitochondrial function, is going to help the nerve to recover. And so exercise and some of these other therapies can improve nerve function. They may not help a nerve regrow from the back all the way down to the foot, but they can take the nerves that are already there and help them work better and help people function better.

Joe

16:00-16:36

One of the things that most physicians, not all, but most physicians, especially the orthopedists like to prescribe are the non-steroidal anti-inflammatory drugs. So if you sprain your ankle, if you hurt your shoulder, if your back is giving you trouble, out come the NSAIDs. And of course, they’re also available over the counter, Aleve, naproxen, ibuprofen, Advil. And so people have come to just love non-steroidal anti-inflammatory drugs. You’ve suggested that they might be counterproductive in some ways.

Dr. Tom Buchheit

16:37-17:20

Well, they can be. And anti-inflammatory medications, what we call NSAIDs, they can, in fact, impair the strengthening our body’s experience with a workout. And this has been looked at in patients, this has been looked at in laboratory studies of laboratory animal models, that if you slow down or stop the inflammatory response to exercise, you also impair the muscle building and the strengthening you get from that workout. So NSAIDs, sometimes we may need to take them for a severe headache or a pain that’s keeping us from moving.

But if we take them chronically, they impair the very healing mechanisms that our bodies need to stay healthy and recover.

Terry

17:20-17:26

Now, if you were to take an NSAID for a workout, when should you take it and why?

Dr. Tom Buchheit

17:26-17:30

That’s a great question. So I think the clear answer is after the workout, not before.

Joe

17:32-17:42

A lot of my tennis buddies call it vitamin “I” and they take it religiously before they go out on the courts. So you’re suggesting maybe not such a good plan.

Dr. Tom Buchheit

17:42-18:06

I think if one can hold off until after the workout and wait as long as you can, it’s better off than before. I think it’s probably better for our joints and our bodies to have a shorter workout without an anti-inflammatory than a longer workout with.

Now, that’s never been studied in a randomized controlled trial, but I think it’s a good idea to avoid taking it before whenever possible.

Terry

18:07-18:15

You’re listening to Dr. Tom Buchheit, an expert in pain management and founder of the Triangle Regen Medicine and Biologic Center.

Joe

18:15-18:28

After the break, we’ll learn about steroid shots in joints. What might work to ease osteoarthritis pain? You may have heard of PRP and stem cells. We’ll get the details.

Terry

18:39-18:42

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

20:18-20:21

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

20:21-20:39

And I’m Terry Graedon.

Joe

20:39-20:48

Today on The People’s Pharmacy, our topic is healing joints and nerves. What are regenerative therapies and how do they work?

Terry

20:48-21:14

Our guest is Dr. Tom Buchheit, founder of Triangle Regen Medicine and Biologic Center. Dr. Buchheit was chief of pain medicine at Duke University from 2013 to 2019 and is an adjunct associate professor there. His new book is “Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies.”

Joe

21:15-21:50

Dr. Buchheit, corticosteroids, very popular on the tennis court. You know, “Oh, my shoulder hurts. I need a steroid shot. Oh, my back aches.” Another steroid shot. “Oh, my knee is giving me trouble.” Another steroid shot. Doctors love them because people feel better oftentimes immediately after or within a few days and it lasts sometimes a couple weeks for some people maybe as long as a couple of months, but there’s a downside. What is it?

Dr. Tom Buchheit

21:50-23:48

Well, there is a downside, and it is true that a steroid injection can produce rapid pain relief, and can be helpful in some people to get them back to the gym, get them back to the workout.

My concern with steroid injections or corticosteroid injections is the repeated use of them. There was a study done now almost 10 years ago, and it was a randomized control trial looking at individuals who had osteoarthritis of both knees, and one group had saline injections into the knees. The other group had corticosteroid injections. And at the end of two years, there was no difference in the pain, which didn’t really surprise a lot of people because we know steroid injections tend to be shorter lived.

But the individuals that had repeat steroid injections actually had less cartilage in their knees than the ones that had saline. And I feel like that study was a bit of a wake-up call to all of us. And I did a lot of steroid injections at the time as well because patients seemed to do well with it. But it made me start rethinking how I was approaching this concept of how do you treat someone with joint pain, some arthritis, they don’t need surgery, again, the patient [in] orthopedic limbo.

We’ve relied on corticosteroid injections as a bit of a crutch, and I think we need to flip this paradigm and think about how do you improve cartilage health, how do you improve tissue health? This year is the 75th anniversary of the first corticosteroid injections that were done for arthritis pain. And it was a remarkable event.

But interestingly, I’ve gone back and I’ve read a lot of the historic literature on corticosteroids and their use in arthritis. And the physician who published the paper noted that 37 of 38 of his patients did extremely well after the steroid injections. But what he didn’t emphasize is some of the patients required up to 17 injections per year to maintain that.

Terry

23:48-23:49

Oh, my.

Dr. Tom Buchheit

23:49-24:00

And I think that’s the part that we’ve been missing within the medical world, is that a steroid injection can be an important tool, but I would argue it’s an overused tool in a lot of settings.

Terry

24:01-24:15

Well, 17 injections a year definitely sounds like it’s being overused. And one of the things that steroids do is they suppress the immune system. What’s the impact of long-term immune system suppression?

Dr. Tom Buchheit

24:17-25:22

Well, gosh, there’s a lot of things that [it] would do. Obviously, we could go into, you know, bone health and bone density. We could go to the endocrine system and looking at, you know, someone who is borderline diabetic who becomes frankly diabetic after repeated steroid injections.

We can look at tissue healing as well. But if I kind of focus on the cycle, I think we need to think of our bodies as cycles, right? We cycle day and night. We sleep. We wake up. And exercise and this immune stimulation that keeps our joints healthy is also a cycle. It’s a cycle of exercise and recovery.

And anyone who’s trained knows this inherently. You have hard workout days. You have recovery days. And I think if we use tools like steroids or anti-inflammatories continuously, we remove those necessary cycles of stress and recovery, stress and strengthening. And steroids, I think, act in some ways have similar effects as the anti-inflammatories do. And I can quote, we can talk about a study as well that dives into that.

Joe

25:23-25:52

Well, I’d like to talk about one of the reasons that a lot of people get steroid injections and one of the reasons why they take a lot of the anti-inflammatory drugs, and that’s osteoarthritis. And it can affect your fingers. It can affect your shoulders. It can affect your knees. It can affect your hips. It can affect just about every joint in your body. And I remember someone saying a long time ago, well, exercise is going to make it worse.

