Julian Dorey Podcast - 🧐 #91 - The Good Doctor Tells It Like It Is | Dr. Joseph Sambataro

Episode Date: March 17, 2022

(***TIMESTAMPS in description below) Dr. Joseph Sambataro is a doctor. He specializes in internal medicine and also works as an Emergency Room Doctor. ***TIMESTAMPS*** 0:00 - Intro; Doc was a late bloomer; Cocaine Residency Theory; Legionnaires D1S3ASE backstory is a horror movie; Doc explains a common ailment 25:43 - Doc addresses the problems with the extremes and c0nsp1racy theories floating around out there; Doc is a huge “why” guy; The difference between medicine and gravity; Reverse psychology in media; Doctors love you 51:52 - How doctors readjusted at the beginning; the problems encountered with the vents; The documentary that cam. out right before disaster struck; Sitting down is very bad for you 1:13:23 - The science behind intermittent fasting; Julian talks about his own experience with Intermittent fasting; Glucose and sugar processing in the body; Doc explains the sociological changes in anxiety from our earliest ancestors to humanity modern times; Doc is screwed in the zombie apocalypse 1:31:48 - Mental health and the thing; David Sinclair and animal testing; Breaking down our metabolisms; Michael Phelps, LeBron James, & Tom Brady’s genetics, dieting, and training habits analysis; Future health assessment capabilities to diagnose all problems in real time 1:58:57 - Doc talks about when the Eureka moment happened a couple years ago; HOSP1TALS looked like warzones; Doc gives his reasons why we didn't repeat NYC; Encouraging people to act better 2:18:15 - The tradeoff of ailments/problems conundrum; More on mental health; Doc explains The falling people fallacy; Docs who get sued 2:26:52 - Why Docs tell their kids not to be Docs these days; Administration vs. Docs problem; The problems with the business behind healthcare; Doc’s special system ~ YouTube EPISODES & CLIPS: https://www.youtube.com/channel/UC0A-v_DL-h76F75xik8h03Q  ~ PRIVADO VPN FOR $4.99/Month: https://privadovpn.com/trendifier/#a_aid=Julian   Get $150 Off The Eight Sleep Pod Pro Mattress / Mattress Cover: https://eight-sleep.ioym.net/trendifier  Julian's Instagram: https://www.instagram.com/julianddorey  ~ Beat provided by: https://freebeats.io  Music Produced by White Hot Learn more about your ad choices. Visit podcastchoices.com/adchoices

things like anxiety you know people come to me with anxiety issues right it's like well anxiety was important when you were running away from lions because the physiological response of anxiety would end for in one of two circumstances you either successfully ran away from the lion or you fucking died because the lion ate you whoa one of those two things ended that norepinephrine cortis you know this massive, send the blood to the brain and the muscles and beat the heart fast and breathe harder and all the things. And now it's like, how am I going to pay for my kid's college? And that lion never, you never get away from that lion and that lion never kills you. What's cooking, everybody?

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If you haven't already, be sure to follow on either one of those platforms and leave a five-star review if you have a second. And I look forward to seeing you guys again for future episodes. And by the way, I did mention last week the sharing around of the episodes and the clips is also an enormous help. So everyone has been doing that. I do look at my analytics. There's been some decent numbers over the past few weeks. I really, really appreciate it. That helps get the word out. It helps figure out how eventually we're going to start pages like on Reddit and stuff like that for this show so that when we drop an episode, it can have like a third party resource that's putting out that an episode dropped we got to get there but it all starts with

people sharing the show and creating some buzz around it and so i really really appreciate everyone who's taking the time to do that now i am joined in the bunker today by dr joseph sambitaro and i ain't gonna lie we got to a lot more than I thought we were going to this was an action-packed episode of a lot of different topics across all kinds of medical ideas you can probably use your imagination on that as to some of the things we talked about but I think it was a very very important conversation to have let's just say given the state of things right now and I'll I'll be very vague this week in the intro and leave it there.

So that said, you know what it is. I'm Julian Dory, and this is Treadify. Let's go. This is one of the great questions in our culture. Where is the nuance? You're giving opinions and calling them facts. You feel me? Everyone understands this

But few seem to do it If you don't like the status quo Start asking questions You didn't become a doctor until 28? I didn't start to become a doctor until No, I started medical school at 30 That's what I meant You didn't start medical school until doctor until, no, I started medical school at 30. That's what I meant. You didn't start medical school until 30.

I thought it was 28. Holy shit. At 28, I was in graduate school, sort of like trying to bolster my application to make sure that I, you know, I didn't want to do this more than once. I didn't want to apply more than once. So, um, I was, you know, I got a master's, well, I went to a master's program for biomedical science at the same school that I wanted to go to, you know, Rutgers, Newark. And, um, and that was when I was like 28. So by the time I started, yeah, it was like about to turn 30. Like we started that August, I'm born in August. So that, that August and, uh, yeah, I was 30 years old no

shit so you did you had to do a couple year program or something entirely different before then well just undergraduate you know what i mean but i like because you've been to college though i thought yeah so i went to college right out of high school and it didn't go well i just kind of was wasn't an adult yet you know what i mean like i so i always like wonder how we ask like 18 year old kids to make decisions about like hey here's like you want to borrow a couple hundred thousand dollars to like figure it out, right? But yeah, so I didn't do well. But then like kind of just figured out, you know, got my head out of my ass when I was like 26. I went back to school and I was going to teach phys ed.

I was coaching football. I was doing – I was working with like special education program children as an aid and so on and so forth. So I went back to school and I just like, it mattered to get an A, you know what I mean? Like I cared about like doing well in school and I was like racking them up and I go, the thing about being a doctor that I always thought about, like maybe I could do it. Right. So took the MCAT, you know, did well enough to get in.

Um, and I, like I said, I didn't, I was, it was late to the game, so I didn't want to do it. Right. So took the MCAT, you know, did well enough to get in. Um, and I, like I said, I didn't, I was, it was late to the game, so I didn't want to do it twice. I didn't want to have to apply on two cycles. So I said, what do I got to do to make sure I get in? So there's these master's degrees that you can go get that sort of like, if you do well enough, the curriculum is sort of interwoven with medical school curriculum. And then they'll say like, Hey, we'll give you an extra look if you sort of like, you know, coursework so i went there and i was able to knock on wood perform well enough to sort of like you know um make sure that i didn't have to wait two cycles because it's devastating at that point in life to have to wait another year to start

oh my god which is already an eight year you know sort of thing yeah what the full thing is including residency like to get all the way through to say like you are now dr san bataro it's it is eight years right so it depends on what you do so you're a doctor after you get your degree from medical school which is four years but you are so not prepared to do anything with that degree like if you're a p when you get your phd as a doctor you could you know you know the thing you studied as an md you could go do it no shit yeah you get an md after your medical school is over. But then in order to practice medicine clinically, you have to do at least an intern year and then a residency.

And then the residency lengths are varying depending on what you do. I got buddies that are doing neurosurgery that are like, they're going to be residents for another three. I mean, it's like seven, eight, nine years depending on what you do. Internal medicine happens to be three years. So four years of graduate school, four years of medical school, and three years of residency is absolute minimum in the United States. Makes sense. Right. So you're looking at, you know, you're looking at that long, but most people have some level of, you know, extra training or, you know, lengthy, whatever. So it could go anywhere from,

you know, 10, 11 to like 15 to 17 years on the one hand you hear something like that and you're like that's crazy yeah like to ask for that kind of buy-in you basically especially once you're coming out and you're doing the things like the residency and stuff you're getting the graveyard shifts you're doing the 36 hour stuff and and things like that sometimes so it's like the toll on you is insane yeah at the same time though you're a doctor yeah right like you as a citizen yeah you want the best of the best doing this you want the people who eat sleep and shit this stuff all the time you know what i mean in the case yeah i mean yeah so the thing about the so residency is hard right and i i have specific feelings about

medical training in the united states because like oh do divulge it's brutal right and it's here's the thing like the old the old guard will be like oh in my day you know right so like the running sort of theory behind how residency was created is the you know the dude the dude at johns hopkins the surgeon i think it was william halstead who was uh a surgeon at the turn of the surgeon, I think it was William Halstead, who was a surgeon at the turn of the century and had this amazing ability to operate without getting, like his patients didn't get infections. I mean, there wasn't antibiotics. And I go, how?

And this guy's up for like three days in a row. And he makes his students stay up with him three days. They're operating all day, every night. Turns out he was just absolutely crushing rails of cocaine, like nonstop. You know what I mean? So it's like, oh, hey, that makes sense. But then like flash forward to now, it's like they're still asking, you know, doctors to make, you know, do 30, 30. So they made rules on how many could work in a maximum week.

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exclusions, and terms apply. Instacart, groceries that over deliver. Those rules are sort of like, you know, write it down how they want you to, so your program doesn't get in trouble. So point is, is that like, it is, it is brutal. They, you know, they beat you up. And when it's over, when when you're in it you're like i i want to change this like you're so motivated chain and when it's over you're like fuck that you got to be a special place in your heart to like go back and like try to change things but at the same time i do think i do think in order to be good at it at all to be adequate at all you do got to get your butt kicked a bit yes you got to see a lot of fucking patients dude you got to see a lot of things you got to be able to like recognize stuff

you know um you want to be really good at bread and butter stuff but you also want to be able to notice when something is not bread and butter what do you mean by that you know like you know everybody that comes in who can't breathe it's like okay first and foremost is it you know you're like i'm gonna go to brand is it the heart or the lungs? Right. But it could be, it could be a combination of both. It could be, there could be a lot of things, but you know, if you see a spot on a lung and somebody who's coughing and has a fever, you're like, okay, it's pneumonia. Right. And then what's the most common thing that causes pneumonia? Okay. Strep, you know, sometimes staph. So you give them antibiotics that do that. But if there's, if there's another thing about the story and you haven't seen it enough, you'll miss.

And that person could get sicker, right? So if they happen to have a sodium that's off or they have diarrhea as well, and I'm using this because we're outside of Philadelphia, but maybe it's Legionnaire's disease. And if you haven't spent enough time seeing patients where you never saw that, you might miss it. I thought you were going somewhere else with that. So can you explain that instead so i thought you were about to make a philly dunk joke on no i i trained in philly dude temple university so all right good uh legionnaires disease was uh discovered in philadelphia there was a conference of legion like legionnaires and the uh they were at a hotel and these these guys all got really sick and died and they were like they couldn't figure out what it was so like there was a pathologist who was on the case and

he's like doing the autopsy he's like what is going on here right so uh i think there was like a forensic files episode or something on it and the dude was like at christmas party he's like i gotta go i gotta go like i gotta figure this out and it turns out it was this bacteria that was or you know this this organism legionella um that was causing and it was from the air conditioning it was it was in the it was like in a droplet form and it was being spread throughout the hotel and these guys were getting this respiratory this respiratory pneumonia and wasn't responding to typical treatment right and what was that? Oh, gosh. A long time ago, right?

I think it was like the 60s or something like that, you know? But the point is, is that, you know, you do got to see a lot of patients and you got to see a lot of pathology and you got to see a lot of treatments. And you got to see a lot of like failure of like conventional treatment to sort of like have a backup plan. And I think, I think the really important thing in medicine is, is that like, you understand that you could be wrong with your first thought and hospital day two is a really important day because everything you thought on the first day, when you first meet the patient who's sick, then you get some of the feedback. Like that test was not, that wasn't, that test was, didn't tell me anything. This one, oh, oh gosh, that's, that's that. I was completely thinking it was this and it was that, you know you know that's like you know my first covid patient that i ever saw didn't we'll go there yeah we'll go there i'm sure but i but i was wrong when was that when like how early was that was early it was like still a thing on tv you know like january

are we talking like maybe february something like you know, kind of thing. Okay, that's fair. But like early, you know, and the – Did your mind go straight to COVID? No, no. In fact, so the emergency department is the first – you know, they get everything first, right? And they have a general idea of what they're doing. And ER docs have to have such a wide breadth of knowledge that I – it's like it's like a trust but verify situations like they tell you that they think this is what's going on you go down there you see for yourself and you you you know you take that doctor's

thought process you go okay all right i'm going to see this patient when they said hey she's she can't breathe her oxygen's low and she's coughing but not making any like phlegm mucus right um we know she has congestive heart failure. That's what we think is going on. So we went down there and, you know, I'm doing my exam and I'm listening. And this is pre-mask, pre-anything, right? So I'm listening. Yeah, February 2020.

You're listening to the heart and lungs and, you know, and she's just coughing blast in every like orifice that I have in my face. And I'm not even thinking about it because like i'm like oh they think it's congestive heart failure and there was a component of congestive heart failure there where like fluid is now backed up into her lungs so she her lungs is trying to unsuccessfully expel this fluid and um so i give her some medication to make her remove some of that fluid and then the second day of the hospital she just tanks now she happened to be um she happened to be positive for hiv so she didn't have a lot of ability to mount a huge infection response there wasn't a big fever you

know what i mean like there was a lot of things that sort of like wouldn't have told us like hey this this person has an infection she was a prime case for this is a problem if you get it correct so we had to pit we go what is you know hospital day two here she is she's worse after the initial treatment and workup big fever too obviously started she blasted one off yeah and her oxygen dropped like a rock and she had to go to the icu and you know um so they tested her and i get a big hand slapped on my shoulder in the middle of like doing what i'm doing there today like you gotta go home like why they're like you have been exposed to sars cov2 they said this in february

yeah i was like oh gosh i gotta go home and i and i you know quarantine and i got the i had to come in occupational health checked on me every day and i got the swab and it was negative and i want to not being infected but i was exposed like we all everybody who took care of that patient was exposed whether it was late february i don't remember the date expect whatever whatever the earliest time was you know what i mean yeah i was gonna say because what's interesting is we didn't get data here yeah until march so it had to be march but they had the first case though i remember this so maybe this maybe this part did come out in february actually i think it did but the first case reported here was it was 30 days after they claimed the first case was in china which was around january 28th january 27th so this is march this has to be march because

i was on the regular hospital wards and you know what i mean like so it had to be had to be march but point is is like we hadn't had very many cases if any in our hospital at the time at temple university hospital and uh you know the point being is it was like super scary for me because like i didn't like you know this is this is like all of the things you could possibly have go wrong in it early on was being projected you know I mean like this is gonna be the worst thing and it was really bad but it certainly was like even scarier before it actually became a thing it was so unknown dude we're doing like I remember talking about like if this thing spreads like the one of my attendees at the time this thing spreads as contagious as the if it were as contagious as the regular flu with a mortality

rate that they had at the time they had you know at the time like this is going to kill a shitload of people yeah you know what i mean and um so that you know we i'm you know i'm nervous i'm home and i'm like in my house and i can't leave and like like, you know, and I'm like, am I going to get sick? Like, I don't know. You know, is this going to kill me? And then I didn't get sick. And then I sort of like, then we just got, then it just happened. Then we got in the swing of things.

It just went, here it comes. Yeah, it's, it really depended where you were too. Sure. When you look back on it, of course course it affected everywhere and on some level but one of the pieces of the science that i have not gone and looked at recently that i'm curious about okay is the whole viral load aspect because you know i was up in north jersey when this was going on i was hanging around new york city if if you're from up there which you are as well like you know what that was it was it was bad you know people were getting it people were dropping like flies and it was a real thing now you know are there

plenty of people that had comorbidities sure yeah but you saw a lot of normal age even younger age people just like dropping in a way that then you maybe didn't see it at that level ever again right after the beginning correct and i tend to think that you know without looking at the research it's like you got to wonder if that is just because they're so it's first of all it's new it's viruses are most powerful at their beginning sure as well the science does support that but also you know there's literally you know no pun intended here but pun intended like there's so much of it in the air yeah that people are just getting massive amounts of it and then hospitals are overrun and then you know you had the city shut down right so if you look at like in north jersey so you have to ask yourself right off the bat like why

north jersey why new york city why north jersey right so you have like this two these two very like uh this perfect storm type of scenarios where you have international airports and huge hubs of travel huge hubs of people moving around and then you have every the most densely populated part of the entire nation right you look at like jersey city right where you have multiple generations of people living in the same home right like large large groups of like families all occupying the same dwelling and multiple generations and people and somebody had to go out and earn money and do the grocery shopping etc so you know this kind of close cluster you know and then when you talk about viral load it's just a matter of like could you

there is a threshold with which you know i would imagine if you could consider the amount of viruses like you know ping pong ball or you know like a like bingo balls you know what i mean like like you know the more you have the better chance there are for you for for there to be you know uh for attachment and you're talking general viruses this isn't just covet 19 yeah yeah i mean you have to have you know there has to be i mean think about things about you know they're not related in any way but think about like when we talk about viral load for things like hiv or hepat C, it's like viral load for HIV right now. Like, you know, we consider a viral load that's undetectable almost like a cure, right?

Like, you know, there's, we now say confidently that once your viral load is undetectable that on certain medications that you are not going to transmit this through sex. You know what I mean really yeah so there's like you know hiv is sort of the quantitative virus where it's like if there's a lot of copies you know what i mean like that's when you're gonna see you know measuring viral load and the amount of uh immune cells that the person has and usually they kind of go against each other the more virus the less immune cells they have the cd4 count um but yeah so i think there's there's certainly a quantitative portion of virus that you need to be exposed you needed to be exposed to in order for it to get in you know what i mean like yeah you know um and then attach itself to your to the particular and you know the particular protein in your your lung cells that that it um you know that it did interestingly

enough i was reading about some of the autopsy reports how this how this how this virus was different from like how it did its damage to say the flu right because everybody likes to compare to the flu because the flu is deadly right it really is um and we do forget that but it is we do but the flu sort of does its damage by sort of altering the ability of certain cells in the lining of the lungs to kind of like it makes it it makes it a very very nice environment for bacteria to come in and do their thing and then the devastating pneumonia after the fact is is a bacterial pneumonia oftentimes what quick question on that when do we start the designation to pneumonia with any type of virus where it moves to that?

