AMD: Iron and the Immune System
|
|
- Bryan Jefferson
- 5 years ago
- Views:
Transcription
1 AMD: Iron and the Immune System May 30, 2018 Transcript of Teleconference with Josh Dunaief, MD, PhD from Scheie Eye Institute at the University of Pennsylvania. The information provided in this transcription is a public service of BrightFocus Foundation and is not intended to constitute medical advice. Please consult your physician for personalized medical, dietary, and/or exercise advice. Any medications or supplements should be taken only under medical supervision. BrightFocus Foundation does not endorse any medical products or therapies. Please note: This Chat has been edited for clarity and brevity. MICHAEL BUCKLEY: Hello, I m Michael Buckley with BrightFocus Foundation. Welcome to today s BrightFocus Chat, Iron and the Immune System: How They Impact AMD. If this is your first time on a BrightFocus Chat, welcome, and I just want to give you a little overview of what we ll do today. BrightFocus funds some of the top scientists in the world who are trying to find cures and more effective treatments for macular degeneration, glaucoma, and Alzheimer s disease. And at BrightFocus, we try to share the findings and the latest information from these researchers with families impacted by these diseases. We do this through a number of resources on our website and free publications, and we also do it through the BrightFocus Chat. Today s a great example of taking one of the top researchers in the world on vision disease and, through his generosity, taking some time to learn the latest from the world of research, particularly as it relates to iron and the immune system in age-related macular degeneration (AMD). Let s start by introducing today s speaker, Josh Dunaief. Josh is
2 2 a Professor at the Scheie Eye Institute at the University of Pennsylvania. We have been very fortunate to partner with him on research through our macular degeneration research program. If Dr. Dunaief s name sounds familiar, he s been on several BrightFocus Chats over the last few years, and we re very fortunate to have a number of articles written by Dr. Dunaief on the BrightFocus website so it s a great opportunity to have you with us today. DR. DUNAIEF: Pleasure to be with you again, Michael. MICHAEL BUCKLEY: Dr. Dunaief, it s always a pleasure to work with you. I know we ve been able to partner with you and your colleagues at the Scheie Institute at the University of Pennsylvania on really some of the most exciting research on vision disease in the world, and we really appreciate the clarity with which you re able to communicate this information to folks. So, I just want to welcome you to today s BrightFocus Chat. What would you like to talk about today? DR. DUNAIEF: Well, thank you, Michael. It s always a pleasure. I like to be with you and your listeners to talk about some of the latest findings in macular degeneration, and we have some pretty exciting new findings to talk about today. The first thing I d like to talk about is a brief summary of some of the known modifiable risk factors for macular degeneration. These are things that many people have heard, but I want to emphasize that there are things that people with macular degeneration can do today to decrease their risk of losing vision. Those things include stopping smoking, if you re a current smoker; eating whole foods, especially fruits and vegetables; and eating fish two or three times a week, especially salmon or sardines. These things have been shown in epidemiological studies to decrease the risk of vision loss. Another study shows that eating lots of red meat is a risk factor. So, I recommend eating red meat once a week or less to decrease the risk of vision loss from macular degeneration. Also, processed foods and lots of sugar are risk factors.
3 3 In the summer, we should really think about light exposure as a risk factor, because several studies have shown that bright light exposure is a potential risk factor. So, when out there on the beach or by the pool, it s important to wear sunglasses and a hat to avoid excess light exposure for the eyes. Those are things that people have probably heard before, but there are some more recent findings that we can talk about now. One of them is a clinical trial with an inhibitor of the immune system an inhibitor of something called the complement cascade, and if you d like, Michael, we could first take a step back and discuss what a clinical trial is and how they re done. MICHAEL BUCKLEY: Yeah, that would be great. I think that would help our listeners and it would be interesting to see how scientists reach some of the findings. DR. DUNAIEF: Sure. A lot of the early studies in macular degeneration looked at genetics of the disease and also used mouse models or tissue culture models, where retinal cells are grown in plastic dishes, to identify molecules that could be targeted to help protect vision. Then, once we have good candidates for molecules that could be targeted, we start clinical trials with patients, and they re divided into three types: Phase I, Phase II, and Phase III. Phase I is primarily designed to test safety. It s a small trial. It will usually look at several different doses of the drug to ensure that it s going to be safe. Then Phase II is a little bit larger trial that looks mainly at safety, but also starts to look at whether the drug is effective. And then Phase III is the largest trial, and it looks at both effectiveness and safety, and if the U.S. Food and Drug Administration (FDA) sees that the drug is safe and effective, then it may approve the drug for clinical use. So, if you go to your eye doctor and ask if you might qualify for a clinical trial, then you might be told that your condition is being studied in current clinical trials and that you might be eligible, or you might be told that there isn t currently a clinical trial for your disease or your stage of the disease but to stay tuned and hopefully there would be one in the future.
