The Checkup with Doctor Mike - Doctors Should Stop Acting Like Scientists

Episode Date: February 20, 2023

Watch the full interview on YouTube here: https://go.doctormikemedia.com/youtube/UnbiasedSciencePod Dr. Andrea Love and Dr. Jessica Steier are two of the smartest people in medical media. Together they host The Unbiased Science Podcast where they attack the trending medical controversies relying exclusively on the data. This allows them to remove emotion from their discussions and allow research and math to lead them to conclusions that are often messy but reliable. They've done deep dives on intermittent fasting, infant feeding, COVID vaccines... you name it. I invited them on the show to discuss some issues that have been on my mind lately, especially surrounding the way medical experts have been communicating with each other on social media. We talked about that toxicity as well as shaming people for how they've responded to the pandemic, treating inflammation with cold plunges, and whether or not doctors are actually scientists. If you like nuanced discussion about health and medicine, you’re in the right place. Follow The Unbiased Science podcast here: Apple Podcasts: https://podcasts.apple.com/us/podcast/unbiased-science/id1531526782 Spotify: https://open.spotify.com/show/7JMSODgbC5auqScduzYVZn YouTube: https://www.youtube.com/@unbiasedscipod IG: https://www.instagram.com/unbiasedscipod Twitter: https://twitter.com/unbiasedscipod Executive Producer and Host: Dr. Mike Varshavski Produced by Dan Owens and Sam Bowers Art by Caroline Weigum CONTACT: [e-mail]

This was a really tough decision. And when they make it personal, that's when we, because we've left, oh, 90% of our content is controversial. Yeah, we get a lot of, like, sexualized death threats. But then when that stuff comes in and they bring my kids in or anything like that, uh-uh. Like shutting that right down. It's frequently said that doctors aren't scientists and we need to stop speaking as if we were scientists. Well, my next two guests are both scientists. Please welcome Dr. Steyer and Dr. Love to the show, hosts of the online.

unbiased science podcast to debate that very point. When I say debate, it's more like discuss because we not only discuss that, my RSV controversy, all the topics that exist in the health and wellness space surrounding natural supplements, natural cures, and is inflammation to blame for all of our problems? This is going to be a really contentious, exciting, educational, and even collaborative conversation. So please enjoy. Let's get started with the checkup. two scientists in front of me. I am not a scientist, but I feel like doctors like to think of themselves as scientists. It feels like you have a controversial stance on this, at least within our community of doctors. Who wants to take first stab at proving why I'm not a scientist?

Well, I think the thing is, is that some clinicians are scientists, but not all clinicians are scientists. And the public just automatically assumes that all clinicians are scientists. But, I mean, you could speak to this better than we can. My husband's an ER doc. And he always says he had no formal training in epidemiology and data science and how to critically appraised evidence. You don't get training in that. So yes, you have clinical expertise, but do you all know, do you? I mean, I don't know. Do you know how to really read and critically appraised research? I would like to take a step back. Okay.

Sorry. No, no, no. This is a good place to be. But for the audience, what is your definition of what a scientist is versus a clinician? Okay. That's a very good question. So I can jump in. I think there is a difference.

So I think clinicians can often be called like applied scientists, right? So you're taking scientific information, things that have been designed, developed, evaluated by trained scientists, basic scientists, you could call them, and are using it to apply to treatment of a single individual, whereas scientists by and large are looking at population level information, they're designing studies in order to evaluate or investigate a given phenomenon or an observation, and then they're evaluating the data that they collect to make generalizations or interpretations of the body at large. And that could be an entire human population. It could be a population of cells and a petri dish. It could be a

population of animals. But it's very different because you're making these broad conclusions based on a comprehensive body of evidence as opposed to tailoring the knowledge that's been created by scientists in order to apply it to a single individual. That makes sense. It makes a lot of sense. Now, why is it on a practical level? an issue when a doctor starts treating themselves as a scientist when they don't have the background knowledge to do so? Well, I think the biggest thing comes down to the training in study design and interpretation of the data. So a lot of times clinicians are going to be provided clinical recommendations, right, from a variety of credentialed organizations that provide

clinical guidance, right? Like, you're not expected to pull out treatment plans, you know, out of a hat, as it were, right? There are a lot of standard procedures, not to say that there aren't exceptions, right? Certain cases, and that's why, you know, you collaborate and have differential diagnoses and try and, you know, investigate the problem. But there's not a lot of formal training

with regard to, okay, is this study designed in a way that will appropriately evaluate the question at hand? Are we actually collecting the data that need to be collected? Are there variables that might skew these data that we're not accounting for. And, you know, that's totally fine because people can't be trained in everything, right? There are reasons that there are specific fields of expertise.

And that's why scientists and clinicians really need to work together to do that. Because just like, just like clinicians, we're not going to go treat people. We're not going to go make treatment recommendations. We're going to say, okay, well, the data support this as a treatment for X, Y, and Z, or the data do not support, you know, the evidence for the treatment of X, Y, or Z. The way that I'll put this on a practical perspective is if I have a patient in front of me, and I am a clinician, I'm a doctor, I am going to diagnose the patient based on my evaluation of what's going on, which includes a history, a physical, potentially some tests. And then my treatment plan will come from the evidence that was collected by scientists that was evaluated by scientists. And therefore, these clinical guidelines that were sort of laid out for me, I go off of those.

And I feel like good quality clinicians, which is myself, would go not saying that I'm a good quality physician, but meaning the clinician is myself, will base their decisions more so off good evidence-based data as opposed to just solely their experience. Exactly. Right. And we just want to say, like, we are pro-clinician. Like I think a lot of times we're pitted against clinicians and that's why I'm so happy that we're tackling this because it's like people assume that there's a hierarchy and that clinicians

are at the top and we're just somewhere in the middle, but that's not the case. You guys are amazing, you're experts in treatment and, you know, diagnosis and treatment and all that, but you're not necessarily trained in the scientific process. And so like Andrea was saying, people can put anything they want, like you could publish anything, but we've been trained to understand the quality of the evidence. And that's like the eye, that's how we approach every, all the information that we consume is, okay, what are the threats to the validity and the reliability of this. Is this generalizable? Or is this just an anecdote? Is this an outlier? What's the body of evidence? What's the scientific consensus? And that's where I think the difference lies.

But I do want to also make the point. And I know, you know, Ethan and I even spoke about this. So Ethan's her husband. Yep. ER doctor. Dr. Ethan Schapen. So, you know, he has come up against us as a younger clinician where some of the older, more entrenched clinicians are very, you know, intractable in this expertise-based or experience-based practice as opposed to an evidence-based practice. And younger clinicians, more, you know, newer generations of clinicians are really looking more to the science, which is great to see because that's how it should be working together, right? But we saw a lot of this during COVID and during a lot of other medical issues.

But, you know, a lot of people, you can publish an opinion piece in, in, you know, prestigious journals. And the general public doesn't know how to discern, you know, this is an opinion piece with no data to support it. And it happens to be in a journal name I recognize versus a very well-designed study with an appropriate number of sample subjects, you know, appropriate number of controls, you know, whatever the case happens to be. And they're really unable to discern like, well, why is this one credible? and this one isn't when they're in the same journal. Absolutely. I don't think it's one or the other because when I get general guidelines, population-based guidelines on what I should do for a given patient,

I have to remember that that is not given to that patient. Because if that was the case, AI would just diagnose and treat everybody. But the reality is medicine is the science and art. That's what I think differentiates a clinician. They have to incorporate that art. Yes. Where in the lab, if you're doing art stuff, maybe that's a problem actually. So I think the human is part of their art form.

So while I may know, I'll just finish the point, I'll, I may know that this is what's recommended for patient A. Right. But I know patient A has a bias or they've experienced something with this negatively and I know they won't buy into this yet. And I have to take an extra visit for this. I can adapt the research that you've provided me into an individual piece of this. Exactly. And I think that really comes to the crux of all like science. and health in general is that it's multifactorial.

And too often people get hung up on this, like, singular antidote and not realizing that there's a lot of other factors in play and what works for a single individual does not necessarily mean that that is, you know, the de facto data-driven evidence. And I've seen a lot of clinicians get frustrated with scientists and these guidelines because it's like, I'm the clinician. I'm sitting in front of the patient. I know their history, you know, like the nuance of their clinical background or whatever. Like, why should I follow a guideline? I'm the clinician. And so working in data science,

like you mentioned AI and machine learning and there's all these amazing things that I think are going to come out in the next few years where we could figure out, okay, this patient has a probability of success or of being discharged if we follow XYZ protocol. But we always have to work in conjunction with the clinician. I don't think personally, and I know, Andrea, I don't speak for you, but I think you agree, that should never supersede your clinical judgment. But we're a team, and I think, like, that thinking needs to change. Like, we're often pitted against clinicians, but we are a team. No, the team aspect is absolutely right.

