Critically Speaking

In this episode, Therese Markow and Dr. Daniel Buchman discuss chronic pain, affecting over 20% of the population in the US, Canada, and Europe. Chronic pain (persisting pain lasting over three months) includes conditions like arthritis, lower back pain, fibromyalgia, and phantom limb pain, among many others. Daniel highlights the challenges in pain assessment, the role of AI in pain management, and the ethical considerations, including bias in pain reporting. He notes that chronic pain increases suicide risk, and the conversation also touches on the stigma surrounding pain and opioid use.
 
 Key Takeaways:
Pain can come from an identifiable condition, but sometimes doesn't have a clear cause.

Primary pain is the type of pain that is not explained by another disease. Secondary pain is pain that arises because of or is related to an underlying condition - perhaps injury, illness, disease, or other reason.

When we talk about bias in health care providers, we also need to look at the broader societal bias that plays into those biases.

As AI is used more in medicine, we do need to be aware of bias in the data sets that the AI is utilizing to learn and then use to make predictions. 

Pain is a warning sign. It is not, in and of itself, bad. It is telling you that something might need to be addressed in your body. 

 
"There isn't a blood test or a brain scan or anything that can determine how much pain somebody's in, or what it's like to experience that pain. This is subjective because it depends on the person, and it depends on a whole host of factors, not just their biology. It depends on their psychology, social factors, cultural factors, and gender is a big part of this as well." —  Dr. Daniel Buchman
 
Episode References: 
Buchman, Daniel Z.a,b,c,d. 2025 AI and the ethics of techno-solutionism in pain management. PAIN 166: 469-470. | DOI: 10.1097/j.pain.0000000000003389

 
Connect with Dr. Daniel Buchman:
Professional Bio: https://www.camh.ca/en/science-and-research/science-and-research-staff-directory/danielbuchman 
Bluesky: https://bsky.app/profile/danielbuchman.bsky.social   
X: https://x.com/DanielZBuchman   
Google Scholar: https://scholar.google.ca/citations?user=3Yja_7QAAAAJ&hl=en 
 
Connect with Therese:
Website:  www.criticallyspeaking.net
Bluesky: @CriticallySpeaking.bsky.social
Instagram: @criticallyspeakingpodcast
Email: [email protected]
 
Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.

In this episode, Therese Markow and Dr. David Hill discuss the rise of peanut allergies in children. David explains that anaphylaxis, a severe allergic reaction, is common in children, often triggered by food. He emphasizes the importance of early allergen introduction to prevent allergies. The LEAP study from 2015 showed that introducing peanuts before six months reduces the risk of peanut allergy. They also discuss other common allergies and the fact that many children outgrow milk and egg allergies by age four. 
 
 Key Takeaways:
The major allergens are milk, egg, soy, wheat, peanut, tree nut, fish, shellfish, and sesame, which are among the most common foods around the world. Thus we must do everything we can to prevent food allergy in the first place. 

The part of the immune system that causes allergic reactions, was originally evolved to fight parasites. 

There is still a lot to learn about what causes allergies. Multiple people are working on it now, and we will likely see, in the coming years, new risk factors emerging.

 
"In the first year, specifically somewhere between four to six months of age (once the child is able to handle a solid food in their mouth and swallow appropriately), at that point, we should start to introduce the major allergens." —  Dr. David Hill
 
Connect with Dr. David Hill:
Professional Bio: https://www.chop.edu/doctors/hill-david-a 
LinkedIn: https://www.linkedin.com/in/david-a-hill-md-phd-aab8744 
 
Connect with Therese:
Website:  www.criticallyspeaking.net
Bluesky: @CriticallySpeaking.bsky.social
Instagram: @criticallyspeakingpodcast
Email: [email protected]
 
Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.

In this episode, Therese Markow and Dr. Fred Miller discuss the autoimmune disease epidemic, highlighting the economic burden and the rise of diseases like juvenile diabetes, lupus, and multiple sclerosis. Dr. Miller explains that autoimmune diseases occur when the immune system attacks the body, affecting various organs. He notes that there are at least 150 types of autoimmune diseases, with prevalence rates varying from 0.1% to 5% of the population - the exact number is unknown due to the need for better registries to track these diseases. Dr. Miller also discusses the role of genetics and environmental factors, lifestyle, and exposure to chemicals. He also mentions new treatments and the importance of lifestyle changes in prevention and management.
 
