The Checkup with Doctor Mike - The Lies Behind "Alternative Medicine" | Dr. Jonathan Stea

Episode Date: August 21, 2024

Buy Dr. Jonathan Stea's new book "Mind the Science: Saving Your Mental Health from the Wellness Industry, here: https://www.penguinrandomhouse.ca/books/727047/mind-the-science-by-jonathan-n-stea-phd/9781039008236 Follow Dr. Jonathan Stea on X/Twitter here: https://x.com/jonathanstea?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor His website: http://www.JonathanStea.com Executive Producer and Host: Doctor Mike Varshavski Produced by Dan Owens and Sam Bowers Art by Caroline Weigum 00:00 Intro 01:16 Where Misinformation Comes From 26:30 Is There Any Value In Alternative Medicine? 31:37 A Gap In My Knowledge 35:23 Worst Therapy He’s Seen 45:10 Dr. K / Unethical Treatments 48:00 Cannabis 55:33 Anecdotal Evidence 1:06:16 Is It Our Fault? / TikTok 1:12:52 Acupuncture 1:19:52 Prescribing Habits / Adderall 1:23:46 Is Mental Health “Weakness”? / Andrew Tate / Elon Musk 1:36:55 Life Coaches 1:47:00 Family Medicine Doctors Treating Mental Health 1:55:40 Biggest Misconceptions About Mental Health

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Is it making difficult for you to take care of your patients? Yes. Why? He's tweeting to hundreds of millions of people that depression doesn't exist. You're lazy and you're weak. More people hear that mental illness doesn't exist, more people are to believe it.

Dr. Jonathan Steia is a full-time practicing clinical psychologist and an adjunct assistant professor in the Department of Psychology at the University of Calgary. He has become popular on Twitter for his efforts combating misinformation and debunking quackery. In his new book, Mind the Science, he uncovers how alternative medicine grifters are able to trick you into skipping out on proven treatments

and instead pursue completely bogus wellness hacks, including buying expensive supplements and weird tech. I'm extremely excited to chat and ask him some hard questions on why so many fall victim to these schemes, how we can fight back against snake oil salesmen, and most importantly, If there's any truth in alternative medicine, that might actually be helpful. Sir, you've become an expert on debunking the world of misinformation

and allowing people to see the truth where there's a lot of lies. But a lot of those lies feel like truth. Why is that? The brain's not good at differentiating familiarity with the truth. It's called the illusory truth effect. Oh, okay. And so I think that's what we see, just rampant. all over social media.

You see repeated lies, repeated lies about mental health misinformation, repeated lies about health misinformation more generally. And we have, as health professionals, you and I, have an ethical obligation to try our best to correct some of that stuff because it affects people and it can affect their health decisions. Yeah, like if you're scrolling through social media and you haven't been taking care of your health, and you know that, and then you

come across a product that says it will fix the fact that you haven't been taking care of your health or the fact that it could be a shortcut for something where otherwise you would need to put in a lot of work for. Why is that shortcut so appealing to the human mind? Like being a psychologist, do you know if there's a mechanism by which that kind of trips us up? Well, we know that our brains kind of think in shortcuts. We think in heuristics rather than algorithms because it's just it's what's more expedient. It helps us make sense of our environment. There's so much information floating around that it's hard for our brains to process every single piece of information in our environment. It's just it's too much. We get overloaded. It's too effortful. And so our brains have developed heuristics and shortcuts that are supposed to work. They mostly work. That's why our brains evolved that way and they help us to make sense of the world. The problem is when they go awry. And that's what leads to things like cognitive biases or personal biases.

And that's, that is dangerous, for one. And more than that, it's more than dangerous because it's also capitalized on by, I think, the real world that we're living in now, which is the social media era. Because social media preys upon those biases. It literally capitalizes on them. So we want sexy headlines.

We want emotion-laden language. We want the kind of messaging that's going to tap into those. biases. And then our brains just kind of light up and say, okay, that makes sense. And it's hard to peel ourselves away from those biases. And so we know that there's a, there's a, there's a, there's a, Daniel conman was he won a Nobel Prize in economics. And he detailed these two thinking styles that we have. One's this intuitive kind of thinking style that sort of quick effortless, just quick processing, processing of information. And then we have this more. effortful analytic style of thinking. And we know from the research literature that when we can tap into that more effortful analyzing style of thinking, that protects us more from this kind of misinformation. Makes sense.

Thinking fast and slow. Excellent. One of the best. Huristics. Define that for the audience. Heuristics are, to help me understand it, I just think of mental shortcuts. So just, yeah. So, like, give me any, like, so is one example.

of this. When you see a word that's missing vowels, you can plug it in yourself? Like that you could still read the word, even though letters are missing? Yeah, absolutely. Okay. Because to me, when I figure that you feel your leg vibrate and you automatically reach for your phone, but it wasn't your phone. It just felt like the idea of something vibrating that your brain's like, oh yeah, use that same pathway and it creates the same action. Whereas you didn't even really think to say, oh, is that my phone vibrating? You didn't go into that deep, thoughtful state. And it seems like these days it's happening more and more,

to me, I think because companies are realizing that they can profit by tapping into the thinking fast mindset. Do you see a pattern in that with that evolving? I think so, yeah. That makes total sense to me. And it sort of goes back to that illusory truth effect, too, that we were kind of just mentioning. So, you know, if our brains are seeing repeated messaging over and over,

it sort of capitalizes on this on this heuristic it's like well then maybe maybe it's true right yeah like if we if you hear it enough times it could be true yeah yeah because think of think of how you know that would have evolved back in the day if we're you know if we're hearing repeated things over and over why would we question our our peers because they've survived so long they have wisdom et cetera et cetera yeah it brings a very unique situation where you want to to lean on experience because there's value in experience, but you also want to rely to some degree on innovation. And there has to be like this push-pull between the two of, okay, you want a doctor who's evidence-based, but also uses their experience to individualize the treatment

for you. And that's really tricky for me, even in the physical world of medicine, meaning treating pains, treating illnesses, viruses, bacterias, but in the mental health space, that's even more tricky because now it's becoming super subjective. Do you ever find that difficult when working with a patient or a group of patients? Totally. And what you're speaking to to me reminds me of what our ethical codes and our legal standards of practice are based on, which is evidence-based medicine. It's this delicate dance between three pillars, right? It's paying attention to the science or the research literature and the evidence space. We need to consider that when making clinical decisions.

But what also matters is our previous clinical judgment. So that's that subjectivity that's coming in and patient values and preferences. And so we're trying to delicately dance and juggle these balls in the air, so to speak. And that's what makes the clinical world challenging and more challenging than the lab, say. In the psychotherapy languaging or the psychotherapy research, world. We call that the difference between efficacy versus effectiveness. So we can evaluate whether a treatment works based on in a lab setting where it's really more controlled. And that's whether a treat if we find the treatment works is efficacious. But is it effective? Meaning real world

practicality. Real world practicality. Yeah. Where it's not just someone dealing with depression, but they're also dealing with depression and maybe substance abuse and maybe homelessness and marital conflict and job loss and they can't get their medications covered. And so there's all of these other psychological and social factors that come into the picture. And maybe they've tried evidence-based treatments and they don't necessarily work. So now what's a clinician to do? Yeah. Yeah, I see that happen even outside of the mental health space as a simple example of like condom use.

Condom use in a lab is very different than condom use in real life, which is why when we talk about these statistics, people can get really torn up because they don't realize that just because something works in a study doesn't necessarily mean it will work for you. you and it also take it a step further where people love to make leaps and bounds just because it works in a petri dish or an animal model even less likely that it will work in you right absolutely and it's the same you know it speaks to the perils of randomized control trials which um you know i know you've discussed in the past but you know randomized control trials are the highest one of the highest forms of evidence that we have but they also have limitations one of which is that they speak in averages so to speak. So they can tell us whether a treatment works on average for a given population, but not for the patient sitting in front of you in your office. Absolutely. That's why I hope algorithms will

change and improve in terms of an AI standpoint. If we can find out better mapping of who should take a blood pressure medication that will actually benefit through algorithms in AI, our number needed to treat will drastically drop. And then I can say with much more certainty to a patient, that, hey, when you take this, it doesn't just work on a population level 30%, it works for you. And I feel like that's where I feel like the next frontier will be, but the people who are anti that frontier are usually in the pharmaceutical industry, because that means there's going to be a lot less medications prescribed. Because when they are, they're going to be actually working and not just, you know, there to be there. Totally. That excites me too. That's precision

medicine, right? And just sort of being able to tailor our treatments for the individual. And, you know, I love and appreciate how we're talking in this sort of nuanced way and just sort of acknowledging the limitations of evidence-based medicine and randomized control trials because that's what ethical clinicians do. What bothers me, though, and it's sort of what I got into writing in my book, was that the alternative medicine community, say, and the wellness industry at large, they really capitalize on those limitations. and I try to make the case that they're pitching a narrative

that's very, it's anti-evidence-based medicine. And so it will amplify and so distrust in mainstream medicine to grift and to sell its pseudoscience. And so that really bothers me because it's very exploitive for patients. And so, you know, you and I are talking about, you know, the next frontier is precision medicine. With more research, we'll get there. We're both excited about it, and that's amazing.

you go to an alternative medicine website and they'll pitch it as if they're already there. And that mainstream medicine doesn't know what it's talking about and they have the treatments that can cure you by tailoring it with their pseudo-scientific treatment. And the research is it's not there. Yeah. I struggle with that world a lot, not just talking about it with my patients and on my channels, but also like I get an invitation to go on someone's podcast and I know that they've hosted many guests who spread that level of misinformation or perhaps I know or I've seen episodes

of that podcast where they do a sponsorship for some genomic probiotic tests to tell you what food you should be eating. Like when I look at those tests to see what gut bacteria you have that should tailor your diet, it's ridiculous because we only know as far as what's probably. beneficial for your gut bacteria? And that's it. And guess what? When they test your gut microbiome, it almost doesn't matter what they find. They'll just make that same recommendation to you. And guess what? I can do it for free. And I don't need to test anything. But people love the idea of the sci-fi future. Oh, they're going inside my gut. I'm getting an advantage. I can buy good

health. And to me, that's just a non-starter. It doesn't exist. You can't buy good health. there's a limitation to health where it's health care can be good but once you try to get it perfect oh boy the outcomes are so bad totally is there an example from the mental health space where you feel people strive for perfect and then they get into trouble one of the things when i was writing my book is that one of the that i discovered is one of the things about pseudoscientific treatments is that they pitched themselves as a panacea so it you know you'll you'll find some sort of pseudo-scientific treatment that says they can cure your depression or your post-traumatic stress disorder or your anxiety. But the same treatment can also cure your cancer

or your glaucoma. Just happens to work for me. Or COVID-19, right? So that's one of the things. I don't, by virtue of pseudoscientific treatments pitching themselves as a panacea, they're not specific enough. And so they'll say past life regression therapy or energy healing or homeopathy can treat all of these various things using these pseudoscientific treatment. And, you know, you and I were talking about earlier that it's not, um, we can't blame people for seeking these alternatives. I mean, everyone, we're all human and we all want our ailments to be remedied. Yeah, exactly.

Yeah. What bothers me is the grifters. What bothers me is hucksters, people that prey upon that financial and emotional vulnerability of people to make a profit. And even that, it becomes even more nuanced than that because I think that majority or many of these people who are grifting, as we say, I think a lot of them actually believe in it, too. I think there's a percentage that are malicious

and they're actually just solely profit-driven. But in my experience, just talking with the other side, so to speak, or talking to some of these grifters, they totally buy into it. And I think that's really dangerous. We see it in things like the anti-vaccine movement where a lot of the leaders in that space, I think,

you know, we can't peer into their minds and actually see whether they believe it or not. But the way they speak about it certainly suggests that. Do you think that there's a world where they said it enough times that they've convinced themselves it's true? Absolutely. I think that, yeah, that's almost a cliche and for a good reason. You repeat a lie often enough and it becomes your truth.

