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PeerSpectrum

PEERSPECTRUM

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PeerSpectrum
PeerSpectrum

PeerSpectrum

PEERSPECTRUM

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About Us

Welcome to PeerSpectrum, where we dive deep with uncommon conversations in and around medicine. Expand your practice by exploring the world and ideas beyond it and get ready to make your downtime count. Get ready for PeerSpectrum with Dr. Keith Mankin and Colin Miller.

Latest Episodes

Lockdown. Inside Prison Medicine with ER Physician, Dr. Jeffrey Keller.

All right welcome back. Here's a quick trivia question, which group of US patients are constitutionally guaranteed access to free medical care? And no this is not a trick question. The answer...prisoners. Today we're jumping into an area of medicine few, if any of us, know much about. Let's be honest, how many of you out there have even seen the inside of a prison of jail? Not many, we guess. Criminal records and professional medical licensing don't mix well. For those of you who've been with us for awhile, you know this isn't a political program. I say this because I'm going to read a few stats here. Don't worry, we're not gearing up for a policy discussion on prison reform. It is an important issue, but outside the scope of our conversation today. As of 2016, there were 2.1 million people incarcerated in the US. That makes us the world leader both in the total number incarcerated and a per-capita incarceration rate (655 per 100,000). That rate beats everyone, even places like Chin...

56 MIN4 days ago
Comments
Lockdown. Inside Prison Medicine with ER Physician, Dr. Jeffrey Keller.

Trading Places. Do Doctors Make Better Patients? MIT Economist, Jonathan Gruber, PhD.

All right welcome back. If you could pick the ideal patient population, armed with the best knowledge, fluent in medical jargon, generally healthy and willing to comply with recommended treatments, who would you pick? How about doctors? Doctors may not be perfect patients but at least they should outperform similar non-clinicians, right? Surprisingly, little to no research has actually been done comparing the care, compliance and outcomes of doctors to comparable groups of non- physicians. For reasons we'll soon see, this is actually a difficult question to tackle, but it's a very important question with broader implications. Today's guest is MIT economist, Jonathan Gruber. He recently co-authored a study using a unique data source to examine just how good doctors and their family members are when they find themselves in the patient seat. Spoiler alert, obviously if the results aren't surprising, we probably would not be here talking about it. That's for the first part of this episo...

53 MIN2 weeks ago
Comments
Trading Places. Do Doctors Make Better Patients? MIT Economist, Jonathan Gruber, PhD.

The American Doctor at Chernobyl, Part II: Dr. Robert Gale

As you heard last time, Dr. Gale (a bone marrow transplant specialist from UCLA) rose to international prominence after being the first American physician invited by the Soviet Union to treat patients suffering acute radiation trauma, only days after the horrific incident at Chernobyl. Our journey continues as Dr. Gale is flown in by helicopter to personally survey the Chernobyl nuclear power-plant. This only weeks after the meltdown of reactor number four. We'll see what it was like walking through the eerily empty streets of Pripyat. This was literally one of the most dangerous and heavily restricted areas on the planet. For an outsider, especially an American, to be personally inspecting this area, actually treating patients, all during the height of the cold war, was simply unthinkable... until it actually happened. For those of you who enjoyed the recent hit HBO series on Chernobyl, we'll spend a little more time there. Then we'll move on to subsequent nuclear incidents such as Tokiamura and Fukushima, and Dr. Gale's first hand experience with those. We'll discuss his lessons learned and his thoughts on the future of nuclear energy. We'll also see what he's up to today. It's an incredible part II for this rare series. With that said, let's get started.

65 MINJUL 24
Comments
The American Doctor at Chernobyl, Part II: Dr. Robert Gale

The American Doctor at Chernobyl, Part I: Dr. Robert Gale

Thirty three years after the worst nuclear disaster in human history, the name Chernobyl rings ominously, and continues to inspire fear, outrage, debate and grim curiously. It's a captivating story now being re-told dramatically, though not completely accurately, through HBO's new and very popular mini-series. We've had some pretty unique people on this program but perhaps today's guest is more unique than most. Dr. Robert Gale is an academic physician who's spent his career researching and treating patients with Leukemia and other bone marrow disorders. He's published over 800 research articles and books, he's an international expert on nuclear disaster response, and get this...he's even written for, and appeared in several Hollywood movies. Oh, he's also the shared recipient of an Emmy award for his work in a, "60 Minutes" piece. As you heard in the opening news clip, Dr. Gale rose to international prominence after being the first American physician invited by the Soviet Union to ...