 Key Takeaways:
Virtually any organ system or tissue in the body can be damaged by the immune system, which makes autoimmune diseases difficult to assess, diagnose, and treat, as they can be so varied from person to person, and they can change over time.

There are no fully agreed-upon definitions for autoimmune diseases. As such, we don't know how many there are, but most experts would say at least 150 different types.

All of the autoimmune diseases are developed from interactions of many genes and many environmental risk factors in combination.

Various environmental exposures might not change the genes themselves, but they might alter the normal way that genes are supposed to be turned on and off.

 
"We really don't have a way to measure all of these yet, but we are expanding the range of the types of exposures we can measure every year, and there are a few ways of capturing which exposures or mixtures of them we've experienced at what times, and by integrating all these together into a single number, this could help us understand the cumulative exposures that are that are probably important for the development of these diseases." —  Dr. Fred Miller
 
Connect with Dr. Fred Miller:
Professional Bio: https://www.niehs.nih.gov/research/atniehs/labs/crb/pi/ea/staff/miller 
 
Connect with Therese:
Website:  www.criticallyspeaking.net
Bluesky: @CriticallySpeaking.bsky.social
Instagram: @criticallyspeakingpodcast
Email: [email protected]
 
Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.

In this episode, Therese Markow and Dr. John Kisiel discuss early cancer detection using liquid biopsies. Dr. Kisiel explains that liquid biopsies detect cancer signals in blood and urine, including tumor cells, fragments, proteins, and DNA. He highlights the FDA's approval of a blood test for colon cancer and the development of multi-cancer early detection tests. Dr. Kisiel notes that false positive and false negative rates vary by test. He emphasizes the potential of liquid biopsies to complement, not replace, standard screening methods and the need for further validation and clinical trials.

Key Takeaways:
Liquid biopsies have been used in the oncology community to test if cancer is still present, may need additional or more aggressive treatment, or if the cancer has come back.

Each test will have its own false positive and false negative rate, partially based on where manufacturers set the thresholds for that positive/negative result.

Peripheral blood-based tests for colon cancer do not detect polyps, and it's the finding and removing of polyps that actually offers the greatest preventive benefit, so that somebody never gets cancer in the first place. 

 
"Another word of cautious optimism, I think that I, personally, and many other people active in the space really view these as an addition to standard of care cancer screening and not a replacement." —  Dr. John Kisiel
 
Connect with Dr. John Kisiel:
Professional Bio: https://www.mayo.edu/research/faculty/kisiel-john-b-m-d/bio-00092659 
 
Connect with Therese:
Website:  www.criticallyspeaking.net
Bluesky: @CriticallySpeaking.bsky.social
Instagram: @criticallyspeakingpodcast
Email: [email protected]
 
Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.

Some people live more than a hundred years with no health problems and very little cognitive decline.  How come?  While healthy lifestyles certainly play a part in healthy aging, these "centenarians" share a number of special biological attributes.  Furthermore, these attributes, along with attaining an age of 100 or greater, show a strong genetic component.  Dr. Stacy Andersen of the Boston University School of Medicine has been studying these centenarians and the factors that are associated with not only their attaining an advanced age, but also doing so with no history of major physical or mental health problems.  In her interview, Dr. Andersen discusses what she and her colleagues have discovered about this unusual group of older people.
 
 Key Takeaways:
Centenarians are people who have reached 100 years of age, while "supercentenarians" are 110 and older.

Recent studies of these groups of adults reveal that during their lives, they have "escaped" diseases such as cancer, cardiovascular problems, dementia, and diabetes that cause earlier mortality among adults born at the same time.

Dr. Andersen discusses her work on the genetic bases for being an "escaper", as well as the lifestyle and personality characteristics they have in common.

 
"The older you get, the healthier you've been." —  Dr. Stacy Andersen
 
Connect with Dr. Stacy Andersen:
BUMC Bio: profiles.bu.edu/Stacy.Andersen  
 
Connect with Therese:
Website:  www.criticallyspeaking.net
Bluesky: @CriticallySpeaking.bsky.social
Instagram: @criticallyspeakingpodcast
Email: [email protected]
 
Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.