Beyond the Prescription

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What gives you meaning and purpose? How do you measure success? What does it mean to be healthy?

Suneel Gupta is helping people grapple with these essential questions.

His new book, Everyday Dharma: The Timeless Art of Finding Joy in What You Do, is about reconciling what we do with who we are. Gupta describes our “dharma” as our calling—or what Gupta’s grandfather called our “essence.” Gupta recognizes the central tension between outward markers of success and finding this internal sense of purpose. A successful entrepreneur and bestselling author, Gupta has also grappled with depression and self-doubt, fueled by the natural tendency to measure success with external metrics instead of asking ourselves the “Why?”

On this episode of Beyond the Prescription, Gupta explores the harms of hyper-vigilance and the power of vulnerability. They discuss the “Arrival Fallacy,” the false assumption that once you reach a goal, you will experience enduring happiness. He shares parts of his own process of self-discovery that allowed him to pursue his inner purpose and help others do the same.

Join Dr. McBride every other Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, and review the show!

The transcript of the show is here!

[00:00:00] Dr. Lucy McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight.

[00:00:31] We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts.

[00:00:57] So let's get into it and go Beyond The Prescription. My guest today is the ever dynamic. Suneel Gupta, who's passionate about helping people achieve success in a healthy, sustainable way. Suneel is a beloved speaker, a visiting scholar at Harvard Medical School, and best selling author of two books. His new book is just out. It's called, Everyday Dharma: The Timeless Art of Finding Joy in What You Do. It's really a practical guide to finding your dharma, your inner calling, and learning to integrate ambition, work, and well being to create a balanced life. The book combines Suneel's own stories with history science, Eastern philosophy, and Western methods. Suneel, thank you so much for joining me on the podcast today.

[00:01:49] Suneel Gupta: Oh, Lucy, I'm so glad we were introduced and it's good to be here.

[00:01:52] LM: So let's talk about Dharma. There's something about it that resonates with me as a physician who's in the constant quest tohelp patients pull the curtain back on their story. So what is Dharma?

[00:02:04] SG: Yeah, I mean, I wrote this book really for the same reason. I think that we are experiencing an overwhelming sense of emptiness right now and society sort of speeding up. All right, we're using artificial intelligence, we're using automation to continue getting faster and more productive. But I think as individuals, we're kind of in a lot of ways moving in the opposite direction.

[00:02:28] We are starting to feel like we are disassociating with our work, we are quietly quitting. And I think the result of all of it is that we are losing an emotional connection to what we do, which I think is a shame because we spend so much of our time either at a job or with the work that we do. 

[00:02:45] And to not feel that connection is, I think, I think it's devastating, right? It causes, I think, a lot of the symptoms that you talk about on this show. And so the reason that I wrote this book is because I wanted to to talk about how do we bring that emotional connection back to our work in a way that really feels real to us? And dharma is an age old philosophy really about that connection and one of the underpinnings of dharma is that while it may be tempting sometimes to try to find happiness and bliss outside of your work, there also is another path which is finding it through your work, right?

[00:03:22] And Dharma is really the alignment of who you are and what you do, because when those two things are lined up, you feel creative, you feel energized. My grandfather called this your essence, right? And when you are expressing that essence, you're lit up, you're energized. But when you're not, you feel depleted, you feel burnt out.

[00:03:43] And so I think the question for us is, how do we now start to come back to this essence, right? And it's something that's available to I think all of us. It's not the kind of thing that you get to luxuriate about when you've hit a certain level of status or wealth. I think it's it's available to every single one of us no matter where we are in our career the the challenge though is that most of us don't know what our Dharma is and even if we do understand to a certain degree, what our Dharma is, what our inner calling is, we don't necessarily feel like we have the time or the space or the money sometimes, or even the courage to pursue it. And I wanted to write this book because I wanted to go directly into those struggles. Not to write a book about what purpose is sitting behind a desk, but how do you take this thing that you feel that you need to express, right, it needs to speak, and how do you once and for all start to bring that into your everyday life?

[00:04:39] LM:  I love that I commonly talk with patients about this gap that exists in all of us between our best intentions and the execution of them. Meaning, like, we know we want to eat healthy. We want to exercise. We want to be more purposeful. We want to be more intentional. We want to put our phones down. We want to be happy and pursue things that are joyful, but there's that gap and the river is wide between the intentions and the execution. And you just said it, Suneel, sometimes the gap is filled with financial insecurity. Sometimes it's filled with logistical obstacles. Sometimes it's filled though, with fear and maybe even ambivalence, and then maybe even not knowing what your purpose is. So talk to me about how you might mind the gap. Those are my words, but how you kind of actualize and take control over your sort of sense of purpose and meaning.

[00:05:37] SG: Yeah. So two different things that come together, right? Who I am and what I do, right? And I think the what I do is the execution. Who I am is really sort of getting into like, what it is I care about. Let's start with who I am because I think that's just a natural place where I think a lot of us, I think me, me included would skip over. And the reason I would skip it over is because I would look to what everybody else sort of had, right? I would look to people I saw with nice cars and nice homes and really nice sounding LinkedIn profiles and bios. And I'd say, let me go follow that. And what I found over time is that I was really walking somebody else's path, not my own.

[00:06:12] And I think the work to sort of coming back to yourself and understanding what you want, it doesn't have to be something that you go on a huge meditation retreat. to do, right? I think it comes through starting to ask yourself certain questions. And in the book, I go through a list of sort of questions that really sort of helped me kind of get to this point.

[00:06:31] I call these the chisels. And the reason I call these the chisels is because Michelangelo, when he would look at a …

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Confused about how to handle COVID this fall and winter? Wondering how to think about masks, boosters, and reducing your risk of getting sick?

On this episode of Beyond the Prescription, Dr. McBride talks with Monica Gandhi, MD, MPH, who became one of the most prominent public health experts in the country during the pandemic. Dr. Gandhi is a Harvard-trained physician, expert in infectious diseases, and professor of medicine at the University of California, San Francisco (UCSF). She is the director of the UCSF’s AIDS Research Center and the medical director of the San Francisco General Hospital HIV Clinic. 

Dr. Gandhi’s career centers on the principle of harm reduction, born out of her decades-long work in HIV. Harm reduction is the belief that public health policies should consider not only the pathogen (i.e., HIV or COVID) but also people’s basic needs for social connection, intimacy, and agency—and that public health’s job isn’t to shame, stigmatize, or even to eliminate risk (that’s impossible) but rather to arm people with information and tools to mitigate the inevitable risks we face.

Her new book, Endemic: A Post-Pandemic playbook, published in July 2023, aims to reckon with the country's present condition: comprehending and living with a new respiratory disease and how to face the coming variants and next pandemic with reason, science, courage and compassion.

Listen to hear Drs. Gandhi and McBride discuss where we have been, where we find ourselves now, and how we ought to manage the virus this season, and in the coming years.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, and review the show!

The transcript of our conversation is here!

[00:00:00] Dr. Lucy McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight.

[00:00:31] We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts.

[00:00:57] So let's get into it and go beyond the prescription. Let's talk about Covid. Joining me today is my dear friend, Dr. Monica Gandhi. Monica is a physician and professor of medicine at the University of California, San Francisco. She's the director of the UCSF AIDS Research Center and the medical director of the San Francisco General Hospital HIV clinic.