54 MINJUN 6
Comments
The American Doctor at Chernobyl, Part I: Dr. Robert Gale

Treating Mother Teresa & Model-T Medicine: Cardiac Surgeon, Dr. Devi Shetty

Today's guest is Dr. Devi Shetty, a cardiac surgeon, entrepreneur and one of the most famous physicians in India. What's he famous for? Well, he performed the very first neonatal heart surgery in India, and actually served as Mother Teresa's personal physician after operating on her following a heart attack. Obviously, we weren't missing the opportunity to explore these unusual stories, but they are far from the main focus of our conversation. Dr. Shetty is best known for the unique and innovative health system he created. A system so revolutionary, the Wall Street Journal has nicknamed him the "Henry Ford of Medicine." We'll uncover what it takes to perform an advanced cardiac procedure, with western trained doctors, state of the art equipment, comparably lower complication rates than most US hospitals, for only $2,000 with a profit. The same procedure that would cost over $100,000 in the US with higher complication rates and additional OR time. Make no mistake, their model isn't simply about cheaper overseas labor and this isn't a story about medical tourism. We'll see how Naryana Health functions as a working laboratory for testing and implementing new techniques, technologies, models, and training allowing them to be more agile, efficient and safer than any hospital you have likely yet encountered. We'll see how Naryana Health has become a profitable publicly traded company while adhering to a policy of never refusing care to a patient regardless of their ability to pay. Yes, you heard that right! A profitable private hospital system that also provides free medical care. An hour just wasn't enough here. It was incredible conversation that only just scratches the surface of what's going on. It's also a forward look at what's coming whether we like it or not. With that said let's get started.

58 MINMAY 8
Comments
Treating Mother Teresa & Model-T Medicine: Cardiac Surgeon, Dr. Devi Shetty

Meditation Head-On: Neurosurgeon and Buddhist Priest, Dr. Patrick Codd

Keith and I have long considered doing an episode on meditation. What held us back was our goal (as it is with every episode) to answer these two questions: how would the episode specifically benefit you, the physicians and medical professionals in our audience, and how would we avoid simply rehashing a well worn topic explored elsewhere? As you know, we're not big on chasing trends here. So we tabled it, until just recently, when we came across today's guest. Dr. Patrick Codd earned his M.D. in the Harvard Medical School/MIT Health Science & Technology Program. He then completed his residency in Neurosurgery at the Massachusetts General Hospital/Harvard Medical School. Patrick then served as the Director of the North Neurosurgical Service at Massachusetts General Hospital, and an Instructor in Surgery at Harvard Medical School before joining the neurosurgery staff at Duke University Medical Center where we find him today. [Read more…] Not only is Patrick a solidly credentialed neurosurgeon at a world class institution, he's also, get ready for this, an ordained Buddhist priest. Not a combination you find everyday but just the kind of person we knew we had to invite on the program. We'll explore Patrick's uncommon path and his unique perspective on meditation. After-all, the brain isn't just the focal point of Patrick's meditative practice, it's also something he actually operates on every week. We'll learn how meditation initially helped him manage the daily encounters with stress and patient suffering he experienced as a resident. Then we'll see how a busy neurosurgeon fits meditation into his daily workflow, becoming a critical element of his life and practice. Maybe you already have a meditation routine, maybe you've tried it but found little benefit, or maybe you're still highly skeptical of the whole thing. Wherever you're coming from, this episode will have something for you. With that said, let's get started...

