Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Medical Reversals

Episode Date: July 12, 2019

You're well acquainted with all of humanity's history of medical mistakes, but even modern medicine changes it's mind from time to time. This week on Sawbones, Dr. Sydnee and Justin explain what a medical reversal looks like! Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. All right, time is about to books.

One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We were stomped through the broken glass and had ourselves a look around. Some medicines, some medicines that escal skeleton my cop for the mouth. Oh. Hello, everybody, and welcome to Saw Bones, a marital tour of misguided medicine. I'm your co-host, Justin McElroy. And I'm Cindy McElroy.

Very clean. That's felt like a very clean intro from me. I don't want to take a moment to enter up the flow of it to talk about how smooth that was. Good. Well, now you've, have you ruined it or? No, I've highlighted it. It's important to highlight your successes in me.

Is it, like your own? Highlight your own? Don't let anybody steal your sparkle. That's what I say. Well, sure. So what's your sparkle, they said? What's, what shine are you bringing? This feels like the opposite.

This feels like the like a dullness. T then, or is it shade? Is it shade? No, it sounds like shade. I want to do a dress. I know on saw bones, we usually talk about history, ancient stuff, plenty of the elder, et cetera, et cetera. No hole bit.

But there was a news article caught my eye, a title of a news article caught my eye. a title of a news article caught my eye. I found several news articles that were titled similarly. I thought this would be worth addressing on our show because it kind of speaks to the nature of science and medical science is not excluded from this, that things change over time. We learn new things and our ideas and our understanding changes. And if you're not careful with how you talk about that, you might say something like

almost 400 medical practices found ineffective. Scientists declare nearly 400 medical practices ineffective. Hundreds of current medical practices may be ineffective. Or I actually liked, I thought this was the least scary, 10 findings that contradict medical wisdom doctors take note. So you're saying that this is all fake news? No. No. You are.

No. The media, the anti-medicine media. No, no, you are. No. The media, the anti medicine media. No, I refuse to, I refuse to use that term. And I also refuse to ever say sad with a period at the end, as if that is it, as if I have expressed a thought. But I do, I do think that while these are accurate in terms of what, what they're saying, they're accurate statements, they sound very alarming because you have to imagine there are only so many medical procedures and practices and if 400 of them have been found ineffective, the question I think for the average reader would be, has my doctor done one to me?

Here's the thing folks, you shouldn't, there are certain reporters at every outlet, I'm probably not as many as there used to be. Some people have expertise, but certainly speaking, reporters don't know anything about the top, it's like you can't know everything about everything, so they're just trying to go with the most accessible angle. That's why Sydney tends to rely on like reporting from like journals, medical journals. Exactly. Because the study that they're referencing, which, I mean, this is, they're not, again,

I'm not saying they're wrong. This is accurate. This is factually accurate. There was a recent study that was published on an open access journal called E-Life, and it goes through details 396, so I guess you could say it's not 400, I guess that's not technically, it's almost 400, 396 medical reversals that have occurred

in the last 15 years, and they just, they went through three of the top rated, like most red medical journals. The Journal of the American Medical Association or JAMA is what we tend to call it, JAMA. Yeah. The New England Journal of Medicine, which we don't call Nijm.

Cause that Nijm. That doesn't make sense. That's nothing. That's nothing. And the Lancet. and they looked through the last 15 years they went through about 3,000 randomized control trials and looked for any sort of

commonly practiced accepted like Wisdom dictates. This is what we do medical practice from today that had been reversed through study and It's important. I think for us to talk a little bit about, I want to give you some examples of some things they found, and what this really means and what they were really indicating, as opposed to the idea that all, like your doctor may have no idea what they're doing, which I think is what you may clean from that. So first of all, medical reversals are always going to happen because we get better at things.

We learn new things. Our technology gets better, our science gets better. That's the nature of science. You could say that our entire show is about medical reversals, honestly. Right. We get better at things and we understand things better. I mean, we know that, well, it's interesting. Like, people always like to talk about bloodletting or leeches as something like we used to put leeches on people.

And we did. And then we realized that for most things that doesn't work. And then we realized that for some things that actually could work. So there's a big ol' medical flip flop, right? That's science. It's flip flopping sad But basically a medical reversal is a if you find a low-value medical practice

and And that we have found that through further study and randomized control trials No, wait, what do you mean by low value? Low value meaning that it is not giving the benefit that you would expect of a standard of care. Okay. So that doesn't mean that it doesn't help anyone, right? It's helpish. It's helpish.