4 4 MICHAEL BUCKLEY: Yeah. DR. DUNAIEF: The one that s got me excited right now is by a company called Apellis, and they re studying a drug that inhibits complements. So, a complement is a part of the immune system and for macular degeneration, it s really not a compliment, it s more of an insult and what it does is it kills retinal cells when it s inappropriately activated. So, this Apellis trial is a Phase II trial that shows that inhibiting a complement protein called the C3 could slow the progression of a form of macular degeneration called geographic atrophy. So that is now progressing to a Phase III trial, and we should find out within probably a year or two whether that Phase III trial was successful and whether inhibiting complement C3 can actually slow geographic atrophy expansion. If so, that would be the first drug approved to slow expansion in geographic atrophy, which would be wonderful. MICHAEL BUCKLEY: That s amazing. And it sounds like a really helpful, promising development out of that clinical trial. DR. DUNAIEF: It sure is, Michael. Another clinical trial that just ended was a Phase III clinical trial, which tested gene therapy for patients who are born blind, and this Phase III trial showed effectiveness and the FDA decided to approve it. So, this is really remarkable; it s the first FDA approval for a gene therapy that s delivered into the human body, and it corrects a gene that s defective in children who are born blind from a disease called Leber s. The trial was conducted by investigators at the University of Pennsylvania Jean Bennett and her husband Al Maguire, who s a retinal surgeon and they showed, along with collaborators around the world, that this gene therapy can be delivered into the retina safely. And children who were born blind can now navigate through a maze, or some of them can catch a ball; it s really a groundbreaking development that is going to lead the way to gene therapy for other retinal diseases, because they have developed the methods needed to deliver genes into the retina safely. MICHAEL BUCKLEY: That is amazing. That is a true miracle, really, a testament to a lot of the work going on at the University of
5 5 Pennsylvania. Before we turn to some of your own research, we have a few questions already from our listeners. A caller from Michigan is wondering, how many servings of red meat do you recommend in a typical week? DR. DUNAIEF: One or less. There s evidence from a clinical trial in Australia that people who ate a lot of red meat had an increased risk for macular degeneration. There s also evidence that red meat increases the risk of other diseases, like cardiovascular disease. So, one serving a week or less is my recommendation. If you re a vegetarian and don t have any meat at all, that s probably even healthier, but I don t think a serving a week is going to hurt very much, if at all. MICHAEL BUCKLEY: Sure. DR. DUNAIEF: One of the reasons that red meat may be harmful is that it contains a lot of iron, and you absorb a lot of the iron that you eat in red meat. A lot of foods that contain iron have it in a form that s not easy to absorb, so it doesn t get into the body. But when we eat red meat, 50 percent of the iron that s in that red meat gets absorbed because of the form that it s in. So, that can load our bodies with more iron than we need. MICHAEL BUCKLEY: And I know your research has been looking at the impact of iron in AMD. Would you mind sharing with us what you ve been learning from studying the issue of iron? DR. DUNAIEF: Yes, absolutely. So, iron is kind of like Goldilocks. It needs to be just right: We need to have not too little and not too much. A lot of focus in medicine is on avoiding iron deficiency and making sure you have enough iron, because if you have too little iron then you can become anemic, meaning that you don t have enough red blood cells, and that makes you tired. This is especially common among menstruating women because when you lose blood, you lose a lot of iron. However, there s been very little focus on the potential risks of having too much iron, and a lot of people have too much iron because our bodies continue to absorb it as we age, but we have no way to get rid of it except when we bleed. So, there are some women who were
6 6 told to take iron when they were menstruating, and then they just continued to take it when they were post-menopausal, and they can wind up with much more iron than they need. That s a problem because iron can produce free radicals. It can cause something called oxidative damage. What is that? That s when electrons get stolen from proteins or fats or DNA, and that causes structural changes chemical changes to the DNA, causing mutations or causing proteins to stick to each other inappropriately, and that can then lead to disease. So, we know that too much iron can lead to disease because when people get a piece of iron in the eye in an accident it very rapidly causes degeneration of the retina. We also know that people who have hereditary diseases that lead to excess iron in different organs have degeneration of those organs. So, there s a condition called hereditary hemochromatosis where people absorb a lot more iron than they should, and that causes disease. It causes degeneration of the liver; degeneration of the pancreas, leading to diabetes; pain in the joints; and if the iron accumulates in the brain or the retina, then it can potentially cause damage there. We found that people with macular degeneration who then donate their eyes upon their death have more iron in the retina than agematched controls. And because of what I said about iron causing oxidative damage, we thought that iron might be contributing to the macular degeneration. To test this, we used some mice that we genetically engineered to accumulate a lot of iron in their retina, and the iron buildup in the retina caused degeneration of the retina that looks in some ways like macular degeneration. We were able to recreate a degenerative disease in the mice, so they re a model of retinal degeneration caused by iron. Now, I don t think that iron alone causes macular degeneration, but I think that it cooperates with other factors like complement proteins and probably lipids and fats to cause damage to the retina over time that then manifests as macular degeneration. MICHAEL BUCKLEY: Wow. Let me just jump in for a second. This is all really interesting. I think your Goldilocks characterization of it is right
