The People's Pharmacy

Breast cancer is the most common cancer affecting women, while prostate cancer is the most common for men. In 2022, the CDC found that approximately 255,000 men got a prostate cancer diagnosis. The same year, doctors diagnosed nearly 280,000 women with breast cancer. Breast & prostate cancer affect different patient populations and different parts of the body. Nonetheless, doctors have found common themes in diagnosing and treating these malignancies. We’ll learn how they are changing the odds.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, October 31, 2026, through your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Nov. 2, 2026.

Changing the Odds Against Breast & Prostate Cancer

Over the course of a lifetime, one in eight American women will get a breast cancer diagnosis. The odds for prostate cancer in men are similar. So are the chances of dying from these conditions: one in 43 women die of breast cancer. One in 44 men die of prostate cancer. How are oncologists changing the odds to improve survival from breast & prostate cancer?

Better Screening

The first step in controlling a condition is diagnosis. Screening techniques for breast & prostate cancer differ because breasts are easier to image. That’s why doctors prescribe mammograms to detect early signs of breast cancer.

Screening for prostate cancer starts with a blood test for prostate-specific antigen (PSA). Although it is imperfect, middle-aged men should find it a fairly easy first step. If the PSA turns up something alarming, doctors will probably proceed to order imaging, in this case an MRI of the prostate. An MRI reveals prostate tumors with greater accuracy than the old-fashioned unguided prostate biopsy could. A biopsy may still be needed as part of the diagnosis, but it is more likely to be guided by imaging, either MRI or ultrasound, than in previous decades.

Screening Controversies

Over the past few decades, public health experts have scrutinized screening in an effort to limit overdiagnosis. For several years, the United States Preventive Services Task Force (USPSTF) advised doctors against ordering PSA tests for men without symptoms. However, that approach led to more men being diagnosed at advanced stages of prostate cancer. These are more difficult to treat effectively. Now, men diagnosed with an early stage of cancer that does not require urgent treatment may be offered active surveillance. They are screened on a regular basis, and if the cancer starts to progress, the doctor offers surgery, radiation, chemotherapy or other treatment.

Mammography has also seen some controversy. Sometimes doctors disagree about when women should have their baseline mammogram and how often these should be done. Dr. Anders treats breast cancer patients. She recommends women start at age 40 and undergo mammograms every year.

Causes of Breast & Prostate Cancer

When we asked our guest experts about the causes of these cancers, they suggested that diet and lifestyle contribute. They also emphasized the importance of genetics. BRCA1 and BRCA2 gene mutations are well known for their role in elevating the risk for breast cancer. In addition, about 12% of men diagnosed with stage IV metastatic prostate cancer have a BRCA mutation. These genes also raise a person’s chance for ovarian or pancreatic cancer as well as melanoma.

Treating Breast & Prostate Cancer by Blocking Hormones

Both cancers are fueled by sex hormones. Many breast cancers (though not all) respond to therapies that block estrogen and/or sometimes progestogen. One example of such a medication is tamoxifen, a selective estrogen receptor modulator. Hormonal therapy for breast cancer might include a multiyear regimen of aromatase inhibitors such as letrozole, which block cells from manufacturing estrogen. Other treatment options include PARP inhibitors, which block DNA repair in actively dividing cells found in tumors.

Doctors frequently treat prostate cancer by blocking androgens such as testosterone. One exciting (though pricey) new therapy uses a radioisotope to target prostate-specific membrane antigen. This is an entirely different protein from the PSA used in screening for prostate cancer. It appears to extend life expectancy of men with advanced, metastatic prostate cancer by about half a year.

Preventing Recurrence

People who have completed treatment for either breast or prostate cancer will readily describe the sensation that they are living under a sword of Damocles for several years afterwards. What can people do to reduce the risk for recurrence? A healthful diet without plastic or chemical exposures is key. A Mediterranean-style eating plan seems to work well for many people.

Research indicates that physical activity can play an important role. Unfortunately, the insurance companies that compensate people for cardiac rehab have not yet seen fit to reimburse for cancer rehabilitation. That is despite the quite modest cost of prescribed exercise when compared to treatment for a recurrence. Social support, especially for breast cancer patients, is another crucial pillar.

