This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of July 2025
News You Can Use with your Hosts Dr Craig Joseph and Dr Nick van Terheyden
The show that gives you a quick insight into the latest news, twists, turns, and debacles going on in healthcare with my friend and co-host Craig Joseph, MD (@CraigJoseph), Chief Medical Officer at Nordic Consulting Partners, and myself, where every diagnosis comes with a side of humor. We hope you stay curious, stay engaged, and keep seeking the truth in healthcare in a world that thrives on information.
Buckle up as we dive into the ER of excitement, the ICU of irrationality, and the waiting room of wacky wisdom in this month’s show that features a review of:
- Antibiotic Use and Obesity
- Open Evidence
- Are we Over-Trusting AI, and
- HRT is back in
This month, we throw down our stethoscopes and pick up the threads of news to dissect three head-spinning topics in medicine: antibiotics, hormones, and AI’s growing ego. First up, the childhood obesity mystery possibly linked to… over-prescribed antibiotics? Turns out nuking little Johnny’s gut flora with amoxicillin for every sniffle might be setting him up for a lifetime of elastic waistbands. But is it………once again we find ourselves stressing the difference between “interesting correlations” and “actual science,” or in other words
Correlation vs Causation
Hot Flashes, Cold Facts
I go on a mini go full hormone vigilante as I rant about the hormonal horror story caused by the 2002 WHI study, which sent HRT prescriptions for menopausal women off a cliff. My impassioned defense of common sense and estrogen, he calls out the lingering dogma that keeps women needlessly suffering—despite overwhelming evidence supporting the benefits of HRT when used appropriately. So impassioned am I that Craig is left almost speechless and, importantly, in agreement. No bonus points for using the phrase “bee in my bonnet” while burning down medical myths with evidence and exasperation.
DK Theory
Finally, we tackles the love-hate triangle between doctors, AI, and gullibility. Craig gives OpenEvidence kudos for making ChatGPT into ChatMD and citing actual literature (imagine that). But our cautionary tale as we warn against AI’s confident lies and the “technical Dunning-Kruger effect”—where the machine sounds smart but is often just bluffing. Dr. Craig even drops the acronym “DK Theory,” because clearly, this podcast now doubles as a TED Talk in disguise. Buckle up for humor, outrage, and just the right dose of gut-checks—pun 100% intended.
Frequent Early-Life Antibiotic Use Associated with Increased Likelihood of Childhood Obesity
Children prescribed 5 to 9 courses of antibiotics before age 5 are 7% more likely to be obese at age 6 compared to those with no antibiotic exposure. Those prescribed 10 or more antibiotics before age 5 are 14% more likely to become obese at age 6.
Limited antibiotic exposure (1-4 courses) before age 5 was not significantly associated with obesity at age 6.
We hope you enjoy our take on the latest news and developments in healthcare and want to help you keep untangling the web of information, dodging the sensational pitfalls, and emerging victorious, albeit a little dizzy, on the other side. In the end, the stories we uncover, and the discussions we ignite, all shape the narrative of our shared future. We want to hear from you especially if you have topics covered or questions you’d like answered. You can reach out directly via the contact form on my website, or send a message on LinkedIn to Craig or me.
Until next week keep solving healthcare’s mysteries before they become your emergencies
xx
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
Go. Welcome to the month of July. I am Dr Nick and I’m Dr Craig. This week, we’ll be dissecting the latest healthcare news, unraveling twists and turns and making sense of at least some of the debacles.
Craig Joseph
Just remember, life’s a lot like breaking news stories, unpredictable, often absurd and occasionally leaving you wondering if it’s all just a cosmic prank.
Nick van Terheyden
This week, we take a look at AI for a change, and are we over trusting it?
Craig Joseph
And we dive into open evidence, and we wonder if HRT is really back.
Nick van Terheyden
But first off, this week, let’s talk about antibiotic use, particularly in children and obesity. What is going on? Craig? Well, the pediatrician. So I asked you to know everything here, I do
Craig Joseph
know everything, and I’m glad that you finally have acknowledged that. And we are recording, and so I
Nick van Terheyden
will I control the editing. I’m just saying, but that is accurate, unfortunately.
