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Rethinking Dementia: Prevention, Treatment, and Healthcare Gaps feat. Dr. Dung Trinh

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Can lifestyle choices truly prevent more than 50% of dementia cases? Join Dr. Douglas Beck and Dr. Dung Trinh as we explore this thought-provoking question and uncover groundbreaking insights. Our discussion dives into the 2024 Lancet study, highlighting 14 modifiable risk factors for dementia and the potential to prevent or delay nearly half of all cases. You'll learn about the crucial role primary care plays in managing Alzheimer's amidst a shortage of neurologists and the importance of addressing lifestyle factors like sleep and obesity. We also weigh the benefits and challenges of FDA-approved monoclonal antibodies, exploring their promise and limitations.

In our in-depth conversation, we explore the evolving landscape of Alzheimer's detection and treatment. Hear about the promising potential of biomarkers like P-tau-217 and the role of genetic factors like APOE4. We discuss shifting treatment strategies, moving beyond amyloid-targeted therapies to consider tau proteins and the immune system's involvement. The conversation also shines a light on the flaws in our healthcare system's focus on treatment over prevention, examining the impact of lifestyle industries and Medicare Advantage plans on preventive health measures. Join us for this enlightening discussion that promises to challenge your understanding of Alzheimer's care and prevention.

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Blaise M. Delfino, M.S. - HIS:

Thank you. You to our partners. Sycle, built for the entire hearing care practice. Redux, the bes t dryer, hands down. CaptionCall by Sorenson, Life is calling. CareCredit, here today to help more people hear tomorrow. Fader Plugs, the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host, Blaise Delfino and, as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

Good afternoon. This is Dr Douglas Beck with the Hearing Matters Podcast and once again I have the honor of working with my dear friend and colleague, dr Young Trin h. Dr Trinh, is a physician in Southern California, and he treats diagnoses and works mostly with Alzheimer's patients. Dr Trinh, welcome back to the Hearing Matters podcast.

Dr. Dung Trinh:

Thank you so much, doug. Good to be back. Lots of exciting things last year in 2024, in the world of Alzheimer's.

Dr. Douglas L. Beck:

Absolutely, and we're going to talk about some of those today, and I'm so glad that you're here because you are one of the experts in this and you know some of the things that come up immediately. Well, is Dr Trin a neurologist? And the answer to that is he is not a neurologist. There are only about, I want to say, 10,000 to 12,000 neurologists in the USA, and there's probably in the USA 8 to 10 million people who have been diagnosed with Alzheimer's disease, so obviously they cannot see most of them. So the actual diagnosis and care, I think falls to people like Dr Trinh. Is that correct? Or am I way off there?

Dr. Dung Trinh:

Yeah, I'm an internal medicine physician with that and I have a special niche in working specific to the brain because we do Alzheimer's clinical trials and have done it for many years, and so internal medicine docs belong to primary care. When you are a general internist, of course you can self-specialize to different studies, but the majority of Alzheimer's and dementia is seen at the primary care level.

Dr. Douglas L. Beck:

Yeah, and this is very important because it would be impossible for neurology to see all of them and many, many cities don't even have neurologists, absolutely.

Dr. Dung Trinh:

I don't know where you're at specific in Texas, but where we're at in Southern California, orange County. Average wait for neurologists to be seen six to eight months.

Dr. Douglas L. Beck:

Which is a very long time when you're suspected of having dementia.

Dr. Dung Trinh:

Yes, when you're thinking about dementia and Alzheimer's time is brain. I love that. Yeah, time is brain. And to wait six to eight months to see a neurologist, you're losing brain cells as time goes by.

Dr. Douglas L. Beck:

Yeah, and they don't come back. Even if we are successful with titrations of different drugs, right now, nobody has shown any evidence that memory come back. Once those memory cells are gone, they're gone, and that's unfortunate, but that is the state of the art. I want to talk to you specifically now for a few moments about where we are in preventing decline. Based on the Lancet study of 2024, now includes 14 potentially modifiable risk factors, so they're including high LDL cholesterol as well as visual loss. Now it's funny because you and I spoke years ago about, well, why doesn't the 2020 Lancet study include vision? Because obviously that's a main sensory pathway to your brain and I guess they realized that too. We weren't the only ones. But now they do include that in 14. And what's happened? Also, rather than the 12 previous modifiable risk factors equaling about 40% of your risk for dementia, now these 14, that's about 45%. So tell me your thoughts on that, because I know you have a lot of things to share there.