Yeah. How would you, because I'm a big fan at the start of podcast to do some defining of terms, how would you define alternative medicine and grifter? So a grifter is just a tuxter, a someone who, is out to exploit people financially and emotionally. Scammer? Snake oil salesman, which actually derives from Clark Stanley in the late 19th and earliest 20th century.

He sold snake oil liniment, which was a cure-all for various health conditions, didn't work, didn't even actually contain snake oil. So that's where we get the... What was it? I don't even know. But it wasn't snake oil. It was not snake oil. Can't even get good snake oil these days.

It's just like homeopathy will say, like they're, they'll say that They have an ingredient in it, but homeopathy is literally just water or sugar or outlaw. Diluted to a degree, yeah. Diluted out of existence. So, yeah, so. Well, that's because water has memory. Yes. And what a story it could tell.

Yeah, exactly. So a grifter is a snake oil salesman, a scammer, essentially. Okay. Alternative medicine is more complex. And one of the things that I've been trying to help people understand is that, based on what I've learned, it's more than just a set of unsupported. treatments. It's more than just a set of pseudoscientific treatment. So it's not just energy healing or homeopathy. It's an entire ideology and it has a narrative attached to it, kind of like

we were talking about earlier. So it has its own tropes and its own fallacies that are used by grifters, whether intentionally or not, to sell pseudoscience. And it's an old narrative. And so what I mean by a trope is an often repeated idea or theme or phrase. So, For example, if you Google a local alternative medicine website, 99% of the time, you're going to see something like, unlike mainstream medicine, our treatments treat the root cause. They don't just mask the symptoms. Our treatments are natural. They have no side effects. And so those are the kind of tropes that I mean.

And the problem with that is that that's part of the ideology or the narrative. The problem is that even with respect to the treating the root cause, if you dig deeper, you'll find that the cause that they're speaking about is a pseudoscientific or a false root cause. So, for example, if you have depression, they're going to treat your root cause by unblocking your energy blockages through energy healing or Reiki or whatever it might be. And so I think that's very deceptive. But that is part of the ideology or the narrative. So it's not about the particular treatments. because if a particular treatment garners enough scientific credibility, it garners enough evidence, then it can cross the somewhat arbitrary threshold into evidence-based medicine.

And that's a fantastic thing. We all want our patients to do well and we want to cure or treat or manage as many health conditions as possible. But alternative medicine is this ideology and it serves as a foil to the medical industry at large. And I think that is what's very lucrative and it's very dangerous. And I mentioned, you know, it's not just tropes, but it also uses fallacy. So appeal to nature, the appeal to nature fallacy, for example, what is natural is good, right? Plenty of things that are natural that aren't good. Yeah, right? COVID-19.

Yeah. Although some people will argue that these days. Touche. We won't go there, but yeah. Touche. Yeah. Appeal to tradition fallacy is another one. This treatment's been used for thousands of years. therefore it's effective. Maybe, but it's a logical fallacy.

So you go to these spaces where alternative medicine treatments are marketed and sold and you'll find this language, this ideology, this narrative. And so that's what I really want to help people see with their own eyes because it's a marketing pitch. And I think that's what's very dangerous and it runs counter to,

an evidence-based philosophy, which we talked about, which is what's baked into bonafide healthcare professions. It's baked into our codes of ethics and legal standards of practice, and I think it takes advantage of patients, and it's dangerous. There's another really, even more insiduous way that I believe alternative medicine sort of markets itself, and by insiduous, I mean kind of sneaky or underhanded. and that's by publishing findings in pseudoscientific journals. And so many people might be aware of scientific journals. They vary in quality.

We have top medical journals like nature or the Lancet. And then you have kind of lesser tiered journals. There's also predatory journals, which kind of, you know, you'll find them in your inbox, people trying to, you know, ask you to partake in the study or you'll pay an author fee, $1,000 to have your study published. But that's not quite what I mean. By a pseudoscientific journal, I mean journals that are devoted to publishing

on unequivocal pseudoscientific topics. So for example, there's one called Explore. This is a journal. People can look it up. You can find in that journal a randomized control trial that suggests or that supports the finding that if you send positive vibes to water,

you can make its ice crystals look more beautiful. beautiful. So it dresses it up as science, right? It's got a introduction. It's got a method. It's got a result section. It uses terminology like randomized controlled trial. Who's publishing in that? There, so there's journals like the journal of evidence-based alternative medicine. There's explore. And they are peer-reviewed, but they're peer-reviewed by people that have the same pseudoscientific beliefs. There was another journal, I think it was called the Journal of Religion and Health, but it entertained the idea that demonic possession is an explanation for schizophrenia.

So back, so what I mean by insidious is that you can find journal, you can find studies that are being published on unequivocal, so clear pseudoscientificic topics, and then grifters can draw from this literature and use it to support their treatments. And then on their websites, they can say, hey, look, I have research to back up what I'm saying, even though the vast majority of the way in which they market there, Pseudo-scientific where, so to speak, is using testimonials or anecdotes. That's another pseudo-scientific warning flag. But again, underlying that is sort of this whole pseudoscientific journal industry,

which I think is dangerous. Yeah. What's your take on legitimate medical institutions, Cleveland Clinic, launching integrative or complementary health departments where they frequently talk about alternative medicine? I don't like it. To put it mildly as an understatement. I mean the I so I write about this topic as well I think that alternative medicine so the term alternative medicine wasn't used until the 1970s before that there was various other terms that were used fringe medicine holistic medicine unconventional medicine etc drug drugless healing

there's different kinds of ways alternative medicine then began to be used the the historian James Horton wrote about this. He wrote a really great book detailing the history of alternative medicine. And he said it's sort of a, it's a slight of hand because the term alternative medicine connotes a modicum of legitimacy or a false balance. It suggests that alternative medicine can be on the same plane as a legitimate alternative as mainstream medicine. And so that it's sort of a, it's a branding technique. And then as time went on, the branding changed. So in the 90s, we got complementary in alternative medicine, which is CAM. Then we also got integrative medicine pioneered by Andrew Wheel out of Harvard, and he's a best-selling author. And there

then came functional medicine, invented by Jeffrey Bland to sell dietary supplements and really shot to fame by its poster boy Mark Hyman, who was an advisor to Bill and Hillary Clinton. So yeah, a lot of these major medical schools are now taking up these programs which use the terms of integrative medicine and functional medicine. But when you dig deeper, they are really, so it's argued, and so I argue, they're really a way to try to sneak pseudoscience, alternative medicine, pseudoscience into mainstream healthcare. Because what integrative medicine does, again, it's sort of a branding trick. It uses the rhetorical power of language. It suggests that we can integrate mainstream medicine and pseudoscience.

They'll say it's the best of both worlds. David Gorski is an oncologist. He's a very well-known skeptic. He heads up science-based medicine, one of the amazing skeptic websites that we have that can debunk a lot of misinformation. And he described functional medicine as the worst of both worlds

because it combines the massive over-testing and overtreatment that we do see in mainstream medicine with just pure quackery. So all that to say, I think I don't like it. It's to answer your question in terms of that branding because I think it's branding. I think that at the end of the day,

evidence-based medicine shouldn't be a brand. We should be relying on science. We should be relying on clinical judgment and patient values and that we don't need that narrative, which again I tried to highlight, because if you go, whether it's an alternative medicine website or an integrative health medicine website or a functional medicine website,

you'll see those tropes that I mentioned. We treat the root cause, unlike mainstream medicine. They create this polarizing, divisive narrative. And I think that narrative does a big disservice to patients. It's not for them. We should all be on the same team. We should all be looking to embody the scientific spirit to support evidence-based medicine.

Yes, I get that the, obviously, as you mentioned, the pharmaceutical industry doesn't get a patient. has in any of this. They, you know, they've done great harm. There's lots of corrupt research and conflicts of interest. Fair enough. The answer to that, though, is better science, better accountability, better transparency. It's not to buy into this narrative that alternative medicine does it better and the integrative medicine and functional medicine does it better. And so I think that's sort of one of the biggest messages in my book and that I want people to really understand is that we have, gaps in our health care systems, and we have gaps in our knowledge, especially when it comes

to mental health. We don't fully understand the science of psychopathology. If we fully understand post-traumatic stress disorder or anxiety disorders, we would love to be able to treat it and help everyone with it. We don't. And so even our best evidence-based treatments that we have, like evidence-based pharmacotherapies and psychosocial interventions like cognitive behavioral therapy, those don't work for everyone and that sucks and we wish that it we really did so we have gaps in our knowledge and we have gaps in our health care systems but that doesn't mean those gaps signal a call to fill those gaps with better science more equitable and competent patient care gaps in knowledge and our health care systems doesn't justify filling those gaps with pseudoscientific

treatments in patient exploitation under the guise of wellness in alternative medicine or integrative medicine or functional medicine. After all these years of brewing Coors Original, we've learned one undeniable truth. Any legacy is possible. You just have to start. Core's Original. How will you start your legacy? Celebrate responsible.

Must be legal drinking age. Yeah. Do you think about at all that there ever is some potential nugget of value? in the complementary space where, oh, you know, this is something we didn't do enough research on or just haven't prioritized this research, and yet people are getting great outcomes from it, even from, let's say, a placebo effect. Is there ever value in tapping into that, or do you feel like that would be unethical? It's a great question. I think there is. Yeah, I mean, we see the placebo effect in mainstream medicine and alternative medicine. And so you're right. We do,

We don't want to straw man alternative medicine, which means my intention is not to make a cartoonish, easily defeated version of what alternative medicine is so that we can attack it and say it's all bad. The best approach to counter something that I'm trying to say is dangerous like alternative medicine is to take a steelman approach, which means you offer a charitable definition or charitable depiction of what alternative medicine is. And so all that to say, what I think alternative medicine does really well is it capitalizes on the placebo effect, like you mentioned.

But I think what it also does is it kind of clumsily stumbles upon what we call it in the psychotherapy research world as common factors of treatment or non-specific factors of treatment. So what I mean by that is things like cultivating a therapeutic relationship between clinician and patient. Which is the most important thing. Absolutely. It's the most important thing. And so it's no wonder people seek that in alternative medicine because the five-minute family physician appointment times don't cut it. And the dangerously long specialist appointments, those wait lists don't cut it.