Dr. Tom Buchheit

25:53-27:48

Right, that’s the old wear and tear hypothesis and that was the hypothesis about osteoarthritis for years which is that well you just you’re just wearing your joints too much and they’re just wearing down.

That ignores the fact though that exercise restores cartilage health, and you know some people talk about well someone loses weight and they have less joint pain and it must be less weight on their joints and less wear and tear. But the hand arthritis also gets better if you lose weight.

And so I think it’s an issue of a systemic chronic inflammatory problem that’s improving with weight loss. We’ve then moved from the wear and tear hypothesis to the inflammatory hypothesis of arthritis. And it made sense. We can see inflammation on ultrasound if we do an ultrasound exam of a joint. You can pull out fluid, and it looks inflammatory if you look at it under biochemical analysis. The patients feel the inflammation, but if you treat the inflammation, it doesn’t improve the disease state. And that’s been shown so many times.

There have been at least four studies of strong inflammation suppressors in the rheumatoid arthritis drugs that have been looked at for osteoarthritis. They did not work. There have been studies of corticosteroid injections. Again, they tend to worsen the problem, not make it better.

The concept that I think we need to focus on is osteoarthritis is a chronic wound. And we need to think about how to heal the wound. If you heal the wound, the chronic inflammation also improves as well. And that explains, I think, the chronic wound concept explains why studies have failed in the past and why some of the therapies we do now, such as some of the regenerative therapies, can actually have a role.

Terry

27:49-28:09

Well, maybe you could tell us a little bit about what could work for osteoarthritis, because so far, we’ve talked about things that are less than ideal. The steroid injections, the NSAIDs, those are the most common. And there have to be things, maybe even a lot of things, that can be useful.

Joe

28:09-28:22

Well, first, what the heck is regenerative therapy? And second, why would exercise, because you’ve sort of alluded to that, be helpful for osteoarthritis? So give us the one-two punch.

Dr. Tom Buchheit

28:23-28:36

I always think of it as we start with a healthy diet, healthy fruits, vegetables, healthy fats, and exercise to that. And that is the core, I think, of keeping joints and nerves healthy.

Terry

28:36-28:37

And the rest of us.

Dr. Tom Buchheit

28:37-30:03

And the rest of the body as well, right? What’s good for your heart tends to be good for your joints as well, right? It’s enough for a lot of people, but it’s not enough for everybody. And it’s not enough for people who have had injuries in the past. It’s not enough people who have a systemic inflammatory issue going on.

And that’s when I think about layering on what some people call regenerative therapy. Some people may call it an ortho-biologic. These are ways of stimulating those immune cells I talked about and pushing them into a state where they are resolving and building tissues again, where they’ve been suppressed in the past and they’re kind of low level. They’re chronically inflamed. They’re not behaving well.

You need to push them into a new state, this resolving state. And I think of it not as suppressing inflammation but resolving it. And it might sound like a little bit like splitting hairs a bit. But if I think of suppressing inflammation or fighting inflammation, I think of you’re putting a drug on it to tone it down temporarily.

When I think of resolving inflammation, I think of our body’s natural processes that resolve it. There are some wonderful fats that do this. They’re called SPMs. They’re derivatives of omega-3 fatty acids. Our bodies use those and other compounds to naturally resolve inflammation. Matter of fact, in the lab, some of those compounds are more powerful than morphine in animal models of nerve pain to resolve inflammatory pain in models.

Joe

30:04-30:07

Wow, that’s amazing. Tell us, how do you do that?

Dr. Tom Buchheit

30:08-30:10

Well, our bodies make these compounds.

Terry

30:10-30:22

And you say they make them from omega-3 fats like fish oil or walnut oil or the fats that we get in very small quantities from dark green leafy vegetables.

Dr. Tom Buchheit

30:23-30:53

Precisely. If we eat a diet rich in healthy fats, as you pointed out, from walnuts, nuts, cold water fishes like salmon and anchovies and tuna, as long as it’s not too high in mercury, our bodies take those fats and they make other compounds from them. And those other compounds will resolve inflammation.

They work with the leafy green vegetables and all the colorful vegetables that you all have talked about that are so important to overall health.

Terry

30:53-30:55

We love talking about colorful vegetables.

Dr. Tom Buchheit

30:56-31:13

But that all works together. And that, to me, is the foundation of really regenerative medicine is what our bodies are already doing and how can we promote those activities themselves. A lot of people focus on a procedure and injection, and they can be helpful, but we have to start with our own bodies.

Joe

31:13-31:43

So it sounds like diet is critical and the healthy fats, the omega-3s are especially beneficial. So your body can do this resolving stuff. And exercise is also important, presumably if it’s, you know, mild exercise, if you’ve injured yourself so that you don’t re-injure yourself.

But what are some of these other agents, this regenerative process that you’re talking about that you practice when you see patients who have had injuries?

Dr. Tom Buchheit

31:43-33:05

Yeah, great question. I would put them in three different categories, things like platelet-rich plasma, which we’ll talk about, stem cells, or something called autologous conditioned serum. Some people know it as the Regenokine program. PRP or platelet-rich plasma is probably the one I’d start with because it directly activates our own healing cascade.

Interestingly, back to my analogy of the wound in a joint, PRP was first used to treat wounds. It was first used by a wound surgeon published in 1986. It’s been around for a while. Then it was used in the oral surgery field to heal non-healing wounds. And then it kind of leapt into the world of arthritis and nerve issues and things like that. But what it is, is if you take blood and you spin it down and you collect the platelets and the white blood cells there, they can act with the growth factors and act in a way to flip that immune switch I was talking about to start to rebuild tissues.

So it’s a way to almost use that, almost like exercise. It’s almost like exercise in a tube in a way. You take that blood product and you inject it onto a knee or a shoulder or hip, and it further turns on those healing mechanisms that our body can have, but aren’t always strong enough by themselves.

Joe

33:05-33:17

Now, let’s make it very clear. We’re not talking about someone else’s blood. We’re talking about our own blood is being removed. And I assume it’s not gallons. It’s just a little bit. How much?

Dr. Tom Buchheit

33:18-33:30

Well, actually, that’s a very good point. You need a fair amount. You need a fair amount because you have to make sure the PRP dose is right. So how much is 60 to 120 milliliters?

Joe

33:31-33:33

So for people who are not metric.