The multifactorial thing is right because multifactorial is probably the answer for all these things that we're going to be discussing today. Nluence, as Jonathan Haidt said, actually on my channel, is a superpower that we need to start training in many. In most people. I will say to play a little devil's advocate. older clinicians will oftentimes rely too heavily on anecdote in their experience and therefore less so on evidence-based medicine.

I have seen that pattern. At the same time, I have seen a new pattern in my younger residents that I'm training that are very focused on the evidence-based information and guidance, so much so that they forget that there's a human sitting in front of them. Yeah. So that's where the like boots on the ground thing. Yeah. And why I think collaboration between scientists, clinicians needs to happen more.

often when we're making clinical guidelines, when we're making legal decisions on what is covered in insurance plans and pharmaceutical plans and all that. So I feel like being the clinician, the thing that I'm seeing on my side is both ends of the spectrum and the pendulum constantly swinging one way or another and constantly trying to bring it into homeostasis back into the middle somehow. Absolutely. Totally agree. No, I totally agree. I mean, you know, you could certainly see, you know, someone who's so fixated on what do the data say and they forget, you know, a very potentially critically important key detail of patient history, right? And that could lead them to a misdiagnosis. And so, yeah, I mean, in medicine, you need both of those things.

Absolutely. I think that's cool. And to answer the question that we started with, I think there's a wide spectrum of how doctors learn research and science in the first two years of medical training. Right. Some get a heavy lecture on it. Some get a very glossed over sort of summary of it. But then in residency training is where I see either a strong emphasis from the program where they're learning and they have journal club and they have times where they're dissecting weaknesses of articles and research that has been put out. And there's such a wide variability. Right. So I think it's difficult to pan down and say all doctors are not good at research or they are. And when we do say, doctors aren't scientists. The problem that comes up is then the skeptics of medicine come in

and use that as an entryway and say, your doctor doesn't know what they're talking about. I know the science. And most people don't have the time and the energy and the dense informational background to know the difference, as you said, between two different opinion articles or research articles. And they're left confused. Yeah. And I think, I mean, you know, to play devil's advocate on the other side, you know, you obviously get the people who say, I know the science when they, in fact, do not know the science. And that can be true even for scientists, right?

There are scientists that, you know, we've seen it a lot in the Twitterverse, where they are going outside of their field of expertise and they're misinterpreting the conclusion of a study because it's not in their scope of knowledge. And that's true for scientists, clinicians, general public. I mean, everywhere in between. So I think, you know, that's why there has to be,

be collaboration. And that's why there has to be discussion and, you know, constant evaluation of rigor of data that's emerging. Agreed. And this brings us nicely to our point of how we met. Do you remember how we came to? I remember. So did I slide into DMs? No, no, Dr. Mike. Yes, there was a DM. Yeah, kind of. I think it was me. I think it was me that slid into the DMs. So he had, you were on, you were a guest or you had a guest on your show. and you were talking about the RSV surge, and you were discussing how there was an increased proportion of hospitalizations or severe illness

because there was this timing shift. Timing shift, exactly, what we can call the exposure gap, not immunity gap, everyone. We've covered that already. But the fact that the first time a child gets RSV is most often the most severe time. And you got a lot of flack from people about that.

From clinicians. Actually, immunologists. No, not from clinicians. Oh, from scientists. From scientists. Wow. So it was actually heavy from the science community. Very interesting.

And they were using the same talking points that you're saying right now, which is interesting and why I really want to discuss this. Okay. Because they were saying he clearly doesn't understand he's a clinician, not a scientist. And I remember I slid into his DMs and I said. Before the drama started. Before the drama. And I was like, I appreciate your take.

on this, and I sent him our video about, you know, debunking the, yeah, about why there are immunity death. Yeah, why is there, why there's such a surge of respiratory viruses this season and a lot, the multifactorial aspect of it, right? Absolutely. We have, you know, the, the COVID burnout. People are going back to pre-pandemic behaviors. You have routine circulation of a lot of respiratory viruses.

And, and, and I think, you know, it was just like, it was like a commiseration sort thing initially. What was frustrating about it was that I said in opening my statement that this is one of the leading theories, essentially saying that this is multifactorial. Right. But there's no nuance. No, no, no. And I asked you, even after the critique started, do you think I said something wrong that I need to issue a correction? Because I want to, as a clinician, put out accurate scientific error. So you're absolutely correct. Typically, a lot of these child, I don't want to say child or illness because, of course, adults can get RSV as well. But these illnesses that are typically more severe in childhood, influenza, RSV, otitis media, I mean, a lot of these things, right?

Your first interaction with that pathogen is most often, and I don't want to say always, because it's multifactorial, things change the other course of someone's life. But very often is- In fact, most often, RSV is fine. Kids do fine with them. So that's what, reassurance for parents, because as a clinician, I'm also worried about the parent. Right. Being worried that if they're child. For the most part, yeah, it's generally mild, but your first interaction, your first encounter with that virus typically leads to the most severe illness presentation.

And so if there are kids, not that their immune systems are compromised from not being exposed to it, but it's just the first time they've seen it, it will often be more severe than the next time they see it. Now, that's because we don't develop full immunity, long-term immunity to RSV. And that's why you can get infected repeatedly. However, you have a little bit, there's a lot of different components of the immune system, right? You have the innate immune system, which doesn't have any memory, and it's always there to patrol. But then you have different arms of memory immunity.

And some of those taper off more quickly, and some do not. And so you can still get sick, but it's typically less severe in future encounters. But nothing of what you said was incorrect. There's a lot of factors at play this year. Yeah, the immunologists were pointing out that they're saying the size of the, the size of the airways changing as the child gets older is the reason for the second illness being less bad. And that's true. We don't disagree. It's one of the reasons. Also, general development of the immune system occurs as people age. So, you know, and that,

and that also goes the other direction, right? You have a peak and then you have a valley when you have immune senescence. So then older people, their immune system is less responsive. And they now have similar risk factors as you would as a younger person. Can I just say? I think it was awesome how you went about like you reached out and you really wanted input and you were open to, you know, is any, are there any inaccuracies? And I feel like what's so interesting about what we're doing, it's so public. And when these scientists or clinicians, whatever, it's like clinician on scientist violence, like they do it so publicly. And then think about what the public is seeing. Exactly. That's my concern about it. Right? It like totally discredits everything that we're doing.

It's like a journal club or a peer review process, but like in front of an audience eating popcorn. Like scientific discourse is normal. It's encouraged. It's the beauty of science, right? But now that it's all playing out in the public eye, they're like, oh, look, this is wrong. They can't get it together. They're such disagreement. And I just feel like it erode public trust in science and medicine.

And also, like, when you're a professional in the field, clinician, scientists, whatever, when you're on social media, What is your purpose? You have to think about what is your purpose? Are you just trying to have a pissing match with another person in the field to make yourself feel better or feel smarter? Are you trying to do something for the general good of society, right? If it's the latter, then what is your point of calling someone out publicly? If you have a critique about what they're saying, message them privately.

You don't need to go and dogpile them to make yourself feel better. That's completely unproductive. and, as just said, erodes public trust in both science and medicine. And I think the goal is evidence-based medicine and getting people to buy it. You should avoid that at all of us. Exactly. Exactly. We have to get our act together.

Honestly, like I feel like COVID really lit a fire and there are so many of us out there who are now inside common in the public eye. But like, I don't know, there's not a whole lot of kumbaya behind the scenes. At least it hasn't been for us. I don't know if it, well, I know it hasn't necessarily always been the case. Tell me about a time where that's happened. Well, so I recently, so we've gotten a lot of messages from people who have seen people, and we're not super active on Twitter.

I'll just kind of preface that. We do most of our work on Instagram, and we do have the weekly podcast. But, you know, every now and then, and Jess is kind of forcing us into the Reels world and TikTok. Sorry. I mean, that's where the world is going. Right. And TikTok. Just just facilitated.

I want to hide my face. I'm a scientist. I'm going to go hide in my face. lab with my coat and my sweatpants. You just also happen to be beautiful and I think it would be nice to be on your face on social media. But okay, go on. But anyway, so we have gotten a lot of messages from people who follow the podcast

page because, again, our page is really geared towards providing content for the general public. It's not really designed for complex scientific discourse. Like, let's talk about toll like receptor signaling and how it activates interfere on regulatory factors. I don't know what that means. That's not. That's not.

I am not. I regret. I was saying I was a scientist at the beginning. But that's, but, you know, so that's like the Twitter verse of like the scientist. I raise you a TNFL phone. So anyways, you know, we got a lot of, a lot of messages from people who were so concerned with a lot of these articles coming out about post-COVID and long COVID and how it was leading to immunodeficiency.

