American Thought Leaders - The Perverse Incentives Eroding Patient Care, From the Opioid Crisis to the Gender Craze: Dr. Carrie Mendoza

Episode Date: February 9, 2024

“When Obamacare happened, what it did was really give more power to the insurance companies and middlemen. I saw a lot of some of the smartest doctors in my group basically retire early, leave, or go into health tech. There are people that have gone into different areas in terms of autonomy, creativity, increasing their wages, but the actual clinical practice of medicine continues to have been marginalized.”Dr. Carrie Mendoza is an emergency medicine physician and an advocate for the depoliticization of health care and education.“The detransitioners … There aren’t services for them … There’s not even a billing code. If you don’t have a billing code, you can’t be in the insurance stream, right? So, you’re kind of like a non-existent person in the medical world. But yet, these are young kids who’ve had surgeries, or some now need hormone replacement because they’ve had their ovaries removed,” says Dr. Mendoza.For years, Mendoza has been tracking the transformation of clinical medicine and the doctor-patient relationship.“It’s written into regulations that the hospital wouldn’t get paid if their scores weren’t at a certain number. And so, then the pressure rolls downhill,” she says.In this episode, we dive into the impact of the administrative state on medicine and health care, and reflect on the opioid crisis and its similarities to the social contagion of transgenderism sweeping the youth today.“The detransitioners are like the people that overdosed and were harmed by the opioids,” says Dr. Mendoza.Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

When Obamacare happened, I saw a lot of some of the smartest doctors in my group basically retire early, leave, or go into health tech. The actual clinical practice of medicine continues to have been marginalized. Carrie Mendoza is an emergency medicine physician and an advocate for the depoliticization of health care and education. The detransitioners, there aren't services for them. There's not even a billing code. So if you don't have a billing code, you can't be in the insurance stream. So you're kind of like a non-existent person

in the medical world. But yet these are young kids who've had surgeries, hormone replacement because they've had their ovaries removed. For years, Mendoza has been tracking the transformation of clinical medicine and the doctor-patient relationship. It's written into regulations that the hospital wouldn't get paid if their scores weren't at a certain number. And so then the pressure rolls downhill.

This is American Thought Leaders, and I'm Janja Kelley. Carrie Mendoza, such a pleasure to have you on American Thought Leaders. Thank you very much for having me. I'm going to roll a bit of tape here. It's something that's troubled me immensely for some time. Under COVID, there was this, what I would call, othering of the unvaccinated. And in one particular instance, it's relevant to your profession

as an emergency room doctor. The number of new cases is up more than 300% from a year ago. Dr. Fauci said that if hospitals get any more overcrowded, they're gonna have to make some very tough choices about who gets an ICU bed. That choice doesn't seem so tough to me. Vaccinated person having a heart attack?

Yes, come right on in. We'll take care of you. Unvaccinated guy who gobbled horse goo? Rest in peace, Wheezy. So what's your reaction to that? It really is really deeply concerning that, you know, a public figure would advocate that patients should be treated differently, you know, based on whether

they got a vaccine or not. And, you know, it really emanates from what happened with COVID, where it became really sort of a litmus test as to how you were behaving to the risks around COVID. And of course, it really diverged from actually what was going on in terms of who was really getting sick, the focus protection idea, you know, looking at patients who were older that we should protect more versus, you know, not penalizing, you know, younger kids and eliminating them from the culture. And then once the vaccine came out, really looking at the data as to, well, who would benefit from the vaccine?

Who needs it? Who doesn't need it? Who might it be harming with some adverse effects? As we were seeing some young men were having potentially a signal related to myocarditis. So really a complex mix of medical decision making that happens. And for me, who was on the front lines at the beginning and still works in the ER, so I was in the ER before COVID, the roll up to it during COVID, and, you know, now after, so much of the information that

really got scaled up in the media, and it was whether it was, you know, conservative media or traditional mainstream media, you know, really, really was different than what was the experience going on in the hospital or the clinic with the patient. And so to have it get to a place where a comedian and then, you know, other people in positions of trusted, thought to be trusted positions like the CDC, really demonizing patients that were making different choices about the vaccine is really just, you know, unconscionable and really, I think, is a big marker as to how poorly the truth really was getting out. But just othering patients is just really not something that ethical doctors do or an ethical health care system. No, absolutely. I mean, this video that you made comes to mind, a video made for FAIR where you talk about, you know, treating someone with a scar on their face, realizing