[00:01:21] She studied at Harvard Medical School and then at UCSF where she focused on infectious diseases, specifically HIV. She holds a master's in public health from UC Berkeley, with a focus on epidemiology and biostats. During the pandemic, Monica became one of the most prominent public health experts in the country.

[00:01:42] National and local political leaders, medical professionals, and the media often turn to Monica for her thoughts and recommendations on how to handle the constantly shifting dynamics and demands of COVID. She has now put her thoughts together in a new book, Endemic: A post pandemic playbook out in July 2023.

[00:02:02] It aims at reckoning with the country's present condition, comprehending and living with a new respiratory disease back in 2020, and how to face the coming variants and the next pandemic with reason, science, courage and compassion. Monica is not only an accomplished physician and public health star, she's also a dear friend.

[00:02:24] I got to know Monica during the pandemic when I started noticing that patients were suffering not only from COVID, but also from the sustained fear, anxiety and social isolation of the pandemic. I was immediately drawn to her straight talking, evidence based and compassionate voice.

[00:02:42] It was a rarity in a sea of COVID experts. She seemed to consider the whole patient, to value the importance of human connection as much as guarding against an infectious disease. So we became fast friends. We've written op eds together. And we started a group text of seven women in medicine and public health who now have communicated multiple times a day for over two years today, Monica and I will discuss where we have been, where we find ourselves now and how we ought to manage this virus this fall and in the coming years, Monica, it is so fun to have you on the show today. Thank you for joining me.

[00:03:21] Dr. Monica Gandhi: Thank you so much. It's so good to see you.

[00:03:23] LM: So tell me about your book, let's start there. What are the lessons learned and then how can we move forward with COVID in our midst in perpetuity and the potential for new viruses coming along? So tell me about the book and what are the major themes in the book?

[00:03:40] MG: Yeah, so thank you. It starts out with an introduction to the concept of why I was so interested in infectious disease and I went into it and that really had to do with my interest in HIV, even from a very young age, my interest in social justice, my interest in disparities, and my interest in the fact that people are stigmatized for infectious diseases, which I always found completely shocking in the world of HIV.

[00:04:04] It's kind of Lehman's language on the whole pandemic and where we are with vaccines and therapeutics. And then it goes into harm reduction. And what that means is really that you have a pathogen. Let's say we had HIV which we did and we still do. And the way that we dealt with HIV, at least those people who are expected dealt with HIV is they dealt with this kind of whole person aspect of care.

[00:04:29] So you have a person living with HIV, but you also have their mental health and their sexual needs and their needs for companionship and their needs to have hope and it to become an HIV doctor became a really, I think, a doctor that sees the whole person and doesn't just see the disease or the pathogen or just the virus.

[00:04:51] And what I saw with COVID 19 is that we used the same bad stigmatizing language that we used with HIV with COVID. There were actually public health people that said, COVID idiot, or you're a bad person for getting COVID, which I still will never understand. And then I thought of harm reduction. What are the ways that we can absolutely fight the pathogen?

[00:05:12] In my mind, it's biomedical advances, but also minimize the harm done to society. And the three I think, or supposed mitigation, because I don't think they helped, that did harm, in my opinion, were prolonged school closures, were closing other medical care, not taking care of other medical needs, especially mental health, and then third is not letting people see their family members in the hospital.

[00:05:36] I think that's actually, frankly, inhuman. So I dwell on those for some time, chapter five is all school closures, then the subsequent chapters on around global equity, because if biomedical advances are your way out of a pandemic, you need to give them to everyone. And then the last chapter is a 10 point pandemic playbook.

[00:05:54] How do we go forward. If this happens again, and I hope it doesn't for 100 years and not get to this point where we are now, where there's about a 30% trust in public health. By the latest poll, a health affairs paper showed that in March of 2023, 30% of people trust the CDC. I mean, there must have been mistakes made …

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Manish Agrawal MD and Paul Thambi MD are oncologists who have spent decades caring for patients with cancer. They realized early in their careers that chemotherapy could treat the cancer—but what about the emotional, psychological and spiritual impact of facing mortality? 

When they learned about the potential for medications like MDMA and psilocybin to help people gain access to parts of their minds they didn’t know existed—and to address the human experience of suffering—they quit their day jobs as practicing cancer doctors to found Sunstone Therapies, the sole psychedelic-assisted therapy research and treatment center in the Washington, D.C. area.  

The data are increasingly clear: these non-addictive substances hold the power to expand consciousness and improve quality of life.

When guided by a trained therapist in the appropriate setting, even one experience with a psychedelic medication can help people unlock closed doors in their minds and to feel safe enough to explore its contents. They can be the catalyst for patients’ ability re-route well-worn pathways of negative and maladaptive thoughts, feelings and behaviors.

It turns out that science and spirituality aren’t mutually exclusive.

On this episode of Beyond the Prescription, Drs. McBride, Agrawal and Thambi discuss the inseparability of physical and mental health; the promise of psychedelic therapy to treat the psychological impact of cancer and other diseases such as PTSD, anxiety, and depression; and their shared excitement about the potential for these drugs to fundamentally expand the standard of care in medicine. 

Bios:

Manish Agrawal, MD

Manish brings an extensive background and experience that spans medicine, engineering, philosophy, and ethics to his role as CEO of Sunstone Therapies. Driven by a deep interest in healing, Manish is particularly passionate about whole person healing and the transformative potential of psychedelic therapies. Manish previously held the position of Co-Director of Clinical Research at Maryland Oncology Hematology, where he dedicated 15 years to the care of cancer patients. He completed a fellowship at the National Cancer Institute, National Institutes of Health, and his residency at Georgetown University Medical Center.

Paul Thambi, MD

Paul brings deep experience in oncology care and clinical trial design to his role as Chief Medical Officer at Sunstone. He is a proponent of strong organizational culture and strives to create a compassionate, open and accepting workplace to advance whole person healing in medicine. As a medical oncologist, Paul developed important and meaningful relationships with patients, witnessessing their emotional and physical distress upon diagnosis and throughout treatment, leading him to explore psychedelic therapies to improve the emotional and mental health of patients fighting cancer. Paul completed his oncology fellowship at the National Cancer Institute and, prior to pursuing medicine, he began his professional career in engineering and consulting.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, and review the show!

The transcript of the show is here!

[00:00:00] Dr. Lucy McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight. We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go Beyond The Brescription. 

[00:01:03] Buckle your seatbelt. Today we are going to talk about one of my favorite subjects, the re emerging field of psychedelic medicine. I truly believe it is going to change the landscape of modern mental health care in this country. I cannot wait to introduce you to my guests today, Dr. Manish Agarwal and Dr. Paul Thambi. They are oncologists who have spent decades caring for patients with cancer. They realized early in their careers that chemotherapy could treat the cancer, but what about the whole person? What about the emotional, psychological, and spiritual impact of facing a hard diagnosis and mortality? When they learned about the potential for psychedelic medicines like MDMA and psilocybin to address patients’ whole health, to offer some acceptance and insight and access to the patient's interiority in ways that they had never seen before, Paul and Manish left their day jobs as practicing cancer doctors to found Sunstone Therapies. 

