Return to Healing: Common Sense Health Care

We grapple with the question many people ask: how do we age well, live longer, live better?  That is why many people go to the doctor, why they check their numbers and take medicines, why they buy that apple watch to monitor nearly everything!  But as we discuss, none of that is the ticket to longevity.  And is longevity the only barometer of aging success?  We argue it is not.We discuss that how long you live healthy and independent is, to most people, even more important than how long you live.  Independence, mental acuity, the ability to engage in activities and be with people important to you is part of what we call quality of life, and how long you can maintain that is crucial.  Our country does the worst in the world on that score.  While we have among the lowest longevity of industrialized countries, we have even a lower health-gevity, how long you can remain healthy.  Taking a medical path to wellness when you are old is often a way to make things worse.  We discuss why this is the case, and what's really important including your social interactions, your family, your diet, your mobility, and your happiness.  Drugs don't fix any of that, lowering your cholesterol and blood pressure can make those worse without helping you live a day longer, but paving a path towards wellness through your own devices is always the best way to go.  There is science behind this, and a lot of experience, and we'll lay it all out."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

AI in such mediums as Google, Chat GPT, and Claude is becoming a device through which doctors and patients can make diagnoses, prescribe treatments, and distill symptoms down to diseases.  If you are dizzy, what can be causing it, is it an emergency, how do you fix it?  What if you are having chest pain?  Are all your medicines necessary, can there be interactions?  In some ways AI can answer simple questions, but like most protocols and many doctors, it will typically suggest a conservative approach with more tests and visits, sometimes a trip to the hospital, because it cannot fully understand you as a person and the nuances of how your symptoms may not be diagnosable through the algorithms and the large studies it can access.  Primary care providers who know you well, who know the data well, who understand how to apply that data to you and how your symptoms may not fit in protocolized boxes, are far more likely to find the right diagnosis in conjunction with you.  That's something a computer or protocol or even physician-held calculator can't do.  This is why good primary care is not replaceable with AI.  We  run through several examples of this and show where AI is useful and where it can be lacking.  "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

The Trump Administration has elected to decrease the recommended vaccine schedule for children, and the political boxing gloves came out immediately.  The mere notion of vaccine reduction, and the fact it occurred in Trump's administration, made the issue a left vs right slugfest. But hold on, these changes have been suggested by some of the most prominent scientific minds in our nation, and they mirror what's already been done in Europe based on ample evidence.  They are not anti-vax; they promote certain vaccines with proof of efficacy and dispute the need to recommend others that do not.  Today we not only discuss the science of vaccination, and dispel the utility of their being anti-vax and pro-vax camps, but also go through many vaccine controversies and take our own fact-based center road.  Science should not be imbedded in politics and should not be driven by specialty medical societies and drug company ads.  We need sense, and every patient needs a good primary care provider to discuss what the internet and the media has turned into political infighting."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We are two primary care physicians with 75 years of collective experience. We both are passionate about what we do, we get to know our patients well, we dig into issues and don't accept protocol robotic medicine, we typically offer a counternarrative to specialists, we are patient-centric and believe that patients deserve the truth about illness and treatments (no matter how nuanced and messy that is) and that they should make the final decisions, and we stress wellness far more than over-medicalization.  But our way is being pushed aside in favor of a number-based, specialty-oriented, over-aggressive dogma that makes the patient into an asterisk and pushes tests/procedures/medicines over holistic changes.  More and more corporations and health systems are using nurse practitioners to create an illusion of primary care but whose real job is to make money for the hospital or corporation.  More and more primary care doctors are either creating concierge practices that can help just a few who have money, or are being squeezed into 15 minute visits that negates their true purpose.  And virtually no medical students pursue a primary care profession.  We discuss all of this in detail in our book Return to Healing, and here we provide experience, statistics, and insight into what's going wrong and how we need to fix it.  Without robust primary care we will keep paying for corporations, hospitals, and specialist doctors to spend more money without any improvement in health or longevity, as every study and all our experience has shown us."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Alan and Andy both lived through COVID not on the sidelines but in the center of it all.  Both took care of patients directly, Alan in a hospital for weeks at a time in the epicenter of the pandemic, Andy in multiple long term care facilities.  Andy also wrote a book about COVID communication and studied the virus and public health responses in other countries.  So what do we think about Anthony Fauci's leadership, and about the Congressional hearings?  Well, this is a 45 minute podcast, and we could have spoken for hours, so that's what we think about him.There are two issues we discuss.  One is whether Dr. Fauci committed criminal acts.  This is what he was being investigated for, and after being pardoned and then still pleading the 5th over 100 times, it is likely we will never know.  Clearly the nation deserves to know, and that may or may not happen.But to us, the second issue is more crucial.  Did he do a good job during COVID, and even more significantly, did he cause harm.  The United States suffered the worst outcome in the world during COVID; the most deaths from both the disease and from our response to the disease, a response largely orchestrated by Dr. Fauci.  Under his leadership Dr. Fauci dictated our response to COVID in an atmosphere that turned its back on science.  Dr. Fauci made multiple policy declarations automatically taken up by our nation's leaders, none of which had any scientific basis of reality, as we knew then, and we have truly come to terms with now.  He did not instigate a single scientific study nor did he take advice from other nations who were conducting research and opening their societies, all with fewer deaths.  He advocated censorship of those who disagreed with his policies or who suggested other policies.  And in the end, he did not educate doctors or the American public about how to best protect the most vulnerable from COVID, how to open society for those less vulnerable, and which drugs likely would rectify the manifestations of the virus (which we already knew about before the virus hit our shores but which he never advocated) and which were experimental.  Needless to say, Alan and Andy believe that his leadership during this crisis was non-scientific and dangerous.  And if we're going to learn anything before the next crisis, it is crucial we stop politicizing this man and his actions, and have a full accounting of his actions and what could have and should have been done differently.  Science is about discourse, study, disagreement, trying new things when what we're doing isn't working.  None of that occurred under Dr. Fauci's watch.So as we think about Anthony Fauci we must reevaluate what we expect from our medical leaders and from the medical system.  To us, it's not about him not remembering what color tie he is wearing, or even if he was responsible for the lab leak.  It's about our medical leaders and our medical system.  In these arenas he failed us miserably, as does our medical leadership on a daily basis."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We are hearing more and more about amyloid, a protein that can be deposited in the organs of humans and cause great harm.  Or is that too simplistic?  We now have very expensive and poorly tested drugs that will reduce amyloid load in the heart and brain.  Because the drugs are available, now amyloid has become testable and has reached a level of great importance.  But just how accurate is it that we need to look for amyloid in these organs and if we find it we must treat it with drugs barely old enough to have any validity?  Is amyloid really the cause of disease, or is it an innocent side product of that cause, or is it even a way for the body to protect itself?  We just don't know.  We do know that the one study showing its impact in heart disease was financed and designed by the drug company that makes the amyloid-busting medicine, and the study is so flawed that even we can tear it apart.  And we know that the drug that treats amyloid in the brain has never been shown to improve cognition but does cause a huge number of brain bleeds.  How do we assess new technology and new ideas in a scientific manner when specialist doctors and drug companies leap on them as being the next coming of God?  We'll discuss the facts we have and the uncertainly that exists, and show how amyloid is much like other miracles in modern medicine: the next great discovery until it's not.  The end of this podcast was struck with technical issues, so please pardon the abrupt ending!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