It means that it's probably, once you do the study and the math, I mean, because this isn't about one individual person. We're talking about once you do the, once you do the study in the math and I mean, because this isn't about one individual person We're talking about once you do it to or give it to a lot of people It's probably not really better than some other Previous standard of care or or something else that you might do right? So it's not actually a better treatment or procedure That's what we're talking about. It can be difficult to figure out that.

I mean, that seems like an obvious thing, right? Like how did you not know that it wasn't working or that it wasn't as effective as you wanted? Well, the problem is early on, when we test new procedures or medicines, one, we can only test them in so many people, right? You mean, you have to do clinical trials, you have to try things before you start deploying them,

widespread. So that's part of it is that you don't know until you release something out to everyone, how effective or ineffective, ultimately, it might be. Two, if you're talking about something that we have no previous treatment for or procedure for, and then you find a way to do something or treat something, it's going to be adopted a lot faster, you know, because not all of these are like drugs. Some of these are just ways of like protocols and things. And if you've got nothing else else and this is the first thing,

okay, well, okay, let's try this because we had nothing previously. And then over time you realize, like, well, this might not actually be as effective as one would hope and we're probably going to have to find a better way. So this is just part of the process. This doesn't necessarily mean that doctors don't know what they're doing. Part of the reason that it's hard to find these things sometimes is that you have to do an intensive review of a practice, like a double blinded or a randomized control trial, something has to be done that takes money to study it.

And a lot of that has to be done by an independent organization from whoever made the device or the pill or whatever we're talking about, right? Because they already paid all their money and did all their trials. So to do these reviews, it usually takes government organizations, some sort of grant funded study, something like that. The other thing is, each review, like if talk about cochlearne reviews, cochlearne reviews

are done to look at how high quality is a medical practice. And you can usually trust if there's been a cochlearne review of a procedure or a medicine or something that says it works, it works. If cochlearne review says it doesn't, it doesn't. So you can trust these reviews because they're very intensive. But they're very focused. Each cochlear review just looks at one, one simple thing. It would take a long time to do that for everything we do in all of medicine. So we don't have those for everything, right? They just couldn't exist. So the other thing is how do we get this information, right? Like once something has been proven to be not as effective, how do

doctors find out about it? Well, I asked me the list of this episode. That's recursive logic, Sydney. I mean, it can be hard. It can be hard to find out. Everything moves so quickly. Stuff that I learned in medical school has already been proven false and then proven true again and then proven false again since I graduated, which is getting longer and longer ago, but it's still not that long ago. So things move quickly and you can read the journals and you can try to keep up, but you can't read every journal, certainly. You can try to stick to the ones in your specialty and maybe some of the more general ones,

but you can't keep up with everything. A lot of, I know my fellow physicians will go to something called up-to-date, which is up-to-date information that we have access to. Good name for it. Yeah, you got to pay a lot to get access to it. I prefer that old junk. That's a different one I use where it's just all outdated, whack, medicine that I can get for cheap.

And my patients are crazy about it, because the value. Is that defined that it works for you and your patients in your practice? I mean, either. What do you do? Either they keep coming back or they don't. That's kind of my philosophy. Either way, either I make a bunch of money,

I get to go home early and play Halo. More of a caveat, and tour kind of. Sure. Listen, I don't, I don't speak Spanish that it, I'm sorry. And I know that makes my practice more narrow. I would love to be a welcome more, more patients, but I'm just building a practice right now.

So before I get more into why, what are the barriers to all doctors knowing these things as soon as they are proven? As soon as the study is done and we, as soon as, before I get into that, I wanna talk about some of the examples so that you kinda see what a medical reversal really means. Yes, put them on blasts.

Sydney. It's not like, well, it turns out that that surgery I just did on you was totally wrong and I accidentally made you sicker. It's not like that. I mean, it sounds, it can sound very dramatic, but it's often a lot less exciting than you would probably want it to be. Certainly I would think as a, I imagine reporters had a rough time finding things as they look through this list of 396 practices that would be very exciting to write about, would

be my thought. Right. So when they broke it down, they found that the most common thing that there was a change in was something to do with cardiovascular disease. And this makes sense because we're still understanding as scientists, as doctors, all of the roots of cardiovascular disease. And you know that intuitively if you think about how often we change dietary recommendations, right?