Craig Joseph
So I hesitate to call this a study epic, which is one of the big because it’s not really epic, is a is a huge electronic health record vendor, and many, many of epic clients take de identified data as as such, and upload it to one big database, and then epic, or researchers, can kind of play around with with those data. And they did us, they did a an analysis there. That’s a better term to see if, if children who got a lot, many courses of antibiotics, by many, I think, more than five or so courses of antibiotics before maybe age four or five, were they more likely to end up obese? And it seems, it seems that statistically speaking, based on their data, and there’s hundreds of 1000s of children in this in this analysis that they did, that the answer was yes, you were more likely. I think it was in the teens, kind of 17% 14% something like that, more likely to be obese if you got multiple courses of antibiotics as a young child. Why? That seems very strange to me. There was some mention about altered gut flora when you’re on antibiotics. So sometimes the antibiotics, oftentimes the antibiotics, kill off bacteria that are in our guts that we need, of course, and that’s why people often get things like stomach upset or diarrhea when they’re on antibiotics as a as a unwanted side effect. But it seems odd to me that I’m just trying to understand the the physiology here of how this would actually occur. You know, if you’re on antibiotics for 10 days for typical ear infection, which we used to do a lot more than we do now, we’re much more judicious in our God, yeah, yeah. And I’m, and again, you know, I, I was one of them that did all of that, because that was the thinking at the time. You know, hey, that’s you do need to get rid of these ear infections as quickly as possible.
Nick van Terheyden
I’ll Fess up. I had a big, big bottle of amoxicillin in my household just, well, we did it because that, again, exactly what we thought science
Craig Joseph
is
Nick van Terheyden
changes right? Grams to Yes,
Craig Joseph
well as it must. And that was the that was the best thinking. And we’ve run through this so many times when we talk about COVID, too, and people you, you know, doctors lied, well, researchers, scientists lied. No, we were basing our best available evidence on the best available evidence. And now we look back and we say they’ll probably over, over, did it with the antibiotics. So I you know, I don’t know it’s a it’s an interesting analysis. I’m not sure it’s actionable. Like I said, we are much more judicious about using antibiotics. Nowadays. When you take your child to the doctor and we look in the ear and we see an ear infection, we don’t jump to antibiotics right away. We often will say, Hey, can you wait? Let’s wait two or three days. And if, if little Johnny’s not getting better, you you don’t have to come in, we’ll just give you that, that prescription right now. But often, little Johnny is better in two or three days, doesn’t need the antibiotics and so, so this is probably a moot point in terms of being able to do something about it, but it’s, it was interesting. I’m not sure what to do with it, though. Yeah,
Nick van Terheyden
I guess that’s my sort of question around this. I mean, I’m you and I are probably both subscribed to this output from this thing, and there was a point where the. There were emerging interesting findings, but you know, as you say, what do you do with them? But I’m now sort of wondering, what exactly is the point of this? It just, it’s a little bit disappointing, because it feels like it’s an attempt to sort of point to something that you know, as you rightly say it’s not a study. I mean, that that you know is important to understand, because it’s not, it’s just based on what we have in the database, and it doesn’t deliver anything that’s truly actionable. It is interesting. I mean, let’s be frank, we’re starting to understand the bio much better and its impact. And you know, I’m working my way through super ages by Dr Eric Topol. And you know, each chapter is just astounding revelations. And the biome, multiple biomes, not just the gut biome, but that alone, and I even feel it, you know, in my own sort of experience, and as a result of, you know, variety of things, you know, I end up having to take antibiotics occasionally. And, God, the impact of that, now that I sort of think about it, just on me significant. And we also can see the impact, particularly with the GLP agonists that are influencing this cascade that limits your hunger is tied to production that’s in the gut. So there’s some validity, but you know, as usual, this is correlation, not causation. But, you know, I don’t know. I just, I wish they would, rather than putting out things for the point of putting them out is, you know, be a little bit more thoughtful, because it is a wealth of information that you could mine. It would certainly be interesting. I’m sure I don’t I’m not allowed to have access, because I don’t play in that pool, but, you know, if I did,
Craig Joseph
