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The Psychology of Social Media

18 Jun

We all know we are chained to our computers and mobile devices at times just looking for another fix of Facebook gossip or Twitter drama.  If you don’t use those 2 sites, I’m sure you have another social media vice.  This episode, Chad digs into some of the reasons why we all love social media so much.  While you are listening, be sure to like us on Facebook and follow us on Twitter! :-)

Thanks for listening!

 
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The Internet of Medical Things

04 Jun

So a few ‘casts ago I took issue with some of Chad’s “internet of things” podcast because I was skeptical that it was really going to change our lives. I understand that there are some cool gadgets that we can connect to the internet and get some fun automation for our homes, but I couldn’t get over that the internet of things was ‘transformative.’ So I was grappling with this a little bit and then heard a podcast on my all-time favorite ‘econtalk’ about the internet of medical things. In this podcast, Russ Roberts interviews Eric Topol who wrote the book ‘The Patient Will See You Now’ About how the medical world is about to undergo a drastic upheaval thanks to technology, the internet, and our devices.

I was so excited by some of the stuff they were talking about that I bought the book and got about 40% through it. I wish I could have actually finished it, but there was enough packed into that first 40% that I think we can start a really good discussion. What really struck me as I read through that first bit was how much I wanted to talk to Chad and Geo about it, because we have a REALLY unique perspective here at GG2K of 2 young guys that have grown up with technology that are in the medical profession. We’ll probably get into this a little more as we go on, but the average age of a doctor right now, is 55. For listeners that don’t know, Chad is a psychiatrist, and Geo is a genetic counselor, which has some SUPER exciting things to talk about. So I’m SORT of going to play the role of a stupid prompter, go over some of the main points from Topol’s book, and have you guys react to them.

So as a side-bar, I want to call out that one of the things I love about all of the Good Guys, and one of the true hallmarks of a good guy to know, is to be aware of your own biases. I’m going to talk about some stuff this episode, that, honestly, if you take them to the extreme, means that their jobs are going to look VERY different in the future. And a lot of people would be very threatened and defensive about that. My ‘guess’ is that Chad and Geo will not have this knee-jerk reaction, but I could be wrong so stay tuned.

So what is ‘the democratization’ of medicine? What do you guys think that means? Topol uses ‘democratization’ to mean “to make something available to all people.” He mainly is talking about data here. Now here we have yet ANOTHER good guy to know connection, because Perek knows a TON about medical data and all the challenges it presents so he may have some thoughts. But the main point that Topol drives home (for quite awhile), is that the content and flow of our medical data should be controlled and accessible for US. Up until the last couple years, and still in most cases, all of your medical data are controlled by the doctor. You go to a checkup, maybe get some labs run – if you’re lucky, you get the results in the mail – but most likely it’s a phone call and they say ‘everything’s normal’ and that’s the end of it. Want to take a stab at how many patients out of 10 in the united states actually email back and forth with their doctor? 1/10.

Now things are changing because there is a ton of medical data being generated by US, on our devices – and Topol only expects this to increase. We’ll get to examples of specific technology in a minute, but for now, suffice to say, it’s not just labs that can produce the data, it’s US. And once we have that data, it’s up to us what to do with it.

As with a lot of things in the technology age, the devices are cool, but their real power is unleashed when they connect to the internet. Topol argues that we are soon going to have an army of smart, hyper-connected consumers of health care that is really going to challenge the traditional – what he terms ‘paternalistic’ medical establishment.

Part of what Topol suggests we are doing as we are creating all of this data on our own, is creating a more complete picture of our health based on a ton of ‘omes.’ I’m not going to attempt to do all of them, but want to focus on two – the physiome (stuff we can measure with sensors) and the genome.

So things that can measure the physiome: Topol spends a good portion of the book talking about different devices that can be hooked up to smart phones to generate data. Some are just native that come with every smart phone, but some of the fancier ones are actually separate devices. Let me read an excerpt of what’s out there for ‘bio-sensors’ right now.

