What the Health Just Happened?
Can I get an ENCORE?
Ladies and gentlemen, welcome to this week's episode of what the health just happened. Where we talk about all things health care, community, business, and life, the goods, the bads, the ups, the downs, the lefts, the rights, and everything in between. We're lucky to bring on a variety of guests to bring their perspective on what they find to be healthy or not healthy for their wisdom and advice. I'm pumped for today's guest so much so that I actually wore a jacket, I dressed up for him. This gentleman is way smarter than anyone in the room. Joining us today is Dr. Michael Corrin, practicing cardiologist and CEO of Encore Research Group, who received his medical degree cum laude. Is that how I say that? Yes, cum laude. Is that right? Prolers. I've never heard of this school, Harvard Medical School, with his fellowship at New York Hospital, Memorial Sloan Kettering Cancer Center, Cornell Medical Center. That's correct, yes. This is a long intro here and it just goes on and on and on. Dr. Corrin has served as an investigator in over 2,000 medical trials, co-authored over 100 peer-reviewed articles and been published in the most prestigious medical journals in the world. Whoo, he's a host of Med Evidence Podcast, the truth behind the data. Welcome, Michael Corrin. Man, that was a mouthful. How'd I do? These are fabulous and thank you for having me, I appreciate it. That was a lot. You have two pages here of just incredible stuff that you've done. Well, thank you. Where do you want to start? Let's talk about clinical trials. Clinical trials. Have you guys talked about clinical trials before? We have not. That's why you hear that in Med Evidence. So for anyone not familiar, do you guys know anything about clinical trials? Let's consider we don't know anything. I actually don't know anything. Have you heard the term clinical trials? Yes, sir. OK. Have you heard the term evidence-based medicine? I have, yes. Would you guys heard that? I've heard evidence-based research, not medicine. No, no, not at all. That's why I love these guys are in here, too. OK. So for centuries, millennia, physicians would kind of figure out things just based on their experiences. So you try it in five patients. If it works great, if it doesn't work, you try something else. And it was all sort of experiential and a bit haphazard. And what happened about 50 years ago, we said, hold on a second. If we're going to progress a medications and medicine, we have to have a structured approach. And that's when the modern clinical trial was developed. And the concept in a modern clinical trial is a structured experiment. So we're doing things with a plan. We call it a protocol. And what we do is we randomize patients to one arm versus another. And the only thing different between these two populations is this randomization process, which is completely by chance. So it could be drug A versus drug B. It could be this surgery versus just medication. It could be this type of diet versus this type of diet. But this concept of randomization in a structured experiment is key to discovering the truth. And once you do that, you look to see who does better. And you basically say, this is the outcome we're looking for. It could be heart attacks. It could be death. It could be your weight. It could be whatever you decide is the outcome. But based on this randomization structure and the structured experiment, you figure out what works better. Then when you figure out what works better, then you tell the world about it through publications. And that's how we communicate as physicians. And that's how we make progress. So one, how do you communicate it with the world? Is that in the peer reviewed articles? How long do trials take on average? Sure, so it depends on the trial. Some trials can be very quick. So for example, if you want to do a trial just to see whether or not a drug works for blood pressure after one dose, it would be a one day trial. If you want to look at something that says, OK, if you treat my cholesterol, you treat my diabetes, do I do better in five years versus not doing better in five years, that takes five years. So trials can be anytime between minutes to hours to years. Are you doing these on behalf of pharmaceutical companies, physician groups, local hospitals? I mean, you're doing this local to Northeast Florida, too, right? Yes, we have multiple sites in Northeast Florida. Actually, we have other sites outside of Northeast Florida, but our core is in Northeast Florida. And we are doing these for all types of sponsors. So the person who pays for the research is called the sponsor. Sponsors can be, and are often pharmaceutical companies, but they could be device manufacturers. It could be the government. We do work with the National Institute of Health, which is government-sponded. Who pays the biggest check? The pharmaceutical companies probably pay more and do the best research of all of our sponsors. OK. But the concept of the sponsor is who pay the bills. And just so you know, we don't have any best interest in the outcome. So when we sign a contract with a sponsor to say, OK, well, if you showed that it was epic works, then-- That was my next question. Yeah, we'll pay you more. It doesn't work like that. We are independent parties. We don't even know what you're on half the time. And we report the data objectively to the Food and Drug Administration. And we get a fee for providing data for certain patients. And so it's basically a contract. So as you get paid, X amount of dollars to get data for 10 patients, put it together, send it to the Food and Drug Administration, and then we'll look at the results. So we have no vested interest. So would they be considered different studies? Like, say, for example, a zempick comes through, and they say, we want to know one month, one year, five years. Is that three different? Or would that be bulk in one? Yeah, great question. It's usually three different studies. But they can be studies that have different endpoints at different time periods. But typically, each of the questions that we ask is very specific, and the answers are specific at a certain time point. Have you ever been brought in to do the study after something's hit the market? So something's been on the market for 10 years, but then it's like, hey, we want to know what's the effect 10 years you do? Oh, all the time, yeah, many, many cases of that. In fact, we mentioned a zempick. And that's it. This is not an advertising program. Come up a while, right? But I know that's a very hot area. So a zempick is a diabetes drug. And we were originally asked to do studies to show that it was safe for people