And there, and people are liking it, likening it to HIV and acquired immunode. deficiency syndrome. And I was like, I just wanted to alleviate people's concerns that there's no body of evidence to support primary immunodeficiency after COVID. And in fact, even these temporary changes in immune cell populations are totally normal. I got to set this up because what you're saying is really important. And if we don't set it up, this might go over people's because I feel it going over my head and yet I already know what you're saying. There is a concern. Yes. This is the problem. We're going to set the table. The problem is people are worried that after COVID, their immune systems are going to be weakened.

Correct. The theory is potentially kids are having worsening RSV spikes because they've been sick with COVID. Right. Right. So what has the evidence shown us on a practical level from experiencing COVID to what happens to our immune systems after? So there's a lot of different things that happen. And that's the challenge, right? So there are some data that suggests that some of the.

persistent symptoms of what we're calling long COVID, which is the post acute sequelae of the infection, can be due to overactive or hyperactive immune responses, meaning you have persistent populations of T cells, inflammatory populations of T cells that are leading to inflammation that is then leading to some of these symptoms that people are reporting. There's also some data that suggests that. Okay, so some data says there's inflammation happening after you're sick with COVID and you might have some symptoms as a result. And then there's some data. There's some data that also suggests that some people memory immune system is less responsive,

which is one of some of the theory behind why people are getting sick more frequently with other respiratory viruses that are always circulating. And then there are some data that suggests that there are no long-term changes or persistent changes for other people. And that is kind of what you would expect after a viral infection. There are going to be some populations that have one response. some populations that have the other extreme and then some in the middle, right?

It's a bell curve. And so unfortunately, a lot of media outlets and professionals on Twitter have kind of leaned into one of those directions and really harping on this like long COVID is destroying your immune system and leading to immunodeficiency and it's suppressing your immune responses.

On par with HIV. Correct. On par with HIV. A lot of fear mongering. A lot of fear mongering. And there are very vocal people on Twitter who are doing this. And so we wanted to simply alleviate the concerns

that there are no data to suggest that COVID. Right, that it's that bad. That it's that bad. That there may be temporary changes to your immune system, but that makes sense, right? Your immune system's fighting a virus, so it's going to take some damage

and it's going to take a little bit of time to recover, as you would expect. But people are not getting infections, opportunistic infections that you would expect if your memory immune system was basically destroyed. Got it.

So it's not as bad as people are making it seem on that lane. Correct. What's the other lane that some people are going into? Well, so what happened there was that I got called out for basically ignoring all of the data

that are suggesting that there is temporary perturbations when that was not what I was saying at all. And I actually noted that there were temporary perturbations. So the fear mongering camp of COVID is destroying everybody's immune systems

and you're going to be sick forever basically dogpiled me. and they thought we were downplaying long COVID. That was the whole thing. Like, why are you downplaying this? Like, this is feeding into this idea that COVID is over. We shouldn't be concerned with it anymore. Have never done that.

And this is the problem of social media. You have a very limited amount of time, right? Like, we had a 60 second, 90 second real. And Andrew was responding to that fear, to the fear-mongering headlines. Like, oh, my goodness, you know, 50% of people are getting long COVID. It's like HIV. Our immune systems will never be the same. and they came after her

and really you're not even I mean it was vicious people really going after her specifically there are people who have pages dedicated to trying to take us down and they were ripping into credential I mean I'm sure you've experienced the same and again I mean it's sort of interesting

like the medium as message like the medium of social media is interfering with our ability like if you want a thesis on like what Andrea obviously you could talk for hours 150 page thesis on but that's not productive right you know what you're experiencing right now? And I'm only smiling because you're experiencing what clinicians

experience. You're trying to take a lot of complex data. Yes. And you're trying to simplify it into a visit. But the challenge is, but the people that are attacking, the people that actually were doing the attacking were clinicians. Yeah, there was a very angry dermatologist. Yes. Well, I'll tell you why I actually agree with you on your stance. Um, why I'm against fearmongering specifically and not to downplay long COVID or the temporary changes that we see in the immune system's effectiveness post-COVID. Because the human mind is so powerful and it really shouldn't be mind and body, it should be mind-body, that if I plant the seed in either one patient or in many patients by talking on social media, that their

immune system is weakened, their immune system gets weakened. That's actually true. Yes. I agree with you. And, okay, so this, so this. Is that wild? No, but, but it's, but it's 100% true because we know, again, multifactorial, um, word at the day.

Stress hormones, cortisol, there's a whole path, a whole lot of pathways that get activated, but your endocrine system feeds into your immune system. Your immune system is involved in every bodily system, you know, that exists. Yep. So everything, there's interplay. And this is actually a struggle I'm having with the long COVID because there is no clinical diagnostic criteria. There is a giant encyclopedia long list of symptoms that are associated with long COVID,

many of which can be associated with the fact that we've all been living in a pandemic that is in traumatic. Absolutely. And people have PTSD and people have depression because they've been locked. in their home. Is that actually a consequence of a viral infection? You can't say that because there's no way to parse that out. And so all of these things are getting lumped into the umbrella of long COVID. And that is, I think, in some ways, inflating the numbers of people that are reporting saying that they have long COVID. Because if you look at the actual biology of this

virus, yes, it can do some damage. For sure. We have never downplayed that. We actually have a lot of posts on long COVID and COVID in general and highly encourage people to get vaccinated and take mitigation measures. But there is no robust body of data that suggests that physiologically plausible that, you know, all of these things are going to be associated with all of these people who had COVID. And it's like correlation does an equal causation, we always say. Just because it happens after you had COVID, it doesn't mean it's because of COVID or it's long COVID. And anytime we try to articulate that, people, come for us because they feel like we're down playing.

I feel like in medicine, what ends up happening is you have arguments over nomenclature. Like what word did you choose to describe this givens? When in reality, we're talking about the same thing. We are on the same team. You might think this is 5%. I might think it's 7. But the difference doesn't matter. And I think what is created is like a very tribalistic situation where there are

ulterior motives to argue about the 5 to 7%. difference and then the person that suffers in all of this is not the person like you getting attacked or the person doing the attacking but the viewer the average person who's trying to figure out what the heck is going on so we so out of the interest of that we actually ended up taking down that particular post because i feel bad that you guys i mean honestly the only reason we did it they were they were they were really doxing her they were coming for her hard but then now you've empowered them to say if they docks you hard enough you can do it well no but but the reason we took it down is because we want to do a more comprehensive summary of it.

Well, you could have done that as well and left that one up. No, I know, this was a really tough decision. And when they make it personal, that's when we, because we've left, oh, 90% of our content is controversial. Yeah, we get a lot of, like, sexualized death threats. But then when that stuff comes in and they, if they bring my kids in or anything like that, uh-uh, like shutting that right down, you know?

But normally, like, we have no problem arguing, you know, publicly or not. But it was, it was more because the whole thread just completely lost track of like the purpose of it. It was not for some clinicians to get into a pissing match. It was, we were trying to alleviate a very specific concern that, you know, people are afraid now, right? Because the public health emergency, it's ending. Nobody's wearing masks. Only 15% of people have gotten the bivalent booster. So there are people that have a lot of health anxiety and they're afraid to leave their house. And so we're literally trying to alleviate and be like, it's okay. Yeah. Yeah. It, I don't want to say it's

inevitable, but right now with, you know, XBB 1.5, like, it's going to spread pretty quickly. But we don't want people to have this overwhelming paralytic fear that if they get COVID, they're never going to be the same. Not to say that there's not bad outcomes, but vaccination booster, all of those things can improve, you know, improve your outcome or reduce the risk of severe outcomes. Can I say one other thing? I feel like what we try, how we try to set ourselves apart from some other scientists, SICOM pages, is that we're obviously, yes, we're scientists first, but we're also practical.

And it's like real life. Like, you know, like people really came for us when we said, like we're not necessarily masking all the time. Like this is when there was a real lull. It's like real, real life. Like I have young kids. Like we are. We're slowly returning to normalcy, going to restaurants.

And a lot of scientists and people in the SICOM community were like, how irresponsible of you. It's like, we're being. But what's interesting is there's a level of hypocrisy there from people that are pretending like there's perfect levels of protection that exists. Right. And that you'll even see Dr. Fauci, who's on my channel a couple of times, we're talking about appropriate levels of risk for you might not be what's an appropriate level of risk for you. And that's what we try and talk about a lot is that, you know, if I lived with a family member

that was really high risk, I would be doing things. changing your behavior. Exactly. But there's some people where it's an all or none, and initially early in the pandemic when we didn't know anything about this virus, like, I was very cautious. I didn't leave my house for the few questions. I stopped hosting group runs outside because we didn't yet know how quickly this could spread even outdoors.