7 7 on because a lot of us growing up we re told by our parents or told by our science and health teachers or the magazine articles we read that iron is good and the more you have, the better. This is really interesting research, and I appreciate you sharing this with us. How does someone know if they should be taking more iron or less iron? How does someone resolve the Goldilocks situation in their own life? DR. DUNAIEF: Yeah really good question, one that isn t frequently looked at by clinicians. So, people who are anemic meaning that they have too few red blood cells may be anemic because they re iron deficient. However, there are other causes of iron anemia. Just because you re anemic doesn t mean you re iron-deficient. There are blood tests that measure iron levels in the blood, and what should be tested is the blood-iron level; the transferrin saturation, which is a measure of how much iron is bound to the protein that carries iron in the blood, which is called transferrin; and the ferritin level. Ferritin is a protein that stores iron in the liver, and when iron stores are very high, ferritin levels in the blood increase. So ferritin, which is not very frequently measured and certainly not measured in standard routine blood tests you have to ask for it ferritin levels will tell you what your total body iron levels are. So, I think it s a good idea to have the ferritin level test. People who have enough iron have a ferritin level somewhere in the range. So in that range, you should have enough iron to make your red blood cells and to do the important other things that iron does in the body. But if ferritin levels are above 100, then it s likely that you have a lot more iron than you actually need, and you could reduce the amount of red meat that you eat and eat more plants, vegetables, and fruits, and that iron level may come down a bit. Another way to reduce body iron levels is to donate blood, which not only could help you but, of course, is a good thing to do to help other people who need blood transfusions. Since there s a lot of iron in red blood cells, every time you donate blood you get rid of a lot of iron. MICHAEL BUCKLEY: That s really interesting. We ve gotten several questions in about iron supplements, and Gladys from New York is wondering, is the amount of iron in a vitamin supplement that you d
8 8 get at a store is that amount of iron too much? Or, what do you think of the vitamin supplements that are sold with iron? DR. DUNAIEF: Well, the amount of iron and the form of iron is going to vary depending on which supplement you re taking. Many multivitamins will contain some iron, and if you re taking a multivitamin every day that contains iron, then that may be leading to more iron than you need. So, there s a supplement called Centrum Silver, which does not have any iron in it anymore. It s for older people who are not menstruating or not losing blood routinely and don t need iron supplements anymore as a group. I mean, there may be some elderly individuals who do need iron supplements because they re truly iron deficient, but as a group, most elderly individuals will not need iron supplements. MICHAEL BUCKLEY: That s interesting. I know that in the past we ve talked about the AREDS which is an acronym for the Age-Related Eye Disease Study the AREDS supplements that researchers have shown to be promising for folks with AMD. Do AREDS supplements have any iron? DR. DUNAIEF: No, the AREDS supplements have a form of vitamin A called lutein, vitamin C, vitamin E, the mineral zinc, and a little bit of copper in them. It s interesting that the Age-Related Eye Disease Studies showed that zinc is protective for people with early macular degeneration it protects against progression of the disease and zinc can actually compete with iron for uptake into the body or binding to proteins. So, one of the potential mechanisms of zinc s protection is by protecting us from iron. MICHAEL BUCKLEY: That s interesting. Another kind of vitamin question. We ve got a caller from New Jersey who, probably like me, grew up thinking that spinach is good and you should eat a lot of it, and we always said that s what made Popeye so strong. I m just wondering, is spinach high in iron, or is that something that might not be good for vision health? DR. DUNAIEF: That s a great question. So, iron is generally not very well absorbed from food, except from red meat. If we eat a lot of red
9 9 meat, we absorb a lot of iron. Spinach has a fair amount of iron, but it s not well-absorbed, so I don t think that the iron in the spinach poses the risk. On the contrary, it s been shown that people who eat more green leafy vegetables like spinach and kale and collard greens have a decreased risk of macular degeneration. So, the evidence is that spinach is helpful, not harmful, and I m not worried about the spinach iron because not much of it is going to get absorbed. MICHAEL BUCKLEY: Well, that s good to know. I m kind of switching gears. We have a caller from Missouri wondering about acupuncture. She s heard people talk about clinical trials or other forays related to acupuncture for AMD. Is that something that you re familiar with? DR. DUNAIEF: Yes, I ve heard of people doing it. It s hard to evaluate. It hasn t been tested in clinical trials; it s hard to do these clinical trials. They re very expensive, they require a lot of patients and a lot of time, so it wouldn t be easy to launch a clinical trial for acupuncture for macular degeneration. Without clinical evidence, only with anecdotal evidence, somebody might say, I had acupuncture and I think I see better now. That s just one person or a few people saying this. It s not really evidence that it works, so I can t really say whether it works or not. MICHAEL BUCKLEY: No, I appreciate that. We have another question that just came in a caller from Washington State. They re interested when you were talking about blood and AMD. Does it vary by particular blood type that a person has? Is there any connection between blood type and AMD? DR. DUNAIEF: No, there s no evidence that there s any connection between blood type and AMD. The blood type doesn t impact how much iron is in the blood. There s Type A, Type B, Type O. Those types just depend on what kind of a flavor of proteins, if you will, you have in your blood and that relates to potential immune reactions when you have a blood transfusion. MICHAEL BUCKLEY: Interesting. Another question relating to supplements. The supplement aisle at your local pharmacy or
10 10 supermarket can be pretty overwhelming. Do you have any kind of guide for how to navigate, literally, a floor-to-ceiling array of choices? DR. DUNAIEF: It s a huge industry, and for the most part unregulated. The only supplement that s been proven effective for macular degeneration is something called PreserVision, which follows the AREDS 2 formula. AREDS 2 was a study that was run by the National Institutes of Health looking at thousands of patients over the course of 10 years, and it showed that a specific formula decreases the risk of macular degeneration progression in people who already have some macular degeneration. That is, the ophthalmologist has seen little white spots in the retina called drusen and have told the patient that they would benefit from these AREDS 2 formula antioxidants. Any other antioxidant claiming to protect eye health has not been supported by clinical trials not supported adequately. So, I would really not recommend at this time taking anything supplement-wise other than the AREDS 2 vitamins unless you re directed by your ophthalmologist to take them. I would recommend eating lots of fruits and vegetables, lots of green leafy vegetables, and not a lot of red meat. MICHAEL BUCKLEY: I appreciate that. We have a couple more questions that we have time to get in. We have a caller from Michigan wondering about intermittent fasting. Does that have any effect on AMD and eye health, either good or bad, if one were to do strategic intermittent fasting? DR. DUNAIEF: That s an interesting question. There is some evidence that high glucose in your blood can increase the risk for macular degeneration, and some evidence that ketones that are produced by fasting may be protective for neurons. So in theory, it might be helpful, but again, it s something that hasn t been tested in a prospective clinical trial, so we can t be sure. Speaking of clinical trials, there s one that we re currently running based on our iron hypothesis. We are testing a certain nutraceutical that is available in drug stores over the counter it s called lipoic acid and we re testing it for its ability to slow the progression of geographic atrophy when taken orally. The reason we re testing this is it was very