that they're probably a Nazi or a Nazi sympathizer, reflecting on the fact that you're Jewish, and of course, treating them as you would any other patient, which is for quite some time what has been the approach. This is the Hippocratic oath, do no harm, you treat everybody equally, right? That's my understanding anyway. This has been turned upside down and this is actually what put you on my radar as someone who's just asking serious questions about what's happened to the medical system. Yeah, absolutely, absolutely right. You know, my work through FAIR, the nonprofit, you know, we're really trying to depoliticize medicine and raise, you know, raise the ethical standard saying, hey, you know, we really don't treat patients,

we don't other them, we don't demonize patients. And, you know, we really don't treat patients. We don't other them. We don't demonize patients. And, you know, my work in the emergency department, you know, in our country, you can't refuse care to a patient in the ER if they can't pay. So anyone can come through the door. And, you know, the way the health care system has grown, you know, in the past 50, 60 years, you know, there's a lot of people that come to the ER that it's not necessarily an emergency. You know, maybe they need a medication refill, or there's a variety of social ills, or we deal with drug abuse, people, you know, who have, you know, Nazi tattoos. The thing is, I'm there, I'm trained to take care of everyone. You know, that's my duty.

What they're doing outside, that's not the issue at hand. I mean, if somehow that's a role in, you know, weakening their health, I would talk about that, obviously, with alcohol and drug abuse. But someone's political belief, you know, has nothing to do with my duty to take care of them and address the medical issue at hand. And that's really been the tradition of health care that, you know, in part, you know, came out of the Nuremberg trials, you know, with all the horrors from Nazi Germany and experimentation they did. You know, it's concerning that medical students and trainees are taught, you know, to other people or the oppressed or oppressed context where they would consider not even necessarily treating someone that they had a different political belief. And that's just not at all ethical medicine. Tell me a little bit about your background. You know, you're an ER doc, but you've taken some prominent stands in the issues in the area of medicine that are not common, or at least publicly.

So just tell me a bit about that. Sure. Well, I'm a granddaughter of someone who walked out of Russia during the Russian Revolution, escaped when he was like 18, my maternal grandfather, and escaped through Poland and was able to get over to Chicago and had some family there that had escaped. But a lot of his parents and his sisters stayed. And I'm named after one of his sisters. And they lost contact with them during World War II. So, you know, they stopped, let her stop. So, you know, they got killed. They don't know the exact circumstance. So I think, you know, growing up with that history and hearing the stories from my grandfather and understanding, you know, how he left everything.

He was an engineer and how he, you know, the persecution of Jews and pogroms and then came over to Chicago and, you know, built up a life, an immigrant story. And so, you know, that's part of my background and plus being named after somebody who, you know, was killed in World War II, likely because they're Jewish. You just feel a sense that, you know, you're so lucky to be in this country where things are free, but you, I have this innate sense of when things are starting to go off track that would lead to tyrannies. So I think that that's a big part of it. I also have an older brother who just was always fascinated by politics since he was young and growing up. He was obsessed with the Watergate hearings. So I grew up, you know, kind of hearing him talk about that.

And he was very, very into political philosophy. So I learned a lot about Marx, Hegel, just a whole host of things when I was growing up. And so I think also that education, I really feel like I have like a sixth sense for when things seem to be going off into the tyranny track, because I think you live with the fact that you know where these and where this all goes if it's unchecked. In terms of practicing medicine, I feel that once I got through my training, which really wasn't politicized at all when I went through, you know, over 25 years ago. But as I was getting into practice and really understanding how the administrative state was affecting physician practice and ethical choices, again, you know, I'm kind of thinking, what is going on here, you know, like when with the opioid crisis? And just very briefly, you're schooled in ER medicine.