My husband lived in, like again, he's an ER doc. He lived, we got an Airbnb for him. He showered outside. Like he was literally like writing his will. Like we thought it was like end of days. No one knew what was going on. Well, that's what the problem is they start kidnapping the end of the end of the information from what you said, you know, when the pandemic first started, to what's going on now.

You lied. Yeah, you lied. Right. But it's, no. No, science has evolved. It's not even, that's what science is. Like our knowledge evolved, science evolved, all those things changed. Data has emerged.

Yeah. Outside safety. But what's interesting is that there are some SICOM pages who are still like very militant about a lot of things, like the mask wearing and almost shaming. Like, how dare you go to the supermarket without a mess. Let's talk about the shaving because I think this is smart because, again, let's go back to the goal. If this person's goal from a psychological perspective is to increase masking, and throughout the years of practicing medicine, we know shaming does not work. We saw it with HIV pandemic.

We see it with vaccine hesitancy. You shame, you break lines of communication. You don't help anyone. So what are your theories as to why people are shaming? If there are evidence-based people who know, shaming doesn't work. I mean, you know. Is it emotional? It's, yes, yes. I was going to say it's emotional. You know, they've kind of, they've kind of dug their heels in about this given topic. And I think it, I think it's a gap in effective communication skills. They don't know another way to communicate that someone should be wearing a mask aside from this kind of shame rhetoric. I also feel like we're not academics. I worked briefly in clinical academia, but we're not academics. And I feel like the academic approach to the,

non-academic approach is very different. Like there's a lot of pride, a lot of like ivory tower type approach. And I feel like they take a stance and they just double down. You know, like I, and I, but I think so I would say yes. I think it's very emotional, a lot of pride. They want to be an expert, you know. And for whatever reason, the black and white, very bold statements, those are more impactful. Those are the things that get shared and for whatever reason. And it's so frustrating for us because we always say, science is all about the gray and there's nuance. And like, now I do mask if I'm going to a like a you know I don't know a supermarket or whatever and it's because there was an optic in cases like things change like I don't see the reason that we need to double down

on a particular stance it's like why can't we evolve why can't we acknowledge that there's nuance and gray so I don't know if I'm answering your question no I mean I have a different theory oh I want to hear yeah but but but I would I mean I think it's also I think it's definitely there's definitely a little bit of that ivory tower yes because because again I did work in academic research, and now I'm not. Now I'm in biotech. That's my full-time job. But now I'm also involved in, you know, this Lyme Disease Foundation. And, you know, again, the goal of that is to provide, you know, evidence to the masses as well and dispel misinformation. And I think, you know, academics who live in that academic bubble, they don't, they don't realize that the rest of the

world, there's a gap, right? There's a gap in scientific literacy. There's a gap in understanding the granularity of things. Trust. there's yes yeah exactly yeah i'll tell you what i think is causing it algorithms oh yeah i could agree with that too i mean it not like this is an evil ai thing coming to get us i think clinicians scientists whoever these people are that are very heels dug in yes one way or the highway have realized that if you take the stronger stance the algorithm then will have a higher chance of recommending your content. Totally great.

Therefore, this is the point where I think they make the mistake. Therefore, they think they're being more effective. Yep. Because they're saying, look, this, when I'm very heels dug in, I get more views. That means I'm being a better clinician doctor or whatever. But the reality is the type of view where you're getting there is someone who just wants to argue rather than the person's mind, you actually need to change. You're becoming the clickbait.

Yeah. Yeah. And we always say, like, just beware of any extreme. statement. But you're right. The statement's like, this is going to kill you or this is going to cure you. Like, those are what people want to hear. It's like, oh my goodness, here's the answer. And it's boring when we say, well, sometimes, you know, like there's sort of not, not exactly, like sometimes, you know, whatever. You know what I'm getting at. And I feel like sometimes we get sucked into, like, will, like some of our posts, and I guess I'm being a little self-critical here,

like they, I guess people now, our followers who like our nuance are like, oh, no, this is a little bit reductionist. Like you came down too hard on this and there's nuance, there's middle ground. And you're right. Yeah. But I would argue that those posts that we do, it's because we're trying to reach other audiences. Yes. And it's a topic that we've already done a two-hour podcast on, that we've already done, you know, 10 slide carousel post on. And sometimes you need to draw in, but it's never a single format or a single type of media. But to your point, like we're not doing this like just for fun like this take what we're doing on psychom takes a ton of time and energy and effort and the reason we're doing it is to reach a large audience and have an impact yeah absolutely

we have to take notes no no that's that's what that's why that's what we're doing it it it the way that i like to think about it because i'm everything is reductionist to me because i'm not very smart so i have to make everything very simple okay so when you are in first grade i don't know when this is actually happening to learning you tell kids you can't subtract five from two because they're not ready for negatives yet. Right. And then you have a calculus professor going into this teacher and say,

you're an idiot. Of course you can. And it's like, well, yeah, but they're like five. But you're not there yet. Yeah, we're not there yet. So when you're making a piece of content and you're saying the end of the world is not here because COVID is happening.

And the researcher, that's the calculus scientist in this example, goes and starts yelling at you. You're like, dude, I know. But I'm trying to get this message. You have to think about your audience. And match the level of understanding. Exactly. And that is,

think the challenge with the academics because they're in teaching and communicating with other academic bubble they don't necessarily frame things in a way that's going to resonate with the public that's not at that level well and also i don't know if this is getting off topic but like the different platforms of social media it's like they're totally different so we're big on instagram which is you have an infographic you have 10 slides and then a caption on facebook it's all you know, what seems to do better, is more text-heavy. If you're on TikTok, it's a video. What was my point of this?

Twitter? Twitter. I don't know. Some of them are different in terms of effectiveness or anger. Well, and so what Andrew was getting at, like on Twitter, a lot of academics, like, really they get into the details and it's like academics talking to academics. On Instagram, we're using infographics to, to, like, take place for the general public.

And then when we like cross post, that's when we get into trouble. Exactly. Sorry, that was my point. We don't spend a lot of time in Twitter, but, like, I'll go on Twitter, and it's like, you know, very reputable immunologists who are literally dissecting a paper and going through all the different cellular pathways and the inflammatory cytokines and the different populations of T cells. And it's like, that's cool.

But, again, what's your goal? Should that be in a Med-Sai room on Twitter? Like, does that, should that be in the main feed? Like, is that adding to confusion to the general public? Like, I think it is. Because I think what our role should be as scientists and clinicians is communicating to the audience that needs to hear it. We go to conferences throughout the year where we can get into the nitty gritty, the granularity, the presentations, every single cellular process is happening. We don't necessarily need Twitter as a forum for that as well.

And we're focused on the takeaways. Like what's going to have the most relevance for the public? you know this is not a we're not speaking to peers necessarily right and we always say like I'm not an I call an architect if I want to build something like I'm not saying I'm better than anyone because I have a doctorate right but we have very specialized expertise we went to school we trained for a freaking decade you know what I mean like we can't communicate all of the detail in all of our posts so our goal is to distill it yeah yeah no there's there's never been a theory or concept presented at a medical symposium that's not met with some level of debate

But if that level of debate happened in the public every time, it would make people very confused and that's what's playing out on social media. And nobody would trust science or medicine as a result. And we're seeing that erosion in a very concerning rate right now, I think. Which is why I am trying to prep the audience and educate the audience that this level of discourse is to be expected. That's my new thing on the channel is to get people to say, okay, here's what I'm saying and expect a level of pushback

that not everyone will agree with what I'm saying and here are the reasons for why to hopefully the same way that if you're making a marketing campaign, you're telling the brand, hey, I will do this. 90% of people will love my post, but then 10% of people absolutely hate it.

