We’re using our medical background to focus on the strange, baffling, and downright unsettling world of medical mysteries.
We’re gonna dig into unusual cases, diagnostic puzzles, unexplained symptoms, and medical misadventures.
Our first three seasons covered a little bit of everything, including crime, conspiracy, mystery, and the occasional rabbit hole we probably shouldn’t have gone down.
Those episodes aren’t going anywhere. So the archives remain open for anyone who likes their mysteries a little more broad spectrum.
But from season four on, the prescription is different. More medicine, more mysteries, more questions. So grab a drink, hit the follow, and tune in every Tuesday for a new episode.
We’re going deep into the vault to bring you a special episode. In season one, we had our Farm D consultant, Dr. Andrew, join us for a great discussion regarding the conspiracy theories surrounding the big pharma. Before we take you down that rabbit hole again, we have a few favors to ask. First, make sure you’re following Three Scene Queens on Facebook, Instagram, and Reddit so you can keep up with all our shenanigans in between episodes. And if you really want to help us out, please, please, please join us on Patreon. Your support helps keep this podcast going. And you’ll get access to bonus episodes and even more of the nonsense you know and love. Seriously, Patreon is one of the best ways to support the show. And finally, we need your help spreading the word about the podcast. So don’t forget to scroll on down and leave us a five-star review. Then send this episode to three people who you think would love it. Your best friend, your coworker, and that one person who loves to nerd out an all things mystery, conspiracy, and medicine. You know who they are. Every little bit helps us keep doing what we love. And we appreciate you more than you know. Disclaimer: the views, opinions, and commentary expressed on this podcast are those of the hosts and guests, and do not represent the view or opinions of our employers, organizations, or professional affiliations. Can I get a drum roll, please, Megan? Introducing to the podcast.
Our Pharm D consult, our pharmacist, Dr. Andrew, our pharmacy expert. Our Farm D. Yeah. Farm D is nuts. I like consult with Dr. Andrew pretty regularly. He always gives me good medical advice. Yeah, yeah. He’s not, he’s not like down in the basement, you know. He’s a clinical pharmacist. He did a residency.
He’s legitness.
Yeah. You may have seen him at ER at some point in your life. You may have seen him at an ICU at some point in your life. T knows what’s up. All right. Should we talk big pharma?
Big pharma.
Big pharma. People have long alleged that the pharmaceutical company suppress cures for diseases to maintain a steady revenue from ongoing treatments. In fact, there’s a belief that Big Pharma is actively working to suppress alternative treatments that could compete with pharmaceutical products. Further conspiracy theories include assertions that data from drug trials are manipulated to ensure FDA approval and market success, that the government colludes to enforce regulations that favor their interests, and that big pharma influences doctors through kickbacks and promotions, which could lead to biased prescribing practices. Today we’re going to have our resident pharmd break down these and other conspiracy theories. Oh, that was good. Thank you. Before you start, what is everybody’s thoughts and feelings on it?
Anti-big pharma, but also I use meds. Do you believe that they are like hiding cures? I want to think that they know cures, but I I want to assume the reason they don’t have the cures is because they just don’t have enough evidence. Like I’m sure there’s experiments. Like it’s being done.
So you think they like discovered it already, but it’s not ready yet.
But what I do believe, and I think it’s pretty much a fact, that like they feed into certain marketing schemes to get people to buy meds that don’t do anything. Like the cold and flu aisle.
Oh, yeah, for sure.
So I am not anti-big pharma. I think that’s like I mean, obviously, right? I do think that if you want to approach it from like a business aspect, I think that like people making money off of illnesses is kind of wrong, jacking up the prices, but that’s like more ethical versus do I think that they’re trying to sell something that isn’t right or isn’t promoting health? I do think that there is like a fundamental problem with polypharmacy. Like that’s my problem with it, with it is like I think too many people are too medicated because honestly, doctors don’t have time to sit down and like go through every disease process with them and like talk about preventative medicine and all of that. But anyway, that’s sort of my stance on it.