Right. Sure. Yeah. I mean, we lived in a no fat world for a while. And then we realized, well, that's not really the problem. Carbs are the problem. Sugar is the problem. And now we're moving towards plant-based diets are probably the key.

That seems to be the... That's where the evidence seems to point. So it's really hard. I mean, things have changed. And we've gone down weird avenues where we thought like everybody should drink wine for a while and that olive oil was the key to success. So if you think about how often we change dietary recommendations

in terms of heart health, then it makes sense to you that we've changed our concept of cardiovascular disease a lot over time. We just don't have a lot to learn as to the whole process, how it happens and why some people are higher risk than others. A lot of things with public health and preventive medicine change. And again, that just has to do with, you've got to see what's best for a whole population.

And you can't know what's best for a whole population until you try something in a whole population. Right. Right. It's hard to figure that out in a lab. You really need it to be in vivo. And then they also found that the most common thing to be reversed was like a medication.

If we're talking about a type as opposed to a procedure or a supplement or a device or a whole system, the most common thing that we found over time was that a medicine wasn't as effective as we had hoped it would be, or as somebody had hoped it would be. I guess the pharmaceutical company that made it. Put them on blasts, dude.

So, no, I'm not putting anybody on blast. This is how science works. Like what? Tell me about all this stuff that my doctor has been doing that it turns out was nothing. So, to start with some medicines, because I think most people want to know what medicines don't really work.

Hold on, when we get to the cabinet, it's starting to start throwing this stuff out, as you say it. The one example that I already started to talk about, I wanna explore a little bit more, there was a study that looked into ZopaClone, which is... Hold on, how do you spell it? I'm throwing it out. I'm looking through my bottle and see how it happened.

Oh, okay. Z-O-P-I-C-L-O-N-E. Okay, don't have any of that, we're fine. Which is a type of medicine for insomnia. That it's very similar to ambion or zopodem. Okay. And actually some of the studies even explored ambion. The one they focused on didn't, didn't,

but they were, I think you could put ambion in this same, based on the other studies into the same category. What they found was that for insomnia, it's actually not very helpful and that neither Ambien or this other drug, Zyboclon, were better than cognitive behavioral therapy. And this is a big deal to suggest

that the sleeping pills are not very good for sleeping. It's also, I would say there are a lot of people and probably some listening who would say, well, that's not true for me. These medications are widely prescribed. A lot of people take them. And I've observed people. Fall asleep. Fall asleep. On ambient.

And so this seems very counterintuitive, but what they found is at the end of the day, once you give it to enough people, and then you start asking them about their overall quality of sleep, and you look over a long term, it's probably not that effective. And it's certainly not as effective as cognitive behavioral therapy that focuses on the root problems of the zombie. Exactly. But you can see why these medicines are still being prescribed. One, CBT takes a lot more time. It is also, is it available to you?

Is it something that you can easily access? How much money does your insurance cover it, almost never? And then there's just harder to access. There's the weed connection that I think that freaks people out. CBT, does it get you high? It does it. It's very melo high. CBT, okay.

CBT. CBT. He all did that on purpose. I know you all. We're just tricking you. Another thing that I found very interesting, so I wear a watch that counts my steps and I have used apps with which to track my calories. And what they found is that sort of wearable or stuff you would carry with you technology to track your movements or your calories or whatever has zero impact on weight loss.

Oh. Yes. Well, but maybe fitness. Well, they didn't study that. I don't know. Okay. I'm not saying that you shouldn't do it. I'm just saying if you're doing that

in pursuit of weight loss, it like right now we don't have evidence that it's gonna help. That's what I'm saying. Which again doesn't mean- Specious links though, right? Like, I don't know. Doctors recommend this stuff.

But there's also not a great link between fitness and weight loss, right? That's, I mean, that's the bigger thing, right? Like there's, we don't have a good connection, like weight loss and fitness hell. Exercise, right. Exercise, like your physical fitness are different things that we, I think, have tied up

as one whole. Right, and we know that health is a distinct fitness and health is a distinct entity from weight. Right. And the two should not be tied together because there is no ideal weight you need to be to be healthy. You can be healthy at many different weights. You know, those are two different concepts.