And so when a patient goes to an alternative medicine practitioner, they get an hour and they get to be seen and heard and validated. And that's not something that necessarily happens in a five to ten minute family physician appointment. And so that alternative medicine practitioner gets the opportunity to cultivate that therapeutic relationship. They also get to do some other things. Like I mentioned, they clumsily stumble upon these common factors of therapy, which means things like instilling hope and motivation. for change, trying to encourage new ways of behaving and thinking about one's health and expressing empathy and non-judgmental acceptance and positive regard. These are things that it's actually the forte of the mental health professions. That's why I mentioned clumsily stumble upon it because

we're trained to do those things. That's what, you know, social workers and psychologists and psychiatrists and psychiatric nurses, people allied mental health professions, they we're trained to to cultivate this therapeutic relationship and to cultivate common factors because we know that that's that accounts for a large part of what is healing and that and so a shortcut or a shorthand name for that you could call it the art of healing and so I think alternative medicine kind of stumbles on this art of healing Harriet hall was a legendary skeptic in the community she unfortunately passed away about a year ago and I think she perfectly captures what alternative medicine does. She says alternative medicine does that is good is not special. And what they do

that is special is not good. Meaning what they do that is good is not special is not special is the ability to cultivate the therapeutic alliance, the relationship, the instilling, cultivating our hope, our motivation for change. So things that good healthcare clinicians do. So it's not special in that respect. But then what they do that is special, what is not good is not good is your pseudoscientific treatment. So you get a foot in the door. They're telling you this stuff. And then they're doing, it's in the context of acupuncture or energy healing or homeopathy or past life aggression therapy or God knows what else of the countless pseudoscientific treatments that we have, which could be harmful. And so that's where, again, where the danger lies. And it's not just the fact

that the treatments themselves can be harmful, but it's also deceptive to patients because a foundation of evidence-based medicine or evidence-based health care is honesty when it comes to informed consent. And that means accurately balancing the risks and harms of treatment. And so we have to do that.

And I think that's flagrantly ignored in the alternative medicine community because if they were honest about their treatments, they would have to say something like, like with energy healing, for example, this treatment doesn't work beyond the placebo effect. And the other evidence-based treatments do work and are likely to be more helpful. Yeah.

I want to get back to acupuncture in a second because I have a unique question for you on that. But you mentioned earlier gaps of our knowledge. What do you think a gap exists? And I'm not talking about grifters. Do you think a gap exists between how evidence-based medicine should be practiced and then what medical practitioners across the board are actually doing. Because in my world, where I venture outside into the space, let's say big city, New York City, a patient comes in,

starts talking to a psychiatrist, says that, you know, there are symptoms of anxiety, 10 minutes later they're walking out with a clonipin, a benzodiazepine prescription. That's clearly not evidence-based medicine. And yet, again, not taking into account the people that are grifting full on. There's this practice of medicine that feels like it's been corrupted to some degree. Do you feel like that's happening on a large scale or is this my bias being in a big city

or maybe with the wealthier clientele that are demanding this from their doctors? I agree with you. I think it is on a large scale. I think mental health misinformation and pseudoscience is embedded in our culture. It's on social media, popular culture, but also within the health care systems themselves. I think a large, it's hard to trace exactly the root of the problem, so to speak. I think a lot of it, though, derives from variability in quality of care between practitioners. I mean, that's a sad reality.

I mean, we have good restaurants, we have bad restaurants, we have good health care practitioners, we have bad health care practitioners. And so the ones who are ethical and competent are doing their very best to, again, navigate that delicate balance between the evidence-based clinical judgment in patients. values and that can be difficult. I think there's, like you said, there's systemic, not barriers, but systemic factors that make that harder. So for example, a five minute, five to ten minute family physician appointment, that doesn't free up a family physician to develop a therapeutic alliance or to, you know, even practice evidence-based medicine the way that they would want to. And,

you know, that sucks too. And so, yeah, I mean, in my job, my day job is a clinical psychologist. I work in an outpatient hospital clinic. So for over a decade, I've been helping people who experience what we call concurrent addiction and psychiatric disorders. So what it means is someone comes to our clinic and they have both addiction and a mental disorder. And they've had some treatment before. It hasn't quite worked and we're trying to help them. And so I work on a really fantastic interdisciplinary team with other psychologists, but also social workers and addiction medicine physicians and psychiatrists and nurses. And so we're trying to help people navigate that. And yeah, a lot of what we're doing, we take what's called a biopsychosocial approach. So we try to

help people from a biological perspective and psychological and social. What that means is we try to do group therapy, individual therapy, and then pharmacotherapy, which is medications. Often we will see people coming in on a benzodiazepine prescription. And so whether they're addicted or dependent, which are two kind of different constructs or ideas, either way, we have to, the psychiatrist will try to develop a tailored taper schedule to try to kind of taper them off it. And where did they get it? They got it from their family physician. It wasn't from the wellness grifter, the one who's unlicensed to even prescribe that stuff. So yeah, it absolutely exists in our health care systems, even in my own profession as a, you know, in psychology, psychologists will

practice non-evidence-based psychotherapies, right? What are the worst psychotherapies that you've seen that position themselves as evidence-based? I hate past life regression therapy. It's the worst thing I've ever heard of in my life. Can you define that for me? So it's, I'm laughing because of the absurdity of it. So it's the idea that someone's trauma or distress that they're experiencing in the current life can be traced to a previous life. So it's based on the reincarnation hypothesis, basically meaning that you could have been a, I don't know, a peasant living in the 1200s. And something really terrible happened to you. and you lived in that life

and so now in this current life you're experiencing somehow some sort of trauma some sort of post-traumatic stress disorder symptoms that are linked to that trauma and so what past life regression therapy does is it puts you in a hypnotic trance or it uses hypnosis

to regress a person to their past lives so that they could I don't know relive that trauma or process that trauma or however a past life regression therapist wants to pitch that idea. And I think that idea is terribly exploitive emotionally. And it can be harmful because, number one, it's very suggestive.

I mean, you can implant kind of a false memory into someone. You can use leading questions and, you know, people that are score higher on something called suggestibility, which is just your proclivity or your, yeah, your proclivity to be suggestible or to buy into these ideas. they may actually believe that. And so there's just something very shady and deceptive about that. And it's dangerous because often what a past life regression therapist might be treating is someone who is experiencing the devastating consequences of a post-traumatic stress disorder.

I treat people with PTSD all the time. They've gone through horrific, horrific traumas, often repeated traumas. And so those patients and those people, deserve the best shot that they have to remedy their symptoms, which is evidence-based treatments. And our evidence-based psychological treatments for that are advanced branches of cognitive behavioral therapy. So it's called exposure therapy or cognitive processing therapy. We can get an EMDR, which is it's sort of in the gray zone for me. It is an evidence-based treatment for PTSD, but the debate becomes about the mechanisms of change and why it works rather than whether it works. I think I'm happy if my patient

experiences or receives EMDR because it is evidence-based, I think what they're actually doing is this exposure mechanism, and it's not due to any sort of eye movements. But that's besides the point. The point is that they should be getting, whether it's EMDR or cognitive processing therapy or exposure therapy, a patient with PTSD deserves those treatments. They don't deserve past life regression therapy and that kind of deception, whether or not a past life regression therapist believes in it or not. Yeah. How do we balance that? You know, we're obviously, when you bring up the topic of past life regression, you and I kind of chuckle, given that we're so much in the evidence-based world, and we've seen people get tricked that maybe we're

bordering on cynical with some of these treatments, past skepticism. If you have a patient in front of you who perhaps believes in reincarnation as part of their religion, how do you approach that? if they believe that this works because of their religion. It's a tricky concept. And so I'll try to, there's two main points I want to try to get to, if I can. So one is that when we offer treatments as clinicians, again, we have to, we don't necessarily have a choice with respect to, we're obligated to evidence-based practice.

It's baked into our codes of ethics and our legal standards of practice. So even if I wanted to as a clinical psychologist to deliver past life regression therapy, that would be unethical. And in my opinion, my licensing body, so we have regulatory bodies, they should be more stringent with the cases of unequivocal or clear cut cases of pseudoscientific treatments. It gets tricky in the gray zones, things like cannabis or psychedelics or mindful, not mindfulness, but we can go there if you want. But there's other kind of gray zone pseudoscientific treatments and then there's this clear cut ones the clear cut ones are like past life regression therapy is unethical and so if I had a patient literally in front of me obviously I would

use my therapeutic relationship and be cultivating that and explore you know is that meaningful for them explore why that's the case but at the end of the day I wouldn't be able to deliver it and I would explain why and I would I I would explain that I can't part of respecting patient autonomy is is to, you know, they're free to go and find that elsewhere, which I wouldn't necessarily recommend they do. But I wouldn't be able to do that. It goes, it hinges on this concept called the Two Hats Fallacy, which was coined by Timothy Caulfield, who is a friend of mine,

and he's a professor at the University of Alberta. We just spoke together in my hospital, so that was cool. Yes, yeah, I know you know him as well. He's a great guy, a leader in the misinformation space and kind of debunking it. And so he's a professor of health. and law and policy. And so he's really navigated this terrain well. And so he coined the term two hats fallacy to kind of capture that dilemma that you're that you're asking about, which is

this choice between. So the two hat fallacy means it's the idea that as a clinician, we don't get to wear two hats. We don't get to wear an evidence-based hat and a pseudoscientific hat when we're offering treatments. We only get to wear the evidence-based hat. We only get to wear the evidence-based hat when it comes to informed consent. And so it comes back to that idea that if the most ethical way for a clinician to proceed, if they were to offer a past life regression therapy, would be to say this treatment doesn't work beyond placebo and that there's other evidence-based treatments that can work for your PTSD more than this.

I'd go a step further and say that clinician shouldn't be offering this at all. It runs counter to our philosophy. It runs counter to evidence-based medicine. And from the patient perspective, I get it because desperation, we're all, you know, we're all human and we all want our ailments kind of remedied, as we mentioned. And people find meaning in all sorts of things. And people find meaning in all sorts of things. And that's, that's fine. So yeah, we don't. And it's not, we don't want to shame anyone for seeking alternatives because I've lived that personally too. We don't, it's not about that. It's about, it's about respecting patient autonomy. And it's respecting our codes of ethics. And I'd say, too, that, you know, a, someone who's offering past life regression therapy that doesn't say that, that doesn't give them the, doesn't present the idea that this treatment doesn't work beyond placebo effect, they're not respecting patient autonomy. If they say that this treatment will cure your PTSD, they're effectively lying.

They may not believe they're lying, but they're not drawing upon the evidence base that says that it doesn't work beyond placebo. And they're not paying attention to. Or expert opinion, which we know. Or expert opinion. So, yeah, that's not respecting patient autonomy. If you really want to respect patient autonomy, we're forthright and honest about the respective harms and benefits of a treatment. That's true respect for patient autonomy.

Yeah, I think that's what separates, for me, the line between alternative medicine and evidence-based medicine so clearly in that evidence-based medicine has so many things that does wrong or incomplete or imperfect. whatever adverb or adjective you choose to use, it's not perfection, but it is the one field of evidence that is not scared to call itself out for being wrong, or at least it tries to constantly improve. Even when you're running a randomized controlled study, you're doing a null hypothesis. You're trying to disprove yourself. So like you're always challenging, even if you're doing a replication study. You're always challenging the norm, but in a way that you can validate,

you can go back and check versus an alternative medicine. You have to accept what the preconceived notion is, the overlying theme, the overlying message. And if you don't buy in, you're not part of this alternative medicine club. And I find that really disingenuous because it's easy to poke holes in evidence-based medicine. There are things we can't test. We've never even done a randomized controlled trial to show that smoking is bad for you. But there's enough data in other types of studies that show it's plenty bad for you. And that's because it's an imperfect system. But just because something is imperfect doesn't mean it's not the best thing that we have to use. And I think that's the difference that people fail to get right when they

talk about science, when they say like follow the science. Follow the science doesn't mean follow the scientist, some person claiming to have the answers. It's the idea of doing something, checking it, rechecking it, tweaking it, then rechecking that tweak and constantly building off of that versus alternative medicine. You're not building off anything. You're just doing the same thing you've always done and hope for the best. It's so messy in that regard. And I actually have a question very specific to the idea that you can have a licensed medical provider that really shouldn't be doing a proven evidence-based treatment and also some kind of unproven treatment because it goes against Code of Ethics. I actually had Dr. K. Healthy Gamer

on my show and he says that he does everything evidence-based, you know, when it comes to CBT or different types of medications. And he talked also about how he leans into some Ayurvedic principles, looking at people's dohas and the way that they're facing. are shaped into guiding them. And he does a very good disclosure to patients explaining that this isn't as evidence-based. This has only a foundational layer of evidence, but he believes it could have some benefit to them and he offers it to the patient. Do you believe that that's ethical or do you feel like that could be crossing the line as well?