Bone Health After Treatment

Bones use hormones to maintain their strength. Consequently, hormone-blocking therapies for both breast & prostate cancer can weaken bones and put patients at higher risk for osteoporosis. Unfortunately, administering these hormones creates a quandary–how much and what form of estradiol for women will strengthen bones without triggering recurrence? Likewise for men, there are questions regarding the safety of testosterone. It may strengthen bone, but it may not be safe for every man who has been treated for prostate cancer.

This Week’s Guests

Carey K. Anders, MD, FASCO, is Professor of Medicine in the Division of Medical Oncology at Duke University Health System. She is Director of the Duke Center for Brain and Spine Metastasis, Associate Director of Clinical Research and Translating Duke Health Scholar at Duke Cancer Institute & Duke University Health System.

Dr. Carey Anders, Division of Medical Oncology, DUHS
Photo by K. Huth

Andrew Armstrong, MD, is the George Barth Geller Distinguished Professor for Research in Cancer. He is Professor of Medicine at Duke University School of Medicine and Professor in Urology, Professor in Pharmacology and Cancer Biology, and Professor in Pathology. Dr. Armstrong is a Member of the Duke Cancer Institute.

Dr. Andrew Armstrong

Listen to the Podcast

The podcast of this program will be available Monday, November 2, 2026, after broadcast on Oct. 31. You can stream the show from this site and download the podcast for free. In this week’s episode Dr. Armstrong describes what to do if the PSA test is high and how to manage an increase in PSA over time. Both doctors mention that patients are interested in ivermectin, but clinical research is lacking. You can learn more about ivermectin and cancer at this link.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

We are only about a month into fall, but flu season is already underway. Today we are considering the best actions to take against winter infections. First, however, we asked our guest expert about measles. There have been large outbreaks in so many places this year. Why is measles such a big deal? One reason is that measles induces “immune amnesia,” so that our bodies forget how to fight off infections they have previously overcome. The MMR vaccine for measles, which prevents infection extremely well, does not have the same deleterious effect on the immune system. Consequently, vaccinated people maintain their protection not only against measles but also against polio or diphtheria if they have gotten those immunizations.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, October 24, 2026, through your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Oct. 26, 2026.

What Really Works Against Winter Infections?

Our guest, Dr. Roger Seheult, is certified in pulmonary and critical care medicine, as well as internal medicine and sleep medicine. So he is eminently qualified to tell us how to prevent and treat respiratory infections that are so common in the wintertime. We asked him why these problems are so prevalent in winter. He suggested that lower levels of humidity, temperature and sunlight might all play a role. When we asked whether the phenomenon of people gathering from across the country for Thanksgiving and Christmas might be important, he pointed out that Australians also gather for Christmas and New Year’s. Yet their flu season does not coincide with those holidays, but rather with their wintertime in June and July. Limited sunlight might be far more relevant than most of us imagine. The immune system is more active when exposed to sunlight.

As with measles, where the immune amnesia is a serious lingering problem, the consequences of many winter infections can go far beyond coughing and sneezing. More people die from heart attacks during flu season than at other times of the year. In fact, there are more cardiac deaths than deaths from influenza. Other infections also have deleterious impacts on the rest of the body systems. As we learned during the pandemic, COVID-19 can trigger diabetes. Consequently, we ought not dismiss these infections lightly.

Testing for Winter Infections

In the hospital, when Dr. Seheult and his colleagues admit a patient, they test to see what type of infection has made the person so sick. Most of the usual infections produce similar symptoms: cough, congestion, runny nose, fever, wheezing and body aches. Body aches are more common with influenza than with colds, but there is a significant overlap in symptoms that makes it hard or impossible to diagnose based on clinical appearance alone. To treat inpatients, doctors first test them. The test will reveal quickly which of 13 different viruses have made the patient ill. Sometimes, more than infection is contributing to the misery. While we do not have access to such sophisticated tests at home, we can purchase tests that will identify COVID-19, influenza A and influenza B. Knowing what infection is causing trouble can help a doctor prescribe a treatment, if there is one.

Treating Respiratory Infections

Once the physicians have identified the cause of the infection, they can determine if there is a treatment. There are a few for influenza A. Perhaps the best known is oseltamivir (Tamiflu). However, while Tamiflu have been shown to shorten the duration of the flu, Dr. Seheult cautioned us not to expect too much. Taking Tamiflu can shorten the duration of the flu from about a week to roughly six days, on average.

For many other infections, we do not have effective treatments. Influenza B, for example, does not respond well to Tamiflu. There are no treatments for infections like human metapneumovirus either.