Right. Yes, I agree completely. But I think if I am a, and I have been this doctor who has said to a patient who's asking me how should I keep track of what I eat or know, how do I know better what to eat and what not to eat. And I have shown them apps that they could download. I mean, I have talked to them about this stuff

and that's not evidence-based. So like they're more like crabs, they're made. And as a scientist, I should do things that are evidence-based, not just that make me feel good. Right. Another thing that I thought would be interesting to people, the use of compression stockings,

those like tight hose that they'll put on you in the hospital sometimes. Some people are outside the hospital, but you see them a lot used in, and this is where this was done. Sexy am therapeutic. What they put them on you to try to prevent a blood clot from forming in your leg. And what they found is that when used after a stroke, because we use them a lot after a stroke, because people are bedbound frequently for some period of time, that they do not reduce the risk of a blood clot. But we still use them. Now, is this harmless, probably?

Like, is this for most people, is a very benign thing to do? But I think this would fall into that category of you don't want to do nothing. This is when I when you were mentioning this to me, this is one of the ones you talked to me about. It's an interesting thing because it's like, okay, well, they probably don't help. Well, if you don't use them and then the patient gets a blood clot, you are then like, it looks bad for you, right? Like, well, they could could be and probably are at many institutions still considered standard of care. Right. Um, standard of care can be, I mean, it's, standard of care is really based on what your institution does and what the doctors around you do and what doctors kind

of accept as normal. Mm hmm. And doctors would accept this as a normal practice right now. So yeah, it would be really hard to defend yourself if you didn't. There are other ways, by the way, of preventing a blood clot. I know there are probably medical people listening to him. We'll just do something else. We'll just do the blood out. No. No. There are blood thinners.

There are reasons we... No. We've been experimenting with Husking and Michael. A couple other things. I don't want to get into things that are, a lot of these things get really deep into medical practices and they're just not, like for most people, be like, okay. And you may think of it as a solbund's listener, you may think of someone who's interested

in this stuff, you don't know. You don't know how deep some of these guys would sit. The one that shook me was the use of contact precautions in an ICU. What they found is they did a study where they looked at if you've ever been in a hospital, you'll see people put on these paper gowns and gloves before they go into a room and we call that contact precautions. We do that to try to prevent especially resistant bacteria, things like MRSA, methicillin resistant, staphlicococcus orias, marsa, most people call it,

or VRE, vancumse, and resistant intercogus. Things like that, we try to prevent those very like, I hate to use the term super bugs, but this is what people call them, super bugs, strong bugs, very resistant bacteria from spreading. And so we wear this stuff. And what they found is that it didn't help. Oh no. It didn't do anything.

And we have these paper gowns all over our hospital and we have to wear them so much and there's such a pain in the butt and everybody hates them. But you get in trouble if you don't wear them, so everybody wears them. And then they did a study that said they probably don't help. Oh no. I found, but again, what if we just stopped? People are still gonna get MRSA. Right.

Right. So right now I don't see that as a practice that's gonna stop. Yeah. Um, well I'm sorry that everything you learned is, I guess we're kind of on an even playing field again if you think about it. We're kind of like even, we're even out of stuff we know because like the stuff you knew, you know, that was all wrong.

I never learned it in the first place. I'm almost kind of leg up blank slate. Do you think about that? I do think about that. I'm not. I think that's true. Well, that's the kind of fresh perspective I bring. Yeah.

An institution like yourself, somebody who's kind of fresh perspective I bring. Yeah. An institution like yourself, somebody who's part of the institution, wouldn't be able to see it that way. Fresh eyes, fresh thinking. I want to talk a little bit more about this and why it takes a while for this information to sort of disseminate through the medical community. And also, I want to reference that this is not the first time a study like this has been done.