So first, I'd say I love what you just said there. I think it just rings true with in terms of evidence-based medicine being limited. And that's totally right. and I like to borrow Winston Churchill's quip on democracy because it really rings true to me. It helps me understand sort of the idea behind it, which is that evidence-based medicine is the worst form of medicine

except for all the other forms that have been tried. So for me, that makes sense, right? We don't have anything better. That's the Nirvana fallacy. If you're going to critique evidence-based medicine, give us a better alternative. And alternative medicine doesn't do that. It focuses on confirmation rather than refutation,

which is kind of what you said. back to Dr. Kate, um, I personally, I do think that's unethical. I, I, I, I wouldn't do it as a clinician myself. I think it, it does, there's a gray zone and I don't know, you know, these are tough ethical problems to talk about. I don't know where that, where that, um, topic lies in terms of who, who are supposed to navigate these ethical issues. Is it the clinician? Is it the regulatory body? Is it pure support system of, of other physicians? that are supposed to do this.

So, yeah, I wouldn't, if I knew something was unequivocally pseudoscientificic, I wouldn't be able to, I wouldn't feel justified and ethical to provide something like that to a patient. I guess where it does get gray is where clinicians may believe there's more or less evidence in support of a particular treatment or idea or not. And so that's where I think it can become very, very murky. And I don't have a solution for how to navigate that. And we have that rule all the time, for example,

with psychedelics or cannabis, say, but with something like energy healing. Yeah, I mean, there's all sorts of promises for psychedelics and cannabis in the medical world. And I find specifically with marijuana, I find it so interesting that it's a Schedule 1 medication. and yet there's, you know, cannabis-derived medications that we use for childhood seizure disorders. So, like, how can both worlds be true? That this is a Schedule I with no medical utility, which is what Schedule I really means, and yet we use it. And yet, it's also misused.

How do all three of these possibilities live together? And where I live in Calgary, Alberta, it's legal everywhere. I think it's legal here. Sam, a fact check? Is marijuana legal in New York? I didn't know that. Dan, as far as I know. Yeah, I'm pretty sure it's legal full on.

Oh, interesting. Yeah. Okay. So it's changing all the time, obviously. And it's definitely medically legal in New Jersey because some providers that I work with end up prescribing it. But, all right, let me ask you this. Are there any evidence-based uses for smoking marijuana?

Yes and no. And the reason that's a complicated kind of cop-out answer is that cannabis is super complicated. I did my dissertation on this topic, so I have a great interest in it. Yeah, that's actually how I started in science communication to begin with. I was out there trying to debunk myths around the nature of cannabis and cannabis addiction per se. But yeah, the cannabis plant is super complicated. It has over 600 cannabinoids in it, which basically means it's sort of chemical soup. And so cannabis itself is an umbrella term because you could get different combinations of these, different strains and different combinations. And so those will have implications for whether it's a treatment or not. So for example, the two most famous cannabinoids are THC and CBD. And so we know from the research literature that THC can be anxiety inducing and psychotic inducing at certain dosages and euphoric inducing as well versus CBD. Some research has anzeolytic effects, which means it can reduce someone's anxiety and even antipsychotic effects.

So depending on different combinations that you're getting, that's what makes the research in this area so complicated. And by, and I should backtrack for a moment, just because I mentioned that CBD has anzeolytic properties and antipsychotic properties doesn't mean. that it's a necessarily a front-and-result, yeah, going to be working for you in that regard. Exactly. It doesn't mean that we should now go treat people with schizophrenia with that either, or anxiety disorders as a frontline treatment. So, because we need better quality studies to support that idea. But we know, you know, there is some evidence that cannabis can be helpful

in certain kinds of things, certain kinds of, I think is neuropathic pain, chemotherapy, and do side effects like nausea. It can be helpful for those things. It gets much trickier in the mental health world, which is where I live, um, in terms of, you know, I'll have patients asking me because they'll hear it online, although they'll hear it everywhere that can I use cannabis to treat my depression or my anxiety. And in my experience and the research kind of bears this out as well, um, the bulk of findings tend to say no. It's not helpful for mental health, like depression and anxiety. It tends to make those things worse. Um, so that's what I mean by it's, it's sort of complicated. is it because it's different for each patient we haven't yet figured out which patient population

or which strain works best or is it more so that the drug isn't suitable for those purposes and there's better options i think there's there's so many layers to it it's like even depression itself is a umbrella term and so it's like one person's depression could be caused is it more biological is it more psychological is it more social induced and so do we want to be prescribing a pharmacotherapy intervention or do you want a psychosocial intervention like a therapy? So number one, the health conditions themselves can be variable. And number two, though, like most often what I see

when people say something like they want to use cannabis to treat their anxiety or the depression, sometimes people will say that it does quote unquote help them. But when you dig deeper, much like alcohol or other kinds of substantive abuse, it numbs them. Yeah, it takes away uncomfortable feelings. and it kind of helps them escape. Which is almost the opposite of what you want to give a patient.

You want to give a patient control over their feelings, emotions, behaviors, as opposed to reduce it with a medication. Yeah, especially with acutely psychoactive substances like alcohol and cannabis, where by acutely psychoactive, I mean you take this drug and it can immediately alter your experience of anxiety or depression because what happens, especially if they have a propensity to develop physiological dependence like alcohol, that's how addiction can develop over time.

So every time you're angry or you're anxious or you're depressed, you can smoke a joint or take a drink. Your brain learns that, hey, I can temporarily numb out. And then soon enough, you're just doing that over time and you've developed an addiction. And so a lot of what we do in addiction therapy work is to try to help people learn how to identify, tolerate, and express uncomfortable emotions in the absence of using.

Is this like just a form of condition? like Pavlov's dog where I feel this way and when I reach for this, that awkward feeling goes away and I'm going to do this every single time. Yeah, absolutely. There's two, there's two conditioning processes happening. So Pavlov's dogs is your classical conditioning. So you pair an uncomfortable emotion with a substance a hundred times. So every time you're angry, you drink, your brain salivates, so to speak, like a dog would to the sound of a bell with food, your brain salivates to the, it salivates to the feeling of anger. So you feel angry. If you've drank every time you're angry, your brain says, I need to drink because that's what

helps me not feel angry. And so that's the bad news of it, which means that your brain and it means that anger and alcohol has become so well paired, that's almost like a neural pathway to put a metaphor on it. So it's an association now. And so that, that, that, that, that's a really strong association. And so what we do in treatment is we try to decondition or break that association. And so what that means is presenting anger 100 times in the absence of alcohol.

That's how you get a dog to not salivate with the sound of a bell. You give it food without a bell a hundred times. It learns that the bell doesn't mean anything. So that's what we need to do. We need to unpaire uncomfortable emotions. It's super uncomfortable. And then the other kind of conditioning process

is what we call operand conditioning, which in the case of substance use, It's called negative reinforcement, which just means our brains are reinforced, which means we're more likely to do something by taking something bad away. So alcohol is negatively reinforcing by taking away something bad, which is the anger. And our brains learn, hey, look, alcohol takes this bad thing away. I want that. I want more of it.

Be the mouse pushing. It reinforced. Exactly. So those are tough processes to break. I mean, we're not dogs. we're much more complicated, but at the end of the day, we still follow the same behavioral patterns. This episode is brought to you by Mewmew. Introducing Mutein, the new feminine fragrance by the iconic fashion house. Mutine captures the youthful, unconventional essence of the Mew-Mew-Girl

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Please play responsibly. Oh, hi, buddy. Who's the best? You are. I wish I could spend all day with you instead. Uh, Dave, you're off mute. Hey, happens to the best of us. Enjoy some goldfish cheddar crackers.

Goldfish have short memories. Be like goldfish. Yeah, I feel like this, um, Pavlov's dog thing. strikes me a lot in the alternative health space. And I'll explain to you why I feel that way as a trained DO specifically. So part of my philosophy that's a little bit different, although it's merging so quickly in the American healthcare system between MDs and DOs, is that we focus a lot on the body's ability to heal itself. And that's kind of how the field started. And as a result,

I've always preached that to my patients about trying to not intervene when possible because intervention for the sake of intervention leads to harms. That's what I found. And research bears that out as well. So for my patients who I say, look, your body will heal itself, it will heal itself. That also goes true to alternative medicine, meaning that when I have a friend that swears by Miracle Supplement X, that's to be taken at the first side. of a cold, the body heals itself no matter what you do. So they are literally conditioning themselves. I'm sick. I take this. I get better. But you would have also gotten better had you not taken the thing. And I don't know how to do the ringing the bell and not giving the food

or giving the food and not ringing the bell in that scenario on an individual level for like, let's say one of my friends or family members. Any tips or ideas of how to do that? I mean You see the connection though Absolutely It makes perfect sense Yeah so they're conditioned to believe that they take this treatment

I feel better Therefore it works It's the same idea It's why alternative medicine uses anecdotal evidence To market itself And so Let's say you

You discover quantum neurological reset therapy Which is a bizarre existing alternative medicine treatment That I've seen online and it's actually a real thing. It's absurd. But let's say someone does it

and their depression went away, therefore it works. The problem with that is it's anecdotal evidence. Just because it worked for you doesn't mean that it's going to work for other people. And more than that,

we don't know that it worked for you because we didn't test, we can't infer causality from that. And so your friend who's taking a supplement and the cold goes away, we don't know that the supplement is what made the cold go away.

That is feeding off one of the most powerful fallacies of human logic that we have, which is the post hoc, ergo, proctor, hawk fallacy. Oh, that's a mouthful. It's a Latin. It took me a while to memorize that one. So it means that... Do it again?

I want to hear it again? Post hoc, ergo proctor hawk. So it's the fallacy that just because an event happened earlier and then an event happened after that, the first event caused the after event. Is this like correlation doesn't equal? causation in Latin? Yes. Okay. Yeah, pretty much. So it's the idea that just because you shower every morning and have to use the washroom and then the sun rises, your shower and using

the washroom didn't cause the sundarize. Right. They're correlated. There's two events that happened. So your friend, the cold went away and he took the supplement. Well, okay, we don't know that that's the causal factor. And so I guess my tip or my antidote to that is to make people aware of these kinds of fallacies that alternative medicine kind of uses to cajole audiences. That's why on alternative medicine websites, you'll see testimonials everywhere. Quantum Neurological Reset Therapy works, says Bob or says Karen or whoever it is. And so, number one, we don't know, they're usually anonymous people, but just because we have anecdotal evidence doesn't mean a treatment works. And so I think that's very dangerous. From a psychological perspective,

Is anecdotal evidence so powerful to us as humans because of the concept of emotional mimicry that we almost feel like we're going through it? Tell me what you mean by that. So the idea that we could watch a movie in an FMRI machine, the same patterns light up in our brain as if we're doing the running, right?

So is the same thing happening where my friend tells me that whenever they take this supplement, they feel terrible, and then it somehow goes away, after that supplement. And if I hear that enough times, it's almost like I live that. Yeah, I think that's certainly part of it. Yeah, it's playing into our, yeah, our desire or want to believe our peers or to believe our, you know, it activates our empathy system, so to speak. I think it's also just playing off the heuristics that we mentioned earlier, right? It's like it's too complicated to, our brains can't do a randomized control trial or analyze

all of the factors that would tell us whether something in an earlier event causes a later event. it's easier just to see it with our own eyes. And so that's an example where a lot of the time it could work, but sometimes it goes awry, like in the case of a supplement causing a cold to go away. Yeah, that's true. And they would never be aware of the story of when the supplement harmed them because they would never think it's the supplement that harmed them.