Dr. Dung Trinh:

Yeah, absolutely. My thoughts is that it's not just 14 modifiable risk factors. There are many other risk factors that are modifiable, that are not on the list yet. And I say yet, and what's interesting is that in 2020, when the Lancet Commission came out and published the 12 modifiable risk factors that will either slow down or prevent up to 40% of global Alzheimer's cases, so we move the needle from 40% to 45% by adding two additional risk factors, right from 12 to 14. And I can only wonder how high that needle can be moved as we add on other risk factors that are known, such as sleep right, the importance of sleep.

Dr. Douglas L. Beck:

And other people have identified sleep and obesity and other lifestyle factors, and when you and I were talking offline, you said that there was a reasonably good chance that in the near future, over 50% of dementia cases will be attributable to choices.

Dr. Dung Trinh:

Absolutely, absolutely. I have no doubt we have not looked at all the risk factors to add onto that list, but I'm sure that the Lancet Commission is continuing to evaluate. Absolutely.

Dr. Douglas L. Beck:

And when you think about this, you know globally it seems that a lot of nutrition, a lot of exercise, a lot of diet, a lot of simple and basic lifestyle choices absolutely impact, you know, your later years and this stuff comes back to haunt you. So I think this is brilliant and I think it's going the right way. And is it fair to say, if you were to attend to the 14 known potentially modifiable risk factors, we would expect to prevent about 50% of dementia cases.

Dr. Dung Trinh:

Yes, prevent or delay or slow down up to you know, 50%, that's remarkable.

Dr. Douglas L. Beck:

That's absolutely remarkable.

Dr. Dung Trinh:

Yeah, without taking a pill.

Dr. Douglas L. Beck:

And when you think about now the pills, which is one of the areas I wanted to ask for your thoughts on, we still have these monoclonal antibodies right that have been FDA approved and you know they're miraculous, they're great, they have been shown to really reduce amyloid plaquing in the brain, right. But these are not a pill that you take. These are infusions that take hours to have a complete infusion. They're very, very expensive and tell me the outcomes that you would expect in a typical person who's in early stage Alzheimer's and they say, doc, I want to get one of the Amicams.

Dr. Dung Trinh:

Absolutely so. We have three approved medication. One of the three is Accelerate Approval, which is Biogen's Aducanumab. That was a few years back, 2021. In 2023, licanumab was approved, which is Lekembe, and last year, 2024, donanumab was approved, which is Kinsula. So both Lekembe and Kinsula are fully approved monoclonal antibodies. What that means is that these are medications that are antibodies that are designed to go up to the brain, find the plaque tag onto it and alert your immune system to go up there to clear it.

Dr. Douglas L. Beck:

And it does to a large extent, right.

Dr. Dung Trinh:

Yes, yes, so it's been shown to effectively. These medicines can clear plaque. The question is, what can they do to memory by clearing plaque? So I'll tell you what they can do and what they can't do so that we can have some realistic expectations. What these medications are for is that they're FDA approved for a certain level of Alzheimer's dementia, meaning they're approved for mild Alzheimer's cases, mild Alzheimer's stage. They're not approved for moderate or severe. They're also approved for a stage which we call the mild cognitive impairment, which is kind of like pre-Alzheimer's right before you move over to Alzheimer's you have MCI, right. So these medications are approved for MCI and mild AD, mild Alzheimer's. They're not approved for anything before MCI, meaning your memory is fine even if you have plaque Although those studies are ongoing now to look to see if medications are effective for that and they're not approved for moderate or severe cases of Alzheimer's.

Dr. Dung Trinh:

So what can these meds do? They're IV infusions. In the case of Lekembe it's every two weeks, through an IV, you infuse a monoclonal antibody to tag onto what I call the protofibrils, which is a state actually before even the plaque occur. You have these different micro changes, yeah, these different stages as the plaque's building up to become plaque. The one of those stages, the protofibral, which is what Lekembe attaches to Sure, and as a result of that, clears the plaque. The medication, donanumab, which is Kinsula, it attaches directly to the plaque itself. Yeah, and that was the second one. Yeah, right, the second one attaches to the end stage of that process, which is the plaque.

Dr. Dung Trinh:

Both these medications can and has been shown in clinical research to slow down the process of memory loss, compared to the placebo group, compared to the group patients not getting treatment. What they cannot do is they cannot bring back. So we can't make a U-turn on memory, right, if your memory decline is like this over time, what we can do with these meds is slow down the decline right, slow down the slope of decline. We're not seeing this and the reason we're not seeing this is because over time, with Alzheimer's, we're losing brain cells, right, neural degeneration. The brain cells are dying, they're going away and as we lose brain cells, we're not bringing dead brain cells back, which is why we're not seeing this. This argues for the importance of early detection, when you have more brain cells than later detection when you have more brain cells than later detection when you have less brain cells.