The cardiology community is quite adamant about their newest guidelines, whether it's about pushing LDL cholesterol below 70 or driving systolic blood pressure under 120.  The patient's age, wishes, symptoms, and even the full breadth of science behind these dogmatic declarations is irrelevant; protocols are above all that.  We will discuss the truth behind the dictate that lower blood pressure, especially once it slips below that magic threshold of 120, is  always helpful.  In fact, as most studies show, it's dangerous much of the time.  While guidelines reduce complex human beings to simplistic allorhythmia, some doctors are pushing back, and we will look at their critiques.  In this podcast we discuss why lower blood pressure is often the wrong choice, how the guidelines are more about pushing drugs than helping people, and why specialist doctors so often fall into the pit of treating people robotically rather than within the nuanced world of medical science that values care and compassion, that is patient-centric, and that is tempered not only by a few drug company studies by rather by the full spectrum of medical literature sprinkled with the lessons of experience.  That was Osler's message, and through the lens of hypertension we'll see how far off the rails our medical community has drifted."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

This week we discuss medical TV shows, such as House and the Pitt and Grey's Anatomy, as well as medical moments on non-medical shows.  Studies suggest that the message of these shows--the doctor as hero, the benefit of aggressive intervention, the fact that there is always a hidden diagnosis behind every complaint--is potentially dangerous.  It certainly feeds into the narrative that the medical industrial complex seeks to ferment, the idea that lifestyle changes are either useless or dangerous, and that a deep dive into high-cost health care will save your life.  "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