11 11 protective in our mouse model of macular degeneration. Lipoic acid binds to iron, and it s also an antioxidant, so it protects against free radical damage that could otherwise cause mutations in DNA or cause proteins to stick together. I do not recommend that anybody go out and start taking this yet, because we don t know that it s protective. You know, it s our theory. It s backed up by data that we generated in the lab, but we don t know that it s protective. We don t even know for sure that it s safe. There s a lot of history with the substance suggesting that it s safe, but until we have the results of the clinical trial, I don t suggest that anyone go out and get it. But do stay tuned for the results of the trial, which is ongoing. MICHAEL BUCKLEY: Dr. Dunaief, just a concluding question. I know you re on the forefront of a lot of exciting research projects. I know you ve also seen a lot of patients in your clinic at the University of Pennsylvania. Just sort of the big picture how do you feel about the future of vision disease, particularly AMD, whether in terms of more effective treatments or cures? What do you think the future holds for vision disease, particularly AMD? DR. DUNAIEF: Well, Michael, I m very optimistic that we re going to have better and better treatments over time. When I started seeing patients with macular degeneration 18 years ago, there was very little that we could do other than tell patients how quickly they were likely to lose vision and provide them with low-vision aids like magnifiers and reading glasses, which of course were helpful. But now for people with wet macular degeneration we have a drug that can slow the progression and sometimes even stop it. That s only within the past 10 years. That s Lucentis, Avastin, or Eylea drugs that block a protein called vascular endothelial growth factor (VEGF). There s been really a tremendous acceleration of biomedical research that s benefitting all different fields, including and maybe even especially the eye, because we can see what s going on in the eye very clearly just looking into the eye with an ophthalmoscope or taking
12 12 high-tech photos of the retina. We can know exactly what s going on and test different potential therapies. So, we ve developed these drugs for wet macular degeneration, but I think that s really just the tip of the iceberg. We now know more about how to deliver drugs to the eye, we know more about how to do clinical trials for eye disease, we know how to image the eye; the techniques to image the retina are improving. Every year we get better and better resolution images of the retina to the point where we can now see single retinal cells in a living patient with a very fast, painless type of photograph. We can count the number of cells that are surviving over time, so I think the pace of discovery is going to increase; we re going to see more drugs for people with dry macular degeneration. It s going to take some patience, you know, research does take a long time. We have to make sure that what we re doing is safe and effective. It took Jean Bennett and Al Maguire really 30 years of hard work to develop effective retinal gene therapy for the children who are blind. So, it takes a lot of patience and a lot of hard work, but we are accelerating that and we re really developing some effective drugs now. MICHAEL BUCKLEY: Thank you. That is amazing. You ve really given us a lot of useful information and a lot of hope for the future. Dr. Dunaief, I just want to conclude by saying thank you, not only for how helpful you were on today s Chat, but thank you to you and your colleagues at the University of Pennsylvania and to all of the volunteers in clinical trials that you helped run. I think it s really giving us a lot of hope for the future and I want to thank you for all you ve done for people. DR. DUNAIEF: My pleasure, and thank you, Michael, and to BrightFocus, for getting this information out to patients and, of course, supporting research. And I want to thank all of the patients out there who are being patient and hanging in there and doing their best and trying to preserve their vision and waiting for better treatments, which are coming.
13 13 MICHAEL BUCKLEY: Well, that s great. We will keep up with your research through our website, BrightFocus.org, where we have articles about some of the latest research findings. We re fortunate to have articles written by you several times a year and I hope we can have you back on a BrightFocus Chat. DR. DUNAIEF: Absolutely.
14 14 Helpful Resources Useful Resources and Key Terms BrightFocus Foundation: (800) or visit us at Available resources include Information on research funded by BrightFocus Foundation Are You Getting What You Need From Your AREDS Supplements? Clinical Trials: Your Questions Answered Healthy Living and Macular Degeneration: Tips to Protect Your Sight (PDF) How Low Vision Services Can Help You (PDF) Macular Degeneration: Essential Facts (PDF) The Top Five Questions to Ask Your Eye Doctor Treatments for Age-Related Macular Degeneration
Update on the AMD Drug Pipeline
Update on the AMD Drug Pipeline October 31, 2018 Transcript of Teleconference with Dr. Joshua Dunaief of the Scheie Eye Institute, University of Pennsylvania. The information provided in this transcription
More informationAMD: Your Questions Answered
AMD: Your Questions Answered March 28, 2018 Transcript of Teleconference with Dr. Priyatham Mettu from Duke University. The information provided in this transcription is a public service of BrightFocus
More informationDealing with the Emotional Impact of Vision Loss
Dealing with the Emotional Impact of Vision Loss June 28, 2017 Transcript of Teleconference with Dr. Deirdre Johnston The information provided in this transcription is a public service of BrightFocus Foundation
More informationTreating Lung Cancer: Past, Present, & Future Dr. Ramiswamy Govindan Washington University November, 2009
Treating Lung Cancer: Past, Present, & Future Dr. Ramiswamy Govindan Washington University November, 2009 GRACE, the Global Resource for Advancing Cancer Education, is pleased to provide the following
More informationHigher Risk, Lowered Age: New Colorectal Cancer Screening Guidelines
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/higher-risk-lowered-age-new-colorectal-cancerscreening-guidelines/10309/
More informationAn Update on BioMarin Clinical Research and Studies in the PKU Community
An Update on BioMarin Clinical Research and Studies in the PKU Community Barbara Burton, MD, Professor of Pediatrics, Northwestern University Feinberg School of Medicine, Director of PKU Clinic, Children
More informationI don t want to be here anymore. I m really worried about Clare. She s been acting different and something s not right
I just can t take what s happening at home anymore Clare 23 mins Instagram When your friend is thinking about suicide I don t want to be here anymore... I m really worried about Clare. She s been acting
More informationThe Goods on Nutrition: Eat to Live
The Goods on Nutrition: Eat to Live 2 Lesson 1: The Goods on Nutrition Vocabulary list Reference Notes alternative n. something available in place of another. anemia n. a blood disorder characterized by
More informationDr. Susan Steen: I have a special interest in dementia and Alzheimer s in related disorders.