54 MINMAR 19
Comments
Meditation Head-On: Neurosurgeon and Buddhist Priest, Dr. Patrick Codd

Mismeasuring Medicine. "The Tyranny of Metrics," with Jerry Z. Muller, PhD

Most of you know the quote, “If you cannot measure it, you cannot improve it.” It's often attributed, incorrectly, to the famous nineteenth century physicist, Lord Kelvin. Wherever it came from, it's sounds about right. Same goes for this familiar quote from a popular business book author, “What gets measured gets done.” Well, in today's episode were going to talk about what's getting measured and what's actually getting done. What's getting measured are thousands of performance and quality indicators. What's getting done is docking our medical system billions of dollars every year in costs and lost productivity. Nothing new to all of you out there. But what if this “metric fixation,” is doing more than just wasting time and money? Used correctly, metrics and big data analysis offer incredible promise for research, visibility and improvement. Used incorrectly, they can steer us off course, devalue professional judgment, manipulate, encourage fraud, and possibly cause real harm to physicians, hospitals and patients. As you know, every so often we like to venture outside the medical tent for unique perspectives. That's certainly true of today's guest, historian Jerry Muller. Author of many books and a regular contributor to The New York Times, The Wall Street Journal and Foreign Affairs. His recent book, “The Tyranny of Metrics,” arose from his initial frustrations with metric fixation in higher education. As he dug deeper, he soon realized these fixations weren't' limited to universities, and they weren't new. They were already prevalent in business, law enforcement, the military, philanthropy, and of course medicine. What he found was a growing obsession with rankings, scores and a belief that all aspects of human performance and judgment can ultimately be deconstructed, demystified and quantified. This was a fascinating discussion with a rare thinker and scholar, we hope you'll enjoy. With that said let's get started.

59 MINMAR 8
Comments
Mismeasuring Medicine. "The Tyranny of Metrics," with Jerry Z. Muller, PhD

Level I Guidance: “A Random Walk,” with Economist & Investment Icon, Burton Malkiel, PhD

Today's episode is about money, specifically your money. Now, if we're going to take a break from interviewing astronauts, Navy SEAL's, NFL surgeons and cutting edge researchers to do an episode on investing, you can bet we we have a very specific reason for doing so. You can also bet we have a rare and unique guest. That guest is renowned Economist, Burton Malkiel. You can google him later but here's a quick CV highlight reel: PhD from Princeton, Harvard MBA, author of 12 books and more than 150 articles, dean of the Yale School of Management, member of the President's Council of Economic Advisers, corporate board memberships including Prudential Financial , the American Stock Exchange, and the Vanguard Group. At 86 years of age he isn't stopping and currently serves as chief investment officer at Weathfront. All very impressive you say, but what does this have to do with me? Well, Burton is also the author of one the most influential investment books of all time. First published o...

65 MINJAN 22
Comments
Level I Guidance: “A Random Walk,” with Economist & Investment Icon, Burton Malkiel, PhD

Waking Up to Psychedelic Medicine. Neuropharmacologist, David Nichols, PhD.

Clinical research with Psychedelic compounds like psilocybin, LSD and MDMA have gotten a lot of press recently. Major institutions such as Johns Hopkins, UCLA and Yale are leading the charge with dramatic results in drug addiction, PTSD, end of life care, depression and other mental illness that is simply breathtaking. When we think back to the psychedelic sixties, it’s hard to imagine that legitimate clinical research was taking place with psychedelics then, too; although much of it (think Timothy Leary) wouldn’t pass even the most lenient institutional review boards today. Much of this early research in the US came to a screeching halt with the passage of the Controlled Substances Act of 1970. Only now are we beginning to reawaken to the incredible healing and trans-formative effects these compounds can offer. Today it’s our distinct privilege to speak with the researcher who carried the torch through a time when psychedelic research was nearly non-existent. When it comes to th...

93 MIN2018 DEC 18
Comments
Waking Up to Psychedelic Medicine. Neuropharmacologist, David Nichols, PhD.

Examining, “The Dr. Death Podcast.” Award Winning Science Journalist, Laura Beil.

Today we have award winning science journalist, Laura Beil with us. Her investigative podcast series on the notorious former neurosurgeon, Christopher Duntsch is what brings her here today. Since its release last month, "Dr. Death," as it is called is now one of top 5 ranked podcasts in the country. You've probably heard about this story but just a quick recap before we get started: In 2011, neurosurgeon Christopher Duntsch began his first practice in Dallas, TX. Through the next two years, he operated on 37 patients. Of those 37, 33 suffered severe injuries and complications. Several were left permanently paralyzed, and two left dead from what all should have been fairly routine, elective procedures. It's an appalling story, later described by a surgeon (testifying at Duntsch's trial) as a "complete and utter failure of the entire system of checks and balances for patient safety.” A failure that likely would have continued were it not for the heroic efforts of other doctors in the...