At the ADA Research Convention several members trying to pass out information were forced out after the police were called.  They were ADA leaders who wrote an editorial blasting the current Presidential administration for cuts in research funding.  Everyone agreed with their stance, just not their tactics.  The press labels this as censorship.  But is it?   The ADA is primarily funded and controlled by the pharmaceutical industry, the very industry that funds and sponsors the very research it seeks to continue.  It has historically pushed drugs over lifestyle, dispensing with any data that suggests that their policy statements are erroneous, which typically they are.  They invented prediabetes and are responsible for pushing normal sugars so low as to cause potential harm.  And if doctors question their views or provide contrary data--of which there is an ample quantity--they seek to suppress it.  So where is the medical censorship, and do we really care about a small scuffle between leaders of an organization that needs a real revolution to make it relevant to care."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Both Andy and Alan have been reported to their respective medical boards, both have had to hire lawyers, both have had to fight for their right to speak and to practice medicine.  The Board of Physicians is an extrajudicial entity, operating in each state to monitor and discipline physicians.  Most courts have said that doctors do not have the right to free speech or free choice.  Even if what doctors do and say is based on good data and their own experience, even if what they do or say is done is done to save lives or improve the medical system, if their actions or words clash with specialist and drug company protocols the doctor can be disciplined, censored, even lose his/her license to practice.  Such Boards were established at the dawn of modern medicine, intended to assure that all doctors follow the script written by the AMA and corporate foundations after the Flexner Report enshrined the AMA as the singular regulatory entity in healthcare.  During that time, doctors who, for example, did not endorse Eugenics or racial medicine could be disciplined, as too could all African American and women doctors.  Today's doctors are tied to a corporate-specialist orchestrated set of protocols that often fall in the face of good data or appropriate patient care, especially for older patients, but none of that matters to the Board.  Doctors have no recourse when the Board declares them to be in violation of specialty protocols, and most Board members are specialists.  This is yet one reason primary care doctors are handcuffed and often cannot use their common sense, experience, critical thinking skills, and research to care for patients, especially when such behavior challenges protocols.  Profits always trump patient care, and the Boards seek to assure that caveat is never challenged."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Alan and Andy work in different medical environments.  Alan works in one of the poorest neighborhoods in the county, one with many who are uninsured, undocumented, who have to work multiple jobs, who have limited food options, and who had the highest COVID mortality in the world.  Andy works in a middle class environment filled with tech-heavy white collared people, where good nutrition and exercise is common, smoking rates are among the lowest in the country, and the COVID death rates were extremely low.  In many ways, as Alan and Andy discuss, COVID put a microscope to how our nation's health inequities and profit-driven health priorities impact different people.  The haves tend to prosper, the have-nots are neglected.  Sometimes, as the Dartmouth Health Atlas shows us, the haves can be harmed by excessive specialization and medicalization; areas of the nation with the most specialists have a generally lower life expectancy, likely from over-reliance on doctors rather than lifestyle.  But the decision of our health care funders to finance high-cost low-yield medicine at the expense of health equity, nutrition, and basic care has led to a slanting of outcomes that is entirely preventable, where the have nots suffer from the very opposite problem: inadequate care and life style betterment.  We discuss how to fix this American made mess!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We reviewed what several physician podcasts have to say about the new cholesterol guidelines.  We spoke about the guidelines in our March podcast, and also discussed in a later podcast how the local cardiology group in Columbia Maryland reported Andy to the Maryland Board of Physicians in an effort to censor him or take away his license because he dared put published studies in his practice newsletter questioning the value of reducing cholesterol in the elderly, what they labeled as dangerous misinformation.  In this podcast we reviewed what some of these podcast doctors are saying, many of whom sat in scrubs as they insisted that lowering cholesterol is an absolute good without problems and will save lives.  Others questioned the guidelines and the value of measuring cholesterol.  We believe based on articles we have read and written that cholesterol is not itself a major contributor to heart disease, but rather is a substate that sticks to blood vessels and increases heart attack risk IF A BODY IS INFLAMED FROM SUCH THINGS AS A POOR DIET, LACK OF EXERCISE, STRONG FAMILY HISTORY, OR INFLAMMATORY CONDITIONS SUCH AS DIABETES and if they are young.  Lifestyle changes prevent heart disease, and statins can help in some people but not based on their cholesterol.  Studies done on older people have not shown benefit of lowering cholesterol and suggest that there is value in higher LDL cholesterol on longevity in people over 60 years old.  We discuss all of this and more!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