Dr. Dung Trinh:

Yeah you have more to work with. More to work with? Yeah, the other thing we should know is that these medications are not without side effects. The top two potential side effects is what we call micro hemorrhage, which is a little blood that can form, and cerebral. Some swelling of the brain are potential side effects that we see, as well as the plaques is getting removed. These are potential side effects. They sound kind of scary and they can't be.

Dr. Douglas L. Beck:

Yeah, it's a brain bleed, and if you have a brain bleed, we can't just put a Band-Aid on it. You know it's under control.

Dr. Dung Trinh:

We can't put a Band-Aid on it. Statistically, though, these brain bleeds microhemorrhage, I call them, and swelling for the most part they are thematic or mild, meaning patients don't even know that they have these symptoms. That's what we do know. We also know that, for the most part, they go away. They're not permanent.

Dr. Douglas L. Beck:

They resolve by just holding the medication treatment and they got a lot of attention about 18 months ago the term brain bleed was everywhere. Yeah, it was pretty scary, right, but I like microhemorrhage. I think that probably puts it in a more appropriate perspective, and so go ahead. So we're talking about how these can help in patients who have been diagnosed with Alzheimer's early stage or MCI, and we're talking about what the drugs can and cannot do. And you're saying that in essence, they do slow it down a bit, but they can't bring back. And what kind of time would it buy? I mean, are we talking about a week, a month, a year? What's typical?

Dr. Dung Trinh:

So, based on the research that's been done the phase three studies we're buying probably about half a year, six months or so, or plus or minus a few months, depending on how early you catch it. If we're treating someone at the MCI stage, we get better results than if we're treating someone who's a little bit more advanced, at the mild Alzheimer's stage.

Dr. Douglas L. Beck:

Well, let me ask you a question clinically, because I remember in 2022, there was a paper in the JAMA that said of people age 65 and older, about one out of five has mild cognitive impairment. And the important thing there is that of the people with MCI, which is one out of five people over age 65 in the US. About one out of five of those converts annually to full-blown dementia or Alzheimer's in particular. So the question I would have is if you're trying to treat them earlier and they're in the MCI stage, how do you know which one was going to convert, or does it not matter?

Dr. Dung Trinh:

So here's something interesting At the MCI stage, most patients are not even diagnosed. Yeah, because at the mild stages, when you have just mild memory concerns, we all blame it on what? On aging Right?

Dr. Douglas L. Beck:

That's just, dad, that's just grandpa.

Dr. Dung Trinh:

So folks don't even go to the doctor to complain about it, as plaque is building up. Yeah, it's a fair point. Yeah, they don't even go. So we miss MCI at the primary care level and we miss it by over 90% Based on the literature. We miss it by over 90% because patients do not go to complain about mild symptoms.

Dr. Douglas L. Beck:

Yeah, that's a huge problem when we have medications that can address Alzheimer's at the mild stages, at the mild stage, and that also argues for more cognitive screenings, because if we're not screening, then we're going to miss more and the patients are invisible to us.

Dr. Dung Trinh:

Absolutely. It argues for early detection and the need for awareness, especially now that we have data on prevention. We have data on, you know, the Lancet Commission's 14 modifiable risks. It's so important to find out if you're at risk or not. What I'm excited about are these new blood biomarkers that we have been hearing.

Dr. Douglas L. Beck:

That looks really good Because with a blood biomarker, when somebody has the appropriate anneal the APO4 in particular right, when you're seeing that from mom and dad, you're saying that you've doubled up on that in your karyotyping. You're seeing that from mom and dad.

Dr. Dung Trinh:

You're saying that you've doubled up on that in your karyotyping. Yes, so there's two types. So when you're looking for genetics, you're looking at the APOE4 specific to see who are at risk. If you have the genetics, the blood biomarkers look for the specific protein yeah, that's fantastic. The amyloid and the tau right, the leading blood biomarker today is the P-tau-217, phosphorylated tau-217. Yeah, I read about this. Yeah, it has an accuracy rate of around 90% or so. We can improve that by adding additional tests.

Dr. Douglas L. Beck:

So if the patient has signs and symptoms of MCI and they've got this blood biomarker, they're a candidate for infusion.