You're prepping them for the potential negative feedback. Same thing for the audience when it comes to medical knowledge. And I've seen this play out on Twitter with some infectious disease docs that I'm friendly with up north in Canada and they're getting absolutely destroyed for things that they've said in the news. Unfairly, when they are presenting a very balanced approach,

and it's not one way or the highway, exactly what we've been talking about. Let's move off actually the pandemic, because I think it's people are probably, pandemic of tired. There are three subjects that you guys wanted to discuss today that you're feeling is very prevalent in science communication, maybe in the health, wellness, woo-woo, space, there I say. yeah what uh what's one of those topics so i think i think the first and actually you know this really kind of goes back to a lot of what we've been discussing but it's the concept that you know people

will co-opt a legitimate scientific term something that's happening on a cellular level or an organism level and they co-opt it to explain away a whole slew of ailments and you know one of the the terms of the day is inflammation right so inflammation is a normal process of the body it needs to happen for life. For life. It's balanced by the anti-inflammatory responses, but you find even scientists, even clinicians, definitely the general public, definitely like the wellness influencers, use it as a way to explain or create in some ways new medical issues, right? So, oh, you have GI issues, it's inflammation. Oh, you have brain fog. Oh, it's inflammation. Oh, you have this. Oh, it's inflammation. Like, it's not, again, nuanced multifactorial. If you didn't

have inflammation in your body, certain cellular processes would not exist. Every time you literally consume something, you generate inflammation because you're, you're breaking down a large molecule into smaller molecules. That's a catabolic process. Are you launching a PR campaign for inflammation right now? Yeah, do it's not every time you say. You're like, inflammation is not always bad. No, is that true. It's true. It's true. So you're saying people have villainized inflammation. to make it like a buzzword for every condition. And while it's true inflammation occurs in a lot of those issues,

it's always balanced. Yeah, it also occurs in other things that are very good. Yeah, and also, like, the most inflammatory thing that you could do as a person is exercise. Yeah, exactly. So, you know. Or get an infection and need inflammation. Right, right, right.

Right. So, you know, it's very frustrating as an immunologist because, you know, that, you know, a lot of the other buzzwords that come along with it, like autophagy and free radical. Like, these are all, like, work. words that have meaning in science. They're sexy words. Yeah.

But don't have meaning when they're being applied in like the health and wellness space. And it's leading to a lot of like cropping up of faux medical diagnosis, a lot of pseudoscience. And of course, it's praying into these people. Narrow something down. Give me some pseudoscience diagnoses. Well, so like the leaky gut syndrome. That's one that is often. What is, what do people say about leaky gut?

Let's define it for the audience. So people are claiming that leaky gut. syndrome is an issue where your intestinal cells become permeable so that food bits and toxins are leaking out from your GI tract into your bloodstream and are leading to inflammation. And that's why you have all these symptoms, fatigue, lethargy, brain fog, headache, bloating, diarrhea, whatever, like every symptom under the sun. So intestinal permeability is a scientific term because your cells are not cemented to each other. They have little junctions, little proteins that are like little gaps, and that

actually allows the transport of molecules that you need, but it's not allowing food bits and bacteria and toxins to leak into your bloodstream. And so again, scientific term got co-opted for the wellness. And now they're diagnosing this or self-diagnosing it and then selling supplements to cure your leaky gut because it's all due to this inflammation. Got it. So they've kidnapped the word inflammation, created a condition called leaky gut that people have real symptoms for, and instead of getting the treatment and diagnosis of what their symptoms are coming from, they're getting this faux diagnosis, leading them to missing the proper treatment, which is the big problem.

And that's the big problem that I have is that, you know, they're getting preyed upon by these people that are making a profit. Well, that's the thing. They're all vilifying pharma and industry because it's for profit. what do you think the wellness industry is? I mean, everything, are people so naive? Everything is for profit. Like, we don't work for free.

I don't understand this concept. It's the most frustrating thing in the world and love to talk more about that. But yes, so then it gets co-opted by the wellness industry. And my big thing, I guess, related is this natural and the appeal to nature fallacy and that everything that's natural and clean is automatically better for us.

And that anything that's synthetic or made in a lab It's just, it's bad for us. It's toxic and it's full of chemicals. And we always say everything is a chemical. And of course, you know, that's not true. And the example we once gave is that, was it Willow Bark? Yeah, well, yeah. What is that thing?

Salicillate, which is now, you know, now we've synthesized it into aspirin. So people were chewing on Willow Bark, eating Willow Bark for pain relief. And yeah, that was great, but they were, you know, pooping their brains out vomiting. There were all these GI side effects. And now we're able to concentrate it in a lab, get rid of all the stuff. that was making people violently ill. And also, spoiler alert, by synthesizing things in a lab,

we're preserving nature because we don't need to destroy nature. You know, we're able to. So I just don't understand. I feel like we're as a society moving towards this idea that everything that's a drug or synthesized are made in a lab manufactured

is automatically bad for us. And this wellness industry, multi-billion dollar, you know, booming based on this premise. So that's my act to ride. And the reality of the wellness quote-unquote wellness space is the supplements they make are

not regulated by the end up yes yes but I was they're synthesized and purified in the same ways that yeah they're made in the lab no no I'm even in the same ways in worse ways because there's no oversight no quality control exactly exactly

and that you know and like so you know like the appeal to nature fallacy I mean it's everywhere right like I only want all natural ingredients it's like well you know arsenic is all natural too and botulism toxin is all natural too and you know I mean and you know again those have higher toxicity

than a lot of synthetic things. So I have someone in my family. I'm not going to say anything more than that who was just diagnosed with Graves disease. And, you know, her whole thing is that she does not want to take any medication for it because it's synthetic

and she only wants to go on the, what is it, the AIP, autoimmune protocol diet. Which we've covered on our podcast. She's going gluten-free, dairy-free, and she's only doing homeopathy. I mean, you as a clinician, like I'm sure you deal,

I'm sorry, I'm asking you a question. But, you know, ask me a question. But like, how do you deal? I'm sure you get a lot of people who come in and are like, oh, no, I don't want to treat that with medicine. It's toxic. It's bad for me. I want to treat it naturally. I mean, do you get that a lot?

All the time. In ways on both sides of that equation. Okay. So I'll have people come in and say, I don't want the pill for this. I want the natural approach. And then on the other end of the spectrum, I have me saying you don't eat antibiotics for this. And they're depressing. Oh, yeah.

Yes. Or I'm depressed. And I'm like, okay, well, we need to do some therapies and talk therapy. And they're like, go, I want the pill. Right. So it happens on both ends. Right. For sure.

Which is why the pendulum, again, I'm trying to bring it back to the middle. And it's multifactorial because, you know, it's what, like I want to tell her, you know, we're not saying that you take a pill for everything. I mean, medication helps people, you know, all the time. But yes, there are other things, other factors, other lifestyle changes that we could make. It's not like we're saying you take a pill, you take medicine, it'll fix it. And then to your point, you're right on the other side of it, you know, people, like I know, my best friend's a pediatrician and she said, like, parents come in, they want to leave with

a prescription. You want to feel like you're doing something tangible to make your child better or yourself feel better. So they'll, you know, they're prescribing medications and antibiotics even when they know this is viral and antibiotic is not going to do anything. Yeah. Another one of my friends, actually, he was a med student when I was doing my PhD and we taught clinical microbiology to the second year med students. And he's an emergency room physician in Arkansas now. And he was like, I'm guilty of prescribing antibiotics when I know I don't need to because they come into the ED and they want something to leak with. Yes. Yeah. Yeah. Well, the way that I try and position myself in times where a patient might come in and want something natural or have a distrust of the

medical system, I try and put myself in their shoes as much as possible and figure out what is the cause of this. Yes. And as a person who's experienced a decent amount of life in my young age of 33, I have still seen what they have seen, which is doctors don't spend enough time. They want to make a quick diagnosis. They want to throw a pill at it because we don't have the time to discuss lifestyle modifications, to debate lifestyle modifications, to see if the patient is actually doing this because we don't have enough appointment slots available for follow-ups. So as a result, I get why people believe in the naturopathic cure so everything better than the modern system. We talk about this all the time. I mean, the healthcare industry has a lot of flaws and

that's a top for another. People are suffering. There are chronic issues. There are major problems with their health care system. And I hate when people come in and are fighting with my husband and blaming him. It's like he, first of all, he's getting chastised from the higher reps in the administration. Move fast. See as many people as possible. He wants to spend more time talking to his patients. So we get why some people are drawn to like naturopathy and chiropractic and you know, stuff like that. And we just want to educate people like, okay, we understand why you're drawn to it. There are problems. But the evidence is. just not there to support it. And if you're foregoing actual, you know, necessary medical

treatment and, and, you know, care, that's the problem. Right. You want to put onions on your feet. That's fine. You know, if you're sick, that's fine. But if you're not getting your kid an antibiotic, if they need it for a bacterial infection, that is a problem. Yeah. This is where my sort of clinician hat gets put on and my scientist hat comes off because guidance general for the population might be, okay, get this patient, you know, thyroid replacement medication, but patient wants to do this unique diet. The treatment says only do the pill, not the diet. But now for this patient, I will try and find some level of middle ground where, okay,

maybe we don't have to take the dose that I was going to start you on. Let's start on a lower dose, recheck, and make some... This is against what the evidence shows. Yes. But I'm doing this with the knowledge. Well, you want to get trust. You want to get trust and make my way to the time. Because presumably you know or at least have an inkling that the other modifications are not going to be as effective.