with diabetes, because there was concerns that other diabetic drugs were actually causing harm in cardiac patients. So the FDA mandated about 15 years ago that any new diabetes drug had to go through careful cardiovascular safety assessments. So we started doing these safety assessments. And lo and behold, we found all these, quote, side effects. One of the side effects being weight loss. And now-- [LAUGHTER] Surprise. Yeah. Right. And so all of a sudden, there's a much different interest profile on this particular product. But the other thing is that as a cardiologist, we're now using it for cardiovascular protection. So we just finished a study called the Select Study, a study that was a five-year study, to see whether or not people that were treated with a zempick versus a placebo would do better in terms of fewer heart attack, strokes, and death. And lo and behold, a zempick lowered those events by 20% over five years. So not only does it help people lose weight, does not only just help control the sugar, but we know for cardiovascular patients that actually improves their prognosis. Do you think that has to do with the weight loss? Do you increase your number of factors? It's weight loss is part of it, but their lipids get better, their blood pressure gets better. Everything moves in the right direction. So the-- Lipids, by the way, is cholesterol, just to clear up that term for fat. That does help. Yeah. [LAUGHTER] Let me-- before we go too far down that path, I'm sure we'll do. Sure. So Encore Research Group is the organization that does that, right? You're the CEO for Encore Research Group. What does that look like? How many physicians? Who are doing the studies? How do you find patients? Sure. All good questions. So Encore is an acronym for Encouraging Community Research in Education. Encouraging Community Research and Education. OK, I like that. I like wordplay. Yeah, and it's fun. And Encore-- you know, give me an Encore, so we'll give myself a hand for the good word we're doing. This is a JZ, right? And actually, my daughter came up with that. Oh, that's great. When she was maybe eight or nine years old. Shout out to your daughter. Yeah, shout out. Yeah, so she did a nice job. So I say, hey, this is great, let's use it. So we ran with it. So that's the name of our organization. I started the company back in 1997, and we have now over 100 participating physicians in the area. We have 100,000 people, patients who have indicated their interest in learning more about it. And probably half of them have participated in clinical research at one level or another. The participants, are you out in the community just educating and someone says, man, I've been fighting blood pressure forever, I need a different solution. Yeah, there's different reasons. And it's a great question, because it gets into what is the value proposition for people to get involved in trials. So some people hear about clinical research and say, oh my god, I don't know if it'll be a guinea pig. And they have that concern. But in fact, nowadays, we know a lot about different medical products before we've been testing them in humans. We know this through analyses in the lab, analyses with investigational animals and a number of other things. When we test things, we have a really, really good idea of their safety, especially with the newer products. So for example, when we use a monoclonal antibody as a product, this is something that's been designed just to interact with one thing and nothing but that one thing, which is very different than the old days when you had a molecule that went everywhere. So if you took a pill-- A little on tight, see what happens? Yeah, exactly. So we now are using incredible precision medicine as a term that we use all the time. So we have a pretty good idea, even before we start human research, that it's going to probably work out pretty well. But again, our job is to check it out and make sure there's nothing unexpected. But getting back to your question, there's a lot of nuance in what we do, and a lot of nuance in terms of the reason people do it. So we do some work that's called First in Human Studies. And in First in Human Studies, these are really early exposures to medications. Sometimes their healthy volunteers are very stable patients with the disease that we're trying to treat. And typically, the motivation for those people is to get paid. So they come into our office. They can actually stay in our office. We have bedrooms set up and showers and lockers set up. And they come and they can stay with us from anywhere between overnight to two weeks. Can middle-aged dads who need a break from their wives and children do a study? We can do that. In fact, we're working on that study right now. So it's funny to mention that. But yeah, that's one of the motivations. Sometimes people just want to get away from it all. Wow. But you know, so that's one motivation. But the more common scenario is people that have a condition and they're looking for relief. So whether or not they're struggling with obesity and they're looking for relief, or they're having anginal chest pain, or they're having arthritis, or they can't get their blood pressure and control, whatever the case may be, they're looking for relief. And by getting them involved in a program, we help them find that relief. Again, we don't guarantee our results. But we do guarantee is that you'll have knowledgeable people that will educate you about your problem. And that will try to help you as best we can. So again, you'll be in a program. Typically, there'll be two arms. It could be drug A versus B or A versus a placebo. But we're going to make sure all your background therapy is correct. We're going to make sure your diet isn't messing things up. We're going to make sure that you're doing the right things in terms of drug-drug interactions and point that out. So there's a lot of ancillary benefits, and we help people with that. But the other big piece of it is that a lot of people do it because of legacy issues. And you can imagine, if you have an illness that's genetic, you're going to want to do it because you want to help your kids. Oh, yeah. So a good example of that is there's a-- Retention. Have you heard of this lipid particle called lipoprotein little A? Yes, and little B. Have you guys heard about that? No. OK. Little A is a little bit different than lipoprotein B. But I can get really nerdy here if you want. But I would tread lightly. I would like-- We'll tell you to get a certain nerdy. OK. Look, if you enjoy this, we'll have you come back and just dive deep on that too. Because obviously, I do lectures for scientific audiences. And I can get super-- [INTERPOSING