Like you mentioned spot on a lung or something like that. Is that all it is? So a pneumonia is basically... I just want to thank Eight Sleep Chief of Staff, Alex Horowitz, once again, for providing us with that beautiful statement last week, thanking our entire community here at Trend of Fire with Julian Dory for the impact we've had in propelling eight sleep to international success

i mean really it all starts and ends with what we've done here and and to to have him put that into words and allow me to read it on the show was a beautiful thing now despite the fact that i wrote the entire statement myself that's neither here nor there. I can confirm that that is very much what he would have wrote. That is the impact we've had here. And if you are out there listening right now and you haven't been a part of that impact because, I don't know, for some reason you don't want to improve your sleep or get your energy levels up throughout the week. And maybe you just don't want to live that long because, frankly, a better sleep is correlated with a longer, healthier life. But anyway, if you haven't done any of that, and you'd like to at least learn about that side of the fence,

the greener side of the grass, if you will, use that link in my description for eight sleep, along with the code trendifier at checkout, and you will get $150 off your own eight sleep pod pro cover today. The eight sleep pod pro cover today. The eight sleep pod pro cover comes in queen or king sizes. It goes right on top of your current mattress and it starts working for you the very first night you use it to make sure that your sleep is the most optimal sleep you've ever gotten. So as I always say, you'll sleep six hours and feel like you slept eight. Like a, like a lower respiratory tract infection that like so like once we get past just the airways and the you know the sinuses the mouth the the trachea

the main bronchi all that stuff now we're in the lungs we are a pneumonia clinically is um you know shortness of breath chest pain or tightness, and cough, other signs of infection, fever, elevated white blood cell count. Sometimes you see decreased oxygen. And then when you say spot on the lung, it's usually because if the pneumonia is concentrated in one area, you can see it on a chest x-ray or a CAT scan. If it's spread out like a virus, these viral pneumonia typically like both sides of the lungs kind of like patchy and everywhere it wants to be so pneumonia is basically a diagnosis that it puts together these scenarios together and say okay you have an infection in your lung it's essentially when your body just really failed to fight back and it just kind of got overrun interesting interesting that you say

that because the truth of the matter is is pneumonia in essence is an inflammation of the lungs right but the the usual causation is a infection when we call a pneumonia right because there's a designation designation pneumonitis because everything in pneumonitis if you were to say uh inflammation of anything in the body it would be an itis right like arthritis you know what i mean like so pneumonitis can happen when your lungs are inflamed you know something you know sometimes you've ever had the water go down the wrong tube yeah you know did it today you can get an aspiration pneumonitis no the lungs do not like things that don't belong there because it's the only open organ to the world it's constantly taking in pathogens so it has to have a pretty strong defense system so the you know the on the ready defense in the lungs is like so to to reclassify

the way i was putting that when the rest of your upper respiratory system did not fight back adequately such that there's leakage this is now the lungs in in this way fighting back and that's how you land yeah yeah because the damage the dan like way the way when you feel shitty when you have an infection it's usually from the the battle you know what i mean like not the you know not often the bacteria is doing the damage the virus is doing the damage but the battle itself is what causes you to have the this inflammatory response in fact if you've heard the term sepsis i have heard of that yeah so people say i went septic yeah yeah so in essence what septic is is sers which is uh sudden inflammatory i forgot the acronym i'll look it up what's the letter s-i-r-s um that's just because i'm on a podcast and i'm nervous it's all good you're doing great um and

the uh so you know systemic inflammatory response syndrome yes but then when it's when you're confident that it's caused by an infectious organism it's now sepsis right and basically the the the sers which is things like fast heart rate, fast breathing rate, fever, elevated white blood cell count, evidence of lack of tissue perfusion, not getting oxygen to your tissues, not getting nutrients to your tissues, etc. It's from the fight, from the system is like the avengers and even if they take out the the the invading organism they they're still going to be like the you know the guy that comes to go dude you fucking blew the whole city up you know what happened here you know yeah so that's basically that inflammation that happens and that was part of the that was part of the covid pneumonia thing is that like this inflammation was so profound.

The virus itself was causing serious damage at the level of the little air sacs in the lungs. Plus it was causing baby blood clots. So all these little thrombi everywhere in these people's lungs, scarring and scar tissue that's forming from the constant turnover of like, hey, that hole that just the virus just ate and they're gonna patch it up with some you know patch it up with some scar tissue so there was really bad inflammation um and and that's the for the most part people couldn't handle it so we got into this talking about the whole concept of paying your dues and being kicked kicked in the ass on the way up i do want to come back to that let's's go. But we're deep on this right now. So I don't want to get off it and then have to circle back around and everything.

To me, I think it's more important than ever to have the conversation around the medical field, specifically how everything went with COVID, because it's impossible to not pay attention to the camps that you see online yeah and the camps who get attention are the extremes and i can imagine i'm just a douchebag podcaster you're a doctor this this kind of thing has to be just absolutely brain damaging to you listening to people who are frankly all wrong right yeah it's it's so let's start off by saying morale's certainly not at an all-time high yeah right um you know i think that um first of all you know the sort of the credit has to be given to um nurses respiratory therapists and all of

these sort of the people that are constantly in the rooms with these people who are carrying a deadly pathogen in their bodies are trying, that pathogen is actively trying to expel itself and go get you, you know. So, yes, it was, it's hard to go do the job and then have, you know, the world outside talking about it in a way that you know to be, frankly, mostly yeah mostly untrue or at least speculative at the time you know um i think you know but the other thing is that like you know when you're a clinical when you're a clinical physician right and you're not a researcher like i'm in there you know doing you know their trials are going on at this at the time but like i'm a i'm a frontline like guy i don't i don't get the i hear what works from the dudes and chicks at the top you know what i mean like they're the ones running by at the running like the people who are at the academic centers the big institutions who are running the trials going like this medication

we're going to try this medication in combination with this we're going to see how those people do and then we're going to take that information and we're going to write a paper about it all right so he so here's a good question on this i I'm glad you brought that up. The camps that I was referring to are pretty obvious, but just for people listening to make sure they know where I stand with all this. The camps I'm referring to are the camps of people that formed probably within, as early started, within a month of this thing hitting. And that was either the people who were like, this is literally not real, which that blew my mind that people could think that, but okay.

And then the people who were like, 20% of everyone's dying. Yes. Which also we saw that was not going to be the case. This was not the stand by Stephen King. Exactly. So you're talking about it where now you have a job to do where you control what's right in front of you, right? You're a doctor. You're not running the business. You're not in there doing all the tests at the top from academia

and things like that no but we've seen a lack of a scary lack of transparency and then also public trust as a result yes where now anytime doctors bring up testing on anything yes people immediately go it's probably some people not a lot of people but some people do oh it's probably bullshit yeah whereas what it sounds to me talking with doctors like you and guys who are there is that forget the whole vaccine and all that stuff like when you guys were trying to figure out just ways to save your patients yeah the people who are running a lot of these studies it's not some fucking conspiracy where you know what i mean like they're trying to save people too no i i mean are the people that are running the trials want to be the response like do they want the pat on the back and the name on the paper that figured out how to do it yeah

yeah and fucking i want them to have that ego good if whatever drives them i don't give a shit but come up with the right answer it works and they're not like i i just don't give a shit, but come up with the right answer. If it works. And they're not, like, I just don't see how, you know, any, like, you know, take ivermectin and hydroxychloroquine. Like, there's no doctor who was not early on excited when you hear that a very sort of like, you know, medication that's being used for certain things for a long time has this other property potentially. And then you read it and you go oh that study seems a little flawed and then you got a medical student who like who like determines that the paper is like a total farce and then you look at like what it did it's like okay in the dish in a petri dish right or whatever you know the the controlled situation the in in vitro situation not in a in an animal model and had some ability to prevent the virus from making copies of itself

awesome that'd be great turns out you needed like 120 times lethal dose for it to be like truly effective now why do you think people here's what i want to know then why did people in your opinion latch on to stuff like that so heavily i listen i understand that there and we can talk about different overshooting the expectations that happen and i fully understand that with people and i'm not i'm not going to lecture people on any of that i want people to do what they want to do but like you saw people form teams around things like ivermectin and it's like these people you know including myself by the way i'm gonna sit here and read medical documents all the time.

You know what I mean? Like I'm no doctor. They're no doctor. And yet it's like, oh, ivermectin must work. Like why – what led us to the point where that became like your social media status? I think – well, it's – you know what's – you know what the answer to that question is actually – it's pretty – it's so nuanced. But there's a – have you ever seen the movie contagion with it's matt damon gwyneth paltrow i've never seen it okay but i know what you're talking about i really want

you to watch that movie if this isn't like a net like julian you got to check this nit flip and you're like yeah sure i will and then you never never pay attention to watch it okay because this movie came out a while before covet 19 the pandemic and it's unbelievable the parallels like unbelievable so during the movie um and spoiler alert for the for the for the folks who haven't seen it spoil away baby jude law's character um is a like you know sort of like fringe journalist okay catches the the disease and then cures himself with this uh homeopathic agent called forsythia puts it on social media and goes the government's lying to you the vaccine's a farce you know this is forsythia works and then you see lines at pharmacies where they're like we're

running out of forsythia and people are literally beating the shit out of each other for that last dose of forsythia and forsythia did not work and i think that there's like um you know there's an all-time high of distrust of the medical field and the medical field has done some gnarly shit to the human population over a long time and there have been some bad actors and there are still some bad actors just like every other field yes the stakes are really high like Like, get that, you know? So when you have, like, you know, doctors or pharmaceuticals, whoever, doing things that are unethical

in the name of a prophet, the stakes, these are people's lives. So I can understand how people, you know, but that whole sort of, like, I want to get on the team that is calling, that is, like, that is of the belief that this is a lie just i don't understand i don't i don't understand i don't understand how you know anybody could like you know like i i like i like when my questions ask my patients ask me questions about why that

you know i'm a huge why guy why why why why why why you want me to do that why don't we that's key it's why is the most important question anybody could ask about anything that's ever been done why yeah because if you don't understand why then all you're doing is just blindly trusting somebody or blindly distrusting somebody but if you under if you ask the why that's a great question then i can tell you why and if you believe me great and if you don't then i don't know what i can do for you but with that being said i don't understand why you would believe that i would walk into your room when you can't breathe and not give you something that would save your life and then i could go home and sleep at night i think that's that would make me a mass murderer listen Listen, I hear you. You know? Of course I agree. Right?

It's wild to think about, especially when you're talking about, like, guys who have long-term relationships with their patients and everything. Like, suddenly they're going to start hurting them. Right. Because, like, oh, you know, people got programmed. Yeah. That's not what happened. Yeah. I think the issue becomes where certain people could have anecdotal evidence yes that is also by the way

it's a great point it might work it's a great point maybe it's a great point but also what if it's it's it's a coincidence you know correlation not causation yes to something you know what i mean and there's a lot of that where people i feel like cherry pick some things and i'm not again like i'm not sitting here going oh you know do whatever all these pharma companies tell you to do or do whatever you know the people on tv tell you to do in fact you know i think trust is an all-time low that's why that's why the question why is so important but the doctors that's what i'm getting at i just yeah like i don't i don't know i don't i think i think this goes back to what i said about me waiting to hear

what the what the guidelines are on a thing because i I'm not, I'm not in the laboratory. I'm on the, you know, I'm, I'm actually seeing the patients and sort of giving them, you know, what the treatments are. So perhaps, you know, perhaps maybe there's, there's some level of like, hey, you're the, the, the clinicians are not being told the right answer, right? So they're not, they don't even know that they're, but any clinician worth their salt is going to go does ivermectin work like let's let's look let's look into that let's see you know and then when you know when you read when you do your due diligence and you read the medical literature that supports or refutes and you say no no it indeed does not it may have helped a couple no no that's a lie right there may have been a couple people who

got better right did other things too but that's what I said the studies were shitty because it's like how many how many people were only on ivermectin were not on dexamethasone which was the only proven treatment remdesivir dexamethasone dexamethasone was indicated and somebody who was hypoxic meaning they had an a blood oxygen methods oh that's a steroid okay right I don't know if I'm familiar with that so it's a steroid it's an IV steroid that was um given if a patient was indeed had a blood oxygen saturation below a certain amount it was proven to be uh to be effective and not for everybody but it did help some that's why when you say blood just real fat i'm sorry i gotta clarify to make sure everyone's

following sorry but this is such a shitty no no no you're you're the you're the expert here i gotta make sure the terminology we're fine when you say blood oxygen level yes saturation yeah what do you mean by that you want at any given time to have um your ox your blood saturated with 90 or more of oxygen right below that okay um is a condition called hypoxia or in the blood hypoxemia which um it would be indicative of you not getting enough blood uh oxygen delivered to your tissues got it so it's not necessarily like oh something else replaced it it's just the fact that you literally have to have a system that flows for a bloodstream and if you're not being able to suck in the air yeah so there's right and and and figuring out why somebody is hypoxic is, is a very interesting sort of path.

It's like, okay, is it the fact that they're not getting it into their lungs? And then, or is it their ability to pass it from the air in their lungs to the bloodstream? Or is it then something wrong with the blood delivery system? And that's, that's,

that's the coolest fucking thing about medicine is like what, you know, you see what's wrong and you go, why? And you figure it out and you get you know what i mean like and that's that's the coolest thing i think about being a doctor is like when you kind of like when you have a physiological problem and you go okay it could be it could be one of these eight things and then there's some evidence to point to this one evidence point that one etc and then you kind of come up with it with a story but medicine is also the shittiest science because anywhere you go on the planet earth for you know within a degree of

reason the acceleration due to gravity is 9.8 meters per second squared um you know, the fact that, you know, one blood pressure medication may work for you and not for me makes no sense to a person who is a pure scientist because they go, well, both of the systems that, you know, this person is operating under should – you know what I mean? stuff is is kind of powerful but also dangerous because medical studies require a certain number of people in order to be statistically significant and show proof of efficacy i think another issue that i don't know if the word is issue there i don't know if that's what i'm looking for but a psychological aspect of this that has had me very interested for a long time yes just looking at society is the reverse psychology on purpose possibility go ahead again i don't know but something like the ivermectin where you as a doctor and plenty of other doctors could say i think you said it could be 120 times lethal dose to be effective or something yeah whatever whatever that number was but it's something that would be outside the realm of what you would be able to do right and you may look at that and say the evidence is so strong that that's the case

that yeah we don't really want to see people thinking that they should take this right when you then can profit off of that i'm talking about the media now once again watch contagion please my gosh i'm gonna i'm gonna have to do that based on what you're telling laws characters the most important character in the whole and you said he's a fringe journalist in there so that makes sense yeah so like you look at cnn and one of the things that they did and this this wasn't just them i think they were the people that started this though so i'm pointing them out was like when rogan got covid and he by the way did a whole bunch of things yes one of the things happened to be some form of ivermectin

whatever when he said that they then made sure to go out they angered everyone because they said he used a horse to worm around everything instead of recognizing that it is an actual drug very much yes it is human beings for other things right so let's can i can i try to piss yes they try to piss people off as my point it feels that way a hundred percent because i really want to talk about what you just said about what cnn did to sort of you know to to to how how they got a headline there right ivermectin is indeed a horse to wormer but it was it's been recognized for for many years as an anti-parasitic drug that is a it attacks chloride gated neuron ion channels in the in neurons meaning so it its job is to have any medicine that you take that is going to attack another organism that has invaded

your body has to do two things it has to kill the organism that has attacked you and not kill you right so antibiotics work by figuring out what's the difference between that bacteria and you on a cellular level and then destroying that thing right so ivermectin works by you know uh destroying the nervous central nervous system of these parasites these worms right and then and but not not doing that to the animal right right? So, it is appropriate to call it a horse dewormer, but it's inappropriate to leave out the fact that it's used to treat humans. Correct. And it has been for many years. They're deleting by default.

It's literally, in my opinion, it is deception by, what's the term to set when you when you like withhold information it's deceptive dude i know what you're it's deceptive i can't think of the word it's deceptive i don't think it it didn't help joe rogan joe rogan's an amazing shape yeah the guy can kick the like a hole in your wall yes and there's nothing scientific about the way joe rogan got treated because when you do more than one – when you change more than one variable in any situation, how could you ever prove what was the – What it was. Exactly. So when you talk about – you used that gravity example.

What is it again? 9.8? 8 meters per second squared. I got a C in physics. So sorry. You're going to have to forgive me here. Not smart enough to be a physicist. I like physics though actually.