[00:02:13] This is where I am now sending some of my patients, not just to face cancer diagnoses, but also for anxiety, depression, and PTSD. Sunstone Therapies is the sole psychedelic assisted therapy research and treatment center in the Washington, D. C. area. The goal of Sunstone is to better treat the emotional and psychological impact of cancer and other disorders. Paul and Manish are contributing to the fundamental expansion of the standard of care in medicine and it is a wonderful thing to be part of and to watch. Paul and Manish, thank you so much for joining me today on the podcast.

[00:02:53] Dr. Paul Thambi: It's a pleasure to be here. Thanks for having us.

[00:02:55] Dr. Manish Agarwal: Yeah, it's great having you. Thank you. 

[00:02:57] LM:  The two of you together have backgrounds in medicine, engineering, philosophy, data science, and research, yet you landed in the field of psychedelics for a reason. Tell me why that is. What is so exciting about this field to you?

[00:03:15] MA: Paul and I both have been practicing oncologists for almost 20 years, and over time we got really good at taking care of cancer patients, their physical symptoms, but their quality of life was not always directly proportional to how they physically felt. And over time it really starts eating away at you, that you're not able to take care of the emotional health of cancer patients.

[00:03:35] When we saw this emerging field and started looking at the data, We visited and learned about it and then got training and explored to see is this real. And that's what sort of led us down this path is, for me personally I've always been into philosophy, that's why I have my masters in philosophy.

[00:03:54] I've been interested in the human side of medicine not just the science side. Both have fascinated me and this really brought both of them together. The reason that Paul and I both went into medicine is to treat people and to make them feel better. And really, for the cancer patient, for any patient, you have to take care of everything, not just the physical symptoms.

[00:04:14] PT: Everything that Manish said is echoed in my life and how I was drawn to this. And I think there were a few patients that really suffered emotionally that really hit home for me. And I carried that pain from what they went through with me. And when Manish showed me the data on psychedelic assistive therapy, it wasn't really the data, it was really more these YouTube videos where we saw how there were a couple of patients on the NYU trial and the Hopkins trial, and how they were before they went on that treatment and after. And there was a palpable change that you could feel through the video even, and it was just something that I wanted to be able to see if we can bring to our patients. 

[00:05:00] LM: Can you gi…

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Kelly Casperson, MD, is a urologist, sexual medicine expert, and best-selling author. She is on a mission to empower women to live their best love lives.

In her wildly popular book, You Are Not Broken, Dr. Casperson breaks down the common narratives that women have been told about their bodies such as “I shouldn't enjoy sex,” “I can't get any better at sex,” and “It is my partner's job to give me pleasure,” in order to help women play, explore, and normalize their sex lives.

Combining the power of mind, body and relationships, she breaks down the societal barriers that keep women from fully embracing their sexuality and intimate experiences.

On this episode of Beyond the Prescription, Dr. McBride and Dr. Casperson discuss desire mismatch, relationship communication, and tools to help put women back in charge of their health and sex life.

It is time to normalize healthy, enjoyable sex worth desiring, and Dr. Casperson is here to help!

Submit your question about sex (or anything else) for this Friday’s Q&A right here!

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, and review the show!

The transcript of the show is here!

[00:00:00] Dr. McBride: Hello and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my Dr. Caspersons like I do my patients, pulling the curtain back on what it means to be healthy and redefining health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight.

[00:00:31] We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their stories and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts.

[00:00:57] So let's get into it and go Beyond the Prescription. Today on the podcast I have the honor of speaking with my friend who's also a doctor, a urologist, and a sexpert: Dr. Kelly Casperson. Last year, Kelly published the wildly popular book You Are Not Broken: Stop shoulding all over your sex life. It's a combination of real stories, conversation starters, and journaling prompts about how to have a better sex life. Kelly and I agree that mental health is health, that sexual health is health, and that women and men are unstoppable when we're armed with tools, facts, and the agency to be healthier from the inside out. Kelly, I'm thrilled to have you on the podcast today. Thank you so much for joining me.

[00:01:53] Dr. Casperson:  Thanks for having me.

[00:01:54] Dr. McBride: So let's get right after it. You are someone like me who believes that health includes many of the invisible components of our everyday life, including sexual health, mental health, a sense of agency over our everyday thoughts, feelings, and behaviors. You're someone who was trained in urology, which is a surgical field. And when people think about urologists, they typically think about male doctors treating male genitalia.

[00:02:27] Dr. Casperson: That's right.

[00:02:27] Dr. McBride: So, talk to me about what it's like to be a urologist in a male dominated field that people consider as a male dominated field, and then tell me how you came to understand Sexual health as a sort of a moral imperative to dispense more information about. 

[00:02:44] Dr. Casperson: Well, currently practicing urologists in America, 9% are female. We’re getting there. We're about 30% of the residency slots. There's only like 200 residency slots a year. So it's not like we're going to change the 9% much quickly. It's been great. I kind of… It was challenging to get into urology.

[00:03:01] I loved that. I loved the instant gratification of urology. And people are still surprised, you know, that there's women in urology and it's like I've been out of residency for 10 years now. So I don't know if that's gonna change in my career at this point. It's not changing fast. But the superpower that being a urologist brings to this whole sex medicine discussion is that I treat men.

[00:03:22] And so I get to see every single day how men are treated, and I see how women are treated, and it just becomes so glaringly obvious that we treat these two people very differently, and I get to have a voice because of that. In contrast to the gynecologists who don't see that we don't downplay men's complaints, and we don't say, well, that's just a quality of life issue, or yeah, you're just getting old.

[00:03:42] We don't treat men the same way we're treating women. And the sex meds and… I met a patient who was crying in my office, and the more I opened my eyes to what was going on, the more I said, I thought, “this is a huge problem, an absolute huge problem,” which I hadn't really seen before because I was not taking care of women's sexual health before I kind of got awakened to it. It's going to be lifelong work because we've got a lot of work to do.

[00:04:11] Dr. McBride: Let's, so let's talk about that for a second. I think what I'm hearing you say is what I experience myself as a doctor and as a person is that we countenance men's sexual dysfunction with ease and there's a whole specialty built around men's sexual health. It's urology. But in reality, urology encompasses everyone's pelvic floor, everyone's sexual health.

[00:04:37] It's just that men tend to go into the surgical field, men tend to treat men, and then the narrative is that it's really for men. So, it sounds like that was your professional path, and then you began noticing, like I do, that, hey, guess what? Women have sexual health as well. Women have pain with intercourse, low libido, pelvic floor dysfunction, vaginal dryness. And like men, women are entitled to pleasure, the absence of pain, and most importantly, in my mind, is access to nuanced information about their own bodies.

[00:05:13] Dr. Casperson: Yeah, we do a very interesting thing… to stereotype what we do, we say all of men's problems are biological and all of women's problems are psychological. And so like, you know, he's got erections issues. That's a blood flow viagra problem. We've totally forgotten it could be anxiety, depression, all that stuff going on.

[00:05:30] And conversely with a woman, we're like, oh, she's just depressed. She’s just too uptight. We're like, no, she can have a hormone problem. Women are allowed to have biological issues also. And we really put them in these little containers and then forget about the humanness of everybody.