There are now wearable wireless sensors either commercially available or in clinical development, to capture physiologic data on a smartphone. This includes blood pressure, heart rhythm, respiratory rate, oxygen concentration in the blood, heart rate variability, cardiac output and stroke volume, galvanic skin response, body temp, eye pressure, blood glucose, brain waves, intracranial pressure, muscle movements and many other metrics. The microphone of the smartphone can be used to quantify components of lung function and analyze one’s voice to gauge mood or make the diagnosis of Parkinson’s or schizophrenia. One’s breath can be digitized to measure a large number of compounds, such as nitric oxide or organic chemicals, which could enable smartphones to track lung function or diagnose certain cancers.

I think a year or two ago, I would have said that people are never going to want to wear sensors all the time that constantly are tracking their health – but how many people do you see walking around these days wearing a fitbit to track their steps and heart rate etc. People are going to be doing this stuff.

Where it starts to get scary powerful, is when you combine some of this physiome stuff with the genome. Now we’ve done some podcasts on genome sequencing, but Geo, since you do this for a living, can you give us a 60 second explanation of what our genome is, and then a 60 second treatment of how accessible our genome is to us today versus let’s say 10 years ago when we were in college?

Cost for sequencing an entire genome was $28.8M in 2004 – is now less than $1500.

So there are a few big wins here – one that most people are super interested right now, is am I more susceptible than the general population for certain diseases/cancers, and is there anything I can do about that if I am? He spends a lot of time talking about Angelina Jolie and her choice to have both breasts and most recently, her ovaries removed.

The other one that we may have talked about before, but I had forgotten until reading this book is Pharmacogenomics. To keep this one really high level, this is tailoring the drugs you take to your specific genetic profile on how you respond to it. This is the type of thing where people are going to look back on it, and not believe that doctors just always prescribed the same thing to everyone of certain ailments.

Topol goes on and on about this stuff, but for now, let’s just stop with those two, and imagine some of the pieces of this puzzle fitting together. Maybe a person learns via their cheap genome sequencing that they are at higher risk for developing asthma. So they get a device they can monitor their breathing and have their smartphone alert them pre-emptively when they are going to have an attack, so go find an inhaler BEFORE they feel the symptoms etc. This is a really crude example but is stuff that we are months, not years away from.

He also talks about handheld ultrasound devices, and I wanted to ask Chad about this because of the following excerpt:

Availability of this technology has lead to at least two medical schools in the united states providing a device, instead of the traditional stethoscope, to all of its students on the first day. One health system in Minnesota has recently completed training its primary care physicians with handheld devices to conduct head-to-toe ultrasound physical examinations.

So let’s talk about a few more technologies that are here:

  • How long do you think the average NEW consultation with a doctor lasts? 12 minutes (Repeat visits are 7 minutes)
  • How long is the wait time? (62 minutes)
  • Health Partners (A Minnesota company) has started to roll our virtual visits. This is happening now – where a user logs in, fills out some surveys, and gets a diagnosis and sometimes a prescription. This is an extension of minute clinics that have become super popular, and Topol sees no reason that this will extend to more and more doctor visits as time goes by.
  • There’s an app called First Opinion that actually leaves you anonymous but also keeps you with the same doctor. (Since it’s anonymous, it gets around a lot of HIPAA regulations)
  • Finally there are two companies called Medicast and Pager that offer doctors on demand 24/7. This is Uber for health care.

So one last thing that I ran across that I really wanted to get Chad’s/Geo’ opinion on that I read. As I was reading about all of these sensors, lab-on-a-chip, apps that allow you to text back and forth with a doctor, etc, I was thinking the whole time, ‘Well at least Chad’s gonna be safe, he’s a psychiatrist – his whole jam is talking to people and figuring out what’s wrong with them based on how they act, symptoms that aren’t physical. He has to ask questions based on hunches, and figure out more of a mystery.’ Then I read this:

Add to that psychiatrists who read an article in The Economist that a virtual shrink may be better than a real one, reviewing a study that showed that patients are more apt to confide and be open and honest with a computer avatar than with a counselor.

And Geo – one last excerpt for you to react to regarding tele-consultations:

A randomized trial was undertaken of 669 women receiving new data on their BRCA gene mutations who were assigned to either an in-person or telephone consult. Extensive evaluation after the information was reviewed showed that telephone consults were just as effective. With less than three thousand genetic counselors for a population in the United States of 330 million, surely this is good news for fixing the incongruous mismatch between the supply of this expertise and its increasing demand.