It's awesome. I'm just not that great at it. It's awesome i'm just not that great at it that's awesome so the thing about that is you're talking not to say don't mishear me here not to say the universe is not a very complex thing it is yeah but you're talking about one giant mass within a system that has an overall level of variables as to how it works like the solar system yes right if you're a small speck as a human being like a micro of a micro of a micro of a micro speck yeah the chances that a seven foot five guy who's 300 pounds versus a five foot four woman who's a hundred pounds soaking wet yeah are going to have a difference in their pooling gravity it's like mathematically not possible however when you are

now looking at an individual human's body yes and you know we all have we're supposed to have 98.6 temperature but what what are all the variables coming in what we breathe every day where we live who we're around so what our mental is like yep what we put in our mouth yes what we drink or don't drink all these different things there's a there's i mean i think there's 30 to 50 000 just decision points in a day which by the way is using your brain and therefore using energy and things like that decision fatigue there's all these different variables that occur in billions trillions of iterations throughout the day yeah so when you're talking about like oh as a scientist it shouldn't make sense that one thing affects someone else

differently in my opinion it should make sense because you're dealing with different planets. Right. And that's a great analogy that the system inside the human body carries as many variables probably as the universe does on an exponential scale. scale um and and the key thing here is like when you're performing a scientific experiment which medical study is you want to isolate one changeable factor that's the scientific method yes isolate one changeable factor so when you do pool patients together you're trying to figure out hey can we get the most people the same age the same area they live in the same you know can we make them look the same the most so that when we try this variable to change this one variable on them either the removal or addition of a of a of something then we can measure the change and even that you still if you could get as a scientist right yeah with your hat on there

yeah but i'm saying like doctors or medical scientists, so to speak, quote unquote. I'm using a broad term. But as someone who's like thinking about this in the field, if you could get 12 iterations of a study versus two, you want the 12 every single time. Yeah. The more – like it doesn't even make sense the first time a lot. Being able to reproduce something is very much the the tenant like the basis of basis of science like in you in order to prove a theory somebody else has to be able to take what you did and reproduce it like without you around yes right so i have to be able to take ivermectin and give it to my patients and have to see the majority of them improve if they otherwise wouldn't have and here's an here's another thing

then you're you're you're going right along here i like this like you're you're picking at all the different things that i wanted to talk with you about but in order to learn if something works or not you do have to test it on people that's why we have trials that's why we figure things out another part of another layer of that psychological deletion that we were talking about the deception Yes. of just medicine right like among the douchebags like me just sitting around and talking right we cancel it based on oh no so and so brought that up so we're not going to look at that or that person in the medical field is thinking it they've thought this before so we're not even going to consider it and to me the whole point of science right is to challenge ideas you are constantly trying to correct or fix or find a new way and so in order to do that it's like anything else you have to find failure too i'm not saying not to

extrapolate doc but i'm not saying hey let's go give you know hydroxychloroquine to 100 million people i'm not saying that i'm saying like on a small test basis why are we not allowing to see these results in the public so that people can at least learn like oh ivermectin doesn't work yeah here's why so nothing to hide yes i think um i think that uh you know failure in science is not a bad word right because when something when when a when an idea fails in a test, you have now eliminated that from the, like, okay, we don't have to test that again. You know what I mean? Like, that's, you know, the answer must now live with the remainder of ideas. You know what I mean?

I do think that they, you know, they did, there was enough people who got dosed with those those medications you know what i mean to to recognize that there wasn't any you know what i mean because i'll tell you right now how many studies did you see with that i would be lying to you if i told you that i i i could come up with i saw what you know like what basically are like meta-analyses which are studies that kind of collect other smaller studies bring them together see how relatable they are and then produce a bigger yeah they produce like a bigger result they'll take like hey you know these 12 centers or you know groups did the and then we put them together we try to line up the variables as close as we possibly can and then spit out a bigger a more more scientifically powerful study do you what

just quick question as a clarifier do Do you worry sometimes about, especially if it's something that's become politicized, about the accuracy on some of these versus not saying again that people are just going in there and cooking, but they're trying to get to an intended result. So maybe they conduct the studies on people who are less likely to respond or things like that. Is that at least a a thought just as like a little challenge point in your head i think that um i think that there are a ton of studies being done on a daily basis with populations that are pre-selected to give them the best opportunity to prove whether whatever they're trying to prove with that being said um that's what the peer review system is for. And the peer review system is basically like when you write a paper, when you try to prove something from a study, other people that are independent of you have to review it and give you feedback on it. And then once it's reviewed, then it can be published and certain journals are certainly not as effective or as you know powerful or impactful or or even you know as trustworthy as some but you know there are some

that are just the holy grail like when the new england journal of medicine says something you listen because it's been reviewed it's been reviewed by the the best minds that we have without but with with with hopefully without any bias but there's always going to be bias but i understand what you're saying you're asking me if if you know you try to cherry pick uh situations where your idea is going to be proven of course everybody wants the everybody wants to be right but it has to in order for it to get like real capture it has to have more impact than that it can't't just survive your small preselected group. It has to be extrapolated to a larger group or whatever.

You know what I mean? So the process with which scientific or medical ideas are taken and put into use is a little bit more rigorous than a study a study with like 500 patients that so that showed that this thing did this it's okay we'll look at that and then we'll do it amongst 5 000 or 500 000 and if it works there then we'll start to make that a guideline you know what i mean so yeah i think i think there's certainly i don't know you got 20 30 years to unpack what happened here man because i don't know yeah i don't know we had a long time to figure out what happened here and there will be people that will be looking at this from with so many different pairs of glasses on um but all i can say is this i gotta tell you like my i wouldn't have been able

to i would not have been able to rest my head on any given day after coming home pronouncing two or three people dead knowing that like all i had to do was give them this like one thing and I was like right fuck that I'm too principled I believe my camp this is what I mean man like my people the people that voted for the guy

that I voted for so that I can't give them that so they're dead now but like I'm okay with that like no fucking way see your your face no way

on camera no way as a doctor no way putting behind it this is what we need more of no way like I there's do

you understand though there are people who legitimately they think that like doctors are are just completely brainwashed i i i understand like all doctors right i understand that like when an idea is seeded so powerfully in your head that that's the that's the inherent issue here is like there is no level of proof that you know there's no level of proof that will make somebody change their thought process at this point for some of these things they're just dug in man they have like they're dying the wool you know but like as somebody who's like you know somebody's dying in the middle of the night in the icu like like take covet out of the equation somebody's in the intensive care unit in the middle of night and they're 50 something years old and their wife's out in the icu like like take covet out of the equation somebody's in the intensive care unit in the middle of night and they're 50 something years old and their wife's out in the hallway

crying and like i'm gonna throw shit at them that i have no idea was gonna is gonna work sometimes if i've run out of ideas i'm calling people hey what do you come you know take a look we're trying everything we can you know what i mean like there's i just don't i just don't see a scenario where like i don't ever want that to stop either i don't just i just don't see a scenario where – I don't ever want that to stop either. I just don't see a scenario on a large scale where people would be like, oh, this thing doesn't – I kicked my headphones out. Oh, sorry. Yeah, just hit this. You see that middle thing right there?

You just go like that. Okay, cool. And then you go right back in. There's no scenario which I think – that I think a large herpetologist would have let this many people die. That's what i'm saying i just don't now let's go back to the beginning then yeah on that point i actually think that doctors did a great job overall just looking at the general population readjusting okay at the beginning obviously i don't think anyone did a great job because no one knew what they were

dealing with however no what you saw is about maybe it was quarantine started roughly like March 13th, that Friday, up in New Jersey and New York. So then it got to the rest of America by Monday or whatever. Maybe six to ten weeks out of that, what you started to hear about, and I'd love to get your perspective because I'm not on the inside was that doctors were figuring out that oh respirators are not a way to go let's stop that because we're making people train themselves not to breathe on their own and they never get off them and then they also started figuring out at least like some things that could help mitigate whether it was and correct me if i'm wrong here there was like some people using remdesivir or stuff like that and you started to see at you know, they talk about like the flattening of the curve. You saw the gravity of it, of deaths every day in May 2020 start to dissipate overall.

And so I think like, you know, it's easy to just boil it down to those things I just said. But what it like, take me into the hospital when you were there what were you guys when did you guys have eureka moments and what when did you start to feel like there was certain things changed the game there was a study that like the new the data from new york started to come down and i don't like like i feel like the whole thing's been such a blur that i will never be able to be right on like a month or a year whatever it's okay but um we'll be broad there was like a broad. There was some information from New York that came out and said that like X amount of patients, like 90% of patients who went on a ventilator died.

And then so that doesn't give you an answer. That just gives you a piece of data and you go, okay, well, what did that mean that they were done for anyway? Was there some pressure trauma like when you go when you go on a ventilator right you have to you're there's there's a million little variables to adjust the ventilator right how much oxygen to deliver um how much how how much air at any given time how often to deliver that air are you gonna let the patient draw the air on their own or is the machine gonna force it you know i mean and then how much pressure are you gonna to let the patient draw the air on their own or is the machine going to force it?

You know what I mean? And then how much pressure are you going to deliver? So there's like, there's this amazing fluid dynamic physiology and physics that are involved in mechanical ventilation. For people out there listening, just to give a visual, because I feel like we don't do this enough. We just put these words out there. Sure. When we say someone's going on a ventilator, can you walk people through what happens? Okay. So typically what will happen is a patient will be in a condition that we believe either by looking at them or by some data points that they are not bringing in they're not exchanging gases in their lungs or they're not

like driving the they're not breathing like you know like there's either a gas exchange issue inside the lung where they're trying to breathe but they it doesn't matter or they can't or they're not trying to breathe because their mental status is too you know on the decline and their their blood saturation levels are insanely low every yeah so right or or or we think maybe there's going to be there's an impending collapse and we kind of get ahead of it right where they're going to they're going to go into what might make you think that like things like the saturation level saturation or if somebody's re if like for instance if somebody has really bad like emphysema or something like that and they're having an exacerbation and they start

to they start to have a difficult time breathing there's only certain there you know breathing is a relatively passive process right so you don't pull in air you air falls into your lungs because what happens is your diaphragm creates a larger area inside your chest which means that you're in the air inside your chest is now at lower pressure than the air outside your chest and all fluids will go from areas of higher pressure to lower pressure air is a fluid so when you create this lower pressure system inside your chest air will fall into your lungs and that's breathing then you create a higher pressure environment in your chest by your diaphragm going up, your lungs kind of compress, and now we have the reverse process. When that system is flawed because either the airways are smaller because you have an asthma

attack or whatever is going on that that's not working that way, you will use small muscles. We call them the accessory muscles of breathing in the neck and the chest to sort of help that process. Chest expansion, chest wall mechanics, movement of the air in and out. Those muscles are not like ready to rock and roll for two or three hours. You know what I mean? Like when somebody's using the, you know what I mean? When they're doing that thing, you know, and you see it and you go like guys that guy's not gonna last very long doing that right and their oxygen starts to plummet where they're breathing like 40 times a minute

when they're only supposed to be breathing 15 times a minute there's just tons of data that you put together and go that person's either in respiratory failure or pending respiratory like they're going to go there so let's do something we got to do something so then you get somebody who's trained to intubate meaning they are going to be able to take a plastic tube and stick it into their trachea now do they stick it through like they actually make an incision not no typical uh in under some circumstances if there's some like trauma to the face or something like that in an emergency situation but for the vast majority of times done through the mouth okay um if they stay there if they stay out a long time then they'll switch to the neck because then you need to not like

have their mouth deal with that right there's too much muscle movement there's there's tons of things that are going on in the mouth that you can't just let them have a tube down their throat for you know for weeks at a time so there's a period of time if they don't if they don't get off the ventilator right away so you switch but in the end in the in the acute scenario like right now you put the tube in right you get you visualize it you know old school way would be like to look you know now they have these like amazing cameras that you'd like put down there and basically be like you're here go you know like that's your spot hit it um and then once the tube is in the airway is secure they put them on a breathing machine a ventilator right and it just it manually does all the things you described the

body's supposed to do pull in the air and then releasing depending on the setting so the ventilators are very very very complicated to the point where there's entire fellowships devoted to learning ventilators and then so the ventilators can decide like you can set the ventilator like i said to if the patient is completely unable to trigger breath on their own like there's no part of their their body that's going to say i need a breath right now you set the ventilator to do it for them but if the patient can can try like the body wants breath the ventilator will sense that and give it to them based on how much you at you tell the ventilator to give you know what i mean and how often you do it and with what

oxygen percentage etc and certain numbers and settings can cause some damage you know too much pressure not enough you know it's like so but also people once you put them on this, they're on there for an hour, two hours, three hours a day, a week. As time goes on, all these extra muscles and movements that you talked about that are involved in helping compensate for breathing and stuff like that or a part of the breathing process, they all atrophy because they're just chilling. It's always the goal is to safely remove the patient from the vent from the ventilator as as soon as you can safely i say that safely because it's not the goal it's not the goal to get them off as soon as possible the goal is to get them off when they can tolerate being off and how do you tell that that's a great question because they have yet to come up with a app like an 100 accurate predictive system but there are some guidelines which with with the patient should should meet in order for you to believe that

they're ready to be extubated or have the tube removed they have to be requiring from the ventilator a certain percentage of oxygen or lower so they need to be on about 50 percent of oxygen or lower because the oxygen in the room air is 21 so we want to get to 21 as close to 21 as we can right they need to be breathing uh on their own so you pause you take the ventilator and say pause let's see what they do on their own right and you don't take it out you just just let them go through this on the machine pause the machine so it's a called a you know a breathing trial right and we see and how long does that last depends on how long they can tolerate it like we try to get them hey let's see let's see how long they can take to tuck her out because then we get a real good idea how long they're going to last you know so then there's this thing called the rapid shallow breathing index meaning like you

should not breathe fast and you should not breathe shallow so So we want you to take good, long, deep breaths on your own. So if you're not doing that, you're probably going to fail extubation, right? Right. You also need to be mentally alert enough to participate in the protection of your own air. You need to be able to keep your airway going, be with it, and not be completely and totally zonked out.

So you need to be with it and not be completely and totally zonked out so you need to be like you know with it enough to like um you know breathe on your own and not have things go into your lungs that don't belong there so the the muscles that protect your airway from swallowing or you know just your saliva every minute of every day every time you're not breathing there's a muscle that closes a flap over your airway to say no just air please everything else stay out if that's not going to work we can't take the tube out so there's a lot of things that give us an idea that you may be ready to come off and by the way i am not a pulmonologist um i have good friends that are pulmonologists and i trained like a place where pulmonology is like it's it's it was really done really well so that's the only

reason i know this stuff but i'm not a lung doctor i'm just an internal i did not take the extra training but i do do some critical care as part of my job so ventilators are something i'm very familiar with it a lot i see you time when i was in my residency but we don't have a hundred percent prediction like a way to predict but we have a good idea and that's medicine you know we're never going to be 100 right but we have a good idea and most people are going to benefit from what we know already you know what i mean like so yeah mechanical ventilation is something you should avoid but it is often necessary and then the goal would be to get them back to breathing on their own as soon as possible in a safe fashion when they're ready all right bookmarking for one sec just where we were going

with this about i was asking you about where, like when a little eureka moment happened or like how that went down and you said it could be, it could have been April or May or whatever. But before that, just to clarify one other thing, there was a documentary that creepily enough, sounds a little weird, especially looking at it now, came out on Netflix right before the pandemic. And I think it, I think it might have literally been called pandemic i'm not sure it was very weird but it was they were tracking flu yeah around the world yeah and you know as you said earlier on flu has been a problem for a long time and it does kill people every year when they were i remember there was there was a scene in there i think it was in India on an emergency room ward where they showed the process of somebody who was put on a ventilator. And the doctor, I believe, if I'm remembering this correctly.

So if I'm wrong, please tell me, people. But the doctor was talking about how he needs to be able to breathe on his own because if we let him keep doing this, he's never going to get off it and he's going to go. Now, this was just the regular flu because this was way before COVID when this was filmed. So it sounded to me based on the fact the guy got off and he wasn't in good shape either, survived the whole bit, and this has happened. This was something where they're able to do this with people. Some people don't make it, but a lot of people do. With COVID, as you said, it was like 90%, some ridiculous number. Like literally, like I know a guy who made it covid as you said it was like 90 some ridiculous number like

literally like i know a guy who made it who was on it for like 56 days and he had newspaper articles everywhere because it was so rare right why was it with covid like you once they went on they were done yeah i think i think that that that question is tough to answer because of the fact that you know um we i don't know how much the ventilator itself played a role versus the fact that you're like, if, if you required a ventilator, it meant your lungs were destroyed.

Right. So like, I don't, I don't, I don't know if that's a question that's easy to answer. Like I mentioned before, I had written, read the,

um, some of the autopsy information coming back, looking at the lungs of these people and the lungs were so beat up like we're talking you know that analogy i said about the avengers like you know we're talking like they're fighting ultron in there and the the the your lungs are the the buildings are just everything's destroyed right so did it mean that you were already at the end stage of your lung of your respiratory failure with no recovery right like did you not recover appropriately or did the ventilator contribute to your demise i don't know how easy of a question that is to add to answer it's not

i'm sure it's not you know because if you needed a ventilator like you couldn't like there's no ethical way to say like we don't let's keep all – like 100 of these guys that can't breathe, let's keep them off and see how they do. If they peter out, they peter out. Then we'll prove ventilators work. That's not something we could ever do. So I don't think that – I think there was probably some level of contribution, but I if you were if you required a ventilator you were probably in bad shape but we to your point about the whole atrophy like the longer you stay on the vent like there's a lot of things that happen and there's also like other things about being a person lying in a bed doing with no movement getting ivs and

all there's a million things that are bad about being in that shape yeah well i mean there's nothing let's get another thing straight the longer you're in a hospital sick period you know or like not even just a hospital like bedridden yes it's the longer anything goes it's worse for your body because all the normal things you get up you walk downstairs you you you drink water you you know your day starts you know you're not doing any of that young heroes of medicine in the last i don't know forever are physical therapists they're starting you know they recognize they recognize that like an icu patient who is on is extremely sedated and on a ventilator okay and like it's not not even remotely with it. Right. It has 95 IV fluids, all kinds of medicines.

Physical therapist needs to come in and move that person's limbs around as much as possible. Because that actually showed benefit to long-term outcomes. Right. So like movement of any, I mean, it used to be that you got an operation that the surgeon was like, don't move for like 60 days or whatever. You know what I mean? Like now it's like, Hey, we just lopped off your leg. Hop around on the other one as soon as you can. You know what I mean, it used to be that you got an operation that the surgeon was like, don't move for like 60 days or whatever. You know what I mean? Like now it's like, hey, we just lopped off your leg. Hop around on the other one as soon as you can.

