Straight Talking Doc Unhinged

Your zip code has some impact on your health, but the details are not as simple as one might imagine.  We know, for instance, that lifestyle health benefits are more difficult to achieve in people in the inner city, who work long hours, who have lower income with financial stress, and who live in rural areas.  People traditionally who live in areas with more health care also tend to engage in more beneficial lifestyle practices.  

But in fact, as indices such as the Dartmouth Atlas have shown, it's not the healthcare making them healthier, it's them.  Higher prop...

A lot of people have started buying devices promising to find problems and lead to cure.  These may include sugar monitors, blood pressure cuffs, and even monitors to find heart irregularities including the dreaded afib.  But are these devices helpful, or could they have a dark side?  We discuss all of this today, but we also focus on what is most important to home safety and health promotion, and it has nothing to do with gadgets.  Well, one gadget is beneficial, one that you can press if you fall!  But a major goal of the home is to set it up...

Alan and Andy discuss the HALE scale, a subset of longevity that measures the average length of years people live without being disabled.  The longevity in our country averages 79 years, about  4 years lower than most industrialized nations.  But we do far worse in the HALE score, where our healthgevity (the average length of life we live not disabled) is 63 years, meaning that on average we spend the last 16 years of our lives suffering poor health or frank disability.  Compare this to other industrialized nations, where the average HALE age is 74 years, a full 8 years longer than us, with less end...

We are hearing a lot about measles on the news.  The escalating cases.  The unprecedented deaths.  The tragic repercussions of the anti-vaxxers and Kennedy in particular  It has become a war between those who fear vaccines and those who demand that everyone get every vaccine we have.  Two extremes fighting it out, as the sensible middle falls prey to this battle and media scare campaign.  

Yes, measles is preventable with vaccination, but are we in the midst of a health crisis because some parents choose not to vaccinate their kids?  And is this a case of public health...

Age has become a diagnosis meant to be treated, not a time of your life to enjoy living.  More medicines, more specialists, more tests, more fear.  We have transformed age itself into a disease as we measure and "fix'" everything we can find, a windfall for the medical industrial complex, but a tragedy for the trusting souls who are tossed into the medical fire.  Alan and Andy use data and their collective 75 years of experience to show how errant this approach is. Slow medicine, a focus on function and symptoms, a leap away from tests and specialization are the ing...

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 en...

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 cann...

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...

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 p...

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.

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 am...

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...

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.  

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 erroneo...

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 med...

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 nat...

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...

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, whe...

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 Co...

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 proto...

The first half of American Medical History ends at the Flexner Report, which entirely morphed American Healthcare into a monolithic corporate entity under the complete control of the AMA.  Every aspect of healthcare transformed, from education, to payment, to philosophy, to licensing, to dogma.  The Medical Racial Script, long unspoken and oft ignored, became the law of the land.  What are the repercussions of Flexner today?  We will discuss some of the ramifications of the AMA's cooptation, and the corporate ownership of, healthcare before moving on two the second part of the course.

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 dr...

Two pages of the Flexner Report condemned African American medial providers, hospitals, and patients to decades of struggle.  Relying on the AMA's medical-racial script, and playing into the atmosphere of Progressive eugenics, Flexner's chapter devoted to the African American medical situation flowed from what united white orthodox providers and fed the corporate impetus that would finance the new health care system.  Essentially, Flexner sought to close all but two African American medical schools, condemn graduates from those schools to being sanitation workers who would assure that African Americans don't spread disease to whites, and deflect corporate funding elsewhere.  The res...

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...

Once the AMA and William Welch orchestrated an alliance of Progressive reformers, corporate interests, and state medical licensing agencies, it was time to sanctify the cogs of a new medical system.  That is what the Flexner Report is all about, a survey of US medical schools largely scripted by the AMA, conducted by a little known educator working for the Carnegie Corporation named Abraham Flexner, and financed by complicit corporations.  The Report entirely transformed the American healthcare system into one that focused on lab rats over clinicians, number measurement over patient-centered care, and a dogmatic top-down system run entirely by...

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 t...