yeah, you know, I can tell you what their stated intention is, epics. And it’s, it’s not to have people change their practice based on on things that they’re doing. It’s to, it’s to kind of put ideas into people’s heads and say, like, hey, we found this kind of correlation someone, if that’s interesting to you, someone should do a real study. And that’s not just because Epic is a electronic health record vendor. They’re never going to do a real study, but they have this huge database that is almost unrivaled. Maybe it is unrivaled and and so their idea is to kind of tickle the fancy of researchers and scientists and say, Hey, we’ve got these data. Maybe you can do something with them along these lines. Maybe it’s, you know, for we could just dig this one apart. They said they looked at maternal obesity rates and kind of compared those, but they certainly didn’t look at paternal right? They couldn’t, they couldn’t. And so, because oftentimes that’s just not, that’s not available and and so, yeah, we don’t really know. We certainly know genetics plays a big part in in obesity so well, yeah,
Nick van Terheyden
and also social, social environment. You know, I’m not even talking about food deserts here, but if you hang around people that are overweight, you tend to lean to be more overweight, whereas if you hang around people that are not you tend to lean that way because your influences, you know, lots anyway, interesting, but, you know, questionable. Let’s talk about HRT. And you know, I’ve, I’ve got to be honest right out the gate here, I have a big bee in my bonnet. I have a bee in my bonnet over some of the a few things where I do get a bit worked up, and this is one of them. Well, let’s talk about what is HRT Well, oh yes, good point. Hormone replacement therapy, that was a mainstay of treatment for women who at the point of menopause, I recently learned the derivation of that which you know, another one of these terms that we’ve created that anyway, and they stop producing hormones and stop being fertile. Unlike men, who essentially go through a steady decline over time, particularly around testosterone, which is the primary male hormone. But to be clear, those two are or not. It’s not as simple as that, and women have testosterone as well, in much smaller quantities. But for women, their cycle, or menses, as it’s called, The. Position is created by the cycle between estrogen and progesterone, and I’m oversimplifying. And at menopause, all of that stops. And importantly, what happens around that time is, unlike the men’s steady decline, those two hormones plummet. I mean, literally, it’s a cliff drop of amount. And what we understood was we could replace that with artificial drugs and relieve what many suffer from menopausal symptoms, hot flushes. Is the well known version. There are plenty of other elements to this and that alone, had a lot of women, millions, if I recall, prior to the study, the Women’s Health Institute study that published early claiming that this was linked to an increase in breast cancer. Come to find subsequently that that was misrepresented, I’ll be kind, and they had performed a poor analysis, and also the subject data was all pushed in an older age group, which didn’t apply to the age group that were receiving it. And it was there’s lots of lots of undercurrent to this, but unfortunately, much as we see today, we didn’t have social media, but we had the news, and it became a lightning rod, and overnight, millions of women were taken off HRT. I know, at least in my own circles, I saw that, and it will it had huge negative impacts. And now, even years later, as we’ve disproven, probably one of the worst studies, and there are still people that claim that it’s great. It’s very hard to find a physician who will prescribe HRT for a woman who is entering menopause and feels or wants needs it not providing medical advice here, but it is for a variety of very good clinical reasons actually much better for you, particularly given that cliff drop and despite a flip in the evidence, the dogma remains, and I know I hear it still to this day, 2025, For crying out loud, women who do end up talking about this, and I bring this subject up, say, but my physician won’t prescribe it. That’s shocking. And so what we’ve seen is the new folks in town are essentially saying that we are changing this and trying to push back to where we should be, which is, this is a safe and appropriate treatment for lots of very good reasons, and try and reverse the damage that’s been done and the many people that have been negatively impacted through that change and that, to me, is a huge positive. It’s it’s been a big bee in my bonnet. It’s driven in part by Martin McCary, who referenced this in his book blind spots, which was published before he came in as the FDA commissioner. He published a book prior to that, which covered a lot of the challenges in medicine. I’m excited about this. I don’t know it. I know there’s lots of criticism of the administration and things that are going but this is this, to me, is a good thing.