You know what I mean? Yeah, they're really aggressive. Yeah, and it's important because we are a sedentary lifestyle in general. Like they take away the critical ill. Take a person whose job now makes them sit down all day. It's really bad for you. Like really bad. I don't have it. I don't have the study up right now I can pull it up in a minute hopefully but I remember there was I think it was an amalgamation actually of studies that came out maybe I feel like this was even

before the pandemic not that that matters but where they talked about the one of the ultimate slow killers of the human race is sitting down yes and the science had to do and I'm really just trying to recall this right now but the science had to do with like blood circulation and the the unnaturalness or something of this position that we're literally in right now and Because more and more people are doing it. It's actually inhibiting our ability to lengthen lifespan because enough people are getting different health benefits from being in a seat 12 hours a day yeah so i don't know i i'd like to read that right and i you know but i could just imagine right off the bat the mechanism by which they're discussing is that like you know um if you're if you're if you're

if your blood vessels are kinked at certain angles like you know if you're sitting down you have you have multiple sets of large blood vessels that are now at 90 degree angles you know what i mean or even more acute angles and that is that adds turbulent blood flow right so if you imagine a large blood vessel is a tube going straight down that tube you have laminar flow. Blood is easily moving. But when you have like angles, now you have blood bumping up against walls and, you know, things don't move as good as they can. I mean, that's part of the reason why we get blood clots when you're after a long flight, right? Like no movement and non-moving blood is sticky blood. Sticky blood is cloudy blood and cloudy blood is deadly blood.

Cloudy blood is deadly blood. Yeah, like sticky, like your blood, if if it's not moving it's sticking together that's that's by that's by design because when you bleed if you didn't have sticky if your blood wasn't sticky you would never not bleed so that's you know we that's how we patch up ourselves i also i did just pull this up too so i want to cite it because I was able to get it. So this is from the Heart Foundation. I was right. It was shortly before the pandemic. August 10th, 2019 is sitting the new smoking.

What are you doing as you read this? Having a cup of coffee, taking a break from work, getting ready for bed. Of course you're sitting down. Most of us have heard the phrase sitting is the new smoking referring to the growing epidemic of sedentary lifestyles in the United States. But is this true? Is sitting in a chair that bad for you? We decided to find out the facts. Over 25% of American adults sit for more than eight hours a day every day.

44% of those people get little to no exercise. And by the way, people, again, this is August 2019. Extrapolate this after a pandemic that sent everyone home and now has people used to things like remote work. The average American watches approximately three hours of television a day most likely sitting down the average american is active less than 20 minutes every day 60 to 75 minutes of moderate activity steady walking can counter the effects of too much sitting so there are ways to fight back against this get the blood flow a 2011 studies this is years ago documented 800 000 people i like that number it's a big number that's the important size,000 people. I like that number. It's a big number.

That's the important size that when we talk about like when that's when you have that many people, you listen to the results. Yes. All right. So 800,000 people of their sitting habits. The study found that people who sit the most compared to people who sit the least have a greater risk of disease and death. 112% increased risk of diabetes. 147% increased risk of cardiovascular events like heart attack and stroke, 90% increased risk of death from cardiovascular events, and 49% increased risk of death from any cause.

You guys can Google this by checking the Heart Foundation and Googling with it is smoking the new sitting and you'll see the article. I'm not going to read the whole thing. But like right away, by the way, Doc, here's a good example. A question I would have is of that study you see these numbers they make a ton of sense how many of those people were already correlated to sitting because for other reasons they're already way out of shape right like someone is already quote-unquote obese and so naturally they sit more right this is inherently the like sort of domino effect that all you know

what i mean everything begets everything else right so it you know i think and that i think that is the problem the most difficult and i'm you know people are watching this on youtube they're looking at me they go how could this guy ever tell me anything about like weight loss or anything because i you know i'm battling my weight my whole life i was 330 pounds of my heaviest holy shit what are you now you're a lot less than i want to tell it's 240 and change so um all right nine pounds down but uh but um you know it's harder to get it's harder to do any of the things that are, like, would give you the anti of this when you're already getting bigger. You know what I mean? Like, you watch a show like My 600-lb Life, you go, how the fuck do you get to that point?

And I want to say, like, Fat Bast bastard from austin power said it best he's like if you're looking to search the web privately and not have all these websites track you when you leave check out my friends over at privato vpn privato is the vpn company that gives you all the privacy without losing any of the speed and that's why i love it so much i can use it on both of my devices my computer and my phone at the same time. And if you have up to 10 different devices, you can use it on all 10 at the same time, full service, because that's the Privado way. So use that link in my description for Privado and you will see my landing page with the company. And there will be a plan there for $4.99 a month.

It is the same one I use. You're going to love it. So check it out and let me know what you think. I eat because I'm fat. I'm fat. And I'm fat it out and let me know what you think i eat because i'm fat i'm fat and i'm fat because i eat you know like you know what i mean like like like you're already is that a line from that i remember the check one i ate because i'm unhappy and i'm not happy and i guess mike myers wrote both of those lines yeah that's true you know um got that but like you know when when you're not moving and you're you know you're sort of you know, when you're not moving and you're, you know, you're sort of, you know, it's inertia, dude.

Like, you know, things don't want to move if they're at rest. And humans are no different. You know what I mean? Like, so if you're already sitting a little and you start to develop a little bit of weight gain and you start to develop a little bit of like muscle loss and a little bit of fatigue and a little bit of that you're going to do more of it by virtue of how you feel and then you're going to be in 112 12 percent increased risk of developing diabetes right so you know sort of movement i think there's two things right now um that i think are the both toughest thing to do that have the greatest benefit that we are have a difficult time doing especially as americans is moving and eating less not eating less eating less often okay eating less often um you know i'm i'm like

big into the the reading about um you, you said longevity is something you mentioned, right? You know, moving around and being physically active is huge. And then like we eat too often, you know? Yeah, I've been an intermittent faster for about four years now. Good for you. And it is, in my opinion, at this point, very natural. I have to watch because of my circumstances at the moment not to go all the way into that and bore people. But I have to watch not eating enough, right?

So, you know, I will get busy working because I went from – for eight straight years, I worked out six to seven days a week. All right. Lifting. And then I did cardio most of those days too. And I was nuts about it. I trained very, very hard cause I enjoyed it. And for a few different reasons, I have not health wise been able to do that. And I've been building this thing by, you know, coincidence there, which is not, that was not planned. That's just how it's worked out but the difference now not working out nearly as much and not being able to yeah you know my body was used to demanding calories all the time you know i even when i was an intermittent faster i needed to pound four or five thousand calories a day because i was you know i was i lifted for an hour a day minimum you know i boxed the whole nine.

Now, not doing that, I'll be sitting here sometimes, by the way, in a studio sitting down. And my sleep schedule is weird. I go to bed at like 5 a.m. I'm up at like 11, 11.30. But like, you know, it'll be 5.30. I'll be like, oh, shit. I have to eat. I forgot to eat. And that, in my opinion, you got to be careful with that because it can fuck you up the other way.

Because then your body like gets used to like, it's almost like you're starving yourself a little bit but for people who have like a good balanced life like i'd like to have again at some point here you know to me i got very because i did this when i didn't have this schedule i got very used to feeling that form of you you're almost operating on like free energy throughout the morning yeah and then when you eat you actually eat in like decent portions and you feel more it's hard to explain you feel more balanced you feel you feel clearer headed your body doesn't just store and let it sit in your stomach as much it starts using it fast so it's all this is all extremely spot on what you feel and it's explained very easily by the biochemistry of, of eating and processing the food. And I, you know, breakfast is a meal that is by definition breaking a fast, right?

The problem is, is that that fast is just not long enough for most people. You know, we are, you know, everybody, I actually always use this point, like, you know we are you know um everybody i actually always use this point like you know when people are like oh you know this is what we did when we were you know cavemen or whatever and i go well we only lived till about 30 something yeah but i think that was had a lot to do with like you know lions tigers and bears oh my plus the ability to not fight off infections and there's a lot of reasons why they're eating what's that what are they eating too right you think they're eating mcdonald's right you know what i mean that's the point the point is is that and they ate and our bodies are set up to when you're out there early man and you come across like a dead yak or some shit you eat the whole like even even if you're full

you're like i gotta i gotta eat i gotta i't know when I'm going to see another one of these. Right. And your brain rewards you with dopamine and insulin spikes. And insulin is a storage hormone. Insulin says, insulin is field mouse, not cricket. If insulin goes, winter's coming, we need to keep this and store it as fat. Like we need to put this in the, use what you need to right now, but everything else needs to get stored. Um, and that's a great system for when food and eating only happens once a day, once every three days, whatever it is that you, you know, you find

yourself the scenario you find yourself in as early human. Now, when food is literally every everywhere i mean you literally go on your phone and and an hour later somebody will drop off at your door and you never have to lock eyes with them will drop off a meal at your door any time of the day and your insulin levels are constantly up and there's when you fast there there are things that happen on a cellular level even like a like a smaller level than that on a molecular level that are longevity based that are energy that are protective of your against cellular damage there's i mean google the shit when you have time like mtor which is the like mTOR, which is the mammalian target of rapamycin. It's a signaling pathway that seems to be important when you're younger and growing, right?

So it's like cell proliferation, like let's make more cells. Let's do, you know, let's build things, you know? Then it gets to a point where you're like, yeah, I got got a lot of i got a lot of stuff in my body i don't need more stuff but if you're eating constantly you're taking in new proteins you're storing fat your insulin levels are always high you're becoming you know the boy who cried wolf excess it's excess all the time when you fast mtor is go uh activity goes down and then you start to do things like recycle your own like old beat up cells right autophagy and program cell death what is the optimal length i don't remember i should know this but you mentioned a few minutes ago that like we break the fast too soon with

breakfast so maybe someone eats dinner at eight o'clock and then they're having breakfast at 6 30 or 7. or let's even say they're having breakfast at 6 30 or seven or let's even say they're having breakfast at 8 a.m that's 12 hours is it like like the regular intermittent fast is 16 8 i've always been like a 17 7 or 18 6 guy but like is it literally like 16 hours where it's optimal so that that extra four hours is your body getting rid of excess i don't think that's a question i i think so i think the optimal one is the one that works best for you because um there are a lot of flavors to this you can once again you can go on youtube there's a lot of people that are sharing their anecdotal stories back to the

anecdote versus scientific evidence thing but there's some people that will like you know do eat whatever they want on a monday and then limit themselves to two to five hundred calories on a tuesday and then do that you know what i mean like they want on a Monday and then limit themselves to two to five hundred calories on a Tuesday and then do that. You know what I mean? Yeah, that was always crazy to me. But hey, you know, like whatever you can tolerate, right? I think the key here is that you want to, you want to sort of, there's a, there's a lot. And in fact, your optimal length of time would be really, really evident to you if you had really like tight blood like if you could draw blood in like like a controlled environment because what you want to do is you want to have

ketones start to show up ketones as many of us have heard like ketogenic diets etc um ketones are the byproduct of the breakdown of fat for energy rather than sugar rather than glucose right can you explain that yeah so um when you eat something right um the only two things that our body can use for energy are glucose which is a sugar or ketones which is a sort of another molecule that like i said is the end product of the breakdown of a fat molecule um glucose is the main thing that we are always using we use it as glucose we store it as another form called glycogen which is basically just a storage form that's like readily available in our muscles and our liver and so on and so forth but when glucose is not around you're in your you know

your body is of the of the idea that hey where is the food right like let me go dip into the stores which is your fat you start to burn down break down fat a little bit for energy and when you start to do that ketones are the end product ketones um in a in a bad situation usually diabetics okay in a situation called diabetic ketoacidosis where they build up really to a hot to like unhealthy levels and they're acidic and the blood the blood the blood becomes acidic and it's really bad or in a starvation state a prolonged starvation state where they build up too that's also bad but you want them to like you want to burn enough fat like use enough fat for energy that they sort of show up because they do some things to your body on a molecular level they change the writing it's

like threading the needle a little very much so very much so and then you want to replenish your stores so that you don't rely solely on ketones so what happens when let's say you're a 16 8 person which is like the standard quote-unquote i think it's faster that's what i aim for when i'm doing it what happens at 16 hours now i eat something let's say i eat something decent i'm not eating right what happens now yeah so now you've introduced you've introduced uh food into the body and your insulin levels are going to spike up. Right. And they're going to say, Hey, food's back. You know what I mean? Let's go back to, let's go back to our normal, uh, regularly scheduled program of using glucose as this energy substrate. Let's put, you know, let's, let's put into the storage system, whatever we have, you know, like, or, you know, whatever is around and the ketones sort of like they're, you know, they're, they go out the urine and you know they sort of things go back to normal you stop using fat as your main substrate energy substrate and you start to and protein do you use that too when you're in a starvation state you go back to using glucose and glycogen for the most part how quickly does this

process happen within five minutes of eating uh well that's that's tough to that's tough for me to say because um i don't really there's there's a phd somewhere that would be able to answer that question immediately but the truth of the matter yeah oh dude i am not the smartest guy in any room i've ever been in um but so there are this guy in here no i don't think so so there there's definitely um there's definitely immediate changes that happen whenever whenever hits your stomach, right? Like there are enzymes that are being released and protein changes and stuff. I mean, if you've ever seen somebody who is having low blood sugar, right?

And then was like getting a little bit woozy and then like took like a sip of apple juice and they pop back like very quickly. So there are very rapid changes that occur and then there's some more long-term changes because remember food boluses have to be broken down food bolus when you eat something you chew it up and then it goes into your stomach now it's like a ball of stuff right you're using big words i'm sorry so it's a ball of stuff and it needs to be broken down and um it you know as it goes through your gi tract it's process it's a ball of stuff and it needs to be broken down. And, you know, as it goes through your GI tract, it's processed, it's broken down into smaller and smaller pieces to the point where now it can go and, you know, interact with the lining of your GI tract, your small intestine and be brought in as small molecules that are able to be transferred from the GI tract, which is technically outside the body. Right. from the the gi tract which is technically outside the body right like mouth to anus is outside the body because it's it's not it's not it's protected by a by a layer of yes yeah once the transition

occurs from there to inside it has to be in really really small pieces it takes a while to get to that small pieces you know so the more complex something is like a that's you know you heard the term complex carbohydrate versus simple sugar simple sugars go right in and they act really fast and they spike insulin like a mother bitch the complex ones they take longer to break down and they go in on kind of slower pace and that's why you want that's why they're that's why they're considered more healthy and that's like comparing apple sugars to chocolate correct yeah or even yeah i mean even apple sugars are pretty simple it's like um comparing because understand that like what celery is made of is technically a sugar like cellulose yeah like it's just it's just you can't you fucking taste horrible like you just can't you can't right but if you ha

it only tastes horrible because you can't break it down to the to the form of sugar that tastes good which is glucose and all you know all the simple sugars that's how they get you you actually cannot digest like fibrous stuff because it's too the chain is too big but when it gets too small that's why you have some uh in your saliva you have some enzyme to break down sugar to make it simple enough so that your tongue will taste it. Got it. Which is wild because we're eating something that's sweet.

And 90% of that shit's not even like hitting the tongue. It's going right into the stomach. It's like, well, what was the point of eating that thing that tasted so good? Because that little bit that we did taste was so awesome. But the rest of it just made us have a dumpy ass. Right. There's also, though, it depends on who you are like anything else, because, you know, like I have good friends who are serious, serious athletes, right? And they're

training all the time. They'll do two a days and stuff like that. And so they got to eat all the time. They intermittent fasting quite literally for their schedule would not be possible, but what do they do in addition to replacing all the nutrients they get in through crazy training some of the people i know also are very very diabolical about every single thing that goes in yeah so there's a reason that like oh this week we're going to do sweet potatoes of some form at 6 a.m right and then we're going to have meal x at 12 p.m or something you know what I mean? Like something like that.

And so you can – the amazing thing about the body when you're talking about being able to break down fat and restore it as muscle and therefore get all the benefits of having a good blood flow and longevity that it turns into and like a good quality of life. The beautiful part about it is that there's a million different ways yes to cut the cake and it has a lot to do with all the all of your habits yes you know if i'm somebody that works a 12-hour job where i'm sitting down what i just said right there first of all i'm not doing two days in that scenario what i just said that's not gonna work no you know but if i'm the guy who's you know maybe i sit down eight hours a day. Right. But, you know, I'm a legit athlete. Right. And I do it two days.

And that's an extreme example. But I do something like that. Yeah. Well, now it works. Yeah. I mean, I think the issue is that trying to take those people. First of all, the people that live that super regimented lifestyle are such a small portion of the population. Very small.

Right. We're trying to extrapolate this to overall population health. Like, how can we get people to live? Because I said to my friend, I was talking to my buddy today, he's an orthodontist and he works like a beast, but he started fasting. He's like, I feel so much better.

I go, yeah. I mean, you know, I know that our, our, our like ancestors didn't live very long, but I bet you they didn't feel like shit all day.

