The Broken State Of The Modern Healthcare System - Doctor Mike

Dr Mike welcome to the show excited to be here let's uh chat evidence-based medicine my favorite it's having a Resurgence at the moment what's it like being on that side of the fence well you know I feel like I was one of the early adopters doing this on social media because when I was coming about during my residency training it was mostly people doing it on television and doing it quite poorly might I add in terms of confusing people or selling some miracle cures so that's why I started social media medical conversations and now it's just exploded into every different possible Niche whatever you want to find online there's a confirmation bias waiting for you well that's the problem this multiplicity and the democratization of access to health information sounds great in principle but in practice what it feels like to a muggle like me or everybody that's listening is just confusion and an abundance of conflicting messages yeah I think it's uh encouraged all of us to develop healthier skepticism which I feel like before the age of social media we might have been lacking but now with the rise of AI people don't right away see a video and assume it's real in fact they're more likely to say is this real where is this from can I see the original video can I see the sources and the description of where the evidence is coming from that stuff gets me excited one of the problems with that is when skepticism runs too far and whenis my friend credentialed experts no no they're part of big insert your favorite evil organization of choice big EG big farmer big food big earbuds big whatever yep I think uh in that regard there's negativity if you want to find it everywhere it's about understanding where that negativity lies and how it impacts people's messaging so I think just broad stroking or broad brushing certain subjects in healthcare will always be an incorrect message so you can't say anything is all good or all bad you can't say humans are all good or all bad in fact that's the first thing we really teach when we Institute cognitive behavioral therapy with patients that are struggling with anxiety and depression because it's very easy to get into this cognitive distortion of labeling things as all good or all bad or this is a terrible catastrophe and it's going to end everything for me just because I got this C in my class it means I'm a failure and labeling ourselves when in reality if we just have a little bit of a pause go back and think a little bit rationally with less of our emotional mind we can go a lot further and that's not easier that's a lot easier said than done that's why we need the help of some Mental Health Specialists from time to time are you trained in CBT not professionally or not officially I I would say but I was trained by a family medicine institution that put a huge emphasis on Mental Health we have a behavioral specialists in our faculty that consistently trained us that brought in diff different psychologists and psychiatrists to conferences that would actually interview patients at these conferences to teach us how to be better in our interviewing techniques they would watch our patient interactions encounters and give us feedback on how to be better um so because of that I have a a much greater interest and understanding of how I guess Primary Care CBT works and for me what that means is a general introduction to CBT a general introduction of why anxiety happens how we can fight back against it from an evidence-based perspective and unfortunately many of my colleagues don't go that far and have to rely on Specialists and these days with our American healthare System the disaster that it is it's near impossible to find someone in a reasonable amount of time give me the overview of what you've learned about anxiety treating it through CBT what the evidence says what it doesn't say yeah recently we've seen the evidence show that the best quality treatments that exist for anxiety and depression and when we say anxiety and depression we're really quoting from dsm5 this is generalized anxiety disorder major depressive disorder uh the highest level of evidence goes for a combination of mental health therapy which means usually cognitive behavioral therapy or some other avenues plus medications which are usually ssris but there is a whole range of medications that can work for individuals now if you have h a mild case of these conditions which we use validated scoring systems and conversations with our patients to figure out we don't have to Institute both simultaneously it really needs to be tailored to the specific patient you're working with so there's some patients that their case is so mild that we can just Institute bibliotherapy and talking with me as a primary care physician bibliotherapy being reading some information uh a book on the subject doing some handouts from that book that is written by a psychologist on the topic and then the next level of that would be working directly with a therapist getting someone on board to see them week in and week out and then medications as another option as well if their case is that significant what's the book that you prescribe the most common book that I give to my patients is called Feeling Good by Dr David Burns who I'm actually scheduled to have a conversation with the next month um kind of on the Forefront of the development of CBT and talking about how our cognitive distortions which are natural emotional reasoning part of our brain that we're all susceptible to can sometimes go too far and drive these symptoms of anxiety and depression in Us and how that therapy can actually help an individual and what I like about cognitive behavioral therapy and why I've been on board on it on the on recommending it for such a long time is that not only is the evidence for it great that it works but it's also really rational it's very reasonable a lot of people think when we say therapy there's some kind of woooo involved in it I say woo woo in quotes because it's not really woo woo it's just a very practical way of thinking and it doesn't mean that therapy is not going to make you feel it's not going to remove all anxiety or all depressive symptoms it the goal of it is to recapture some control so that when you do feel anxiety doesn't take you to that really dark place that when you do feel depressed you don't go to that dark place and it's really a way of giving you back that layer of control are there some CBT strategy or techniques that you find yourself relying on the most I'm sure that there's times when a video goes up and the comments begin to light up and oh God here here we go again uh there has to be something that you rely on for yourself yeah this is I guess less of a CBT principle but something that I force myself to do when I get into dark times is our brains are wired for negativity there's great books on the subject called literally the power of bad or the power of negativity and that's a assumed to be the reason why we've survived so long because we were constantly worried about the risks and threats around us and now we live in a safer place in comparison to a thousand years ago and therefore those anxieties are still present but a lot of times they're overblown and when you have uh a mind that's not moving meaning that you're not doing much you're not surrounded by stimulus you will experience more anxiety than the person who is busy doing something or that is facing a true threat and what I have to remind myself quite often is the positive things that happen I'm not great at celebrating my wins and that's something I've been striving to change for a long time and it's not easy to change but it's important to have some techniques ready if those symptoms or um I guess situations arise where you do feel down it feels like there's a an adult ADHD diagnosis happening every day on Celebrity Instagram have you you noticed an uptake among your patients too or is this just famous people um I think that there is a a pretty fair uptick in it whether that's recognition of the condition and more people being aware of it whether that's patients coming in requesting treatment specifically for said condition and Doctor goes along with it without truly doing a diagnosis whether that's a doctor giving someone ADHD medication in order to help them from a performance enhanc standpoint which does happen um hard to say What percentages those things fall under but there's definitely been an increase in the diagnosis at least of ADHD and the treatment for those who struggle with ADHD is amazing because if you're truly struggling with hyperactivity with attention deficit you can't maintain good social relationships you can't focus while you drive you can't do well on Tech you can't get a good education these are things that actually contribute to not just a shorter life but a life that is less quality meaning that you have true mental health issues that arise as a result of the undertreatment of ADHD so the fact that we're treating people who are truly suffering with it is amazing and we need more of that what does a person on the absolute extreme end of ADHD look like I think most of the people I I've my business partner in my productivity drink James had an adult ADHD diagnosis but you know it's I'm going to guess that it'll be mild it'll be enough to be classified but I'm going to guess it's mild what does someone the absolute extreme end of that look like someone who can't sit and concentrate for more than seconds at a time constantly having to shift their attention because they're unable to control it and really it's that lack of control that we'll probably come back to throughout this conversation where people struggle with ADHD who have a severe case of it and what's interesting about ADHD it's not going to be just noticeable to the person it'll be noticeable to their co-workers if they're a student it'll be noticeable to their teachers they'll get in trouble more they be uh labeled as a troublemaker in their class their parents would know about it so a lot of times when we're doing these investigations especially in adolescence we give papers that allow us to do a scoring system for the patient but also for those around them to get a better view of how they're interacting with their outside world what's going on in the brain that causes that to happen overactivity the exact specifics we' probably have to get a neuroscientist on board and uh give you those details the difference between myself uh as what I like to call an expert of family medicine is that the advice that I give in my understanding of conditions is on a practical basis how it impacts my patients how can help not just the individual patient in my room but also the population of all my patients of all people who are undergoing treatments or preventions so the specifics I tend to not memorize exact molecules and names of chemicals unless they're specifically important to the treatment of my patient I've never heard family medicine before I came to America what do you mean when you talk about that it's your GP it's your equivalent of your GP in the UK the only difference is I believe that we also do obstetric care and I'm not sure that in the UK that is