VOICES] Coming down to the three of us. Well, I can really nerdy. But lipoprotein-- first of all, do you know what a lipoprotein is? Come on. It's a fat protein. OK. OK. Well, it's something that circulates in your blood that's a combination of fat and protein. So you're close. And why do you have that? Well, you have that because every cell in your body makes cholesterol. Cholesterol is important for multiple cellular functions, including the wall of the cell, has cholesterol in it. So you're-- all your cells make cholesterol, and they make it from basic ingredients. So the stuff that's in your blood isn't what you need. It's what you're trying to get rid of. And most people don't understand that. They think it's what you need. But every cell in your body makes cholesterol. So cholesterol is a fat. Does fat mix with water? No, we don't know that. So how do you get cholesterol to circulate in the bloodstream and get to the liver to get out of your body? You make lipoproteins. So lipoproteins are these combinations of proteins and fat that allow them to circulate in the bloodstream. Now, these are packages. And some of the packages are favorable. And some are not. A favorable package is called HDL or high density lipoprotein. An unfavorable package is called LDL or low density lipoprotein. So we know that if you get your LDL down with medication and you have heart disease, you're going to do better. If you have high LDL, because of genetic reasons, you're going to do better if we get that down. But there was another particle that's called LP little a, or lipoprotein little a. And it's a form of LDL that also has another molecule associated with it called-- it's called plasminogen. It looks like plasminogen. Spill that tray. Plasminogen? Yeah, that's unimportant. But the only thing that's important about it is that it's a combination of a factor that's a lipid and something to do with coagulation. And it's a very complex molecule. And it's a molecule that your body has a hard time clearing out of your circulation. So LDL, your body can clear it pretty well. And there's receptors in the liver called LDL receptors that help your body clear that. But they don't work for lipoprotein little a. But a lot of people haven't heard about it, because their doctors don't order that test. HDL and LDL. They are that. But they don't order LPA or lipoprotein little a, because we haven't really had any way of treating it. So why order something that you can't do anything about? Not everybody had that opinion. I've always been somebody that looks at it. But a typical scenario is a family that has multiple members who have had heart attacks or strokes in their 40s, 50s, and 60s. And you see it over and over again. And it seems to be inherited, specifically from one parent. And the reason for that, this is an autosomal dominant inheritance pattern. So if you are a parent, you have this gene. There's a 50% chance you're going to give it to one of your kids. Autosomal dominant. If they get it, they're going to have this problem. So now, only in the last three to four years, we have multiple solutions in clinical trials that lower this bad protein by 90% to 95%. And it's remarkable. And we're doing studies as we speak to see if that reduces heart attacks and strokes. Man, look, I love-- So that was pretty cool. --you got on this. It was a lot. But just for a second, are you familiar with Dr. Peter Atia? Yes. So I would say in our age that, let's say, 28 to mid '40s, males predominantly, are getting more into health and wellness, fitness, ice baths, saunas, et cetera. But Dr. Peter Atia had a book called Outlive. Then it came out. I don't know if you read that. Yeah, I haven't read it, but I know basically what it should be. Again, but what you're talking about is a section now that it's a term that's growing-- I wouldn't say growing in popularity, but at least people are familiar with it. And you're saying, this is something that people should be increasingly aware of. Yeah. So if you have a family history, or if you've had a heart attack, and you're listening to what we're talking about, and you're not sure if you have this problem, we'll test it for you for free. And of course, if we think you're a good candidate for a clinical research program, we'll get you involved with it. You got-- go ahead. Well, I have a question about, sorry, this is kind of going back to the beginning. But when you're talking about sponsors, and so let's say a sponsor reaches out to have on-court fulfill a service. It doesn't go well. You have to deliver the news. They unfortunately don't want to hear. Sure. How many times can a company receive that-- how many thumbs up do they have to get for it to maybe make it to the market, and how many thumbs down it? Oh, one bad study, and they'll drop the program. Immediately. Yeah. It's game over. Yeah, pretty much. Well, that's good to know. Unless there's some extraordinary circumstances. Gotcha. So I'll give you an extraordinary circumstance. Is the development of Viagra, or Sildenafil? Well, I know. All right, so I have a bunch of guys in the room. None of you need that, of course, but just in case. You know, there might be people listening to me. You got three samples, right? Young growth. Oh, man. So Sildenafil was actually developed by Pfizer as a drug for coronary artery disease. It was for chest pain that people get when they have blockages in the coronavirus. Is it a dilation? Well, they thought that was part of it, yes. And so they did studies in coronary artery disease patients, and the drug did not work. So I wasn't involved in that specific trial. I was involved in subsequent Sildenafil trials. But they found that when you're treating angina or chest pain related to your heart, it did nothing. And so Pfizer was, say, OK, we spend $200, $300 million, but that's what happens when you're a big farmer. You sometimes have to just suck up the losses. But something interesting happened is they weren't getting the study drug back from patients, particularly male patients. And so the male patients were kind of perceiving that there was some lifestyle benefit of using this drug. And they said, what the heck's going on here? And so the patients were keeping the pills? At the end of the study, we tried to get all the pills back, and they were having a hard time getting the pills back. And from male patients. So hey, how do they start exploring this? And they realized that dealing with erectile issues was one of the side effects of this drug. So then after spending several $100 million for cardiac indication, they went and they developed a free urological indication. And of course, it was a huge hit. And there's an example where