The Emergency Room can be life saving, but also can be a place to be feared.  We discuss several cases in which protocols and robotic thinking put patients in precarious positions, exposing them to unnecessary dangers, creating diseases where none exist, and base diagnosis more on tests that should have never been ordered rather than on a history and physical and common sense.We talk about two issues about which we have written articles.  By clicking the hyperlinks you can access the articles, which are at the bottom of the page in each case.  One is syncope, where someone passes out, and in which the testing commonly done in the emergency room and even hospital admission are both unnecessary and potentially dangerous.  The second is the use of a blood test called Troponin, which is supposed to be used to diagnose heart attacks in people who present with symptoms consistent with an MI, but when done on people without such symptoms has a 5% accuracy and 95% over-diagnosis potential, exposing patients to dangerous over-treatment and labeling."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We talk a lot about Big Pharma throughout this podcast but today we discuss its many tentacles.  Soon after making the podcast, Alan watched a hockey game and there was a drug ad on the ice!  The Pharma industry controls virtually all medical research; subsidizes medical schools whose "expert" physicians are dependent on Pharma funds to pay for their grants; finances and provides leadership for many respected institutions such as the FDA, CDC, American Diabetes Association, Alzheimer's Association, American Cancer Society, American Heart Association, and virtually every medical professional society; is one of the biggest doners and lobbyists in Congress; is (with Big Food) the top advertiser in the media, print, TV, and internet; is the biggest advertiser in medical journals and medical conferences; and of course regularly bribes doctors.  We speak a lot about these tentacles in our book Return to Healing, as does Gardiner Harris in his book No More Tears, as do so many health reformers, but the deep penetration of their financial power to manipulate our perception of what healthcare should be has become so normalized as to make it invisible.  Few doctors realize that the protocols they use, the calculators they dazzle patients with, the articles they read, the conferences they attend, the organizations they follow, and the "experts" they listen to are all tentacles of Big Pharma.  And of course, since Medicare is contingent on Congress to determine what it will pay for, and since Congresspeople are heavily supported by generous Pharma gifts, it's no wonder that the most expensive drugs are always passed by the FDA, endorsed by the CDC, and paid for by Medicare.  We will give a brief synopsis of this problem and a few ideas how to fix it."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

This week Andy was reported to the Maryland Board of Medicine by a local cardiology group because some studies he included in his practice newsletter offended them.  These were major studies, peer reviewed, but did not coincide with the dogmatic messaging they seek to spread, and thus they accused Andy of spreading dangerous misinformation.  They want the Board to silence him or take away his medical license, merely for sharing medical data with which  they disagree.  These cardiologists, as well as many specialists, practice by using protocols that are written by self-interested specialty societies and by drug companies.  Such protocols are usually buttressed by garbage observational drug company studies and do not include more robust data that gets in the way of their narrative.  Many specialists, including the local cardiology group that wants to censor Andy, robotically follow the protocols and denounce any study or doctor who dares question them.  But isn't science, isn't medical care, all about dialogue, divergent arguments, nuance, concern about the whole person rather than his/her organ of interest or numerical measurements?  Not according to the cardiologists, and we'll see if the Medical Board agrees.  But if we must simply be AI robots who obey flawed protocols and are punished for using our brain and common sense, what is healthcare becoming?  As Osler said: "The greater the ignorance, the greater the dogmatism." And as Einstein reminded us (likely thinking about the cardiologists who are so offended by facts and data that they seek to censor another doctor): "Great spirits always encounter violent from mediocre minds."  Sadly, in our system, the mediocre minds run the show!We also discuss a documentary Andy was in recently, and a link to that documentary is: https://www.theepochtimes.com/epochtv/video-series/healthcare-decoded-6006002?=epochHG"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Dementia tells us a great deal about our healthcare system.  Not even noted to be a disease at the time of Medicare's birth in 1965 it is now one of the most onerous and common diseases of the elderly.  Why?  And why is the incidence so much higher in the United States than the rest of the world?  We have tried to medicalize dementia and memory loss and created a multi-billion dollar industry around it including useless drugs, unhelpful tests, and far too many specialist visits.  But we've missed the point.  Dementia can't be prevented or treated by throwing money and drugs at it.  It is a disease of lifestyle, and only by improving inflammation through diet, exercise, and other lifestyle changes can we seek to prevent and mitigate it.  We'll discuss all of this in our podcast."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

As the medical community scripts new cholesterol guidelines, the media has compliantly announced that our nation's top scientists, most respected medical agencies, and academic centers want to prevent heart disease by screening for high cholesterol more aggressively and treating cholesterol more aggressively.  The geniuses who created the guidelines want screening and treatment to start even in 10-year-olds!  But there are flaws.  First, no new science is incorporated into the guidelines, and other than drug-company designed observational studies all randomized trials show no value to measuring and fixing cholesterol.  In fact, not only is cholesterol not a prognostic risk factor for heart disease, not only does lowering it not help heart disease, but in people over 60 and in kids/young adults high cholesterol portends better outcomes.  Second, the organizations that printed these guidelines are tainted and self-serving, seeking to push lower cholesterol levels not based on any likelihood of helping people, but solely to sell more drugs, create more office visits, and justify more testing.  The American Heart Association (AHA) is funded and led by drug companies; the American College of Cardiology also has strong ties to drug companies and has as its main objective increasing salaries of cardiologists.  Third, the academic doctors who put their name on these guidelines are a who's who of docs who conduct drug company research, research that pays their institutions.  We know that cholesterol is not worth measuring, especially in kids and elders.  We know that statins come with risks and should be reserved for people with high risk of heart attack and stroke who are over 25 and under 80, but are not helpful in people with high cholesterol.  And we know that pushing LDL cholesterol under 70 is frankly dangerous and medically negligent.  We will explain!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Depression is a very vague concept.  How do we determine if someone is depressed?  What does depression even mean, and how is it best prevented and treated?  The realities of depression veer sharply from how the medical industrial complex would like you to think about it.  They have designed screening tools and have incorporated them into the quality indicators required for all doctors to complete.  Then, of course, we have to treat those who test positive, typically with drugs.  And is that not the point of screening, to medicalize what is often normal emotional fluctuations in our lives, and then to sell people medicine?  We will discuss why such screening is flawed, why treatment is dangerous, and how we have all been sold yet another medical myth that profits many and harms many more."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Alan and Andy discuss why they are dinosaurs, why primary care is becoming extinct and why its disappearance will instigate harm to the health care system, to patients, to our national debt, and to reason and sanity in health care.  Talking about changes within the medical environment, they show not only why primary care is being left to die, but also the measures needed to revive it.  It's not hard, but any reasonable measures we as a society institute will run into the wall of profits derived from keeping the system dysfunctional.  "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