So, this is, while this sounds very dramatic and exciting, this is just the process. Before we do that, let's go to the billing department. Let's go. The medicines, the medicines that ask you let my God before the mouth. So Justin, I want to talk about a few more of these medical reversals before we discuss this further because there are just a few more that I thought were interesting. As I said, this was not the first time a study like this had been done. This same group of researchers who did this comprehensive review of randomized clinical trials and three medical journals revealed 396 medical reversals. That's a name, that's a cumbersome name for an article title. But this is science, it's actually much less cumbersome than the majority of them, I

would say. They previously, just a few years ago, did another one where they had about 150 or so, I think, in that one, but same idea. So I mean, this isn't, we're constantly re-evaluating the things we're doing. Some interesting things that they've found more recently are in the recent past. So you know how sometimes in health class, they'll try to teach you about teen pregnancy

by giving you a doll, like one of those dolls that cries and peas. Yeah, my real baby, or something? Something to take care of, and it's a way of trying to like scare you To not have a baby before you're ready mm-hmm Those don't work oh no they're no they're not effective. Yeah, so much fun And then they just think I can handle it well I'm not saying they increase the rate of they do the rare romantic, but they do not decrease

Which you know which you think like well, what's the harm? Well, I mean, that's money and goodness knows our public schools don't have enough money and we're going to spend money on a bunch of dolls for them to take and it didn't do any good. So like, you know, we could talk about sex more in a frank open way. Yeah. That might be a better option to better route to go. Unless expensive

But some some other things that I think it's interesting because when you hear about some of these other things that are even just a few years older This is stuff Even if you don't know this even if as I'm saying it if you are if you are outside of the medical field You might hear these things and go how is that what are doctors doing? I don't know I as a physician read some of these and thought, oh, well, I know this. This is, well, of course, that was a reversal. We do this. The new thing now. For instance, it was just a few years ago that they kind of re-evaluated their position, our position as physicians on how intensively we should control glucose for a diabetic patient.

There was a push for a while to like get those numbers as close to normal as possible. And what we found after doing a lot of research is that if you are too intense with your attempts to control glucose, you actually do more harm than good. You're not improving their outcomes and you are increasing the risk that they'll have a low glucose episode, hypoglycemic episode, which can be much more dangerous acutely. So there was a lot of information, give it a doctor's to like, maybe ease up just a little. That doesn't mean like eat more cakes. Right. And then doctors chill out a bit. Chill out a bit.

Maybe our goals don't need to be quite so regimented because we're not actually helping people with these goals. There were something like a prostate exam. You're familiar with the concept of a prostate exam? Oh yeah, that's where they go check the Nano's on with their hand or tools and look for a prostate. There were so many different things wrong with that on different levels. I'm just going to let you. I'm going to stop you before you do more harm.

I took an oath to first do no harm. And I'm going to stop you before you do more harm. I took an oath to first do no harm. And I'm going to stop you at this moment. The accounts enabling me to do harm, I think. Yes, I just I shouldn't have asked. So we can examine a prostate for those of you who have one for for prostate having folks, we can examine them in different ways. There is the digital rectal exam where you insert a finger into the rectum and feel the prostate. Or you can- The subject of so many great stand-up comedy routines. It really is. Or you can do a blood test, PSA, is what it's called prostate-specific

antigen. You can do that too. And they're both used sometimes, but what we found is that just routinely doing these tests on everybody probably doesn't help at all. So the idea that- That's the heavy, how does it not help at all? Well, so this is an interesting thing we've learned. The more we learn about certain types of cancer, the better we are at managing them because

specifically when it comes to prostate cancer, it in not and this is not across the board, this is a generalization, this is again statistically. In many, many patients, it's so slow growing that you're actually more likely to die with prostate cancer than of prostate cancer. Because of the age that it affects most people who get it and how slow it can move, in many cases, we're better off not being very aggressive. That's one thing that changed our monitoring too. The digital rectal exam is difficult to perform well every time.

You're just kind of blindly feeling around. And unless you feel like a distinct hard mass on the prostate, you're kind of guessing, like, is it bigger? And they just found doctors in general are not very good at it. Certainly, there are probably some who are better than others, but generally doctors just aren't very consistent with their findings. You know, when somebody is putting their finger in your B hole, the thought that I think I would have is, I bet they're good at this. I know this is unpleasant for me, but I bet this is a talent of theirs that they are skilled at and this is very necessary and important. And, and please let me underline.

Certainly they wouldn't. Certainly, they wouldn't insist on me taking down my pants and putting the fingers in my butthole if it wasn't very important and, and thoroughly tested. Here's the problem. I know the problem, Sydney. And this is why I'm being very careful about how I'm saying this. I am not saying that no one needs a prostate exam.