It was my body failed. I should have been doing this, I should have been that. And there ends up being a lot of this victim blaming that happens in the naturopathic or alternative world or wellness community, if you will. I think I even saw a tweet that you put out from one of the big podcasts the other day where you feel like this is a constant thing

with mental health. That if only you thought differently, if you were only more positive, if you were only more strong, do you see that pattern happening a lot these days? Totally. The perils of anecdotal evidence is that it allows grifters to cherry pick the winds

and ignore the losses. And so, yeah, we'll see that on websites. Incidentally, it's literally unethical for psychologists to do that as well. So as a practicing psychologist, I work in the public sector, so I don't have a private practice. But if I did and I wanted to have a website, I wouldn't be able to put patient testimonials on there because it's considered, at least in my profession,

to be unethical for those very reasons because it leads to inaccurate advertising, as well as kind of taking advantage of power dynamics between patients and clinicians. But yes, back to kind of patient blaming. I think that that is a, it has a long history in the wellness community and in the alternative medicine community.

And I think it's very, it's very tricky because there's obviously tremendous merit to lifestyle medicine, say. So eating well, exercising, getting adequate sleep. These things are fun. fundamental to good health and good mental health. And we know that. What I've noticed, though, as part of alternative medicine ideology, is that they'll try

to own that as if it's not part of evidence-based medicine. That's what evidence-based medicine does. I've been running a self-care group of nutrition and exercise every week for the past decade. But I get people online saying, well, just tell people to exercise and cure their depression with, you know, obviously we talk about these things and then it becomes much more complicated because someone with debilitating depression, I'm trying to help them shower and brush their teeth, not, you know, run outside. Obviously, that's a goal that we can work

towards, but things get much more complicated. And I think what we see in the alternative medicine community is that, is that patient blaming, change your mindset. But in a way that's not nuanced and that's not kind of, the messaging is not patient sensitive. And it's also, in my experience, it can also pitch it as a cure-all. So take this diet plan or take this supplement regimen and that's what's going to lead you to feel better and so there was a friend of mine and colleague michelle cohen she's a family physician in canada she said that um lifestyle there's a big difference between lifestyle counseling and pitching lifestyle is a cure all the former the former makes you a health care

practitioner. The latter makes you a grifter. That's the difference, right? Because what we see in the alternative medicine community is that they'll often just be pitching lifestyle as if it's the be all end all. And it's only, it's a super important part of what evidence based medicine practitioners do, but it's not the be all end. Yeah, that's why when like I first heard the term functional medicine and I kind of read the definition of it. I was like, oh, I'm a functional medicine doctor because like I talk about diet and exercise and how important that is, for your blood pressure, blood sugar. So, like, that must be me.

And then someone commented on one of my videos, like, oh, you should not listen to this doctor. He's not even a functional, like, who decides that? Like, is that just a full-on marketing term that you can just slap on yourself, like organic or GMO-free salt or whatever that you see on the supermarkets? Like, yeah, I don't get it. Yeah, I think it is. I think functional medicine is absolutely a marketing term.

I also think one of the propaganda tactics that I know in the book, too, that is used by say functional medicine doctors or or integrative medicine practitioners is this sort of baiting and switching so they'll they will praise the idea that we need exercise and you know nutritious a nutrition to help with our health conditions which is obviously very valid but that's to get them in the door get the patients in the door then what they're doing is they're selling pseudoscientific treatments whether psychosocial or supplements or whatever it might be and I think that's very, again, dangerous. And unethical, because you're promising one thing

and then you're kind of doing something else because it's hard to get someone to make a huge lifestyle swap. Yeah. You know, like I frequently hear from these like 10x people where it's, oh my God, we changed his life because we did this red light therapy. It's like, well, you helped him lose weight. He started exercising.

He stopped drinking alcohol. He stopped doing drugs. Yeah, of course he's going to be healthier. It doesn't matter that you did all these magical things around it that have no proof for working. yes totally so and i think that that's what happens and so that that's again it's sort of capitalizing it's alternative medicine capitalizing on we know on what we know works in evidence-based medicine we know that having a therapeutic relationship works we know that lifestyle management works

but those things rightfully fall under the purview of evidence-based medicine and and so just because alternative medicine does that couched in energy healing or acupuncture or whatever it might be doesn't mean that the mechanisms of those treatments are what caused the person to feel better. Yeah. Is the rise of misinformation our fault? Our fault? Healthcare industry.

I don't know. That's a good question. My gut instinct, I tend to blame social media for a lot of it. I think it's just so rampant. I mean, obviously, it's always been with us. You know, there's always been health misinformation everywhere. but I think that with social media giving everyone a mic

which can be a good thing again it's not black and white it can be a good thing and it can be a bad thing and one of the byproducts a bad byproduct of that is the amplification of misinformation by people who are unqualified to understand topics related to health and science because they're not trained in health or science

and I think that can really magnify what we see I can take an example in the mental health space. There was a study that looked at the top videos on TikTok, the top ADHD videos. And so the researchers analyzed these top ADHD TikTok videos for their content and they categorized them as misleading or not. And they found that over half of the ADHD TikTok videos were misleading. And they reviewed millions of times. Similarly, I was really, I'm grateful to be invited on to a research team. So a guy named Marco Zenon, who's a public health researcher, fantastic researcher in the misinformation space. He asked me to come onto one of the studies,

and they looked at the top 1,000 videos on TikTok with the hashtag mental health. So top, we looked at a specific. Top meaning most viewed? Most viewed. Yeah. So most viewed in a third of them were off. In a specific time frame. So yeah, October 2011 or 2021. top 1,000 of mental health, and it was. It was one third of them were misleading. But what blows my mind about it is that those videos reviewed a billion times, a billion. We can't even rack our minds around a billion. To me, that just shows how pervasive this stuff is.

Yeah. I think the major counter of it is putting it accurate information and doing it in a transparent way. Short term, that doesn't obviously solve the problem. But I think long term, it can foster some more trust. And I feel like a big thing that we've lost trust with, is one, the obviously marketers of it that I've understand how to hack into people's minds, for lack of a better term, the fact that our human minds innately like controversy and drama,

and as a result, social media becomes fuel for that. And I've always said, like, social media is life on steroids. So everything is massively amplified. How happy someone is always bigger on social media. how sad they are, maybe can also be amplified. And what we see is our evidence-based health care system is broken. And it has some serious flaws that need repair. So when one person has a major error play out in the system,

and now it gets amplified because of that inherent want for drama and confrontation, it creates the label. So it's like almost social media is a creator or purveyor of cognitive distortion. to some degree. Absolutely. Yeah. I love that idea that you said. It's sort of like life on steroids

because it amplifies the... The thinking fast part of our brain. Exactly. It's playing into our biases. It's playing into our heuristics. And in many ways, it does the opposite of what happens in science and academia.

Because if you read a great paper in a top scientific journal, you'll see very nuanced, tentative language. It may be this. It may be that the conclusions may support this. This is why it's limited in these ways. You go on social media, you see oversimplifications

and just black and white thinking, emotion-laden language that just fuels, it's going after, it wants to go viral. It wants headlines to go viral because that's what captures attention. And it's dangerous. And so you're right, I, so in that sense, social media does us and people a great disservice. And at the same time, that's why we just, we need, there's such a need for science communicators to go to the front line, so to speak, where this misinformation is being spread and to fight it on the front line. And it's hard for the average person to know who to trust. And, and that's fair. But I don't think shying away from it is, I get why people do, because there can be a lot of harassment and trolling on social media. You and I talked about that earlier. We both have experienced that.

And it's not for everyone, and I'm not saying it is, but I just think that there's also a need for more of this kind of stuff that helps people navigate what is true and what's not and try to help people evaluate what is credible messaging and credible evidence versus not. Yeah, I almost feel like we also need to study what snake oil salesmen do and try and leverage it for evidence-based medicine. So they have good catchphrases. I have like the silly catchphrase of chest compression, chest compress, chest compression. on my channel. So like figure out what works and then try and use it to create good content.

It's not easy. It makes it way hard. It's already hard to create content. But now if you're trying to do it for evidence-based medicine, it makes it hard. But I think it can be done. It can be. I'll be very transparent and honest. I found that really challenging writing my book because I wrote this book to reach a large general audience. It was not an academic book where it's meant for a niche kind of set of researchers. I wanted to help people take their mental health into their own hands to help protect them

and so I needed to reach a large audience. Well, how the hell am I going to do that? I can't write in very academic speak so to speak. So what do you do? You have to story tell because that's what a good kind of general public book is supposed to do. And so I'm telling

stories and then part of my brain is conflicted because well now am I just using anecdotal evidence to spread misinformation and the counterpoint to that is no because I'm also presenting the science to back it up but I need to convey that science through storytelling I think you're doing an introduction through an anecdote and supporting by evidence and that's different than just supporting with anecdote so I give yourself credit that makes me feel better I have a very personal relationship with acupuncture so everyone probably watching my

YouTube channel knows I'm a skeptic when it comes to a lot of alternative medicine, wellness claims, but I try not to be cynical. And when I was younger, I thought I was macho man and I was benching and I tore my rotator cuff. I had some fraying of tendons, labrum tear, labral tear. And my shoulder was so bad that even like lifting my arm up was most of the time not feasible. And it was an issue that I had for well over a year. So it wasn't like something that was going on and would heal if I just gave it a few weeks. I somehow ended up in a pain management office that did acupuncture. And the doctor, who's an MD, was also trained in acupuncture, said, let me do a session

of acupuncture therapy on my shoulder. No exaggeration here. One session, and I did not believe it would work. I found it ridiculous. My shoulder never hurt again. How is that possible? I wish I knew. No, but it's like I'm anti this, right?

And I just don't understand what's happening. And the only other time I've had acupuncture in the future, which is kind of ironic, is I became a professional boxer a couple of years ago. And when you're boxing a lot, you can develop medial epacondulitis inflammation here in the elbow. And I was like, let me try acupuncture because I have this fight. I have to do this. and after one session, 80% of the pain went away, despite me trying all sorts of things.

And I said, oh, well, let's make it perfect, which is something I say to never do. And I went for a second session. He hit my nerve, and I had the worst neuropathy for weeks. So it's like, it helped me, but it also destroyed me. And yet I know the evidence for it is very low quality. What's going on? help me wrap my mind around what's happening here i don't know i think it just speaks to the complexity

in our gaps in knowledge about how we it it speaks to our gaps in knowledge with respect to the nature of our health conditions and the treatments that are supposed to help them i don't i don't have an answer and we see those we see those stories all the time i worked in a chronic pain clinic for um for a year or so as well and we saw some of those my my own mother i write about this in the book She grew up. During my youth, she grew up with a chronic pain disorder, but she still experiences. And so we tried everything. We tried. And the reason we tried everything was because evidence-based medicine was failing us. No one quite knows what the hell complex regional pain syndrome is. Again, it's an umbrella term. It's characterized by excruciating pain. I saw it with my own eyes growing up. Her legs would double in size. Her hands were blue. They leaked lymphatic fluid. I ended up, in general. her as a kid with opioids and benzodiazepines just to give her, you know, muscle relaxation and pain management. And she ended up doubling and tripling her doses inadvertently, became addicted and depressed on them. And it was terrible. And so what would any reasonable people do? We look to

alternatives, right? We looked, we tried energy healing. We tried acupuncture, detox foot baths, chiropractic, ear candling, ralphing, um, psychics, healing crystals, everything, right? And so because desperation is intoxicating, who wouldn't turn to alternatives? The problem is that evidence-based medicine didn't help us at the time. Um, some things made her feel worse. Acupuncture made her feel worse. Detox footbaths made her feel worse. Chiropractic made her feel worse.