[00:05:47] Dr. McBride: Yeah, I think, you know, we can walk and chew gum at the same time. We can have anxiety about performance, and that can be rooted in an experience that was traumatic. It can also just be rooted in low self esteem, or... Body image issues. You can also have low libido from not having enough estrogen because you're going through menopause.

[00:06:08] In other words, human beings are the complex sum of different parts. So to assume that women have sexual dysfunction because it's all “in their heads” and to assume that men have sexual dysfunction because it's all just a blood flow problem is to reduce people to these very simple parts and then assign them by gender. And that is not our job as doctors. It's also just completely inappropriate. It's really depriving people of the deep understanding of how their body and minds work in tandem.

[00:06:40] Dr. Casperson: That's right. Absolutely.

[00:06:42] Dr. McBride: Okay, so you are sitting there with a patient who's crying. Who's and by the way, I tell my patients when they cry in my office, like, you know, they'…

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Dr. Mary Claire Haver is a board certified OBGYN and women’s health advocate who has helped thousands of women going through menopause actualize their health and wellness goals. Dr. Haver’s goal is to empower and educate women in their mid-lives, and help women advocate for themselves in the doctor’s office. 

On this episode of Beyond the Prescription, Dr. McBride and Dr. Haver break down the myths and facts about menopause and hormone therapy. They discuss the harms of fear-based narratives in medicine and the importance of balancing risk to help women live longer and healthier lives.

So, should you or shouldn’t you take hormone replacement therapy? Dr. McBride wrote a longer piece about this decision-making process here. 

The upshot?

* Menopause is defined as having gone a full calendar year without a menstrual period. A woman’s midlife decline in estrogen and progesterone levels can cause short-term symptoms (like hot flashes, vaginal dryness, and insomnia) and can increase the risk for long-term health problems (like cardiovascular disease and osteoporosis).

* In general, menopausal hormone therapy (MHT) is considered safe for most healthy women when it is initiated within 10 years of menopause.

* Estrogen itself does not seem to increase the risk of breast cancer for the vast majority of women.

* Unless she has had a hysterectomy, a woman should take estrogen and progesterone together.

* Micronized (aka “bioidentical”) progesterone does not increase the risk of breast cancer; synthetic progesterone does seem to increase the risk, but only slightly.

* Dr. McBride recommends not panicking about the new Danish study suggesting an increased risk of dementia in women who take MHT. Why? It was an observational study (not a randomized controlled trial or RCT) therefore it cannot prove causation; the study population used oral estrogen and synthetic progesterone which are not the standard of care in the U.S.; myriad RCTs show the opposite finding: that MHT is likely protective against premature cognitive decline, especially when started early. 

* Too many women needlessly suffer through menopause because of false narratives about the safety of MHT and because discussions about quality of life often aren’t prioritized.

* Don’t take it from her! Dr. McBride encourages you to share the latest expert statement from the North American Menopause Society with your own doctor to help guide your decision-making process.

* Women are entitled to make their own decision about hormones, armed with the data, and with an understanding of their unique risks and benefits.

Dr. McBride will answer your questions about menopause and HRT on Friday. Submit your question right here!

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, and review the show!

The transcript of the show is here!

[00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor, I've realized that patients are more than their cholesterol and their weight.

[00:00:31] We are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my free weekly newsletter at lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts.

[00:00:57] So let's get into it and go Beyond The Prescription. Today on the podcast, I'm talking with the incredible Dr. Mary Claire Haver. She's a board certified OBGYN who has helped thousands of women who are going through perimenopause, menopause, and beyond actualize their health and wellness goals. She realized after decades of practice that she hadn't learned as much as she should have about the science of menopause, aging and inflammation.

[00:01:27] She really took a deep dive into the science and has created an online course called The Galveston Diet with the goal of empowering and educating women in their mid lives. Mary Claire, thank you so much for joining me today on the podcast.

[00:01:41] Dr. Haver: Thanks for having me.

[00:01:42] Dr. McBride: Let's talk about the fact that women have been notoriously excluded from medical studies. Women have also been deprived in many ways of access to nuanced information about their own bodies and health. And so it's interesting right now that menopause is having this moment, right?

[00:02:01] It's like Susan Dominus wrote this beautiful article about how women have been misled, and I think women around the country, around the world were like, “yes. Oh my gosh. Thank you for seeing me and hearing me.” And I think it's a historic moment where women are finally recognizing that they need to be seen and heard, and that their menopausal symptoms are not just in their head and that it's time to get the facts to put ourselves in the driver's seat. So let's just start with that article. So tell me what happened when that article in the New York Times came out, did that change increase the volume of phone calls coming to you? What? What did it mean to you?

[00:02:39] Dr. Haver: I think it just validated and reinforced what I was already doing on social media and that really people were sending me the article by the thousands—I was getting tagged. I was getting, “why aren't you in this article?” I didn't even know it was being written, and I just felt like it was really well done and it really was the tip of the iceberg, but it was the first meaningful publication—in such a respected area—that really was drawing attention to the problem. But women have been screaming about this for years, and I'll tell you, so I finished my OBGYN training in 2002, which was also the year the WHI stopped the study on hormone replacement therapy and basically ended any meaningful research into menopause care for at least 20 years. 

[00:03:36] And when I graduated from that training program, I would've sworn on a stack of Bibles based on my board scores and my level of training that I was a world-class menopause doctor. And it wasn't until 20 years of clinical practice that I realized in going through my own menopause journey that I was not a good menopause doctor, that there were serious gaps in my own education and training.

[00:04:03] So when you look at an OBGYN residency, and I know this because I was a former residency program director, and over half of what we do, probably 55 to 60% of what we do is obstetrics. All important stuff. Then everything else gets shoved in the box called gynecology. And in that gynecology box we have pediatric gynecology, we have GYN oncology, we have reproductive endocrinology, which is fertility.

[00:04:29] We have everything, and menopause gets a tiny sliver of that time and education. There are only 20% of residents coming out today who feel that they had any clinical menopause training, meaning went to a clinic where they were specifically addressing a woman in menopause. When multiple surveys have been done, the doctors are realizing this is important, but they didn't get the training.

[00:04:56] Nothing was really focused on that. Not to say that what we learned wasn't important. It's just menopause has never been prioritized.

[00:05:03] Dr. McBride: Why do you think that is?

[00:05:05] Dr. Haver: So I think it's a perfect storm of societal norms of medical education, how women have been treated through the years in medicine. I don't know about you, but we had a saying, if it walks like a duck, it talks like a duck… we love a differential diagnos…

You can also listen to this episode on Spotify!

Did you know that all children, regardless of genetics, are at risk for substance abuse?

Jessica Lahey is a New York Times bestselling author, mother, and parent educator on teen substance use. Her most recent book, The Addiction Inoculation, is a practical guide to help children grow up to be healthy and addiction-free. 

On this episode, Jessica sits down with Dr. McBride to discuss her own path to sobriety, the myths about substance abuse in adolescents, and how to help kids feel comfortable setting healthy boundaries. 

This is a must listen if you’re looking for ways to talk with your kids, grandkids—or yourself—about alcohol. Feel free to share this episode with others who may be, too.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, and review the show!

Transcript of the podcast is here!

[00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts.

[00:00:33] Our stories live in our bodies. I'm here to help people tell their story to find out are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at https://lucymcbride.substack.com/subscribe

and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go beyond the prescription.