They can be very beneficial in the right patient in the right situation performed by the right physician. The right delicate fingers. Knowing and probing fingers. That just every doc across the board doing routine prostate get fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers.

Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers.

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Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. Knowing, probing fingers. is what I'm saying. So there are certainly doctors who do a lot more prostate exams and they're probably better at it because they do so many more, the experience helps. So again, this is not me saying never get a prostate exam. If your doctor suggests you might need one, then you probably need one. I would talk to them about it. But if your doctor isn't doing one on you, I mean, certainly ask, always ask. If you have questions, always ask. But it doesn't necessarily mean they're neglecting an essential part of your health, right? You just might not be in a group

that statistically would benefit from those exams without symptoms. And there are many, I could keep going. There's a huge list of all these different things that they discovered. And like I said, these are things that I know, these things I'm listing right now, we've already made these changes. So yes, these were reversals, but they have drifted throughout the medical community.

And people know the big cholesterol drug Zedia was on the list. You probably saw the commercials for Zedia. Is it the one where the people look like eggs? Yeah, you could have gotten it from... Maybe you have high cholesterol from eggs or maybe you have it from Uncle Egg Bird or something. They're trying to tell you that cholesterol comes from both food and genetics is the point, I think. But their big point is by Zedia, it really was not very effective. The thing is, this was one of those cases where the randomized control trials proved it, but I got to tell you, if this brings you any comfort, many of us physicians already

knew that and weren't using it widely. One, because it was expensive and brand name, and two, because it wasn't effective. And I'm not saying again, this doesn't mean that in every single patient, it's utterly ineffective, but it means broadly prescribing it to everybody is not going to help. I mean, that's not a good idea. Well, why is this bad? I mean, How is it hurting us? So part of the way that this is hurting us, because many of these things that I've said are benign, not all, but many, is the cost.

So there was a study in 2014 of 26 different low-value services that were provided through Medicare. The reason they did that is because it's a lot easier to... Medicare collects a lot of data. It's a lot easier to analyze if you go through something through Medicare. The reason they did that is because it's a lot easier to Medicare collects a lot of data. It's a lot easier to analyze if you go through something like Medicare. But the estimated spending on low value services, meaning services that I, like the ones that I've mentioned that could well be reversals,

was between $1.9 and $8.5 billion in 2008 to 2009 alone. That's a lot. Yeah. $9.5 billion in 2008 to 2009 alone. That's a lot. Yeah. A lot of money. So one, we spend ridiculous amounts of money on healthcare in this country, especially when you consider the outcomes that we get for that.

How many people still don't get proper care. And this is money that we shouldn't be spending, really. So cost is a huge problem. And then you get into the, I would say, the more immediate concern for me and you, which is some of these things could do harm. So putting compression stockings on somebody, whether or not they need them or wearing a paper gown

when I go into a patient's room to protect them and me from spreading bacteria, those aren't harmful things inherently. They will be benign, maybe a waste, but not, right? I mean, that is not dangerous. But when you do talk about some of the medications, they do have side effects. Sure, right. Or their contraindicated is one thing I like to know that means. That is. And I would say there aren't a lot of these reversals where they found medicines that were We gave you something to try to fix it and it actually made it worse

I mean, that's not really what we're talking. We're really thinking about it inefficient Yes, that maybe it works in so few people that you would have to treat so many people to see any Statistical benefit because again, I'm not saying that You know ambian works for somebody, probably. It just doesn't work for as many people as we hoped. Why does it take this long though? Why does stuff, I mean, cause you know we do all these clinical trials

in the FDA, as to approve meds and devices, and blah, blah, blah, blah. I have a guess, is it money? Money's a big part of it. If you look at like who funds the trials that where they found reversals, who funds the research that checks the research? A competitor.

Non-industry sources. Yeah. The vast majority are non-industry. Like what? Like the government? Like the government. So what you need is you need somebody who doesn't have a vested interest

in making money off of something to tell you whether or not it works I know surprise surprise and I'm again, I'm not saying that pharmaceutical companies are all lying I'm just saying that if you really want a non biased view of whether or not a drug works you probably need somebody outside the pharmaceutical company To do that study. Yeah But most of the time, most of the time, if they say it works, it works. But there you go. The other thing is dissemination of information.