In the 1980's dermatologists were somewhere in the basement of the doctor world in terms of reputation and reimbursement.  It was always felt to be an easy job--not too much thinking, a limited scope of care, no after hours calls--but did not pay well  So the American Dermatology Association hired a publicist and some lobbyists in Congress and created a generalized fear of skin cancer, stating there was an epidemic, that annual skin screens would save lives, and that aggressively removing both cancers and precancers is necessary.  All the sudden it became difficult to even become a dermatologist and their incomes and reputations skyrocketed, with many earning $500,000 to $1,000,000 a year and still working less than virtually every doctor according to statistics.  Yes, despite all this surveying and slicing, skin cancer deaths have not dropped at all.  This has occurred simultaneously with the sunscreen craze, and now we are blocking our skin with substances that have not reduced skin cancer deaths but have likely increased sickness, including cancer, since sun hitting the skin is necessary for our immune system, and we are blocking that with all this toxic cream.  We will dissect the truth of skin cancer and the role of dermatologists, and tell you how you can best protect yourself not from the sun but from snake oil salesmen who have abused your trust."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We are always amazed watching TV.  What used to be ads for car companies, beer, clothes, products are not proliferated by ads for drugs and companies seeking to sell you drugs.  These companies, like Hims and Hers, are willing to provide you with drugs to help everything under the sun, whether your obesity, hair loss, anxiety, ED, or infections.  No need to see a doctor now, just get on line, chat with an AI doc, and buy the recommissioned drugs sold by the company, and you are all set.  Once again, drugs can be had on the cheap, real medical care evaporates in the wake of easy access, and more harm and cost flood the system.  Hear as Alan and Andy discuss this disturbing new trend in healthcare."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Few people realize how important nutrition is, and it's not all about weight loss.  You can lose weight and be less healthy because you are not eating food that will feed your gut bacteria, energize your muscles, and strengthen your brain.  This is occurring in a lot of people on fad diets and taking GLP-1's.  The newer nutrition triangle, which replaces one that was antithetical to health, places fats, fiber, and fruits/vegetables in their correct place as being the very lynchpins of health, with processed foods, sugars, and fake fats being the poisons we should minimize.  We all have our treats, and that's fine, but the key is to focus most of the diet on the good stuff.  The best diet is often the very opposite of what doctors tell you: it's high fat and high carb, and it's important to know how to chose the most quality fats and carbs and avoid the rest.  "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

The very landscape of organized medicine is being altered by corporate takeovers.  Whether in long term care, hospitals, or large groups, corporations are taking charge and offering "perks" that enhance the wealth of institutions, their leaders, and many specialist doctors, but take one more step in decimating primary care and focusing more on profits than patients.  Andy and Alan will explain why what these corporate vultures sell is appealing but ultimately dangerous and often lethal.  "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Antibiotics are one of the most impactful medical discoveries in the past century.  Along with sanitation and sterile technique, antibiotics have led to a dramatic increase in life expectancy.  However, now we have moved down a different road.  We are over-using antibiotics, killing our gut bacteria, causing resistance leading to superbugs that can't be stopped by any of our technology.  The judicious use of antibiotics is lifesaving.  The overuse of antibiotics is just the opposite.  Hear the two docs talk about this important issue!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Drug companies, the media, physician groups, and patient advocacy groups, month others, have convinced the American public that the key to health is more testing, more doctor visits, more drugs, more procedures.  We have invented more diseases and diagnoses the past decade, scared more patients into falling prey to "necessary and lifesaving" interventions for conditions that are more phantom than real, and yet no one is talking about what really matters.  In areas of the world where people live far longer than we do, and have far less chronic illness, they don't see doctors, take drugs, or suffer from fabricated diseases.  They eat well, exercise, and have strong communities, all of which contribute to their better health.  While our system is excellent at fixing urgent problems such as a ruptured appendix or heart attack, it is awful at keeping us healthy, largely because it has spread a false gospel that people are sick when they're not and that they need more of what our system has to offer, all of which contributes to the $5 trillion healthcare cost and simultaneous drop in life expectancy.  Today Alan and Andy discuss what really matters!  And it's not what your doctor will likely tell you!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Today we talk about the impact of drug advertisement on both patient and physician decision making.  These companies know that a huge investment in ads will result in more prescriptions, one of many ways Big Pharma infiltrates so many aspects of the medical industrial complex."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