Saving Memories With a Shake: The Alzheimer's Drink Susan Steen, MD Susan Steen, MD, a neurologist at South Tampa Memory Center/President, Axiom Clinical Research, talks about a new medical food for Alzheimer's
More informationLiving well today...32 Hope for tomorrow...32
managing diabetes managing managing managing managing managing managing diabetes Scientific research continually increases our knowledge of diabetes and the tools to treat it. This chapter describes what
More informationHow to Foster Post-Traumatic Growth
How to Foster Post-Traumatic Growth Module 7, Part 2 - Transcript - pg. 1 How to Foster Post-Traumatic Growth Two Ways to Ignite Accelerated Growth Part 2: How Your Choice of Language Can Transform an
More informationNews from ASH: Updates on Lymphoma and Other Blood Cancers ASH Conference Coverage December 8, 2008 Andrew Evens, D.O.
News from ASH: Updates on Lymphoma and Other Blood Cancers ASH Conference Coverage December 8, 2008 Andrew Evens, D.O. Please remember the opinions expressed on Patient Power are not necessarily the views
More information"PCOS Weight Loss and Exercise...
"PCOS Weight Loss and Exercise... By Dr. Beverly Yates Dr. of Naturopathic Medicine, PCOS Weight Loss Expert & Best Selling Author Table of Contents Introduction... 2 If You Are Dieting Do You Need To
More informationSmoking Cessation Strategies for the 21st Century
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/lipid-luminations/smoking-cessation-strategies-for-the-21stcentury/3862/
More information3 Secrets to Beating Pancreatitis Pain. the Pancreatitis Vegetable Connection
3 Secrets to Beating Pancreatitis Pain the Pancreatitis Vegetable Connection This ebook is for information purposes only and does not constitute professional medical advice. Copyright and all rights reserved
More informationAge-Related Macular Degeneration (AMD)
Age-Related Macular Degeneration (AMD) What is the Macula? What is Dry AMD (Age-related Macular Degeneration)? Dry AMD is an aging process that causes accumulation of waste product under the macula leading
More informationNew Food Label Pages Diabetes Self-Management Program Leader s Manual
New Food Label Pages The FDA has released a new food label, so we have adjusted Session 4 and provided a handout of the new label. Participants use the handout instead of looking at the label in the book
More informationHold the Sunscreen: Your Body Needs that Vitamin D
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/hold-the-sunscreen-your-body-needs-that-vitamind/4149/
More informationThe Role of the Certified Diabetes Educator: A Team Effort
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/diabetes-discourse/role-certified-diabetes-educator-team-effort/7587/
More informationThe HPV Data Is In What Do the Newest Updates in Screening Mean For Your Patients?
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationWelcome to Progress in Community Health Partnerships latest episode of our Beyond the Manuscript podcast. In
Beyond the Manuscript 45 Podcast Interview Transcript Larkin Strong, Zeno Franco, Mark Flower Welcome to Progress in Community Health Partnerships latest episode of our Beyond the Manuscript podcast. In
More informationParkinson s Disease Webcast January 31, 2008 Jill Ostrem, M.D. What is Parkinson s Disease?
Parkinson s Disease Webcast January 31, 2008 Jill Ostrem, M.D. Please remember the opinions expressed on Patient Power are not necessarily the views of UCSF Medical Center, its medical staff or Patient
More informationThe ERA JUMP Study: Reevaluating the Omega- 3 Index
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/lipid-luminations/the-era-jump-study-reevaluating-the-omega-3-
More informationThe Truth About Fitness, Weight Loss and Improving Athletic Performance by Kevin Quinlan
The Truth About Fitness, Weight Loss and Improving Athletic Performance by Kevin Quinlan First of all, let me set your mind at ease I m NOT trying to sell you anything here! The purpose of this report
More informationExpert Tips for Diagnosis and Management of Bacterial Vaginosis
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/miscellaneous/whats-new-bacterial-vaginosis/expert-tips-for-diagnosismanagement-of-bacterial-vaginosis/9894/
More informationMaking decisions about therapy
JANUARY 2011 Making decisions about therapy Making decisions about treating your HIV may feel overwhelming. Developing a plan that helps you think about, plan for and make treatment decisions can help.
More informationHello and welcome to Patient Power sponsored by UCSF Medical Center. I m Andrew Schorr.
The Integrated Approach to Treating Cancer Symptoms Webcast March 1, 2012 Michael Rabow, M.D. Please remember the opinions expressed on Patient Power are not necessarily the views of UCSF Medical Center,
More informationThis is an edited transcript of a telephone interview recorded in March 2010.
Sound Advice This is an edited transcript of a telephone interview recorded in March 2010. Dr. Patricia Manning-Courtney is a developmental pediatrician and is director of the Kelly O Leary Center for
More informationFood, Supplements and Healthy Lifestyles in Slowing and Preventing Macular Degeneration Julie Mares, Professor For the Nutrition and Eye Health Research Team http://nutritionforeyes.ophth.wisc.edu Preserving
More informationLet me introduce you to her. That s Barbara Scribner who joins us from Kent, Washington. Barbara, thank you so much for joining us.
Lung Cancer: Detection and Early Intervention Webcast November 30, 2009 Douglas E. Wood, M.D. Jason Chien, M.D., M.S. Barbara Scribner Please remember the opinions expressed on Patient Power are not necessarily
More informationHow a CML Patient and Doctor Work Together
How a CML Patient and Doctor Work Together Recorded on: November 5, 2012 Jessica Altman, M.D. Assistant Professor, Department of Medicine, Hematology Oncology Division Feinberg School of Medicine, Northwestern
More informationCOPYRIGHT 2016 MY NUTRITION ADVISOR, LLC. Authored by Founders of My Nutrition Advisor: Dr. John Fitzgerald, DC Matt Fitzgerald, MS
COPYRIGHT 2016 MY NUTRITION ADVISOR, LLC Authored by Founders of My Nutrition Advisor: Dr. John Fitzgerald, DC Matt Fitzgerald, MS TABLE OF CONTENTS 4 5 11 21 Welcome Part 1: Why Detox? Part 2: Why Superfood
More informationCarrier Screening in your Practice Is it Time to Expand your View?
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-industry-feature/carrier-screening-your-practice-it-time-expandyour-view/9648/
More informationI m NOT Interested in Anything I m NOT Interested In!!