[00:01:01] My guest on the podcast today is Jessica Lahey. Jessica is a New York Times bestselling author, mother, longtime teacher and educator for parents and teens on the subject of substance use and overuse. Her most recent book, the Addiction Inoculation, is a crucial resource for anyone who plays a vital role in children's lives, from parents and teachers to coaches and pediatricians. Helping raise kids who will grow up healthy, happy, and addiction free. Jessica, welcome to the podcast.

[00:01:35] Jessica: You are so welcome. I'm so happy to be here.

[00:01:38] Dr. McBride: I'm really happy to be here too because you and I were talking before the show started recording about how medicine in the current landscape is failing people. It treats people like a set of boxes to check, like humans are a bag of organs. We cattle herd, we box check, we move people along the conveyor belt, when health to me, and I'm sure to your husband, who's also a doctor, is rooted in the relationship with a patient, is founded on trust. And particularly when we're talking about complex issues like substance use and overuse, it requires time to get to know the patient and then unlock those complicated stories.

[00:02:25] So, this is why I'm thrilled to have you here because it's clear to me that this is not just your job, but this is who you are. So I'd love to talk first about your story and how you became interested in substance use.

[00:02:39] Jessica: I couldn't avoid it because I was raised in a home with someone with substance use disorder. One of my parents and one of my parents was raised with a person with substance use disorder and so on and so on, and so on and so on. And when I first got sober, On June 7th, 2013. Not coincidentally, my mother's birthday, I got blackout drunk at her birthday party.

[00:03:03] My very first thought was, okay, well hold on. If I'm part of this long legacy, and by the way, my husband is part of a very long legacy of substance use disorder, how on earth do I make this stop for my kids? I mean am I just, are they just destined to carry? And I had so many questions about genetics and risk factors and all that stuff.

[00:03:27] And more than that, I had also been a teacher for 20 years. And after I got sober, I started teaching in an inpatient recovery center for adolescents. And I wanted to understand very specifically, how those kids ended up there, what could we could have done differently, both from a parenting, from a social, from an educational perspective, how those kids ended up there.

[00:03:50] And then looking at my own kids, I got sober when they were nine and 14. And I really just needed some answers. And I was hearing, most of the information I had in my head was myth. It was magical thinking. It was myth, it was rumor. I needed to understand, if we give kids sips when they're younger, does that do anything about helping them learn moderation or should we be aspiring to be like those European families that we talk about so much?

[00:04:19] And anyway, so all of that stuff, I needed answers. I have the coolest job in the world, which is to get curious about topics and then get paid to research the heck out of them, and then translate that research for people who don't wanna dive in and research for two years to get the answer to a topic.

[00:04:36] So my job is not just… I'm a writer, but I'm at heart, a teacher. I mean, not just to kids, but now I get to go out into the world and translate all of this stuff. And if there's nothing I love more, it's helping people think about topics that freak them out. Whether that's letting your kids fail with Gift of Failure, whether that's substance use prevention stuff.

[00:04:59] It's the reason that I've stuck with this substance use prevention stuff, because it’s just so hard to get people over the shame, the guilt, the fear, the denial in order to talk about this stuff. So that's one reason that I make daily videos about this stuff. I'm out there speaking to lots and lots of people, and sometimes it's an uphill battle, but it's really, really fun.

[00:05:23] Dr. McBride: I can tell you're enjoying it and you're so effective at communication. I'm the same way. I love complicated patients. I love the layered kind of kernels of people's interiority and how their thoughts, feelings, and behaviors are interrelated and then explaining it to people. I also love tackling topics that tend to freak people out, like death and dying, delivering bad news, like somehow that's like my Super Bowl. And I think one of the reasons is because, at least for me, I see the fear in people's eyes and I see the shame that they carry and then being able to kind of convey a message to people that is, that they can wrap their arms around is really gratifying. When it comes to substance use disorder, I think a lot of parents are freaked out.

[00:06:12] I think they read the headlines. They see how pre pandemic, we had an epidemic of diseases of despair, including substance use disorder that is only accelerated during the pandemic and they don’t know what to do. And they know their kids in their adolescent years are trying alcohol, drinking in kids' basements.

[00:06:30] They're kind of looking at what other parents are doing and not knowing who to trust. And so I'd love to hear from you what are the common myths that parents tend to hold in their minds about substance use disorder in adolescence?

[00:06:47] Jessica: Yeah, I think this is really important because it's also the myths that get translated to their children. And the big ones are things like, first of all it's a fait accompli—kids are going to drink anyway, so I might as well teach them how to do it responsibly, either because I have beer at my house and I take away everyone's keys, and at least they'll be safe.

[00:07:06] That sort of just fatalistic, it's going to happen anyway because that's simply not true. The numbers are so much lower than people understand, and I get into that. In the book, there's this thing called pluralistic …

You can also check out this episode on Spotify!

Juneteenth is a celebration of freedom and liberation. I can’t think of a better person to speak to the importance of self-expression, autonomy, and living without oppression than Nedra Glover Tawwab.

Nedra is a practicing therapist, relationship expert, and two-time bestselling author. She understands that health begins with individual freedom—and that healthy relationships require supporting each other's freedom, growth, and self-identity while maintaining mutual respect and healthy boundaries. Her books, Set Boundaries, Find Peace: A Guide to Reclaiming Yourself and Drama Free are born out of her philosophy that a lack of boundaries and assertiveness underlie most relationship issues. Today, Nedra sits down with me to discuss the physical and emotional health consequences of relationship drama—and the importance of self-awareness and acceptance in order to have agency over our life and health.

I hope you enjoy this very special podcast episode. Listen above! 👆🏼👆🏼👆🏼

Together we are helping redefine what it means to be healthy. To join this community—and for lots of fun extras—consider a paid subscription!

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, and review the show!

Transcript of the show is here!

[00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts. Our stories live in our bodies. I'm here to help people tell their story, to find out are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at https://lucymcbride.substack.com and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go beyond the prescription.

[00:00:58] Okay. Buckle your seatbelts. I am thrilled to be speaking today with two-time bestselling author, licensed clinical therapist, and relationship expert Nedra Glover Tawwab. Every single day, whether it's counseling patients in her therapy practice, or talking to her 1.8 million Instagram followers. Nedra is helping people create healthy relationships by teaching them how to implement boundaries.

[00:01:29] She has written two books Set Boundaries Find Peace and her most recent book, Drama Free, both of which are born out of her philosophy that it's a lack of boundaries and assertiveness that underlie most relationship issues. Nedra, I cannot tell you how happy I am for you to be here today. Thank you so much for joining me.

[00:02:02] Nedra: You're welcome. Thank you very much.

[00:02:04] Dr. McBride: As patient-facing providers, you and I both know that relationship stress, relationship drama, can affect people’s health. During the pandemic I witnessed patients coming into my office with headaches, migraines, back pain, high blood pressure, weight gain, alcohol use increasing as a result of a spotlight being shined on a troublesome relationship, or until they had to make hard decisions about parenting, caregiving, living through a trauma. 

And so when I saw you on Instagram I knew I loved you at first sight, because you were there talking straight to the audience your 1.8 million followers about the relevance of relationships to our health and then you were dispensing practical guidance to this the drama and lean into the joys of relationships. And so thank you for doing that and thank you for being here.