With the opioid crisis looming on the horizon always, the question comes as to how to treat pain.  So many medicines have side effects an are overall dangerous.  Some work about as much as placebo.  We'll talk about medicines, but then discuss better ways to deal with pain, from mindfulness to exercises to other non-medical modalities.  Pain is real, but pain should not be an invitation to be smothers by medicines and the medical system.  We will help you through this!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We have always known about basic cancer screening tests, like mammography and colonoscopy.  But we have expanded the universe of cancer screening, relying on scans, blood tests, and genetic testing.  As we screen more, we find more, we treat more, but are we saving lives?  Much of the screening we do has not been shown to save as many lives as advertised, if any at all once the complications of the screening are taken into consideration.  A new study in JAMA questions some newer screening tests, and past studies in Archives of Internal Medicine have found that overall most screening is not life saving.  The new screens are even more perilous, introducing increased uncertainty to an already uncertain field.  It's interesting to read Malcom Gladwell's take on screening in the New Yorker, helping us to learn about the promise and perils of basic screening.  Alan and Andy will tackle this issue through the lens of their experience and a whole lot of data!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Many books and studies have pointed to the fact that we are a nation swimming in mental health diagnoses and drugs.  The DSM--the bible of mental health diagnoses--has exploded the numbers of mental health sicknesses you may have, and for every sickness there is a drug.  Both the DSM and the American College of Psychiatry are heavily funded by the drug industry, and their recommendations have led to a skyrocketing of drugs for the brain, without any reduction in depression, anxiety, hyperactivity, or any other common ailment; in fact, they are all on the rise.  We are exposing kids and elders to these drugs which are outright dangerous.  We'll talk about this disturbing trend and highlight some books and articles that may be helpful.  "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

The American Heart Association (AHA) has devised new blood pressure guidelines.  In this iteration, the AHA tell us that any blood pressure over 120 is dangerous and must be treated, with pressures over 180 requiring immediate hospitalization.  There is no age cut off, and no accounting for individual variability. That the AHA is highly dependent on Big Pharma for its financial coffers, and has on its leadership many ex executives of Big Pharma, likely helped trigger there anti-scientific and dangerous recommendations.  In fact, only one flawed study supports their recommendations, while dozens of others refute them.  We will discuss this through the lens of science and common sense, and we'll demonstrate why guidelines are often worrisome, and how these recommendations demonstrate the power of Big Pharma over medical care. "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

New studies show that as we are drugging our senior more, they are falling more and dying more from their falls.  We may think that dramatically lowering blood pressure and sugars, fixing cholesterol with statins, using blood thinners to prevent stroke, and medicating sadness are beneficial, but the pile of drugs we're tossing into elderly bodies to "fix" aberrant numbers is leading to more deadly falls.  We must turn our back on specialists who demand we must take so many drugs, and return to common sense and healing as a guide to treatment."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

In Return to Healing we lay out a very simple fix to the medical mess we are in.  We spend the first half the book explaining why it is a mess, and then the second half talking about who is profiting from the mess.  Then we give the fix.It's really very easy to repair a system that is simply off the tracks.  We lay it out simply.  This is one you don't want to miss!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Alan and Andy talk about how medical school does not prepare students to be whole-person doctors, focused on numbers and multiple choice answers and slices of the body.  William Osler devised an ideal medical school at Hopkins before the Flexner Revolt took it down.  In the Osler model students work with community primary care doctors from day one and throughout their entire medical school curriculum.  They see patients and then learn the science behind the diseases and aspects of health they present with.  We can easily fix medical school to produce doctors and not technicians, but it requires a knowledge that it is now very broken."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

As two primary care doctors with a collective 75 years of experience, we understand the benefits of having a primary care doctor who develops strong relationships built on trust, who customizes care to each patient, who takes a patient-centric and whole-person view of care, and who is critical thinker looking beyond the protocols and drug-company dictated "truths."  Multiple studies have shown that in areas with more primary care providers outcomes are better, people live longer, costs are lower, and patients are happier.  That is because we're not paid for doing things to you--tests, procedures, drugs--but rather are paid to take care of you.  We talk about how a primary care system would work."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

