PodcastDX – Details, episodes & analysis

"Rethinking DX: A Digital DSM" looks at how the Diagnostic and Statistical Manual of Mental Disorders (DSM) quietly shapes almost every part of mental health care—from who gets a diagnosis and insurance coverage to how people understand their own symptoms and identities. In this conversation, Lita and Jean Marie unpack what the DSM actually is, why the current DSM‑5‑TR matters, and how a future, fully digital "DSM‑6" could function as a living document that updates more quickly, links to decision‑support tools, and better integrates real‑world data from electronic health records.​

They explore the growing push to move beyond symptom checklists and include factors like biology and inflammation, social determinants (poverty, racism, housing instability, community violence), culture and language, life stage, trauma history, and even nutrition and the gut–brain connection when understanding mental health. The episode also imagines what a visit with a clinician using a digital DSM might look like—from plain‑language criteria and prompts about trauma and physical health, to culturally sensitive questions and age‑specific guidance—while encouraging listeners to bring their whole story to appointments, ask how environment and biology interact in their own case, and get involved in shaping future DSM updates through advocacy and lived‑experience input.​

Over the next decade, medicine won't just add new gadgets—it will change what it feels like to be a patient. In this episode of PodcastDX, we explore how AI as a clinical co‑pilot, stem cells and regenerative medicine, genomics and precision care, wearables, and hospital‑at‑home models could reshape everyday care. We talk about the promise of earlier detection and more personalized treatment, the risks around bias, privacy, and hype, and why equity and shared decision‑making must stay at the center as technology races ahead. Most of all, we ask how patients and caregivers can be partners—not passengers—in guiding the future of medicine.

AI in medicine is best understood as a powerful tool and a conditional partner that can enhance care when tightly supervised by clinicians, but it becomes a problem when used as a replacement, deployed without oversight, or embedded in biased and opaque systems. Whether it functions more as a partner or a problem depends on how health systems design, regulate, and integrate it into real clinical workflows.​

• Decision support and diagnosis: AI can read imaging, ECGs, and lab patterns with very high accuracy, helping detect cancers, heart disease, and other conditions earlier and reducing some diagnostic errors.​

• Workflow and documentation: Tools that draft visit notes, summarize records, and route messages can cut administrative burden and free up clinician time for patients.​

• Patient monitoring and triage: Algorithms can watch vital signs or wearable data to flag deterioration, triage symptoms online, and guide patients through care pathways, which is especially valuable with clinician shortages.​

• Errors, over-reliance, and "automation bias": Studies show clinicians sometimes follow incorrect AI recommendations even when the errors are detectable, which can lead to worse decisions than if AI were not used.​

• Bias and inequity: If training data underrepresent certain groups, AI can systematically misdiagnose or undertreat them, amplifying existing health disparities.​

• Trust, explainability, and liability: Black-box systems can undermine shared decision-making when neither doctor nor patient can understand or challenge a recommendation, and they raise hard questions about who is responsible when harm occurs.​

• Potential partner: By handling routine documentation and data crunching, AI can give clinicians more time for conversation, empathy, and shared decisions, supporting more person-centered care.​

• Potential barrier: If AI outputs dominate visits or generate long lists of differential diagnoses directly to patients, it can increase anxiety, fragment communication, and weaken relational trust.​

• Keep humans in the loop: Use AI as a second reader or coach, not a final decision-maker; clinicians should retain authority to accept, modify, or reject suggestions.​

• Demand transparency and evaluation: Health systems should validate tools locally, monitor performance across different populations, and disclose AI use to patients in clear language.​

• Align incentives with patient interests: Regulation, reimbursement, and malpractice rules should reward safe, equitable use of AI—not just speed, volume, or commercial uptake.​

In practice, AI in medicine becomes a true partner when it augments human judgment, enhances relationships, and improves outcomes; it becomes a problem when it is opaque, biased, or allowed to replace clinical responsibility.​

This week we will discuss Multi-Organ transplants with Zachary Colton.  Zach is 35 years old and recently underwent a successful 5 organ multivisceral intestinal transplant surgery at the Toronto General Hospital in his home country of Canada. The organs he received were: stomach, small intestine, colon, liver, and pancreas.  