Craig Joseph
Yeah, I don’t I You did a great job in discussing that. I don’t have much to add. You’re
Nick van Terheyden
not going to disagree with me. And I know, I know. I’m sorry, but, you know, I do. I’ve got bias in this. I just it’s been an outrage to me that we’ve done this disservice to people, and I hear it from the general population, even some folks, when I bring this, oh no, no, that causes cancer, and there is a small increased risk based on the data, but based on what we know, the benefits vastly outweigh except in certain circumstances. And this is all something you should have, but you should have an intelligent, informed discussion with somebody who’s willing to take you forward with this. And that’s not been the case, and I’m hoping that’s what it will drive but Okay, so my, my, my diatribe is over. Well,
Craig Joseph
it’s fair, and it’s kind of like we were talking about with ear infections with children. Let’s steer this back to my area of specialty, HRC for peds. No, it’s It’s like you. Just said benefits versus risk. There is if someone says, Hey, I want this therapy, as long as it has zero risk. Hey, it doesn’t exist. Whatever that therapy is, whatever we’re talking about, there’s nothing with zero risk. There’s there’s risk for you walking out to your mailbox to get the prescription in the mail, right? There’s all there’s risk. And so there’s always going to be some risk, but does that risk? Is it outweighed by the benefit? And that’s really what we’re all talking about, right?
Nick van Terheyden
Well, I would just encourage listeners, and hopefully this, along with the push on the part of the commission, to really move, move move the thinking around this in a positive direction, to really sort of think about this slightly differently and open up to what I believe the evidence suggests, which, you know, for a lot of women entering menopause, if it’s appropriate, it’s entirely safe, and the balance of risk versus reward is very much in favor of the reward. All right, moving on. So we’ve got open evidence. I know you’re a big fan. I actually am a fan. I don’t use it as much as I probably should, but I’m grateful for the fact that I do have access, and they actually treated me like a real physician who does practice medicine, although some people believe that that’s not the case, just because I graduated from a foreign medical school, but I am licensed in more than one country, which can’t be said for everybody, but that country doesn’t include the United States of America, but they accepted my license, which I’m grateful for, because it gives me access. But I know you’re a big fan, so tell us about it and tell us what’s going on.
Craig Joseph
Well, open evidence is a private company that created a large language model and AI like chatgpt. Kind of looks like chatgpt, but it’s based solely so I’m told it’s based solely on the medical literature. So they’ve gotten licensing agreements from many, many publishers, and have loaded their knowledge base with articles and textbooks and those kinds of things that are, of course, not always right, but are the same sources that practicing physicians use and are taught in medical schools and residency. And so you can interact with this just like chatgpt. So I can ask a question and say, I have an I can put in, as we’re certainly not supposed to put in personal health information, but I can say, hey, I have a 55 year old male with a past medical history of this who now presents with these signs and symptoms, I’m thinking that he might be in congestive heart failure. But are there other things I should be concerned about? And you can literally just type those words into it, and it will come back to you with a conversation, just like chatgpt would. One of the two big differences. One is it’s not based on what it’s read on the internet, right? It’s based on an information that’s fed from the literature. So that’s much more authoritative. And two is, it’s referenced. It’s referenced, which means that when it says 32% of patients like this have you know, congestive heart failure. You can see where there’s going to be a little footnote, a little number at the end of that sentence, and I can click on it, and it’ll take me to directly. Yep, it’ll take me directly to that article. And so, so we’re and then I can
Nick van Terheyden
read that. Can I just ask a question here? Because I have used it, but I’ve not, sort of dived in, but I love that aspect. But when you click on that article, do you actually get to see it, or does it still sometimes, no behind a paywall
Craig Joseph
it? Well, it actually just so if, if I’m recalling correctly, the way it works now is actually you click on it, it takes you to the bottom of the right the chat, where you’ll see a list of all of the footnotes. And then you can click on that. I think it takes you to takes you to PubMed, right, which you can see the abstract. And then from PubMed, which is from the government that I think the Library of Congress puts that out, I can click on it, and then I get to the article. Your point very well being is, hey, if the article is behind a paywall, yeah, you still, I still can’t read it, but that’s not, I mean, that’s not their fault. That is not their fault.
Nick van Terheyden
That’s a whole separate idea.
Craig Joseph
They have a license to read it. Yeah, I don’t have, and
Nick van Terheyden
I think that’s also an important differentiation. They paid for this, as opposed to went screen scraping around the US. So I it’s a cool space. And, you know, all credit it was, I think it was a non physician that sort of, you know, created this. And, you know, he’s a chat. MD, I think was the big article that sort of talked about this, you know, very cool. I’m, I. If you haven’t, I would highly encourage you.