Dr. Dung Trinh:

Yeah, absolutely. If you've got MCI and the blood biomarker shows the presence, you know you get a positive P-tau 217, then you can go on. To confirm how much of it is up there, you can do a PET scan or a lumbar puncture to actually quantify the amount that's up there and once you quantify the amount then you can discuss the options for treatment. With that, if you get a PTAL 217 blood test and it's negative, you can at least have some peace of mind that at least for now you can cross Alzheimer's off your list for now, right, and this is one of the issues that I'm reading about quite a bit in the newer literature 2024, 2025.

Dr. Douglas L. Beck:

So to a large degree, we can attack amyloid, maybe too late and maybe after the damage is done, but there's a lot of literature now that's pointing to tau proteins as the more significant issue, right, and this blood biomarker talks to that too. There was a paper I was going to bring up. I'm going to have to read this because I haven't memorized it yet. This came out by Katherine Posson, jeff Burns and Brent Forrester and it's in December 10, 2024 on the geminetworkcom, and they talk about monoclonal antibody treatments are approved by FDA. And they talk about monoclonal antibody treatments are approved by FDA lacanumab, as you said, and donanumab, as you said based on their ability to clear amyloid and slow clinical progression. No-transcript somewhat and not see. You know, it's got to be the right patient at the right time. Maybe the pathway is through tau proteins.

Dr. Dung Trinh:

Absolutely. The ultimate pathway is combination therapy.

Dr. Douglas L. Beck:

Yeah, tell me about that, tell me about that, tell me about that, yeah.

Dr. Dung Trinh:

What's interesting, I've noticed this past year, like several years ago, everyone was attacking the amyloid right, anti-amyloid Right. Past year there's been more studies now focused on tau, yeah, and, as a matter of fact, the majority of studies for Alzheimer's today are not anti-amyloid studies anymore. They're looking at different mechanisms of action dealing with the immune system. I've seen vaccination studies now for Alzheimer's, studies that are cutting down inflammation. Even the weight loss medicines are being studied for Alzheimer's right the GLP-1s.

Dr. Douglas L. Beck:

Yeah, well, it makes sense, because they're doing something and nobody knows exactly the limits of what they're doing.

Dr. Dung Trinh:

Yes, so the ultimate solution in my view, is combination therapy combined with lifestyle. Yeah, you got to live that lifestyle.

Dr. Douglas L. Beck:

right, you can remove plaque, but if you're not living a lifestyle to prevent, you know what you're talking about. Now harkens back to 20, 25, 30 years ago, when we were doing, you know, cabg procedures, which is, coronary artery bypass with a graft, and lots of people were getting this done, but they never changed their lifestyle. So you know, eight years later they would die of a heart attack or myocardial infarction because they didn't adapt their lifestyle, and so they had the procedure done and so they had good perfusion through their heart, but the lifestyle wound up killing them anyway. Right, it comes back at you.

Dr. Dung Trinh:

Absolutely. Bypass surgery is cleaning the plumbing, but you have to stop the lifestyle that causes the plumbing to clog up. Same thing with Alzheimer's right. We have to stop the lifestyle that allows production.

Dr. Douglas L. Beck:

All right, let me just get your thoughts. I'm going to let you go in a few minutes. But you and I have often talked about we don't necessarily have a health care system. We have a sick care system. That's a quote from you about six months ago and I've heard it before and I love it. And I don't love it because it's reality. I love it because it's accurate.

Dr. Douglas L. Beck:

And when you look at the different ratings for the American healthcare system whether it's private pay insurance doesn't matter we are rated anywhere between number 35, 36, 37 by the World Health Organization, all the way up to number 65 in the new study that came out of the UK, and that means there are 35 to 60 countries that have better healthcare for their citizens, providing better healthcare. We have the most expensive medicines and drugs in the entire world. We have the most expensive healthcare. We have the most expensive medicines and drugs in the entire world. We have the most expensive healthcare and I would argue that the biggest issue is that we may have the best physicians, like you.

Dr. Douglas L. Beck:

We may have the best audiologists, like some of my colleagues, and that's great, but the issue to me is that people do not have access. You know you have to go where your insurance tells you to go. You have to call ahead of time and get pre-approved, and you know they're not going to pre-approve something that cost them a lot of money, and that's what I see as the issue is. You know, if they can't make a lot of money on it, then they won't approve it, and I think that insurance is a debacle. It is a mess.