There is no question that primary care is dying in this country, much to the detriment of our entire healthcare system and every person who utilizes it.  We talk about an article called The Eulogy for Primary Care that talks about why it's dying and missed opportunities.  Not only are no medical students entering the field, but those in it are burning out and having almost no time to actually care for patients.  We talk about our own experiences and how grateful we are to have been able to carve out a way to still be real doctors for whole people who we have known for long periods of time.  In the end, unless we can revive primary care, there will be no healthcare system, just number fixing and organ repair, all at huge expense with horrific outcomes."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We look at the role of primary care in our health care system and discuss why it is the crucial ingredient to save lives, lower cost, and help people feel better and be healthier.  As we gravitate toward a technician-run specialized system that rewards expensive drugs, tests, and procedures rather than whole-person holistic care, we are devaluing primary care and valuing what makes our system worse.  We talk about the data showing how a viable primary care system is crucial to any reform and why this is not occurring."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We know that at the hospital medical students, residents, and hospitalists dive into a Flexnerian orgy of tests, treatments, and more tests.  Is this helpful?  We'll go back in time and look at Osler's dream at Hopkins before it became the poster child for Flexnerian medicine.  "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

People are losing weight on the new drugs, but at what cost?  First there is the financial cost: we're paying $35 billion a year for these drugs, and don't be fooled, all of us are paying.  While insurance pays nothing for nutrition or exercise, it gladly pays for this.  And these drugs are untested long term, with some horrific potential side effects if you take them for a long time or if you stop them.  This is how our pharma industry works: big promises, little data, hide the side effects, but no money for actual lifestyle changes.  Maybe these drugs will be great, likely they'll have severe long term problems, but we are all paying a steep cost to put pharma profit over truth and not spending any money for real determinants of health: diet, exercise, stress reduction.  A shot seems appealing and requires no effort, but it can't substitute for what we know will work."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Alan and Andy discuss specialty care and its inherent dangers.  We tell about specific patient examples, why excessive specialization seems appealing but results in over-testing and over-treatment, and how we can instantly change policy to mitigate the damage from specialization.  Ultimately specialists are paid more to convince people they are sick and lead them down a road of testing, procedures, and medicines.A few book and article recommendations:-No More Tears, by NYT journalist Gardiner Harris, which explores the history of Johnson and Johnson and the complicity of media, the FDA, and academic medicine in the drug company's deceptive assault on the American public with dangerous drugs and products.-FDA Approved and Ineffective, by Shannon Brownlee and Jean Lenzer, in The Lever magazine, showing that much of what the FDA approves is both dangerous and ineffective as they bow to the wishes of Big Pharma.  Click Here for Article. "The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Alan and Andy discuss cancer screening, focusing on breast and colon.  These screening tests can save lives, but just how much do they help you as an individual, what are the risks, and is there a point in your life that they are not helpful?  Screening for cancer is never as cut and dry as the pundits suggest, like everything in medicine it is cluttered by nuance and uncertainty.  We'll help you better understand these screening tests."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We will discuss cancer screening in the next two segments, but will start with the PSA.  Why this test?  Because it is the poster child of what is wrong with screening.  One third of men develop prostate cancer in their lives, but few die of it.  The 10 year death rate is 1% and the 15 year death rate is 3%.  Because these cancers move slowly, and because the few that are lethal will kill you whether you are treated or not, treatment doesn't change those numbers.  Yes, if you have prostate cancer you will have a 1% risk of dying in 10 years whether you are treated or not.  And the treatment is toxic; it causes impotence, incontinence, a reduction in masculinity, and other potentially severe complications.  It will lower your PSA and give you the illusion of cure, but it doesn't actually help you.  So, yes, we can screen you for prostate cancer with a PSA, we can provide toxic treatment and harm you all in the name of lowering that PSA, but you won't live a day longer.  You will only be sicker.  Studies have shown that merely getting a PSA can shorten your life.  But it's big business, it earns tens of billions of dollars (perhaps even hundreds of billions when you look at downstream costs) for doctors, radiation centers, hospitals, and drug companies.  That's why when the US Preventive Service task force gave PSA testing an F, meaning it causes more harm than good, the urology society and radiation oncology society lobbied congress and forced them to change the grade to a C, may cause more harm.  So, learning about PSA and its perils and deceptions is a good way to start!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

The Drug Industry was front and center in the creation of our health care industry.  The reforms that created modern healthcare in 1911 and beyond were predicated on developing a research infrastructure in medical schools and in the medical community to generate money for industry.  Nothing really has changed.  Now the drug companies have control over federal agencies like the CDC and FDA; over academic research and academic doctors who are paid to conduct research designed by drug companies; over consumer agencies like the American Diabetes Association, Alzheimer's Association, and the American Heart Association; over Congress members from both parties who they pay; and of course over the media where they advertise endlessly  They have taken over the reigns of our clinical protocols and even invent diseases like prediabetes and osteopenia to sell more drugs.  We dissect this situation and talk about solutions."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