Yeah. Up until the day they died. They were also trying to survive too. You know what I mean? Like they had a thing, you know what I mean? So, but like,

you know what I mean? Like, I don't think they had the, like the aches and pains and the sort of like, you know, just the low energy and the, you know, just to just, you know, they didn't have a case of the Mondays. You know what I mean? know uh i have a lot i have a lot of ideas about how like what translates to like early ancestral our ancestors early on and and things that benefited them that fuck us over now you know what i mean like share i mean you know things like anxiety you know people come to me with anxiety issues right it's like well anxiety was important when you were running away from lions because the physiological response of anxiety would end for in one of two circumstances you either successfully ran away from the lion or you fucking died because the lion ate you

one of those two things ended that norepinephrine cortis you know this massive like send the blood to the brain and the muscles and beat the heart fast and breathe harder and all the things and now it's like how am i going to pay for my kids college and that lion never net you never get away from that lion and that lion never kills you what do they say about exercise that's a really broad question i'll answer i'm sorry there's that could be a million things but like the point i'm trying to make is that they say it's a release yes stress release it resets your hormones i'm speaking out of medical terms here but like that's that is the broad thing it does why does it do that because we are animals we are ancestors to your point i

love this example you just used they were running away from things that could fucking eat them yes you know and so they had to deal with that they had they couldn't be obese right you know they're dead if they do that they had to survive not until we They couldn't be obese, right? They're dead if they do that. They had to survive. Not until we become like – not until civilization starts to like form where there's like roles where people who are protected from being out there in danger can become obese. Everybody else, like if you weren't like in shape – like I think about it all the time. Like I'm the guy that's – like in my group, like my group of friends are out to dinner and I have like weird thoughts in my head. I'm like if the zombie apocalypse came, I'm the guy that's like if in my group like my group of friends out to dinner and i have like weird thoughts in my head i'm like if the zombie apocalypse came i'm i'm the guy they're all gonna outrun me nobody's tripping me but they don't have to you know what i mean like yeah so i'm like i'm you know but yeah no i think it's i think um a lot of things and exercise is a great way it's

funny because they're trying to find study they're trying to study this to the point where like they show real improvement in mood and so on and so forth and they they have a real rough time like really quantifying it and showing it in studies but there's no way that you're going to tell me that somebody who exercises on a regular basis in a healthy way not in an unhealthy way yes yeah um doesn't isn't going to feel better they do they they just do take that but you said it best they take that generational or biological genetic energy it's always been built in and they put it somewhere yeah you know and so when you are like the quote i've said this on the podcast before but people will say the the hardest thing for a man to do is sit alone in in a in a room alone with his thoughts and be okay.

Yes. And the concept is if you're just sitting alone in a room in perpetuity, your mind starts racing. You start thinking all these things. You're going to go crazy. Exactly. So like, dude, even the smallest things, because like I said, I'm sitting down more than I ever have in my life. Like I'll go, I'll eat lunch around someone and they'll be like, dude, like relax. Because I'm taking the plate.

It's not even nervous. I just, I'm very calm when I'm doing it. But I'm like, oh, I don't have to be sitting down in the studio. So I take the plate right here. I walk around. I'll throw the phone on speaker in the island sometimes. I'll just like eat standing up. And they're like, sit down, relax, stay a while.

I'm like, no, no, like you don't understand. Like I'm putting it somewhere right now. Smallest little thing like that. You know, but we get like we talk about the mental health crisis with covid to pull it back there you know i'd love to know what you've seen because what do you what do you expect from people of course you know the economy took a shit for a while people lost their jobs everything changed they're at home they can't go anywhere they can't see people people started sitting down all the time they're not working out there's no

camaraderie like what the fuck do you think they're going to do? Well, I mean, like all things related to depression, anxiety, suicidal ideations, things of that nature, right? Increased use in alcohol off the charts, increased use in drugs, drug-related overdoses, you know, all of those things. And in my – so I do hospital medicine and I also do primary care um and in my primary in my hospital medicine setting like there there was just like this new normal where you know a third of the emergency room was constantly you know uh filled up with people who were there for mental health related issues that were not yeah at any given time if the if the emergency room had 30 patients in it like 10 of them were there either like boarding long term because they couldn't find a place to send this person you know what i mean like that you know or you know was coming in for some sort of like um like i said suicide attempt or you know drug overdose or something that had related to that swath of of things it it was it's it's not

even close it absolutely skyrocketed during this time you know um so yeah that is the, those are part of the un sort of the unseen, like the non-sexy, uh, numbers, you know, CNN used to love to have that death toll up there, man. You know what I mean? Like it was like disaster porn at its finest, but there are a lot of things brewing underneath that weren't just long COVID that were, you know, the fall of relationships. You know, I saw, I don't know, it was a comedian or somebody said, marriages are obviously shown to be, you know, like a 12 or 14 hour a day job, not a 24 hour a day job, you know, like people who had to spend all day in a room with each other and they didn't go to separate jobs. Like that's a rougher, that's rougher, that's a rougher relationship dynamic. So just a lot of things, a lot of fallout. But, you know, but yeah, I think, I think there's a lot of things about, you know, trying to kind of take what we used to do naturally and put that into our lives today, which is, I think, you know, fasting. So there's a guy, the head of genetics and aging at Harvard University, David Sinclair is his name.

David Sinclair. He said he's showing he's talking all the time about the fact that they are able to control the lifespan of their animal models purely based on how often they feed them. Whoa. Caloric restriction has always been the most proven way to extend life. Right. has always been the most proven way to extend life right but now they're able to take animals and say like we'll feed that rat a lot often you know uh every couple of whatevers and we'll feed that rat every whatever and one of them is going to live longer and i'm going to tell you which one and they prove it and they do it all right so here's something i've always wondered about this

actually when you talk about like rats and testing because i recognize that a lot of studies be it straight up science studies or particularly in the context we're talk about like rats and testing, because I recognize that a lot of studies, be it straight up science studies, or particularly in the context we're talking about, like medical studies start with animals. And that's always been the case. But whether it be rats or some sort of other organism that has a different setup in at least some ways than a human body, different lifespan, the whole bit like how how accurate and you don't have to give me an exact percentage but like how accurate is that stuff versus how much of it is just to say like all right let's see if we're in the right direction here yeah that's exactly what we that's exactly what those things are for like you have to you have to try it out in an in a controlled environment to start off like uh

you know in a dish right like in a situation where you just take a you know take something inject it into a cell or whatever you know whatever it is that you do and then from there if that works then you get to graduate to trying it in an animal right that's uh as close to us as possible right um and then but no matter how close you get, you're not going to ever get your real answer until you try it in humans. Right. But yes, it is very much about, are we going in the right direction? Can we, you know, and if it fails in an animal out of any sort, then there's really no point in moving on. Right. Um, so that's the, that's the reason for trying it on. And, and remember on and and remember you know you're

using you're attempting i guess from an ethical i hate it because like i hear i hear about some experiments done on dogs and then and chimpanzees and shit breaks my heart like i i cannot like i yeah i'm not afraid to say by the way you know i'm sorry there's an enormous difference between it's an enormous difference between what they do on a rat and a dog. Like if that, if PETA wants to get on me for that, fuck it. No, I think there's a, I think there's a big, uh, you know, it's funny. I think, um, I think that people don't recognize the, what the difference between pain and suffering is. Pain is like, you know, it's a thing, it's a, it's a signal sent to a central nervous system or in the case of like, you know, invertebrates, not a central nervous system, but it's a signal that says that, you know, that hurts move away from that.

Right. Um, and suffering, which is like the ability to be cognizant of how shitty your situation is. And a lot more animals are intelligent enough to suffer than we understand and those are the animals all animals should be treated as cohabitants co-inhabitants of the planet with some level of respect i understand i am very much believe that we we should eat meat and so on and so forth but but there's a way there's definitely there's definitely there's no way you can look at a fucking pig that spent life in a slaughterhouse and go, that pig didn't fucking know how bad it had it. It did. And it suffered.

And pigs are smart, too. That's what I'm saying. And a dog knows when its situation is bad. you start to have animals that are you know when you can really like really recognize that the animal has the intelligence level to suffer you should stop doing bad things to that animal in the name of like advancing medical science and stuff like that like well well said but on the actual point where you brought this up where you were saying the rats he found that the ones that caloric deficit yeah were your words yeah caloric restriction or longevity they had lower longevity and that's like i said so there's there are the there are increase in some gene products that make that are that uh like you know that are protective to cells against damage there are decrease in some gene products that are like cancer causing and and sort of like uh

would would damage the cell and and it's sort of like the the 30 000 foot view every time you eat right you create energy with the food that you put into your body when you use that when you use food to create energy when you use glucose to create the the end product that we use as energy which is atp it's a molecule called adenosine triphosphate. We take adenosine diphosphate, ADP, and we add a phosphorus to it to make it ATP. And then we run all of our bodily reactions on busting off that phosphorus and sending it back to ADP. So in English, a lot of science shit happens,

and if you don't use all of it it gets stored yeah okay and uh and well actually no I mean so when you make that thing that I said you actually uh that's the reason you breathe oxygen you need oxygen to do that thing and when you use that oxygen that oxygen now becomes oxidative damage you know you ever heard antioxidants blueberries I'll say yeah shit okay yes yes That's what your antioxidants are supposed to mitigate the damage caused by oxygen use for metabolism so in a way the less because I think there's a couple different angles to look at like Burning fat and using energy and stuff but in this lane that we're looking at it

the less Overdrive you can have of the not antioxidant stuff yeah equals yes less damage less damage okay i mean they see it in hybrid eating animals animals that feed up get a layer of fat and then kind of slow their whole metabolism down i mean the fucking turtles live 100 years because they got a slow metabolism slower animals live longer slow metabolism hummingbirds die like that like the less but we also want to have a fast metabolism to be able to burn stuff right well only you only need a fast metabolism if you're if you are trying to lose weight if you never have to get to that point then you kind of want that like that goldilocks metabolism the one that uses what it needs and doesn't store too much but

stores enough interesting you know so if you change like let's talk about like intermittent fasting for one sec bring it back in if you change your habits over a long form to intermittent fasting that also technically slows down your metabolism then in that scenario no that so that that whole like thought process between like eating many small meals will increase your metabolism is sort of debunked you know what i mean like you just switch energy substrates it's like at the end of the day it's always going to be you're always going to be making the thing you need to to make energy but what do you use do you use sugar that's available like or do you use the fat that you've stored and when you use the fat that you store you turn out you do less damage so why does michael phelps for example because this is one of the more ridiculous examples i ever heard when he was at his peak and training he was known to eat

i don't remember the number but it was a ridiculous it was five digits of calories every day and he would his diet was set up such that a lot of it would be like hardcore like bake cd you know pizza like shit that's not supposed to be good for you that was just very high in carbohydrates of some form that he could eat in high masses such that the ridiculous training he did it would get used my thought there though was if you're eating so much shit that's like in that case processed and changes to sugar in your body which is right along the vein of what you just said you shouldn't do yeah like why did that work so well and give

him such high energy well that dude is oh i mean it's not like they gave him the energy he required it i mean he was like i mean what he swimming is the most uh is the most taxing one of the most taxing movements that we do yeah it's your whole body i mean like so like he was routinely like you have stored sugar in your muscles that's that that's the quickest form of like i need energy can give me something called glycogen he was constantly like depleting his glycogen and refilling it back up with that you know plate of big z right like so i mean i don't know if he's the appropriate uh approach to take from a like once again this guy's a genetic freak right like you know what i mean like his body fat his body fat percent you know what i mean like what he's doing is insane and yeah there's there's tons to be said about like

we could go down a huge you know uh you know one day we're gonna bring a whiteboard like like i i hate the fact that i have a couple of friends we'll go to like you know when we were kids we go to mcdonald's and they would eat like three times as much as me and i would smell what they ate and i gained five pounds and they would just never they would never put an ounce of body fat on and there's a lot of things metabolically happening different in their bodies than mine yes it's not just a lot of it has to do with like we overeat and self-control etc but like the it's funny that process that i told you about creating energy turns out the more efficient it is right the fatter you probably will get people who have

an inefficient energy creation process a lot of the food that they use will sort of like be just that's really genetic they won't go yeah it's genetic it won't go down it won't go down it won't go down the like it won't end up where it needs to be and it'll be like just kind of like fall off as heat or you know i mean like so you know it's a really complex process but the truth is is like um there are a lot of bio biochemical and molecular processes that dictate how you use what you put in your body. And the best way to give yourself the best chance of being healthy, feeling well, and living long is to eat good foods and eat it less often. It's kind of the ribbon. I'm not a guy – like I just don't really spend on stuff.

I've just never – I don't know. I've also never really had money. So I haven't had the ability to, but I really don't buy much. But one thing that when I do have money, I'm looking forward to spending on just as like a passion project and also like for your health is I want to be one of those guys who spends a lot of money investing in my body okay right i'm not talking like plastic surgery like that although i could probably look a little better for sure but you know like looking at it good we'll be talking but in all seriousness like looking at the health stuff i love seeing some of the athletes including like genetic specimens yes like and i'm less familiar with michael phelps so i won't use that example for this but like lebron james okay lebron james i mean he's the greatest specimen i've ever i've

ever seen easily what i love about lebron james though too is his work ethic is insane yeah the guy has been spending like over seven figures dating back like a decade ago on his body every year so he's already built like like a greek god i think better i think a better example of what you're saying is tom brady who's not that's built like a genetic specimen who is who has taken a very like you know nfl quarterbacky body but has turned it into the ability to play to be one of the top best five quarterbacks in the nfl in his fouries based purely off of being a really good quarterback but also like how he's what he's done to treat his body a certain way Tom Brady's the other example from the other end that I would absolutely go to okay the reason I was leading with LeBron is because he like you ever seen

Tom Brady run a 40 all right so it's a it's a joke worst thing I've ever seen in my life you know no disrespect to the goat but I'm just saying, LeBron James, he's God. And yet he still, still invests like that because it makes a difference. That's why he's 19 years into an NBA career, averaging almost 30 points a game. It's unbelievable. Right. I say this to people all the time. You don't think that there have been, I don't know, just purely on numbers.

I mean, we're talking about 8 billion people on the planet, right? That's an insane amount of people. You don't think that there have been at least 100 people who were significantly better than Michael Jordan at basketball who never either picked up a basketball or if they did, they didn't come anywhere near how hard he worked. You're talking naturally. Yeah. This is, this is, this is where like the, like nature and nurture coming together to make a better product. Right. Yes. I mean, there are dudes who have been cut out of marble, you know what I mean? Who look like LeBron, but would never be as successful as LeBron because of that extra, that's where the nurture has now taken over and

it's you know it's funny because your podcast when i you know when i listen to it it always seems to be like attempting to find the answer that is in the middle of the two extremes of anything yes pull politics or whatever glad you got that this is exactly the same when we're talking about like human performance or just or to extrapolate it to the everyday guy or girl how do you fucking feel right and how sick are you or not it is always a combination of nature and nurture right you know they go look for these clusters of people that are you know around the world where they're like oh there's like a ton of people there that lived over 100 like what are they doing how much sun are they getting how much what is their diet it's like okay that's cool but like on the grand scale that doesn't work for people who are like you know to use lebron james in

cleveland ohio right they're like their their surroundings are a little bit beat up and you know they're eating a lot of fast how can we make those people feel better and then it's like now you have nurture has to take over a little bit more you have to do a little bit more more to invest in your health and what in your body etc but yeah i mean i think it's the lebron james is the is a great is probably the prime example of nature and nurture coming together like you took this guy who was already going to had he not done a single thing he's going to be a top 50 player of all time i agree and then he excelled he he puts in the extra effort to be to go down in history as probably, if not the best basketball player of all time,

certainly the most absolutely insane athlete to watch. And statistically decorated. I mean, it's just, and it's such a cool thing. And to go back to your Brady example as well, looking at it from the end of someone who had no business being there. Right. Now. More nurture than nature.

What I will say is for all the lack of athleticism and, like, being ripped and stuff that Tom Brady doesn't have, he did. You can watch tape of him in high school. I almost wonder how teams missed it. He did have a very natural ability to throw a football. Oh, yeah. And he trained it. He played at Michigan. You know what I mean? I mean, that ball was always pretty.

You know what I mean? So there's still an element of that. But think about it. The guy playing the NFL, taking hits. He was playing at the top of his game, leaving. It's the greatest thing ever. He could come back in three years and be a guy that almost anybody would trade their quarterback for in three years. Maybe.

Because of the way, you know, like, he's the kind of guy that like you know i i tell my patients all the time like you know especially my guys that are like like big like you know they like working out in the gym and doing a lot of lifting you know but you know they look great and it's like you know they're ready for the jersey sure but like you know but their cholesterol's shitty and their blood pressure's like dude you love to wash the car but you hate to change the oil you know what i mean like what do you know what is going on here so tom brady cares about what's going on with his body to the point and so does lebron james and that's what makes them yeah you know and and and how you can take that and apply it to your like how you are as a like you know your avoidance of chronic illness

and sort of how you feel on a day-to-day basis and be the best anything that you want to be. And it's not going to be a basketball player for most of us, but most of us is going to be just like being a living, breathing person is to fucking invest a little bit in the nurture side. Your genetics are what you got. Yep. But there's definitely a lot of things you can do to treat your body in a certain way that it'll respond. That's like, with my practice, I have a very, because I have a different kind of practice, so I have a smaller group of people and my goal is for none of them to develop diabetes. And I'm really, really passionate about trying to make sure that I have a cohort of people that I can get to never develop diabetes. And I'm probably going to have a few, but I'm going to try my damnedest in a multifaceted

approach to prevent that from happening. And I'm going to use some of these tools like moving around a lot more than you already do or intermittent fasting or paying attention to what are you putting in your body, all the things, you know intermittent fasting or you know paying attention to what are you putting your body all the things you know what i mean like in addition to medications obviously but um but yeah lebron james and tom brady are very very good examples of what you can do to take everything to the next level when you just when you do what modern science is like hey these fucking things work i'm looking forward to the day where we can get up in the morning and walk into the mirror in our own self-contained network hopefully and and be able to have a quick process of your iron levels are low they're at x percentage right now like all

these different things to be able to say here's a way to remedy it optimize your day with so you know i have one patient who i just saw uh the other day who had seen had visited this like longevity center where they did a head-to-toe like they cat scans of everything mris of everything uh blood work and you know uh all of the all the testing to feed to spit out and i think that's becoming like a little bit of a thing you see this with like these forward you know these like new these new like health care microsystems that are attempting to like use a ton of data um i think there's going to be some cool ways you know to because the truth be told is i can measure if you're in the hospital setting i can i can take

your blood four times a day and tell you you know minute to minute you know so we can already do something like that yeah but um right now we're in a position where um there's a lot of information that's going to be given to a patient that is clinically irrelevant but anxiety driving so like the full body scans one day when imaging gets cheaper and safer and quicker getting a full body full body mri might be a good thing as long as everybody's really really hip to the fact that like there are all kinds of things growing inside your body right now that probably don't belong there if you think that you belong looking like da vinci's man picture right that are not cancer and it's okay that they're there they're not supposed to be there but they're so they're not going to kill you how cool would it

be though if a scan like that mirror example you walk in and it said oh by the way we just read you have like what's a small number of cancer cells that's like normal uh i don't want to say normal you're all you all every minute of every day you're growing a cancer cell in your body and it's your body's telling it like commit suicide you don't belong here okay so let me use it it's starting to hit to it's a critical point like it's getting to the point where this may turn into a tumor let's let's give it an arbitrary who cares you make the number because I don't want to sound like I know what I'm talking about. Yeah, let me make an arbitrary number for like the blockheads out there like me. Let's say it says, oh, there's 10 cancer cells right there in the area of your pancreas.

