National Academy of Medicine

And so we decided, oh, what if we do a little riff on that and call it Your Good Death? And the more I embraced that, the more I really liked it.

So one thing I did in the book was to write about what did the Greeks and Romans have to say about a good death? What do Native Americans have to say? I'm kind of trying to bring it up through different spiritual, cultural, historical contexts, um, sort of bookending it with the Institute of Medicine today and what they think a good death looks like.

Um, and then kind of underscoring for the reader, but like what it looks like for you is going to be very specific to you.

So the challenge, I think, for each of us is to think about what our individual priorities are, what quality of life looks like to us, what our specific situation is.

You know, so I think those recommendations aren't going to change for the right now, we may get some different recommendations for fat and different types of fat.

But I would say at this point, the RDAs can only be changed by the Institute of Medicine committees, not the dietary guidelines.

So it is still 0.8 grams of protein now.

And remember too, as you look at different ages during growth and development, pregnancy, lactation, children, there are higher needs.

One of them was to...

Not a NHTSA thing, but they had put my name forward to be on the Institute of Medicine report on civilian and military trauma systems and how we can better mesh them together so they learn from each other.

But the one that was really distinct was this one on lights and siren because I was basically asked to author a – monograph a white paper or whatever you want to call it on um the use of lights and siren by ems and you are right uh retu it was that was a major lift because um in the way uh and and they really um gave me free reign to do it however i liked but um I ended up wanting to make an annotated bibliography of everything that we could find out there related to the use of lights and sirens.

From, you know, from trade journal things to books.

He spent decades researching endometriosis, has published more than 400 papers on the topic.

served as president of the American Society of Reproductive Medicine, and was elected to the National Academy of Medicine for his contributions to the field.

He's also the first author on the trial that led to the first oral GnRH antagonist approved for endometriosis pain, work that's changed how we treat our patients every day.

Today, his lab is behind some of the most exciting new diagnostic research out there.

Now, that will very likely reduce systolic blood pressure by five to six millimeters of mercury in somebody who already has hypertension.

But that also, at least according to the most recent meta-analysis I've seen from the Institute of Medicine, also increased all-cause mortality.

So we have to be a little bit careful there.

There's some evidence that increasing dietary potassium, so eating potassium-rich foods, bananas, potatoes, things like that, and not doing this through supplements, by the way, 'cause you can sort of get into a bit of trouble there, but can lower blood pressure based on the relationship that we see between potassium and aldosterone in the kidney.

So there's a couple of things I want to talk about, but I want to start with an event which absolutely rocked me at the core.

Remember I was talking about I worked with Dr. Andy J. Morris? So the Institute of Medicine put out a call in 1991.

They wanted people to send in proof of vaccine reactions.

He worked with me together on the nature and frequency of adverse reactions for the hepatitis B vaccine.

But, you know, when you've gone for a couple of years and you've put everything together and you've presented this much data.

Yeah, read out the title and who published it.

Adverse events associated with childhood vaccines, evidence bearing on causality, Institute of Medicine.

Right.

So the diet needs to, of course, meet the fetal growth requirements and particularly the brain requirements because they rely solely on glucose.

And the Institute of Medicine has actually calculated out that in order to meet the pregnancy requirements of the mother, as well as the fetal brain development requirements, that women need a minimum of 175 grams of carbohydrate a day to meet the energy requirements needed.

Now, people have viewed that potentially the Australian Guide to Healthy Eating is too much carbohydrate for women with GDM.

However, it's not the core food groups that the average pregnant woman is eating too much of.

So this does suggest that we need to not only treat blood glucose levels but also manage maternal weight gain.

in pregnancy to prevent adverse outcomes.

So what is healthy maternal weight gain in pregnancy? Well, I'm sure most of you are aware of the Institute of Medicine maternal weight gain guidelines, which indicates how much weight should be gained according to the pre-pregnancy BMI, where the higher the pre-pregnancy BMI, the less needs to be gained in pregnancy, because of course the fetus can use the stored energy to grow.

Now, there are many clinicians who view, again, these weight gain guidelines as being excessive in GDM.