I m NOT Interested in Anything I m NOT Interested In!! A Teenager s Guide to ADHD Booklet 1 In a Series Chesterfield County Public Schools I don t want to hear anymore about this ADHD junk!!! People won
More informationIron Deficiency Anemia in Patients with Inflammatory Bowel Disease ReachMD Page 1 of 7
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationPractices for Demonstrating Empathy in the Workplace
Practices for Demonstrating Empathy in the Workplace These practices have been developed to help leaders at all levels to develop and demonstrate empathy. These practices, when employed in combination,
More information11 INSTRUCTOR GUIDELINES
STAGE: Recent Quitter Ms. Barnes is a 28-year-old woman who has been filling her oral contraceptive prescription at your pharmacy for the past 6 years. Four months ago, you assisted her in quitting smoking
More informationModernizing the Mitral Valve: Advances in Robotic and Minimally Invasive Cardiac Repair
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-breakthroughs-from-penn-medicine/modernizing-mitral-valveadvances-robotic-minimally-invasive-cardiac-repair/7686/
More informationGenetic Counselor: Hi Lisa. Hi Steve. Thanks for coming in today. The BART results came back and they are positive.
Hi, I m Kaylene Ready, a genetic counselor who specializes in the education and counseling of individuals at high-risk for hereditary breast and ovarian cancer syndrome. Women with an inherited BRCA 1
More informationKids Booklet 5 & on Autism. Create an autism awareness ribbon! Tips for parents & teachers. Activities puzzles
Kids Booklet on Autism Create an autism awareness ribbon! Tips for parents & teachers 5 & Activities puzzles Take a look at what s inside! Questions and Answers About Autism page 2 Brothers and Sisters
More informationDeciphering Chronic Pain and Pain Medicine
Deciphering Chronic Pain and Pain Medicine Deciphering Chronic Pain and Pain Medicine Hello and welcome to Primary Care Today on ReachMD. I m your host, Dr. Brian McDonough, and I m very happy to have
More informationReducing Adverse Drug Events Related to Opioids: An Interview with Thomas W. Frederickson MD, FACP, SFHM, MBA
Reducing Adverse Drug Events Related to Opioids: An Interview with Thomas W. Frederickson MD, FACP, SFHM, MBA Iyer Hi, this is a podcast from the Physician-ient Alliance for Health & Safety. The podcast
More informationThe Parent's Perspectives on Autism Spectrum Disorder
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/autism-spectrum/the-parents-perspectives-on-autism-spectrumdisorder/6809/
More informationA NEW DAY. Eat Well, Feel Better: Cheese Please! Live Longer: Reduce Stress, Relax. Create Your Own Personalized Recipe ebook. The MealEasy Magazine
Edition # 004 - Spring 2013 The MealEasy Magazine Eat Well, Feel Better: Cheese Please! PAGE 4 & Live Longer: Reduce Stress, Relax PAGE 5 A NEW DAY Chef Paul s Everyday Cooking Tips PAGE 3 Create Your
More informationAspirin Resistance and Its Implications in Clinical Practice
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/aspirin-resistance-and-its-implications-in-clinicalpractice/3819/
More informationSickle Cell Disease: How Should YOU Reassess Management & Treatment?
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/changing-conversation-sickle-cell-disease/sickle-cell-disease-howshould-you-reassess-management-treatment/10184/
More informationSection 4 Decision-making
Decision-making : Decision-making Summary Conversations about treatments Participants were asked to describe the conversation that they had with the clinician about treatment at diagnosis. The most common
More informationVery Short Notes. Short Notes. 1 placebo definition 2 placebo effect definition
Chapter 5 The Placebo Effect Notes and Transcript When you make a speech or presentation, you want to know the material very well, even if you have notes and a transcript to look at. You can learn the
More informationSection 4 Decision-making
Decision-making : Experience of health professional communication Conversations about s Participants were asked to describe the conversations they have had about mitochondrial disease options. The most
More informationFINDING THE RIGHT WORDS IN ADVANCED AND METASTATIC BREAST CANCER (ABC/MBC)
FINDING THE RIGHT WORDS IN ADVANCED AND METASTATIC BREAST CANCER (ABC/MBC) Real people. Real communication. Making a real difference. 000989_NOV19_Breast_Cancer_Language_Guide_HCPs_V4_CL.indd 1 What do
More informationGinkgo Biloba: How Supportive is the Data?
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/ginkgo-biloba-how-supportive-is-the-data/3203/
More informationWhat is the Economic Impact of Autism Spectrum Disorder?
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/autism-spectrum/what-is-economic-impact-autism-spectrumdisorder/10263/
More informationBronx, New York Patient-Caregiver Forum Part 4 November 1, 2017 Page 1 of 10
Bronx, New York Patient-Caregiver Forum Part 4 November 1, 2017 Page 1 of 10 Speakers: Amit Verma, MD Aditi Shastri, MD Ira Braunschweig, MD Arun Sunny, PA Amit Verma, MD: There are looking promising in
More informationDr. Coakley, so virtual colonoscopy, what is it? Is it a CT exam exactly?
Virtual Colonoscopy Webcast January 26, 2009 Fergus Coakley, M.D. Please remember the opinions expressed on Patient Power are not necessarily the views of UCSF Medical Center, its medical staff or Patient
More informationThe 3 Week Ring Reducer!
The 3 Week Ring Reducer! Tinnitus Treatment Written by Liam Boehm Liam assisted me all the way through my process of getting rid of my tinnitus! It s amazing to me that the solution was so simple all along!
More informationYou re listening to an audio module from BMJ Learning. Hallo. I'm Anna Sayburn, Senior Editor with the BMJ Group s Consumer Health Team.