Dr. Dung Trinh:

We, as you mentioned, we have a sick care system, not a system that is focused on prevention, and quite simply, the system itself is sick because prevention does not pay Right Right. Hospitals shut down if their beds are not full yeah. Doctors will close their shingles if nobody walks in the door yeah. So we have a system that is kind of backward we pay for sickness, we don't pay for health, and on top of that, we have industries that are funneling a lifestyle of poor health the fast foods, you know, the junk food, the food industry, cigarettes. Everything else around us tells us to live this lifestyle that leads to chronic disease. I was reading the other day that we have thousands of chemicals in our food that are currently banned and not allowed in Europe and other countries that we eat every day.

Dr. Douglas L. Beck:

Absolutely.

Dr. Dung Trinh:

And there's a problem with that, isn't?

Dr. Douglas L. Beck:

there there's a huge problem, and even down to water bottles. Right, you're drinking water because you're trying to stay healthy and not absorbable while you're absorbing the plastic.

Dr. Dung Trinh:

Microplastics, right, nanoplastics Huge, huge issue. Now we're seeing microplastics in the brain. Yeah, Oregon has microplastics. Huge, huge issue. Now we're seeing microplastics in the brain. Oregon has microplastics.

Dr. Douglas L. Beck:

You know, the issue is that nobody knows the long-term results of any of this stuff, and we're doing it every day and it's frightening, it's scary and I don't know how to fix it. I really don't, and I'm not suggesting that I do, but I think you know the first step, of course, is recognizing there's a problem. And we, you know, we've been aware of nutrition and exercise and the need to stay healthy for a long time, but, as you say, we don't encourage it. We, you know, doctors are there for disease, not to encourage health.

Dr. Dung Trinh:

Yeah, we used to say knowledge is power, but I'm questioning that now, because knowledge alone is not power. Knowledge is free on YouTube. You can learn anything you want. What really is power is taking action.

Dr. Douglas L. Beck:

Yeah, that's good.

Dr. Dung Trinh:

And I think there's a big gap, right? We all know, in theory, how to prevent obesity and diabetes, and yet two out of three of us are overweight in the United States, right? So it's not just knowledge. We got to find a way for support and accountability as well. Yet two out of three of us are overweight in the United States. So it's not just knowledge. We got to find a way for support and accountability as well with that.

Dr. Dung Trinh:

It's why I have a personal trainer. My personal trainer isn't there waiting for me, I'll never show up to the gym. It's kind of sad, right, very sad for a physician. But yeah, it's the accountability, along with that knowledge and it's the accountability, along with that knowledge.

Dr. Douglas L. Beck:

And it is needed. I just want to talk about insurance for a minute, because almost 50% of people who are eligible for Medicare are on Medicare Advantage and I read about this all the time and Medicare Advantage programs are commercial programs, run by whomever. But I think it's important for consumers and patients to understand how managed care programs work. When you sign up for a Medicare Advantage program, the federal government gives that commercial entity about $1,000 a month to take care of you, and what that means is that that commercial entity will say oh, we're going to give you this trinket. Here's a shiny thing that you might like silver sneakers. You might get a bad hearing aid. You might get a free dental exam with no dental care. You know they do this sort of thing.

Dr. Douglas L. Beck:

People sign up and the money that they are not spending on you is their profit, and many people think that these things are free. Well, it's not. It's costing the federal government about, you know, $12,000 a year for everybody who signs up for Medicare Advantage. Now, I may have those numbers a little wrong.

Dr. Douglas L. Beck:

I'm speaking off the top of my head, I don't have any sources in front of me, but my point is that when you have regular Medicare, it's more of a fee for service and you know how much you have to pay. They can see on the guideline, the providers can see how much they're going to get reimbursed and you just do whatever you need. So I think this is a part of it as well. Is that so many people are on Medicare Advantage but they don't really understand how it works or who's paying for it. They just know what they're getting and what they're getting. There was an article in the Journal of the American Medical Association, I want to say about 14 months ago, and the title of it, I'm pretty sure, was higher prices and less health care, and I don't think you want to weigh in on that.

Dr. Dung Trinh:

But if you have a comment on it. I'd love to I will weigh in on it. I will weigh in on it, Please. Yes, because I live. I have lived in this system for a long time and seen insurance and insurance processes, so I would say there's pros and cons. The theoretical benefit of Medicare Advantage is that your care is managed. So managed could be a bad word or a good word right.