Tapping the Power of Fever

What people often do in such cases may be counterproductive. Very often parents give their children acetaminophen to bring a fever down. Adults may take an NSAID such as ibuprofen or naproxen, or perhaps they too will take acetaminophen. That is a mistake because fever is part of the body’s natural defense against infection. Instead of suppressing a fever–as long as it’s not too high–we should consider augmenting it.

In the 19th century, doctors prescribed balneotherapy, in which the patient is draped with hot wet towels or actually immersed in hot water. An early Nobel Prize went to a physician who cured neurosyphilis, a dangerous bacterial infection, by infecting patients with malaria, which produced a high fever. Once the syphilis had been eradicated, the malaria could be treated.

In the 1940s, medicine shifted from this labor-intensive approach to utilizing aspirin to lower fever and penicillin to fight bacterial infections. The motivation was not that aspirin is more effective. Rather, it is far more efficient for nurses to administer a medication than to spend half an hour heating up wet towels and applying them to a patient. You can do this at home if you are careful to avoid burning yourself or the patient. A hot bath or a sauna can boost the body’s defense against winter infections. Of course, if you are sneezing and coughing you will need to take care not to contaminate the air for anyone else who might be using the sauna. You should also take care that the hot water treatment does not lower blood pressure unexpectedly.

Calming a Cough

The cough that accompanies a cold or other infection can be very annoying, keeping the patient and anyone else in the vicinity awake all night. We asked what to do in this case. Dr. Seheult suggested checking if the cough is bringing up phlegm. If so, the doctor might need to check for a bacterial infection.

If the cough is not bringing up phlegm, it might be due to a post-nasal drip in the back of the throat. In that case, nose spray might be the best treatment. Fluticasone (Flonase) or azelastine (Astepro) are both available over the counter. Azelastine has the further distinction of being able to reduce the risk of contracting COVID-19. If neither of those works, the doctor may prescribe Tessalon Perles (benzonatate). These should be swallowed, not chewed or sucked. They contain an anesthetic that numbs the cough center and should offer relief.

Preventing Winter Infections

Step Outside

Considering the limitations on treatment of these nasty infections, we asked Dr. Seheult about prevention. The top of his list might be a surprise: spend 15 minutes outside early every day to get natural light. Even if the day is overcast or rainy, the amount of light available outside is far greater than what we can manage indoors. Moreover, following this practice early helps set the circadian rhythm for better sleep in the evening and a stronger immune defense throughout the day.

Healthy Hand Hygiene

Some infections are transmitted through droplets or even tiny aerosols that a person emits while coughing or sneezing. If you must be exposed to an infected person, wearing a high-quality mask with a tight fit such as an N95 would be prudent. But good hand hygiene always make sense. We discussed the touch screens that have become so common in public places including pharmacies. They may not be disinfected regularly, and many people touch them and leave their germs behind for you to pick up. Frequent, thorough hand washing after touching a screen, a doorknob or a shopping cart is a rational precaution.

Supplements to Maintain Good Health

Dr. Seheult takes n-acetylcysteine, also known as NAC, throughout the cold and flu season. He takes 600 mg twice a day. Another supplement he uses himself is quercetin. Of course, we also asked about vitamin C. He responded that he takes it only if he comes down with something. It works better to speed healing than to prevent infection.

Hot and Cold

Research on sauna bathing shows that exposure to heat and then abrupt cooling can strengthen the immune response. Most Americans don’t have ready access to a sauna bath. But we can mimic the effect by taking a hot shower and following it with a cold rinse.

Vaccine

You will not be surprised that vaccination is also on the list. There are no vaccines for many winter infections, including those we refer to as the “common cold.” But people who get vaccinated against influenza are also protecting themselves against cardiovascular complications and lowering their future risk for dementia. An additional motivation for some people is to protect the infants and toddlers in their lives. Babies do receive vaccines, but they spend a good part of their first year vulnerable to infections. Their immature immune systems cannot protect them, so it is important for family members and friends to get vaccinated so they don’t inadvertently expose the child to a potentially deadly condition.

This Week’s Guest

Dr. Roger Seheult is an Associate Clinical Professor at the University of California, Riverside School of Medicine. He is also an Assistant Clinical Professor at the School of Medicine and Allied Health at Loma Linda University. He is quadruple board-certified in Internal Medicine, Pulmonary Diseases, Critical Care Medicine, and Sleep Medicine through the American Board of Internal Medicine. His current practice is in Beaumont, California. He is a critical care physician, pulmonologist, and sleep physician at Optum California.