Right. No big deal. But by the way, just have a fiber pill today. Right. And somehow it'll go. That doesn't make any sense. But you know what I mean? Yeah.

Like that will be so cool because people will get to see in real time. It's like you talk about full body MRIs. I remember in, I think I was in in i was young when i asked this question i might have been like late middle school or early high school i don't know anything about the health care system we talked about that but like i used to have some thoughts i think someone got sick who i knew okay and i was thinking about like mitigation right it was cancer and i like, why doesn't everyone just get a full-body MRI? I would do it three times a year. And then my teacher was explaining to me, they're like, well, that costs like, I don't know, $2,000 a pop.

Insurance pays for it. So it's a money thing. Oh, yeah. And I'm like, damn, what if we could have that over time? Money and convenience comes together in a way that convenience goes up and money lowers the technology improves where it's not as expensive right and I and I think that's a so it's interesting you say that it's a money thing because when you the definition of a screening test right like so screening

right is something that is the guidelines for what to screen for brought down by a group called the United States Preventative Task Force, and they spent a lot of time deciding what things we should screen for and who should get screened and how we should do that. And a screening test has to meet certain parameters in order to be recommended. It should be something that can be done easily, right? And if you find something, can you do something about it, right? And it also should be safe. And lastly, it should be cost-effective, right? So that is one of the key things.

So they just expanded the criteria for lung cancer screening. And it's like, well, why doesn't everybody get screened for lung cancer? It's a low-dose CAT scan of the chest. Like, why not? Well, it's like, like well they spent a long time figuring out like who are the people more likely to develop lung cancer and if we catch it early what can we do we now do something and now that we are able to do something about early caught lung cancer and we know the types of people that are more likely to get it we screen those people but we don't screen everybody because a it would cost a lot of money it's everybody because a it would cost a lot of

money it's exposure radiation and lastly there are a lot of things that are going to show up on the cat scan that you don't have anything to do about but it's going to make people nervous and again that's a full test it's reading papers and stuff like that you think about the world 25 30 years whatever it is out where it's like no no it's just like a quick that's what i can't yes we are going to get to think about colonoscopy colonoscopy is the gold standard to to screen for colon cancer right now and for diagnosis of cancer but here comes coligard and this like fecal immunohistochemical immunohistochemical coligard coligard it's just basically like you know taking a stool sample and based on the dn you know some of the cells that come off the colon and checking this you

know to see are they what's the what's the shit test i did that yeah so now so now we're starting to sort of like see as a screening alternative to somebody who doesn't want to undergo a colonoscopy you can get the the test the the which is less invasive and it's exactly what you're saying now it's like cheaper and more convenient and now it's you know we're merging those things now the problem with that is is like if it comes back any sort of like way you got to get a colonoscopy anyway because it's still the most important test but it's it you're seeing that change that you're predicting right where you're seeing that that sort of like coming up with a cheaper quicker safer way to get more information that it can be acted upon

earlier right like we we probably don't screen for pancreatic cancer because when it happens it grows really fast yeah and it's devastating and that's the most deadly one of the most deadly ones and not because not because pancreatic cancer is like uh like you know because it's like decided to be angry it's just because it grows it like it's quiet and it grows quickly and you don't realize until one day you're yellow as a banana and you can't understand why and you go get the cat scan and though there it is you know so it's crazy it is very crazy just having a normal life going about your day and then like one day oh this this thing's been growing for 90 days and that's and that's the

inherent issue there is like how much how much information do you want to know because if you can't do anything about it all you did was add a period of time in your life where you lived under like a death sentence you know so like right now they there was a recent law passed where patients have access to all their charts and documents and notes and all the other stuff in real time which should a doc should a patient be have free access to their medical records yes it's their data however that wasn't the case it is the case but it's like should they get the study results before they talk to me like they're laying in their they're laying in their hospital bed and they get their cat scan report i'm dead and it says something like cannot rule out

malignant neoplasm yeah and i walk into the room and they're in tears i go what's wrong they're like i have cancer i'm like no you have a small bowel obstruction like you don't you know what i mean like you don't like but you know what i mean like you know it you're not qualified to interpret that to anything other than it's the same thing as like if you google your your symptoms, you're going to come up with something that's going to kill you. They basically did that and said, here, go run wild with it. So yeah, the healthcare system is. I see where this is going, doc. And I want to come back to it because I want to like close out the conversation on that. I want to close out though before I just use that twice. I was fucked up, but I wanted to come back to the thing that we were kind of like getting

through and went on some really good tangents with it just to like get it all done. But when we were talking about the tide turning where information started to come out, you had mentioned there was a big study, I think in the new England or whatever. And then we started talking about respirators and then we came back one other time,

talked about something else. How did I notice things were changing? Yes. And then, if you don't mind, and if we get there, great. If we don't, great. You also had brought up in there in a tangent about the mental health trade off in the epidemic. So there's there's two things on the bone here that I think are important now that we're two years out of COVID over two years to be able to see where we're at. And that is when you thought the tide could have changed and therefore changed in society sooner than it did possibly don't want to put words in your mouth okay and also when you started to see the other things whether it be like drug overdoses and stuff like that we're mounting to

a point where it's like well what what's the least evil here so early on this is i mean this is a very interesting like sort of like uh trip down memory lane for me because uh early on um you saw a very swift and impactful change in the things that were coming into the hospital it it got to a point very quickly that the only patients that were coming into the hospital were patients that were covid 19 patients okay and it was both because people were on lockdown and people with illnesses and even people without chronic illnesses who normally come to the emergency room were scared shitless of going the hospital was like this is the ground you didn't want to go there i will never forget this doc i i lived close to one up in North Jersey one of the main ones

about a block and a half away and I went for a walk maybe like four days into quarantine and it was a fucking military base and I'm like if I'm somebody coming up if I had a broken arm right now I might be like fuck it I'll come back tomorrow it was scary

you want to talk about like a change it's like well we we had so where i did residency um we had a separate building um that was connected by a skybridge that was basically for neurosurgery urologic surgery neurology like the neuro icu strokes and that kind of thing um your nose like very specialized surgical subspecialty orthopedics and because there were no um you know no voluntary surgery non-emergent surgeries happening and we needed to play we kicked i mean we i wasn't making a decision but the you know the the the pulmonary critical care

department like kicked everybody out of there and said no no, no, that's our, our place now. And built that into like the fortress of COVID. And when you went over there, it was like, I mean, there's people in hazmat suits and there's, you know what I mean? Like there, you know, and then I go to my, I go to the hospital I worked at after residency, which like, you know, same thing, you know, we're talking like the cafeteria was turned into a COVID ward. You know what I mean? Like, and it's like, this is where I used to get pizza. It's funny. Cause I took my first job at a residency is where a hospital I rotated at a medical school. And I'm like, I'm true. I'm like seeing a patient with COVID-19. I'm like, this is where I used to stand to get pizza, like in, like in medical school. And here I am like seeing this guy, you know,

and you know, it was like, you know, just this very eerie feeling in that, you know and you know it was like you know just this very eerie feeling in that you know that everything was quarantined even inside the hospital right like these like extra precautions the ppe everywhere was a paper bag with like somebody's n95 and face shield and all this other shit and they like it ran out so they had to like put your name on it so you know what i mean like there were like entire lockers where you would go in change your clothes and put on scrubs and then drop a you know stories of dudes who were like going home and like they had a pregnant wife so they were sleeping in the garage and they would only communicate through the through the garage door and it's like this is fucking wild you know so you had that

early on and again you and i were up by ground zero yeah i mean well so in right so beginning i was in philadelphia and then i go back to north then i go to north jersey and it's all right and and it was funny because there was a sort of like there was these like like maybe oasis is oasis oasis whatever the plural i always make up plural words too like oasi i always go with it octopus is actually is the plural of octopus i looked that shit up the other day but anyway oasis oasis of relief in cases going down during like summer or whatever you know i mean like when there was there's a lot of things there's like transmission outside wasn't transmissions whatever that's too much to talk about now but the point is is there were some sort of relief but you didn't see any of the other

chronic things that you normally saw right then take that and they're still happening they're real oh no and this is and and that's a spoiler alert because like not only are they happening but like the outpatient world is also not seeing anybody either there were people staying at home like they're having a heart attack oh it'll pass yeah yeah so then then when the sort of here was what i thought I, I thought when I was the busiest, when COVID comes, when Delta comes around and the people who were not, you know, coming for their like, you know, every three month hospital stay to get fluid removed or their kidneys or whatever. We're also like, I can't not come anymore. I can't, I'm, I'm fucked up. You know what I mean?

Yeah. I'm fucked up. You know what I mean? So now here is this like convergence of like COVID patients coming back and rocket style numbers, plus the chronically ill who we used to just be keeping together with like, you know, duct tape and bubble gum as it was. And here they are. They haven't been seeing a doctor in a year. This guy hasn't had insulin in like three months. Oh, that long. Yeah.

You know what I mean? Like, because the outpatient world was beat up. Like, telemedicine is great and i think telemedicine is is very much the future of the outpatient world but golly it was really really wild to see this like now like this double it we used to be like okay covid sucks and this place looks like a war zone but at least this is one like you know your your brain was like in one mode where it's like this is what you do for covid patients you know what i mean like and and once we started to have some like guidelines what to do with steroids and what kind of treatments blah blah it was sort of like okay and when did

that because that was the crux of the question it sounded the way you were going earlier maybe like may yeah i think that's a great i think that's a great mitigation at least yeah i think that we um we could probably look up that like when the the study was published at some point where like dexamethasone and and uh the steroid was like hey in fact um temple university's rheumatology department developed a predictor of bad outcomes based on like a bunch of inflammatory markers which early on we were ordering blood tests like through the roof but it's like at some point it's like okay this is a kind of a cool thing but like it doesn't fucking matter we're just you know we're getting all these like crazy pieces of information at the end of the day it's like can they breathe and or they cannot they can they not

breathe are they developing blood clots are they not developing you know all of this stuff really boiled down to like cooling off the inflammation and keeping their lungs protected while they try to heal themselves and that was about may and so then because when you look at viruses and before the pandemic i never looked at any of this shit but like some of the basics that i learned is that i might have learned on the podcast too from somebody smarter than me but you need as a virus the ability if you're thinking like the virus to survive so when you start as as a virus and you go into someone's body and you start then you go into a bunch of people's bodies and you're killing them you're killing the host so this is why generally speaking over time all

viruses as they add on to hosts get through the herd or whatever they lessen they're in danger because they realize oh shit we're killing everything we need to just we need to suck a little less blood right we need to be a little less of a leech and so you see the quote-unquote curve go down which is why you end up with something like omicron what was weird to me though is that the death percentage curve for a long time remained at least somewhat consistent until you got to omicron however we did see after maybe like that may period and whatever we did see fewer serious like ground zero scenarios like new york you know and i think a lot of that must have to do with at least earlier mitigation tactics that doctors learned on the fly i think you have three things i think three reasons why you didn't see a repeat of the new york situation right and that is as you very very

very eloquently put it put it together like you cannot like viruses do not typically present both deadly and contagious you know because you can only be so deadly if you also want to be contagious right like and that is why these like really really crazy pandemics of infectious disease like the spanish flu or the black death etc happen only once every one you know a couple hundred years you know or so because you know uh infectious organisms would prefer to make copies of themselves and that requires them to be able to get more hosts what viruses do and i'm going to get to the other two things um that i think uh prevented that sort of what viruses do is um the exact opposite of what we do we make every time we make a genetic mistake when we're trying to copy a cell, we have a proofreader that goes up and down the DNA and goes, no, no, no, that's not the one.

Take that out. Replace it with the right one. That's okay. And that happens all the time. And when we don't do that, we have mutations. Some of them are effective and they stay and other ones are not and they're and etc viruses are constantly mutating with no proofreading ability and they are willing to sacrifice generations of themselves to hit the right mutation by accident on purpose that gets them to stick around right so they're constantly fucking up but like but just completely rolling

the rolling dice all day every day all day every day rolling the dice and then they hit and it's like okay we got a we got a new thing that keeps us going so that's you know that's the mutagenesis of a virus and because it became more continued like we saw the we saw the omicron just like spreading like wildfire but like really not that many people were dying it took long enough i mean jesus christ it took two years there were so many fresh hosts where the the you know the virus could be like i can kill you and pass on i'll be all right you know what i mean so and i think the other thing is obviously the um in like the treatments prevented some deaths certainly right that steroids the

remdesivir certainly helped um you know people use that what was it called hydra hydroxychloroquine yeah also similar thing um in the dish it was interesting it changed the ph of the of the environment so the viral replication machinery broke down in people it didn't work all you had was a bunch of people with lupus who couldn't get their fucking medication because it was being stockpiled in some you know somebody who knew a hospital ceo or some shit yeah exactly yeah um but there were two other things there was three you said oh and yeah and the third thing was our behavior we i mean we did you know even if people hated it or didn't listen or whatever like we did do a lot of things like we should be proud of ourselves in some way that like for at least a period of time most of us did some a lot of things that helped this thing not be a lot worse and it's spread almost i i very hesitate i'm very hesitant to

use this word because i don't want it taken out of context but it's spread in a more controlled manner that way so that as you got it quote unquote across the herd so that the virus could get new hosts and then start to figure out how it needs to survive. You didn't see it happening where everyone walks into Grand Central Station. No one knows anything's going on. Everyone walks out of there with COVID. That's the thing. Right.

Like, so, right. So, in fact, if you got COVID, when I got COVID, I know I did a thing that I shouldn't have did. Like, I went to, you know, it's funny because like I was double vaccinated at the time, but it was the vaccine was probably now that we know that the vaccine sort of like loses its efficacy after a certain period of time. I was probably waning in my immunity. And I was I went to see I went to hang out with a couple of friends in the city. And, you know, they one of them is an infectious disease doctor. One of them is a pulmonologist. And I'm a hospital hospital doctor.

And, you know, the three of us were in a room and we're like all you know and and we're like in really tight like my friend's got there's a fellow in the city and she has a super tight apartment it's like i don't know who gave who what what but we you know what i mean like we're we're in there just like breathing each other's you know yeah funk air you know and um and that type of thing happened less often later on so those situations where everybody walked in a grand social station one person went in sick and then the rest everybody came out sick happened a lot less which i think was that's what was happening i mean dude we i mean like you know it got to the point where we in the hospital system you know we didn't see a fucking common

cold we would see rhinovirus adenovirus and teravirus um influenza pop up i think i like i would normally see personally see i don't know hundreds of those viruses come in and you test them in people who have really bad lung disease because like it doesn't matter if a 21 year old gets it but if a 75 year old who's you know three pack a day smoker gets rhinovirus that could be that could be curtailed so we test for it that's masking and social distancing like like like i'll tell you this right now i do not advocate for living this way yes but we will we would not have common cold flu season type situations on a yearly basis that we had if we if we behave this way yeah i'm more of what's the trade-off that's the point i exactly i'm like you know what let's just get better at treating these exactly how about we get better at preventing

people from having those really bad uh chronic lung diseases and heart diseases etc so that they can tolerate tackling the flu at 60 something years old like how about we encourage people to be healthy that's my point yeah because the like run do something the elephant in the room is the vast majority of the people that died and please whoever's listening to this do not take this as that this is okay that this happened because i'm the guy that believes that everybody who died from covid even if they were really really really already sick and maybe they would have died in that calendar year anyway i still go to work and my entire career is based on keeping them alive long enough to catch season three of ozark i don't know how long it's going

to be whatever it is whatever it is my job is to not let them die unless it's really their time and they're ready and everything is you know um then they can be at peace but like other words i i'm not cool with a certain amount of deaths because they had you know kidney failure or whatever it's not just numbers on the page that's the thing you know what i mean like and so you know so my point is is that like but everybody that died was fat or old or had lung disease man and i'll even hedge for you i'll say a a significant number of people were a lot of people were you know and you look at the data i don't have the numbers in front of me but you are supported and yeah it's like i wouldn't say it if i wasn't because i am overweight myself

and you know and i have and that's the thing this is funny because the comorbidities argument is hilarious uh you will watch somebody on tv being interviewed by some gotcha TikTok guy who's trying to catch somebody saying something to incriminate themselves. And you will see like a 250-pound dude with a cigarette hanging out of his mouth going, oh, the people that died are the ones with comorbidities. I was like, brother, I don't even know you, but you are a walking comorbidity. You know? You know? So it's like people think comorbidities means that like that person was going to die within the next half hour anyway. No.