We're getting better at stuff. Things are changing, I mean, daily. It's very quick that something that was effective isn't or now we have something better or,, turns out we shouldn't do that. On your own busy, I mean, you got patients to see and you got all kinds of stuff to keep track of. It's tough to just look at the latest trends and pills. Well, I mean, that's part of it.

When we're taking care of people, we can't be reading journals. And I think if you're the patient, you want me focused on you and not a journal at that moment. So there's a lot of journals to read. There's tons of articles to read, research is changing every day. The data changes every day,

we were constantly trying to keep up. And then it's who is, where is the information being published? You get into a lot of politics where journals are publishing, what articles are they publishing, and how big were the studies and who who who who is behind it? It's just sometimes hard to disseminate that information quickly. I got a solution to this. What?

So you what you do is when a patient shows up for their appointment, you hand them one new journal article and have them read it for comprehension, get it to a point where they understand it really well. And then as they're making small talk with a doctor, they just drop the facts in about their one journal article that they read. So like while you're treating the patient, you are also learning from the patient

who just read this one journal article. Do you think as a patient that you would enjoy that? Yes. Really? Yeah, to be able to help shape the future of medicine, that's a teddy stuff. Oh, hey, I mean, I don't mind this plan. I'm behind it because it really, that's part of it is just trying to keep up with the constant influx of information. I really think it's putting on a shirt that the patient is wearing.

So as you're doing the check out. Okay. That's seeing how I think things are getting out of hand. And you know, the other thing that makes it hard is if we're talking about something where we have found a treatment and we have nothing else, even if it's not, even if we know it's not the most effective thing, if it does anything that feels better than doing nothing in the face of disease.

I think that's a very human impulse. I think, honestly, which is why we all need to be more open and talk about these things. Not doctors, patients too. We need to tell patients this. I don't know that this is going to help you, but it's all I have. And if you want to try it, let's work together, let's give it a shot. I have some evidence that says maybe it would help a few people, but I got a lot of evidence that says it's not as effective as we wish it would be. But this is what we have.

I mean, I think that the more transparency and the more open you are about these conversations, then you don't get hit with a news article, a news story like these that can be very disturbing that tell you that your doctor is doing 400 things to you that don't work and you don't know about it. Because it's not that's, if you take one thing from this episode, that's what I want to get across is that it is not that doctors are doing a bunch of stuff and have no clue, you know, that it didn't work. It's just that science is constantly changing and we're re-evaluating.

And if you challenge your physician with many of these things, they probably already know that and they're not doing them. And they probably don't apply to you anyway. 400. That's reassuring. that probably already know that and they're not doing them. And they probably don't apply to you anyway. 400. That's reassuring. Folks, thank you so much for listening to our program this week. We hope you've enjoyed yourself.

We sure have enjoyed having you here on the show. I mean, you're not on the show with it. You know what I mean? Yeah. Appreciate it. Yes, and take this one of those episodes that I hope inspires you to not on the show with the, you know what I mean? Yeah. Appreciate it. Yes, and take, and this is one of those episodes that I hope inspires you to ask your doctor questions, you know, I mean, always ask questions.

I never mind being asked questions. It doesn't hurt to say, hey, tell me about this pill I'm taking. Or tell me about this pill you want me to take. Let's talk about it. Ask your questions. July 16th, 17th, and the 19th,'m going to be on the road on tour with my little brother griffin talking about the adventure zone graphic novel as part of our little book tour. Um, I'm leaving my family, so please don't let my sacrifice be in vain. Come out and see me.

I go to bit.ly4dslash become the monster or macarade out family and click on tours and you can find those and a lot of other shows that are coming up in the near future. So we have a book called The Saul Bones Book that you can buy. That is accurate. That is accurate. It is a very good book that we wrote and Sydney's sister Taylor illustrated and it's good. Lots of pages in this one. Thank you to taxpayers for these sort of song medicines.

It's the intro and entrepreneurial program and thank you to you for listening. That is going to do it for us for this one. Thank you to taxpayers for these for our song medicines, this is the Intro and Entrepreneur program, and thank you to you for listening. That is going to do it for us for this week. So, until next week, my name is Justin McRoy. I'm Cindy McRoy. As always, don't draw a hole in your head! Alright! Maximumfun.org Comedy and Culture Artist Oat? Audience Supported