Dr. Seheult lectures routinely across the country at conferences and for medical, PA, and RT societies. He is the director of a sleep lab and the Medical Director for the Crafton Hills College Respiratory Care Program. He is co-founder and presenter for MedCram.com, a site that offers concise and easy-to-follow medical videos on a range of topics.

Roger Seheult, MD, MedCram, Loma Linda, UC-Riverside

Listen to the Podcast

The podcast of this program will be available Monday, October 26, 2026, after broadcast on Oct. 24. You can stream the show from this site and download the podcast for free. This week’s episode includes a discussion of the proper doses for vitamin C and quercetin.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Do you run out of go-power in the middle of the morning? Maybe you find it hard to focus and your ability to call on your memory is strained. Or perhaps you suffer from an after-lunch slump. Some people find that their brain fog is troublesome most of the time. While there are some medical conditions that produce brain fog, you just might find that changing what you eat could help your mental clarity and reduce brain fog.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, October 17, 2026, through your computer or smart phone (wvtf.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Oct. 19, 2026.

How Could Eating Better Reduce Brain Fog?

Our guest, Dr. Uma Naidoo, is a leader in nutritional psychiatry. She found in her practice that what people eat can make a big difference for their mood and even their cognition. Breakfasting on coffee and donuts is often a preamble to needing (not just wanting) a coffee break mid-morning. Evidence has been growing that people may perform differently depending on the type of breakfast that they had. This could well vary from one person to the next. Some thrive on a bowl of steel cut oats with yogurt and berries, while others notice that it doesn’t carry them through the morning. Dr. Naidoo suggests that in most cases a low-carb breakfast with plenty of protein will serve us better than the typical Danish and coffee.

The Impact of Sugar on Cognitive Health

A fascinating study published earlier this year demonstrated the surprisingly persistent effects of consuming sugar. The investigators took advantage of a natural experiment occasioned by the rationing of sugar during and after World War II (NPJ Aging, July 22, 2026). They compared people born between 1951 and 1956. Some of these were exposed to sugar rationing only while in utero, some were exposed to it in utero and up to age two, while the third group was conceived and born after sugar rationing had stopped.

Those babies are now in their 70s. Those with their first thousand days under sugar rationing have dramatically lower risk for developing dementia–a 27% lower risk for any type of dementia and a 46% lower risk for Alzheimer disease. We don’t have any studies showing that limiting sugar in adulthood can benefit the brain in the same way, but the evidence we do have suggests eating less sugar might reduce brain fog.

Is Your Medicine Causing Brain Fog?

When psychiatrists prescribe pills to treat depression, anxiety or other mental illnesses, they are aware that one of the effects might be confusion or lack of mental clarity. These are not the only types of medication that can cause trouble, though. Many people rely on over-the-counter sleep aids night after night. Nearly all of these contain diphenhydramine (DPH) as their active ingredient.

DPH counteracts the activity of a neurotransmitter called acetylcholine. As a result, pharmacologists classify it as an “anticholinergic” drug. Even by itself, but certainly in combination with other anticholinergic medicines, DPH can lead to brain fog. If you are interested in exploring what those other anticholinergic drugs are, you will find a list here.

The Insomniac’s Dilemma

Many people who frequently have trouble sleeping feel like they’ve been put between a rock and a hard place. To function at their best, they need adequate sleep. But the sleeping meds they rely on, whether they contain DPH or a Z drug like zaleplon (Lunesta), zolpidem (Ambien) or eszopiclone (Sonata), may lead to next-day fuzziness or eventually chronic brain fog. When possible, lifestyle measures such as early-morning light exposure, vigorous exercise during the day and avoiding caffeine after midday might help a person avoid this difficult dilemma.

What Diet Is Best to Reduce Brain Fog?

If you want to improve your mood and mental alertness, what diet should you choose? Recently, we spoke with a nutritional psychiatrist who is enthusiastic about a ketogenic diet for treating anxiety or depression. Dr. Naidoo says a thoughtful approach can allow for a keto diet, or a paleo diet, a vegetarian diet or a vegan diet. The keto diet can be effective, but it requires a great deal of attentive management, which may be just too much for some patients.

