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On ‘Sound Medicine’: Pap smear guidelines, cancer cell evolution, and PTSD in heart attack patients


“Sound Medicine” covers breakthrough research studies, controversial ethics topics, and the day-to-day application of recent advancements in medicine. It’s also available via podcast and Stitcher Radio for mobile phones and iPads and posts updates on Facebook and Twitter.

Do heart attack victims experience symptoms of PTSD? Donald Edmondson, Ph.D., assistant professor of behavioral medicine at Columbia University Medical Center, discovered that as many as 1 in 8 people experience clinically significant PTSD symptoms after a heart attack. Edmondson shares with “Sound Medicine” host David Crabb, M.D., how PTSD, traditionally associated with combat veterans, can affect heart attack patients including symptoms of intrusive thoughts about their heart attack, flashbacks, and nightmares. These symptoms may even lead to another heart attack. Currently, the process used for diagnosing PTSD is the same in each type of situation.  Edmondson believes that more could be understood about PTSD if it were studied and diagnosed specific to its cause.

What prompted new recommendations for pap smears? For decades, teenage girls and women were urged to have a pap smear annually. The U.S Preventive Task Force and American Cancer Society have revised their recommendations, advising women wait until age 21 for a pap smear and that women age 21 to 65 undergo a pap smear every three years. For women older than 65, the woman and her physician have many elements to consider as to whether or not she has one. Michelle Berlin, M.D., MPH, tells IU health specialist Theresa Rohr-Kirchgraber, M.D., that the new recommendation is based on years of findings from decades of research. Berlin is the director of the National Center of Excellence in Women’s Health at Oregon Health and Sciences University.

How do Darwinian principles explain the resilience of cancer cells? Researchers at the Moffitt Cancer Center in Tampa, Fla., recently published a paper that concluded that cancer cells become resistant to targeted chemotherapies because they can quickly evolve to fit their environments through the Darwinian principle of natural selection. Kathy Miller, M.D., a professor at the IU Simon Cancer Center, talks with Host Barbara Lewis about how this idea dictates everyday practice and treatment, including finding effective treatments for specialized cancer cells with a selective advantage. Miller speculates on the possibility of cancer specialists anticipating the evolution of cancer cells to make treatments more effective in the future.

How can you and your doctor make the right choices together? Physicians and their patients may hold very different beliefs about maintaining quality of life or treatments that prolong life. Peter Ubel, M.D., professor of public policy at the Sanford School of Public Policy at Duke University, urges patients to ask their physicians about their value sets before seeking their advice regarding medical treatments, especially in the instance of cancer or other highly debilitating diseases. Ubel has found that physicians place more emphasis on prolonging life while patients give a higher value to quality of life. He also believes patients give their physicians an opportunity to discuss priorities when they bring information they’ve found about their illness to their appointments.

How do long years on the job affect a police officer’s physical and mental health? Before John Violanti, Ph.D., research professor at the School of Public Health and Health Professions at the State University of New York-Buffalo, transitioned to the academic world, he was a police officer for 23 years, leading him to  study the physical and psychological dangers of  being a police officer.

So far the results have been startling. Twenty-five percent of the sampled populations show symptoms of metabolic syndrome, which is indicative of heart disease. . Increased levels of job stress also contribute to the increased risk for heart attacks among police officers, along with lifestyle, diet and shift dynamics. Violanti describes how in the culture of the police world, individuals don’t feel the need to seek out help, because they feel they are expected to solve problems and they should be able to take care of themselves.

“Sound Medicine,” co-produced by the IU School of Medicine and WFYI Public Radio (90.1 FM) and underwritten in part by Indiana University-Purdue University Indianapolis, is aired on the following Indiana public radio stations: WBSB (Anderson, 89.5 FM), WFIU (Bloomington, 103.7 FM; Columbus, 100.7 FM; Kokomo, 106.1 FM; Terre Haute, 95.1 FM), WNDY (Crawfordsville, 91.3 FM), WVPE (Elkhart/South Bend, 88.1 FM), WNIN (Evansville, 88.3 FM), WBOI (Fort Wayne, 89.1 FM), WFCI (Franklin, 89.5 FM), WBSH (Hagerstown/New Castle, 91.1 FM), WFYI (Indianapolis), WBSW (Marion, 90.9 FM), WBST (Muncie, 92.1 FM), WBSJ (Portland, 91.7 FM), WLPR (Lake County, 89.1 FM) and WBAA (West Lafayette, 101.3 FM).

“Sound Medicine” is also broadcast on these public radio stations across the country: WLRH (Huntsville, Ala.), KSKA (Anchorage, Alaska), KTNA (Talkeetna, Alaska), KUHB (Pribilof Islands, Alaska), KUAF (Fayetteville and Fort Smith, Ark.), KIDE (Hoopa Valley, Calif.), KRCC (Colorado Springs, Colo.), KEDM (Monroe, La.), WCMU (Mount Pleasant, Mich.), WCNY and WRVO-1 (Syracuse, N.Y.), KMHA (Four Bears, N.D.), WYSU (Youngstown, Ohio), KPOV (Bend, Ore.) and KEOS (College Station, Texas).