Dr. Dung Trinh:

Managed can be a bad word when your care is controlled. You can only go to this group of doctors, that group of specialists, to contract with the Medicare Advantage plan. Managed could be good if you're getting reminders for your colonoscopies, your mammograms, your eye exams. From a prevention side, if you have pure straight Medicare, no one's sending you reminders to go get your prevention studies and things of that sort. Well, that depends on who your doctors are. The doctor too, yes, depends on the doctor and the group. But I know that Medicare Advantage are incentivized to offer prevention, not necessarily because they want you to be super healthy, but because if you can prevent disease, you spend less money on the disease, right?

Dr. Douglas L. Beck:

Yeah, and if you can prevent it, obviously they don't have to pay for it, which is beneficial for everybody.

Dr. Dung Trinh:

Yes, absolutely. Medicare Advantage does give you these supplements that straight Medicare doesn't pay for, sometimes dental hearing aids, you know things of that sort. So there's pros and cons. Folks sign up for Medicare Advantage mainly due to the supplemental stuff like the silver sneakers and things of that sort yeah.

Dr. Douglas L. Beck:

but then the problem comes in right when you find out that you had a heart attack and you have to go to this and you're not at the hospital and you have to get there. Yeah, you can't choose your hospitals.

Dr. Dung Trinh:

You can't choose your doctor. You got to be within that network. So you're giving up freedom. You're giving up freedom in Medicare Advantage with the hope of getting these supplemental benefits, and the prevention side is kind of what you're giving up.

Dr. Douglas L. Beck:

Yeah, and if prevention works, then you're in great shape on Medicare Advantage, right? But anyway, so it is an individual decision. My point was to discuss how it's actually funded, because I don't think people understand that and, as you say, you know, when you sign up for it there are some advantages and there are some disadvantages as well. So it's up to the consumer. But I got to tell you, you know, I turned 65 a long time ago and trying to make your way through all those programs is a nightmare. But listen, before I let you go, I know you have a new YouTube series and I was actually watching it this morning and it's really good because it's all very, very brief YouTube videos. So what's the name of the of the YouTube series? How do people find it?

Dr. Dung Trinh:

Well, it's so. It's sponsored by East side and it's it's unlocking Alzheimer's with that. They can probably go to my LinkedIn, I suppose, and find the link on there.

Dr. Douglas L. Beck:

Yeah, okay, well, you know we'll do, we'll do. We'll put it in the description of this podcast. We'll add the link.

Dr. Dung Trinh:

We'll add more content to it. Short snippets of educational material over time.

Dr. Douglas L. Beck:

Right, and the ones I saw were things like reflections of the real world and you were talking about. You know, when we talk about Alzheimer's, it's important to understand who the patient really is, Because in the Hispanic community it's one and a half times what it is in the Caucasian community In the Black community?

Dr. Douglas L. Beck:

I don't recall, but it was substantially greater, yeah, twice yeah, and so it's a great discussion on things that most people are not aware of. And then you talk about in one of the other ones it was how to evaluate if a epidemiologic study or any study, really is appropriately compared to your own personal health or, you know, appropriately involves you, because a lot of studies you know they can be longitudinal, they could be random control trials, they could be prospective, they could be retrospective, and all this stuff matters as far as it doesn't mean any of the studies are bad. It just means you have to understand what it does mean.

Dr. Dung Trinh:

A study is not a study. A study means a whole, wide, different types of studies, right A whole wide array of studies. They all answer different questions.

Dr. Douglas L. Beck:

That's right, and I think that's why there's always confusion among patients and also among professionals, because, you know, we can easily find things that support our viewpoint, but then somebody can point out other studies and the question is is this the same population we're talking about? Is this the same treatment we're talking about? Is there a control group? Is there an experimental group? You know, in all these questions which matter, so I really enjoyed your recordings on that.

Dr. Dung Trinh:

Thank you. There's good science and good marketing and they're not always the same. I've seen these big headlines cure for this, cure for that and you try to find the study and they may have a study. And you read the study. Oh, it's a cure in rats, not humans. Yeah, and that's extrapolated to everyone else.

Dr. Douglas L. Beck:

So yeah, Absolutely, Absolutely All right. Well listen, it's always a joy to talk to you. I hope we do it again sometime soon and in the meantime, I wish you a joyous and healthy new year and I will look forward to speaking with you sometime in the near future.

Dr. Dung Trinh:

Very good to see you, doug. Have a great day. Thanks so much. All right, bye-bye.

People on this episode

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Blaise M. Delfino, M.S. - HIS

Host
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Dr. Douglas Beck

Co-host