And so eventually you're going to have to get them up to that dose, but you have to take baby steps because they're not there. You're being practical and realistic. You want some adherence, you know, better some medication. Let's start them, you know, then just having them completely say, okay, this guy, this doctor is not listening to me at all. You know, he's not hearing me. And we want to be heard. Right, exactly. So we totally get that. Andrew, you sometimes though, and I love to talk about this, like the slippery slope, like we sort of try to figure out like, do you want to talk, is it okay? We talk about it? Yeah. Yeah. Okay. How like, you know, sometimes people will come for us. It's like, well, don't, you can't say blankedly that like, you know, chiropractic is bad and acupuncture is bad and all this and that. And like, it's true. Like there is no evidence, right? So we don't want, we're not condoning it because there really is no evidence to support its use. But then if we see. say, like, don't do it. It's not helpful.

Like, people shut down on that. We try to, you know, approach it from like a risk like, like there are some legitimate risks with X, Y, or Z. Right. You know, the data don't support it. Right. We've done a lot on the placebo effect, which, you know, we kind of discussed earlier on here that, you know, if people believe that they're getting something that's going to help them feel better and sometimes it can also contribute to that. And a lot of people, you know, they're like, well, I took the supplement and I felt better. And it's like, well, you could

have been at the end of your infectious illness to begin. with. And so it's just a matter of time. But we're trying to get people to think more critically about those sorts of things. And, you know, the wellness industry plays on this, like, desire to get a quick fix. They're like, well, you're going to take this, that, and the other. The reason why they're, quote, unquote, winning is because the wellness industry, you're requiring people to think critically at a time where they're exhausted, they're tired. They have a lot of stuff going on. And maybe they don't have the health background to know. And then the wellness industry is simplifying and asking them to not think critically and saying, here, we've already solved this for you. Just take

And then we expect people to be like, wait, why don't you agree with us? But you know, what's interesting, and I would love your thought on this is that, you know, so you said, you know, you have people, they come to you, they don't want to take a pill. But then the wellness industry packages up a pill of herbs or whatever and are like, take this pill and they're much more inclined to take that. You know, what's what I would explore. That's what happens in my visits. So just my last guest on the podcast was Angela Johnson-Reyas.

And she was telling me about how she prefers this naturopathic approach. And it would have been very easy for me in that moment to point out and say why her thing isn't proven to do what it's doing for her. But what do I win by doing that outside of making myself feel good that I'm morally superior or not morally knowledgeable superior or whatever? It gives nothing to the conversation. So instead the conversations changed to what happened that she went this route. And she started telling me all those stories of doctors neglecting her.

not answering her questions, jumping to medications, giving her an antibiotic when they were like, I don't really know if you need an antibiotic. And now all of a sudden, I can then create some education, not even in the moment of where we disagree, but in general, why my mindset is negative on an industry, higher on this industry, and we can create a level of common ground instead of constantly putting stones in our path. Yeah. And I think it's a broader issue. Like we know there flaws in the health care industry. Often scientists get conflated with the health care industry, which were typically not, you know, directly involved with. And clinicians often get lumped into the category of, I had this one bad clinician that ignored my complaints. They didn't believe

when I said my pain was at an aid. They didn't do this. And then, and then that leads to a general mistrust of all health care providers, which is a whole other, you know, issue that needs to be addressed. I don't think that's unreasonable. Yeah. I think if you've been in one crap situation, and then you're put in that same exact situation, the fact that you're experiencing the same set of feelings that you did on the previous one is almost human. Yeah. And for us, as doctors, to not believe it or be confused by it is weird.

Right. Well, people always have risk aversion and aversion to negative experiences. Like, think about, like, you go to a particular type of food restaurant, you had a really bad meal. Like, you know, the next time you're thinking about a restaurant, like you might not even look at that type of cuisine, not even just that restaurant, right? That's how the mind works.

Yeah. And we've seen that even like an animal, mouse studies or rat studies, being someone that has studied medical history to some degree, mostly for the YouTube channel, not because I'm smart again. I've seen how science gets really overconfident at times. Yes. And I have to be open to the idea that things change and not just data like improving, but also breakthroughs in how treatments that we once believe to be really good are not really good

or something that we believe to be bogus actually got some proof behind it. Yep. So when I hear like the topic of, let's say, acupuncture come up, and I have a patient who's trying to skip surgery because we've seen negative outcomes in their specific instance with musculoskeletal surgery, and they said, I've tried physical therapy, I've tried epidural injections, I've tried this, do you think I could try acupuncture? I think it works, and they try it.

I in this situation as a doctor have to think about, okay, what is the risk of them trying acupuncture and not overplay it, the risk. Because it's very easy as a doctor has to be like, this is risky for no reason. Right. It's not risky for no reason. Even if you believe acupuncture doesn't work as a doctor, there's a 30% chance of it will work because of placebo. Right, right, right.

Now you have to think, if they can get a 30% benefit from this that they believe in acupuncture, what is the true risk that they're experiencing? And the risk is quite low. So that's why I say, I think it's worth a try. But would you agree with that? Well, so, you know, we actually did an episode on acupuncture. And, and I, you know, our general conclusion when you look at the evidence is, yes, the risk is pretty low. There are some documented really severe adverse events like pneumothorics because the, you know, needles are placed inappropriately.

But if you look at kind of like the realm of pseudoscience, I guess we can kind of lump that into that bucket. We're going to get a tag for that. No. Yeah, I wouldn't put acupuncture in pseudoscience. Psexual science is made up. Yeah, that's true. Okay. So alternative.

Yeah. Integrative. In the bucket of all of those options, the risk of acupuncture is low. And again, there could be a, you know, a potential benefit per placebo. I think there was a little bit of evidence that for certain particular conditions, especially when coupled with other modalities like physical therapy, actually did have a benefit. And I think if you are an individual and your option is invasive surgery with long recovery

and maybe trying this for eight weeks, you know, and the risk is low and you make that personal risk assessment. That's why I don't destroy integrative therapies, simply on what you just said. And there are doctors in this space who will say never. Yeah. It's quackery, they'll downplay. And I understand where they're coming from. But at the same time, I got to think of that practical implication that you just referenced.

It's so interesting because I feel like we're now kind of labeled as like the bitches of cycle. I'm like, me like, I'm sorry. You're on biased science. Sorry. No, no, I'm not self-labeling, Andrew, I'm telling you, people call us this, and that we just, like, shoot down anything that's alternative. Yes. And I need people to understand, like, it's because we're coming from the perspective of scientists, and there's not a whole lot of evidence for it. And you as a clinician, I understand why you're maybe more open-minded to it and trying to establish a connection with a patient. You don't want them to shut down completely. Right, you need them to buy into your recommendations. The context is different. From an evidence point of view, there's not a whole lot, whole lot of evidence for its use. Right. And I worry as a population as a population. But then what individually. Exactly. We're working on a post about clinicians versus scientists and how it's

individual versus population. Right. Well, exactly. And people like we're describing, our goal is to describe the average. And yes, there are outliers. I don't know. It's such a different like different world. And I think. Well, it's also a different end goal, right? Yes. It's a different end goal. Yes. So the approach will be different. I don't want us to be seen as like just being anti all these things. It's just where we're trying to educate people on the available evidence. And then, but by the same point, it's like, are we also eroding then the impact of the potential placebo effect by telling people, you know? I don't think so. I don't think it's that true. No, because I think, I think, you know, and I think your job is to be unbiased and fair.

Yeah. And so most people, you know, I think most people are like, yeah, we get this. You know, and we always try and balance it with potential risk. So like if the potential risk is low, then, you know, that's fine. But like, a lot of times it's like, well, you don't need to waste your money on this supplement because there's no evidence to support its use. And a lot of it is like, people are spending thousands of dollars on these things that are being sold to them on social media. And our issue, like, we're not judging the people who are taking these things and trying these therapies or whatever, alternative therapy. You know, because again, I understand, like, I saw my dad struggle with emphysema and cancer. And, like, we were thinking, like,

are there? Like, for a time, we were thinking, like, okay, the treatments aren't working. Like, should we explore these things? Like, I understand that. I understand that. mindset of desperation and of chronic pain and fear. I get that. Where was I going with this? I lost my dream of thought. But balancing it with evidence. Balancing it with evidence. I don't know what I'm going. Sorry, thank you. I'm not judging the people. It's about the industry that's playing. Thank you. I'm sorry. I do this all the time and she has to finish my thoughts. So we're not judging the people, but I think oftentimes people come at us like you're being so rude and you're judging us. No, it's the industry and the charlatans and the

sneak oil salesman. That's what frustrates us. They know there's no evidence. The way that I pose it to someone who is a firm believer in supplements and believes that they work for all of these issues is if you walk into a supplement store, there's a supplement to cure aging. There's a supplement to cure ugliness. There's a supplement to cure sex drive. And yet we're all suffering with those things and every person in that store still has always right yes so like that's my thing I'm like if it worked then everyone in the supplement store would be yeah they would be gorgeous and invincible and no great hair yeah so like I hope that I can just induce skepticism on that yeah it's a great I mean it's a great tactic and and you know I mean we try and we try and approach it

you know okay well this is the evidence you know if if this was you know like There's a reason that they have to use these buzzwords, right? There's a reason that they have to sell it in this way because there isn't the data to support it. And we're not in front of a patient like you are. Like, it's different for us when we're presenting information. Like, we don't have that same relationship with people. So I really do understand, like, what you're saying and I respect it. I think what we're all coming back to the point is that this is a collaborative effort.