And so, you know, um, that's what we find a lot of patients in the mental health world and just in the health world, you know, who have chronic diseases and chronic pain disorders, they're left to navigate that terrain. And I totally get it. I mean, it's hard not to have to feel the stirs of resentment towards mainstream medicine. You know, science can send us to the moon,

but it can't help me and my family navigate a decade-long trek through, you know, through a health care system that felt really unguided. But again, alternative medicine wasn't the answer. either. And it had a lot of false promises and a lot of exploitation. Fortunately today, my mom's in a much better place. You know, she learned how to do chronic pain management strategies like activity pacing and relaxation. And, you know, she learned through self-help materials. She learned evidence-based principles that followed along the lines of cognitive behavioral therapy to kind of

get her out of depression. And also, too, complex regional pain syndrome has a really, um, the prognosis tends to be that it can get a little better with time, but it's still very variable. In her case, time kindly lifted the roar of her symptoms. So that was really great. But again, I get why people turn to it. And we get why sometimes people may find benefit from energy healing or acupuncture. And then it can make them worse.

And I think at the end of the day, it just speaks to, again, why science itself is such, is so important and much more important than energy. anecdotal evidence. We want to study this stuff in, in robust, methodologically sound ways in the service of patient care. That's why we're doing it. And that's why we want to pay attention to it. And again, we don't want to, it's not about shaming anyone. And if people find benefit from these things, fantastic. But we also just want to be very honest, forthright, and informed about the evidence behind these things. Because I've seen doctors, and I'm sure I've done this in the past as well, where you have a patient with back pain that has gone through

injections, surgery, physical therapy, maybe even behavioral therapy, if we thought that could have been a confounding factor or causal factor even. And nothing worked. Then we say, oh, try acupuncture. Try marijuana. And technically, by the standard you mentioned earlier, would I be then doing something wrong by advocating for those things? Or is that still in the gray zone? of things in your mind? In my mind, my own personal, ethical kind of line is I wouldn't, respecting patient autonomy means I'm empathizing with them and I'm again being honest about the risks and harms of treatments and I wouldn't offer these things. Obviously though, when I have patients in front of me, I'm saying do what you find helps for you. But I'm not

going to deliver those treatments myself. And I'm probably not going to name specific treatments that I think are pseudoscientific and have the potential for harm. Got it. For the current state of prescribing habits, what I found, and we kind of touched on this earlier with the prescription for a benz-o for someone who is having some component of anxiety symptoms, currently it seems like it's very easy to start and then potentially get. hooked on a prescription like Adderall. And there's people who need a medication who have a diagnosed medical condition whose lives benefit greatly from being on a medicine. You know,

otherwise they can't focus, they can't drive. Other mental health values start deteriorating. What do we do for the over-prescription side of things where people are trying to use certain medications in the psychiatric space for over-optimization as opposed to a treatment for a legitimate condition? I wish I had the answer to those things. I think it falls on, again, sort of back to the practitioner or the clinicians, their codes of ethics and illegal standards of practice. They should be prescribing in a way and practicing in a way that fully aligns with their codes of ethics and legal standards of practice. And I don't know.

I don't know how to solve that because obviously over prescribing and over-treatment is a very real problem. Do you think it's an issue that a lot of college students, for example, use Adderall? Sure.

Why? I can't draw on any research to back that up, but in my personal life, I've heard people say that to me all the time. I treat people with addiction and I've treated college students who've had not addiction to Adderall, per se,

but they've had stimulant addiction more broadly, and Adderall just kind of gets thrown into the mix of these things, whether it's cocaine, crap cocaine, or any kind of stimulant producing drugs. Is there any harm for, like, if you're speaking to the college community, what's the harm of taking Adderall for your test? Well, there's a risk of dependence. There's a risk of addiction to it.

And with addiction comes loss of control. It can interfere with your responsibilities. It can interfere with your schooling over time. So I wouldn't recommend that. I would recommend other behavioral strategies. I would never recommend someone do that. Is the world of psychologists, psychiatrists, struggling these days with the rise of influencers saying things like

anxiety and depression are not mental illnesses. It's just that you're weak. Is it making difficult for you to take care of your patients? Yes. Why? Because it reaches so many people. So Andrew Tate put out a famous set of tweets famous. But he's infamous.

Infamous. Notorious. He's tweeting to hundreds of millions of people that depression doesn't exist. And that, yeah, you're lazy. and you're weak in doing so. Elon Musk similarly will tweet to millions of people that SSRIs or antidepressants do more harm than good. And that wellbutrin is terrible or whatever.

And that wellbutrin is terrible and the Adderall is terrible. And so just no nuance whatsoever and just these blanket kind of statements. And yeah, again, it goes back to the idea that misinformation just has this giant reach. There was another study I recently posted. It was published in Nature where they found that false news claims

and false health claims spread further and faster than the truth. Like 70% yeah. The tweets that are misinformation spent 70% faster. The white chocolate macadamia cream cold brew from Starbucks is made just the way you like it. Handcrafted cold foam

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Which one? When Andrew, when Andrew Tate says depression doesn't exist, mental illness. doesn't exist. This is a mind control simulation, whatever vocabulary he chooses. Why is that untrue? Because he's parroting anti-ps and doesn't even know what he's doing it. So I write about that in the book as well. So many people are probably less familiar with the anti-psychiatry movement. They're more familiar with things like the anti-vaccine movement or the perils of alternative medicine. But one of the tropes, and again, by, again, by I mean an often repeated idea or theme in the anti-psychiatry movement is that mental illness doesn't exist, that all psychiatric medications are harmful, and they, maybe I'll back up and just kind of explain the anti-psychiatry movement so that people can kind of understand it.

So it can be, its roots can be traits back to about the 1960s. And at that point, the anti-psychiatry movement was quite, quite good, like it served a purpose. And it was basically a reaction to psychiatry's dark past and its various missteps. So there was inhumane treatment of patients in asylum care. There was inappropriate pathologizing of minority groups. And there was this perceived arbitrariness of mental illness diagnosis. And so Thomas Sass was a psychiatrist who was one of the pioneers of the anti-psychiatry movement. And he wrote a book and an essay called The Myth of Mental illness. And he tried to basically say why mental illness doesn't exist. And he was joined in his efforts by other pioneers of the anti-psychiatry movement. David Cooper coined anti-psychiatry in

1967. Michelle Foucault was one of its intellectual pillars. Anyways, these guys were kind of coming at, it's a bit philosophical, but they were coming at psychiatry from what's called a critical theory lens. So they're trying to look at psychiatry through the lens of examining its cultural assumptions and its power dynamics and just sort of critiquing it in that way. The good news, though, psychiatry listened. So at the end of the day, psychiatry got its act together. It closed down a lot of those asylums. It moved patient care into regular hospitals and the community.

And it got its act together with respect science-wise, too. So it focused on a more lively understanding of the biological, psychological, and social factors that contribute to mental illness, which is our biopsychosocial model, which is really pervasive in health care. And so what we saw was essentially by the 1980s, the anti-psychiatry movement greatly diminished. But it didn't die. It just sort of transformed and lost its way. And so now it's really a movement that's outlived its cause. And so now what I try to help people understand is that it really exists as a disorganized entity outside of mainstream medicine. And it kind of has, it's given breath by a few different lifelines.

So one is Scientology, which is, you know, people hear that as a religion and sort of, you know, it's something to be laughed at. But they will parrot anti-psychiatry tropes like Tom Cruise telling, you know, book shields that that she shouldn't be taking antidepressants for postpartum depression because it's dangerous. So Scientology has a lot of these tropes. In part, that's because they had, Scientology has a, an organization called the Cismodic. CCHR, the Citizens Commission on Human Rights, and it was co-founded by Thomas Sass, who I just mentioned, pioneered the anti-psychiatry movement, and Elron Hubbard, who founded Scientology. I recently went to L.A. on a vacation, and I dragged my wife to the CCHR Museum called Psychiatry and Industry of Death, and she was upset with me about it. We only lasted about 10

minutes, but you go in there and you just see Holocaust imagery everywhere and just kind of the perils of psychiatry basically saying that psychiatry is just a plague on humanity and that it needs to be shut down. And so that's what anti-psychiatry does. And so one branch is Scientology, but that's sort of... What's the modern version of anti-psychiatry? So the modern version is so Scientology still promotes these ideas, but there's also fringe scholars. The they are self-identified psychiatrists or psychologists or scholars in critical what we call critical psychology or critical psychiatry. So there's sub-disciplines, which again use that critical theory.

And what they do is they'll publish kind of insiduously in, you know, opinion articles and books and blogs and websites, like such as Mad in America, designed to flame psychiatry in a way that dodges scientific critique and it's not kind of published in mainstream medical journals. So that's how a lot of these ideas are disseminated. There's also a big social media component to it. So if you go on to online forums

or on Twitter or whatever it is, you'll find, and this is a really sad reality, you'll find patients who identify as being harmed by psychiatry, just like you would find patients who identify as being harmed by vaccines. And so in that way, it kind of parallels the anti-vaccine movement or saga

and that you have patients that were harmed by vaccines and by psychiatric drugs. And that exists. And these patients do deserve empathy and compassion. A problem, though, is that some of them will promote anti-psychiatry propaganda while they're trying to do that, just like you'll see in the anti-vaccine movement. So you'll, you know, we'll see just untruths and misinformation saying, again, that mental illness doesn't exist or that all psychiatric medications are harmful. And so that stuff is permeated online

and it gets spread and it gets kind of baked into our culture so much that guys like Elon Musk and Andrew Tate will end up parroting these tropes. I don't even think they know where it came from, where these ideas came from. But they're the ones with a lot of reach and so kind of back to your question with health influencers, yeah, that they're repeating anti-psychiatry tropes.

And again, if it's reaching such a large audience and a lot of people repeat it, It's back to our original conversation with the illusory truth effect that more people hear that mental illness doesn't exist, more people are to believe it. You also ask, like, why is it wrong? Well, it's wrong because research says it's wrong. Mental illness certainly exists. We know, this is another thing about tropes, though, that I'll add is that just like propaganda,

there's often kernels of truth that get blown out of proportion and amplified and distorted. So, for example, the DSM, the diagnostic and statistical manual of mental disorders is one way in which we categorize mental illness. And it's gone through various iterations from the DSM1 to now the DSM-5 TR, the text revision. In that time, from the DSM-1, it was, or I think it was around 100 mental disorders, and now it's ballooned to about 300 sort of mental disorders. And so what that means is that the boundaries of what we consider to be mental disorders has expanded over time. And so in part that reflects our evolving science and our evolving understanding of how to categorize and describe mental illness and mental disorders. And so even within the field, clinicians like me and scholars and researchers are rightfully chastise the deep. DSM, and it should be chastised because that's how science works and it's evolving.