Transcript of learning module Shared decision making (Dur: 26' 13") Contributors: Anna Sayburn and Alf Collins Available online at: http://learning.bmj.com/ V/O: You re listening to an audio module from
More informationThe Diabetes Breakthrough: Dr. Osama Hamdy on his 12-week Plan
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/book-club/the-diabetes-breakthrough-dr-osama-hamdy-on-his-12-weekplan/7059/
More informationTHE MOST DANGEROUS THING YOU CAN TAKE FOR YOUR HEART!
THE MOST DANGEROUS THING YOU CAN TAKE FOR YOUR HEART! This is possibly the single most important issue I can write about. Heart disease is the #1 killer in the US. It costs us billions of dollars in healthcare
More informationMinimally Invasive Surgery Offers Promise for Pancreatic Cancer Patients
Minimally Invasive Surgery Offers Promise for Pancreatic Cancer Patients Recorded on: August 1, 2012 Venu Pillarisetty, M.D. Surgical Oncologist Seattle Cancer Care Alliance Please remember the opinions
More informationThe changes that patients make to their lifestyle, are as important a part of treatment as their medicines. 1
Healthy lifestyle The changes that patients make to their lifestyle, are as important a part of treatment as their medicines. 1 However, making lifestyle changes can be hard for any of us. We know that
More informationTalking to someone who might be suicidal
Talking to someone who might be suicidal To some it s a tea bag. To others it s a lifeline... Support the Zero Suicide Alliance campaign. Help us tackle the stigma that stops so many from asking for help.
More informationPancreatic Cancer: Associated Signs, Symptoms, Risk Factors and Treatment Approaches
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-breakthroughs-from-penn-medicine/pancreatic-cancerassociated-signs-symptoms-and-risk-factors-and-treatment-approaches/9552/
More informationNutrition Coach: Dan Garner
Nutrition Coach: Dan Garner 1. Eat every 2-4 hours. Eating every 2-4 hours keeps your blood sugar levels stable which in turn, keep your appetite stable and kills cravings. Eating every 2-4 hours also
More informationPathogenesis and Management of Non-Alcoholic Fatty Liver Disease
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/lipid-luminations/pathogenesis-management-non-alcoholic-fatty-liverdisease/8155/
More informationType 1 Diabetes: Control and Cure
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/type-1-diabetes-control-and-cure/1771/
More informationLetter to the teachers
Letter to the teachers Hello my name is Sasha Jacombs I m 12 years old and I have had Type 1 Diabetes since I was four years old. Some of the people reading this may not know what that is, so I had better
More informationPCSK9 Antibodies for Dyslipidemia: Efficacy, Safety, and Non-Lipid Effects
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/lipid-luminations/pcsk9-antibodies-dyslipidemia-efficacy-safety-and-nonlipid-effects/8335/
More informationYou Really Want to LOSE WEIGHT Stop Counting CALORIES and Focus on INGREDIENTS
You Really Want to LOSE WEIGHT Stop Counting CALORIES and Focus on INGREDIENTS It is not impossible to lose weight. Most people simply do not understand the reasoning behind calories, diet, nutrients,
More informationThis American Life Transcript. Prologue. Broadcast June 25, Episode #411: First Contact. So, Scott, you were born without hearing, right?
Scott Krepel Interview from TAL #411 1 This American Life Transcript Prologue Broadcast June 25, 2010 Episode #411: First Contact Is that Marc? Yes, that s Marc speaking for Scott. So, Scott, you were
More informationSusan Erin Susan Erin
Hello, my name is Susan and I would like to welcome you back to Rising from the Ashes, Trauma Talks, a podcast series brought to you from the UB School of Social Work Institute on Trauma and Trauma Informed
More informationLesson Objectives. Core Content Objectives. Language Arts Objectives
Dr. Wellbody s Heroes 7 Lesson Objectives Core Content Objectives Students will: Explain that germs can cause disease in the body Explain the importance of vaccination in preventing disease Identify Edward
More informationCOPYRIGHT 2016 MY NUTRITION ADVISOR, LLC. Authored by Founders of My Nutrition Advisor: Dr. John Fitzgerald, DC Matt Fitzgerald, MS
COPYRIGHT 2016 MY NUTRITION ADVISOR, LLC Authored by Founders of My Nutrition Advisor: Dr. John Fitzgerald, DC Matt Fitzgerald, MS TABLE OF CONTENTS 4 5 11 21 31 Welcome Part 1: Fat Loss the Truth Part
More informationUnraveling Recent Cervical Cancer Screening Updates and the Impact on Your Practice
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationThe Fallacy of Taking Random Supplements
The Fallacy of Taking Random Supplements Healthview interview with Dr. Paul Eck Healthview: We can see from our conversations that you are totally against people taking random supplements even if people
More informationUnderstanding Acute Kidney Injury and Its Impact
Understanding Acute Kidney Injury and Its Impact Recorded on: March 7, 2013 Chi-Yuan Hsu, M.D., M.S. Chief of the Division of Nephrology, UCSF Department of Medicine UCSF Medical Center Raymond Hsu, M.D.