I'm not going to try and run scientific rigorous trials because I'm not good at setting up those trials. and on your end making the deduction on which individual level to make these recommendations probably doesn't make sense either. Right. So that's why we team up

to do it in that way. And that's how it should be and it's unfortunate, you know, and I think social media certainly has accelerated it, but the pitting of each other against each other

is, I think a good title for this podcast is like doctor versus scientist. Ooh, oh gosh, okay. That way it's sounds a little salacious. It does, but it's not actually. It's quite unified.

I was going to just share a quick story of how, okay, for placebo effect to work, you have to believe in it and all these things that we know. I never believed in acupuncture, and I had a torn labrum in my left shoulder. Oh, me too. Really? My right, though. Okay. I had surgery.

Ooh. So here's what I did. I had this issue for three, four years, probably from being a goalkeeper landing on an outstretched arm or maybe bench pressing incorrectly and I had it for a long time it never really went away there was maybe a day there wouldn't be so bad but it would constantly lock and catch and then my dad took me to his friend who's a pain management doctor who also did some acupuncture he did one session and I didn't believe in it I was like what is this ridiculousness I didn't have pain for 10 years really and I don't know how to wrap my head around that as a physician who I can't understand

the pathway of how this worked and then I had a Same instance, I had a medial epicondylitis, not tennis elbow, golfer's elbow from boxing. And I went, I'm like, you know what, this has been going on really long, let me try acupuncture because it worked for my shoulder 10 years ago. I went for a session, 85% relief of symptoms despite physical therapy failing, molyxicam failing, all these things that I tried. And then this is where it gets tricky. I went for the second acupuncture session for the elbow when I probably shouldn't have.

It was already so much better. But the person said, come back for a second session to make it 100%. He hit my nerve. It got worse. And I got, no. And I had ulnar nerve neuropathy. That was terrible for like six weeks that I had to seek second opinions for. My nerve was lighting up.

So it goes to show. Yeah. Can it work. And the risks are there. Right. So I'll tell you my story about my. So I used to be a competitive judo player. Okay.

Player? Yeah. Is that fighter? Fighter. Yeah. Give yourself the credit. Fighter. Fighter.

I used to beat the crap. of people. Don't mess with Andrea. She like, I was a player. And so I tore my labrum. I was going to throw somebody and, you know, my arm was here and their body went that way. And anyway, so it was like an acute slap tear. And I didn't want to get surgery because, you know, I knew it was going to be an impediment.

And I did physical therapy and it helped a little bit. And then I postponed it for 10 years probably. And then it got to the point where my biceps tendon like basically. Started suffering as a result. frayed and so they had to slap it all together again. But I ended up finally giving it and getting the surgery in grad school. And so I remember

I was in my sling and I was pipetting. I'm a lefty so it actually, but I drove stick shift and I had to trade cars with my dad because I couldn't shift when I was in a sling for a month. But I didn't try acupuncture. I just tried physical therapy and it wasn't enough. Imagine it worked.

Did it work? Imagine it worked. Oh, imagine it worked. No, imagine it worked. You were going to have saved the surgery. You could have pipetted. I could have type had it with both hands. But yeah. But it's interesting. And I also had the same thing happen. And I'm also an osteopathic physician.

So I'm a DO. So we have some extra hands-on stuff. But none of it is magical. It's all based on like physical therapy-esque reflexes of the human body. And we see people get better from things that they really shouldn't be getting better from all the time. I had Ashko Schlaher growing up where I had this like inflammation below my knee. And it's very common in young folks and adolescents to experience.

experience this. And it hurt for like four years. Every time I'll play basketball, it was a chronic issue, whether it was Oshka Schlotter or Jumpers Knee, same thing, basically. And I did, I saw KT taping was getting hot. And KT taping looks very popular. It looks very magical. It looks cool, like different colors. It got me excited about I was young. I was like 21 at the time. I put on KT tape. I did it the way that they said for the knee. And I wore it for seven days, showered with it all of it. it never hurt again for the rest of my life. I need an explanation. I didn't believe in it.

So I actually, I started taping my shoulder after. What happened evidence-based medicine scientists? Well, it was during the same fanaticism when there wasn't evidence. Okay. But it was a, it's sticky tape, right? It's sticky, stretchy tape that, you know, and they were like, well, it might, if you tape it tight enough, it might help hold it in place when you're recovering post-surgery. And it's so popular. with the elite runners now.

But yeah, there's really, there's not a lot of evidence behind it. There's not a lot of explanation as to why it would help behind it. It cured me. How? See, it didn't cure me. It didn't cure me.

He wants an answer. How did it cure? I don't have an answer either. So, like, that's where... Yeah, that's your placebo infection. That's my humility of medicine has to be like, okay, like, look, it cured me. And I would be the first person

that if a patient brought that in, I bet, come on. But it cured me and it worked. So, like, I have to be... What color KT tape did you pay? It was just black. It was basic. It wasn't even fancy.

Science needs that humility too. And like we've done posts like science isn't perfect, you know. Yeah. So. Because it's sexy to say trust the science. I know. I know. We used to use that hashtag trust.

It's beautiful for like a wellness influencer to say like all food is toxic. Yeah. Well, we were just in. Well, everything is toxic depending on the dose. At the dose. At the dose. Well, there's a post that we're going to be debunking soon. And it's like, you know.

Sub in for all your organic counterparts. Yeah. Because they're non-GMO. Right. So they show all these things and the takeaway is eat organic because this thing has GMO, da-da-da-da. This has red dye. So what? None of those things are detrimental. Why are we vilifying these things? You know, so. But anyway, again, I don't even know why I said that. I keep losing my train of thought. Don't vilify the things. That's it. But no, no, there was another way. Humility. Humility. Science isn't perfect. I don't know.

And science is sexy or science is. Oh, because it's sexy to see those things. It just, you know, it seems. To create uproar. Right. And this person has a million followers on, you know, Instagram is getting re-shared, re-shared. And then we have a very boring post about how GMOs are not inherently bad and how dies or not, you know.

And that doesn't get shared a million times. It just doesn't because her post is sexier. So we have to figure out how to make science sexy. Well, I have, maybe this is not the solution for you, but this was my solution for society that I could come up with. I have been able to get a pretty big social media following. with never straying from evidence-based recommendations on the channel, which is almost unheard of

because most people who are medical influencers who have millions of followers are usually sharing some kind of bees. They're hawking a product or something. Yes, exactly. They're doing that. That's like Dr. Oz thing that constantly comes up. Don't even get me started.

I live in Pennsylvania. He's not even from there. And I've also, to be fair, when I was a resident, he invited me on his show, and I went on to talk about a program I piloted my hospital with doctors working out with their patients. So at least, like, he gave the evidence-based doctors a chance sometimes.

So I'll just say that. Once upon a time, he was not a Charlottetoracic surgeon. He trained in my hospital, and there's countless physician that said he did amazing surgery. So something happened. Right. Something changed. Evidence changed. And we learned to me.

Or the grief. No, no, me, our evidence of what he was doing. That's why our judgments have changed. We both were like, on you. And I decided to create a course. for professionals, whether you're medicine, a lawyer, bookkeeper, and you want to put out evidence-based good info and you don't know how to do it through media or social media.

I kind of created a playbook of how you can do it and be successful. That's my thing. Because otherwise, what I see young doctors doing is either selling out to the bunk and selling the nonsense miracle cure stuff or they go into this, I'm going to do call-out culture and join Tick-Toxic and yell at these people. Sorry.

No, I hate it. I mean, I'm not, don't do that. There's a middle ground. Yeah, we don't want to do successful. We don't want to do any of that. You can do all of this stuff. We get offers all the time.

This is what I wish people understood. Like, oh, you could make so and so amount of money if you push this product. And we say, no, we're not. We're not going to do that. But if the product was good in evidence-based, you would do it. Correct. And there's nothing wrong with that. Well, the public thinks there's something wrong with it.

I know there's, we know there's nothing wrong with it. And we have to make a living. We have to make a living. Things that we've been, you know, that we've partnered with companies. I have to make a pause. Again, I think scientific minds are corrupting you right now. Uh-oh. Do you really think all of your audience is upset when you make money?