It is very important that the diet be based on whole foods rather than highly processed foods. It should also be tailored to the individual’s cultural preferences. Doctors often recommend a Mediterranean diet because so much evidence points to its benefits. But other diets, such as a Nordic diet (in Scandinavia) or a North Indian diet (in Punjab, for example), can also be healthful within a cultural context (Journal of Clinical Lipidology, Nov-Dec. 2025).

Do Hormones Affect Brain Fog?

Many people are convinced that hormonal changes can contribute to brain fog. Some women find their focus shifts throughout the menstrual cycle. Others report increased brain fog as one of the troublesome symptoms of menopause. People who have experienced thyroid hormone imbalances have noted that their attention and alertness is diminished until balance is restored.

Favorite Foods from our Guest

We asked Dr. Naidoo about her favorite recipes. As a chef, she is very fond of the French tradition. She also loves the Indian foods she grew up with. One of her favorites is chicken tikka masala. Substituting tofu for the chicken produces a delicious vegetarian dish. She also recommended miso-glazed sweet potatoes and a kaleidoscope salad with multi-colored veggies. For dessert, she suggests an avocado-cacao mousse.

Utilizing Food as Medicine

Dr. Naidoo points out that the gut microbes begin to respond to dietary changes within 24 hours. However, it could take a week or more–up to a month–for a person to notice differences in how they are feeling. Some of her colleagues are quite interested in the opportunities to utilize natural approaches along with or in place of conventional medications. The theme of the 2025 annual meeting of the American Psychiatric Association was “Lifestyle for Positive Physical and Mental Health.” Moreover, Harvard Medical School is in the process of integrating lifestyle psychiatry into its curriculum, so future healthcare professionals are likely to be more open to this approach.

This Week’s Guest

Uma Naidoo, MD, is the founding director of the first hospital-based Nutritional Psychiatry Service in the United States. She is the Director of Nutritional, Lifestyle and Metabolic Psychiatry at Massachusetts General Hospital while serving on the faculty at Harvard Medical School.

Dr. Naidoo is also a professional chef, graduating from the Cambridge School of Culinary Arts and receiving the school’s most coveted award, the MFK Fisher Award for Innovation. She is the author of This Is Your Brain on Food and Calm Your Mind with Food. Dr. Naidoo’s new book, The Mental Clarity Diet: Sharpen Your Focus, Lift Your Mood, and Protect Your Memory with Food will be released in March 2027. Her website is: 
https://umanaidoomd.com/

Dr. Uma Naidoo, Massachusetts General Hospital

Listen to the Podcast

The podcast of this program will be available Monday, October 19, 2026, after broadcast on Oct. 17. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Neurological conditions have been increasing over the past several decades, but none more quickly than Parkinson disease. What is this disorder, and what is driving the increase? We’ll discuss symptoms people often miss and find out about treatments.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, October 10, 2026, through your computer or smart phone (wvtf.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Oct. 12, 2026.

What Is Parkinson Disease?

This movement disorder is named after the doctor who first described it in a publication in 1817. As we mentioned, it has become more common in recent years, so you may not be surprised to learn of numerous celebrities who have or have had Parkinson disease (PD). Michael J. Fox may be one of the best known because he has worked so hard to gain recognition that PD can affect people in their 30s and 40s. Of course, like most degenerative conditions, it is more common as people age. Parkinson disease is characterized by a relative lack of dopamine. The areas of the brain that would normally produce this crucial neurotransmitter stop making it, for reasons that are not completely understood.

What Dopamine Does

We need dopamine for proper functioning with regard to movement, mood, sleep, attention and memory. This explains why some people with PD may experience cognitive challenges or depression. The FDA approved levodopa (AKA L-dopa) in 1970. It is still a mainstay of treatment for Parkinson disease, often with carbidopa. This therapy is more helpful for movement symptoms than for the other aspects of Parkinson disease, however.

Symptoms People Often Miss

In the past, it wasn’t possible to tell how much dopamine the brain might be making. A person might search for years to get the appropriate diagnosis because symptoms people often miss weren’t noticed.

People do think of tremor as a primary symptom of Parkinson disease, but they may confuse it with essential tremor. The tremor of PD occurs when the person is at rest. For example, the hands may shake while lying in the person’s lap. Essential tremor is completely different and occurs while the person is active, such as applying make-up or putting on earrings.