So I fully admit that this pillar may have gotten a little frenetic, probably because I haven’t yet finished the book and had a ton of time to digest its implications – but I just had to talk with you guys about some of this and get your thoughts from the inside on how realistic this really is. I personally can’t wait to try an online physical or something instead of going into the doctor.

 
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Em Drive?

21 May

Every once in a while, science news seems to walk a fine line between fantastic and fantasy. Em Drive, the topic of our latest podcast, is a recent example of exactly that!

Em Drive (pronounced “M” drive) also known as RF resonant cavity thruster is a hypothetical propulsion mechanism designed in part for space travel. Em Drive was proposed by Roger Shawyer, a British aerospace engineer who has a background in defense work as well as experience as a consultant on the Galileo project (a European version of the GPS system).

Em Drive “uses a magnetron to produce microwaves which are directed into a metallic, fully enclosed conically tapered high Q resonant cavity with a greater area at one end of the device, and a dielectric resonator in front of the narrower end. Shawyer claims that the device generates a directional thrust toward the narrow end of the tapered cavity. The device (engine) requires an electrical power source to produce its reflecting internal microwaves but does not have any moving parts or require any reaction mass as fuel.” In layman’s terms, the Em Drive bounces microwaves around in a metal ice cream cone which produces directional energy without using fuel.

 

To learn more about Em Drive, and why you should be skeptical, have a listen to the podcast! Thanks for listening.

References:

http://www.nasaspaceflight.com/2015/04/evaluating-nasas-futuristic-em-drive/  (Press release)

http://www.space.com/29363-impossible-em-drive-space-engine-nasa.html

http://en.wikipedia.org/wiki/EmDrive

http://www.space.com/29363-impossible-em-drive-space-engine-nasa.html

http://www.wired.com/2015/05/nasa-warp-drive-yeah-still-poppycock/

 
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Zen Golf

07 May

This episode we follow up on Chad’s challenge to read Zen Golf by talking about the book.  Zen Golf is one of our favorites.  I can personally confirm that it help drop at least 5 shots off of my game after reading and implementing some of the techniques.  Give it a read, or a listen.  As always, let us know if you have any questions or comments, thanks for listening!

Amazon e-book:  http://amzn.com/0385504462

 
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The Great Outdoors

23 Apr

This week we have an awesome interview with Perek’s sister-in-law Andrea on the great outdoors.  Andrea has an incredible resume with oodles of experience educating and living in the outdoors.  Summer, winter, up high, down low, she’s got a ton of awesome experiences that I wanted to share with the listeners.

I asked Andrea to try and consolidate her voluminous knowledge into some awesome tidbits for the listeners who may be planning their next trip to the boundary waters, or a whitewater rafting trip to Colorado.  I hope you enjoy the interview!

Thanks for listening!

 
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Home Automation!

13 Apr

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Hey everybody, this week chad gives us a rundown of some cool home automation tools and discusses the Internet of Things!  Very cool stuff.

 

I hope you like our homegrown songs and jingles, too!

 

Thanks for listening!

 
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Lower Your Bills

26 Mar

Hey everyone.  Any chance you want to save some money on your bills?  I thought so.  This week Mitch regurgitates an awesome article he read over at bakadesuyo.com.  The article is a cool interview with a hostage negotiator on some principles that you can apply to things like your cable subscription.  Mitch even recorded a conversation with his provider actually lowering his bill with these methods!  Companies HATE him, Good Guys love him.  Please enjoy!

 

http://www.bakadesuyo.com/2015/01/lower-your-bills

 

 
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Cutting the cable cord

12 Mar

This last month I paid $70.96 for cable alone. That doesn’t include phone or internet or fancy movie channels like HBO. Only cable. Through many conversations with friends, I know that I am not the only one with ever-growing contempt for cable companies. And like many of those friends, I am also getting ready to cut the cable cord! Just to confirm my anecdotal assumptions, I found the following quote from Bloomberg: “In 2013, the number of Americans who pay for Cable TV, satellite, or fiber services fell by more than 250,000. This was the first full year where cable users steadily declined.”

Now don’t be discouraged; there are other options that give you access to new television shows without the gouging price tag of traditional cable services. Let’s take a look at some of the best options out there.