[00:03:26] Nedra: You're welcome. The only time that, well, one of the only times I'll said, there's two times the only, one of the only times where I felt, oh my gosh, I think I'm having a panic attack, is when I was put in the situation of seeing a person who made me very uncomfortable. I was like, I'm about to have a panic attack… this is how much I don't want to see this person.

[00:03:54] My nervous system is on fire. My body is like run, hi, go. And it's not always, oh my gosh, I need to trust this, but I need to consider it. Right, because sometimes our bodies, our minds could be pushing us away from things we need to do, but there are other times where it's like warning, warning and we're like, okay, I'm going to do this anyway because I have to do it. And for me, in that situation, it was a warning to stay far away from a situation that was unhealthy because of past events.

[00:04:31] Dr. McBride: Another reason I knew we were kindred spirits, if you will, was that I saw you talk about adverse childhood experiences. So ACEs, as many people know, are events or situations or even relationships in childhood that have lasting effects on our health. In fact, there's no shortage of data to show that people who experience childhood trauma, whether it's physical, emotional trauma, experience higher rates of binge eating disorder, depression, anxiety, post-traumatic stress, and even cardiovascular disease.

[00:05:12] And so when I see someone like you who's helping people address the experience head on instead of meeting me when they're 50 and having heart disease, I think this is health, this is prevention. So could you talk to me, Nedra, about how you became a therapist and how the ACEs in your life perhaps informed that decision?

[00:05:36] Nedra: I was trained to be a listener. I listened a lot to my father in particular, talk about very adult topics, complain or, you know, ruminate or you know, do all, and I would just uh huh. I took it on as something that I had to do. I didn't know that this was a profession. I didn't even know this was something I was drawn towards, but it really shaped me into a person who. Was a good listener because with your parent, you're not really allowed to cut them off or stop them from talking. It was just like, oh, I have to listen to this person. And so it became a part of me with my peers, with other people in the grocery store who wanted to tell me random things.

[00:06:22] I'm like, “Uh huh.” And when I went to college, I thought I wanted to be a social worker who worked with children and you know, I got an internship and it was. In a therapy setting. And I realized that I actually like the side of listening where people actually want help. Not just people complaining, not just people ruminating or you know, saying, “Oh, woe is me.”

[00:06:47] It was people who wanted help with their situations. Now they may not all be at the same level of readiness, but they were certainly in the place of seeking. And for me that was a light bulb moment of, “Well, I have the training. I have the parent to fight training to do this. Perhaps this is an opportunity where I can really get into something that feels good to me.

[00:07:14] I felt really good being that person, that hope, [to help] someone think about things differently, because that's really what it is. I never had the opportunity to give insight. I was only a listener up until that point. But then when I was able to give the insight with that and they were like, oh, I never thought about it.

[00:07:31] I was like, “What did I say? I said that. I said that. Yeah, that was really good.” But I just think therapy is a wonderful thing for all people. And I don't just say that because I'm a therapist. I say that because I'm a person that goes to therapy and there is nothing like having a person who does not tell you about themselves for one whole hour a week. 

[00:08:00] Dr. McBride: Amen. And I'm a believer as well, and I love that story that yo…

You can also check out this episode on Spotify!

Pain is an inevitable part of life. But did you know that pain is not just about body parts?

Dr. Rachel Zoffness is an Assistant Clinical Professor at UCSF and leading global pain expert who is revolutionizing the way we conceptualize pain. She explains that hurt (pain) and harm (damage) are not the same—and that pain is never purely biological. Similarly, treating pain is never just about pills. It’s about addressing the social-emotional context around it.

On this episode, Dr. Zoffness sits down with Dr. McBride to discuss how thoughts and feelings inform the experience of pain. And how treating pain must include treating the brain.

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, review — and enjoy — the show!

Transcript of the podcast is here!

[00:00:00] Dr. McBride: Hello, and welcome to my office. I'm Dr. Lucy McBride, and this is Beyond the Prescription, the show where I talk with my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for over 20 years, I've realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts.

[00:00:33] Our stories live in our bodies. I'm here to help people tell their story to find out are they okay, and for you to imagine and potentially get healthier from the inside out. You can subscribe to my weekly newsletter at

and to the show on Apple Podcasts, Spotify, or wherever you get your podcasts. So let's get into it and go Beyond the Prescription.

[00:01:02] I'm delighted to welcome to the podcast my friend Rachel Zoffness. Dr. Zoffness is a PhD, pain psychologist, assistant clinical professor at UCSF, and an author of a new book called The Pain Management Workbook. She believes like I do, that our bodies and minds are inseparable and that we need to think about pain in a much more nuanced way.

[00:01:25] In other words, when I was trained in medical school, we thought pain was about the body part and that pills were the solution. When actually, as doctors, we describe pain as a biopsychosocial phenomenon. Rachel, I am so happy you're here today. Thank you for joining me.

[00:01:42] Dr. Zoffness: Thank you for inviting me on, Dr. McBride.

[00:01:45] Dr. McBride: What I love about you is that we agree that mental and physical health are inseparable. When I was training in medical school in the 1990s and early 2000s, we were taught that pain was about the body part itself, and that we used medicines to treat pain. We used Tylenol, Advil, opiates, and we were taught to get ahead of the pain and to get people more opiates than we thought they might need because it was cruel to deprive people of pain meds, which of course it is in many ways.

[00:02:16] But we now know just how addicting these medications are, and we also know that pain is about more than the limb that is hurting. So could you describe for me how you talk about pain, this bio psychosocial model? Because it's a big word and I'd love to break it down.

[00:02:34] Dr. Zoffness: Yeah, it's sort of frustrating for people who have been living with pain and also for healthcare providers who treat pain because medicine, as you know, has been rooted in this antiquated, dinosaur era biomedical model, which teaches people that everything to do with pain is just anatomy and physiology.

[00:02:54] But neuroscience has known for many decades that that's not actually true when it comes to pain. And one of the reasons we know this is because of this syndrome called phantom limb pain. And phantom limb pain is when someone loses a limb and arm or a leg, and they continue to have terrible pain in the missing body part.

[00:03:14] Now, if you can have terrible leg pain in a leg that is no longer attached to your body, that tells us pretty definitively that pain does not just live in your leg, and it does not just live in your back. And what science says is that, of course the body is involved in pain production, but ultimately pain is constructed by the brain. 

[00:03:38] And the reason that's so profound, at least for me as someone who treats pain and has lived with pain as many of us have, and all of us will because everybody, everybody is gonna have pain at some point, is that there's lots of parts of the central nervous system that process pain. It's not just there's one pain center, and that's how that goes.

[00:03:56] There's lots of parts of the brain that contribute to the pain experience including the brain's emotion centers contribute to the pain experience, and what that means is how you're feeling emotionally in any given moment, whether you're stressed or anxious or depressed affects intimately the pain that you feel.

[00:04:15] So we know from neuroscience that pain messages are amplified during periods of anxiety or during a global pandemic. That's not gonna surprise anybody, and we all know this. We all know that our bodies feel worse during times of duress. So it's really not that shocking. And we also know that, say if you stub your toe at work on the day you get fired, that exact injury feels completely different than if you stub your toe on a day at the beach when you're hanging out with your friends in the sun. So context matters, emotions matter, thoughts matter. Everything matters to the brain when it's deciding whether or not to make pain and how much, and that's always true.