Another common symptom of PD is slower motion. It may take longer to cook a meal or get dressed. That is because we need dopamine to move. However, under some circumstances, slow-moving people can move remarkably quickly. Joe has noticed this with a tennis partner, and other people have seen it in emergencies.

New technology called DAT spect scan (for dopamine tags) makes it possible to tell if the brain is producing dopamine. The doctor may also order a MRI to make sure that the problem is with the dopamine area of the brain and not caused by a stroke or a tumor. After a diagnosis is established, the doctor may ask the patient to perform toe-tapping and finger-tapping exercises to assess how they are doing.

How Do Doctors Treat Parkinson Disease?

When we asked our guest, Dr. Nina Browner, what is at the top of her prescription pad for PD patients, she told us it is not a treatment but a conversation. Understanding the person and what is important to them is crucial in guiding the treatment. For example, one of her patients likes to run with his grown sons. This is their way of connecting. For this patient, treatment to maintain mobility is key.

High-Intensity Exercise for PD

Research, specifically the SPARKS 3 study, has shown that after 17 minutes of vigorous exercise, the brain produces more dopamine. Consequently, the recommendation is to exercise beyond 17 minutes and then stretch to loosen the muscles. For best results, people with PD need much more exercise than other individuals; 30 minutes three times a day provides a good baseline. For even greater efficacy, people might increase their activity up to 150 minutes a day. They can benefit from a wide range of activities, ranging from bicycling to boxing, from tai chi chuan to ping pong, Zumba or dancing. The social aspects of ping pong and Zumba might be especially helpful.

Beyond Movement to Symptoms People Often Miss

Levodopa, the prescription drug used to replace the missing dopamine, helps improve movement but it does little or nothing for the symptoms people often miss. Dr. Browner may refer patients for other treatments, such as speech therapy. Digestive difficulties (especially constipation) are very common, although people may not necessarily associate them with Parkinson disease. Patients frequently need help dealing with that.

Another area that can pose challenges is sleep. People with PD may be prone to something called REM sleep behavior disorder. As a result, instead of being immobilized during a dream as most of us are, they may act out their dreams, kicking, punching or leaping out of bed. Needless to say, this can result in injury for either the patient or their bed partner. The doctor may prescribe clonazepam for some of these sleep difficulties.

Cutting Edge Treatments

People with Parkinson disease may benefit from a treatment known as deep brain stimulation. This surgical procedure implants wires into the part of the brain most affected by PD. The battery to power the stimulation remains outside the body so that it can be changed when necessary. Those who undergo this procedure often benefit for an extended time.

Another nonpharmacological treatment is focused ultrasound. This acts similar to surgery, but it uses sound instead of a scalpel. You can hear more about this treatment in Show 1462: Using Focused Ultrasound Against Parkinson Disease and Tremor.

This Week’s Guest

Nina Browner, MD, is the Bryson Distinguished Professor of Neurology at the UNC School of Medicine and Director of the UNC Parkinson Foundation Center of Excellence. A nationally recognized expert in Parkinson’s disease and movement disorders, she leads clinical, research and educational programs dedicated to improving care for people living with neurological disease.

Dr. Nina Browner, Bryson Distinguished Professor of Neurology at the UNC School of Medicine
Photo credit: UNC Health

Listen to the Podcast

The podcast of this program will be available Monday, October 12, 2026, after broadcast on Oct. 10. You can stream the show from this site and download the podcast for free. This week’s episode contains discussion of alpha-synuclein, an abnormal protein involved in Parkinson disease and Lewy body disease. We will learn more about Lewy body dementia and whether we should worry that taking L-dopa will reduce the body’s natural production of this crucial compound. We consider chemical exposure as a risk factor for PD and list some helpful resources.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Birth rates have been dropping for years. This is happening in many parts of the world, not just the US. Demographers estimate that women need to have 2.1 children, on average, to replace the population. (The US is currently at about 1.7 or 1.8 children per woman.) Where the average number of babies falls below replacement, the country may end up with more elderly people than children. Eventually, this can have economic and social consequences. In this episode, we explore the baby bust. Why is fertility falling?

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

How You Can Listen

You could listen through your local public radio station or get the live stream at 7 am EST on Saturday, October 3, 2026, through your computer or smart phone (wunc.org).  Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Oct. 5, 2026.

Why Is Fertility Falling?

