Jody discusses ACA subsidies - what they are and why it matters that some of them are going away.
Resources:
1) Article on the Impact of Enhanced Subsidies Expiring (KFF)
2) News Article on the Republican Healthcare Plan (Reuters)
3) Interview About Subsidies Expiring (PBS)
4) Federal Poverty Level (healthcare.gov)
5) Reasons to Not Extend Enhanced Subsidies (CATO Institute)
Jody reviews LEGITIMATE information about hepatitis B vaccines in the wake of ACIP's recent recommendation to consider delaying vaccination for infants of non-infected mothers.
References & Links:
1) General Information on Hepatitis B Vaccines (OpenEvidence)
3) Fact Check of the ACIP Press Release (PBS)
4) Impact of Hepatitis B Vaccines in the United States (CDC, pre-RFK)
5) Scientology Network Prescription for Violence (likely fake news)
Jody reviews pathophysiology, diagnosis, management, and prevention of kidney stones.
References & Links:
1) Curhan, G. C. Kidney stones in adults: Prevention of recurrent kidney stones. UpToDate. https://www.uptodate.com/contents/ kidney-stones-in-adults-prevention-of-recurrent-kidney-stones
2) Curan, G.C., Aronson, M.D., & Preminger, G.M. Kidney stones in adults: Diagnosis and acute management of suspected nephrolithiasis. UpToDate. https://www.uptodate.com/contents/kidney-stones-in-adults-diagnosis-and-acute-management-of-suspected-nephrolithiasis
3) Preminger, G.M., & Curhan, G.C. Kidney stones in adults: Evaluation of the patient with established stone disease. UpToDate. https://www.uptodate.com/contents/kidney-stones-in-adults-evaluation-of-the-patient-with-established-stone-disease
4) CDC Revives Debunked "Link" Between Childhood Vaccines and Autism (NPR)
A novel non-opiate medication option for control of acute pain.
References:
1) OpenEvidence Information on Journavx
2) FDA Information on Journavx
Jody discusses insomnia and how to treat it from a primary care perspective.
Links & References:
5) History of Government Shutdowns (USA Today)
7) Zammit GK. Ramelteon: a novel hypnotic indicated for the treatment of insomnia. Psychiatry (Edgmont). 2007 Sep;4(9):36-42. PMID: 20532119; PMCID: PMC2880941.
8) Bennett T, Bray D, Neville MW. Suvorexant, a dual orexin receptor antagonist for the management of insomnia. P T. 2014 Apr;39(4):264-6. PMID: 24757363; PMCID: PMC3989084.
(Doctor) Dale Hutchens is a recent cochlear implant recipient. He and Jody discuss his experience with hearing loss, receiving the implant, and brain training. Stick around for a special performance by Dale at the end of the episode!
Links:
7) Alvin & The Chipmunks Theme
8) R2D2 Sounds
Updates on current medical news, Jody's Epocrates exodus, and a review of hepatitis B pathophysiology, diagnosis, and treatment.
References:
Lok. A. S. F. Hepatitis B virus: Screening and diagnosis in adults. UpToDate. https://www.uptodate.com/contents/hepatitis-b-virus-screening-and-diagnosis-in-adults
Lok. A. S. F., Hepatitis B virus: Overview of management. UpToDate. https://www.uptodate.com/contents/hepatitis-b-virus-overview-of-management
CDC ACIP Presentation: https://www.cdc.gov/acip/downloads/slides-2025-09-18-19/03-su-mmrv-508.pdf
ACIP Recommendation Statement: https://www.hhs.gov/press-room/acip-recommends-chickenpox-vaccine-for-toddlers.html
Tang LSY, Covert E, Wilson E, Kottilil S. Chronic Hepatitis B Infection: A Review. JAMA. 2018;319(17):1802–1813. doi:10.1001/jama.2018.3795. https://jamanetwork.com/journals/jama/fullarticle/2679946
OpenEvidence Conversation: https://www.openevidence.com/ask/4dde6fd5-1bca-4a86-a6f3-3a335f0334a1
AAP Recommended Vaccine Schedule for Children & Adolescents: https://publications.aap.org/redbook/resources/15585/AAP-Immunization-Schedule
Vaccine History (Hep B Foundation): https://www.hepb.org/prevention-and-diagnosis/vaccination/history-of-hepatitis-b-vaccine/
Vaccine History (CDC): https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a3.htm
Jody reviews recent developments in the US healthcare dystopia, then discusses pathophysiology, diagnosis, and treatment of gout.
