🎙What is MedEvidence: Devil in the Details - A Guide to Informed Health Decisions Ep 156

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This episode wraps up our MedEvidence Guide to Informed Health Decisions by unlocking Dosing with the Devil in the Details. Dr. Michael Koren and Kevin Geddings journey together through the complex and often misunderstood world of medicine, revealing how the magic lies not just in the medicine itself, but the dose in which it's taken. Yes, you heard it right, dosage - a critical but often overlooked aspect that can turn a remedy into a poison. Using real-world examples like digitalis, a toxic substance used medicinally at low doses, we demonstrate this delicate balance. 

Discover how the interaction between different drugs can either amplify their effect or neutralize it – a key factor in medical safety. With Dr. Koren's expertise, we delve into the concept of dose response, highlighting the potential dangers of exceeding the drug's maximum effect. We also unravel the role of personal factors such as race, ethnicity, body size, and diet in drug metabolism, underscoring the necessity of personalized medicine. So, join us as we navigate the intricate details of medical research and illuminate their importance in making informed health decisions.

Part 1: Risk Vs Benefits - Release November 1, 2023
Part 2. Who You Are - Release November 8, 2023
Part 3: Value and Convenience - Release November 15, 2023
Part 4: Dose, the Devil is in the Details - Release November 22, 2023

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Music: Storyblocks - Corporate Inspired

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Episode Transcript

Narrator (00:01):
Welcome to MedEvidence , where we help you navigate the
truth behind medical researchwith unbiased, evidence-proven
facts, powered by ENCOREResearch Group and hosted by
cardiologist and top medicalresearcher, Dr.
Michael Koren.

Kevin Geddings (00:16):
We're spending time with Dr.
Michael Koren.
Of course he's with ENCORE Docsand specifically today we're
talking about a great websitethat he and his team direct,
MedEvidence.
com.
That's MedEvidence.
com I'd love for you to check itout it deals with all sorts of
issues, including risk versusbenefit for you, the notion of
who you are, because thatmatters when you're processing

(00:38):
and making use of healthcareinformation.
Now we're going to talk alittle bit about well, we just
talked about value andconvenience as well, but we're
going to talk a little bit abouthow the devil is in the details
, Dr.
K oren.
Oftentimes, when we see aheadline that flies across our
social media feed, we don't getmany details right.
We get three or foursensational sentences designed
to pull us in, but we don'treally know the details, and

(01:00):
those details can make all thedifference in the world for us
as individuals, right?

Dr. Michael Koren (01:05):
Absolutely yeah, the devil is in the
details, and the detail is thedose.
If you use logic, the dose isthe devil, right?

Kevin Geddings (01:15):
Yeah, because I think a lot of us is
non-healthcare and I certainlypeople that are not medical
doctor, research scientist likeyou would believe that, hey, if
a little bit of something worksas a medicine, double that it's
going to work twice as good.

Dr. Michael Koren (01:28):
Yeah well, that's where the devil is, in
the details, and I have to dealwith that detail quite a bit in
my practice in cardiology.
But yeah, thanks for the greatintroduction.
And again, we're all about howto evaluate medical products,
tests and claims in theMedEvidence website, and the
dose detail is a great exampleof it, and literally every day

(01:50):
this comes up.
So yesterday, for example, Ihad a patient come in treating
that patient's blood pressure.
The patient was on the maximumdose of a drug that was approved
by the FDA and he told me yeahwell, on days when my blood
pressure is high, I just doubleup on it.
And so what he didn'tunderstand is what we call the

(02:12):
dose response, and the reason weknow so much about our drugs
and the reason drugs arefundamentally different than
nutritional supplements is weunderstand exactly how they work
and most drugs have an effectand they have a range during
which the effect changes as yougo up.
But they also typically have amaximal effect and once you hit

(02:34):
the maximal effect, you're notgoing to get any more benefit.
Many examples of that Imentioned ACE inhibitors.
A lot of blood pressure drugsare like that.
So if you double the dose at alow dose, it'll have an
additional impact.
If you double the dose at themaximum dose, all you're going
to do is put yourself at riskfor side effects.
Statins are like that also.

(02:55):
If you start on the low dose,you get a decent degree of LDL
lowering.
So for an effective statin likea atorvastatin, lipitor or
rosuvastatin, crestor, the firstdose, the lowest dose, will
drop you by 35% to 45% LDLlowering.
But you double the dose andthen you get only an additional
7% lowering and you double thedose again and you only get an

(03:19):
additional 7% lowering.
And if you double the doseagain you're going to get liver
problems.
So just keep on doubling thedose doesn't make it better and
better and better and better.
So again, the devil's in thedetails and the dose is the
devil.
So many many examples of that indifferent realms.
My other favorite example ofthat is talking about poisons.

(03:45):
Poisons can be good for you.
You like mysteries, don't you?
Kevin, I think we've had adiscussion about that.
Yes, like how do we try to bumppeople off in an old Agatha
Christie mystery?

Kevin Geddings (03:58):
He would use arsenic right.

Dr. Michael Koren (03:59):
Yeah, you can use arsenic or a digitalis.

Kevin Geddings (04:01):
Oh, okay, right yeah.