Fertility in the US is at a historical low, according to our guest, Dr. Linnea Zimmerman. Whether or not this baby bust constitutes a crisis depends upon your perspective, however. Those who see young people primarily as eager working hands could perceive the economic effects of falling fertility as a future crisis. Others who worry that we are straining the ecological limits of the planet might view a decline in fertility more positively.

We asked Dr. Zimmerman about the sources of this baby bust, and she explained that the factors are complex. Although there will almost certainly be some economic consequences of a steep drop in fertility, economic considerations are also important for people considering parenthood. Housing is expensive, and so is childcare. Do they feel confident about their healthcare coverage?

It is not clear that the lifetime fertility rate of American women has declined as steeply as the statistics suggest. One good aspect of the current situation is fewer teenage pregnancies. In addition, many women in their 20s, when past generations would have been bearing babies, may be waiting until they feel more settled in their lives, or until they find a suitable partner to raise children with. This can take time.

Has Environmental Contamination Affected Fertility?

We asked Dr. Zimmerman if we could attribute fertility falling to exposure to environmental factors such as forever chemicals. While PFAS compounds are certainly not good for humans and should be avoided as much as possible, we don’t yet have evidence that they are contributing to a baby bust.

What Can You Do About Fertility Challenges?

We turned to Dr. Genevieve Neal-Perry to learn about what options people might have if they discover they need help conceiving. According to Dr. Neal-Perry, the available technology has improved greatly over the years, and fertility specialists are frequently able to help a woman conceive and carry the pregnancy to term. Moreover, many more people now have fertility benefits as part of their health insurance. In past years, this was much less common.

The source of a fertility challenge is not always obvious. Dr. Neal-Perry suggests that a third of the time, the difficulty lies with the female, a third of the time with the male and a third of the time with the combination. If a woman has endometriosis and is not ovulating, that would need to be addressed first. Men’s fertility begins to drop when they are in their 40s or 50s. Men who take testosterone may have lower sperm counts. In addition, people with very high BMI (40 or above) often have reduced fertility.

How Long Should You Wait for Nature to Take its Course?

Dr. Neal-Perry suggests that healthy women 35 and under could try for a year before seeking out assistance. Beyond that age, six months is a more realistic time frame. Women who plan to freeze their eggs for future pregnancy should also consider doing this while they are in their mid30s, as they have the best chance of retrieving viable eggs for future use at that age.

How Do Medications Affect Conception and Pregnancy?

Obstetricians do not recommend that people undertake major weight loss while they are trying to become pregnant. Although there has been some media attention to the phenomenon of “Ozempic babies,” we do not have safety data for GLP-1 agonists such as semaglutide or tirzepatide during pregnancy. In fact, a preconception review of medications a few months before beginning the attempt for a pregnancy is highly advised.

Interventions to Promote Conception

If the woman has intact fallopian tubes, intrauterine insemination may be helpful. It overcomes barriers that may exist at the cervix and helps the sperm unite successfully with the egg. If the fallopian tubes are not open or not present, the best option may be in vitro fertilization. The eggs are removed and inseminated in the laboratory (“in vitro” implies in glass). The embryos are incubated for the first few days of development. The doctor may then take tiny samples of the embryo to do genetic testing before introducing it into the uterus. As Dr. Neal-Perry put it, the implantation is “out of our hands.”

Throughout the fertility journey, from before conception to after birth, people are encouraged to continue their best health practices: following a well-balanced diet without junk food, getting regular physical activity and sleep, avoiding chemicals that may be harmful.

This Week’s Guests

Linnea Zimmerman, PhD, MPH, is an associate professor of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. Dr. Zimmerman studies family planning and women’s reproductive health, evaluates use and barriers to critical maternal and newborn health interventions. Her website is https://publichealth.jhu.edu/faculty/3046/linnea-a-zimmerman

Linnea Zimmerman, PhD, MPH, Johns Hopkins University

Genevieve Neal-Perry, MD, PhD, is Department Chair of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. She is the Robert A. Ross Distinguished Professor of Reproductive Endocrinology and Infertility.

Genevieve Neal-Perry, MD, PhD, UNC Chair of OB-GYN

Listen to the Podcast

The podcast of this program will be available Monday, October 5, 2026, after broadcast on Oct. 3. You can stream the show from this site and download the podcast for free. This week’s episode contains additional discussion on over-the-counter drugs to avoid during pregnancy and some possible treatments for the future.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.