Two of American medicine's pioneers, and co-founders of Johns Hopkins Medical School, represented a fork in the road.  William Osler, whose scientific humanism pushed back against a healthcare system teetering between commercialism and quackery, created a solution at Hopkins: clinical care, doctors as teachers, patients as teachers, an end to protocols and dogma.  He believed in patient centric care: "If you want to know the diagnosis, ask the patient," he said.  He believed that America was becoming a society of drugging rather than healing.  He believed that nuance and uncertainty were inherent to healthcare, and that there could never be o...

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 AMA grew up in a libertarian America, but chose to change its nature during a top-down Progressive America, where experts and scientifically based rules were determined to be crucial to any viable reforms.  Working with corporate foundations, Progressive reformers, and German-inspired Progressive academic doctors, the AMA shifted course and transformed into a top-down organization that sought to control all aspects of American medicine, including education.  It changed its structure to rely on a very narrow board of "experts," it adapted a German ideology of care, it worked with corporations and drug companies to increase its base of money an...

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 the...

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 medi...

As the AMA gained power and scripted a plan to commandeer the medical system, it used its medical-racial script to leap on the progressive train, including an embrace of eugenics. Eugenics flowed from the medical racial script, and according to historians, was the secular religion of progressives.  It was deemed to be sanctified science, taught at all major universities, and penetrating the hearts and minds of those who believed that science would solve the world's problems.  Like German progressive medical science, eugenics relied on discrete numerical measurements to reach conclusions about race, intelligence, and even body habitus deemed to be...

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...

Born in Republican America, with its emphasis on democratic decentralization, the AMA was floundering in the late 1800's, with few doctors latching their sails to its agenda.  Most orthodox doctors remained fully independent, many graduated from poorly regulated schools without any firm curriculum, and the medical landscape was dominated by non-orthodox providers.  In this vein, the AMA shifted course in the late 1800's, increasing its funding stream, starting a journal, and gravitating towards a more top-down Progressive model of care.  Part of its shift required certain compromises and a restructuring of its code of ethics, enabling stronger relationships with the...

Excluded from the AMA and from orthodox medicine, African American doctors had to find their own way in the late 1800's.  Virtually no African American doctors existed in the early century, but that changed in the Civil War, especially with the advent of Howard University and then a sprinkling of other medical schools that trained black doctors.  How the African American medical community grew and prospered by essentially engineering an alternate medical landscape is something often overlooked by medical historians, and yet is crucial to understand white orthodoxy, the medical racial script, and the posturing of the AMA.  Ironically, mos...

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.  

While we view traditional medical care as the norm, it was not always that way.  Throughout most of the 1800's Americans chose alternative providers more frequently than orthodox doctors; their outcomes were better, their ideas based on common sense, their focus patient oriented, and even their fees lower.  One of the primary goals of the AMA was to snuff out alternative philosophies, especially homeopathy.  We will discuss these alternative ideas and how they impacted the medical landscape.

With orthodox medicine in disarray, with no standards of education, and with alternative medical philosophies ruling the roost, several prominent orthodox doctors came together to forma national organization to represent the needs of orthodoxy, the American Medical Association (AMA).  Founded in 1847 largely by Nathan Davis, the AMA had several goals: To promote licensing requirements, to standardize education, and to provide a collective where all orthodox doctors could gather.  Although formed as a democratic union of orthodox doctors, the organization from the start sought to stamp a unifying dogma upon its members and the nation, one that included the medical ra...

After the Revolution, American was severed from the European seat of orthodox medical power.  American orthodox doctors were forced to establish their own schools, their own dogma, and their own leaders.  Much of what glued orthodox doctors together and led to copious research was the medical racial script, much of which was inscribed in the standard medical school curriculum North and South.  However, during the Republican period, Americans eschewed labels, rules, and favoritism.  This translated into an ideal that anyone who thought themselves to be a doctor could be, without any desire to regulate physician education or practice.  For insta...

Starting in the colonial period and crystalizing during the Republican Period, American doctors differentiated themselves from their European colleagues and from non-traditional healers by instituting a medical-racial script.  We'll discuss what the script is, how it helped American healthcare and its white male doctors to establish legitimacy, and the toll it took on the African American community.  The script will be woven throughout this course.  Nothing more united white male doctors, helped grow the American medical infrastructure and academic foundation, and imprinted on American medicine its enduring stamp than the script.  As we study the nidus of the AMA in t...