they didn't just fold all their cards. They said, huh, let's study this a little bit more and give me another hand. - That's a good transition too. We got a couple minutes before the commercial break. So let's ozempic specifically, right? Diabetic drug. And then it's reclassified as a weight loss drug. And now it's potentially being reclassified as a cardiac drug. - It is, it's already been, yeah. - So that's essentially what these, the trial you're currently doing is-- - Multiple trials have gotten it to that point, correct. So I mean, at what point does someone say, let's reclassify this? - Well, the sponsor takes the data that we help provide. They go to the FDA and say, hey, this is what we found when we did the clinical trials. We're asking now for new indication. So then the FDA will say, huh, yeah, this is pretty impressive data, you have that indication. Or, nah, you gotta do some more trials. We don't quite trust this for one reason or another. And then you have to go back and show it. - How many, so okay, do you only have to get approval from one group or is it multiple groups? 'Cause you mentioned you get one thumbs down, you're done. But how many thumbs up do you have to get? - Well, again, we're doing a lot of these studies in what's called multi-centered research. So we're not the only group that's doing the research. So all this data is dumped into the same database and it comes from around the world nowadays. So it's not unusual that we'll be one of 100 places around the world where the study is being done. And it's gonna be everywhere. It's gonna be in South America and Europe and China every place nowadays. - Multiple spots in the US, also? - Multiple spots in the US, usually. Now, some studies we do in very few spots or where the primary sites. So one of them was interesting, speaking of Viagra. So one of the things you hear when you use Viagra's, you can't use nitroglycerin with it. - Nitro. - So nitro's that stuff you put under your tongue when you have hard pain. And there's an interaction between those two drugs. So the question came up, what should an ER physician do if somebody has taken syldenophyll or Viagra and they come in with chest pain? Can they use nitrates when they come to the ER? So you can imagine that, you took syldenophyll, you're partying and oh my God, you have chest pain, right? - When I was at the fire department, that's the first question we had. When we showed up and it was a male and they had chest pain, we'd have to ask, have you taken Viagra? - Yeah, it's an important question you had to ask. There's a drug, drug interaction. And if the ER starts nitroglycerin, you can drop the blood pressure dangerously and you can lose somebody. So we did a study where we brought people into our phase one unit and they got syldenophyll or not. They again, it was placebo controlled. And then we very, very, very slowly and carefully gave them nitroglycerin to see how their blood pressure responded. And that was used to give ER doctors information about how to deal with these type of patients and where to start with the nitroglycerin if they actually have to use it. - And again, I love this stuff. I could just listen to you talk forever. Let me go back to, so you said you have a hundred participating physicians? - Yes. - Are those predominantly locally? Are they spread throughout the state? - Throughout the state, but mostly concentrated in northeast Florida. - In what kind of physicians? Are you cardiologists still practicing cardiologists? - In terms of cardiologists, yeah. I still practice, yes. - Where are you seeing patients? Are you tied to any hospitals? - I'm with First Coast Heart and Vascular is the name of my cardiology practice. So, and I do that part time these days. I have clinic on Tuesdays and Thursdays, same clinic, less 30 years. So my patients out there, thank you for listening. - Yeah, shout out. Shout out to patients. - Yeah, and make sure you get your LDL checked. - Yes, that's right, that's right. You may have three new patients right now, right on that tipping point. - But in the event, yeah, so I still practice, but to answer your question, you name the specialty. Chances are we have somebody who have neurologists, we have internists, we have diabetologists, we have a big GI presence with the Borland Groover Clinic. We work with them very closely. Orthopedists, other surgeons, across the board, chances are we're working in your area. - You check the box. - Yeah, dermatology, your rheumatology, you name it. - Any shout outs before we go to commercial break, we love shout outs. Hi mom, I'd just say that every time, by the way. (laughing) - Well, my mom's in South Florida, so. - Well, part. - She was in Boca. - That's where I'm from, Boca Raton. Yep, 551 Northwest 10th Court. - Okay. (laughing) - She lives in Stone Bridge community. - I know Stone Bridge. Okay. - Small world, man. - Yes it is, it always is. - Small world, but I sure hate to paint it. - Oh, truth. (laughing) - We got some of them. - That's a shout out to Stephen Wright. - I like that. - Stephen, do you guys know Stephen Wright? He's a little before your time. - Yeah, but that's a. - He was a great comedian, he's still a great comedian, but he was real famous in the 80s and 90s. - Yeah, that's when you could say a lot of different things in comedy that you can't say now. Speaking of comedy, I got some good dad jokes after this is over. - He's gonna tell us more jokes. - I think, yeah. You got another one to do that too. (laughing) - Man, Dr. Michael Corin, practicing cardiologist, CEO of Encore Research Group. We're gonna talk about meta evidence podcast in the second half as well. Man, that was a fun first half. That's what the health just happened. (clicking) Welcome back to the second half of what the health just happened. Good news is, if you missed the first half here on the radio, you can catch the full episode on your favorite podcast platform underneath what the health just happened. Thank you as always to our sponsors, 212 Benefits. First joke in the check to make this happen. Yeah, first half, Dr. Michael Corin, practicing cardiologist, CEO of Encore Research Group, a host of meta evidence podcasts we're gonna get into. I was, like I'm fascinated by the stuff he talked about in the first half. Some stuff on GLP1s, so it was epic specifically. We talked a lot about Viagra. We talked about research. I think Viagra might come up again. (laughing) You wanna do healthier, not healthy first or dad? - Sure, healthy, healthy, not healthy. - Okay, healthy or not healthy medical school? - Healthy, unless you, are incredibly stress-prone person. (laughing) - Hopefully not healthy, the current pipeline of physicians