We're not, we don't, we have an imperfect understanding of the science of psychopathology. We're not great. It's carving nature at its joint, so to speak, when it comes to mental illness. That's true, and that's why we need to keep evolving our knowledge. That doesn't mean mental illness doesn't exist. And so what the anti-psychiatry movement does is it takes that kernel of truth and it's, it balloons it, it amplifies it. And it says mental illness doesn't exist at all.

the DSM is entirely unscientific. It's just made by committee and no one in psychiatry knows what we're talking about or in psychology and so we should just all throw it out. Schizophrenia doesn't exist. It's all just trauma or it's all just distress and that's really wrong. And then even more insiduously in my experience is like I make the case that the anti-psychiatry movement and much like the anti-vaccine movement, both of them, the anti-psychiatry movement,

the anti-vaccine movement, and alternative medicine as an ideology or wellness, they all serve as a foil to mainstream medicine at large. All of them distrust mainstream medicine. And so what I've found is that the wellness industry is bedfellows with the anti-psychiatry movement and the anti-vaccine movement, say. Because what they do is they so distrust,

in mainstream medicine. So you can see it in the anti-vaccine movement, for example, where they'll say all vaccines are harmful, you need to detox from vaccines by my wellness product to do it. Similarly, you'll see that in the wellness community with respect to mental health. They'll say psychiatry doesn't know what they're talking about. Depression doesn't exist or instead, here's a, here's adrenal fatigue, which is a medically disputed diagnosis that has parallel symptoms to depression. So like fatigue or low motivation or low energy. And we know how to treat your adrenal fatigue by these supplements or this diet or go on our diet regimen.

And so in that way, I think that is so dangerous because what they're doing is there, again, the wellness industry and the anti-vaccine movement or the wellness industry and anti-psychiatry, they're bedfellows because they serve as this foil to mainstream medicine. And they can say mainstream medicine is wrong and we're right and we know what we're doing and we can treat your products rather than being nuanced the way you and I are in saying psychiatry does not know everything. Of course not. It's an evolving science and we do our best to help our patients. But that doesn't mean it knows nothing. Yeah. Is there a problem in the fact that we don't know yet how some treatments work and yet we still prescribe them?

I don't know that there's a problem. I think that's been a mainstay in medicine. I mean, I think that we can, you know, we use anecdotal evidence. The one merit of anecdotal evidence is that it can spawn research. And then from there, we can evaluate things, say, in randomized control trials. And we can use randomized control trials to evaluate not just the effectiveness, but also the safety of treatments. And so if treatments are both safe and effective, then they can essentially fall under the purview of evidence-based medicine.

Kind of like EMDR that I mentioned before is a treatment for post-traumatic stress disorder, it's been found in randomized control trials to be effective for post-traumatic stress disorder. We don't quite know why it works. There's debate in the literature. Is it something to do with, you know, moving your eyes back and forth? Or is it because you're telling patients to expose themselves to trauma while distracted? Yeah, while distracted. And so similarly with antidepressants say, that's another kind of anti-psychiatry trope that's often used is that people will talk about the chemical imbalance theory, which is a really early and early and incorrect way of describing how antidepressants worked. So it says basically that we have an imbalance

in our brain of serotonin and so SSRIs help increase serotonologic activity or serotonin in the brain and that's why it works. And so psychiatry, real psychiatry nowadays doesn't buy that at all. It's an oversimplified version of how things work. We know that that's not the case. Instead, the reality, we don't know why antidepressants work. It's incredibly complicated. We do know that serotonin plays a role, but we don't know precisely what that role is. Is it downregulation of receptors?

Is it the presence? Is it some other down the stream effect of it? Totally. It's hard to know. So antipsychiatry will take that trope and say that psychiatry says it's chemical imbalance. The chemical imbalance theory has been disproven. Therefore, antidepressants are bullshit.

They don't work. We know what we're doing by our supplements. Yeah. It's obviously an incorrect statement from a logical perspective. Forget whether or not you believe it's factual or not. It just doesn't stand up to logic. Because to me, what is logical means you could retest it numerous times and question it and it would still be truthful.

And here in this case, I don't think it is. Speaking of truthful, do you think life coaches are bullshit? No. I don't. I'm being serious. So like if I, if someone wants to hire a life coach to increase their motivation and help with their life goals, all the power to someone. I mean, that's fantastic. I think where it becomes problematic is where is where ethical problems start to emerge when life coaches step beyond their scope or beyond their purview to say that they can treat things like health conditions without.

any qualifications or any training to do so. That's where I think it gets very dangerous. So you want to get motivation to help with your job or your life goals, fantastic. But if you have a life coach telling you that they can help with your depression and your anxiety, that's dangerous. Yeah, the claim itself, I see why that's problematic. The actual practice of it all from a practical nature, it's such a thin line and it's so subjective, right because if you say that you're going to improve someone's motivation and performance at work

won't that maybe reduce some of their depressive symptoms and anxiety and aren't you going to have to address someone's anxiety if you're going to improve their motivation so like how can the field exist if almost by its identity you have to tackle the things that they're not technically licensed to tackle yeah it's it's a fine line i know so you're saying that they have to just tread carefully if they do it ethically yeah like so what's an ethical life coach an ethical life coach is someone that doesn't that is forthright about what services they can provide that is forthright about their training and is forthright with respect to what they can offer and and just being very crystal clear about that and yeah if i if i were a life coach i'd want to say that i'm not here

to explicitly address your depression or your anxiety you may have that some things that we offer could help with that, but that's not why we're here. And if you're really struggling, please seek a mental health professional. Yeah. I just know how the marketing world works. And if they have a testimonial of someone saying that they were depressed and now their job is doing so much better, they're putting that on their home page. So they're not going to outwardly say they're treating depression, but they'll indirectly

highlighted it quite well. Yeah. Terribly unethical. Yeah. And that's what's really dangerous. And that's what I wanted to call out too because even there's countless unregulated providers of mental health services in the wellness space. Their life coaches or their wellness consultants

or their mental health clinicians, these are what we call legally unprotected titles. There is no regulatory body. There's no license to become a health coach or a wellness consultant. And so that's very, it's very dangerous because it lays the, again, the burden falls on patients to be, it's caveat emptor, buyer beware

when shopping for care. And there's even more kind of terms that people may be surprised to know that are unregulated, like practitioner or counselor or psychotherapist. Depending on particular countries or jurisdictions, those titles too could be unregulated, meaning anyone can just, depending on where you live, if it's unregulated where you live, anyone can just set up a website and hang a shingle and say, I'm a psychotherapist and literally have no training or qualifications whatsoever. the reason that's so dangerous is because they lack training.

It obviates codes of ethics because there are no codes of ethics. There's no legal standards of practice. And so when shit hits the fan, so to speak, a patient, if a patient, if treatment goes a ride and a patient is left damaged, there's no recourse for that patient. There's no regulatory body to complain to so that a regulatory body can sanction that person or try to remedy it in some way. So there's no recourse short of filing a. civil lawsuit and the stress of that. I mean, who the hell is going to do that? And if we're

complaining about, and rightfully so, about some health care providers, doctors doing a bad job, imagine if there were no rules what a bad job would be happening. Like right now, there's a lot of rules and there's still, there's some doing a bad job. Now imagine you take a field and you say, hey, no rules, do whatever you want, say whatever you want. How much worse it's going to get? Totally. In a twist of absurdity, though, like I've noticed, that, and I write about it, there's some unequivocal, pseudo-scientific disciplines that are regulated.

So, for example, the practice of homeopathy is regulated in Ontario, where I am. So it's a legally protected title. So to me, that blows my mind because I don't know what's worse,

a grifter with no license and no accountability, or a grifter with a license and feigned accountability. Yeah, that's funny. Wow. For my education, what I got as a family medicine doctor learning of what yields best outcomes when it comes to therapy, cognitive behavioral therapy. It's not so much the form of therapy, not so much who's delivering the therapy, whether it's a LCSW, a social worker, a psychologist, a psychiatrist, it's your connection. So the degree matters less. Do you believe that notion or do you still believe that there's one that's more superior? It's a great question. It's one that's been wrestled with in the psychotherapy literature for decades.

There's a term for it. It's called the dodo bird verdict. It derives from Alice in Wonderland where the dodo bird. There's a bunch of animals. I think they got wet. And they had to run a race around the lake. And the dodo bird had them run around this lake. And then ultimately they ran around the lake to dry themselves because they were wet.

And then the dodo bird announced everyone is a winner. everyone gets prizes. So it's been dubbed the dodo bird verdict because in the psychotherapy research, it was trying to, people were discovering that it doesn't matter the kind of psychotherapy that you had. Was it CBT, cognitive behavioral therapy? Was it psychodynamic therapy? We tended to see the same kind of outcomes.

So all therapies win. And so my take is that there's some, the dodo bird is right in some ways and it's wrong in some ways. And so it's right in some ways by virtue of what you were saying. We know that a large part of why a lot of psychotherapies are similar in their effectiveness is because it's not just the specific factors or the specific techniques. It's also what we call the non-specific factors or the common factors of therapy, which is the ability to cultivate a therapeutic alliance, instill hope, instill motivation,

the very things that alternative medicine practitioners clumsily stumble upon but aren't trained to do. So in that respect, the Dodoberg is right in that we do have that those non-specific or common factors of therapy account for a big portion of why people can get better during psychotherapy. But it's also wrong in the sense that we do know that specific therapies also add to the variance. So they also contribute to why people can get better. So for example, if we wanted to treat obsessive-compulsive disorder OCD, there is one particular treatment called exposure and response prevention, which is an advanced branch of CBT, that is our first line, it's one of the best treatments that we have. And so that treatment outperforms other kinds

of psychotherapies. We also know that some therapies do harm. And so that's also, that's a legitimate thing to, to keep in mind. And so there's, there's a literature on that, harmful psychotherapy. So one example is there's something called critical incident stress debes. briefing, which is sometimes called psychological first aid. And it's an interesting one. So it's basically when it was geared towards emergency responders. So basically when a set of people witness a traumatic event, like a car accident or a fire, this treatment is supposed to help people prevent the onset of developing a post-traumatic stress disorder or anxiety disorders. And so what it does is it breaks people up into groups, essentially so they could debrief or process the trauma

right after it happens, like 24 to 48 hours in small groups. And so this treatment is offered today. It was featured on Joe Rogan at some point, so it gets, you know, a lot of press time. But the research is pretty clear that it actually makes anxiety and PTSD symptoms worse. And no one quite knows why. The leading hypothesis is that it probably interferes with natural recovery processes because not everyone that witnesses a traumatic event is going to develop PTSD. And so if you're trying to mess with that, so to speak, it could actually make things worse. So that's one example of a harmful psychotherapy. Conversion therapy is another classic one where you're trying to change someone's sexual orientation or gender identity.

And we don't have to go into the depths of that, but that's another harmful thing. So all that to say is we have there's reasons why we have evidence-based psychotherapies work similarly in a lot of ways because we have these common factors some work better than others like ERP exposure and response prevention and then we also have harmful psychotherapy I think it's also just the idea of medical touch points like having the ability to go get care will give you better outcomes than if you don't see care just the fact that you're meeting with someone is largely helpful from the a humanistic side of things. Absolutely.

And also, you can, less likely to fall through the cracks in those scenarios. When I found out my friend got a great deal on a wool coat from winners, I started wondering, is every fabulous item I see from winners? Like that woman over there with the designer jeans. Are those from winners?

Ooh, are those beautiful gold earrings? Did she pay full price? Or that leather tote? Or that cashmere sweater? Or those knee-high boots? That dress, that jacket, those shoes. Is anyone paying full price for anything? Stop wondering, start winning.