something that is done under gp's guidance obstetric care for uh pregnancy oh okay Gynecology as well I don't know if that's done by your GP yeah maybe that is a specialist there's yeah pregnant women screaming into their airpods at the moment oh yeah just going back to the uh ADHD have you got any idea what's driving this because it seems there's always kind of a nod toward well you know increas in smart phone use and ah you know technology and Tik Tok and and shortening attention spans but I don't know whether overusing your smartphone can induce ADHD that seems like a very specific diagnosis or whether it creates symptoms that are similar have you thought about how you sort of split all of this apart it's very difficult to tease apart one of the major questions that I ask my patients that are concerned about the diagnosis is whether or not their symptoms are present during all aspects of their day so if they have trouble concentrating while in class but then when they're hanging out with friends or even hanging out at a library or hanging out with their parents they don't have those symptoms that signals to me that maybe this is something else going on that they might not enjoy their time in the classroom that they might be craving the dopamine Rush that they get from their cell phones especially in the way those things are programmed there probably is something to be said about about the epigenetics of it all so epigenetics is how our interactions with our environment and how we treat our bodies how it actually impacts our genes and there's probably something to be said with an individual who is constantly bombarded with this stimulus from our phones of constantly giving that feedback dopamine Rush when you get a like dopamine Rush when you get a comment and that constant flickering it definitely has some effect on our neurophysiology the consequences of it I think remain to be seen I think we need to study more of it because we on the front lines don't have perfect answers to all these questions and that's why I get frustrated a lot of times on health podcasts because I frequently see guests come on and talk about things that they claim to have all the answers to and boy I wish that was the case because I could be helping a lot more patients if that were true yeah very interesting what's the current state of description for ssris because I saw a study that came out I think last year talking about ssris are kind of got thrown out of the window a little bit that it seemed like the impact was only negligible then that got pushed back against it what's sort of the the world of ssris at the moment the world of ssris is that they're still very much prescribed they're still very much first line indicated for major depressive disorder in some cases General generalized anxiety disorder uh I use them quite frequently do I use them on every patient absolutely not um I think they've been villainized there's stigma attached to them there's also um misinformation about them constantly on the web I mean there's even a a popular I guess you could call him a health influencer Gary Brea who I've made reaction videos too where he talked about how these ssris work and it just was like flat out wrong like scientifically about how they work um hard to remember exactly the details but it was about the mechanism of action of how ssris work and the unique thing about ssris is it was a medication that we quite didn't understand the physiology of of how they work and yet we saw the positive outcomes initially back back in the day when these medications were coming about we thought that Depression was a issue with serotonin in the brain so then we put out these medications uh in trial form where they would increase the amount of serotonin in the area where they work and what we found is an improvement of symptoms over several weeks and we assumed it was because of the increase in serotonin well that's been disproven and yet some people are still repeating that and talking about that there's Now new theories about the fact that when your body sees more serotonin as a result of the medicine it downregulates its response to the serotonin which are the receptors that serotonin binds to and the body actually over a period of weeks decreases the amount of reactivity to serotonin and it's been theorized that that's a possible mechanism by which these medicines work but we have to be honest and transparent about our knowledge of what we know what we don't know when we claim to say like this is how they work we're 100% confident we have to be really care and this is I don't want to single out Gary Brea here a lot of people do this in fact we as medical institutions the broader Wei did this throughout covid and it was a disaster for mass communication where initially I remember on my YouTube channel we talked about how masking wasn't recommended because of reasons a b and c that we were short on masks we didn't think it would spread uh through the air we thought it was droplet only driven and then at time went on we learned more and we changed that guidance luckily and I guess fortunately for our Channel we were very clear about that early on and said this may change but there were some people in the major agencies like the Surgeon General at the time who was making fun of people for wearing masks on planes and boy did that end up hurting the public message because then people took that information early on and then used it to discredit his message later and that's problematic twofold one because I wish the messaging was different early on on his part but on the Bad actors front they're acting as if science doesn't change as if we don't learn new things every day and adapt our recommendations in fact if we didn't adapt our recommendations to New Quality guidance we'd be failing as scientists so I think it's a two-fold problem that we need to discuss on both ends rather than just nitpicking or cherry-picking one person how difficult is practicing medicine in the wake of what happened through 2020 government agencies and the CDC and all of these very famous well-known medical professionals showering themselves in something that wasn't Glory it was it it's a it's never easy practicing medicine period because medicine is science but it's also an art so you have to at the same time understand what's happening in a disease process in the treatment process but also understand how your patient is experiencing it how they're understanding The Words that you're giving to them the options that you're giving to them their financial situation of whether or not they can access those treatments and that's hard at the outset but then throw on top of it a trash Health Care system that favors profits and private Equity over patients uh the mess that we had with covid and the errors of mass communication the rise of misinformation through algorithms and social media trends now our jobs have become exponentially harder and I ultimately want my patients to have the best experience and to get the best treatment for them but that starts with a good line of communication and I feel like on our YouTube channel that's what I've strived to do from day one to make sure that anything that I'm saying comes from a sound financial backing and then from there if we make a mistake or if knowledge changes we admit it openly and honestly so that people know that they're getting the real deal and unfortunately that's not always the case on social media so that's why uh we're kind of out there debunking and doing what we do on our Pro uh programs when you said that it's a trash healthc care system that prioritizes profits over patients as someone who still have only been in the US for two years many people might not understand how the US healthcare system works and goes wrong what is there to know about that we have a hybrid system meaning that there's some people who get government funded insurance if they're over a certain age if they fall below uh certain poverty level uh they get covered and if they have certain disease States they get covered then there's people who get insurance through their employer then there's people who buy individual plans and just get coverage for themselves and this hybrid system is incredibly messy and I don't yet know if there exists a country that is as big and diverse as the United States that has gotten Healthcare right because I hear complaints from Canada I hear complaints from the UK all the issues with NHS that's going on so I don't yet know who has it all figured out but definitely the direction that we're going towards is more problematic and I'll explain why you're a sharp individual you're a business person you understand how companies work their sole goal especially if they're on the exchange is to not just have a profit but to grow said profit and the way that this works these days especially when starting a business we frequently hear oh this person made an exit of 10 mil 100 Mil one bill and we all Envy those individuals well what we're not seeing is the back end of that problem where an exit means that they're exiting to a larger company that is buying that information that data that process C of however they generate income and then they're trying to streamline it as much as possible by maximizing profits and getting rid of waste in some instances amazing I love getting my product shipped to me faster I love being able to access certain things quicker there's some Avenues where this is great like the ond demand car sharing option is amazing then there's some instances like healthcare where it becomes a disaster because for example in the United States we get outraged when we find out police officers have a quota of how many tickets they have to write we go on the news and we say oh it's not right they're just giving tickets just to give tickets because of quotas no no no the real problem is doctors have quotas of how many patients they have to see in order to get paid what what if I have how many times have I had a patient that was scheduled for 15 minutes that comes in with a stomach ache and then I find out their loved just died that they got a recent diagnosis of brain cancer I'm not walking out of that room in 15 minutes you have to be a human as much as a doctor and when you see how often those things happen in an exam room you understand that putting a quota on healthc care is just flawed from the start and the sad part is private Equity doesn't care it's whoever is going to drive those growth and profits that's who they're going to pick and that's why the things that private it has jumped into the most when it comes to Health Care are things that are scalable teley medicine urgent cares there's one popping up on every corner and young people think oh urgent care it's awesome I can go get treated quickly because it's quicker than seeing my primary care doctor where there's a weit in some instances true in some instances relying on urgent care as your form of primary care is not good long term not establishing a relationship you're not uh the doctor doesn't know you well to help give them uh the best advice for what works for your body for your mind the best way to explain uh treatment to you uh to calm your nerves when you're going through a stressful time