coming into the American healthcare system. - I would say overall healthy, but I do think that there are changes in the way physicians are being trained that is not as healthy as it could be. I'll give you an example of that. - Yeah. - So we actually are working with a medical school, and we have third and fourth year medical students come through our facilities. And when you ask them to do things from time to time, one of the things we ask them to do is to draw blood in a patient. So when I was a third year medical student, I was already an expert in drawing blood on patients, but the current physicians didn't even get exposed to that because you have phlebotomy teams and other specialists that do that. So I think it's probably a good idea for a medical student to be able to draw blood, even though-- - To start an IV. - Yeah, and stuff like that. But that is not actually being trained anymore because it's being pushed off to technicians and specialists. So that is a complicated answer. - Here's a complicated question to, health you're not healthy, the current American healthcare system and how it's designed. - Again, another plus minus. So there's some great things about our healthcare system. So if you need advanced imaging, there's no better place on earth. If you need advanced therapies and have medical insurance, there's no better place on earth. If you have a complicated issue and don't ask a lot of good questions, you can get lost in the system very easily. Electronic medical records have been a disaster for the system by and large. - I'll clap to that. - And it's like what? - And so unfortunately, we're 15 years into this EMR era and it's still very difficult to get information on a day to day basis as a practicing clinician. So that has not really worked out. But the most telling statistic is this. We saw in the cardiovascular disease realm a beautiful drop in morbidity and mortality between the years of late '70s, 1980, all the way through around 2012, 2014. And then there was just a plateau there. So we really haven't made any progress in cardiovascular disease over the last 10 years or so in fact, it's up ticking a little bit compared to where it was. So for years and years and years, we're able to reduce this trend line. Actually, we reduced it by 60% in Duval County. - That's incredible. - Yeah, but we haven't nudged it for the last 10 years. So there's both good and bad there. So the good is that we've done tremendous progress in the perspective of the last 50 years. The bad is the last 10 years, we're not really making more progress and we've got to figure out how to make that better. - What do you think the cause of that is? - It's, there are multiple elements to it. - That's a pretty heavy loaded question. - Yeah, well, and it's, there's a lot of answers and no one knows the exact answer, be honest with you. So we're gonna get into this whole mid-evidence platform that I'm part of. And what I like to tell people is there are things we know, there's things we don't know. And probably the most interesting thing is, how do you find out things you don't know? How do you get to figure that out? So with the data, yeah, well, we're gonna talk about it. - Yeah, well, we'll see about that. But Ahab, the epidemiology, the statistics are what they are. And so there's been a plateau in all these health outcomes. And this is despite the Affordable Care Act and the despite spending all this money and the electronic medical records, we're not moving the needle very much. So there's a lot of interesting reasons for that. One is that we're taking on less healthy habits. So people are more overweight, there's more diabetes, there's probably more, there's more choices that people are making that are not the most healthy choice. And before we start, you gave me a couple of choices there and you might want to go back to that. - Bacon or bacon? - Right, so you asked me, is bacon healthy or unhealthy? And I said, B-A-C-O-N is unhealthy. B-A-K-I-N apostrophe is healthy as compared to fryin'. So again, a lot of these things are lifestyle issues. We're not maybe exercising as much as we should, et cetera, et cetera. - Sedentary lifestyles. - But I'll give you another example, where there's been a backlash against something that was probably helping us. So for years, we had drug reps that came to the office and they would try to sell their products. And they were very effective at selling stents. Stents are drugs like Zocor, Lipitor, Crestor, you've heard them advertise. They lower LDL cholesterol by 40, 50% very reliably and they save lives. And we had drug reps that were coming in, oh, Dr. Corin, did you prescribe Zocor or Lipitor this week? And oh, yeah, yeah, I'll do that. So again, they're selling things and they're doing it for their own interests. But in turn, we were prescribing these drugs and we were helping patients. Well, now they don't come to our office anymore. And a lot of institutions ban them because they don't want to have undue influence of the pharmaceutical companies in medicine. But the side effect of that is that we're not reminded about things that actually help people. And so-- - Oh boy, that's heavy, right there. - Yeah, so that is a very complicated issue. - You think that is based off of the opioid pandemic? - Well, that's another example of it, is that as you well know, people came in, they were selling pain relief. And if you go back 20 years, everything was about pain relief. We actually had charts in the emergency room, is your patient getting enough pain relief? And so people were overscribing opiates, got a bunch of people hooked, and then we were dealing with the backlash of that. And now, you know, you can't get opiates, even if you need it. Patients have to go through this rigamarole to show that they're not abusing opiates. And most physicians, like 20 years ago, I would prescribe a short-term opiate if a patient needed it for the reason. I won't do that now. 