Craig Joseph
But, and there are others, there are others besides, yes, so let’s just put this out there. They’re one of the big players, but there are other vendors that are creating this, a similar service, right?
Nick van Terheyden
But on that, I mean, one of the things that we’re seeing increasingly, and you know, a number of articles. And you know, I’ll call out Graham Walker. I love reading what he puts he’s, you know, thoughtful about this. He talks about some of the AI pieces. And you know, as he rightly stated, a confident lie usually wins. And you know, one of the challenges with these llms and AI in general is that they’re sort of pushing out. And there’s this, these errors or incomplete, miss, disinformation, even a question. I don’t know if you saw it, but just recently, there was a an article for one of the repository coding tools, and it went berserk and essentially lied and then deleted things behind the scenes, even though it was told not to, and it tried to cover its tracks, which is just highly concerning, especially if you’re a coder, obliterate everything that you’ve Been working on. But it’s this over trust issue. And what do you think
Craig Joseph
it’s I would not blindly trust anything that a large language model or an AI told me period.
Nick van Terheyden
And thought you did. I thought everything you produced was coming right out of that stuff. I
Craig Joseph
didn’t say that everything I produce does not come from it. I said that I wouldn’t trust so you as as as we’ve described, to assess the output of of anything, whether it’s a journal article written by human or something that comes
Nick van Terheyden
from something put out of our mouths, right? I mean, absolutely it can.
Craig Joseph
You know it can I can tell you what I what I think about how a well designed house should, should act, but an architect and an interior designer are probably much better.
Nick van Terheyden
I’m sorry. I’ve got to insert in here my best friend. He was also my best man. Was an architect, and at the wedding, he was horrified when I shared with the audience that one of the houses that he designed and built slid into the ocean. Yeah, that’s even the experts get it wrong. But anyway,
Craig Joseph
well, I yeah, I My point being, it’s all you know, if you’re going to put out a suggestion about how to deal with ear infections, it’s, it’s, it’s, you need a pediatrician or an ear, nose and throat doctor to assess that right to really tell you whether that’s true or not. And your point is, if you’re not an expert in the area, chatgpt and other large language models make it sound really good, whatever it is, it sounds really good. And it may be true or it may be completely false, or more likely, it’s, you know, true ish, mostly true, mostly
Nick van Terheyden
Well, yeah, and you know, that’s the thing. I think it’s worse than that, in my view, which is when you know nearly true, or it’s trying to guess, or whatever. But what bothers me is when it completely out and out, makes stuff up that is entirely convincing. And what all this feels like to me is a technical version of Dunning Kruger. Yes. Is that not a fair comment? Yes,
Craig Joseph
yes. And and Dunning Kruger? Is that that theory? It’s
Nick van Terheyden
probably a law that is. The hell that’s a theory. That’s a fact. I’m just gonna say,
Craig Joseph
the more knowledgeable you are, this is what the Dunning, the DK theory. The more knowledgeable you are, the more you know very you realize you know very little, yeah, and the less knowledgeable you are, the more you feel like you know everything. So
Nick van Terheyden
just talk about your teenager pressed I am that you call it the DK theory. DK,
Craig Joseph
I like that. But just think about a teenager. They are an expert in everything. They know more than everyone, right? But as you get older, you’re like, Ooh, I guess I really didn’t know all that much at that time, even now, even now,
Nick van Terheyden
I I was big into T shirts and, you know, creating my own and when, when all of the capabilities came that you could put things on the t shirt that I made that has, still to this day, has the most comments as I walk around wearing it is, I don’t need Google. My teenagers know everything. And I get so many parents. Oh, that’s great, you know. And quite often it’s in airports and they’ve got children in tow, and they’re
Craig Joseph
done in Kruger.
Nick van Terheyden
I need to update my T shirt collection, but I need a dk. DK. Unfortunately, we find ourselves at the end of another episode. Of exploring health care’s mysteries before they became your emergencies, until next time, I’m Dr Nick
Craig Joseph
and I’m Dr Craig do.