long-term continuity of care is better than just Band-Aid Band-Aid Band-Aid band-aid and unfortunately the young people of our country the Millennials that Jen ears are have largely relied on urgent care to get their treatments to get their primary care and that's that's no bueno Chris it's it's led to a lot of disruption in our Health Care system and I can't even blame them because if you call a good primary care doctor and you ask to be seen same day that's like you get laughed at by a receptionist and when you're sick that hurts even more so I'm going to guess that young people in particular this is impacted because medical insurance is expensive if you have to pay for it yourself maybe you don't have a job that is offering Healthcare cover uh but so you're so young that you think you're made of rubber and magic and I'm not going to get sick in any case and it happens so infrequently that it doesn't really matter so I'm it's kind of playing a reverse Lottery that I'm not going to bother putting the money in and once every 500 days when something goes AR off to Urgent Care I go yeah and what's interesting about health care is we much prefer to do things on a Proactive or elective basis rather than a respond of uh respondent emergent basis so for example if I have a patient that I can schedule for a hernia surgery ahead of time so I can do a surgical clearance for them I can make sure that they're medically optimized to make their make sure their blood pressure is under good control their sugars are under good good control they're going to have better outcomes during that surgery as the opposite end of that example waiting for that hernia to become incarcerated where the uh intestines are literally being choked out and you have to go for emergent surgery the risks exponentially go up so we want to plan for things as opposed to react to things happening and there are certain things that we can do from a primary care standpoint to get ahead of issues and prevent them to a degree and Institute those things for our patients and I specifically say to a degree because there's a lot of even Physicians and experts online who think that we can prevent every problem and that we should be doing more for prevention but that's only thinking from one side of the problem as opposed to viewing it holistically it's interesting that you brought up the UK I have a number of friends that were doctors that I was friends with as they went through med school as they went through F1 F2 as they finally got the finally got themselves signed off and uh I mean God if the us if the US is a mess the UK is is something else they're still using Windows XP that's the operating we still have pagers my residents still have pagers like literally beepers why just because they've been grandfathered in from the old system yes and there was some talk about that maybe in the basement of the hospital there's bad reception but the pagers work on a different thing so the signal will be better I don't know it's it's just this it's this wonderful cocktail of cuttingedge medical assessments with an ient technology and trying to get these two things to fuse together some of the horror stories that I've heard man about uh a doctor needs to prescribe something or or or get something cleared for a particular patient and one floor below them is where they need to go in order to get this done but they go down to that floor below them physically they go there and ask for it and they say no sorry you need to fax us a piece of paper I can't email it I can't call you I can't ask you while I'm here I can't even fill it out physically on a piece of paper and hand it to you it needs to be faxed through here so that we've got the record of the facts and then the fact needs to be filed in a particular place but it needs to be signed off and the guy that signs it off he's not actually back in until the morning so they're going to have to wait and you just think here's another one actually so a good friend of mine uh has a um Fitness business online and he wrote programs many many years ago that were just Evergreen and they're still selling away in the background but they were super cheap PDFs for12 something like that I think that while he was doing F1 his first year out of med school uh in the UK I think he was on about 1150 an hour so I think that was around about the the wage that he was getting so he's one ebook was was more than that um a particular patient had been uh struggling uh passing solids for a while and needed to be I think is it called decompacted yeah so needed disimpacted sorry decompacted close enough um disimpacted which is uh put a gauntlet on get in there and and and pull pull out what hasn't come out of the back passage of the patient so sure enough at 3 in the morning Yousef rang the specialist he said look is there something that can do you need to come in he says I'm not coming in for that you can do it yourself so on Goes The Gauntlet couple of pairs of gloves Yousef spends the next 30 minutes This Woman's in discomfort her family there there's an issue with them they want her to be right she wants him and he's just doing his thing and after he maybe 45 minutes later peeled off all of the layers of gloves and checked his phone to see that he'd sold a eBook that he wrote N9 years ago for 50 P more money than he just earned from doing that one thing and the attraction for working in that kind of an environment it doesn't surprise me that the NHS is struggling with talent and that they're losing people and that nurses and doctors are going on strike and then I don't also completely understand why patients are thinking iron you the the people that after our health are striking that feels like they're playing roulette with our well-being that doesn't seem fair either and yeah it's it's not good it's not good I think you're right in saying that nowhere's got it right yet it's between a rock in a hard place where healthc care providers find themselves in because they want to do the right thing by their patients and I I understand your example cuz it's so clear of the patient needing that disimpaction and yet uh your bu was earning more money by selling the book that's not even the biggest concern for doctors or nurses that is actually the part we have a problem with least like it sounds to the average person like oh disimpacting someone that's below us or it's not we want to help patients do you know what is the most destructive thing when we actually want to help the patient for 11 lbs an hour and we can't because we're forced to see so many patients so certain institutions make more money or we want to give the patient a medicine but it's not covered by their insurance so we can't help them or after working a full day where we stay late in order to be able to disimpact and help all our patients and get paid not the greatest salary we still have paperwork to do to prove that we did all of these things on Ancient systems that require dozens of clicks to get even the simplest thing done and that is disheartening way more than it is about not being properly reimbursed for disimpaction because that strikes at the soul of why we're doing what we do this impacting a patient is what we signed up for sitting and writing charts for hours at a time after actually helping our patients and then getting one administrator to make sure that the billing is done and that the billing like all the fact stuff that you talked about that is the prime example of why doctors are burning out and nurses are burning out at historic rates because it's like doctors used to run hospitals and be in charge and on the leadership seu teams and now doctors have become laborers and the people that are in charge are these Financial folks who are thinking about the profits more than anything and I think that's ultimately uh a bad thing for patients more than anybody talk to me about the rise of aestheticians and cosmetic procedures I mean I see it happening I I've seen that happening all all the time that's not a new phenomenon uh I just think that probably social media Zoom has fueled uh people's self-criticism of what they look like and there's probably been a Spike as a result of seeing themselves on camera more often these days I saw some surveys where like half of gen Z feel like they're creators or influencers and when that happens people want to look a certain way they want to have more control over the way they look and it's not necessarily A Bad Thing the issue comes up when it's people who are not licensed to do it who are not well trained to do it who are not adequately giving people information about side effects of certain treatments like who am I to tell someone what's right for them nobody it's not my job it's it should I should never act paternalistic to a patient unless they have some cognitive issue or someone's hurting them like a child and they can't speak up for themselves or elder abuse some rare situation but in general my job as a physician is to give the best quality of information that I have in a given moment about a treatment about a topic so that the patient can decide for themselves and what happens when someone who's unlicensed or untrained does a procedure that person may not realize what they're signing up for and that happens quite often I see issues with medical tourism where people to save some money go to other countries to get treatment where there's less supervision and things are cheaper sometimes because of less bureaucracy like all that paperwork you discussed and that could be good but it also could be bad because there's less oversight in what's going on and I've seen some pretty horrible infections and complications that happen as a result of that what are the most dangerous aesthetician cosmetic procedures that you're seeing people have more of at the moment um I think BBL is um a procedure that people have gotten excited about I don't necessarily see a lot of the consequences of it but I've covered it enough from a research standpoint for Content online where I've seen that a risk of a fatty embolism where you actually get uh a piece of fat lodged in an artery that then travels to a different part of your body and it creates a blockage happens like one in 3,000 cases and that's one in 3,000 healthy people you know if you're going for an emergent surgery because you're having a life-threatening condition one in 3,000 to save your life is good odds but when you're healthy and you could potentially get this life-threatening condition and lose your life that's absolutely terrible so I just hope people understand the risks of what they're signing up for and not just getting excited but what they see on social media where are you practicing Family Medicine Clinic uh at a community health center in New Jersey New Jersey right okay I was going to say you may see more of them if you were in Miami Miami seems to be the the the the hot bed for for bbls what is it about that procedure you know people have had boob jobs for the rest of time I thought a BBL was just a a boob job for your ass what is it about plants okay uh unlike uh with breast augmentation a BBL requires lipos section so removal of fat from one part of your body and then inserting that fat in another part of the body