'Cause the regulation is too thick, and the regulatory requirements would have me doing paperwork for hours. So there's a lot less access. So a lot of these things are double-edged swords. - As I say, it's like a pendulum that swings, whether you have easy access to it, and then it's just not even available at all. - But unfortunately, the net effect is we're not making the progress that we should, even though we have amazing new imaging, we have amazing new drugs. And there's a lot of barriers to getting the best to the people that really need it. - It's funny, you say EMR, which is what, electronical medical records. And you mentioned, like for me, you say that that's a disaster. I kind of am like, wow, I didn't even realize that. Can you give an example of like why it is such a disaster? - Sure. So we're not gonna kind of downer it here right now. - I mean, we'll get back to jokes in a second. - Well, again, it's plus and minus. I don't wanna say it's all a disaster. So the theory is, is that if you have information, especially if that information can be shared with a patient on a portal, that they'll become empowered and knowledgeable, et cetera, et cetera. But the reality is, is that there's not very good communication between different parts of the healthcare system. So for example, in my EMR, if I want to find out whether or not my patient had their cholesterol profile done, dependent upon an outside vendor, that's a pick on the outside vendors, but then-- - Hey, callin' 'em. - Yeah, let 'em get back. - Well, again, they go to Quest or Lab Core, and they get it done. Now, if they go there, and I put down the wrong diagnosis, or somebody puts down the wrong diagnosis, or doesn't put it into the computer system, they won't do the test, or they'll do the test, and they'll charge the patient a bunch of money, and they'll be aggravated at you. And then you have to depend on them to get them back into your system. And it doesn't always show up, or you think it's gonna show up in the system, so you're looking to figure out where the heck those lab results are, and you're spending tens of minutes to try to figure that out, and you don't really have tens of minutes with each patient. So that's an example. But there's also just some technical issues. So this is not an exaggeration. I do clinic on Tuesday and Thursday afternoons. I see typically 18 to 20 patients. On average, no exaggeration, one to 1.5 times in each clinic session, the computer freezes, and I can't get information. - What? - For each patient? - No, no, just at some point during the session, there's some glitch, there's some software incompatibility, and basically, I can't get the information. At all, the computer stops working. - Not healthy. - Not healthy. - Not healthy. - What the hell? - What the hell. - What the hell? - So I have to kind of change my whole routine, and then I have to figure out how I'm gonna continue my clinic and still be able to document when I need to document, or send a prescription or do whatever I need to do. So there's a lot of technical issues, and you would think that electronic medical records would make it easier to see patients, but it makes it more difficult. So everybody across the board will say that it takes us about a third longer to do the exact same thing in the electronic environment than the old environment, or I just pulled out my prescription pad and just wrote down what I want the patient to do. - There's that pendulum again. Okay, let's do some dad jokes. - Yeah. - 'Cause apparently you like dad jokes. - I do. - What do they call it in medical school when a cardiology student drops out? - Is this a serious one? - Heart failure. - Ah, there we go. (laughing) Why do cardiac surgeons make it? - Okay, so you realize you're not a cardiologist in medical school, then that's a criticizing dad joke. - These are dad jokes. - These are good. (laughing) - Oh, just these ladies hold on. These are not cardiology dad jokes. - Yes. - Why do cardiac surgeons make the best public speakers? - 'Cause they put people in bypass. - Nobody else can touch as many hearts. - All right, not bad. - What would we do cardiac surgeons tell their patients to watch before surgery? - What's that? - Braveheart. (laughing) - That's pretty good. - That's a good one. - Cardiologist send his patient to gastroscopy. - Why is that? - Because the way to a man's heart is through his stomach. - Okay. - Oh my gosh. - Okay. - Okay, that's it. That's good enough for now. We gotta go back to get some. - Hey, don't knock. - I did that. Let's go to med evidence too. That's a great transition. - Well, I don't get a chance to get one. - Oh, firewall. You got a great, you got some good ones. - What do you call a phony macaroni? - What? - An impostor. - Oh. (laughing) Let's see. How do you organize a party in space? - How? - You plan it. - Oh. - Oh. (laughing) - These are good. - What are the ninja order from Burger King? - What's that? (laughing) - Okay. I think we lost him already. - No. - They keep dumbing back from order. - No, seriously, that's, that's a good transition into, 'cause I did Google those jokes. I looked at some cardiology shows. So, med evidence is a show you're doing, a website. I wrote here, the truth behind the data, navigating health information with podcast videos, articles, and presentations. So, let's talk about med evidence. You're kind of the point person. I know Brennan's hiding in the corner there, but what is that? - Who do you want to disperse this to? - Sure. Yeah, so med evidence is our platform where people can understand the truth behind the data. That's our tag line. So, we mentioned about Google or chat GTP or other places where you might try to get medical information. And unfortunately, most of that is driven by people who are advertising and promoting a product. And what we do in med evidence is we put medical experts together, have a conversation about something, sort of like this. We talk about what we know, what we don't know, and how we're gonna learn about the stuff we don't know. And you get different viewpoints. So, people find this a really educationally rewarding way to understand the type of questions they need to ask, 'cause half the time they don't even know any questions to ask. So, again, if you Google something, you're gonna get somebody who paid for you to get that information. In med evidence, you're gonna get a discussion about that general medical area to help you understand it. And then you can help take that information and apply it to you on circumstances. - I listened to a couple of short ones, just again, I'm like, well, this is the first time we met. I tried to have a, we had a prep call beforehand, but some of my saw were 11 minutes, right? These are not long clips. Some of them were a little bit longer. The guests you're having, so you pick a topic, let's say it's migraines or GLP1s. What's the dialogue? Do you have scripted questions? Is he in another physician chopping it up? - It's somebody who knows the area really well. And I'm a cardiologist, so I don't know all these areas really well, so you mentioned migraines, that's a great example. So, there's a local expert named Steve Tingis, who's a great neurologist. - Shout out Dr. Stingis. - Tingis. - Tingis. - Tingis. - I butcher that name, sorry. - He's a fabulous physician. We have a little back and forth report, he went to Yale, I went to Harvard. So, we play the rivalry a little bit. I