Terry

33:34-33:40

So a cup is roughly 250 milliliters. So we’re talking less than a cup.

Joe

33:40-33:44

Less than a cup. Right. So it’s not gallons. It’s a little bit of blood.

Terry

33:44-33:46

Maybe a half a cup, more or less. Half a cup, a cup.

Joe

33:47-33:57

And you’re removing that blood, and then you’re spinning it down, and you’re extracting the platelet-rich plasma.

Dr. Tom Buchheit

33:57-33:59

Exactly. Now…

Joe

33:59-34:00

And re-injecting it.

Dr. Tom Buchheit

34:00-34:20

And re-injecting it. PRP has become quite controversial. One of the reasons is because there have been a couple of very large trials that have shown it hasn’t worked.

But if you go back and analyze the studies, which I’ve done with some colleagues, it turns out that if the plasma isn’t rich in platelets, it doesn’t work. And it sounds a bit, you know, axiomatic.

Terry

34:21-34:26

Right. So you have to have the right stuff in order for it to work the way it’s intended.

Dr. Tom Buchheit

34:26-34:26

Exactly.

Joe

34:27-34:31

So is it a little less controversial now? Are there studies demonstrating benefit?

Dr. Tom Buchheit

34:32-34:44

There are with high doses, and I think that’s the key. If the dose isn’t right, it just doesn’t work. And that’s why it’s important. And one of the things that I do is I measure the doses of every PRP to make sure that dose is correct.

Joe

34:45-35:03

So our listeners and a lot of your colleagues learn from stories. Can you share a story with us about somebody who came to your practice in pain and maybe not able to exercise, and that person benefited from PRP?

Dr. Tom Buchheit

35:05-35:24

I think it’s a common scenario. I would use the scenario of someone who’s had a prior ACL tear or a lot of knee ligament tear. Especially young women athletes seem to have this quite commonly. The problem with these tears is that it sets them up for early arthritis.

Joe

35:25-35:28

And we know the surgery itself has some issues.

Dr. Tom Buchheit

35:29-36:15

Right. Well, joint replacement surgery can be very successful, but you also don’t want to do that when you’re 45 years old and still active because you may wear out your joint. You might wear out the replacement.

And that to me is a good candidate for what I would call regenerative therapy or biologic therapy, where you can turn this inflammatory process, this chronic wound of a knee that’s had a prior injury and can’t quite get into the healing mode, and you can add PRP or another therapy to it to really turn the corner of that knee and allow it to start healing.

What other joints benefit? Really any joint can benefit. Most of the studies have been done in knee osteoarthritis because it’s so common.

Terry

36:15-36:18

So common and so troublesome if you have it.

Dr. Tom Buchheit

36:18-36:39

Precisely. Precisely. But shoulder, hip, other joints, and actually some of… there’s some very good literature for PRP for ligaments and tendons.

So for the outside of the hip, the trochanter or tennis elbow is a very common, very common scenario. Again, that’s a scenario where a tendon is there and it’s just not healing up and you want to add growth factors to it to get it to heal.

Joe

36:39-36:45

Are the orthopedic surgeons embracing PRP these days or are they still a little resistant?

Dr. Tom Buchheit

36:45-37:06

Well, I think the orthopedic community is embracing this to a fairly significant extent. And it does compete. There’s a question of does it compete with surgery for some people, but I think it has a clear role.

And as we understand what makes a regenerative therapy more effective, they’re going to, I think, gain more and more acceptance.

Terry

37:06-37:09

What about side effects of PRP?

Dr. Tom Buchheit

37:09-37:25

The main side effect for PRP is a flare-up of pain. If you think about it, you’re turning on an immune system, you’re turning on these white blood cells. So I tell people it’s an expected side effect. They’re going to have oftentimes discomfort, sometimes even swelling for a few days afterwards.

Terry

37:25-37:30

So you’re creating short-term inflammation to overcome the long-term inflammation.

Dr. Tom Buchheit

37:30-37:31

Just like exercise.

Terry

37:32-38:05

You’re listening to Dr. Tom Buchheit, author of “Healing Joints and Nerves: Immune Stimulation, and the New Science of Regenerative Therapies.” Dr. Buchheit founded the Triangle Regen Medicine and Biologic Center.

His research has focused on immune mechanisms that help resolve inflammation and pain. From 2013 to 2019, he was chief of pain medicine at Duke University, and now he is an adjunct associate professor there.

Joe

38:05-38:14

After the break, we’ll consider the case of a long-distance runner who has developed hip arthritis that interferes with his running.

Terry

38:14-38:20

Do stem cells help cartilage grow back? If not, what are they doing to ease pain?

Joe

38:21-38:36

What is prolotherapy and how does it work? Injecting dextrose, that’s sugar water, sounds almost like a placebo treatment. Is it effective and how long has it been available?

Terry

38:36-38:45

It does sound like a placebo. You’ll also find out about autologous conditioned serum. What is that? How does Dr. Buchheit use it?

Joe

38:46-38:53

Some of the same therapies that work for joints can also help nerves. How do they work for that?

Terry

39:06-39:21

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Welcome back to The People’s Pharmacy. I’m Terry Graedon.

Joe

39:21-39:38

And I’m Joe Graedon.

Terry

39:39-39:57

Today, we’re discussing some new therapies for arthritic joint pain. We’ll also find out what can be done for trapped nerves. Have you ever heard of prolotherapy? It involves the injection of sugar water into an injured joint. How could that possibly be beneficial?

Joe

39:57-40:33

To learn more about prolotherapy and PRP, as well as other new options, we’re talking with Dr. Tom Buchheit. He’s done research on immune mechanisms that resolve inflammation and pain. He founded the Triangle Regen Medicine and Biologic Center. Dr. Buchheit serves as an adjunct associate professor at Duke University and collaborates with colleagues at the Center for Translational Pain Medicine. His new book is “Healing Joints and Nerves: Immune Stimulation and the New Science of Regenerative Therapies.”

Terry

40:34-41:33

Dr. Buchheit, I’d like to ask you about a scenario. I know a person happens to be related to me, not Joe, not Dave, but this individual actually dislocated his hip on a construction site when he was in his early 20s. He is now 75. He has been a long-term, long-distance runner, and he has recently had a problem with hip pain on the hip that he dislocated back when he was a young guy.