Yes, yes. And I think you mentioned toxicology to me as well. Yes, yes. I did a residency in emergency medicine in Denver. I really like acute care medicine. So someone comes in, you don't know what they have and they may be, you know, there's different levels of distress and true emergencies. But I love that, like, I get to figure that out. I get to manage it. I get to deal with it and hopefully save the person. So I loved, I just fell in love with the critical thinking. And also in the ER, no one is telling

us what to do in the sense that it's not like I have to have a test approved or some imaging study. It was just like pure medicine. You know, it just can think about what's going on with the patient, order what I want. And so when I was in medical school at University of Chicago, I really thought I wanted to do oncology because they had just a great program there. And they do a lot of clinical trials, but I had to do a shift in the ER as part of my education. And I just really fell in love with it. So then I went off to Denver, did that. And then there weren't fellowships for the ICU, which they are now. Like if you wanted to do critical care, you had to do internal medicine. There wasn't a pathway

from emergency medicine to critical care. I think I would have done that. The closest thing was medical toxicology. So the Rocky Mountain Poison and Drug Center in Denver had a fellowship. And so after my residency, I did that for two years where I learned about drug overdoses, pharmacology, how that affects everything. We took call for five states out West and including Hawaii. So like every other, every three nights I'd be on call. And so you'd be getting calls from ERs, you know, saying, oh, I have this particular, oh, you know, they took all these pills or, you know, this or that. And so I really learned, you know, the antidotes or some antidotes to things like, you know, you needed to know with bioterrorism, this was after 9-11. So antidotes for cyanide, just all

the classic things, because the buck stopped with me in terms of deciding, well, hey, am I going to, you know, fly this patient from rural Idaho over to a different hospital because they need dialysis because they overdosed on aspirin. So it was like the critical care element I fell in love with. But in there, I had three beautiful boys who are now almost totally grown up teenagers, young adults. So I actually, I thought I would do academic medicine, but it was really hard to be a mom and try and do academics and work shifts. So I took a job with a private group that staffed hospitals in the Denver, ERs in the Denver area. And that allowed me the flexibility to practice, but be as home as much as I could when my kids were really little. So I was really, really blessed to be able to have that balance. You mentioned you saw the

administrative state intervening into the doctor-patient relationship, if I heard that correctly. And that's interesting to me because typically I hear that it's sort of the corporatization of medicine that intervened into that relationship. I haven't heard so much about the administrative state, so I'd love to talk about that. But just in general, when did you see, notice that something was going wrong? And what did you see with the system as you knew it and loved it? It really, I think, hit home once I got out of all my training into actual practice with this group that was basically a small business. You know, we had contract staffing ERs. Before that, you know, when you're training, at least back in that time, you're somewhat shield from the business side of medicine. You know, you're there very academic. And yes, there's issues with the electronic health record and billing, which, you know, we could talk about later.

But really, at that time, I mean, the electronic health record was very rudimentary. So it wasn't like a main thing. I started out, we would document on paper charts. So it really, the business of medicine, once I joined, I finished training and joined a private group was just really, you know, a shocker, you know, and it was just the seeing the inside of the whole thing where it was like how much money we had to spend in order to extract the money from the insurance companies to get paid. And again, this was like people come to the ER, you can't refuse care. If someone came and they had a heart attack and send them to the cath lab and a million things, they could maybe never pay the bill and we would never get paid.

But yet legally, still potentially someone could sue us. So there were kind of all these just realities of the business side that were really shocking because you learn like, oh, well, we're going to get paid less this quarter because the fee for the billing company went up. You know, that would be one one example. I think the other thing was the relationship with the hospital. Again, we're a private group and the contracts are written where is like certain quality metrics had to be implemented and you had with chest pain. But some things delved into this whole world of the patient experience scores where how the patient felt about their experience had to be a certain number. And I once I learned what that was all about, it was shocking. I mean, it really it's part of the administrative state because it's written into regulations that the hospital wouldn't get paid if their scores weren't at a certain number. And so then the pressure rolls downhill. So if medicine isn't about making a patient happy, it's about solving their medical problem. And as some people come to the ER with things that I can't make them happy about. They may have some chronic pain issues,

or they may have seen 10 specialists and frustrated about why a certain issue can't get solved. And the clinic would say, oh, just go to the ER. So people would get sent to us inappropriately, thinking like we were somehow gonna solve a problem or told to come because I would get them an MRI. But we didn't have instantaneous, you know, ability to get an MRI for non-emergent things. So they would be upset and then give you a bad score.

