The official podcast of Chubbyemu. Heme Review is a podcast about case reports in medicine. Each episode will tell a patient’s story, while teaching about the pathogenesis of disease, the treatment modalities and the dilemmas that arise during their care.
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The More Data You Have, The Further You Are From The Truth- Big Data Paradox in Medicine
Season 1 · Episode 28
Tuesday, May 16, 2023 • Duration 01:10:19
Dr Pavlos Msaouel: https://faculty.mdanderson.org/profiles/pavlos_msaouel.html
0:00 Pretext and context MD Anderson Cancer Center
1:42 The Early Experiences That Shaped Dr Msaouel
3:39 The System of Cancer Research In the United States
5:25 FDA Drug Approvals and Special Designations For Oncology
11:09 A trade-off in our current system
12:35 Whoops 😞 I misspoke
14:35 Randomized trials are not supposed to be representative of a population
18:10 Inference for the treatment of Katie Coleman (metastatic oncocytoma)
25:12 It is much more valuable to refute hypotheses than to confirm them
28:05 All Models Are Wrong, But Some Are Useful
30:05 Recasting the Bias-Variance Trade-off as the Patient Relevance-Robustness Trade-off
33:38 High Relevance, Low Robustness: Subjective Bayes
34:46 High Robustness, Low Relevance: Pure Randomization
41:47 Signal To Noise Ratio
45:49 The Big Data Paradox
53:41 How the Big Data Paradox fits in with Katie Coleman's case
54:33 How the Big Data Paradox fits in with other branches of medicine
57:54 How do we rectify subjectivity in The Truth?
01:00:43 How do we address the problems introduced by the Big Data Paradox?
01:04:21 Duality in nature and a Twitter argument re: the Evidence-Based Deep Medicine Iceberg
01:07:03 Why the ideas coming from MD Anderson are coming from MD Anderson
01:09:39 Where you can find Dr Msaouel
Dr Msaouel: https://twitter.com/PavlosMsaouel
Heme Review: https://twitter.com/HemeReview
Produced by @chubbyemu
Production Assistant: Nick Brown
Secret channel: @BigEmus
Cancer Patient Speaks With Her Oncologist ► https://youtu.be/Nddft_nc3Yc
A Woman Had A Headache Lasting 3 Days (Katie's case) ► https://www.youtu.be/i9fLEvgZzRE
References:
Stephen Senn. Statistical Issues in Drug Development.
Why representativeness should be avoided. https://academic.oup.com/ije/article/42/4/1012/656034
Commentary: Representativeness is usually not necessary and often should be avoided. https://academic.oup.com/ije/article/42/4/1018/658638
Impervious to Randomness: Confounding and Selection Biases in Randomized Clinical Trials. https://www.tandfonline.com/doi/full/10.1080/07357907.2021.1974030
A Causal Framework for Making Individualized Treatment Decisions in Oncology. https://www.mdpi.com/2072-6694/14/16/3923
Causal Diagram Techniques for Urologic Oncology Research. https://www.sciencedirect.com/science/article/pii/S1558767320301932
Causal inference and the data-fusion problem.
https://www.pnas.org/doi/10.1073/pnas.1510507113
Causal Inference: What If. Miguel A Hernán and James M. Robins. https://www.hsph.harvard.edu/miguel-hernan/wp-content/uploads/sites/1268/2023/04/hernanrobins_WhatIf_31mar23.pdf
There is Individualized Treatment. Why Not Individualized Inference? https://arxiv.org/abs/1510.08539
Unrepresentative big surveys significantly overestimated US vaccine uptake. https://www.nature.com/articles/s41586-021-04198-4
Unrepresentative Big Surveys Significantly Overestimate US Uptake https://arxiv.org/pdf/2106.05818.pdf
Statistical Modeling: The Three Cultures. https://hdsr.mitpress.mit.edu/pub/uo4hjcx6/release/1
How “centaur AI” will radically reshape the future of healthcare. https://bigthink.com/health/how-centaur-ai-will-radically-reshape-the-future-of-healthcare/
The Weird Time When Energy Drinks Fixed My Insomnia
Season 1 · Episode 27
Monday, January 9, 2023 • Duration 12:13
Mug is here 😳 ► https://crowdmade.com/collections/chubbyemu
@chubbyemu energy drink video ► https://youtu.be/tAtaIZD0Ebs
A Student Ate Only Chips And Fries For 10 Years ► https://youtu.be/VINtwoyaF_8
A Mom Ate 5 Day Old Sushi 🍣 ► https://youtu.be/R0d6Dpx2li4
Vitamin B12 deficiency can cause neurologic problems. It's stored in the liver and isn't made in humans. It needs to be sourced via diet.
A Discussion On Over-The-Counter Cough Syrup Misuse
On March 13, the FDA was alerted to five cases of acute non-viral hepatitis (resulting in acute liver failure) in infants and children that occurred in November 2020 with an unknown cause reported to the Southern Nevada Health District. All five patients had been hospitalized but have since recovered. All patients were reported to have consumed “Real Water” brand alkaline water. These patients came from four different households. Five additional people, two adults and three children, from two of the four households were reported to have experienced other symptoms as well. Less severe symptoms included fever, vomiting, nausea, loss of appetite, and fatigue.
A Grandma Collapsed From Abdominal Pain. This Is What Happened To Her Colon.
Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia
Interview With A Stage 4 Lung Cancer Survivor (Jill Hamer-Wilson)
Season 1 · Episode 15
Tuesday, March 30, 2021 • Duration 25:57
Video version of this interview: https://youtu.be/oLe9UdL-qIk
Jill's Blog: https://throughthevalley.ca
White Ribbon Project: https://twitter.com/TheWRP4LC
LUNGevity Foundation: https://lungevity.org
GO2 Foundation: https://go2foundation.org
Lung Cancer Canada: https://www.lungcancercanada.ca
Lung Foundation Australia: https://lungfoundation.com.au
Lung Cancer Europe (LUCe): https://www.lungcancereurope.eu
Tweet me: https://www.twitter.com/hemereview
IG me: https://www.instagram.com/hemereview
FB me: https://www.facebook.com/hemereview
Some Chubbyemu Videos That I Might Not Be Able To Make
Season 1 · Episode 14
Saturday, March 20, 2021 • Duration 15:26
Please note the CONTENT WARNING at the beginning-- there's a reason I can't make the videos as described in this episode. They may surface in a different form at some time in the future.
2,4-Dinitrophenol (DNP) is a chemical that is not approved for weight loss. It is a classic case of efficacy, but without safety in the setting of weight loss. This setting of weight loss can be prone to chemical misuse, further exacerbating understanding in human systems. Christopher is one of 2 - 3 cases documented in literature to have survived an accident with DNP for weight loss. As of 2021, one organization has permission from the US FDA to investigate DNP in some neurodegenerative disorders. These are rare diseases with limited standards of care, therefore extenuating circumstances to find anything that could potentially improve patient outcomes.
2,4-Dinitrophenol (DNP) is a chemical that is not approved for weight loss in the United States. It is a classic case of efficacy, but without safety in the setting of weight loss. This setting of weight loss can be prone to chemical misuse, further exacerbating understanding in human systems. Christopher is one of 2 - 3 cases documented in literature to have survived an accident with DNP for weight loss. As of 2021, one organization has permission from the US FDA to investigate DNP in some neurodegenerative disorders. These are rare diseases with limited standards of care, therefore extenuating circumstances to find anything that could potentially improve patient outcomes.
Licorice candy has glycyrrhizin which increases cortisol (stress hormone) levels in the body. This causes hypokalemia. Hypo- low. Kal- kalium (potassium). emia- presence in blood. Potassium signals muscle relaxation. Low potassium, low relaxation. Heart can't relax, then it stops. Real licorice candy is not easy to get in the United States. It's not at big chain grocery stores. Most of what you can buy from the big brands is licorice flavored, and won't do this.
References:
A 54-Year-Old Man with Sudden Cardiac Arrest. N Engl J Med 2020; 383:1263-1275. https://www.nejm.org/doi/full/10.1056/NEJMcpc2002420
The Pharmacological Activities of Glycyrrhizinic Acid (“Glycyrrhizin”) and Glycyrrhetinic Acid. Sweeteners. 2018 : 245–261. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123798/
The mechanism of uncoupling of oxidative phosphorylation by 2,4-dinitrophenol. J Biol Chem. 1967 Oct 25;242(20):4577-83. https://pubmed.ncbi.nlm.nih.gov/4964808/
MECHANISMS OF DINITROPHENOL TOXICITY. Simon E.W. Biological Reviews. Vol 28. (4). Nov 1953.
2,4-dinitrophenol (DNP): a weight loss agent with significant acute toxicity . J Med Toxicol. 2011 Sep;7(3):205-12. https://pubmed.ncbi.nlm.nih.gov/21739343/
Ambient temperature and mortality from unintentional . JAMA. 1998 Jun 10;279(22):1795-800. https://pubmed.ncbi.nlm.nih.gov/9628710/
Dinitrophenol as a Medicine. Cells. 2019 Mar; 8(3): 280. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468406/
The Interaction of Highly Active Uncouplers With Mitochondria. Biochimica et Biophysica Acta, 639 (1981) 225-242.
Beware the yellow slimming pill: fatal 2,4-dinitrophenol. BMJ Case Rep. 2016 Apr 4;2016. https://pubmed.ncbi.nlm.nih.gov/27045052/
Dantrolene is not the answer to 2,4-dinitrophenol poisoning: more heated debate. BMJ Case Rep. 2018 Dec 19;11(1):e225323. https://pubmed.ncbi.nlm.nih.gov/30573533/
The effect of 2,4-dinitrophenol on adipose-tissue metabolism. Biochem J. 1969 Feb;111(4):431-44. https://pubmed.ncbi.nlm.nih.gov/4388239/
The mechanism of uncoupling of oxidative phosphorylation by 2,4-dinitrophenol. J Biol Chem. 1967 Oct 25;242(20):4577-83. https://pubmed.ncbi.nlm.nih.gov/4964808/
MECHANISMS OF DINITROPHENOL TOXICITY. Simon E.W. Biological Reviews. Vol 28. (4). Nov 1953.
Identification and Importance of Brown Adipose Tissue in Adult Humans. https://www.nejm.org/doi/full/10.1056/NEJMoa0810780
Mitochondrial uncoupling as a target for drug development for the treatment of obesity. Obes Rev. 2001 Nov;2(4):255-65. https://pubmed.ncbi.nlm.nih.gov/12119996/
LC-MS-MS analysis of 2,4-dinitrophenol and its phase I and II metabolites. J Ana Toxicol. Jan-Feb 2007;31(1):55-61. https://pubmed.ncbi.nlm.nih.gov/17389084/
Uncouplers of oxidative phosphorylation. Environ Health Perspect. 1990 Jul;87:213-8. https://pubmed.ncbi.nlm.nih.gov/2176586/
Funder JW. 11 beta-Hydroxysteroid dehydrogenase: new answers, new questions. Eur J Endocrinol 1996; 134:267.
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