In 1954, the kidney was the first human organ to be transplanted successfully. Liver, heart and pancreas transplants were successfully performed by the late 1960s, while lung and intestinal organ transplant procedures were begun in the 1980s.

​From the mid-1950s through the early 1970s, individual transplant hospitals and organ procurement organizations managed all aspects of organ recovery and transplantation. If an organ couldn't be used at hospitals local to the donor, there was no system to find matching candidates elsewhere. Many organs couldn't be used simply because transplant teams couldn't locate a compatible recipient in time. 

​Since that time UNOS was created in order to provide guidance to patients and physicians in the US with a goal of providing a more equitable base for individuals in need of transplanted organ(s).

​The United Network for Organ Sharing (UNOS) is a non-profit scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established (42 U.S.C. § 274) by the U.S. Congress in 1984 by Gene A. Pierce, founder of United Network for Organ Sharing. Located in Richmond, Virginia, the organization's headquarters are situated near the intersection of Interstate 95 and Interstate 64 in the Virginia BioTechnology Research Park.

• Managing the national transplant waiting list, matching donors to recipients.

• Maintaining the database that contains all organ transplant data for every transplant event that occurs in the U.S.

• Bringing together members to develop policies that make the best use of the limited supply of organs and give all patients a fair chance at receiving the organ they need, regardless of age, sex, ethnicity, religion, lifestyle, or financial/social status.

• Monitoring every organ match to ensure organ allocation policies are followed.

• Providing assistance to patients, family members and friends.

• Educating transplant professionals about their important role in the donation and transplant processes. (CREDITS: Wiki)

• Educating the public about the importance of organ donation.

This week we will discuss Ectoparasites.  The CDC says: "Although the term ectoparasites can broadly include blood-sucking arthropods such as mosquitoes (because they are dependent on a blood meal from a human host for their survival), this term is generally used more narrowly to refer to organisms such as ticks, fleas, lice, and mites that attach or burrow into the skin and remain there for relatively long periods of time (e.g., weeks to months). Arthropods are important in causing diseases in their own right, but are even more important as vectors, or transmitters, of many different pathogens that in turn cause tremendous morbidity and mortality from the diseases they cause.
 

Over 200 years ago Louis Pasteur was born in Dole, France. Among Pasteur's major contributions and their benefit to society, the most important is the heat treatment of foods and beverages to reduce spoilage and eliminate pathogens for consumers.

Probably the greatest achievement of Pasteur was the process that bears the name of this famous scientist who perfected the technique: pasteurization. For liquids, this process does not involve boiling the product to sterility but simply applying just enough heat (ie, par-boiling) to 50–60°C for a specified period to reduce spoilage microbes and potential pathogens. Pathogenic microbes have a lower heat tolerance than most other bacteria. Recognizing that many individuals, from the highly educated to the peasantry, were aware of the effect, it took someone like Pasteur to formalize this knowledge into specific time-temperature standards to assure consistency. 

Unpasteurized foods are sold even though they have not been treated with high temperatures. Foods that haven't been pasteurized include: 

• raw milk
• some artisanal cheeses
• some unpasteurized versions of juices and meats

Many food safety concerns and a high risk of foodborne illness are associated with eating unpasteurized foods, although there may be a few benefits.

Still, evidence indicates that the health risks appear to outweigh any potential benefits in most cases.

Here are the benefits and downsides of unpasteurized food products.

Unpasteurized food is more likely to retain its organoleptic properties and may sometimes have greater nutritional value. The term "organoleptic properties" refers to the food's taste, appearance, and smell.