47 MIN2018 OCT 26
Comments
Examining, “The Dr. Death Podcast.” Award Winning Science Journalist, Laura Beil.

Latest Episodes

Lockdown. Inside Prison Medicine with ER Physician, Dr. Jeffrey Keller.

All right welcome back. Here's a quick trivia question, which group of US patients are constitutionally guaranteed access to free medical care? And no this is not a trick question. The answer...prisoners. Today we're jumping into an area of medicine few, if any of us, know much about. Let's be honest, how many of you out there have even seen the inside of a prison of jail? Not many, we guess. Criminal records and professional medical licensing don't mix well. For those of you who've been with us for awhile, you know this isn't a political program. I say this because I'm going to read a few stats here. Don't worry, we're not gearing up for a policy discussion on prison reform. It is an important issue, but outside the scope of our conversation today. As of 2016, there were 2.1 million people incarcerated in the US. That makes us the world leader both in the total number incarcerated and a per-capita incarceration rate (655 per 100,000). That rate beats everyone, even places like Chin...

56 MIN4 days ago
Comments
Lockdown. Inside Prison Medicine with ER Physician, Dr. Jeffrey Keller.

Trading Places. Do Doctors Make Better Patients? MIT Economist, Jonathan Gruber, PhD.

All right welcome back. If you could pick the ideal patient population, armed with the best knowledge, fluent in medical jargon, generally healthy and willing to comply with recommended treatments, who would you pick? How about doctors? Doctors may not be perfect patients but at least they should outperform similar non-clinicians, right? Surprisingly, little to no research has actually been done comparing the care, compliance and outcomes of doctors to comparable groups of non- physicians. For reasons we'll soon see, this is actually a difficult question to tackle, but it's a very important question with broader implications. Today's guest is MIT economist, Jonathan Gruber. He recently co-authored a study using a unique data source to examine just how good doctors and their family members are when they find themselves in the patient seat. Spoiler alert, obviously if the results aren't surprising, we probably would not be here talking about it. That's for the first part of this episo...

53 MIN2 weeks ago
Comments
Trading Places. Do Doctors Make Better Patients? MIT Economist, Jonathan Gruber, PhD.

The American Doctor at Chernobyl, Part II: Dr. Robert Gale

As you heard last time, Dr. Gale (a bone marrow transplant specialist from UCLA) rose to international prominence after being the first American physician invited by the Soviet Union to treat patients suffering acute radiation trauma, only days after the horrific incident at Chernobyl. Our journey continues as Dr. Gale is flown in by helicopter to personally survey the Chernobyl nuclear power-plant. This only weeks after the meltdown of reactor number four. We'll see what it was like walking through the eerily empty streets of Pripyat. This was literally one of the most dangerous and heavily restricted areas on the planet. For an outsider, especially an American, to be personally inspecting this area, actually treating patients, all during the height of the cold war, was simply unthinkable... until it actually happened. For those of you who enjoyed the recent hit HBO series on Chernobyl, we'll spend a little more time there. Then we'll move on to subsequent nuclear incidents such as Tokiamura and Fukushima, and Dr. Gale's first hand experience with those. We'll discuss his lessons learned and his thoughts on the future of nuclear energy. We'll also see what he's up to today. It's an incredible part II for this rare series. With that said, let's get started.

65 MINJUL 24
Comments
The American Doctor at Chernobyl, Part II: Dr. Robert Gale

The American Doctor at Chernobyl, Part I: Dr. Robert Gale

Thirty three years after the worst nuclear disaster in human history, the name Chernobyl rings ominously, and continues to inspire fear, outrage, debate and grim curiously. It's a captivating story now being re-told dramatically, though not completely accurately, through HBO's new and very popular mini-series. We've had some pretty unique people on this program but perhaps today's guest is more unique than most. Dr. Robert Gale is an academic physician who's spent his career researching and treating patients with Leukemia and other bone marrow disorders. He's published over 800 research articles and books, he's an international expert on nuclear disaster response, and get this...he's even written for, and appeared in several Hollywood movies. Oh, he's also the shared recipient of an Emmy award for his work in a, "60 Minutes" piece. As you heard in the opening news clip, Dr. Gale rose to international prominence after being the first American physician invited by the Soviet Union to ...