body usually people will get their waist Slimmer and then insert it into their butts uh and when you do that if you accidentally position that fat into an artery that's where that complication happens whereas with breast augmentation it's um an opening and insertion of a a breast implant which has risks of its own but you know with this specific condition I feel like the fatty embolism isn't discussed as often as it should be is that in order to get the I know that you don't do bbls on the side or at least I don't I don't think that you do you know night night night flying to Miami to go and do bbls um I'm going to guess that they have to sort of Put the Needle in at multiple locations or else you would just have one huge deposit of fat which wouldn't make for a particularly round shaped ass now again walking through the streets of Miami I've seen what can only be described as a bag of cats inside of a set of leggings you know that sort of it's like this it sort of looks like paws being pushed out so my point being there are uh gradations to the quality of a BBL that you can get in any case but in order to try and create that round um shape you're going in and I'm going to guess that that's what you're getting at there is blood flow through the glutes and then as you're going in if you strike an artery and then you put fat into it very not good yeah the exact pathophysiology of how it happens I'm not super familiar with but the fact that it does happen and again a lot of people especially in Miami I'm familiar with anecdotal cases of people traveling to South America to get these things done and I've actually seen some pretty ridiculous things people getting injected with certain Solutions and um I I believe that there was a case if I'm not mistaken the news of someone getting almost like concrete injected and it's unfortunate that people are taken advantage of because sometimes they just don't know and usually it's people who struggle financially that get taken advantage of the most so yeah I mean the Cosmetics thing is not my expertise but it's just unfortunate where it's another area on social media where people get misguided and they have wishes and expectations so I hope to Enlighten them about the risks of what they're going for have you looked at this leg lengthening surgery Trend that's happening at the moment yeah absolutely I have um I've seen it uh and I'm surprised that people are willing to go through that level of recovery and physical therapy and immobility for a period of time and IM immobility on its own has pretty significant risks of having blood clots and such so yeah pretty surprising the lengths that people go to not no pun intended lengths have have you seen any of these patients in real life have you ever seen anyone that's had this done yeah me neither I've never met anybody that's had it done it's crazy though to think yeah what guys are prepared to to go through in order to gain a few inches in height yeah again as long as they're of sound mind and they're making the decision based on uh knowing all the risks that's their choice you know like some people will look at me and say you're a doctor and you box professionally what's wrong with you don't you know about head injuries I do know and I've signed up for it and I understand the risks I look at someone like what's his name Alex who uh solo climbs and um I'm like oh my God you're doing that without safety equipment cool that he knows the risks way better than I do that's that's not up to me so what should we know about posture that's something else I've seen talked about nor a lot on the internet recently um posture has become a buzzword for certain people online where they say you need to keep this specific posture you need to do this specific exercise and it's rarely ever that cut and dry in healthcare let alone when it comes to posture the the probably most correct statement is that there is no such thing as a perfect posture because because if I was sitting here and I was sitting with what people refer to as perfect posture you know chest out shoulders back down like neck back if I hold that position locked in for the entirety of our interview that's going to cause me pain so really perfect posture is about having a healthy balance of being able to sit up straight like this without overly fatiguing your body taking some time to lean back to maneuver my legs below the camera in certain ways and actually not holding a specific posture for too long because whether you keep this posture while you're gaming or chatting or whatever for a long period of time or you're keeping this posture you're going to run into trouble either way so it's about keeping Mobility keeping circulation going that's really the the correct way to talk about posture look do people have certain deficiencies in posture meaning they have a significant scoliosis to a severe degree where it can impact their functioning yes but a lot of times people have a very mild scoliosis where they have a abnormal uh curve of their spine and they want to blame every issue on that when in reality not every case of back pain is necessarily related to their mild scoliosis curve I spent quite a bit of time researching lower back pain I had two bulging discs and flew to Gravenhurst in uh just two hours north of Toronto to see Dr Stu Mill who is regarded as one of the number one back back pain specialists on the planet specifically for lower back pain uh very conservative with his management so he's quite anti- surgery which I think is probably probably a pretty good position to hold and has been proven as we've seen Ronnie Coleman or you know pick your favorite athlete of choice work their way through through some insane amount of pain just as a side point I from what I know the reason that surgery is so dangerous is the potential for scar tissue to form around nerves and you can already have um certain areas of the back which are impinging on nerves but if you've got Scar Tissue which is formed around it that causes the most sort of intense chronic pain and really interestingly Matthew hussy he's a dating coach guy he had um chronic pain in a headache and he explained it to me that chronic pain is one of the few types of um physical maladies that you don't adapt to so everyone's heard the same story of you win the lottery or you lose a leg in a car crash within the space of about two years your happiness set point has come back to something approximating where you were before hoay we we very robust or boo were robust against winning the lottery that sucks but uh chronic pain is a a permanent reminder of the fact that you have this thing which is wrong with you it is always ticking away it's always going it's always firing and um the sufferers of of chronic pain seem to be the the outcomes for them in terms of mental health uh increase in suicidality Risk all of that stuff um not good so yeah went to go and see Stu Mill and he said something very similar when it comes to posture that sure a neutral spine a tallish neutral spine is optimal but the most important thing is to allow yourself to vary that posture as much as you can which is why you know whichever the biggest company in the world for standing desks is has probably absolutely exploded over the last 5 years because everybody wants to go from sitting to standing I'm going to have one of those sexy rocking chws I'll go back and forth on I'll be a bosu ball like a pregnant woman you know all of these different ways that people can do things to try and Vary their posture and for me as someone you know I'm patient zero two bulging discs L3 L4 and L5 S1 and I have managed to get myself to a place now where I can sit for a 10hour plane Journey and be absolutely fine I can go on a tour where I'm stood upright still for a while listening to some tour guide talk and uh most of that was not putting myself into positions that irritated my spine not going unnecessarily into uh flexion or extension uh shearing forces so that kind of position you get into when you're in a a good morning or you're doing a bent over row where your spine is perpendicular to the ground and the force is going through it like that for me was very very painful so finding out what hurts for you not doing it and giving you back enough time to re recover and then just thinking about building a a relatively good posture for the most part and varying it I went from a lot of back pain five or six years ago to now I I don't notice it I have zero back pain day today yeah that's an amazing result and I'm glad you're able to avoid surgery because a lot of my patients unfortunately either get talked into it or think that they absolutely need it for their pain and as you said those who struggle with chronic pain it's a devastating condition for them me mental healthwise and um the unique thing about pain is that there's a lot of things that impact pain that we don't realize so there actually is this like pain cycle that we go through of where we can actually condition ourselves to feel pain more often and sometimes you know back in the day we would talk about it as someone muring so pretending to have pain in order to get some kind of outcome but there's actually much more evidence now talking about it from a mental health standpoint where you turn up your sensitivity to pain because you expect it and when you expect it and guard against it you're actually like almost you know when you're trying to hear something a little better you concentrate just a little bit more the volume of that sound doesn't change but you perceive it a little better so we can actually train ourselves out of expecting pain therefore decreasing the volume of that stimulus and on top of it our emotional state greatly contributes to the volume of how we experience pain so a lot of times I get into this situation with my patients where they come in for a physical malady back pain neck pain elbow pain and we might do a workup we might not we might just get enough information off the history and physical exam where we end up talking about how their mental health is impacting their perception of the pain and and some people get understandably angry and say are you just saying this is in my head and that's absolutely not what I'm saying the answer is that if you're having true pain it will feel worse if you're an unhealthy mental state because if you have a torn hamstring whether or not you're at work or at a party it will still be a torn hamstring but if you have a mild injury there that hurts only when you're at work but you forget about it when you're hanging out with friends and you're able to do whatever you want when you're relaxed that signals to me that it's not an anatomical issue per se that's the problem it's the perception problem of it and there's many instances where mental health therapy focusing on how they're feeling what's going on in their social relationships is a treatment for physical pain and that's a very unique uh field of evidence that I've kind of had a a lukewarm ception to on social media I can understand why um again speaking as someone who has had a pretty serious injury that absolutely was contributed to is that is that psychosomatic is that what that where that word work could be a form of psychosomatic