So it was like completely unfair. So once I saw, you know, and when you'd say to the administration, like, this is unfair, they were just like, oh, well, this is what we have to do. You know, this is what the government requires. And so it just was like some of the things were inconsistent with the actual practice of medicine and got more into the consumer, like what the patient feels their experience was. See, that's very interesting because this is all not even thinking about, you know, these various woke ideologies and how they started penetrating, you know, the medical system. Yeah. Well, I think that we are clearly at the end of a cycle. I know a lot of people kind of say this with a lot of things, but for health care, you know, I think when Medicare and Medicaid, you know, started in 1965, I think that's when the clock started, you know, ticking in the sense that it became political.

Right. And there became, you know, lobbyists and needing to, like, you know, always go to Congress and they're all of a sudden involved in like health care. And I think that there's been a slow decline in autonomy for physicians and pressure on wages. And I think that physicians weren't really organized to be battling against that. I mean, the AMA doesn't really represent physicians. Their revenue is from their billing codes. So a chest pain has a certain code. They own all that and they're the gatekeepers for it. So you can't get like a new code unless you go through the AMA. So the point is the AMA doesn't, there's really not an organized pushback for physicians. And I think what's happened is as I think the autonomy and the wages have declined, I think that some physicians have gone into administration as a way to kind of keep their wages up or to feel some sense of control and power in the equation. So whether it's administration in the hospital, which then they're sort of on the other side of the equation, right?

It's like they might know it's not right to kind of say, oh, hey, we need those patient satisfaction scores higher, but they're not, you know, on the clinical side anymore. I think some, you know, people truly enjoy academics are in that, but I think some, you know, have stayed in that or risen the ranks where they're not as much doing, you know, patient care. And I think then when Obamacare happened, what it did was really give more power to the insurance companies and middlemen. I saw a lot of some of the smartest doctors in my group basically retire early, leave, or go into health tech. There's people that have gone into different areas

in terms of autonomy, creativity, increasing their wages. But the actual clinical practice of medicine continues to have been marginalized and letting nurse practitioners, physician assistants kind of have a lot of medical decision making, which they don't have the same level of training. We're seeing more of that. And the reason how the woke comes in is I think that it is real easy to pick off the medical industry because physicians are in a weakened position you know it's easy to infiltrate also the administrative state aspect where the woke side and corporate medicine knows that the way to get their policy prescriptions through is through the administrative state, through regulations. And they're very, very knowledgeable about it, very good. That's their business model.

You know, so this is really interesting to me because you're kind of painting this picture of a profession. And my guess is this isn't the only profession where this happened. It's just kind of a bit more shocking that it would happen in the medical profession in a way of just getting kind of primed to be very susceptible to these rating systems. This is one way in which, way in which companies have to fulfill their DEI requirements. If you don't get your score at a certain level, then you're going to suffer. There might be people picketing out your door. You might lose your bonuses. Anyway, there's a whole structure of incentives or disincentives that's been creative to sort of foster, to push ideology? And when did you first notice it, I guess? Yeah, I think that there's such a big...

administrative state blob in healthcare that a lot of policy prescriptions, again, would come down from people who actually don't interact with patients. Are these standards of care that you're talking about as it's described? Some things or guidelines. I think if you wanted to talk about the opioid crisis now, I mean, would be a good way, I think, to illustrate in part your point or this particular line of talking. The pain scale, which is that scale when you go in and it's like, what's your pain level? You know, zero to 10. People could say that came from goodwill, but it really was created not because there was some type of

study that said, oh, people's pain wasn't controlled. It was like the pain society, they said, we have the scale, we should measure it, which again sounds like starts out as a good idea. Where things went sideways was that then the AMA got involved and some of these other parts of the government saying, hey, you know, for us to measure how well the hospital is doing, we're going to use this pain scale. As the bureaucracy grows, I think, and we see this in a lot of others, not just medicine, but in education, they're looking for ways to measure their value. So it's very seductive when you come across something that's like, oh, the scale, oh, we can measure it. And then we can say we did better. And all this bloated government, all this money spent on Medicare and Medicaid in the hospital, it's worth it because we're measuring and people are getting better in their pains control. So you're like, that could be a policy that sounds like, okay, that's reasonable or that's an interesting idea.