like to remind people that there's a lot of bulldogs out there in my world, but they're from Yale, not from Georgia. - Oh man. - But yeah, it's sort of a dead joke. - That's a great Harvard joke. We can't relate to that. We're just simple folk, went to UNF here right across the street, but. - But yeah, putting that aside for a second, so we had this conversation. He's done a lot of clinical trials. He's doing active clinical trials with us in multiple areas, including Alzheimer's disease and migraine. And I just kind of feed him questions and he talks about it. And then I can ask him questions as a knowledgeable physician that other people wouldn't know quite how to ask him. And so we have that back and forth and that rapport. And again, tell people what we know, what we don't know and how we're gonna figure out things that we don't know. So, it's a great podcast. I learned from all these podcasts. - It's Met Evidence, it's called. - Yeah, Met Evidence. - I'm on your YouTube channel right now. We're pulling, we like to promote again, how do we drive an audience, listeners, eyeballs, managers, whether it's. - Metevidence.com, there's an exclamation point on our trademark, but basically, metevidence.com will get you there. - And then, same thing with patients or other physicians or people looking to run clinical trials, that's through Encore, right? - Yeah, again, Encore is the clinical trials group. - Met evidence is separate from that. - Met evidence, we call it our media platform or educational platform. - Okay, any guests you're looking for that you haven't had an opportunity to get on yet? - We're always looking for guests. - Okay. - Can you talk about the, I saw one of them as like the healing power of nature. - Sure. - Can you give like one of the best examples of where nature like did help someone? - Yeah, so that was interesting. We interviewed a guy who is a horticulturalist and he had a very busy practice, a dental practice in Manhattan and got a little burnt out from that about seven years ago and started studying horticulture. And he started being a consultant to hospitals and nursing homes and other places, telling them what plants they should have in their facilities. And he was, he presented one really interesting idea to me so that, you know, there's some epidemiological data showing that people that work in the soil have fewer health problems in certain areas. And he thinks that they're getting micronutrients by getting their hands in the soil and inhaling some of these things. And again, it's an epidemiological observation, which is a little different level of evidence than a clinical trial where we're actually looking at everything really carefully and we randomize people, but epidemiological data is important also. So what's the stuff we know about diet and exercise is based on epidemiology? So for example, why do Italians live longer than Germans? And this is not a dad joke. - I'm like, uh, why? - Well, because the Italians have a Mediterranean style diet and the Germans are eating sausages and schnitzel and all this other stuff that's fried, that's not as healthy. And even though Germany is a richer country than Italy, Italians live longer. (sighs) - Man. - And that's epidemiological. - Yeah, that's pretty cool. Go ahead, Justin. - Well, I was gonna ask you know, in your studies, you know, with that, have you found like, you know, if you're a specific test is happening in Jacksonville and another one's happening in Colorado, have you noticed that they return different results because of just the area that this test has done it? - Well, it's called a sub-analysis or, you know, the primary outcome of all the studies is the most important learning point. And so that will be accumulation of all the information from everywhere. But we can do a sub-analysis where we say, okay, looking at sites at altitude versus sites that are at sea level, we can look at US versus other countries. All these things are doable. And what we do is we create what's called secondary endpoints and this can get really nerdy again. But just statistically, if you ask too many questions to a database, you're gonna find something that's an association just by chance. So you actually have to ask a limited number of questions and doctors get together and say, okay, what question are we gonna ask this database to make sure that we're asking relevant questions and not just throwing a bunch of things out at a computer? And if you come up with relevant questions and you find that there is, in fact, an association, then that becomes part of the evidence that we use to treat patients. - What are some challenges in the research space? Like what are some hurdles you have to get more specific, like what's a win at the end of a trial? Like, man, that went great or what's a loss? Like, oh, that went terrible. - Sure, well, one of the barriers we're addressing right now is getting people over the hump, not being afraid of a clinical trial. So here's one of my favorite statistics. So I'll throw that out to the group. If you ask people who have no exposure to clinical research in Europe or the US and yes people, would you be interested in a clinical trial? What percentage say yes? - Do we know if it's Viagra involved or not? (laughing) 10% maybe. - I'd say less than 10. - Six. - It's a better than that. It's a little more optimistic than that. It's about 40% in the US. It's a little bit lower in Europe. Europeans may be a little more skeptical. But Americans, the last question is like, is my doctor okay with it or something? But you're just in a general sense, 40% say yes. Now, if you've done a clinical trial before, you've actually participated in one and you're asked to do a second one, what's the willingness to do that? - 90%. - 97 to 99%. - Wow. - Well, the experience goes through these. - Yeah, so can you think of a product where you're really a little bit skeptical at first and then once you do it, you're all on board to do it again? - Yeah, Viagra. (laughing) - Oh, I don't have one. - Well, unless you need nitroglycerin. (laughing) Right? - That's a great example. So getting access to people that are willing to do these trials. - Yeah, just getting people over the initial concern about, you know, or just the knowledge of the fear of the unknown. - So let's say you ask me if I want to do a trial and I say yes, what kind of information do I, as the possible participant, get beforehand? - Well, obviously we want to look at your medical records 'cause I don't want to recommend you for a trial unless I know it's appropriate for you. - Sure. - And that you're, I was accounting on my ethical nature and my background as an expert to know that this is not a