Winners, find fabulous for less. For lack of a better term. In family medicine, you know, a lot of times I see my colleagues struggle with the fact that they get so few minutes with a patient, especially a new patient, when it comes to mental health visits and patient may request a medication. and I even saw like a little bit of critique towards family medicine in your book about having to prescribe those medications. I remember even Lady Gaga made a statement like family medicine doctor should never be prescribing antidepressants. And like on a practical level, I know that to be not a correct statement because there's

not enough psychiatrists to prescribe all the antidepressants that are necessary. Number one, number two, it is reasonable if you're training it from a family medicine perspective to do it and you're doing it the right way. what's your kind of landing point for family medicine doctors to start the course of treatment at least first line options it's such a it's a tough question and i have such a soft spot for family medicine physicians they're my favorite i have a great one myself and i call them the swiss army knives of of medicine because they have to they have to know a little bit about everything and i just i value them i think that our health care system would be destroyed without them like

They're our front line. And with that, with that comes so many challenges and especially in mental health. And so, yeah, in my book, I was talking about just a bit of the perils of that because, again, working, from my perspective, working in an addiction treatment program, I'm seeing people come with benzodiazepine addiction or other kinds of antidepressant medications that they probably don't need. And so that's, you know, one way to tackle the over-prescribing, over-diagnosis problem that we have is to just be more vigilant about it. I don't have a good solution for how family medicine physicians per se can do that, again, other than trying to increase mental health training for them. In awareness. Yeah, in awareness. And, you know, and, you know, I guess, too, having them, I wish I had the answers at the systemic level,

but obviously having them consult or work more closely with psychiatrists, say, or having a space where they can share that space, like bring in a quick site consult if that's possible, or even just have that availability. I don't know, because they have to manage so many different problems. Yeah, you know, I always thought about that I feel like hospital systems at the very least are like, we call them like medical center homes or something in our current health care system. should have a specialist like that,

especially a psychiatrist, where they're not doing consults for patients, they're doing like curbside consults for us. Yes. So just the other day, I had a patient who was diagnosed with a mental health condition, failed on some SSRIs,

failed on Welbutrin, and was saying, like, still struggling, wants a medication. And I said, look, should go see your psychiatrist again because there are other pharmacological options that may work because he's already in therapy. And he said, well, what are the options?

And I printed some of them out for him just from like our reference. And they're not ones I regularly prescribe. They have more adverse outcomes. They have unique ones. Some require monitoring. And I'm just not comfortable prescribing them. So I gave a list of those medications. And he said, look, my appointment that I was able to get early.

is in six months, any shot you're comfortable starting one of these medications. That's a dilemma. A patient going six months without the correct treatment because the system can't see them or prescribing a treatment that I'm not very well versed in prescribing. And I said, no, look, I just don't work with these medications enough. They're very specific. I think you should see a psychiatrist. Here's some other options. Maybe we can speed up your appointment. But what are we supposed to do with these scenarios from a practical standpoint? This is a real-life scenario from like one week ago. I'm not even making this up.

Yeah. Well, just as you're saying that, like what comes to mind, because I obviously, I empathize too. Like I'm not able to help all of my patients. And I benefit from consultation as well. And so I work in what's called tertiary care. So it's a specialized treatment for people that have a concurrent addiction in mental disorders.

They haven't responded to treatment. And so you work in primary care. And so where I'm working in tertiary care, we have weekly what we call case rounds. And so, again, I work on a fantastic interdisciplinary team. So if I have trouble with my patients, I get to bring it up to the other psychologists on the team and all the psychiatrists

and all the addiction medicine physicians and all the nurses. And I wish primary care had something like that too. Yeah, we desperately need that consultation aspect. Because otherwise, I feel like it's such a missed opportunity to be able to help a lot of people. Because we want to learn. we want to be able to help people and it's just it's like one step is missing in this equation

from a tertiary standpoint those are some of the systemic problems that are that i totally empathize with and i i'd be lying if i had solutions like it's those are so they're really really tough problems and i'm glad we're airing it out and what i try to do in my book is i'm really clear i say i'm not a public public health researcher i'm not a policy analyst i'm writing from the person of a clinical psychologist, and so I'm trying to help people from the individual level to arm and protect themselves from all of the crap that's out there in terms of misinformation and pseudoscience, because I don't pretend to offer any systemic solutions. I'm trying to just arm people with the defense, the defenses to just guard against all of the crap.

Sure. That makes sense. So if you have a person right now listening or watching and they feel that they need help with their mental health, where should be the first place they look? Well, I think it depends on their, on their jurisdiction and their country. But, yeah, I would look to credible, well, first, I would actually go to their family physician and hopefully their family physician would be able to refer them to a bona fide mental health professional. Are they looking for counselor, therapist, psychotherapist, psychologists, where should they, or if they're a family medicine doctor, makes the recommendation?

Because I'll tell you the reality. When I say, hey, you need CBT, or I think you would benefit from CBT, the next step is I'll give you the referral and please call the hotline on the back of your insurance card. That's a disaster where we live in now and who knows who they end up getting. I hope that their insurance is guiding them to a person who's licensed and checked and verified. But if they have the choice, if they're lucky enough, if they're blessed enough financially to make that choice, where should they go? Yeah, that's really sad because there's so much variability in our system. So like where I live, there's a line, there's a phone number called Access Mental Health. And so

I tell people, like if it's friends even, and they're saying they're struggling with their mental health, they call that line. And what they'll get on the other line is either a social worker or a mental health professional. And they'll do a 10 to 30 minute quick assessment, a triage assessment, because that mental health professional will then be able to triage the best service for them. Do they need counseling? Do they need tertiary care? Do they need more specialized treatment for addiction? Or maybe they just need general counseling. And so I wish that kind of, of service could be more available. Notwithstanding that, in a more kind of broader level,

I would say reach out to kind of major organizations and major associations. So by that, I mean, in Canada, there's a Canadian psychological association. In the U.S., there's the American Psychological Association. There's also various ones within, I guess, your state or within your province, and just trying to reach out to those bona fide, credible sources, and just ask them, email them, and try to say, where can you? can I get help? Who can help me to decide where to get help? Because I totally get it. It's hard to navigate these. It's hard to navigate as a healthy, motivated young person. How difficult is it as

someone who's struggling with their mental health to shower to do that? I mean. And in part, that lack of access and availability of evidence-based care also is what opens the door for pseudo-scientific grifters to slither in. Like, here I am. Yeah. What's, to finish off a couple of rapid fire questions, one, what's the biggest misconception you see in mental health right now? The biggest misconception in mental health.

I think I'm biased, but just what I've been seeing on, I'm biased because I live on social media. And so what I've been seeing on social media is that idea that mental illness doesn't exist. Depression doesn't exist. exist. ADHD doesn't exist. Um, schizophrenia doesn't exist. And at first, to me, that was an absurd claim until I kind of realized how pervasive that people, how pervasive it is and that people actually buy into it. And so I think that's incredibly dangerous. And, uh, it ties into that idea that it leads to patient blaming too. Because if mental illness doesn't exist, well, then what's, what's the problem? It's the problem is the person. And that's what kind of leads to blame. Yeah. Yeah, it's, it's, it's

such a difficult line to strike when speaking in generalities of balancing individual effort versus external options. So, like, maybe Ozempic isn't the greatest example here, but, you know, if we ozempicify everything, I don't know if that's a term, maybe we just created it. Like, if we can pharmaceutical ourselves out of, ADHD out of in a tent not even ADHD because that's a disorder out of inattentiveness if we can pharmaceutical ourselves out of overeating if we can pharmaceutical our way out of anger what problems does that create well it robs us of humanity on some level right we're all we all we all become the same. It's sort of like, it's the idea, I tell that to my patients all the

time, it's like, you know, what is, what is mental health? Mental health is not eradicating uncomfortable emotions. It's not getting rid of anger and sadness and anxiety. Those are, those are, we all, you and I will experience them next week or next month or next year. They're all part of humanity. And so part of mental health, which is different than mental illness or mental disorders, is being able to learn coping skills, learn how to roll with life's punches, so to speak, learning to live a higher quality of life and learning to live a life with productivity and meaning and connection and purpose, that's mental health.

And it can be a moving target and it's very difficult. And so I don't even, there is no, I think it's in some ways it's a false question because I know that the pharmaceutical industry or even the wellness industry will try to offer that as a solution, but I don't think it is a solution. There is no magic pill for that stuff. And so I think it leads people down a rabbit hole of chasing an unattainable goal.

Yeah. And I agree with you about the idea of we're not trying to erase your emotions, even the negative ones, right? You don't want people to never feel sad. You don't want people to never get angry. What is the harm or what is the benefit of having sadness? well all emotions including sadness tell us something like their their information they're they're really low resolution information it doesn't tell us what it is it's just flagging our brains to pay attention to something so sadness says you're sad about something pay attention to that go look look look into it further try to process why you're sad what is the meaning of the sadness behind it so that maybe you can do something about it or not maybe you just need to feel it Maybe you need to ride it out. Maybe it's part of grief.

And so it's sort of information and it's part of our stories. And again, working with people with addiction, we talk about this in group therapy all the time or an individual therapy. It's like the brain, we can't blame people for wanting to eradicate that emotion. It's a normal human experience too. It's like you touch your hand to a stove. You want to withdraw. Like who the hell wants to feel sadness or angry all the time? And so addiction or substances of abuse will help eradicate that temporarily.

It's an unattainable goal. And so part of it, part of addiction therapy is learning how to identify and tolerate and understand these emotions. So the purpose of sadness is to tell us something. We just don't know what that is. We need to go further investigate it. Yeah. It's like emotions like sadness are sensitive stimuli, not specific.

So they have high sensitivity, low specificity from a geeky standpoint of it all. Exactly. I think the way that I put it to my patience, or at least I make sense of it to myself, is that in order to be the most competent human being that is going to be the most functional in the world of which we live,

you need your emotions. And the more you try and get rid of them all together, you're ultimately creating a less competent version of yourself. I don't know if that makes sense, or if that's even accurate. I love that. I love that. And it's also unattainable.

It's unrealistic. You're chasing a never-ending and never-ending goal. Final question. You have a magic wand. You can fix one huge issue in the field of psychology, modern psychology.

What are you fixing? But something that exists within your world, not a piece of misinformation. Within my world. I would want to find a way to I want better funding for mental health research,

but psychotherapy research, I basically want our treatments to be better for those that we have. So like I mentioned, even our best evidence-based treatments that we have, like cognitive behavioral therapy and antidepressant medications or other psychotherapies and pharmacotherapies

won't help everyone. I think the estimates around, you know, for antidepressant is 40 to 50% I'll respond, similarly with psychotherapies. That means about half of people don't respond. And so they may need, they may need a medication switch or a psychotherapy switch or they need to figure out something else. So I want to find ways to improve our evidence-based treatments. Fortunately for me, that

task falls on researchers who actually devote their entire careers to do that. And I wish I could provide ways to do that. I feel grateful that there are people slaving away in the labs every day trying to do that. And that's why science is this molasses, like slow process. trying to make headway. But I wish we can get there faster. So if I had a magic wand, we'd be there faster. Fair. Okay.

Do you think we missed everything? Anything? Everything? I think we got it. We solved mental health. Yeah. We can go home now. Yeah.

We're done. Huge thanks again to Dr. Steia for not just coming to New York City for the interview, but for doing the hard work of tracking down and fact-checking so many of these misleading health claims that are found in his book. Pick up a copy of Mind the Science Now to arm yourself. with some excellent evidence-based information and follow Dr. Stay on his social channels. If you want to see me debunk some misinformation now,

scroll down to find my episode where I interview Dr. Stephen Gundry, where I asked some really hard questions about the information he's been promoting in his books and online. If you enjoy this episode, please give us a five-star review as it's the best way to help find new listeners

and help the show grow. As always, stay happy and healthy. Thank you.