yeah okay well my mindset definitely contributed to how much pain I was in whatever that means and you know I I began to identify with the label of being someone who had a bad back or I I I have a bad back back I have back pain and then you begin to avoid doing movements that put yourself in pain yes that's probably that's probably not too bad especially if it's close to the actual incident especially for for a lower back yeah exactly um but after a while you actually realize that this has become part of your identity and you know you you go into do CrossFit class and you look on the Whiteboard and you realize it's got hip hinging in it and you say oh no I can't that's not that's I I I have backp as if you know this is your family name or something or the country that you're from I have Bank pain which is fine you can say look I'm going to adapt this thing but trying not to identify with it and I understand completely why people would feel attacked and upset if their doctor was to say to them you and your mindset are making the thing that you're feeling worse because they're going to say hey [ __ ] you I didn't choose to have this this pain is real you can't tell that it's real you're disregarding the fact that it's and I go through this all the time and I did and you spiral out and I can see why that would be the case but I also know that as I gave myself more proof in the real world I.E allowing back pain to dissipate allowing myself to not be in so much discomfort and then realizing well maybe it's not quite as bad as I first thought and just one tiny little micro step away from and now if someone says hey what's your back like works pretty well I try not to squat because that's probably a bit of a high risk movement for me but I don't I I don't identify myself as someone who has back pain or is a bad back and um yeah that's difficult that must be a hard thing to try and deliver um delicately to a person who's in pain yeah it's tough you have to be very present and very focused on the visit and you're not getting it done in that 15minute time frame that we're often allotted uh what you did for yourself is essentially exposure therapy and there's certain conditions where exposure ther Works quite well where we gradually work you up into reducing let's say social anxiety or phobias and we gradually expose you to a level of stimulus where you're comfortable and we continually challenge you a little bit but we don't challenge you so far it has to be an acceptable level of challenge so much in the same way you know it's fun to shoot three-pointers you miss sometimes you make it sometimes but no one's standing on the other court full court away lobbing shots the whole time that's not fun because the level of challenge is just way too high so you want to have a level of success or a chance at success and once we could find the right level for the individual we can help them have some exposure therapy there's a great Doctor Who unfortunately passed by the name of Dr John Sarno um who is actually a physical medicine and rehabilitation doctor from NYU that really pioneered the the knowledge of how back pain and pain in general is related to our mental health and while not everything in the book is 100% accurate because there were some theories in there as to why it happens or how it happens maybe they're not perfect but the general thought behind the idea of our mental health impacting how we feel physically is so strong and I really recommend folks to read his book uh one is called The Divided mind another one is called healing back pain really great reads I recommend them to patients so often and the number one thing that patients say when they come in for their follow-up visit is I read the first chapter and that was me and I started thinking about how that could be happening and right away my paint went down a certain level of threshold that's amazing if I could do that without medications that's such a win and some people might say oh well that's Placebo oh man if I'm getting Placebo off reading a few pages of a book I'll take that Placebo all day yeah well what do you what do you when I talk about uh pain which is enhanced by your mindset what is that that's that's the exact inverse of what you've just said okay so if we've accepted that some people's pain can be made worse by their mindset and but you're not going to accept that someone's pain could be made better that's somehow less valid no exactly so like when someone you mentioned that patient that would feel discounted or unheard or like they're making it up uh in their mind how we go about talking to them it's actually in an optimistic way not antagonistic where we'd say hey what I'm saying is your mindset is contributing to it and your current mental health State could be contributing to it if it is this is under a level of control in some ways where you can make this better so there is a bright light here I'm not saying I have no idea what this is and throwing my hands up and saying you have to figure this out I'm saying that there's a way actually out of this and usually when you give patients actionable steps especially if they're not trying to se if you're not trying to sell them some miracle formula or do anything ridiculous they get really excited about it so one of the main things that I tell my patients is avoid guarding if the condition is mild like if I have a patient who I'm not worried about hurting their back by standing up off a chair I tell them don't stand up gingerly like we often times get into this habit of if we hurt our backs let's say two weeks ago we get up like this like we're waiting for the pain to hit us and when you're going to get up like that the same thing happens as if when you're walking into a dark room and you're a little bit scared and someone Whispers near you you jump because you're on edge you're already primed to be in that mindset if anyone Whispers to you on the street of New York City you wouldn't even hear them you wouldn't even care but when your mind is in that primed state that any sound is going to make you jump you're priming yourself every time your guard in your back and look there are times where I tell my patients you have to take it easy and we need to do some serious activity modification but a lot of times with back pain it's about restarting movement safely getting them working with a a therapist a physical therapist who knows what's going on and if there is a mental health component which is very common I recommend talking about that as well are there actually microplastics in everyone's testicles I saw that article I saw it I was worried have I got microplastics in me um probably I mean it's not t um I don't know specifically the testicles I didn't read the study uh fully to know exact details of it but it's not unusual for that to happen in the day and age where we live in where people pollute companies pollute there's these chemicals that we've used for waterproofing that last Way Beyond what normal chemicals last in the Environ very similar in our own bodies so I think that absolutely is a real scenario and just like how we talked about um I feel like I'm villainizing capitalism here and I'm not anti- capitalism by any means but a lot of these private Equity companies they find a product that works as waterproof uh water bottle or jacket or whatever article of clothing they're going to mass produce it without thinking about the effects on society as a whole because again they're main focus is on the profits and I'm not anti- people making profits but you have to think about what's happening with these chemicals and you know with public pressure right now I think a lot of companies are waking up to make some changes and it's not full but it's a step in the right direction for sure I saw you do a video about Lululemon leggings and whether or not they're dangerous what's the what what's the conclusion from thaton leggings killing everyone that would be funny um no there was uh a pretty common claim that I saw that there's this chemical pfas that exists in Lululemon leggings as well as other athletic wear companies and whether or not that's harmful for us and then as I researched that video I realized how pervasive the use of pfas are in our lives that the reality is even if you're a minimalist you still have exposure because of food containers because of the trash that people get rid of and how it transfers to Wastewater and how it's present in our oceans so hiding it from it is not easy there are some consumer things you can do to check if your products do contain uh these chemicals but now luckily Lululemon we reached out for them uh to them for comment they said they're no longer using those chemicals in their products probably from social pressure the fact that uh people are up in arms about it how interesting I had Dr Shana Swan on the show she wrote the book countdown which was about sperm rate decline uh over the last few decades really interest bunch of interesting things from her first one being that I would have thought that we would have had tons more data about testosterone levels than about sperm levels not true apparently sperm counts have been tracked for much long which kind of makes sense I guess where the sperm count level is much more important to the continuation of the species than the testosterone level it's only recently that Bros like me and you have maybe been concerned about whether whether we're in the high 800s or the low 500s um so that that was the first thing second thing being to your point about avoiding in the difficulty in avoiding microplastics that you can get um Farmers Market raw milk glass bottle from the farmer farmer's going to hand it to you and you think oh [ __ ] you Plastics you can't get my testicles are sweet and pure what you don't realize is that what they used to pump the cow was a a tube attached to the other warm milk and it's heat plus these Plastics that are really really not good because they seem to be able to sort of liberate some of these molecules from the The Binding uh going through these plastic tubings what's in the plastic tubings all of the uh materials and all of the compounds that you're worried about in any case so yeah it is so difficult is it what's it packed in what was it collected in what's it been transported in what's the heat that it's been in throughout throughout all of this time spec what's the lid on the top of that bottle made of and what's the it is it is unbelievable so I my friend George who I'm traveling with this is not for the people listening at home I realize we're an hour and a bit in this is not my normal Studio I'm currently in Lake Norman in in North Carolina um George the guy that I'm traveling with has a question he asks which is what is currently being ignored by the media but will be studied by historians and I think that microplastics and the ubiquity of those are definitely going to count as one it's beginning to catch a little bit of steam now but it's still very much in the sort of Micro Niche influencer Fringe and I'm not seeing it really break out into the mainstream just yet yeah we have so many things that pose risk to us on a given day it's hard to know where our attention should fall so I very much hope more scientists