In our book, A Return to Healing, we dissect what is wrong with our health care system, and show how you as a patient can better advocate for your own health in a system that often deceives you for profit.  But too, we want to fix the system and we explore a feasible solution at the end of the book, one that is simple to achieve and one that would lead to massive financial savings at the cost of improving your health.  We discuss this idea in our newest podcast."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

In our book Return to Healing we explore the roots of our healthcare mess, and we dissect the many reasons that you are not being given the care you deserve.  In this audio we offer an introduction to the book and to this podcast."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

There is a code word in medical lingo that all doctors are supposed to follow: shared decision making.  In other words, doctors should provide you with information and then let you make the final decision about what to do.  But that rarely happens.  Far too often doctors hide behind their white coats and declare that there is only one right answer and that you must follow what they say, or else!  Well, not in those words, much more sophisticated words, but that's what they are saying.  Very often the information they insist is absolutely accurate and right is not.  Very little medical information is absolutely accurate and right.  Most is nuanced and should be customized to each patient.  And much of the information endorsed by doctors is fed to them by specialty societies and drug companies.  As a patient you have to be careful, which we'll discuss in upcoming podcasts.  Today we talk about why doctor absolutism is very dangerous."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

In the show Apple Cider Vinegar, the writers create a binary: the good and all-knowing doctors vs the charlatan nutrition gurus.  The gap is so wide between the two approaches that the reader is left thinking that in cancer, as in all things medical, doctors always have your best interest in mind and if they thought you should change your diet they'll tell you.  Doctors are not trained in nutrition and are taught to view your body through numerical measurements that, if abnormal, can be "fixed" with drugs or procedures.  We will talk about why diet is so important and why doctors fear talking about it."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

Whether it is in attacking Kennedy, or in refusing to acknowledge what is dysfunctional about Medicare, Democrats use us vs them binary thinking to defend the medical system.  By finding easy targets that seem inane, or by inventing those targets by twisting the truth, the defenders of our horrific medical system prop themselves up by posing as the reasonable ones.  David Frum in the Atlantic did just that in his piece "Why the COVID deniers won."  The very title presents a binary: we are the COVID accepters, those are the COVID deniers.  What is a COVID denier?  To Frum, its anyone who disputed the gospel of Anthony Fauci or who questioned the need to take an experimental vaccine.  Frum defines science as listening to the "experts."  In fact, the science he uses in his article is absolutely absurd and unsubstantiated, and the experts he points to are the very people who lied to us, bullied us, censored us, profited from COVID, and turned their back on scientific discourse.  He admits, for instance, that closing schools was a mistake, but at the same time discredits the many scientists who from the start said just that.  He notes that COVID was not dangerous to the young, but labels anyone as anti-scientific and dangerous--even those very young people--who didn't want to take the COVID vaccine or who denies that COVID was a severe universal threat.  He presents no nuance about the vaccine, never brings up that government databases have shown it to be the most dangerous vaccine in history, and that not a single study has demonstrated that it had or has any public health benefit.  His notion of science--do what my self-selected experts say and censor everyone else--and his "facts" about COVID--all of which have been debunked--push him down a road that props up the very people who stood in the way of a scientific and humanistic path through COVID, leading us to the worst outcomes in the world.  That's COVID denialism: questioning bad science, dangerous mandates, poor policies, and censorship?  As we will see in this and the next podcast, by erasing the common-sense middle ground, and by positing every medical issue as an us vs them binary, the system stays afloat, even as it continues to harm those who it tricks into submission."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

We all believe that cholesterol is so bad that we better measure it regularly and lower it by drugs.  Just ask your cardiologist: Got to get that LDL cholesterol below 70 or catastrophe will ensue!  But as we explain, this is a myth that germinated back in the 1950's and has been perpetuated and normalized over time.  Virtually all doctors believe in this myth and preach it to you.  The facts are far different.  Measuring and lowering cholesterol does not help prevent heart attacks or allow you to live a day longer; in fact, it is both deceptive and dangerous.  And going on a low-fat died is medically insane and causes significant inflammation in the body that actually promotes diabetes and heart attacks.  This podcast will take you through the history and science and help you to protect yourself from this prevailing myth and become smarter than your doctor."The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com

In our book, A Return to Healing, we explore how our healthcare system came to be the most expensive and worst in the world, looking back through history and focusing on our current mess.  As two primary care physicians with 70 years of collective clinical experience and having written many books and articles, we want to remove the curtain and show you how our system is not helping you to be healthy.  We provide a pragmatic and well-documented assessment of why doctors are so often wrong, why our system is controlled by those who seek to profit off your own fears and lack of understanding, and how you as a patient can approach healthcare (in and out of the doctor's office) with knowledge and confidence to help you be the healthiest person you can be.  In this introduction we set up a roadmap of where we will be going.  We so look forward to being with you on this journey!"The greater the ignorance, the greater the dogmatism."  -William Osler, MDwww.returntohealing.com