 

Netflix:

Price = $8/month

Netflix came onto the scene in 1999 when it introduced it’s flat-rate DVD-by-mail service. Just over 15 years later, Netflix has over 50 million users. The driving force behind what now defines Netflix is the internet video streaming service. A report by Sandvine in 2013 stated that Netflix is the biggest source of North American downstream internet traffic at 32.3%. Now, Netflix offers somewhere around 10,000 online streaming titles. Of all the online streaming TV services, Netflix is also known for having the most exclusive content with shows like House of Cards and Orange Is The New Black headlining.

Hulu Plus

Price = $8/month

Limitations: Commercials

Some people argue that Hulu Plus is a little fish in a sea of sharks. Currently, Hulu Plus only has around 5 millions subscribers. But there is one thing that Hulu Plus does better than anyone else. It offers the most current running episodes of your favorite TV shows. Instead of waiting another year for your favorite show to show up on Netflix, snag a Hulu Plus account and watch the latest seasons now.

Amazon Prime Instant Video

Price = $8.25/month
Amazon Prime Instant Video really doesn’t sound too much different than Netflix. Users of this service have access to over 40,000 titles! More impressive than the video streaming service is that the only way to get Prime Instant Video is to sign up for Amazon Prime shipping which means that you have access to free two-day shipping on Amazon products. An impressive 20,000 people have are signed up for Amazon Prime. But it’s likely that only a fraction (~25%) actually use Instant Video. My suggestion: sign up for Prime shipping and reap the benefits of Instant Video as an added bonus.

HBO Now:

Price = $15/month

Limitations: Available in April, 2015

During Apple’s iWatch announcement event on March 9th, HBO was officially unveiled. HBO Now is a stand-alone service that gives users streaming access to all of HBO’s content. The going rate for access to some of the greatest shows ever created? $15 per month. And don’t worry; it will be here just in time for the season premier of Game of Thrones which is due out April 15th.

Sling TV by Dish:

Price = $20/month

Access: ESPN, ESPN2, AMC, TNT, TBS, Food Network, HGTV, Travel Channel, Cartoon Network/Adult Swim, Disney, ABC Family, CNN, IFC, El Rey Network, Maker, Galavision.

Limitations: You can only watch Sling on 1 device at a time. Picture quality is almost as good as traditional cable. Since you are using the internet to watch Sling, you need an unlimited internet package with no data cap.

At the most recent CES (consumer electronics show), Dish announced a new alternative to traditional cable TV called Sling TV. And on February 9th, 2015, Sling TV was launched. Sling is a version of internet TV that users can access through streaming boxes such as Roku or mobile devices. Basic Sling TV includes Disney, ESPN, Food Network, HGTV, TNT, CNN and TBS. In addition, you are able to purchase more channels grouped by themes (i.e. sports, or kid’s programs) for an additional $5 per month. The TV channels are live channels, just like normal TV, except they are delivered over the internet. An important detail of Sling TV is that it doesn’t require a contract. You can cancel at any time with no penalties.

So there you have it folks. Tons of ways to access cable content without paying the exorbitant cable prices. And as a last bit of advice, it is important to recognize that many of these services have free trial periods! Give some of these options a try and see if you can live with an alternative to cable TV.

REFERENCES:
http://www.bloomberg.com/news/articles/2014-03-19/u-s-pay-tv-subscriptions-fall-for-first-time-as-streaming-gains

http://www.bloomberg.com/news/articles/2015-01-05/dish-sling-tv-service-takes-on-cable-television

http://www.cnet.com/news/sling-tv-everything-you-need-to-know/

http://www.forbes.com/sites/dorothypomerantz/2015/01/30/its-time-to-cut-the-cord-five-ways-youll-soon-be-able-to-watch-tv-without-cable/2/

http://www.theverge.com/2015/3/9/8175619/hbo-now-announced

http://en.wikipedia.org/wiki/Netflix

http://www.businessinsider.com/amazon-prime-versus-netflix-versus-hulu-plus-2014-4

 
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Fatherhood

26 Feb

download (1)

Geo isn’t here this episode.  Quick, let’s talk about babies!  That’s right, without Geo around the Good Guys are discussing becoming new dads this episode.  There is lots to consider, but one of the main struggles I had personally was the overwhelming amount of information out there that my wife and I had to sift through.  The point of this episode is not necessarily to provide more of that information, or to provide the best information.  What I want to demonstrate is that in almost all of these circumstances, there is no one true answer, and even between similar dudes such as the Good Guys, we all do things very differently.  Some things were easy for some of us and hard for others.  I hope you enjoy the conversation, leave us feedback on the website or Facebook!  Thanks for listening!