Exposure to high temperatures during pasteurization not only kills harmful bacteria and viruses in foods. It may also negatively affect the nutritional quality, appearance, and flavor of the food.

For instance, some research demonstrated that pasteurization reduced the protective antibodies and immune-supportive vitamin C and zinc in donor human milk. 

However, other research shows that these nutrient losses in human milk are minor and that the benefits of pasteurization are greater than the risks. 

Unpasteurized foods are associated with the occurrence of foodborne illnesses from bacteria, such as Brucella, Cryptosporidium, Listeria monocytogenes, and antibiotic-resistant Staphylococcus aureus.

In particular, scientific literature frequently mentions that unpasteurized milk and dairy products are particularly high risk foods and common causes of these foodborne illnesses. 

These bacterial infections may last from days to weeks. Effects range from mild symptoms — like fever, diarrhea, vomiting, muscle aches, abdominal pain, and poor appetite — to severe outcomes like miscarriage and even death. 

Unpasteurized foods present even greater health risks and are more dangerous to people with compromised immune systems, such as older adults, pregnant people, young children, and those with health conditions like cancer.

Unpasteurized foods are slightly more likely to retain natural tastes, appearances, flavors, and nutrients, but they are strongly associated with foodborne illnesses. Evidence indicates that the risks of consuming unpasteurized foods greatly outweigh the benefits, especially for immune-compromised people.  (CREDITS)

In this episode we are talking again with our audio editor Jack Scaro.  The topic again is: spontaneous pneumothorax, or collapsed lung.

Spontaneous pneumothorax is an abnormal condition of the lung characterized by the collection of gas in the pleural space between the lungs and the chest wall. This condition occurs without an obvious etiology and can be classified as either primary or secondary. Patients may present with symptoms such as tachycardia and dyspnea. The diagnosis is based on clinical suspicion and can be confirmed with imaging. 

Jack had this condition which surprised everyone since he was a healthy 20 year old with no risk factors except.... you'll have to listen to this week's episode to find out what it is and whether you or a loved one could be at risk!

This week we will continue our coverage of Bile acid malabsorption (BAM),  a gastrointestinal disease. It's a common cause of chronic diarrhea. When bile acids aren't properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools.

This week we will continue our coverage of Bile acid malabsorption (BAM),  a gastrointestinal disease. It's a common cause of chronic diarrhea. When bile acids aren't properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools.

Bile acid malabsorption (BAM) is often misdiagnosed as Irritable Bowel Syndrome or is overlooked in individuals with Crohn's disease.

Bile Acid Malabsorption happens when the small intestine is unable to direct bile acid back to the liver. This means that the body doesn't absorb water properly and affects digestion. The condition results in what is known as Bile Acid Diarrhoea.

How will a new test for Bile Acid Malabsorption be developed?

Currently, the only test for bile acid malabsorption is the SeHCAT test which is expensive, time consuming and uses radiation.

The team have developed a test which they believe will diagnose the condition more rapidly and cost effectively than the current test. For its initial testing phase, it will be used on stool (poo) samples, and in its second phase the research team will assess whether it can also guide treatment decisions on what dose should be given to individual patients.

The aim of the study is to establish a better test for BAM, do the groundwork for a future study of the role of faecal bile acid measurements within the NHS, and use the data collected from this trial to prepare other studies to assist with the diagnosis and treatment of individuals with BAM.

Chronic diarrhea is one of the most common reasons why people get referred to specialist gastroenterology clinics, and can account for as many as 1 in 20 referrals. Bile acid malabsorption is a major cause of chronic diarrhoea and is thought to affect up to 1 million people in the UK.

As well as individuals with Crohn's disease, as many as one in three people diagnosed with IBS with diarrhoea (IBS-D) may actually be experiencing BAM but the current gold standard SeCHAT test is only available in certain UK centres. It is also time consuming and costly.