No. If you got five pounds of extra weight, you got a comorbidity. If you have asthma, you got a comorbidity. I have severe asthma. I have a comorbidity. If you drink alcohol more than two times a day, any day of the week, you have a comorbidity. Yeah. And I think, you you know i got it

and who knows if i had it early on i don't know i'll tell you i was all around new york yeah pretty hard to say i didn't get it but when i actually got it and showed symptoms wasn't until november 2021 and like i'm october 2021 again i'm a dude in my twenties in good shape. Right. So even though I was a severe asthmatic, you know, comorbidities wise, I had a lot of other things going for me. So you're working in your favor. Right. And I got a bad case, you know, where I was sick as a dog, but like I survived the people who have like two of them, you know, they're a severe asthmatic and they're a little overweight or something like that. That's where it starts to get. It seems to me, correct me if I'm wrong. That's where it started to get like, oh, now it's dicey.

Oh, yeah. I mean, dude, 30-year-old guy. I remember a 30-year-old guy at the hospital. Like 380, 400 pounds. Yeah. He never had a chance, brother. Yeah. Never had a chance.

Respirator? He didn't even make it to that point. We had him on the BiPAP, which is the non-evasive positive pressure uh mask um we were going to intubate him difficult airway because of his neck size and the hole in the yards he went into full-on cardiac arrest because it was his hypoxemia was so profound he he you know he never and then performing cpr on a 400 pound man is like you know you might as well no you got to drop flying elbows off the top rope you got to be randy savage you know macho man to get that done it's not so yeah i know this much is clear then this much is clear you know like it was it is certainly in our best interest to take a very very long look at the way

we how we behave on an individual basis our personal responsibility to our health and to the health of our population but the health care system you know and what it and what it values right and the health illiteracy of americans you know um i i just remember and i'm you know so before i became a doctor i was a gym teacher right like i and you know teaching health classes i mean i spent entire curriculums on like you know getting kids to not use steroids and and you know teaching them health classes. I mean, I spent entire curriculums on like, you know, getting kids to not use steroids and, and,

you know, teaching them how many bones are in the body and shit like that. And like, you know, but at the end of the day, like they walk out of high school, they have no idea that the next time that, you know, for 20,

they're not going to go see a doctor for most of them for like for 20 years until that day, they have chest pain that's crushing and right in the middle of their chest. It's the first time they're going to go into the hospital system and then from there they develop congestive heart failure and their kidneys fail and now they're they're now they're chronically ill and they have to navigate this system right and never did they ever like once like be taught or told or like how this is so avoidable in the most for the most part part. All right. Well, you, I think we've, I think you've made your journey with it and how this developed and what your viewpoint was on it

very clear in this episode, which I really appreciate because now again, you know, we're two years out and people are looking at this because things seem to be getting back to normal, which is great. Knock on wood here. And like, now they're like like they're going to start that 20 30 year assessment i'm like all right what what was right what was wrong all that and that's how many books written about this absolutely years documentaries the whole night but like the the final point of the trade-off which you've hinted at now yeah you've even in that last answer right there you hinted at it it's it's a personal topic for a lot of people i i remember like back when i was first doing like marketing videos and doing short form videos the first one

i ever had that blew up on tiktok was a video where i used an example of self-driving cars okay and i said if the government in a hypothetical scenario if the government – in a hypothetical scenario, if the government decided tomorrow that 50% of cars on the road were going to be self-driving cars and 50% were going to be normal-driven cars, and just for the sake of numbers, total arbitrary numbers, 100 people died in actual driving cars accidents but one person died in a self-driving car accident what's the news story news story is person dies in self-driving car accident yes and i was using it as an inflated example of bringing it back to at what point do we say we are not treating all problems in health up to and including death equally with what we're legitimately seeing from covid and this is why i think a lot of people like suddenly went off the deep end and were like oh it's not real and all this shit yes you know they're not new york or they're not in a place where it's as much of a focus and they they convince themselves of this shit right because

they see some of the stuff that you already hinted at they see things like people are dying of drugs yeah people are home and they're dying of chronic diseases and stuff that they're not getting treated. We're seeing that even beyond just death and seeing like quality of life, we're seeing that people are falling off the deep end. They have nowhere to put their anxiety. They're miserable. They lost their job. They're losing their purpose. Morale is at an all-time low.

And it started to get to a point like you mentioned the whole CNN death counter and everything. It was so morbid that you're looking at this. I i said that november 2020 in a podcast here an earlier podcast and i'm like you're looking around wondering where the light at the end of the tunnel is and at what point do we have the conversation and the conversation doesn't need to be oh fuck covid shit it's all over it doesn't need to be that it needs to be we got a problem yeah we can't make it go away but we don't want to make it worse right and so you it sounds like you saw pretty early on a lot of people you mentioned some of the numbers a third of the room hospital of the emergency room was filled with mental health no i that actually that actually um i think is more of a more recent

thing right where it's like where it, mental illness is interesting. Like obviously people who have severe, um, underlying men, uh, mood disorders and stuff like that will, will manifest, typically manifest early enough. And then it will be a problem they have to deal with, right? Like bipolar depression, et cetera. But, um, people who have developed, you know, generalized anxiety disorder, panic disorder, major depressive episodes, um, you know, generalized anxiety disorder, panic disorder, major depressive episodes, um, you know, uh, you know, or, or had a, maybe like a baby, baby obsessive compulsive

personality disorder thing that kind of all of these things grew wings and just absolutely peacocked themselves out where they were like, all right, I used to have a thing where I would get nervous and like tunnels or whatever. Now I having full-blown panic attacks all the time you know um or you know like you said my life is so shitty that i'm like you know i i started taking drugs or i started drink all of these things happened they they sort of brewed right like while you know during the pandemic and we weren't here we didn't know we weren't paying like we weren't paying attention this new story was the single person dying in the dry in the self-driving car right but here we are and covet in this case right and here we are where it's like

okay and and i and i said a couple of my friends go this is supposed to be the prime of our lives and none of us can make a single head nobody can move forward right now but time is passing and it's depressing as shit and it's making everything super difficult and you know there's nothing but a constant stream of negative negative stuff being pumped into your brain and you're watching your job disappear or, you know, you're scraping, clawing to keep your house, whatever. And then look at the situation we're in now. Everything's skyrocketing. Inflation was also brewing. We're paying attention to it now because COVID's the third news story, if it ever is even anymore.

But, like, now the inflation story was what happened the last two years. But all this shit was happening and like you're just going like how the fuck am i gonna like what am i gonna do it pissed me off seeing the people look around and going but but one life and everything i'm like yes but you're also ignoring that like you have ruined other people's lives too like there has to be a point i'm not one of these people like when you look at extreme libertarians and stuff that doesn't work you can't have a single person society dispersed like that's just you have to have some level of tribe you have to have participating in this absolutely you have a do you have a listen you have a duty and a responsibility to participate in a society that you also benefit from yes you know you would hope that your neighbor

would call the police if your car is being robbed yes and you're gonna do that for them someone's gotta show up you know what i mean yeah come on you know so but but you know i do understand that like you know um i'm saying there's got to be the there's some level of personal responsibility at some point yeah if you look at look at look you know i'm i you know i'm i get upset sometimes when i see you know some health care people who are still advocating for like oh my god they're lifting mask mandates it's like dude if you're not well doesn't if this thing could still get you and it could get anybody don't don't pretend like it's completely over it's still a thing a little bit but if you've if you do what you need to do to try to stay healthy okay you got vaccinated you wash your

you do all the things you can't keep you shouldn't be kept locked in your room because somebody else is like potential like you know uh autoimmune you know what you know what i mean like doc someone statistically got hit by a bus in the last day and died does that mean buses stop no that's my point and you know it's literally i've said this all the time do you understand that we're sitting in a room right now where there's a statistical chance that a fucking asteroid could destroy both of us within the next 30 seconds it's ridiculously small yeah and completely and totally improbable but not impossible well we also convince people that like kids could drop by fly like flies and shit like that even though the data showed like

that's not happening right right you know it's funny because in the hot so in the hospital system here's an interesting uh you know head-butting situation in the hospital system um a patient especially an elderly patient falling on the floor is an absolute and total like can never happen event the college of geriatric medicine would tell you we would rather we accept the fact that falls are going to happen because in the the the ways to mitigate falls in elderly patients are more harmful than they are good strapping people down in bed giving them like restrain them chemically and all these other things that we do to these elderly patients to prevent them from falling down is very harmful but the hospital systems are you know they're like well

we can't get sued for that shit so we're not gonna let anybody fall down you just hit it we're not gonna let anybody we don't give a fuck what we got to do to make it not happen but our goal is zero falls and this the group who's the experts go no no falls are bad but what's worse is that you have everybody pinned down in four-point restraints just because they're, you know, just because they don't know where they are right now. And that begets more delirium, et cetera. So, you know, here is the conflicting viewpoints where it's like, no, COVID is bad, but we cannot, we will never achieve a zero bad outcome policy in anything we do. Yes. a zero bad outcome thank you policy in anything we do yes because that is bubble life and even living in bubble life you will still have freak shit that kills people all the time yep you are

pointing out i'm not going to rehash because i've done it on a lot of podcasts now but the litigious society problem i have a lot of friends who are lawyers who are great lawyers too i think they're incredibly necessary an important thing i think we probably have too many though statistically right now because people should on any other field because i people listen i'm just saying it like this we have a lawyer's job and this is correct by the way this is what they should this is why they're incredibly necessary yeah a lot of their job is risk assessment yes right yes critical yes when you it's like anything else though when you put way too much of that at Yeah, a lot of their job is a risk assessment. Yes, right. Yes critical Yes, when you it's like anything else though when you put way too much of that at the forefront

You can convince yourself not to walk out of your front door. Correct, you know And and so I talk about this with lawyers all the time because i'm like, you know How do we rebalance things because we've gotten to a point where it's hard you want to You're so busy covering your own ass that you expose your asshole great i'm gonna i'm gonna trademark i think you should i think you should trademark that i'm i i was here i heard it so for whatever lawyer you hire to help you trademark that i am ready to go my dad there you go there you go um yeah i mean so yes the you know cya medicine or cover your ass medicine right is uh got doctors over testing prescribing shit that

doesn't you know that that doesn't work and you know there's a lot of there's a ton of bad things um from looking at it from like you know that that have are as a result of people suing for every bad thing that's ever happened to them you know and look i think there should be absolute and total accountability in health and health care man like i'm telling you right now like if if you are driving a school bus of kids and you show up drunk like you gotta you gotta pay the piper oh god i mean like you gotta pay the piper like yes if you're a doctor and you fuck up and it's negligent and it wasn't like, you know, and it wasn't something that was, you know, people make mistakes, right?

Like you could also be wrong. Like if you, you know, if, but if you had a really good, you know, if you saw the thing, if you had all of the information you needed and you developed a plan and you're like, this is why I think it's this and it's all well and good. And it turns out you were wrong. And it's sort of, that's not something you should be sued for you were you you were doing what you you know you were doing your best job but you you know intention yeah i think intention is a huge part of it right like you know if you just didn't give a shit and something bad happened then you belong you belong in front of

the judge um i'm glad you just put it like this too this is keep going yeah i mean you know i think you know but like but you know but i think um i think that the fear that's pumped into your brain early on when you go into this field of like oh man i better not i better not do that or else i'll get you know i'll get sued or something like that it's a really really bad you know it's a really bad um path to go down because and then and you see it do you see a doctor who's been sued one time? They fucking changed their whole approach, man. That's the scary part to me, man, because then it takes away people's desire for gain and moves towards their desire for loss prevention. Yes, great.

And that is where you don't get innovation i would love to see i bet you there's a study done but i would love to see a study done that showed the testing practices ordering blood tests ordering imaging etc of a doctor who had been previously sued versus one who has never been sued i would almost wow i would almost bet i would bet a lot of money on the fact that the doctor who's been sued before um tests every potential thing every time on their on a patient that so that so that they don't they don't miss like right now i've you know i've never even you know knock on wood i've never had that that situation happen to me um but i you know i i certainly my approach to medicine is that i i use my history and interview exam and my

physical exam and what information i have thus far to make a couple of things it could be and what i think it's most likely to be i test for the thing i think it's most likely to be and any other thing that i love i can't miss that thing too right like i need to make sure it's not that thing because that thing is deadly like soon. Sure. And everything else can be tested if I'm wrong about that stuff, right? Because I want to do this with common sense. I don't want to order a bunch of tests that don't belong. Why am I testing for this thing?

I don't think. Could it be? Sure. But it's most likely not. I'll get to that when everything else has not been the case. Doctors who are playing CYA medicine, they're running all the tests day one head to which i under by the way oh i get it bro i get it like if i were in that situation especially if i were a good person and i knew that like situation x that happened was true no fault it would yeah shit happens right yeah you I'm going to spend the rest of my life making damn sure that there's never a possibility.

Yeah. You know? Yeah. But we're getting right to it. So let's just – let's hop right in this whole business of medicine. Yeah. Because the point you're making about the test right there and, I mean, that comes back to a monetary thing too. It's bad.

It costs, right? So I probably – I pay attention to this a lot more now and you and I were talking a little bit before the podcast about this. But I remember my first time being exposed where I noticed it. I was in college to how a lot of doctors were looking at medicine now in like not a great way. And a girl I was dating her parents are frankly two like the best doctors in the world incredible doctors and generational like like literally their parents were doctors well one of them was and and the whole bit and their kids were all interested in health and potentially becoming doctors or something like that and they were quietly not like hardcore but they were saying

you should think twice yeah about doing this it's not the same you the focus is not on the patient as much anymore the business of hospitals and medical systems in general is insane like i don't know about that and so i remember being like damn like they're telling their kids not to do this and then i would hear this more and more over the years from doctors talking to their kids who were maybe thinking about it. And they're like, I don't know about that. And to me, doctors are literally like the most important thing we have because they're health protectors. And so I don't know much about it, but in the little bit we talked, you think about this a lot, not just from your seat, but a bunch of seats as to how the business works and what's wrong with it so like for people listening what would you diagnose as the biggest issues right now

okay um so i can preface this i can preface my this my thoughts by saying that like i would like to turn a buck in this world i would like to be well compensated i'm not going to lie to anybody and say that i don't want to make as much money as i can um you know uh without being without being without doing anything unethical or inappropriate you know what i mean i'd like to maximize what i can you know my financially hurting patients yeah i'd love to be able to be financially feel good about you know my my finances uh in the back and you know just a little background i owe like like close to half a million dollars in student loans to the government right so like that you know so there's that right um necessity yeah so i understand that um that you know it's important to recognize that there's a lot of money in health care right

but i i'll ask you a question um of all health care spending what percentage do you think goes to physicians random guess go ahead yeah random guess go random guess 15 15 okay that's a pretty good guess it's eight of all the health care dollars spent in the united states where's the eight percent goes to physicians where's the 92 going um uh biotechnology for uh and drugs and and uh hospitals and stuff like that like basically um if you there's a there's a point insurance companies no no so the insurance companies what they like so this is what they pay out yes yes they yes they are easily the most evil part of the whole scenario however no however um you know there are other bad actors here too and what we're starting to see is that as a result of

doctors for a long time doing well and sort of like paying no no attention to who was steering the ship they were like you know okay we're we're you know i'm a doctor and i'm doing well and you know medical school is expensive it wasn't that expensive and i you know i'm financially really well and you know everything's good and like and then there was there was business people brewing going a lot of money in health care how do we get a piece of that right so you see this line there's a plot you could even probably pull us like there there is a graph um in the increase in in Physicians versus the increase in Administra healthcare administrators over time one line stays flat

and one pay no no the amount of people doing the job like uh increase in physicians versus increase in administrators i'm wondering if you could probably find that graph increase in administrators over time graph yeah this is gonna be rich see if you can bring that up all right let's see here yeah i'm gonna go to images real quick yeah if you can bring that up. All right. Let's see here. Yeah. I'm going to go to images real quick. Yeah. There you go. Is that the first one? Any of them work.

Okay. Healthcare administrators far outpace physicians in growth. Let me just click it. See if we can get it bigger so you can see it. The rise and rise of the healthcare. And this is, by the way, it's interesting you're saying this. I think healthcare is the most important place to say this. This is something you can say about a lot of fields. Oh, yeah.

You know, academia comes to mind. Oh, yeah. For sure. Oh, yeah. But go ahead. It's right there. But like the people on the purple line. I'm going to put this in the corner of the screen for people watching, by the way.

The people on the purple line are not people who can diagnose, treat, or deliver treatment or care to patients. Can you do me a favor just for people listening and not watching? Can you just describe this chart and what it's showing? So this chart starts in 1975 and it shows the amount of percent increase of physicians, which is very flat from 75 to 2010 there have not been that many more doctors being added to the pool despite how every year we hear there's a doctor shortage right is that on the y-axis uh i can't tell the numbers are small uh yes so um the the um we have we so we we have years uh on the x-axis and we have percent increase on the y-axis right okay so and oh shit i just saw it that i see what you're saying now look at the doctor's one the doctor's one has

not gone anywhere it's flatline yeah it looks like a heart attack we're doing like when as many doctors retire as that we've added because that's kept that way because they have not increased the amount of residency training positions on annually like you we increase the amount of residency training positions annually. We increase the amount of medical schools creating new doctors, but we do not create more training positions for them to be able to be clinically licensed to practice medicine. So people are going through medical school and they're becoming a doctor? Correct. They're becoming a doctor.

No, they have the title. They have MD at the end of their name, but they are not licensed physicians because they do not train. And that is another part of the secret dirty side of it. Do you have any idea what that percentage is? It's easily findable because, like I said, Congress and Medicare control the amount of residency positions because it is funded by the government. Residency positions are funded by the government. They increase them by a small amount every year, but nowhere near as much as you would as the amount of medical students. So the amount of unmatched.