So he went to the doctor, and the doctor said, yeah, you’ve got a lot of arthritis there. What would you advise this fellow for relieving his pain? He said, well, I don’t think I’m going to be running anymore. He does walk. But what advice do we have?

Joe

41:33-41:37

And he loves to run. I mean, this is a long-distance runner for decades.

Dr. Tom Buchheit

41:37-42:08

It’s a common scenario. And to me, there are a couple of questions. What is their level of function they’re at now? What do they want to be? How much cartilage do they have? It’s easier to use some of these regenerative therapies for people who have some cartilage left.

And I always think of this as a way to improve tissue health, improve the health of tissues and cartilage that’s already there. It’s not going to regrow cartilage. Even stem cells don’t regrow cartilage. And that’s something we can talk more about, but that’s a misconception out there.

Terry

42:08-42:11

So people think that stem cells will regrow cartilage.

Dr. Tom Buchheit

42:11-42:27

People think that they do, but they don’t. And there’s, I think, a couple of reasons why. The stem cell story is a really interesting story of great science that’s been misinterpreted over the years, and we can talk a bit about the details of that but…

Joe

42:27-42:56

But I’d like to get back to the PRP alternatives. So you’ve made a strong case for plasma rich… for platelet-rich plasma, PRP.

What other regenerative strategies do you have and how else can they help either osteoarthritis or an injury or some other situation that is interfering with exercise?

Dr. Tom Buchheit

42:57-43:16

It all kind of depends on the severity, what’s going on, what the joint looks like. And when I say it looks like, what does it look like under MRI, under x-ray, under ultrasound? And what does it feel like to the patient?

It can be from a, if it’s a tendon or ligament issue, you can use things like prolotherapy to stimulate a healing response.

Terry

43:16-43:19

That’s great. We want to know what prolotherapy is.

Joe

43:19-43:20

What is it?

Dr. Tom Buchheit

43:22-43:27

Prolotherapy was commonly used. Now we use it… Dextrose, actually.

Joe

43:27-43:30

That’s sugar. Sugar water. Sounds like a placebo.

Dr. Tom Buchheit

43:32-43:41

Amazingly, it does sound like a placebo. But if you put sugar water in high enough concentration, it will set up an inflammatory reaction in that same immune response we’ve been talking about.

Joe

43:42-43:44

And prolotherapy’s been around for decades.

Dr. Tom Buchheit

43:44-43:49

It’s been around for, yes, it’s been around for 70, 80 years. Absolutely.

Joe

43:50-43:56

And a lot of times, I think some of your colleagues have said, “Yeah, that’s nonsense.” But you believe it works.

Dr. Tom Buchheit

43:57-44:08

I do. And I use it most often for tendons and ligaments that need, again, they need to flip that switch and they need to go into healing mode because it will set up that immune response.

Joe

44:08-44:13

So you’re injecting sugar water, dextrose, into the area that is painful.

Dr. Tom Buchheit

44:14-44:51

Exactly. Now, it’s partly what you’re injecting. It’s partly how you’re injecting because you do a technique that actually purposefully does minor injury to the tendon or ligament. People call it a fenestration. It has different words to it, but you do a little bit of a peppering technique of the tendon and you add this high concentration of sugar water.

The body responds to that inflammatory cascade and says, we have a problem here to fix. And the body sends in its messengers, just like it’s been an ankle sprain or another injury, sends in white blood cells, and then they start to get to work. So it’s really a calling card for immune systems.

Terry

44:51-45:06

So here again, you’re creating a short-term inflammation to overcome this chronic inflammation that is causing the pain.

You’ve said a couple times that the body needs to flip the switch. Can you tell us a little bit more about that, please?

Dr. Tom Buchheit

45:07-46:10

Yes. And your description is perfect. That’s exactly it. If we go back to the healing cascade and back to, say, the ankle sprain, there’s bleeding, there’s platelet release. The platelets not only release growth factors, but they pull in white blood cells.

One of those white blood cells is called a monocyte or macrophage. There’s been a lot of research into the macrophage that can change personalities. I liken it to the kind of the Incredible Hulk, Bruce Banner becoming Incredible Hulk. He’s uh mild-mannered in the bloodstream. He finds an injured tissue, becomes the Incredible Hulk and very angry.

But once he can resolve that anger, the anger of that macrophage, he can become kind of a subdued Hulk and start rebuilding these tissues. And so to me, it’s the work of the macrophage, which is this white blood cell that is key for healing. And when I refer to the switch, I’m referring to the macrophage switch.

Joe

46:11-46:24

So we’ve talked a little bit about PRP. You’ve mentioned prolotherapy, which is injection of dextrose into the area of pain and discomfort. What other regenerative therapies are there?

Dr. Tom Buchheit

46:25-46:31

There’s stem cells, and then there’s autologous conditioned serum, which is one that I’ve researched in lab and clinically as well.

Joe

46:31-46:32

What is that?

Dr. Tom Buchheit

46:33-46:51

That is a therapy that was developed in the 80s and 90s by a German orthopedic surgeon, Dr. Peter Wehling. And they were looking at ways to, again, resolve inflammation. And they found that if you take blood and let it clot over an extended period of time, again, the blood clot being important here.

Terry

46:51-46:52

Platelets.

Dr. Tom Buchheit

46:52-47:55

Exactly. Platelets and the things that the immune cells… Actually immune stimulation, if you stimulate that system in a test tube and then you pull off that serum, it has all kinds of inflammation-resolving proteins in it and growth factors.

And it’s been studied. It’s been used to… There are a lot of athletes that fly to Germany for this therapy. I use this therapy as well in my clinic now in Chapel Hill. But there was part of it that didn’t make sense because it was lasting longer than you’d expect just a growth factor or an anti-inflammatory protein to work.

So that’s when we started looking at the mechanisms. We found out that actually a lot of the effect of it is driven by these tiny immune particles called exosomes that can reprogram how cells behave.

So in a way, it’s kind of reprogramming tissues and how tissues behave. And that, to me, I think was the kind of the secret of the sauce, which is it’s allowing cartilage, allowing a tendon or ligament to become more youthful, for lack of a better term, because it’s being reprogrammed.

Joe

47:55-48:32

So how would somebody who’s either injured themselves, as Terry’s relative… [we] won’t mention any names… with his dislocated joint, and the osteoarthritis that has resulted, or an athlete who is elite, you know, one of the great basketball players at Duke University who comes to you and says, “Oh, I got to get back in the game next week.”

How do you do this autologous thing that you’re talking about? How do you make this stuff and how safe is it?