[00:04:54] Dr. McBride That's a great example and the phantom limb pain is, is, I'd love to talk more about the phantom limb pain because I mean there couldn't be a better example of the construct that pain is—not to say it's not real— it's to say that it's more than just about the limb. So take that example for a second. How do you treat someone who has phantom limb pain? If it's not about the limb?

[00:05:18] Dr. Zoffness: So there is this frustrating thing that happens in medicine where people with chronic pain are often told it's all in their head. Especially if there's no known etiology for the pain. If you've had a lot of scans and tests and you know, people just aren't sure, the doctors are like, we don't know.

[00:05:31] We can't find a thing. So people get told often that pain is all in their head, and that is not what I'm saying. So I want to be very clear. Pain is never all in your head. If you have pain, your pain is real. The important thing to know about pain is that it's the brain in conjunction with the body always working together.

[00:05:47] The interesting thing about phantom limb pain, again, we've said you can have pain in a leg that's no longer attached to your body. And we've said that's because your brain is implicated in the processing of pain in your brain. You have what's called homunculus, and a homunculus is literally a map of your entire body that lives in your brain.

[00:06:06] So if I said to you, Lucy, without doing anything or moving, sense into your foot, can you feel your foot on the ground? Notice if your foot is warm or cold. Can you feel if your foot is moving or… you can do that. And the reason you can do that is because you have a map of your whole body that lives in your brain, your homunculus. 

[00:06:23] So sometimes if you lose a limb, you've lost the limb, but you haven't lost the leg part in your brain map. So with mirror therapy, what we do is. We hold a mirror up to people who have phantom limb pain and they go through a series of activities and structured exercises to help the brain become unconfused and realize that pain, which is your body's danger detection system, doesn't need to send you any more danger or warning systems because the damage has already occurred and there's no wa…

You can also check out this episode on Spotify!

If you’re anything like Dr. McBride or her patients, you want to live a long life. You want to be healthy! Yet when you try to execute on your best intentions—whether it’s cutting back on alcohol, starting an exercise routine, or taming your phone addiction—you end up defaulting to factory settings.

Well, you are not alone.

The pandemic laid bare how wired and tired we are—and how desperate we are to feel better. We scroll endlessly online for wellness advice and health hacks. We grab quick hits of dopamine through sugar, shopping, booze, or whatever gizmo social media is offering up. We are sleepless and irritable and don’t know what’s wrong.

The U.S. medical industrial complex is failing people. The wellness industry is fleecing people. How do we get ourselves “unstuck” when we don’t know what questions to ask or who to trust?

Dr. McBride argues that first, we must first redefine “health” as more than a set of laboratory tests or a single visit to the doctor. To her, health is a process, not an outcome. Health is about having awareness of our medical data, acceptance of the things we cannot control, and agency over the things we can control.

She calls this the “Three As.” She argues that articulating our Three As allows us to more accurately tell our story. An honest reckoning with the Three As can put us back in the driver’s seat of our health. 

In this week’s (short!) solo podcast, she explains this in more detail. She defines each “A” and suggests a way to move through this process on your own. 

Spoiler alert: getting healthier isn’t particularly sexy. It’s often not very fun. It usually isn’t usually quick, and it never involves a “fix.” In reality, staring down the facts, accepting hard truths, and then challenging our beliefs and our everyday behaviors is arguably the deepest and hardest work we do. 

Our stories live in our bodies. What’s yours?

Join Dr. McBride every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, review — and enjoy — the show!

The full transcript of the show is here!

Dr. McBride: Hello, and welcome to my home office. I'm Dr. Lucy McBride, and this is Beyond the Prescription. Today, it's just you and me. Every other week this season, I'll talk to you like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as a process of self-awareness, acceptance, and agency.

[00:00:28] In clinical practice for over 20 years, I have found that patients generally want the same things. A framework to evaluate their risks, access to the truth and data, and tools and actionable information to be healthy, mentally and physically. We all want to feel more in control of our health. Here, I'll talk to you about how to be a little more okay tomorrow than you are today. Let's go.

[00:00:55] So today it's just you and me. I am pretty excited, because I get to talk to you the way I talk to my patients. Specifically today, we're going to talk about how we might approach the process of getting healthier. If you're anything like me or my patients, you want to live a long life, right? You want to be healthy, you want to feel good, and you probably know that there's some things you could do to be healthier, but you find them hard to do, and you default to factory settings on a day-to-day basis.

[00:01:30] Well, you're not alone. Many of us aspire to get more exercise, to eat better, to get more sleep, to manage stress. In other words, we all want to do what our doctor tells us to do, but when the rubber meets the road, it's actually pretty darn hard. So how do we actually get healthier? How do we mind that gap between our best intentions and the execution part?

[00:01:53] So let's first talk about definitions like, the definition of health. Unfortunately in the US, we kind of think of health as the sum total of our lab tests. If we have normal cholesterol and a normal weight, we're healthy. But health is not just an outcome. It's not just about the absence of disease or pain, it's also not about pleasing the doctor or winning your annual checkup.

[00:02:19] After all, as humans, we're not just a set of boxes to check, a bag of organs to fix. We are the integrated sum of complex parts, and the US healthcare system just does not do a good job of countenancing the whole person. There's such a focus on extending life, which is of course good, but at the expense of thinking about our quality of life.

[00:02:41] And unfortunately in this country, by the time most people are seniors, they have a doctor for every body part, a pill for every symptom, and no one is talking to each other. No one is talking to the patient and asking them simple questions like, how are you, Mr. Roberts? What is your story? Are you okay?

[00:03:00] What are your goals? What's your North Star? What gets you out of bed in the morning? What do you live for? And by the way, how do you define health yourself and how can I as your doctor help you get there? In fact, a lot of people, regardless of age, are walking around feeling completely disenfranchised from the medical system and disenfranchised even from their own bodies.

[00:03:26] In fact, 80 million Americans don't even have a primary care doctor. So what is health? How do we define it? Health, to me, is a process. Health is about our everyday thoughts, feelings, and behaviors. It's not just about that single point in time in your doctor's office standing on the scale in a gown. It is about the 364 days a year you're not in the doctor's office. 

[00:03:53] This is where I get really excited, this is why I'm here, and I can't wait to tell you about what I call the three A's. The process of becoming healthier from the inside out. It's not easy, but it's necessary for health. In my opinion, health is a process of laddering up from awareness to acceptance to agency.

[00:04:19] So I'm going to say that again and then we're gonna break it down. Health is the process of laddering up from awareness to acceptance to agency. So what do I mean by that? First, let's start with awareness. Awareness is step one. Awareness specifically is of the facts, awareness of the facts and data. When I say facts and data, I mean metrics, physical, quantifiable information that we can measure and see.

[00:04:50] I'm talking about your cholesterol levels, your blood sugar, and your diabetes testing, your weight. I'm talking about the results of your mammogram, your colonoscopy, the PSA test if you're a man, your genetic testing when you went to the geneticist because of your family history of breast cancer. These are the things that we can hold onto because these are the things that we can see, that we can quantify and that we can measure. And this kind of traditional medical data is essential to know for our health.