Let's try that. The AMA got together with Purdue Pharma. Purdue funded the quality studies that they pushed through in hospitals around like 2000 to measure this. What happened though is that they tied it to reimbursements to the hospitals and doctors. As more people were getting opioids that didn't need them because you have to have a good score on the pain scale. These people get overdoses, complications, all kinds of things. The harm signal was just like completely ignored, you know, until obviously it started being reported like there's overdoses and this and that. But the AMA never said, oh,

this was a bad idea or, oh, maybe we shouldn't be asking the pain question to every single person, or maybe we shouldn't be matching it to reimbursements or to physician bonuses. Those things have been going on in healthcare for over 20 years. So I first saw it with that because I am in a part of healthcare where I'm dealing with the results of the bad policies because the people are coming into the ER overdosed or they're addicted and can't go to work. So they need a work note or they fell because they were sedated or they got in a car accident, all the things. I'm seeing that. The person at the AMA or the quality healthcare group or whatever is in their office. They're not in the ER, in the hospital with the patient who was yelling at me because I refuse to prescribe them or with a family whose son overdosed to, it was all iatrogenic,

meaning induced, created by the hospital system. So they weren't facing the bad consequences of their actions. And that's the first time I really saw like, okay, there is this giant system that doesn't care about the results of their policy. There's people dying and they don't care. There's people whose lives are being destroyed and they don't care. Why no one went and said, hey guys, your policy is doing this. Or there was no way to tell them? Well, I mean, I think, first of all, clearly their salaries are not based on the results of their, like, wasn't based on like, oh, yeah, there's all these people now addicted to these drugs. And so they didn't have any consequences of that. Again, they're also not practicing physicians, so they're not faced with someone having to deal with that.

And then I think third, it's similar to some of the things going on with gender that we'll probably get to, but they, it's sort of like, I don't know, they get like the ends justify the means or they're so invested in that, like they're, you know, it's like the hubris, like they have a PhD in whatever. And their theory is that, you know, this is the way to show value in healthcare. And they've convinced themselves and they sort of don't want to see that. One of the themes have been sort of unilateral policies to deal with one issue, but ignoring the so-called collateral damage entirely. Yeah.

Like, as if it didn't exist. That's been a theme. And then it reminds me, frankly, of Stalin, actually, of all people, because Stalin had a, is famously said, actually, of all people. Because Stalin has famously said, right, if you need to make an omelet, you've got to break a few eggs. Right. Right?

And so it's just this idea that, yeah, there's going to be collateral damage, and that might be human, but we're doing the right thing here. And so now you've kind of explained to me this system is rife, and if this system gets infiltrated with woke ideology, it's off to the races. That's what you've basically shown me here, right? Absolutely.

And I mean, the opioid story really is the modern example of when healthcare gets captured by bad ideas and then bad things are happening to people when you're supposed to be helping them and somehow the system is ignoring it. And it was like this blob of regulatory people that made up these rules that had nothing to do with the actual practice and didn't care. And the overdoses were climbing, climbing, climbing, climbing. And it's really, you know, the attorneys generals were the first ones to get in and sue basically on public nuisance laws. And then, you know, there was a pathway to the pharmacies. And then, you know, the Trump administration actually was the one that took out connecting reimbursements to some of these quality metrics. In the ER, are you seeing a lot of so-called gender medicine? And how did you sort of fall

into becoming an advocate around this? It doesn't strike me immediately as an ER thing. Gender medicine is very much focused in certain pockets, specific gender centers, academic centers. I'm not getting into Planned Parenthood. So one hospital I used to work at in Chicago was in a neighborhood that was also the gay community in Chicago, and there were transgender people there. No big issue. One of the first issues that popped on my radar, though, was pre-COVID, I think it was like 2017, 18. They changed the way that they allowed the transgender patient to register when they came to the ER.