Dr. Tom Buchheit

48:32-49:06

Well, right now we make it in the lab. We built a lab for this and it’s actually quite safe. It’s been used for 20 years, a couple hundred thousand patients across the globe. It’s been used more in Europe than it has in the United States, but it has a very long track record, partly because the quality control of it is just so tight.

There are only a couple of places, there are only about 10 places in the United States where you can get it. And the lab, our lab technique, and everybody’s trained very highly. So I think the key to it is the standardization of processing and the quality control of the processing.

Joe

49:06-49:07

And what exactly is it?

Dr. Tom Buchheit

49:08-49:10

It’s a serum product, so serum from blood.

Joe

49:10-49:15

So again, we extract some blood from the individual and you do the magic sauce thing.

Dr. Tom Buchheit

49:16-49:27

Yes, exactly. And then occasionally things are added to that magic sauce, depending on the individual in front of you. And it’s injected in several different times, usually over the course of a week or so.

Terry

49:27-49:49

We have spent most of our time together talking about joints, bones, cartilage, and tendons and ligaments. And I would like to ask about nerves because healing joints and nerves, you’re talking about nerves, and nerve pain can be really awful. Why does it last so long?

Joe

49:50-49:51

And what can you do about it?

Dr. Tom Buchheit

49:51-50:16

Right, importantly. Why is it there and what do you do about it? A nerve will cause pain if it’s firing on its own. It has different names, autonomous firing. But if a nerve is compressed, strangled, or otherwise restrained, it tends to fire on its own spontaneously. And that spontaneous firing we feel is pain.

Terry

50:16-50:21

So sometimes we call that entrapment or impingement. They’ve got fancy terms for it, but it’s trapped.

Dr. Tom Buchheit

50:22-50:56

Exactly. If you trap a nerve, if you trap a nerve with a disc herniation in your spine, you’re going to have rip-roaring sciatica down your leg, and that’s an entrapped nerve. If you have carpal tunnel and you have a trapped nerve in your wrist, that’s going to cause nerve pain in your hand. If you have a nerve that’s entrapped around an old surgical scar, that’s going to become entrapped.

And so the key is there are ways to decrease the firing of the nerve with drugs. But to me, that’s an important part to free the nerve up so it’s no longer entrapped. And so that’s a lot of things that a lot of things that I do are freeing nerves up.

Joe

50:56-50:56

How do you do that?

Dr. Tom Buchheit

50:57-51:50

There’s a technique that’s called hydro-dissection that we do. And basically, it’s kind of gently injecting fluid of one of several different types around a nerve to open the space around that nerve so it can glide more freely through that space. And it’s a technique that makes sense.

You know, years ago you know I was… I’m old enough to have been done doing nerve blocks before ultrasound was ever used, and occasionally we’d see patients who got better longer term after a nerve block, and I kind of scratched my head trying to figure out why is this person better long term because all we did was shut the nerve off for a few hours.

In retrospect we were probably doing hydro-dissections without knowing it. Now we can see it. So under ultrasound, you place a needle very carefully around the nerve and you use a fluid to open the space up. So you don’t have to do it surgically now. You can just do it through a needle and through ultrasound.

Terry

51:50-51:54

So that’s what the ultrasound is for, to be able to visualize what you’re doing.

Dr. Tom Buchheit

51:55-51:55

Precisely.

Terry

51:55-51:56

How to do it right.

Dr. Tom Buchheit

51:57-52:04

Precisely. And to make sure you get good separation of the tissues with it. Because you can see it almost looks like a halo around the nerve when you’re done.

Terry

52:04-52:05

How well does it work?

Dr. Tom Buchheit

52:06-52:32

It depends on the nerve and depends on the entrapment. If there’s a true entrapment around a scar, it can work wonderfully. And once or twice, it can completely relieve pain. Other areas, if the nerve is sick for other reasons, for, you know, because of diabetes or other issues, it may work partially.

But my philosophy is if there’s ever an entrapped nerve, you want to release the entrapment first before you start adding drugs to it.

Terry

52:33-52:36

And one other thing, what about side effects?

Dr. Tom Buchheit

52:37-52:57

Side effects of hydrodissection are very low as long as the person doing it has a good view and experience doing it. Because if you put a needle into a nerve, you can injure the nerve. So you have to be very delicate and very confident in being able to place the nerve gently around it but not in it. And that’s the key.

Joe

52:57-53:02

Are there any nutritional supplements that can be helpful for people with neuropathy?

Dr. Tom Buchheit

53:04-53:14

I’m not an expert in supplements, but there are a few that I look at. I look at things that make nerves healthy and make mitochondria work better.

Joe

53:14-53:15

Such as?

Dr. Tom Buchheit

53:15-53:20

Well, one of my favorites, partly because so many people are taking statins, is making sure they’re on CoQ10.

Joe

53:21-53:21

Right.

Dr. Tom Buchheit

53:22-53:40

So I look at that. I am a big believer in omega-3 supplements unless someone is eating sardines daily, which most people don’t do. And I’m also a believer in things like turmeric and some of the other supplements, especially if they allow us to take fewer anti-inflammatory drugs.

Terry

53:42-53:52

Dr. Buchheit, I wonder if you could tell us a little something about stem cells. What are they and how should they be used? Are they useful at all?

Dr. Tom Buchheit

53:53-55:14

It’s a great question. And stem cells have captured the imagination of many Americans and people across the globe. That story started with a scientist named Dr. Arnold Kaplan. And he found these cells that were growing in our bone marrow that he could grow and turn into cartilage. And this was in the 1990s.

Everyone thought he had a cure for osteoarthritis at that moment. The challenge is that when you take those cells and inject them into a joint, they live for a while, but then they die off. And it’s really very clear now that what we call stem cells have a benefit for our immune response.

So, for instance, we talked about that macrophage that flips a switch. They will flip that macrophage switch, but stem cells are actually working through our own immune systems. So the cells that someone gets injected into a knee, a hip, or a shoulder, they’re not living long-term. They’re not growing new cartilage. They’re turning on our own repair systems.

And that’s the myth that’s been out there for a very long time is someone thinks that they’re going to have a stem cell injection. They’re going to grow new tissues. They may have much healthier tissues, but those cells that are injecting aren’t living long-term.

Terry

55:15-55:19

But what I’m hearing you say is there still could be benefit.