are focusing on this it's difficult for me like think about it this way I think it was uh leay Norton that actually said this on my podcast in a different way but same example if I'm looking to pick up the biggest weight as possible and there's different size Boulders around me and those Boulders represent risks I can reduce for my patients like basically beneficial things I can do for them most of the boulders are focused on really the fundamental things of healthc care which means making sure that you're not carrying excess weight you're consuming at least a varied plant-based diet with good sources of protein fish chicken meat all that good stuff um exercising sleeping correct mental health check-ins social relationships those are the big boulders and then the plas while it could be a big threat down the line I I I I don't know if I have the capacity to tackle microplastics right now unless we get more information uh in the next think about how many testicles you'd need to be around if you were going to tackle the microplastic I don't remember how much that study uh s is actually present swimming in testicles uh but that's also why I approach medicine the way that I do in saying that there's so much we don't know like there's so much we don't understand our grasp of subjects is so novice level and while we are Advanced as a society because we compare ourselves to puppies and kittens we say look how advanced we are as a species there's so much we don't know so that when someone comes on and acts very confident that they have the key to everything I think that's great for their work I don't think that's necessarily great for the average person speaking of that you mentioned before some of the independent influences in the health space what is your perspective on the ascendency of Health podcasts and health influences it's kind of been a mixed bag um there's some people who are bringing really great information to the Forefront who are discussing nuanced complex topics there's individuals who fall and have this little middle ground of talking about that but then also straying into weird nonscience evidence-based areas and then you have people full on that are just in it for viewership maximization of profits and look like more power to you but my job is to give people accurate info and if you're going to be one misleading them I'm going to be out there trying my best to correct it who are the people that you like the best who do you think or who who do you follow who do you recommend to your patients you know he's doing less content these days but I really like Zubin de Mana uh known as zg he was doing some really great content especially surrounding uh moral injury as he called it of like burnout when it comes to um being fed up with our current health care system and it needing to change I thought that was fantastic um I also really like uh people who make content on social media that not necessarily is a podcast focused but long form content like Mama Dr Jones she does some great obstetric and Gynecology content I actually have a series where I try include evidence space doctors of answering like one specific question or talking about their experiences in healthcare from different Specialties and I think it's cool to have a variety of that so I applaud those who stay true to the evidence uh and don't sell out as people often say where did Zubin go he was on fire during Co I I mean I before Co he he was doing social media before I was I remember meeting him when I had my little viral moment of popularity 10 years ago in a hotel room and we did like a live stream that went out on Facebook that's how long ago it was and um yeah I don't know I I check in with him every now and I need to yeah he did really really good stuff I was just thinking then when you spoke about uh the Obstetrics and Gynecology that there is an entire world of healthcare that guys are just absolutely blind to like the entire sort of per Healthcare is blind too how so when we did our preliminary research for a lot of the conditions that are common in society we studied males we excluded women from our research so like when we say the classic signs of a heart attack is an elephant sitting on your chest pressure Etc that's a white male's definition of what it feels like to have a heart attack is it different if you're a black male it's certainly different if you're a woman and what ends up happening as a result is women come into the emergency room with slightly different symptoms they describe it differently they do it more in a narrative style description of what happened and because older doctors especially weren't trained in that heart attacks are missed people lose their lives and we need to do more of that when it comes to healthcare even uh you you mentioned for uh a black person the fact that our Dermatology books like the older Dermatology books have only skin conditions on light colored skin which is a problem because not all my patients have light colored skin and conditions present differently in those individuals and as a result I'm not as good as a doctor if I'm not trained in that uh environment we need to do a better job in researching these subjects because what ends up happening is we without proper education won't be as good in treating our patients that's the bottom line what about scented candles how dangerous are they uh fire risk if left unattended for sure um burning many of them in an enclosed environment also not a great idea but interestingly enough as I was researching that what I found is burning the candle itself does not release as much harmful chemicals as the initial lighting of the candle and the put out of the candle why have you got any idea why it's because of the combustion or something someone's going to fact check me and say that I'm doing it wrong but uh it's basically if you don't have complete combustion you create more soot oh as a result it's an incomplete combustion that causes this WOW unique chemical reaction dude so people can go back and look at this my first ever uh Studio which was my old bedroom in Newcastle upon ontin I'd got into a Yankee Candle a little bit of a Yankee Candle phase I like the smell of them I thought they were nice I had a good rotation going um one of the things I had to say I think I shamefully I think I loved this sort of spiced apple thing that was only a Christmas release uh and I I kind of lived Christmas all year round um they had a cotton something cotton one which was quite nice but anyway the uh s that collected on the ceiling made my low ceiling bedroom looked like it was covered in mold and I got absolutely flamed appropriately on the internet for months and months and months so badly that I had to pay for decorators to come around to repaint the ceiling just because of how badly I was having the piss taken out of me so much that I couldn't bear to do it anymore so I had my entire bedroom ceiling repainted uh in an attempt to get away from that which was which is good but no people can go back and and look at that so that's real I see that and there is a bit of me that thought as I looked at the ceiling if that's what it's doing to the paint it's going to be doing something to my precious boy lungs and uh yeah yeah I don't know I the Austin my current home base is kind of one of the ground zeros for a lot of Forward Thinking concerns about health and microplastics and fluoride in your tap water and whatever you've got that's coming out of your showerhead and we can dechlorinate the Water by using and one of the things that's been next on The Chopping Block was uh candles so it was inevitable I think that they were going to come for Yankee Candles eventually but I was I was out ahead of it I'd already quit my my addiction a while ago yeah I mean I I think it falls into that uh Bolder Rock situation I think it's still a pebble in the grand scheme of things and I also think that if you're chasing Perfection when it comes to health you're actually doing your health a disservice because chasing per perfection in health is Not Just an Illusion that's impossible it's a toxic illusion because it comes along with anxiety stress constant worry that you're not doing enough and as a result you end up harming your health more than helping yeah speaking of the big rocks the debate around obesity is um surprisingly contested for something that seemed to be a bit of a slam dunk for what it does to People's Health uh what are your or what do you think is going to be the future of obesity given that we're maybe just about to turn a corner with gp1s and the ability for people to choose to be the weight that they want to be it's very interesting I'm not sure how this will play out because these medications are not just beneficial from a health standpoint they're also beneficial to our Health Care system because if we can prevent heart attacks and all of The Strokes and the situations that can arise as a result of carrying excess weight we would be also improving the burden of in our Health Care system so that's one uh two we're going to be definitely harming the profits of some food companies I think they're going to be pretty angry I've seen them do some unique things actually there's one that just launched a a glp1 focused meal plan where like they're in the supermarket and saying if you're on one of these medicines with goio zic mararo eat our food because it's made specifically for you and I guess it's more protein Rich so that you're still consuming enough protein but it's funny watching them try and adapt uh but at the same time I'm also wondering how Society will react when there is always on hand an option that may take some of the required willpower out of the equation I think it's fair to say that there's a lot of it around it surprisingly so uh I think um I've had a number of convers ations Johan Harry's new book magic pill he came on Scott Galloway came on he spoke about it Dr Mike isrel who you just had on your show he came on he spoke about it the internet really especially maybe my corner of the internet the personal development bro High agency sovereign individual thing um very concerned about it uh and I'm cautiously optimistic but it seems to me based on all of the smart people that I know who would not typically uh fall for he says as he recommends something that's about to destroy the entire world uh would not typically fall for something that wasn't robust uh and that they hadn't done the research on they are basically saying that this is going to be as big of a revolution as the smartphone was um but for healthcare that you know we've been promised and I understand why uh fenfen and all of these previous iterations of drugs that had wild crazy side effects super toxic or dangerous or you know had long-term risk risks I understand why people are not too confident about this one but it does seem like a difference in kind not just a difference in degree and uh yeah flight companies the airlines predicting lower fuel costs because of a lighter populace to transport around confectionary companies trying to drill their margins because they're expecting to do Less sales volume the hip and knee replacement companies expecting to do lower sales volume and the most interesting one Jewelers because