So what you would be Googling right now is how many unmatched doctors are there? Because matched means I got a residency spot after medical school. How many unmatched doctors are there? Let's see if you can recognize this chart i'm just going to go off it for one sec in 2021 slightly more than 38 000 positions were offered in the national residency matching program and rmp the most in program's history a little over 35 000 were for first-year residents so if you like that first question how many doctors do you match five percent of all allopathic medical school residents.

So that's just allopathic. That's MD schools in the United States of America. 5% of people who graduate with MD do not get a training position that will allow them to practice medicine, to get licensed to practice medicine. And that number is increasing. That's what I'm saying. Think about that. 5% a year. It's more than that because they have not added DO schools. They have not added the Caribbean medical schools.

They have not added foreign medical grads. Let's keep it conservative. Sure, sure. And let's say 5% a year, though, even, and throw them a bone. That compounded over, what was this other chart? Right, 5% every year. I'll put it back in the corner. Right.

So you see how this is flattish since 1975. It's because this purple line yes that you were talking about which is the admin adding is adding 100 50 right and then the law of compounding numbers yes it's you know what this looks like this looks just like the wealth gap chart oh almost down to the year absolutely absolutely 10 years earlier and and um inversely proportional to the addition of administrators is the autonomy of the physician. You know what's funny? The Steven Pinker's famous wealth gap chart, I believe, and I'm remembering this off the top of my head.

I think his data in the book Enlightenment now started at 1988, right? And I'm looking at this chart. Uncle Ronnie. Look at what. Paging Uncle Ronnie. Who's Uncle Ronnie? Ronald Reagan. Oh, God. I mean, he created a lot of situations in the 80s before bush one took over yeah but look at look at this chart what happens in 1990 that shit opens up like a v yeah wow yeah

so and and and more importantly so so you're seeing so as the person who's participating in the health care system from the i'm paying my premiums patient perspective, more of your dollars are going to pay for the purple line, right? And for me, also physician wages are stagnant as well. But we do fit into the category that like I don't want – nobody's going to feel bad for me because i you know i do better than the average person right and i don't i don't nobody should feel bad for for people you know who who make more than you know you know but what's more important to me is that like these are people that have to that tell me what to do who are not licensed to practice medicine and that's a problem like i'll give you an example. A patient will come in with urinary tract infections that happen often.

And after a certain amount of time, the urinary tract infection grows the same bacteria, but that bacteria, you know, becomes resistant to certain antibiotics. So you have to go with a bigger gun. So I will order that bigger gun and I will get a message from the hospital pharmacist or administrator say, please ask an infectious disease doctor to order that antibiotic. I go, why? They go, because in this hospital you're required to have an infectious disease consult in order to order an antibiotic. I go, I'm board certified internal medicine. I'm very much aware of how to use carbapenems. The hospital's policy is that you, like I have to ask permission to order certain medications, you know? And that's a very, very small sliver. No, I understand exactly the theme. You know, so for me, you know, spending my life as a knucklehead who always was, like, against authority, I go, what job could I do that I could, like, learn cool shit,, help people and study my tail off for 10 years. And then when I'm done, like the only person I have to answer to is my patient. I'll be a doctor. And I could not be further from the truth there.

Like everybody in the health care system, including the insurance companies that tell you which medication they will. It's not what medication will work best. It's which one they will pay for right what's the business there is there all because i don't know much about that is there a lot of they'll pay for let's say drugs x and y do the same thing and they have the same efficacy but one company company a makes drug x and company b makes drug y is it because there's some deal that the insurance company has with company a makes drug x and company b makes drug y is it because there's some deal that the insurance company has with company a that they're going to choose x and not y most likely there's there's there's that's on multiple levels they'll have like on their formulary they'll say hey we're you know they negotiate everything is pre-negotiated right

everything is pre-negotiated um generics you know uh versus uh brand names even if even if and you said equal efficacy it's not the case. Sometimes the drug, the other drug has better efficacy. Oftentimes the one I want to write for has better efficacy with my patient. But they have to try the other one first and fail that before they'll pay for this one. Right. And here's the other thing. The whole prior authorization situation is basically like I have to ask permission for the insurance company to pay for the drug there are the tests that i want them to

get but really all that is is like let's see how long we can keep this prick on the phone before we'll hang up and give up so we won't have to pay for this oh god right and then there's the float ready for the float what's the float the float is um i submit a claim to insurance as a physician to get paid and they will pay me a year from now and in that year they took that money from the patient's premium okay and all the patients premiums and they held on to it and they put it in an account that bore interest and then they will pay me later after they collect it on an interest that's the float that's why they delay payments reimbursements take forever

and they are declined and denied and redid it and code it wrong and all this other stuff and it's all designed to keep the money in their pocket as long as possible before they pay you out so that they can take seven to twelve percent this is this is the way to make money outside of the collection of premiums because those have to be, you know, so you got a hospital system that's being this is the thing. The hospital systems. And so now individual doctors could not compete. So then they banded together and hospitals, they developed big groups. But now that is morphed into an uglier thing, an uglier monster, which is corporate medicine.

What do you mean big groups? Meaning like if I'm if i'm joe dr san bataro and i hang my shingle and i and i call the insurance companies i say i want to you know get you know x amount of dollars for an office visit and they go yeah we don't pay that much we'll give you this and i go okay well i don't want to take you there no problem who do you have like a thousand people three thousand people cool but if i get together with like a hundred other doctors in the area to join a big multi-specialty group now we go oh we cover north jersey you know so we have a bar we have actual negotiation power but now corporations are involved and private equity and that kind of thing are now buying you know buying uh you know these these places are consolidating and now

they're big humongous systems and all i am now is a medical license with a heartbeat who's there to bill and they don't give a what happens to the patient dude you said something 20 minutes ago or something like that whatever it was where you were saying that and i appreciated it a lot it's the best thing someone could say that in listening to this podcast you see that i like to find the middle ground in most situations. And I truly believe that. The answer is always in the middle. Exactly. Somewhere.

I think physics and historical evidence will back me on that over time, that the answer does not exist right and it does not exist left or vice versa. This is another one of those situations. I often say to people, and this is overly dumbing it down, but I have never heard a good solution to healthcare because I hear Democrats and Republicans provide me solutions where I'm not going to say that this is what they propose. If you start with the Democrat side, they say, we don't want people dying in the streets, we want everyone covered. I go, beautiful, love that. They say to do that, let's, and they don't all say this, but some of them are like, let's do socialized medicine, like country X, Y, and Z in Europe.

And I go, well, you have to have a free market capitalism competition because you want people to competitively want to join the industry and go through all these years of schooling Right like you did you talked about like your value and money and you're trapped. You're a little bit You were hesitant a little bit going over that as a lot of people in your shoes are you shouldn't be you're a doctor You spent all you have five hundred thousand dollars of debt that you're paying off

You spent all these years to be the best of the best to treat people and save lives you deserve to be compensated so that scenario hurts that because it takes away competition yes on the other end you have people who they're human beings they don't want people dying in the streets and everything but they say free market society let businesses figure it out and it leads to a lot of these same problems by the way and so you end up having people who are left behind who have shitty plans or no plans at all and so i look at both of in this case the two political parties and i say go fuck yourself like what are you doing so how do you get people to a point where like you know you're talking about these people who aren't doctors who are telling you what to do and i say yes at the level they're doing it fucked up but at the same time you're a doctor your friends are doctors most of you want

to be doing doctor stuff your passion is helping people you're a good doctor Your friends are doctors. Most of you want to be doing doctor stuff. Your passion is helping people. You're a good doctor. So you don't, you'd rather not make your career being the CEO of a hospital. Correct. And you have people who actually understand and want to understand and operate in that, as I would put it, that 50 mile an hour zone where you kind of get the benefits of both ways without going. So the answer to the health insurance system and then the answer to the hospital system is I think that you can have somebody be the administrator who's not a doctor. But the rules of how the system works for the healthcare system not the insurance but the healthcare system has to be written by doctors and nurses like i don't care who i don't care who like who oversees the day-to-day but the the the the rules and protocols of the system of the healthcare system whether it be a individual practice or a large hospital system needs to be written by people who have clinical experience that's it and then you want you want you want some ceo to come

in and like make sure you know things are done opt whatever okay but um patient care you know the patient care should be you know like uh should be the everything that governs what we do in a hospital should be create it should be those rules and those protocols to be written by clinicians nurses doctors uh you know a physical everybody who's in their you know people who deliver the care yeah it's very fair the health insurance system um i i think it's i think at one point in time it was rescuable, and I don't think it is anymore. I think it's absolutely, totally, because I was always of the opinion, like, we live in the richest country in the known history of the world. Everybody should be covered, but I also think there should be the ability to add on additional care if you can, if you're, like, doing well.

You know what I mean? Like, I think we should take care of everybody, but I also think that there should be some like ability to like, you know, maybe, you know, buy some additional insurance, co-insurance that would like, you know, help you maybe have a little bit wider birth to get, you know, certainly not an additional access to care. Cause I think that's unethical, but something that would allow, you know, I don't know, maybe less, less hoops would allow you know i don't know maybe less less hoops to jump through i don't know but i think the answer was some some convergence of we have to

take care of everybody because at the end of the day we are taking care of everybody people don't realize this like if you don't think that we already have a socialized health care system that private capitalism that capitalism preys upon you're wrong because at the end of the day people are still going to go to the emergency room and the m tolla rule which is that you cannot turn anybody away from emergency care is going to make the hospital and the hospital is then going to turn to the government for subsidy when they treat a certain amount of patients who don't have no coverage it comes to when i say that though i want to be clear just so i'm not i don't sound like a total idiot because on this i i don't know a ton of things.

So there's some things I'm going to be an idiot about. But when I say like, oh, dying in the streets and whatever, yes, treat at the emergency room. Which is the worst place to get your care. Right. Most expensive. What about afterwards? That's right. So someone goes to the emergency room.

They have cancer. They're not covered. They're fucked. They get to die because of their money. They get sicker and then they come back into the hospital to cost the system more money and the outcomes are worse right um yeah so it used to be that there had to be some marriage of like everybody needs to get taken care of um you know so that we're you know um access to care but i don't know anymore dude because it's gotten to the point you know what i mean like it's gotten you say it's unsavable yeah because because now we're

at a situation where like premiums are at an all-time high and deduct like there are so many loopholes added like your deductible is now not being met by everything everything that comes out of your pocket should meet should count towards your deductible but it's not like there's like a million things that you would pay for that's not going to count towards your deductible and then even when you meet your deductible and you have co-insurance like no matter what you're doing you're coming out of pocket to pay your premium and then you're getting left over with a huge bill and they make it complicated on purpose too yeah because they don't want that it's a deterrent it's a deterrent to use it right like i mean i think i don't i don't know i don't know what the answer is anymore but um you know but uh

well actually i don't take insurance myself i i mean in the hospital i built you know in the hospital i am i work in this i work in a hospital you know part-time but i have a private practice um yeah tell people let's let's close on this i love this tell people what you've done there because by the way there's you're you're marrying new school and old school and also working in other business models yeah to this like a subscription model trying yeah i think it's a beautiful thing and by the way this guy can you take your phones out real quick yeah sure i want the camera to see this this guy walked in i used to have a bat phone too that's a whole separate story this guy actually needs a bat phone because

he's got he's got a client phone yeah patients right there because this doctor does house calls and he does he does the the what's it called the the telehealth as well you you're doing everything new school and old school so tell people what's been going on i feel like ari gold um cell phones um honey it's vince yes i gotta answer on a wednesday at 12 o'clock if you want to live in i don't care if it's passover right exactly um so in essence um the way that i do things differently is that um you know and i don't know if this works for everything but i know for primary care perspective from a primary care perspective right because this is your primary care part of the business yeah the average primary care doctor or you know group or whatever in order to keep the

lights on has to have a massive amount of patients and they need entire departments of people that are only there to bill you know electronic health records coding all this other stuff to get their money right um i i think there's enormous barriers to tooth in two ways a the volume of patients that you must see on a day-to-day basis Provides you no ability to spend any time with any patient or get to know any patient on any level that would allow you to be integrally Integrally involved in their uh preventative Care not just when they're sick, but like let's not get them sick, right? so

If I eliminate that right if i eliminate the insurance part of it and say hey i'm gonna i'm gonna ask you to give me a certain amount of money every month and you are going to have unlimited access to me and my facility my uh and i'm going to deliver the care in the most convenient way for you and not limit the amount of time we spend together not limit how often we communicate and but the only thing i do limit is how many patients that i will take in my practice so that i can make sure that i can because i've always said really hard to get to know 3 000 people not really hard to get to know 200 250 people you know like you could get to know and and getting to know patients um and sort of like you could get to know and and getting to know patients um and

sort of like you know knowing you know and having a better you know sort of like outpatient outreach like hey man you're due for colonoscopy what's up what's the deal like oh doc you know that just having these relationships where they feel comfortable divulging things to me and sort of like you know making sure that i'm we are up to date on up to speed on all the things they're doing and you know they feel comfortable like telling me like you know hey this medication doesn't work all of these things and the ability to say hey i'm not feeling well can we talk and i will right now call the doctor's office maybe you can see him three weeks her him whoever yeah um i'll talk to you today if i need to see you in person let's do it

tomorrow that was one of the reasons my doctor dr chris who's like my guy i'm good friends with him it was one of the reasons i really loved him early on and was like oh this guy's this guy's amazing i was always lucky because i had family by where i lived like my uncle greg's a phenomenal doctor so i was spoiled i can call him up whenever right then i moved way out of town didn't have that anymore i gotta find somebody everyone always has a horror story about doctors but like dr chris do early on i would like test it and i'd call because i'm a little bit of a hypochondriac i'd call and i'd be for hypochondria is more frequent visits to the doctor that's the treatment for hyper exactly exactly so i'm one of those guys

let me tell you you're okay expense more often so i would do that and i call him up and he would make time yeah he would invent time i'm like oh that's rare and i'd say that i'd ask friends about their doctor like i don't fucking even know my guy right like no one does that and yours does that by default yes because you're doing it all yourself on this end of things as well and like what would you say you do like you're reachable at all times you keep a tighter book you said like 250 people to be able to know them but you also you have like a subscription model to be able to make it worth your right so that's the thing so like i said in order to have instead of having like three to five thousand people that i bill insurance per visit like you subscribe you you become a member of my practice

right and what do you pay um it's so it's a stratified it's a stratified uh amount based on age so if you're uh up to 45 years old you pay 150 a month if you're between 45 and 55 you pay 200 a month and if you're 55 and older you pay 250 bucks a month if there's some if there's a if there's financial hardship there's always room to negotiate and talk and sort of, you know what I mean? The point is that this is called direct primary care or concierge medicine. It's not necessarily interchangeable, but I don't charge your insurance anything, and you never will pay any additional fee to me for your membership. You know what I mean?

And the truth be told is you pay more for your cell phone right now, typically your health, then, and have me, you know, um, available to you within a day or that day, you know what I mean? To take care of, you know what I mean? To take care of something. So, um, the people that I have, uh, are people that are invested in their, you know, in their health. They like the fact that, that, that I I'm available to them when I am, you know what I mean? Um, not everything is, it requires an hour. sometimes most of the time 90 of the stuff can be handled with a quick tech message like hey doc i'm out my metformin all right yeah okay you're due for that yeah all right um also by the way um you know we're going to check your sugar in three weeks oh okay yeah i got you and boom it's handled wow there's no six there's no half a day off of work

to sit in the doctor's office for six hours while people cough on you. You know what I mean? Like, you know, hey, doc, I'm having palpitations. Okay, tomorrow, 1 o'clock, what are you doing? I'll be home. All right, I'll be by with my EKG machine, and we'll see if there's any rhythm issues there. What I like about this is you found your own solution. And now, as you explained to me, more people are doing it. This is not like it's still rare, but it's not extremely rare.

Like, there are people who are doing it this is not like yes like it's still rare but it's not extremely rare like there are people who are doing it and along the way not just solution for you also a solution for your patients also more personal the most personal solution there is and mixing the two worlds new school and old school i love it because we're getting we're getting we're getting uh sort of the relationship that people used to have with their doctor and i think the the biggest reason why the respect and trust for patients between patients and their physicians is broken down is because the patient is now greatly removed from access to their physician and i mean like you're just a chart yeah in the in the normal system and that's not the doctor's fault you know like for the most part that's not the doctor's fault it's like it's that's right

it's the purple line's fault yeah screw you purple line doc this was uh we're we just did like about three hours right there and this was high octane a ton of information we didn't even talk like a ton about hormones today which i know you're really good at i had a great time but i had a great time too man i think this was um incredibly transparent for people too and i i if if i can give that a platform from the medical community especially now just given all the infighting that society has yeah it's a beautiful thing and it's one thing that we haven't done a ton of in here yet so i really really appreciate you coming in thank you very much uh for you know um i've never done anything like this this was uh you're gonna do one again

hi i uh i you know i think this was like um you know normally i'm telling this type of stuff to my friends and it's like you know it's a very much of a peel back of the onion and you know like kind of exposing like you know the what's going on with the wizard of oz back there like who's the man behind the curtain and and the system is big and it's overwhelming it's scary and you get shuffled through it and um both patients and doctors have to realize that there are other ways to do this but um nobody nobody ever tells you so unless you like you know it's like playing like like a like zelda one where it's like you didn't you didn't bomb every wall when you were a kid like you'd never know where the triforce was like, you didn't, you didn't bomb every wall when you were a kid. Like you'd never know where the Triforce was. Like you have to get lucky, you know what I mean? Like to figure this shit out.

So, um, you know, there, there is other ways to get, to get a high quality care delivered to patients, have a better lifestyle, like work, work, life balance for physicians and make the overall relationship more effective and safe and, and productive. Well, thank you for sharing it today. Some of it, I know we'll talk about it again in the future, but once again, I really appreciate it. And, and you did a great job. Thank you so much. All right. Everybody else, you know what it is. Give it a thought. Get back to me.