dumb thing for you to do, which makes sense for you to do it. But then having done that, you're going to get a full informed consent, which can be 20 to 30 pages nowadays. That's going to list everything that we're going to do during the study and foreseeable possible side effects or other things that we'll be looking out for. So it's a very extended process, which is one of the things that people like about it. The truth is you ask me about good or bad, the modern medical system. Well, one of the bad things quite frankly is that everything is going by algorithm and the amount of face-to-face time that patients get with their providers is very small these days. And in the clinical-- - I think that's not healthy. - Yeah, it's not healthy. - Yeah, I agree with you 100%. I'm still an old school guy, so I spend time with my patients, but the truth is that it's very limited for most people, especially in the primary care setting, where these primary care physicians have to see 30, 40 people a day. It's really, just imagine how hard that could be. The value proposition for people in research is that by rule, when you're in a clinical trial, we're going to spend a lot more time with you. There's going to be much more face-to-face time with the providers. And the reason for that is if you're ear itches, you're in a Viagra study, just quits my life, and you say, "My wife's getting pregnant." And I say, "I love this study, this is great." But my ear is itching. So I have to report this to the FDA, that your ear is itching. And I have to say, whether or not I think the ear itching is related to the study medication, again, not knowing what you're on. This is why it's blinded, and I'm making an assessment based on talking to you and my experience and other things that I can do to try to make that connection or not. - Let's, again, I knew this would have a run out of time. I'm obsessed with this. You're currently doing the GLP1 study. Is it on a ZMPIC specifically? - No, we're not doing it. There's a lot of GLP1s out there. So a ZMPIC is a famous brand, but Majora was out there, this trilicity. There's a bunch of them. - But this study you're doing is predominantly for the cardiac side. - We're doing, well, actually, we're doing a study right now. This is a really interesting study that people might be interested in. So we know that people who are overweight tend to have sleep apnea, and people that have sleep apnea have a lot of other problems, including high blood pressure and age fibrillation. So we're actually doing a study to see if a GLP1 agonist will reduce the likelihood of sleep apnea. - So in this study, you need to find people that have sleep apnea. - We're looking for people that are kind of overweight, that are, these are for diabetic patients that may benefit from these particular products because they sleep better, and they have fewer sleep apneics episodes. So we're looking at a lot of different angles of things, and this is a good example. GLP1's for people who are overweight, need some diabetes treatment, and also have sleep apnea. - Man, have you ever participated in a study? Like just to be, just to-- - Sure, I'd love to, but I can't. - Oh, really? - Yeah, so there's a lot of restrictions. In fact, if I did, I could kind of get into a little bit of trouble because in my organization, now if I went to another organization and it was something for diagnosis that I had, I could do that. - Okay. - I have to be very careful about that. So I'm also, if I invest in any companies that we work with, I have to disclose that as a rule I don't, 'cause I always want to be deceived as neutral. So I personally don't invest in pharmaceutical companies. - So you could technically have access to a drug before it hits the market and know what's going on-- - Yeah, it's all for that. In other words, they would be concerned that I can use inside knowledge to invest in things, et cetera. So I have to disclose, and there have been unfortunate examples of physicians who have used inside information for their own financial benefit. So I have to disclose all that. So the answer to the question is in my organization, I could not participate in a clinical trial. I could for others, but then I'd have to disclose it. So there's rules about people like me and what we can and cannot do. But I've recommended my mom to participate in clinical research study. So I'm a believer in it. - I'm gonna see what's on that list. Anything I can check out? - Yeah, okay, one last question. - Sure, what's the most amount one of these patients has been getting, has gotten paid for in clinical study? It's a match where you're like, oh, buddy, you got paid. - Yeah, I hate to say it because the other thing is we don't want this to be inducement. - Sure. - So, you know, again, we're conservative in the good sense of that word-- - Gotcha. - Of being careful about what we do. And we want, you know, we don't want people to make bad decisions because of the money. But having said that, if you do a phase one study, we have a phase one study that's paying over $7,000 a patient right now. - Okay. - Now that, again, is phase one where you're spending multiple nights in our office or we're paying you for, you know, an extended period of time of being available and recording your experience, et cetera, et cetera. So that would be the exception. For the average study where you're just an outpatient, you're looking at more in the $500 to $1,200 range. - Supplemental income, I'm kidding. We like to make jokes, obviously. - And it's cool to make jokes. - No, it's, look, that was-- - It's healthy to make jokes. - It is healthy. - Actually, healthy, not healthy, that's healthy. - You're gonna start saying that a lot. Everyone has come on the show, we'll text your call me on the side, saying healthy or not healthy. - In fact, we don't have enough humor in our lives. - That is my thing, like you can laugh or cry. I'll pick laughter. - Yeah, and partially political correctness is making people afraid to say things. - I like to see that, we're just getting started and now we're out of time. - Dr. Michael Corin, CEO of Encore Research Group. Practicing cardiologist currently, and please check out Med Evidence, the truth behind the data. I've listened to some episodes so far, I think it's great. If again, if we can ever connect you with someone that's been on the show or you're looking for a guest, like we actually have had some cool people on this. You were awesome, would you come back? - Absolutely. - Dr. Michael Corin, that's what the hell just happened. - ♪ Everybody on hustle, everybody on hustle ♪ ♪ Everybody on, everybody on hustle ♪ ♪ Everybody on hustle, everybody on hustle ♪ [BLANK_AUDIO]