Straight Talking Doc Unhinged

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

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

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 erroneous, which typically they are.  They invented prediabetes and are responsible for pushing normal sugars so low as to cause potential harm.  And if doctors question their views or provide contrary data--of which there is an ample quantity--they seek to suppress it.  So where is the medical censorship, and do we really care about a small scuffle between leaders of an organization that needs a real revolution to make it relevant to care.

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

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

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

The Emergency Room can be life saving, but also can be a place to be feared.  We discuss several cases in which protocols and robotic thinking put patients in precarious positions, exposing them to unnecessary dangers, creating diseases where none exist, and base diagnosis more on tests that should have never been ordered rather than on a history and physical and common sense.

We talk about two issues about which we have written articles.  By clicking the hyperlinks you can access the articles, which are at the bottom of the page in each case.  One is syncope, where someone passes out, and in which the testing commonly done in the emergency room and even hospital admission are both unnecessary and potentially dangerous.  The second is the use of a blood test called Troponin, which is supposed to be used to diagnose heart attacks in people who present with symptoms consistent with an MI, but when done on people without such symptoms has a 5% accuracy and 95% over-diagnosis potential, exposing patients to dangerous over-treatment and labeling.

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

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

We also discuss a documentary Andy was in recently, and a link to that documentary is: https://www.theepochtimes.com/epochtv/video-series/healthcare-decoded-6006002?=epochHG