So historically, if a transgender person would come, say, you know, his legal name is John Smith, he's a male, you know, you're registered as your legal name and your biologic sex. That's not like ever been controversial. But we have on the board, there's a comment area. So the person triaging would just put in there, you know, identifies as a woman, prefers to be called, likes to be called Sue, you know. And so

when you would sign up for the patient, you know, you would just be reading their name, you know, who it is or vital signs and you'd see what the comments were. Other comments on patients would be like, oh, this person has low blood pressure, whatever. But for a transgender patient, they might put in how they identify and what they prefer to be called. No problem. Doctors had no problem. Nurses had no problem. Patients had no problem. No one was offended. No one had problems. No one had issues. But you need to know what their biologic sex is because if you're a man, you come in with abdominal pain, you know, depending on your age, what is going on. I need to look at your genitals because I don't know, you could have an STD. You could have, God forbid, a testicular mass. You could have a twisted, I mean, you could have, my job is to be the advocate of your health.

So I need to know, you know, just, it's just straightforward. And if you're a woman, you might be pregnant and you wouldn't be doing a pregnancy test. You've got to order the pregnancy test. All of those things because you wouldn't, God forbid, want to accidentally irradiate a fetus because they need a CAT scan. So there was no issue. But then all of a sudden it changed where the hospital said, oh, we're letting the patient register how they want. Immediately, I saw that is so dangerous and so regressive going backwards for safety things because you will miss pregnancy tests. You will miss people will stop doing exams on parts of bodies that they need to and miss, God forbid, a cancer.

There's a case study in the New England Journal from 2019 of a female identifying as a man, looked like a man, apparently was registered as a man. She had abdominal pain. Of course, they never did a pregnancy test. She was hypertensive. So she She had abdominal pain. Of course, they never did a pregnancy test. She was hypertensive. So she basically had preeclampsia, which is a dangerous condition. By the time they realized she was actually pregnant, I mean, I think she miscarried. This is in the New England Journal. I left that hospital because when I expressed my concerns, how dangerous it was, it was like, oh, well, no, this is what we've been told to do by the health system. As a practicing physician, the one taking care of the patients and one who, God forbid, could miss something,

that's the main thing, but then also would be on the end of a lawsuit. The person up in the CEO's office wasn't going to, if there's something bad that happened, wouldn't be accountable. It became hard to think through and make sure that everything was right with the patient when they're messing up the data. So I saw it in that way. And then I'm not affiliated with like a children's hospital now, but out in community medicine, occasionally we'll see like a young person that comes to the ER that, you know, it says, oh, they're, you know, non-binary. I mean, they're in the ER for mental health reasons. I've seen some confusion with some of the medications with testosterone and estrogen, but not as much. But I think what people need to know is it's coming, just like what happened with opioids.

There's a lag. There's a lot of underground use also of testosterone, estrogen, and there's going to be a lot of people that are going to, if they can't get prescriptions, are going to end up in the ER. What in your mind accounts for this explosion in, you know, the need for transgender medicine? It's very complicated. There's a lot of strands to it, but I do see a lot of similarities to what happened with the opioid epidemic. Like I talked about with the pain scale, they basically, that created a pipeline because people who weren't necessarily thinking about what their pain was, all of a sudden pain became a priority. Now, again, I'm not saying there aren't people who legitimately needed perhaps better pain control. And certainly we have an aging population with

arthritis and different things, but it just was generalized so much that it created a pipeline. So to me, asking pronouns like in school, it's like the pain scale. So imagine if the school system decided, well, later people are going to have pain and we really don't want them to suffer. So let's, in school, get them knowledgeable about pain. Let's ask every kid every day what their pain score is. You don't think that then you would have a bunch of kids paying attention to like, my knee hurts, my ear hurts, my this or that. You know, it basically gets attached to, oh, well, here's a pill. You see this flood of like patients coming in, these kids that have gotten confused because you have this new cohort of mostly adolescent girls with gender dysphoria who never really had any issues