In 2012 the National Institute for Health and Care Excellence's Diagnostic Advisory Group concluded that a new test for the diagnosis of BAM was needed. (credits: Diagnosing bile acid malabsorption - Bowel Research UK :Bowel Research UK )

This week we will discuss Bile acid malabsorption (BAM),  a gastrointestinal disease. It's a common cause of chronic diarrhea. When bile acids aren't properly absorbed in your intestines, they build up, upsetting the chemical balance inside. Excess bile acids trigger your colon to secrete extra water, leading to watery stools.

​

Bile is a substance your liver makes while filtering your blood. Your liver sorts waste products, such as toxins, dead blood cells and excess cholesterol into bile. Bile acids come from synthesizing these products together. The different acids in bile help to stabilize the lipids in the mix and keep them in a liquid form.

Your liver sends bile through your bile ducts to your small intestine to help with digestion. Bile acids in your small intestine help break down fats for absorption. When that work is done, they are supposed to be reabsorbed themselves, returning to your circulation and then your liver to be recycled into bile again.

​

Malabsorption is any failure of your intestines to absorb all of the chemicals they're meant to. Malabsorption can be a problem with your intestines themselves, or it may result from a chemical imbalance. For example, you may have too much or too little of a certain chemical for your intestines to absorb.

​

BAM has been historically underdiagnosed due to a lack of accessible ways to test for it. But studies now show that at least 30% of those diagnosed with functional diarrhea disorders may have BAM. Functional disorders are those that have no apparent cause and are likely to go undetected during a medical examination, such as irritable bowel syndrome (IBS).

BAM is seen in people with conditions such as:

• Microscopic colitis.

• Crohn disease.

• HIV-related enteritis.

• Diarrhea that persists after a bacterial infection.

• Exocrine pancreatic insufficiency.

It can also happen in people who receive certain medical treatments including:

• Surgical bypass or resection of the ileum, the last section of the small intestine.

• Gallbladder removal (cholecystectomy).

• Radiation therapy, especially in the abdominal-pelvic region.

• Chemotherapy.

• Metformin, a treatment for type 2 diabetes.

​

Typical symptoms include:

• Watery diarrhea.

• Frequent bowel movements.

• Painful stomach cramps.

• Urgency and difficulty holding bowel movements in.

Some people also have:

• Abdominal bloating.

• Gas and gas pain.

• Steatorrhea (fatty stools.)

• Indigestion.

Long-term symptoms can include:

• Dehydration.

• Fatigue.

• Headaches.

• Dizziness.

• Nausea.

• Weight gain.

• Weight loss.

About half of people have constant symptoms, and the other half only report occasional symptoms.

The symptoms of bile acid malabsorption — primarily, bile acid diarrhea, or BAD — result from the buildup of bile acids in your colon, where food waste turns to poop. Normally, 95% of the bile acids in your small intestine are reabsorbed in the last segment (the ileum) before passing on to your colon.

When too many are left over, however, they pass into your large intestine with the rest of the waste. Bile acids in your colon irritate the mucous lining, triggering it to secrete extra fluid and speeding up the muscle contractions that move poop along. This causes frequent, urgent diarrhea and cramping.

What causes bile acids to build up in your intestines is another question.

Researchers have classified the possible causes of BAM into four different types. Sometimes they classify BAM as either primary or secondary.

​Primary BAM is caused by your liver overproducing bile acids (types 2 and 4.)

​Secondary BAM is caused by damage to your small intestine due to disease, surgery or radiation treatment (types 1 and 3.)

Type 1 BAM is caused by a problem with your ileum itself. This is considered true malabsorption, because the problem begins at absorption stage of the bile acid cycle. You may have type 1 BAM if you've had the last part of your small intestine surgically removed, altered or bypassed to treat another condition. Certain diseases, such as Crohn's disease, and treatments such as radiation therapy can also damage the ileum. Significant damage impairs its ability to absorb.