they had to spend money people's fingers have got fatter they've had to spend money to get their wedding rings changed and increased in size so there's going to be an initial increase Boon to get the uh jewelry changed again and then after that a little bit of a nose dive because there will be less gold that'll be need to fit ever thinner fingers I uh I have a question for you I had a world-renowned food expert on it's not a published interview yet Maran nessle she's a PhD Professor um she asked me a question that I want to pass on to you and see what you think is there any industry that will make money on us as a society losing weight and I couldn't think of one so if you do I'm going to be impressed suddenly some niches within the uh food and drink industry will because you just have a you now have a new gastrointestinal environment so uh high density low volume uh I think uh if you can make protein companies are making those Foods they're not going to be selling as much of the foods period so their pric agreed if you have I'm I'm thinking more disruptive you know a single small startup a number of small startups to come in and disrupt Mars or whatever and they make something which is which is let's make it more industry focused as opposed to company yeah uh it's really going to be hard the only thing the only other thing I could think of would maybe be companies that make sportsware stuff because sportsware is a kind of clothing I'm aware that I'm like niching down again so I'm breaking a rule but um Sports is a kind of clothing that people who are more in shape tend to wear um and yeah they're going to make oh did they do that thing is it more expensive to buy bigger people clothes they probably flattened the price right that would be a huge social campaign if the 3XL was twice the price of the small that's definitely going to be like fat tax accusations thrown around I don't know I I think it's really hard to think sport sports stuff like is there a world where people go to gyms less because they're lower weight and they're not worried about their weight what are they doing here's a question what are people doing with their time where does their time go if they lose weight if they lose more weight what is it that they're doing which is different yeah I I don't know and I'd love to see something better than my anecdotal answer on it because you know I have patients on the medication but that's not representative of the entire pop what have you what have you seen what have the results been and the respons is good and bad uh largely people lose weight um their numbers improve from a cholesterol standpoint their sugar control improves um they're happier less muscoskeletal issues a large percentage of those people either have had issues with side effects like nausea being the most common uh some the nausea is mild persistent but manageable to them and a valid enough trade-off um I haven't had anyone personally as a physician where a patient had such a bad side effect that they had to stop it but I am aware obviously that does happen it's fascinating man I I this is this is the most I think interesting development that we're going to see over the next few years I agree and I think it's largely representative of how Society has been reacting as of late and a lot of people who are smarter than me come on my show and point out that when I'm concerned about a new problem they're like ah Dr Mike there's always been new problems there was horse Manu problems and now we have cars and then there was pollution problems now we have electric cars and we constantly are problem solving when problem solving itself begins to be owned by private Equity I'm like it becomes so weird in that look like we created hyper palatable foods that were junk Foods processed foods that were very tasty nons satiating so we're always hungry want more of them they're addicting that was largely driven by private Equity then we created a medicine to solve the Obesity epidemic is there a world where these private Equity companies are creating apps that are making us hyper addicted and shortening our attention spans where now more people are requiring to take ADHD medicine maybe so are we now seeing private equity in telling people well look if you really want to take care of your health you really got get get your testosterone up and if you want your testosterone up you got to look like this person look at the muscle you can maintain their erections whatever and you need to have this level so let me give you some testosterone now they're selling you testosterone so like how many times is private Equity going to create a problem and then sell you the solution that is a very good point yeah I am the it's like uh starting a fire in someone's house and then offering to put it out for a feet yeah yeah yeah yeah and charging them for the water yeah I don't know man I'll be very interested to see what happens over the next few months with with gp1s I think that it's the it's going to make a very interesting moral challenge it's going to create a moral challenge for a lot of the people who have been a part of the body positivity movement and I think that that's one of the most interesting sort of social elements to this that when uh maintaining a heavier weight becomes a Choice uh I.E you have more control more direct control over whether or not you maintain that heavier weight I think that it's going to uh put many people into a catch22 situation uh that uh a lot of people who have been very Pro body positivity and um you know promoting uh bigger Lifestyles I think that they're going to be faced with a very difficult decision because so many of the members of that community that were uh their compatriots are going to elect to not do that and I wonder how many people that were a part of that movement were doing it because they tried dieting it really hadn't worked so I'm going to be a part of a group of people that accept me as opposed to one that villainized me or says that I'm I'm I'm wrong or or undisciplined or whatever you don't know [ __ ] you I tried to die it like it huge percentage of diets don't work for people and I get that um but when you can just take the shot twice a week and you can dial in your weight to the you know poundage that you want by just increasing the dose or decreasing the dose I also want to point out that's not exactly realistic most people still don't have access to the medications can you can you can you explain what that means about the access I'm not familiar with that um the medication's very expensive insurance is largely aren't covering it for weight alone I've had plenty of patients struggle to get uh coverage for it where they have to pay for it out of pocket or pay a company out of pocket to try and get access to the medicine so access is a huge issue and why it's like kind of an exponentially problematic issue is that the people who struggle with access to that medication are also the same people that food industry targets the most with junk food so they're getting doubly harmed and it creates this cruel irony where if you take a king from the 1400s who was overweight because they had access to unlimited food while their populace was starving they come in now and they must think everyone is Rich when in reality it's the people who are struggling with finances that are being targeted with crap foods that live in food deserts where they don't have access to good quality fruits and vegetables our government is asterus in that they put out let's say an accurate recommendation of like hey you should eat mostly fruits uh vegetables plant focused foods with some lean sources of protein and they'll say the percentages correctly as per science but then on the other side of their mouth issue subsidies to the corn industry or to these other industries that make the necessary components for either animal feed or for junk food and processed food so these people who are struggling with finances are getting hit on so many angles in ways that is visible and invisible it's very very problematic um and then the second thing is the idea of dialing in weight with these medications okay the medicines are good they're not that good like I have patients that have taken the medicines have lost significant weight but to say that I can get them to their goal weight so easily to the exact weight number and that's we're not there yet I'd spoken to to some of the smart friends that were uh evangelists for this new category of drugs one of them's on tepati and I can't remember what the next generation one is after that say the first one uh semaglutide to zepeti which has fixed the glucose problem I think there was a glucose issue with one of them um glucose regulation and then there's another one uh and that was the the terminology that he'd used so I may be speaking out of turn maybe it's something that the future Generations if these drugs will allow you to do more they probably will yeah they probably will I just want to point out that the reality where people live these days where because what happens is that's how stigma forms right people hear on the news that these medicines are largely available people can choose their own weight and that becomes commonly said over and over and repeated and then as a result the people like can't afford the medicine that are being targeted by food industry don't lose weight and then are ostracized or shamed because it's like oh why didn't you do that it's like wait it's not even more of a choice now yeah exactly so need to be careful of how uh people are treated these days understood will there be a dialing down of this all things near uh accessible levels of of cost over time right yes it's more expensive now do you predict that in future this will be pretty much available to everybody on pretty much every insurance plan I hope so I react to Medical memes man I don't know I wish I knew these answers I logically I think that as more people take them it it should come down if it's up to the pharmaceutical companies no but hopefully we have some regulation put in place where we can fight back against that and there's uh all sorts of not necessarily clear corruption but just like gray zones where due to a lack of transparency companies can get away with some really problematic things behind the scenes speaking of medical memes how was your conversation with Steven gundry great uh great intro to that um it was bittersweet I was excited to talk to him because you know he has these best-selling books that are influencing millions of people he goes on a lot of podcasts and he says things and people ooh and ah not challenged as often as he should be and I did and I had a great cardiologist Dr Danielle Bardo on Who challenged him on a lot of his Notions and largely what I found is he's a person who's excited about Innovation but lets the lack of experience in mass communication lead him to make statements that land with the audience in ways that he probably doesn't understand that they do like when you say to a parent that grapes are so problematic might as well give them a Hershey's you're making a statement that's encouraging mothers to feed their children processed sugar as opposed to a fruit and that's a problem and he might be talking