Dr. Michael Koren (04:04):
Yeah.
So arsenic, by the way, hasbeen explored as an
anti-infective agent at very,very low doses, but it's a
little bit tricky to use, so itnever really had much of a push,
although I saw it advocatedmaybe for HIV and some other
things, but it's not somethingin a product that we use day to

(04:24):
day.
On the other hand, you'veprobably seen mysteries about
digitalis toxicity from theFoxglove plant.
So if you go back to the oldAgatha Christie's the Sherlock
Holmes murder mysteries, I'msure there's one or two about
how some evil physician evenmanipulated his or her knowledge
of the Foxglove plant to knocksomebody off.

(04:48):
Well, it turns out that theFoxglove plant has a chemical
called digitalis that haseffects on the heart.
They're called cardioglycosidesand they actually help the
contraction elements of theheart.
A digitalis helps the heartbeat more strongly and for many

(05:08):
years it was both known to be apoison but also something that
doctors use to treat congestiveheart failure and signs of edema
.
Interestingly, this was sort ofa nutritional supplement that
doctors use for a long time, andit's only relatively recently
that we studied it as a drug,and it turns out we now know how

(05:29):
to dose it.
Well, we know how it works andhow it doesn't work, and we know
that low doses can actuallyhelp patients with congestive
heart failure, but higher dosescan kill people.
And we also know that digitalishas a lot of drug-drug
interactions.
So a good example of that isdigitalis interacts with a drug
that we use for H-fibrillationcalled amiodarone, and so

(05:53):
amiodarone and digitalis need tobe used very carefully together
, and one should be careful.
Now, usually the same doctorsprescribing both, but every once
in a while you'll havedifferent doctors prescribing
different things, not knowingwhat the other person prescribed
.
In that case, you can have aninteraction that could be
dangerous and you may not be atthe right dose.

Kevin Geddings (06:13):
Very interesting .
Well, these are the sorts oftopics, of course, that are
addressed in detail when you goand look at this website, which
is very, you know, friendly forthose of us who are not medical
professionals, but it has greatinformation that we can use in
our everyday lives and it canhelp us in interacting with
loved ones, family and friends.
Go to MedEvidence.
com.
That's MedEvidence.
com, Dr.

(06:34):
K oren.
Any closing thoughts?

Dr. Michael Koren (06:36):
Yeah, I'll give.
I'll give one final discussionpoint on this dose and the devil
in details, which gets intorace and ethnicity.
You know there is a lot ofdiscussion about that and it
turns out for most things thatall different races and
ethnicities can take similardoses.
Obviously, body size is anelement of who you are, and

(06:58):
there's some products where ourbody size is important, and some
products were, body size isn'tthat important.
There's some products, forexample on what you eat is
important.
So a good example that isWarfarin, or cumin.
In is a blood thinner thatwe've used for many years.
There was an old rat poisontalking about things that can be
poisonous but also can behelpful if you use them in the

(07:20):
right dose.
That's a great example of it,but it's also a drug that
interacts with your food.
So if you're somebody you'revegetarian and you like to eat
green leafy vegetables, wellyou're gonna have a different
reaction to this warfarin thansomebody that doesn't eat any of
those type of products, and sowho you are can be important.

(07:41):
People who are of Asianbackground sometimes metabolize
drugs a little bit differentlythan other ethnicities or races
or cultures, and so the Japaneseauthorities sometimes ask for
specific information aboutpeople of Asian background.
By the way, those studies aredone both in Japan and in the US

(08:02):
.
There's a, there's a few sitesout in California that
specialize in recruitingpatients to clinical trial who
are of Japanese background, andthose patients are put into
studies where their response tocertain treatments are compared
against Caucasians or AfricanAmericans.
So we find that more often thannot, there is little
differences, but when they dooccur, they can be very

(08:25):
important.
So, again, the final word isthat that puts everything
together, that looks at the riskversus the benefit of the
overall product.
It looks at who you are in termsof your genetic background, in
terms of what you eat and drink,in terms what you do for a
living and all the otherelements that help you make
decisions about your life.

(08:46):
These are health care.
It's also about value andconvenience.
I just brought the example ofthe the older generic blood
thinner versus the newer, moreexpensive blood thinner, and how
that may be important based onyour background.
And then, finally, the dose isso incredibly important.
Don't assume that just doublingup on things is gonna be twice

(09:07):
as good or twice as bad as not.
The devil is indeed in thedetail.

Kevin Geddings (09:12):
It usually doesn't work with chili right,
and just because you double thehot sauce doesn't make it twice
as good.

Dr. Michael Koren (09:18):
Interesting note to end on.
Is you talking about the devil,the details?
There was a this lawsuit, Ithink.
They came out because there wasa product that advertised it
was the hottest chili of alltime, or the hottest pepper of
all time, I think it wasactually and somebody I said
well, I love hot food.
They took a bunch of it andthey actually died of poisoning
from the pepper and they'resuing the manufacturer for

(09:40):
advertising the fact thatsomething that was that hot was
potentially something thatpeople would enjoy.
So we'll see where that lawsuitgoes.
Learn more about what Dr.
Koren was just talking about,and so many other topics, by
going Med Evidence.
com the website .
That's MedE vidence.
com.

(10:01):
Thank you very much, Kevin.
The Truth behind the Data.

Narrator (10:04):
Thanks for joining the med evidence podcast.
To learn more, head over toMedE vidence.
com or subscribe to our podcaston your favorite podcast
platform.