​Type 2 BAM has sometimes been called "idiopathic," which means that it happens spontaneously or for unknown reasons. However, current research suggests that it's a problem with the chemical signaling between your intestines and your liver. This signaling is what normally regulates your bile acid cycle (enterohepatic circulation.) Chemicals in your blood signal when your liver should produce and deliver more bile acids and when it's time to stop, reabsorb and recycle them. But with type 2 BAM, your liver doesn't get the memo to stop. So, it keeps sending bile acids — too many for your ileum to absorb.

​Type 3 BAM is caused by gastrointestinal diseases that can affect your ileum along with other parts of your digestive system. These include celiac disease, chronic pancreatitis and small intestinal bacterial overgrowth (SIBO).

​Type 4 BAM is caused by excessive bile acid production as a side effect of taking Metformin.

This week we will discuss a Veteran's hesitancy to receive healthcare at the government hospital system known as Veterans Administration or "VA".  Although many veterans may share the concern over receiving care through a government agency due to the medical care they got while in training or active duty; i.e. sucrettes and tylenol being the standard of care when Jean Marie and I were in training. Our guest, Mark Frerichs, has different reasons to question the quality of care. Mark, a Navy veteran who continued working as a contractor post-war in Afghanistan.  It was during his work after the war that created a hesitancy in trusting anything related to the government.  

​

Mark Randall Frerichs (born July 13, 1962) is an American civil engineer and former US Navy diver who disappeared in Afghanistan in January 2020 and was later confirmed to be captured by the Haqqani network, a group closely aligned with the Taliban. In September 2022, Frerichs was released by the Taliban-led government of the Islamic Emirate of Afghanistan in exchange for Bashir Noorzai.

Frerichs is a director of International Logistical Support whose work had led him to visit Afghanistan multiple times since 2012.  He served in the United States Navy as a diver.

​https://www.tiktok.com/t/ZTLL8pHkA/ 

Frerichs disappeared in Kabul, Afghanistan, on January 31, 2020. The Associated Press reported that US intelligence officials tracked Frerichs's cell phone and raided a village near where he disappeared, approximately a week after his disappearance. Although they rounded up individuals from that village, the raid proved unproductive. The next month, Newsweek magazine reported that officials had confirmed that Frerichs had been taken captive by the Haqqani network, a group closely aligned with the Taliban.

Frerichs's sister, Charlene Cakora, questioned why the US government "signed a peace deal" with the Taliban in early February 2020 that did not include a provision for releasing her brother. The Federal Bureau of Investigation, the lead agency of the Hostage Recovery Fusion Cell, issued a statement saying the cell was working to ensure "that Mark Frerichs and all Americans held hostage abroad are returned home."

On May 10, 2020, the FBI offered a $1-million reward for information that helps lead to Frerichs's release or rescue. In addition, the Rewards for Justice Program offered a $5-million reward for information leading to his location. That same day, Taliban spokesmen asserted that they had conducted an inquiry of their subordinate and associated groups and confirmed they were not holding Frerichs.

​The New York Times reported Frerichs was still a captive on November 21, 2020, when Secretary of State Mike Pompeo traveled to Afghanistan to personally participate in peace negotiations with the Taliban. They reported it was unknown whether Pompeo raised Frerichs's captivity as an issue during the talks.

​On April 1, 2022, a video was released showing Frerichs pleading for help. Following the release of Safi Rauf, an American aid worker who was held captive by the Taliban between December 2021 and April 2022, the US State Department began an attempted inquiry into the release of Frerichs. The inquiry did not result in substantial headway in brokering Frerichs' release. Frerichs's family was a part of the Bring Our Families Home campaign.

​On September 19, 2022, Taliban Foreign Minister Amir Khan Muttaqi told reporters in Kabul that his government and a US delegation swapped prisoners at the Afghan capital's airport. Frerichs was exchanged for Bashir Noorzai. (credits: Mark Frerichs - Wikipedia)