about how fruit is now raised in the nutrient content has changed and the intricacies and all great talk about that but the way that that the message is delivered I think ultimately misleads people in their understanding of what science and Healthcare is the problem of short videos I I wonder whether this is a bigger problem on Tik Tok and uh reals and on YouTube shorts than it is on the slightly more long form stuff just that when you do pull you know a a Gary Breer clip of a protein shake stays in your body for 75 years this is how long it takes for your your body to process it or whatever uh maybe I I don't tend to watch those podcasts in full maybe there is more context in there maybe he does explain that it's to do with the way that grapes are now farmed and they've been changed from their original grape form and what are we putting on them in terms of their fertilizer uh but certainly when you see it on Tik Tok which is obviously affecting like disproportionately affecting a much younger generation but then you also see the same thing happening you know how long has it been these crazy adverts on Facebook that are impacting our parents' generation and you know they're seeing like just wild Boomer misinformation get deployed through Facebook so yeah it's uh medical misinformation at the moment is it feels like it's picking up it feels like you've got a big Harvest to get stuck into yeah and look you're saying that maybe you're doing actually a very psychologically healthy thing right now where you're exhibiting charitable thinking and I like to do that as well um where you're saying that well you know maybe Dr gri and the long form of the information gives the context to that statement now that's partially true he does give context and explain some things but then when presented with the fact that people are misunderstanding it he will not walk the statement back and correct himself and say o I can see how one have misinterpreted that I should give more context folks if you're taking it that way don't but he does it and that's where I really really need to push back heavily yeah that's not cool come on Steven play the game he's not alone in that again this isn't a you know a single person problem it's more of a problem of our day age of social media and it's not just short form there's a ton of misinformation on long form podcasts all day long yeah I think you know certainly for me someone that's been in and around the Health and Fitness and Wellness space for a very long time I quite like the corner that we seem to have turned maybe about three years ago just out the back end of Co um where I think especially Andrew hubman is sort of a spear ahead of that I'm aware some Studies have got Dody values and they've got low end numbers and so on and so forth um but what you what you had to me was someone who made the biohacking community kind of the old school biohacking Community look quite silly look very experimental look very kind of unevidenced and you had someone who was coming in and you know the first whatever two seasons or so two years that uh Andrew did his show it was like Basics sleep nutrition training uh caffeine nicotine concerns for menstrual health and fertility and stuff like that all right yeah these are big big big boulders right um and then I wonder how much of the sort of wake behind that popularity of content uh has opened the door for people who are just prepared to kind of say whatever sounds sexy something that seems to be really cool this is a like the demonization of individual foods and you know the the answer is boring to this which is most things don't have a sexy answer most of the solutions that you're looking for require a moderate amount of willpower and discipline your environment design counts for an awful lot you have a genetic predisposition which people don't really want to talk about all that much but the people that do want to talk about it too much also they're kind of overselling you on something too which is victim Hood narrative as opposed to the kind of self-made man narrative and but like who's listening to that that's not a good 60c re go [ __ ] you Chris a lot of people listen to my podcast and that's exactly what we do I I think over the last like 20 episodes we averaged almost a million views just on YouTube alone good man that is true I want to I want to prove to people and why I started the YouTube channel is that you can make science Nuance sex without overselling it yeah with that style damn right you can with that jawline and that beard damn right look everyone uses uh their own gifts to certain ways and I make my silly corny humor I actually I remember like Men's Health did a a top 10 medical influencer list I think actually huberman was number one on that list and they gave like some people a page and then some people they gave a by line to and to us they gave us a by line and they said you know the the OG medical influencer Dr Mike uh can get corny at times I love it because instead of taking medical information and corrupting it I get corny that's how I get views those the that's the the Spectrum goes from corruption to corniness yeah well you know it's like uh Batman like how long do you live as the hero before you become seen as the villain or whatnot so I you know I see an individual like hberman and you know controversy and all that aside with personal life I don't think that's up to me to talk about I haven't fully dug in to see the research but on one hand I'm very excited that he's gotten this whole swath of people excited to talk about health to learn about health to learn about research uh talking about sources and uh pathology and on the other hand I see like irresponsible statements made made on a decent amount of times on the show and I'm like why why does that happen and I don't have the answer to it and I I wish that wasn't happening as often as it was well I'm sure that you guys will cross paths at some point and that'll be one hell of a conversation right absolutely the invitation is open and uh I'm very excited to have that conversation because I think people will benefit from it I I don't think this is an ego thing at least it's not for me I never planned to be popular on social media um I didn't want to do it uh by giving up anything I I still practice medicine and I don't say it often but I practice for free three days a week two to three days a week in my hospital because I love what I do I work at a community health center could I go quit and not work and just make a great living on social media yes could I uh get a concierge practice where I charge six figures a year for me to be some celebrities doctor yes but that's not why I started this the reason I started this is to help people who struggle with their health who have real problems like how I grew up as an immigrant the things that I was facing as problems that's what I ultimately said out to do and even when I had my viral moment of popularity there was times where selling out was so easy I was in debt as a med student I was in debt as a resident making the $10 an hour as you mentioned earlier working 80 to 90 hours a week it was tempting to take some deals where I would talk about a powder and how it's going to give you all the nutrients that you need it's tempting to take those deals I understand why people do but for me the the the reason of why I started this doesn't let me do that and I I hope more people can look at what I've done and do it better and say oh my God I don't need to sell out and do all these things to be financially well off there's a responsible way to do this and um I just wish more Health influencers looked at it that way because otherwise folks get into a lot of trouble how do you find being the personal doctor whilst being the public doctor now how many complications are you encountering as your online Fame grows are people requesting that they want this Dr Mike because they know that he's over there and he's the person I watch on YouTube the patients that I saw um during my residency they're my patients and I built them up sort of as my portfolio of patients I've seen them I'm treating them there's some babies that I've delivered that I'm still reading and now they're 6 seven years old it's pretty amazing um but I also work in an Urgent Care capacity I also see patients of the other doctors that work in my practice that may not be available same day so we work together as a team in that regard where we can plug holes plug scheduling issues and because of that I'm very grateful to where I work and the ability to help those individuals it just it's it's such a different world like the things that are discussed on social media versus the problems my patients have in their everyday lives are just completely different completely different and that's why I think I've had a lot of success taking what my patients tell me in the office and then bringing it to YouTube because it's so relatable it's so honest to what people want to know what they want to see debunked what they're being misled by and I hope to continue doing that as long as possible on social media does it feel like the Human Social equivalent of touching ass uh it's definitely a humbling experience you're constantly challenged you're constantly taught that there's so much you don't know um my staff that I've been working with for over 10 years now I can't believe I've been in the hospital for 10 years um they humble me all the time they make fun of me all the time it's a big family you know I even had one of my uh nurses that I work with for 10 years on my channel the other day to talk about how I helped her with back pain much in the same way that uh you had uh with your specialist and it was great to be able to show that side because people see what's on camera but social media is not always real and when you have able to have a long form conversation with someone that's known you for that long that's special and I treasure those moments and what anytime social media gets dark or I get down the biggest value in boost in mood boost and Happiness is when I do Monday things as a practicing doctor at a community health center how cool Dr Mike ladies and gentlemen I dude I I really appreciate you I really appreciate the effort that you're going through the fact that you're doing three days a week uh pro bono is a really good credit to you I'm very very glad that we've got people like you giving us Health advice on the internet well look I'm very lucky with social media so don't give me too much credit but it's uh it's still it's still I probably gain way more value from doing and practicing medicine on like a spiritual personal side than any kind of financial benefit I could get d right why should people go they want to keep up to date with all of the things that you do I've somehow been able to Corner the market on Dr Mike Dr spelled out because Dr Mike is the great Dr Mike the diesel Dr Mike Dr Mike is he's your do he's your my podcast yeah and you did as well yeah he's great dude I really appreciate you thank you for today thank you so much Chris if you enjoyed that episode you will love a selection of the best clips from the podcast over the last couple of months and it's available right here go on give him a watch