No. Not all of them. How many of them? Percentage-wise. I think it's a very small percentage. Exactly. So why are you upset by it? I'm, okay.

I get upset by it. Just gets upset. I'm a people pleaser. I don't know what's wrong with me. And I tell her to stay off comments. Because I know how pure our intentions are. And like, I- It hurts her as a person.

really does. It offends me because we could be making the quick cash. And like, I'm going to be real with you. Pfizer and Moderna, they have foundations. We talk all the time about vaccines. We have not taken a penny from Pfizer and Moderna. But like, it's like if they have foundations and we could apply for a grant where we are getting funding to do the SICOM that we're now doing for free, why should we say no to that? And I don't, like, I, that's my struggle. You know, and the thing is, is the critics are going to be the ones that are going to dog pile and comment. And, you know, It's going to be a very small proportion. And I try.

They're the louder. Yes. They're very, yeah, they're loud and they're the minority. Because we're humans and we have a negativity bias. So I try to tell her, turn off notifications, don't read the comments. We don't eat. We don't sleep. We don't shower.

We both have full-time jobs. Sometimes. Whatever. No, yeah. But my point is like, I just knowing. My doctor, mine turned on. Knowing what goes into what we do. It just, it hits a nerve.

Of course. And I don't know. I have to. to stop myself from doing that. And also, it would be... She has to stop reading the comments is what she has to say. But also, we should be compensated for our time and expertise. And so...

I think this is the reassurance I'll give you. Because I am the same position as you are. Okay. I get very upset when I read the comments. Sam frequently tells me never read the comments. Mike, stop reading the comments. Smart man. There was a period of time where I needed to literally go to therapy.

And part of the advice of the therapy was to at night not read comments. And my critique of that advice was initially that that, That's avoidance behavior. We shouldn't practice avoidance behavior. And she taught me that avoidance behavior done recklessly could be problematic. But if it's targeted at something that you see as a problem for you, it might be a good behavior and a good coping mechanism. I've actually taken the practice of not trying to get off social media like after 8 p.m.

Like my job, I often work long hours. And so I will be online officially, you know, in the evenings. But I've started, especially recently, just staying off. and sometimes Jess will like screenshot a comment or a message. And often I just don't even acknowledge them anymore because it does. It adds to my anxiety and I have to disconnect. Otherwise, like, I don't sleep. I already take Trasidone to sleep.

And I have to shut that part of my brain off. You don't know how many times we've considered like just shutting down the page. Like it's like this is just. Please don't. You know what it is. We need you. It's tough because. Us simple clinicians need the smart scientists.

Our name is not helping us though. Like, and I love our name. I had a really clever name when we first, well, I wanted to do like a play on like, you know, show me the data. Like there was like some other, remember, like once. I thought I came up with show me the data. I don't remember. There was a bunch of ones that we were.

Judo match. Yeah. I would throwing around. Very much loose. But, but, you know, we had to also factor in the fact that it was her data analytics firm that was kind of, you know, bankrolling the podcast in the first place. And, you know, there were other people involved in some of the decision making. And so we couldn't be as witty.

or, you know, yes, we wanted to. Like, we are in two very different scientific fields. So trying to, like, find a common ground. Yeah, like, I wanted to do some, like, self-biology. Like, you had, she had some things. I was like, I had some fun. I had some fun. Yeah, I don't even, I don't know. Like, whatever. Anyway, you see her she talks. She's a very very technical. That's why we're a good team. I'm more

a big picture. Um, so what do you think? Can I, this is a really, I'm curious for your input. We're unbiased science. Um, and all the time we hear more like bias science. I mean, you don't even know. What if Moderna and Pfizer, or their foundations funded us not to, you know, talk, oh, get the Pfizer or by Vailant. We would never do something. Like, we just wouldn't do that. But to help fund our education efforts, should we take it or would that be like Sycom

suicide? I don't want to put you, I'm sorry, I'm putting you on the spot. For you, it might hurt, but in general, no. Okay. Meaning for you knowing your personality, as you've shown it today. Oh, me personally. Yes. It might be hard for you to function in that.

space now okay but what about like individual so no no so individual general advice no it's not suicide okay yeah okay individual advice it's might not be great okay that's my clinician okay because i feel like we would be very transparent like i would be fine with it any time anytime we do a sponsor you're very clear you're yeah it's always like she sometimes is over i know i think i say like we just did can i just i know i don't talk too long but like we just a podcast on infant feeding. We brought on two pediatricians. We all happened to be scientific advisors. Except for Andrea. For Bobby. But we're Bobby Labs, which is the scientific arm of this formula company. They didn't even pay us to do the podcast. There was no payment. There was no

script. It was just, I felt it was important to disclose that we do have this advisory relationship with Bobby because I had, you know, people look us up and they're like, oh, look, formula a shill, you know, there's a relationship. So I maybe over-disclosed. There are people. Five people. Yeah, five people. Who are you educated?

Who are you educated? Okay. So maybe I'm over-disclosing. Okay, this is a thing like, I think, when a scientist at a presentation. I mean, disclosures is fine. Yeah, you always do have to dispose. But I don't think you have to go and explain it away in the stories. You don't have to follow it up with like, okay, we didn't take a penny.

We didn't do this. Like, just say it. Short of like giving a, like, a, like, a. copy of the agreement to the public like I've thought about that like literally no one is getting us a script we are in control of everything we're saying we weren't we didn't even if you were shady the audience would know yeah okay and when I say the audience that's the majority of the audience right and you have to remember like how many followers there are versus how many are the people that are actually dog piling in the comments no it's very hard it's very hard because I struggle with the same

thing that's why I can speak to it right but um I even just did a campaign right now with like the COVID-19 vaccine project where they reached out to us to do sponsored posts for the vaccine. I'm like, I don't want to take money for the vaccine, not because I'm high and mighty, just because I don't even want to create that relationship for people. So I said, I'll do it. You could use my image, I'll post

about it, but use the money to buy space in newspapers or billboards or whatever it is to put the message out there. So like, you don't have to fall on the knife every time. You just have to be forthcoming. And once you are, and you're an open book. Yeah, yeah. People will see it.

It's like when you step into a room with someone and you spend an hour with them, how soon do you know that they're full of shit? Immediately. Immediately. That's what your audience is doing. So you don't have to worry. And if you make a mistake, it's okay. And there are people that follow just to be a troll.

And those are going to be the ones, you know, so you don't have to engage with them because that's just giving them energy. Tonight we're doing a partnership with, it might be the group you're talking about the COVID vaccine equity project. Oh, yes. That's the project. So the AAPP. board chair, Sterling Ransson, he's

going to come on and chat with us. So they get funding from that form of Nivartis. We weren't fun. But again, like no one told us what to say. We're just educating the public. And we're just having a discussion with, of course, people focused on that and we had some comments. No, it was person.

It was actually one person. From now on, when you say people, this is an easy trick and something I started doing. Say minority. Minority. Yeah, okay. Just say minority focused on them. And also, same with like when you're like, oh, the comments are coming in hot. Like, it's three people, you know. Okay. Okay. Okay. People. The only time where I actually get upset with the

minority is the situation of how it's your peers. When it's your peers. And that's when I get really important. But it's not your peers. It's randos. Well, that was like the post on Ozmpic or whatever. No, because those weren't our peers either. Some pharmacist and empty. Okay. Well, there was, you know hope. But okay. We're not going to talk about her. But yes. So as you can tell, it's a very complicated space to existence. Yes. Yes. I'm glad we share all these trials and tribulations, even though we're on opposite ends of this collaborative spectrum of clinicians and scientists. But it's collaborative. So, you know, it could be a circle.

Yes. More of this. You know, if you have a line and you bend in a circle. Yes. This is a triple van diagram. If I was having an aerial view, we'd be more overlap than that. Yeah. Well, thank you for coming on.

Thank you so much for having us. Keep up to good work. Don't stop. You're not allowed to. If there's a point where you want to stop, you DM me and say we want to stop. And I'll fight you. Okay. I can't. I just accepted this.

She has a torn labor. I know her weakness on the right side. No, no, it's healed now. I had surgery. No, I'll break it. It's still crappily a little bit. Where can people go to learn more about you? You can follow us on Instagram, Facebook, Twitter, and LinkedIn at Unbiased SciPod. Our website is www.unbiased scipod.com. And we have a substack where you can subscribe.

It gives you access to our monthly live Q&As and our private Facebook group. and that is the unbiased scipod.substack.com. We have show notes for everything. Everything we say is evidence-based. We give the links to the primary sources that we use. We also have, I said show notes, but we have a database, a searchable database that you'll see on our website

where you could actually search by keyword if you have a question about a particular topic. I love it. Yes.