 
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Measles, Vaccines, and Autism

12 Feb

vaccine_infant

 

Measles Virus

Highly communicable (9 out of 10 in same room will become infected)

Airborn

10-14 day incubation period

Fever (up to 104F or 40C), runny nose, sore throat, conjunctivitis, cough

Eventually, rash that starts on the face and moves down.

Koplik spots develop (small white spots on inside surface of cheek)

Contagious 4 days before and 4 days after rash

Mortality is .2% (2/1000) for developed countries, up to 10% for non-developed

Complications include pneumonia, diarrhea, ear infections, encephalitis, spontaneous abortion in pregnant, thrombocytopenia

 

Measles Vaccination

First isolated in 1954, first vaccine in 1963, first MMR combo in 1971

Reported measles cases in the US dropped from around 700,000 per year in the 50s and 60s to the thousands in the 1980s, and to the hundreds in the 2000s.

Recommendations that children receive a second dose around age 5 started in 1989 (93% are immune after 1 vaccine, 97% with the second)

Side effects:

Mild

Fever in 1/6

Mild rash in 1/20

Swollen glands in 1/75

Moderate

Temporary joint pain/stiffness 1/4

Seizure due to fever 1/3000

Temporary low platelet count 1/30,000

Severe

Severe allergic reaction 1/1,000,000

VAERS system for reporting adverse effects

Exemptions:

Medical – all 50 states

Religious – 48 states (MS, WV)

Philosophical – 17 states (MN included)

 

Why vaccinate if measles is gone?

Zhou et al paper published in Pediatrics 2009:

vaccination of 2009 cohort prevents 42,000 early deaths, 20M cases of disease, saves 13B in direct cost, and 69B in total societal cost

 

Herd Immunity:

Protection by breaking the potential for a disease to spread

“freeloaders” making a game theory risk calculation

Measles R0 12-18.  For herd immunity, need 83-94% vaccination

 

 

Andrew Wakefield

Born 1957

Graduated medical school 1981, practiced as a surgeon and researcher

1993 – published reports that measles virus was linked to Crohn’s disease (refuted)

1995 – published a paper in The Lancet that MMR vaccine caused Crohn’s disease (refuted)

1995 – Rosemary Kessick, mother of child with autism and bowel issues, and head of “Allergy Induced Autism” approached Wakefield

1998 – Paper linking autism, gastroenteritis, and measles/MMR

2001 – Wakefield leaves Royal Free Hospital, moves to US

2004 – The Sunday Times releases report that parents of 12 kids in study were recruited by UK law firm seeking legal action against MMR manufacturing companies, and that 55,000 had been paid to Wakefield’s hospital to pay for the research.  Just prior to the report, The Lancet retracted portions of the Wakefield paper, with the consent of 10 out of 12 co-researchers

Later in 2004 – Another news organization alleges that prior to his research, Wakefield had taken out a patent for a measles-only vaccine

2006 – The Sunday Times reveals that Wakefield was personally paid over 400,000 by the same UK law firm

2010 – UK GMC retracted Wakefield’s medical license (he released an autobiography claiming the medical institution was out to get him on the same day).

2010 – Wakefield paper officially retracted from The Lancet

2011 – BMJ releases Deer article

 

2014 – CDC reports 644 cases of measles in the US – highest since 2000 when measles was declared eradicated

2015 – By the end of January, we’ve seen over 100 cases already…

 

Anti-Vaccination Assertions:

Overloaded immune system – no evidence to support this, just more time at risk

Diseases are gone – not really, just suppressed by herd immunity

In breakouts, more vaccinated than unvaccinated get sick – because there are more vaccinated people to start with

Hygiene and Nutrition reduced disease, not vaccination – Chicken Pox

“Natural Immunity is Better” – see above risks with infection

 

 

 

 

PICS FROM ERNEST COFFEE!
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IMG_0182 IMG_0180

 
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