[00:05:19] But guess what, it's not sufficient and there's actually more data we need to collect. Quantifiable information that often gets missed in the doctor's office. Things like, what is your family structure? Are you a middle child? How were you raised? Were you raised in an urban or rural setting? What were your environmental exposures as a kid?

[00:05:40] Were you raised in poverty? What was your socioeconomic status? What about your job? What are the facts of your employment situation? What are the facts about your children, your parents, and your family's system? What is your cultural background? What are your religious beliefs? What about your educational status?

[00:05:58] How many pets do you have? What we need to gather are facts about you historically and currently that are unequivocally true. So this is step one, gathering facts and data, finding out what is true and putting these facts in a box. Now modern medic…

Why are expectations about being a woman—specifically a mother—so unrealistic?

Mother, author, and New York Times opinion writer Jessica Grose has a lot to say on this subject. Her latest book, Screaming on the Inside: The Unsustainability of American Motherhood, is inspired by her own shortcomings as a mother. She interviewed hundreds of women as part of the research process while writing the book. In it, Jessica shines a light on the current state of motherhood, and the historical context around the impossible standards for American mothers.

In honor of Mother’s Day, Jessica and I sit down to discuss the narrative and messaging to parents that “they’re doing it wrong.” Jessica urges parents to learn to trust their instincts and to show up to parenting as their authentic, imperfect selves.

Join me every Monday for a new episode of Beyond the Prescription.

You can subscribe on Apple Podcasts, Spotify, or on her Substack at https://lucymcbride.substack.com/podcast. You can sign up for her free weekly newsletter at lucymcbride.substack.com/welcome.

Please be sure to like, rate, review — and enjoy — the show!

Transcript of the podcast is here!

[00:00:00] Dr. McBride: Hello, and welcome to my office. I’m Dr. Lucy McBride and this is Beyond the Prescription, the show where I talk to my guests like I do my patients, pulling the curtain back on what it means to be healthy, redefining health as more than the absence of disease. As a primary care doctor for more than 20 years, I’ve realized that patients are much more than their cholesterol and their weight, that we are the integrated sum of complex parts. Our stories live in our bodies. I’m here to help people tell their story, to find out, are they okay, and for you to imagine, and potentially get healthier from the inside out. 

[00:00:45] You can subscribe to my weekly newsletter at lucymcbride.substack.com and to the show at Apple Podcasts, Spotify, or wherever you find your podcasts. So let’s get into it and go beyond the prescription. 

[00:01:01] Dr. McBride: Today I'm interviewing Jessica Grose. She is a mother, she is an author, and she is a New York Times opinion writer who writes a lot about parenting. Her most recent book is called Screaming on the Inside: The Unsustainability of American Motherhood. I was immediately drawn to this book because it was inspired by Jess's own perceived shortcomings as a mother, something I think a lot of us women can relate to. The book combines in-depth interviews with mothers and a historical context on motherhood to help explain why our expectations about being a mom are so unrealistic.

[00:01:37] I think there's a narrative that a lot of us women and mothers absorb that if we only read the right book, if we only had the right parenting expert on speed dial, that we could be the perfect mother when it's not that simple, and frankly, we need to be better able to trust our instincts to know that by showing up, by being a good person and by leading with empathy and curiosity about who our kids are that we are good enough. Jess, I'm thrilled to have you today. Thank you so much for joining me.

[00:02:07] Jess: Thank you for having me. I just wanted to mention, we actually recently dropped the on parenting. I will still talk about parenting. I think my last column was about parenting related issues, but I wanted to have a chance to broaden my aperture a little bit, write about all sorts of issues, mostly cultural, but it's been exciting and I'm really looking forward to this year.

[00:02:30] I mean, an example of that was I just did a big piece about midlife and millennials at midlife. I am one. I am an ancient millennial. I just turned 41.

[00:02:39] Dr. McBride: What's the newsletter called now?

[00:02:41] Jess: It's just my name, just Jessica Grose.

[00:02:43] Dr. McBride: Okay, awesome. How cool is that though, Jessica, that you got to move from being a reporter, which I know you loved to giving your Opinion. I mean, anyone who knows me will tell you that. I love data. I love analysis. I love pouring through primary sources. I also have a few opinions and I love delivering them.

[00:03:04] Jess: Well, I don't think that my approach has actually changed really radically. I do what I like to think of as reported opinion. It's unusual for me to just riff on an idea without including data or including interviews. Occasionally I will actually, my next column is just about Brook Shields' new documentary. And so that's more just thoughts about what it’s like to grow up in the public eye for a kid. And it’s unsurprisingly not great. It was really difficult for her to develop a sense of an identity. But typically I still do a lot of reporting. What it allows me to do is draw more aggressive conclusions from that reporting. And anyone who knows me in real life knows I have a lot of opinions, so it feels really nice to share them.

[00:02:52] Dr. McBride: Well, I think that's right. It's the same thing in medicine. I have a lot of opinions, but it's rooted in my understanding of the medical literature and the understanding of the patient in front of me. So I'm never going to just say, do this because I said so. The fun is taking the data and the data in your case on motherhood and the historical context around it, and then giving parents and mothers permission to be less perfect than their Instagram highlights might suggest they should be.

[00:04:23] Jess: Yeah, I mean I had just the genesis of the book was really just in having so many questions about where ideas that I had about motherhood came from. Because when you start to unpack them, they sound crazy. So one example that I often give is I was very sick during my first pregnancy. I had hyperemesis, so I was throwing up constantly. I could not keep food down. I got incredibly depressed and anxious. I honestly think in large part because I had hyperemesis, just as you cover, the body mind connection is very deep. Not being able to nourish yourself, it's tough to feel good in any way. And I had the question, why is there even the expectation that one should feel good during pregnancy?

[00:05:16] Because I've known a lot of pregnant people in my life, and most of them do not feel great. Maybe they have moments where, during the second trimester, they're not enormous yet. They're feeling a baby kick. They're not sick anymore. Maybe you’ve got like two months of feeling pretty good, but often, there are many ways in which you can feel not your best self, and so every chapter of the book started with a question about an ideal that when you think about it for more than five minutes, makes absolutely no sense.

[00:05:49] Dr. McBride: Yeah, it's interesting about the hyperemesis, and I heard you say in an interview that you leaned into the toilet, that was your lean in. So I had a patient recently in my office who is pregnant with her second child. She's in her second trimester, and so, so sick, like on her knees, in her bedroom. She's a congressional staffer and can't even really go to work most days because she's so sick. And she went to her gynecologist and she was explaining how sick she was to her gynecologist, her obstetrician, and my patient asked the question, “can I take Zofran or something for this nausea?” And the doctor said to her, and the patient's crying telling me this story, she said, “well, if you really can't function, I guess you can take some Zofran.”

[00:06:31] That's a tough standard to hold ourselves to. If you're in the fetal position, then you can treat yourself to a medication that's exceedingly safe, particularly in the second trimester. Why are women so conditioned to suffering and why are we depriving them of the permission to experience highs and lows of pregnancy and motherhood, I don’t know.

[00:06:55] Jess: Well, we're working against thousands of years of conditioning, right? I mean, the idea that mothers shouldn't be martyrs and sacrifice themselves, put themselves last in every situation. That is in all of our…