before, but all of a sudden do. So I think some of it is school. Some of it is obviously the internet and social media is a new element that wasn't really around when the opioid crisis got going. But clearly the social influence is one of the things that's like, you know, pulling all these people in, but they're attaching their problem to you need the medical community to solve your problem. A pipeline is created, and then that's where you get to the medical community that wants to please. When people are, kids are doing this, it's clear that the unconventional answers are the good ones, right? You don't want to say my pronouns are, in my case, he, him, or whatever it would be, right? You want to say it's something different. I can imagine that snowballing, I guess. Right. I think with the pain example, some of it obviously is subjective. Like I've had patients who say

they're in extreme pain, they're sitting there looking very fine. And then someone else who's, you know, literally got a paper cut, who's like writhing and not to say it doesn't really hurt, but it's, it can be a very hard thing to navigate through. And again, it got attached to strong drugs. So it's very important to figure out how you're managing that. And I think, again, with gender and the way that our healthcare system works, which is really downplayed, you know, solid clinical practice of medicine, like we talked about before, I think it is somewhat of an assembly line feel where this kid is in distress. Oh, you need to go to the specialist, which is the gender clinic. And this is just the way that they do things.

There's no sense of like, well, what really could be going on here? It's sort of like, you have this problem, here's the solution. And here's the whole kind of systemic solution. This is the process that almost everyone goes through, basically a very, very similar process. This is a theme that keeps coming up. It's not individualized. Exactly. And again, like we talked about with opioids, the harm signal, the detransitioners, the people on every range of dose of testosterone, estrogen, no one's tracking it. Mental health outcomes. on every range of dose of testosterone, estrogen. No one's tracking it. Like who knows? Nobody knows.

Outcomes. Mental health outcomes. Like, are they really happier? I don't know. Some of these people never show back up to clinic. So how do you even know any of that stuff? So the whole adverse effects side or the whole, you know, measuring how are we doing

is just not part of the conversation. And that's similar with the opioid issue. And as the cohort grows, because they've created a new cohort of patients like they did with the opioid crisis, the detransitioners, the people that desist, you'll see more and more challenges in the healthcare system, they will come into the ER. At the very beginning of our conversation, you talked about you're sensitive to tyrannical systems moving towards tyranny. Make that connection for us. Like we said, the sort of ends justify the means. I think it's associations that are sort of conflicted, like the AMA that owns the billing codes, but yet is

saying, oh, this is, you know, great care, but like I've tried to work with the CDC to get a detransitioner billing code. My whole reform policy was vetted by a committee of subject matter experts that's from the American Psychiatric Association. So it's been rejected multiple times, obviously. And the feedback was they didn't think there really was a problem with detransitioners. So they didn't think that there needed to be a code. So that's tyrannical. It's just this kind of bureaucracy detached or not caring to look and be accountable towards the results of this one size fits all care to the point where the detransitioners are like the people that overdosed, you know, and were harmed by the opioids. They're sort of just like, oh, well, that's just, you know, we don't want to talk about

those people. And there aren't services for them. Like I said, there's not even a billing code. So if you don't have a billing code, you can't be in the insurance stream. So you're kind of like a non-existent person in the medical world, you know. But yet these are young kids who've had surgeries, hormone replacement because they've had their ovaries removed. They're thrown into early menopause and there's no infrastructure to help them. Even things like getting their sex

appropriately changed back in the electronic record. We've heard from detransitioners that it takes forever, that people in the hospital don't even understand. They're like, what do you need? They're not even aware of this group. So the tyranny comes from this sort of top-down hubris and are just ignoring the people that are being, you know, harmed, whether it's, you know, like, you know, Stalin did, thinking that their policies with the grain and this and that, yet all these people are starving or with Lysenkoism when they're saying, you know, Stalin did, thinking that their policies with the grain and this and that, and yet all these people are starving, or with Lysenkoism when they're saying, you know, again, back to thinking this is how you do things. Oh, but wait, now the crops aren't growing, you know, and these people are all dying. Oh, yeah, don't look over there, you know.