Dr. Tom Buchheit

55:19-55:50

Absolutely. Absolutely. The cells can be very beneficial in a lot of ways. There’s many ways to harvest them. You can harvest them from bone marrow. You can harvest them from adipose tissue. Now, stem cells have also become controversial because they can come from our cells, like PRP or the autologous conditioned serum, or they can come from a donor. And those donor products, you might imagine, need to go through a higher level of regulatory scrutiny to make sure that there’s no infection that occurs in that process.

Terry

55:50-55:52

I would want them to be regulated.

Dr. Tom Buchheit

55:53-56:12

Absolutely. And so there really are yet to be any approved stem cell therapies from donors in the United States. If you hear of people going overseas to overseas clinics, various countries around the United States, they can do those incubated products over there, but you really can’t do it in the United States right now.

Joe

56:13-56:43

I’d like to ask you about cost. I guess, but I could be completely mistaken, that insurance companies are going to do their best to deny things like prolotherapy or PRP injections, or maybe even the autologous conditioned serum. If they could say, no, no, no, no, no, we don’t really pay for that, how much would it cost if somebody had to pay out of pocket?

Dr. Tom Buchheit

56:44-57:07

Well, it’s a whole spectrum, right? There are certain things, prolotherapy is very inexpensive and stem cells and autologous conditioned serum are much more expensive.

And it is true, insurance doesn’t cover any of these right now. Now I think eventually they will. My way… I look at it is insurance covers therapies that suppress the immune system. They don’t cover therapies that augment the immune response.

Joe

57:08-57:09

That sounds crazy.

Dr. Tom Buchheit

57:10-57:56

But it’s true if you think about it, right? If you want a steroid injection, it’ll be covered. If you want an anti-inflammatory medication, it’ll be covered. But if you want prolotherapy or PRP or any of the other therapies we’re talking about, it’s not. We also need to redo some of the studies. I mentioned before some of the PRP studies that were negative because what they were using really wasn’t strong enough.

And the insurance company can very easily go to that… point to that study and say, “Look, here’s a large randomized control trial that says it doesn’t work. It’s experimental. We will not cover it.”

So it’s I think it’s incumbent on the field to redo these studies and redo them in a strong way, in a multicenter way with good products and then have the evidence. And I think that will happen, but I think it’s going to be a few years.

Terry

57:57-58:28

Dr. Buchheit, we’ve talked today about arthritis and what you do about it. We haven’t really talked as much about what causes it. We have talked about chronic inflammation. And so I want to ask you about one potential cause, which would be infection. For example, a Staph aureus infection, a Borrelia burgdorferi infection.

Do you have anything to say about that?

Dr. Tom Buchheit

58:28-59:24

It’s not an area that I know deeply. I know it is one of the things looked at, and it makes sense. Any driver of chronic inflammatory change is going to chew up cartilage. And if you think about it, so if you have a chronic inflammatory state, regardless of what’s driving that inflammatory state, your body’s going to produce enzymes that digest cartilage tissue. And that’s what osteoarthritis is. It’s the enzymes. The inflammation releases the enzymes. The enzymes digest the tissue.

And so we need to find a way to prevent that from happening. But any chronic inflammatory state would do that. A chronic infection would do that. A chronic inflammatory state would do that. An injury that hasn’t quite recovered would do that. So I’m not an expert in the infectious cause, but if a chronic infection causes chronic inflammation, absolutely it could drive osteoarthritis.

Joe

59:25-01:00:39

Dr. Buchheit, I’d like to ask about pain because pain gets your attention very fast. And people want relief and they can’t sleep. Their back hurts or their shoulder’s giving them trouble. They can’t lie on their shoulder.

It used to be that doctors prescribed opioids in massive quantities, Percocet, hydrocodone, oxycodone. And of course, now because of the opioid epidemic and all of the people who have died, there’s a tremendous reluctance for both physicians as well as patients to rely on opioids, especially long-term.

What’s replaced opioids, however, is gabapentin. It’s [an] anti-seizure drug. At least that’s how it was originally developed. And another medication that has both sort of antidepressant-like activity as well as some subtle opioid-like effect called tramadol. These are the big pain relievers these days.

Your thoughts about gabapentin and or tramadol and what we should be doing instead?

Dr. Tom Buchheit

01:00:40-01:01:36

That’s a great question. So I’ve been using and I’ve been using and seeing people on gabapentin since the late 90s when it came out, right? And it came out, as you pointed out, as a seizure drug. It does, and it can reduce nerve pain. We talked about nerve pain being from, if you have a nerve that’s entrapped, it starts firing on its own spontaneously and gabapentin can quiet that down.

The challenge with gabapentin, and the concern about gabapentin, though, is that it will affect the brain. It was designed to affect our brains as a seizure drug. And so I think it’s a bit of magical thinking to think that we’re not going to have cognitive side effects to gabapentin over time. And that’s my concern.

Some people can do very well with it. Some people need it because they cannot function because of a neuropathy or another issue. But a lot of people are on it, and I do have concerns about the cognitive side effects.

Terry

01:01:36-01:01:41

And the person who says gabapentin gives me such brain fog, I can’t function, they shouldn’t be taking it.

Dr. Tom Buchheit

01:01:42-01:01:45

If they can avoid taking it, it sounds like a good idea to avoid taking it.

Joe

01:01:46-01:02:28

We like to say that pain is personal. Everybody’s different. And my mom, for example, if she had a bellyache, it would be like a 10 out of 10. I mean, she was just incapacitated. Terry’s mother, on the other hand, you know, cut to the bone and she’d say, “Oh, maybe my pain’s at two.” You know, she was a tough old bird.

And so the idea that we can generalize about your pain is very challenging. Some people get great benefit from gabapentin. Other people say it didn’t work hardly at all. How do we find the right strategy for pain relief?

Dr. Tom Buchheit

01:02:28-01:03:56

Oh, it’s hard. It really is hard. And this has been decades and decades of pain research trying to identify therapies based on symptoms. I tend to look also at function.

The reason is that if I have someone who is having 6 over 10 knee pain and can walk a quarter of a mile, if we do a therapy on them and they can walk now 3 miles, but their pain is still 6 over 10, that’s still an improvement, right? Their function is better.

And my hope is that as the function improves, the pain will eventually follow. But it is hard because, right, pain is in us and it is subjective and no one can experience it outside of the individual. And that makes it hard to gauge, right?

