In Return to Healing we lay out a very simple fix to the medical mess we are in.  We spend the first half the book explaining why it is a mess, and then the second half talking about who is profiting from the mess.  Then we give the fix.

It's really very easy to repair a system that is simply off the tracks.  We lay it out simply.  This is one you don't want to miss!

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com

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

"The greater the ignorance, the greater the dogmatism." -William Osler, MD

www.returntohealing.com