These people are like non-people or, you know, not worth figuring out how to help them. Like, we started the conversation where I would treat anyone in the ER because that's my duty, whether they have a Nazi tattoo on them or whatever. What I'm hearing you saying is that if you accept this premise that breaking the few eggs, so to speak, is okay, or ignoring harms for whatever ostensibly, incredibly benevolent policy, that that will lead to just absolutely atrocious outcomes. It's like for a lot of people,

the jump from gender medicine to the Holodomor, right, is a big one. But you're suggesting it's kind of just, it's actually a very simple way of, similar way of thinking. I, yeah, I live it in the ER. I lived it with the opioid issue. When we're seeing these detransitioners, I was like, what? I mean, I couldn't believe that there would be a doctor that would ever do that or a health system that would think that that was ever okay. So to me, it's the next level down in terms of debauchery from where the opioid crisis was, where I was again shocked,

like don't they care that these people are dying? That their dads, moms are just a young person that their life was snuffed out because they, don't they care? I was shocked. And this with taking away these kids' sexuality, deforming their bodies, to just go along with something that's clearly a lie is like

a level below in hell. And so to me, it is all connected because if you don't stop that kind of thinking, and if you don't let physicians who are raising concerns, if you're not listening to that, that's a huge, huge, huge red flag. I'm just thinking of this Canadian woman that was denied her life-saving kidney transplant because she chose not to get vaccinated, which is mind-blowing too, because it would actually, from what I understand of the science now, wouldn't have been helpful to the transplant in the first place, right? And as I understand, she passed, right? Yeah. Yeah. I mean, we didn't, you know, get as much, you know, into COVID. And obviously I was, you know, there on the front lines and saw, you know, the divergence from what is really going on versus, you know, what was magnified in terms of, you know, the divergence from what is really going on versus, you know, what was

magnified in terms of, you know, patient safety and a lot more into in-depth with the different choices. But yeah, with the vaccine, something like that, again, horrible, horrible to think that someone would be denied care based on a lie, you know, based on ignoring the fact that there were complications with the vaccine. And that it wasn't life-saving, it wasn't stopping transmission. The bottom line here, the theme that I'm seeing through this is just simply when this big you know, big system gets something in its mind, you know, colloquially, I'll say that, right? It's... And there's no consequence.

There's no quick way for it to feel the ramifications of those decisions in terms of human life, that it will, you know, just take us down a very dark path and that we're kind of repeating this phenomenon again and again. Yeah. And I think some of the historical cultural amnesia around how medicine has been used to hurt people, it is part of the story. I don't think that that's taught in medical school. And if you don't have, you know, a personal background where that is part of your growing up, you might not know about that. But that, I think it does repeat itself. And I think as things get more

technocratic and, you know, once the gender ideology, I think once there's some guardrails around it, there's just going to be other things. You know, I look at it as really a new form of a drug of abuse. I think there'll be guardrails around the youth. But the, you know, humans always, you know, have wanted to relieve their suffering. The question is, how do you do it and to what degree? And I think that the abuse of the hormones is here to stay because there will always be a market for people who want to try and like escape themselves. But I think that clearly the way our bureaucratic administrative state has has developed has certainly been an accelerant. And, you know, you know, our country, you know, is incredible, has done great things,

but I think we're at the tail end of, you know, the great society coming apart. And I think some of the lessons hopefully we'll learn is that, you know, we are a startup nation, we're great inventors, but we also are really good at scaling bureaucracies. Okay. And I think that that is, you know, part of, unfortunately, if you want to call it entrepreneurial, that's been part of the story here with the Great Society. And that's a business model for a lot of people. And they don't, they don't want to give it up as we've seen, you know, with the Great Society. And that's a business model for a lot of people. And they don't want to give it up, as we've seen with the whole DEI coming in. But that's their superhighway. The next thing that comes along with health care, you've got to watch and see who's going into it

to enact their policy prescriptions. And that can easily, easily, easily scale up. Well, Carrie Mendoza, it's such a pleasure to have had you on. Oh my gosh, thank you so much. I'm honored. Thank you. Thank you all for joining Carrie Mendoza and me on this episode of American Thought Leaders. I'm your host, Janja Kellek. Thank you.