But the other part of this is that we’ve tried to objectify osteoarthritis, for instance, by looking at an x-ray and saying this is grade 1, 2, 3, 4, depending on how big the space is between bones. And it turns out that there’s very little relationship between someone’s function, someone’s pain, and how much space is between the bones.

So our attempts at defining treatments based on x-ray is equally as poor. So I think pain is an important part of this. And it’s a very important part of helping someone to function better. And you’re right, there’s no other way of doing it other than just asking them and talking to the patient.

Joe

01:03:56-01:04:21

Well, we only have about two minutes left, and so this gives us the opportunity to summarize all the things that we should be doing and some that we should not be doing to allow us to keep moving which is critical to your game plan and to reduce our likelihood of ending up in pain for a long period of time?

Dr. Tom Buchheit

01:04:22-01:04:50

Well, I think first off is figure out where you’re starting. Everybody starts at a different place, but I like to say, you know, measure where you are and maybe you can walk a quarter mile. Maybe you can only walk a few steps. Maybe you can go and do aqua therapy, find out where your, where your level is of exercise and then work on building that, but build it slowly.

You know, if you have someone who can’t walk more than a quarter mile and they go walk two miles, they’re going to be in bed for three days and then they’ve lost ground, right?

Joe

01:04:51-01:04:58

And walking is good. You don’t have to be a marathoner to benefit from just plain walking.

Dr. Tom Buchheit

01:04:58-01:05:03

Exactly. And the studies for osteoarthritis are very convincing. Walking is good for joints.

Joe

01:05:04-01:05:05

What about diet?

Dr. Tom Buchheit

01:05:07-01:05:27

Live like the folks that are in the Mediterranean basin. So I always think of fish, fruits, vegetables, nuts, olive oils as the foundation for food. And that diet that’s good for our hearts is also very good for joints and nerves. And it’s been shown and studied to actually decrease arthritis pain as well.

Joe

01:05:27-01:05:42

And when we sprain an ankle or injure a shoulder or our back is hurting, what can we do to avoid taking all those NSAIDs or getting those steroid shots to ease the pain and get us back moving again?

Dr. Tom Buchheit

01:05:42-01:06:17

Well, that’s a great question. And I would argue that we should not soak ourselves in steroid injections and anti-inflammatories. And I had this personal experience of having had a couple of knee injuries. And one, the first one a bunch of years ago, I soaked in anti-inflammatories. And then the second one, I didn’t.

And I can tell from personal experience, it hurts more, but my healing was faster. And I would encourage when people can do it and go without the steroids and the anti-inflammatories to minimize or avoid them if they can.

Terry

01:06:17-01:06:24

Dr. Tom Buchheit, thank you so much for coming and talking to the People’s Pharmacy today.

Dr. Tom Buchheit

01:06:24-01:06:27

Thank you, Joe and Terry. It’s been a pleasure to be here. Thank you for having me.

Terry

01:06:28-01:06:48

You’ve been listening to Dr. Tom Buchheit, author of “Healing Joints and Nerves: Immune Stimulation, and the New Science of Regenerative Therapies.”

Dr. Buchheit founded the Triangle Regen Medicine and Biologic Center. He collaborates with colleagues at the Center for Translational Pain Medicine at Duke University.

Joe

01:06:49-01:06:58

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

01:06:59-01:07:06

This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy.

Joe

01:07:07-01:07:23

Today’s show is number 1,468. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email, radio, at peoplespharmacy.com.

Terry

01:07:23-01:07:54

Our interviews are available through your favorite podcast provider, whichever one that is. You’ll find the podcast on our website on Monday morning. In this week’s podcast, you can learn more about stem cells and PRP. We discuss the pros and cons of pain relievers, including opioids and gabapentin. Pain is so personal. How can we find the right strategy for pain relief for each individual?

Joe

01:07:54-01:08:02

And because we are so individual, the one size fits all does not work. We have to individualize it.

Terry

01:08:02-01:08:02

Exactly.

Joe

01:08:03-01:08:32

At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We would be so grateful if you’d write a review of The People’s Pharmacy and post it to the podcast platform you prefer. If you find our topics thought-provoking, please share them with friends and family. In Durham, North Carolina, I’m Joe Graedon.

Terry

01:08:33-01:09:09

And I’m Terry Graedon. Thank you for listening. Please do join us again next week.

Thank you for listening to the People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

01:09:09-01:09:19

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

01:09:19-01:09:24

All you have to do is go to peoplespharmacy.com/donate.

Joe

01:09:24-01:09:37

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream on Saturday, April 4, 2026, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link  so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on April 6, 2026.

Love Your Liver:

Nutrients don’t go directly from the intestines to the rest of the body. Instead, they pass through the liver first. There, this master organ breaks them down into compounds that can be recognized and utilized by individual tissues and cells. Moreover, if it finds nasty chemicals that shouldn’t be there, it utilizes its superpowers to transform them into less damaging compounds that can be more readily excreted.

You should also love your liver because it can store nutrients for unanticipated periods of fasting and hold off starvation. This was a tremendous benefit during earlier periods of human evolution. These days, we have less need for a hedge against starvation. In fact, when we overload our livers with alcohol or sugar, even its superpowers may not be adequate. The liver’s response to this kind of insult is fibrosis, a condition in which it stiffens and stores fat.

Liver Disease:

One of the liver’s superpowers is that it can regenerate itself so long as we remove the source of injury. That’s pretty remarkable! But what if we keep on eating ultra-processed foods (Nutrients, May 10, 2023) and drinking soda or alcohol?  In that case, the liver continues to try to repair itself. That can change the architecture of the tiny blood vessels that run through the liver, raising the pressure within them and ultimately leading to serious complications. Fatty liver disease, correctly termed metabolic-associated steatohepatitis (MASH), is the first step; cirrhosis and ultimately liver failure might follow.

How Do You Know If Your Liver Is Healthy?

The liver is so effective at maintaining the body in balance that most people don’t develop symptoms of trouble until liver disease is quite advanced. As a result, the best way to keep tabs on liver health is through blood tests. Tests for the liver enzymes called ALT and AST are common and often used to assess liver health.

Agents That Can Help or Harm the Liver:

If you love your liver, consider drinking a cup or two of black coffee daily. This has been shown to help the liver fight inflammation and overcome early-stage liver fibrosis (Redox Biology, March 2025).