More informationBascom Palmer Eye Institute Vitamins for Macular Degeneration
Bascom Palmer Eye Institute Vitamins for Macular Degeneration Vitamins for Macular Degeneration Your ophthalmologist has diagnosed you with age-related macular degeneration, and has recommended that you
More informationDiscussing a health concern
ESOL TOPIC 3 THEME 4 LEARNING OUTCOMES To listen and extract key information about a health concern To listen and respond to a health professional who is giving advice To understand and follow advice from
More informationWhat needs to happen in England
What needs to happen in England We ve heard from over 9,000 people across the UK about what it is like to live with diabetes and their hopes and fears for the future. Over 6,000 of them live in England;
More informationAre KIND Bars Bad For You? Nutritionists Weigh In On The FDA Ruling Some Bars "Unhealthy"
Are KIND Bars Bad For You? Nutritionists Weigh In On The FDA Ruling Some Bars "Unhealthy" Bustle.com We need to look at actual serving sizes, not 40g, nutritionist and author of The Small Change Diet,
More informationBreast Cancer Imaging Webcast October 21, 2009 Peter Eby, M.D. Introduction
Breast Cancer Imaging Webcast October 21, 2009 Peter Eby, M.D. Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or
More informationKETO40 PROGRAM GUIDE TABLE OF CONTENTS
KETO40 PROGRAM GUIDE THIS GUIDE IS DESIGNED TO EXPLAIN WHAT YOU SHOULD BE DOING FOR THE NEXT 40 DAYS ON THE KETO40 PROGRAM AS WELL AS HOW WE WILL BE SUPPORTING YOUR JOURNEY. TABLE OF CONTENTS 1 - We re
More informationMost applicable in consultations where there is a preferred outcome
Motivational Interviewing for Health Behavior Change Ellen R. Glovsky, PhD, RD, LDN The Institute for Motivation and Change And Northeastern University 2010 Missouri WIC Conference October 26, 2010 Motivational
More informationMeeting a Kid with Autism
What s up with Nick? When school started, we had a new kid named Nick. He seemed a little different. My friends and I wondered, What's up with Nick? Turns out, Nick has autism. What is Autism This year,
More informationNew Food Label Pages Diabetes Self-Management Program Leader s Manual
New Food Label Pages The FDA has released a new food label, so we have adjusted Session 4 and provided a handout of the new label. Participants use the handout instead of looking at the label in the book
More informationThings You Can Do Right Now To Stay Healthy
3 Things You Can Do Right Now To Stay Healthy by Dr. Jeff Epstein Introduction We all know we could be doing something better, one way or another, to improve our health. All of us could probably come up
More informationHeart Attack Recovery: Understanding the World s Smallest Heart Pump Webcast February 4, 2009 Antony Kim, M.D.
Heart Attack Recovery: Understanding the World s Smallest Heart Pump Webcast February 4, 2009 Antony Kim, M.D. Please remember the opinions expressed on Patient Power are not necessarily the views of Oregon
More informationCancer Advocacy. Guest Expert: Marion Morra, ScD.
Cancer Advocacy Guest Expert: Marion, ScD www.wnpr.org www.yalecancercenter.org Welcome to Yale Cancer Center Answers with Drs. Ed and Ken Miller. I am Bruce Barber. Dr. is Deputy Director and Chief of
More informationScouter Support Training Participant Workbook
Scouter Support Training Participant Workbook Version 2.1 June 15, 2011 Minor changes November 5, 2012 For use with the Scouter Support Playbook Scouter Support Training: Trainer s Manual 2 Participant
More informationI just want to go back to your early days and how you got started in the fitness
Josh Anderson and Nate Miyaki Interview: 12/17/2013 Josh Anderson: industry. I just want to go back to your early days and how you got started in the fitness Nate Miyaki: Well basically I was kind of an
More informationTriglyceride-Lowering Therapies: Addressing Gaps in the Guidelines
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/lipid-luminations/triglyceride-lowering-therapies-addressing-gaps-inguidelines/8340/
More informationThe Expanding Value of Biomarkers in NSCLC Treatment
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/closing-gaps-nsclc/the-expanding-value-of-biomarkers-in-nsclctreatment/10283/
More informationUSING ASSERTIVENESS TO COMMUNICATE ABOUT SEX
Chapter 5: Sexual Health Exercise 1 USING ASSERTIVENESS TO COMMUNICATE ABOUT SEX Aggressive Passive Manipulative/manipulation Assertive Balance of power Sex Sexual coercion 1. To build learners communication
More informationNews English.com Ready-to-use ESL / EFL Lessons
www.breaking News English.com Ready-to-use ESL / EFL Lessons The Breaking News English.com Resource Book 1,000 Ideas & Activities For Language Teachers http://www.breakingnewsenglish.com/book.html Yoga
More informationAddressing Breast Cancer's High Recurrence Rates: The Breast Cancer Translational Center of Excellence (TCE)
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-breakthroughs-from-penn-medicine/addressing-breast-cancershigh-recurrence-rates-breast-cancer-translational-center-excellence-tce/7981/
More informationPerioperative Stroke for the General Anesthesiologist and Specialist
Perioperative Stroke for the General Anesthesiologist and Specialist 2017 {Music} Dr. Alan Jay Schwartz: Hello. This is Alan Jay Schwartz, Editor-in-Chief of the American Society of Anesthesiologists 2017
More informationThe Ketosis CookBook Review
The Ketosis CookBook Review The Ketogenic diet is one of the healthiest ways you can eat, and many nutritionists and dieticians are now recommending it to people who need to balance their blood sugar levels,
More informationNOT ALONE. Coping With a Diagnosis of Facioscapulohumeral Muscular Dystrophy (FSHD)
NOT ALONE Coping With a Diagnosis of Facioscapulohumeral Muscular Dystrophy (FSHD) FOR THE NEWLY DIAGNOSED AND THEIR LOVED ONES, FROM THOSE WHO HAVE TRAVELED THIS ROAD BEFORE YOU We re not alone. We re
More informationCaller: With regard to assessing asthma control, is there a benefit to using the ACQ over the ACT or vice versa?
Dr. Colice: Hello. I m Dr. Gene Colice, an adult pulmonologist and Professor of Medicine at the George Washington University School of Medicine in Washington, D.C. Joining me today is Dr. Anne Fuhlbrigge,
More informationAl-Anon Tool Time. Tim: Did your wife lose her car again? Hey, by the way, did you find the last one?
Al-Anon Tool Time [Someone in overalls and a tool belt comes out.] Person who holds up sign: Hey Everybody! What time is it? (Holds up a poster that says "Al-Anon Tool Time") That's right! And now, ladies
More informationBeattie Learning Disabilities Continued Part 2 - Transcript
Beattie Learning Disabilities Continued Part 2 - Transcript In class Tuesday we introduced learning disabilities and looked at a couple of different activities that are consistent and representative of
More information