54 MINJUN 6
Comments
The American Doctor at Chernobyl, Part I: Dr. Robert Gale

Treating Mother Teresa & Model-T Medicine: Cardiac Surgeon, Dr. Devi Shetty

Today's guest is Dr. Devi Shetty, a cardiac surgeon, entrepreneur and one of the most famous physicians in India. What's he famous for? Well, he performed the very first neonatal heart surgery in India, and actually served as Mother Teresa's personal physician after operating on her following a heart attack. Obviously, we weren't missing the opportunity to explore these unusual stories, but they are far from the main focus of our conversation. Dr. Shetty is best known for the unique and innovative health system he created. A system so revolutionary, the Wall Street Journal has nicknamed him the "Henry Ford of Medicine." We'll uncover what it takes to perform an advanced cardiac procedure, with western trained doctors, state of the art equipment, comparably lower complication rates than most US hospitals, for only $2,000 with a profit. The same procedure that would cost over $100,000 in the US with higher complication rates and additional OR time. Make no mistake, their model isn't simply about cheaper overseas labor and this isn't a story about medical tourism. We'll see how Naryana Health functions as a working laboratory for testing and implementing new techniques, technologies, models, and training allowing them to be more agile, efficient and safer than any hospital you have likely yet encountered. We'll see how Naryana Health has become a profitable publicly traded company while adhering to a policy of never refusing care to a patient regardless of their ability to pay. Yes, you heard that right! A profitable private hospital system that also provides free medical care. An hour just wasn't enough here. It was incredible conversation that only just scratches the surface of what's going on. It's also a forward look at what's coming whether we like it or not. With that said let's get started.

58 MINMAY 8
Comments
Treating Mother Teresa & Model-T Medicine: Cardiac Surgeon, Dr. Devi Shetty

Meditation Head-On: Neurosurgeon and Buddhist Priest, Dr. Patrick Codd

Keith and I have long considered doing an episode on meditation. What held us back was our goal (as it is with every episode) to answer these two questions: how would the episode specifically benefit you, the physicians and medical professionals in our audience, and how would we avoid simply rehashing a well worn topic explored elsewhere? As you know, we're not big on chasing trends here. So we tabled it, until just recently, when we came across today's guest. Dr. Patrick Codd earned his M.D. in the Harvard Medical School/MIT Health Science & Technology Program. He then completed his residency in Neurosurgery at the Massachusetts General Hospital/Harvard Medical School. Patrick then served as the Director of the North Neurosurgical Service at Massachusetts General Hospital, and an Instructor in Surgery at Harvard Medical School before joining the neurosurgery staff at Duke University Medical Center where we find him today. [Read more…] Not only is Patrick a solidly credentialed neurosurgeon at a world class institution, he's also, get ready for this, an ordained Buddhist priest. Not a combination you find everyday but just the kind of person we knew we had to invite on the program. We'll explore Patrick's uncommon path and his unique perspective on meditation. After-all, the brain isn't just the focal point of Patrick's meditative practice, it's also something he actually operates on every week. We'll learn how meditation initially helped him manage the daily encounters with stress and patient suffering he experienced as a resident. Then we'll see how a busy neurosurgeon fits meditation into his daily workflow, becoming a critical element of his life and practice. Maybe you already have a meditation routine, maybe you've tried it but found little benefit, or maybe you're still highly skeptical of the whole thing. Wherever you're coming from, this episode will have something for you. With that said, let's get started...