Another precaution to take: avoid excess acetaminophen. This is the pain-relieving ingredient in Tylenol and hundreds of other over-the-counter medications. Doctors consider it safe for occasional use at doses under 4,000 mg in a day. Chronic use might call for lower doses yet. Because it is so widespread, people may mistakenly take several different medicines containing acetaminophen (paracetamol in the rest of the world) and end up exceeding the maximum dose by accident. Liver experts like our guest Dr. Ahmad treat such emergencies with a medicine called N-acetylcysteine.

Other pain relievers, such as NSAIDs, are less likely than acetaminophen to damage the liver. Dangerous reactions to such drugs are unpredictable, however, which can make them harder to manage. Fluoroquinolone antibiotics such as Levaquin and corticosteroids like methylprednisolone also fall into this category. Oral antifungal drugs can also be very hard on the liver.

Herbs That Can Challenge the Liver:

Pharmaceuticals are not the only compounds that may test the liver’s detoxifying superpowers. Botanical medicines can also cause challenges. Dr. Ahmad has treated people whose liver injuries were caused by green tea extract, turmeric, kratom or ashwagandha. Most people taking such supplements are attempting to improve their health, so discovering that instead they have developed liver damage is a nasty surprise. If you love your liver, stick with drinking green tea and eating curry rather than taking pills with concentrated extracts.

This Week’s Guests:

Meena Bansal, MD, is Professor of Medicine, specializing in liver diseases, at the Icahn School of Medicine at Mount Sinai. She is System Chief of the Division of Liver Diseases and Director of the MASH/NASH Center of Excellence at Mount Sinai.

Meena Bansal, MD, Professor of Medicine Mt. Sinai, photo courtesy of Mt. Sinai

Jawad Ahmad, MD, is a professor of liver diseases at the Mount Sinai School of Medicine. He is co Primary Investigator on the NIH/NIDDK research initiative to study cases of severe liver injury caused by prescription drugs, over-the-counter drugs, and alternative medicines, such as herbal products and supplements.

For more information on the Drug-Induced Liver Injury Network (DILIN) visit: https://researchfunding.duke.edu/drug-induced-liver-injury-network-dilin-clinical-centers-u01-clinical-trial-optional

Jawad Ahmad, MD, Professor of Medicine at Mount Sinai, photo courtesy of Mt. Sinai

Listen to the Podcast:

The podcast of this program will be available Monday, April 6, 2026, after broadcast on April 4. You can stream the show from this site and download the podcast for free.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, March 28, 2026, through your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on March 30, 2026.

Can You Disagree Without Fighting?

Dr. Goheen did her best to answer the questions her seatmate had. She also listened carefully to his description of life during the pandemic, particularly his objections to mandatory vaccination and his fears of a reaction to the vaccine. As a health care provider, she had been working in a hospital that was overwhelmed with COVID-19 patients. Far too many of them died, and at the height of the pandemic, most died alone rather than with family nearby. She was able to recognize that this had colored her perception of the pandemic and had led her not to give enough attention to the real economic hardship some public health mandates triggered.

The Value of Vaccines

Before the polio vaccine was developed, parents lived in terror of polio epidemics that would tear through communities, leaving some children paralyzed and a few dead. We no longer have to fear polio, pertussis, diphtheria or measles because vaccines can protect children from these common diseases. In a sense, though, their very success has led to skepticism of their value. Most Americans do not know anyone who has died of pertussis (aka whooping cough) because the majority of children have been vaccinated against this pathogen. Recently, there have been few birth defects caused by rubella because pregnant women can be protected from the infection.

Can Trust Be Regained?

During the pandemic, opinions became polarized. People who would once have trusted the FDA or the CDC became suspicious. Public health messages about masking were initially based on conjecture, because no one had conducted actual studies until later in the pandemic. The nature of this new virus and its transmission was not yet well understood. Yet authorities occasionally made dogmatic pronouncements, possibly out of fear. Some opportunities to build trust were squandered, and it will take time and patience to get it back. Learning to disagree without fighting is a great place to start.

Learning to Disagree Without Fighting

After talking with Dr. Goheen, we turn to Dr. Laura Gilliom. She is a clinical psychologist active in the Braver Angels movement. This organization brings people together to bridge the partisan divide. The volunteers run workshops in which people with divergent viewpoints discuss issues of the day. They model basic approaches to good communication, including treating the other person in the conversation with respect.

It is important to listen for understanding of the intellectual and emotional bases for their perspective. After all, people have reasons for their opinions. Even if you don’t understand them, those reasons make a lot of sense to them and are usually the result of significant life experiences. When you speak, the aim is not to win the argument, but to be heard and understood. That is also the goal as you listen–to understand where the other person is coming from.

When Braver Angels bring people together, all agree to state their views freely and without fear. That isn’t always the case in other situations. Sometimes people fail to speak out because they are afraid of the possible reaction. Another rule for Braver Angels interactions is that people treat each other, including those who disagree, with honesty, dignity and respect.

Curiosity and kindness are also critical when we talk with people whose views are very different from ours. In some situations, it may be appropriate to reflect back what you have heard and ask if that is a fair representation of what they said. Before sharing your own ideas, you might ask permission. One other point to keep in mind: humans sometimes make mistakes. That might apply to those on “our side” as well as to those on a different side. Humility can help.

This Week’s Guests

Morgan Goheen, MD, PhD, serves as faculty Instructor in the Section of Infectious Diseases within the Department of Internal Medicine at Yale School of Medicine. As a physician scientist, her current research focuses on the mosquito vector’s role in malaria transmission dynamics and drug resistance spread in sub-Saharan Africa with lab work based in the Epidemiology of Microbial Diseases Department in the Yale School of Public Health. Within her clinical specialty of infectious diseases, Dr. Goheen has specific interest in tropical medicine and helped start the Travel and Tropical Medicine Clinic at the Yale Center for Infectious Diseases. Dr. Goheen is a Public Voices Fellow of The OpEd Project in Partnership with Yale University.

https://www.theopedproject.org/fellowships.
https://www.huffpost.com/entry/infectious-disease-doctor-anti-vaccine-airplane_n_68d2e961e4b03fb4d93463e7

Laura Gilliom, PhD, is a licensed clinical psychologist in Chapel Hill, North Carolina, a State Coordinator for Braver Angels, and a member of the Central NC Alliance of Braver Angels.
https://nc.braverangels.org/

Listen to the Podcast

The podcast of this program will be available Monday, March 30, 2026, after broadcast on March 28. You can stream the show from this site and download the podcast for free.