References:
1) Merriman, T. Gout: Pathophysiology. UpToDate. https://www.uptodate.com/contents/gout-pathophysiology
2) Gaffo, A. L. Gout: Clinical Manifestations and diagnosis. UpToDate. https://www.uptodate.com/contents/gout-clinical-manifestations-and-diagnosis
3) Gaffo, A. L. Gout: Treatment of Flares. UpToDate. https://www.uptodate.com/contents/gout-treatment-of-flares
4) Perez-Ruiz, F. Gout: Pharmacologic urate-lowering therapy and treatment of tophi. UpToDate. https://www.uptodate.com/contents/gout-pharmacologic-urate-lowering-therapy-and-treatment-of-tophi
5) Neogi, T. Gout: Nonpharmacologic strategies for prevention and treatment. UpToDate. https://www.uptodate.com/contents/gout-nonpharmacologic-strategies-for-prevention-and-treatment
7) The CDC's Vaccine Chief on Why Quitting Was His Only Option (The Daily via Spotify)
Music:
In a spin-off of last week's episode, Jody discusses making life and death decisions as a healthcare professional.
Lieutenant Colonel Rick Caniglia, U.S. Army, Retired, shares medical stories from his long military career.
Links:
HHS Statement on ACIP Reconstitution
Restoring Gold Standard Science Executive Order
I tried to prescribe a cognitive behavioral therapy (CBT) app to treat a patient's anxiety. It didn't go well.
F is for Fournier! Jody reviews pathophysiology, diagnosis, and treatment of this (thankfully) uncommon condition.
References:
1) Stevens, D.L., & Baddour, L.M. Necrotizing soft tissue infections. UpToDate. https://www.uptodate.com/contents/ necrotizing-soft-tissue-infections
2) Bersoff-Matcha SJ, Chamberlain C, Cao C, Kortepeter C, Chong WH. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019 Jun 4;170(11):764-769. doi: 10.7326/M19-0085. Epub 2019 May 7. PMID: 31060053.
3) Jean Alfred Fournier. Wikipedia. https://en.wikipedia.org/ wiki/Jean_Alfred_Fournier
Jody reviews pathophysiology, assessment, and treatment of erectile dysfunction.
References:
1) Raymond, R.C., & Khera, M. Epidemiology and etiologies of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/epidemiology-and-etiologies-of-male-sexual-dysfunction
2) Khera, M. Evaluation of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/evaluation-of-male-sexual-dysfunction
3) Khera, M. Treatment of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/treatment-of-male-sexual-dysfunction
Jody went to a conference! Here's what he learned...
Jody responds to the American College of Physicians' Annals On Call Podcast episode released on May 19th, 2025.
Links:
Advanced Practice Clinicians Cannot Replace Primary Care Physicians. Annals On Call Podcast, 5-29-25
Christin Giordano McAuliffe. There Is No Substitute for Primary Care Physicians: A Response to the Association of American Medical Colleges’ Workforce Model. Ann Intern Med.2025;178:590-591. [Epub 4 March 2025]. doi:10.7326/ANNALS-24-03806
University of South Alabama Dual Role NP Curriculum
Razavi, Moaven PhD*; O’Reilly-Jacob, Monica RN, PhD, FNP-BC†; Perloff, Jennifer PhD*; Buerhaus, Peter RN, PhD, FAAN, FAANP(h)‡. Drivers of Cost Differences Between Nurse Practitioner and Physician Attributed Medicare Beneficiaries. Medical Care 59(2):p 177-184, February 2021. | DOI: 10.1097/MLR.0000000000001477
McMenamin A, Turi E, Schlak A, Poghosyan L. A Systematic Review of Outcomes Related to Nurse Practitioner-Delivered Primary Care for Multiple Chronic Conditions. Medical Care Research and Review. 2023;80(6):563-581. doi:10.1177/10775587231186720
Kippenbrock T, Emory J, Lee P, Odell E, Buron B, Morrison B. A national survey of nurse practitioners' patient satisfaction outcomes. Nurs Outlook. 2019 Nov-Dec;67(6):707-712. doi: 10.1016/j.outlook.2019.04.010. Epub 2019 May 4. PMID: 31607371.
Haas, D., Pozehl, B., Alonso, W. W., & Diederich, T. (2023). Patient Satisfaction With a Nurse Practitioner–Led Heart Failure Clinic. Journal for Nurse Practitioners, 19(4), Article 104496. https://doi.org/10.1016/j.nurpra.2022.11.006
Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., Wilson, R., Fountain, L., Steinwachs, D. M., Heindel, L., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners, 9(8), 492-500.e13. https://doi.org/10.1016/j.nurpra.2013.07.004
Savard I, Al Hakim G, Kilpatrick K. The added value of the nurse practitioner: An evolutionary concept analysis. Nurs Open. 2023 Apr;10(4):2540-2551. doi: 10.1002/nop2.1512. Epub 2022 Dec 17. PMID: 36527435; PMCID: PMC10006655.
D is for deprescribing! Jody wrestles with this very complicated and grey area of medical practice.
Resources:
NICE Medicines Optimization Guidelines
The list of deprescribing resources was generated by ChatGPT.
Jody is joined by one of the world's foremost AI experts, ChatGPT itself, to discuss how AI is impacting healthcare currently and how it might change the medical field in the future.
C is for constipation! Jody discuss pathogenesis, diagnosis, and treatment of this surprisingly common problem.
References:
The outline for this episode was created in part by chatGPT.