54 MINMAR 19
Comments
Meditation Head-On: Neurosurgeon and Buddhist Priest, Dr. Patrick Codd

Mismeasuring Medicine. "The Tyranny of Metrics," with Jerry Z. Muller, PhD

Most of you know the quote, “If you cannot measure it, you cannot improve it.” It's often attributed, incorrectly, to the famous nineteenth century physicist, Lord Kelvin. Wherever it came from, it's sounds about right. Same goes for this familiar quote from a popular business book author, “What gets measured gets done.” Well, in today's episode were going to talk about what's getting measured and what's actually getting done. What's getting measured are thousands of performance and quality indicators. What's getting done is docking our medical system billions of dollars every year in costs and lost productivity. Nothing new to all of you out there. But what if this “metric fixation,” is doing more than just wasting time and money? Used correctly, metrics and big data analysis offer incredible promise for research, visibility and improvement. Used incorrectly, they can steer us off course, devalue professional judgment, manipulate, encourage fraud, and possibly cause real harm to physicians, hospitals and patients. As you know, every so often we like to venture outside the medical tent for unique perspectives. That's certainly true of today's guest, historian Jerry Muller. Author of many books and a regular contributor to The New York Times, The Wall Street Journal and Foreign Affairs. His recent book, “The Tyranny of Metrics,” arose from his initial frustrations with metric fixation in higher education. As he dug deeper, he soon realized these fixations weren't' limited to universities, and they weren't new. They were already prevalent in business, law enforcement, the military, philanthropy, and of course medicine. What he found was a growing obsession with rankings, scores and a belief that all aspects of human performance and judgment can ultimately be deconstructed, demystified and quantified. This was a fascinating discussion with a rare thinker and scholar, we hope you'll enjoy. With that said let's get started.

59 MINMAR 8
Comments
Mismeasuring Medicine. "The Tyranny of Metrics," with Jerry Z. Muller, PhD

Level I Guidance: “A Random Walk,” with Economist & Investment Icon, Burton Malkiel, PhD

Today's episode is about money, specifically your money. Now, if we're going to take a break from interviewing astronauts, Navy SEAL's, NFL surgeons and cutting edge researchers to do an episode on investing, you can bet we we have a very specific reason for doing so. You can also bet we have a rare and unique guest. That guest is renowned Economist, Burton Malkiel. You can google him later but here's a quick CV highlight reel: PhD from Princeton, Harvard MBA, author of 12 books and more than 150 articles, dean of the Yale School of Management, member of the President's Council of Economic Advisers, corporate board memberships including Prudential Financial , the American Stock Exchange, and the Vanguard Group. At 86 years of age he isn't stopping and currently serves as chief investment officer at Weathfront. All very impressive you say, but what does this have to do with me? Well, Burton is also the author of one the most influential investment books of all time. First published o...

65 MINJAN 22
Comments
Level I Guidance: “A Random Walk,” with Economist & Investment Icon, Burton Malkiel, PhD

Waking Up to Psychedelic Medicine. Neuropharmacologist, David Nichols, PhD.

Clinical research with Psychedelic compounds like psilocybin, LSD and MDMA have gotten a lot of press recently. Major institutions such as Johns Hopkins, UCLA and Yale are leading the charge with dramatic results in drug addiction, PTSD, end of life care, depression and other mental illness that is simply breathtaking. When we think back to the psychedelic sixties, it’s hard to imagine that legitimate clinical research was taking place with psychedelics then, too; although much of it (think Timothy Leary) wouldn’t pass even the most lenient institutional review boards today. Much of this early research in the US came to a screeching halt with the passage of the Controlled Substances Act of 1970. Only now are we beginning to reawaken to the incredible healing and trans-formative effects these compounds can offer. Today it’s our distinct privilege to speak with the researcher who carried the torch through a time when psychedelic research was nearly non-existent. When it comes to th...

93 MIN2018 DEC 18
Comments
Waking Up to Psychedelic Medicine. Neuropharmacologist, David Nichols, PhD.

Examining, “The Dr. Death Podcast.” Award Winning Science Journalist, Laura Beil.

Today we have award winning science journalist, Laura Beil with us. Her investigative podcast series on the notorious former neurosurgeon, Christopher Duntsch is what brings her here today. Since its release last month, "Dr. Death," as it is called is now one of top 5 ranked podcasts in the country. You've probably heard about this story but just a quick recap before we get started: In 2011, neurosurgeon Christopher Duntsch began his first practice in Dallas, TX. Through the next two years, he operated on 37 patients. Of those 37, 33 suffered severe injuries and complications. Several were left permanently paralyzed, and two left dead from what all should have been fairly routine, elective procedures. It's an appalling story, later described by a surgeon (testifying at Duntsch's trial) as a "complete and utter failure of the entire system of checks and balances for patient safety.” A failure that likely would have continued were it not for the heroic efforts of other doctors in the...

47 MIN2018 OCT 26
Comments
Examining, “The Dr. Death Podcast.” Award Winning Science Journalist, Laura Beil.

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