I’m with you. I do think it’s unfortunate that there’s so much profiting happening. Right. Right. Yeah. I don’t think that they like have the cure for cancer and they’ve just been concealing it from us because why would they do that? Like why would it they make money? They could just make money by curing the curing cancer, right? Right. And because that would that would just be more expensive. But to your point, Kate, I mean, I agree that polypharmacy is an issue, but I think that issue is more so that healthcare has become too much of a customer service industry. Oh, yeah. And it’s like people aren’t happy if they don’t get a pill and then they don’t necessarily understand that it’s like these side effects are causing more pills or more pills. Right. So I do think that’s an issue too. It’s like a cycle.
Yeah. And yeah, people, for the most part, I don’t think, take responsibility for their own health. Well, people are like, oh, I’m sick. I need all the mints instead of just like I have a garden. I have a runny nose. Why is this pay why is this doctor not giving me an antibiotic?
Yeah. And then you leave a bad review, and then the birthment goes down. So we just give you an antibiotic to shut you up and send you on your way. Right. You know? That’s not right. That’s a whole problem. That could be a whole other conversation. All right. We’ll turn it over to Andrew. Tell us what you think.
Okay, so you guys sort of touched on a lot of different angles of what is a bit conspiratorial, but also sort of uh, I guess, market factors. So when you add the money in and people are able to make money, people are gonna do things to maximize that money that pushes the limits of ethics.
Right.
But does that become a conspiracy? I don’t know. It’s hard to say. Right. Certainly, uh, your point about what’s now a movement called functional medicine has been a bit lost, but is having a resurgence.
Yeah.
Functional medicine is kind of the idea that you treat the patient holistically, you educate them on the reasons that they’re ill and that they don’t feel well, and then you guide them through all the things that make them feel better. And that’s certainly a valid approach. But what’s interesting is that conversation, that issue actually stems back to what might be one of the better conspiracy stories in medicine, modern medicine. In 1910, there was a paper put out called the Flexner Report.
Oh, I feel like I’ve heard of this.
And the genesis of the Flexner Report is interesting, which I’ll go through in a moment, but um, the punchline basically is that the report outlined a mechanism, a mode, and a philosophy that was to be adopted by all medical schools in the US to represent how American medicine would proceed in the coming century. Obviously, uh we were learning a lot about medicine and science and that sort of thing between the 1800s and early 1900s. So it interacted in a way to sort of suppress some of that functional medicine, but actually the money is what caused the situation that we’re in now, which is kind of what you guys described.
Yeah. I think functional medicine is sort of having this resurgence, though, because of the way, I mean, this is like sort of off topic, but like functional medicine is it functional and integrative medicine are sort of having this resurgence because insurance companies have made it so that doctors and practitioners providers can only spend an X amount of time with people. And if they go over that time, that they’re not gonna get reimbursed because insurance companies are driving that, right? So, like you go to these functional medicine doctors and these integrative medicine doctors, and what they’re hearing is that someone’s actually listening to them rather than just like, okay, we got to get through this. I have 20 patients that I have to see. That’s off topic. But I think that’s sort of like where this like resurgence is going to, and people are actually feel like they’re listening, and then these functional medicine providers are sort of are they prescribing things that are actually evidence-based we don’t know?
Yeah, the the part that you’re kind of glazing over there and maybe assuming that people know is that these functional medicine integrative medicine practices have taken the money out of the equation in the way that insurance companies manage it. And so you pay for access to this doctor and you pay them cash and you pay them a reasonable fee, and they give you their opinion on your whole health. Right. And then you go from there. And in the broader context, the the main difference there is taking that money feature out of it and that business mind out of the medical the medical practice. One of the major health systems in the region here in Maryland, their business office or medical director sent an email basically to all the practitioners and said, if you’re not seeing five patients in an hour, then you’re underperforming. And that’s completing charts in in that time. So the patient encounter is six minutes and the charting is six minutes, and then you’re done. So if you can’t get it done in that time frame, then you’re underperforming and you’re you’re gonna be penalized. And they had a massive walkout of frontline providers. Yeah. Which is crazy because in medicine there’s a shortage of providers, so they’re the commodity, right? You know, they can walk and they will find a job within days. Right. We can go into PBMs at some point, but I don’t I don’t know if that’s a topic for today. But if anybody wants to hear about PBMs, they’re pharmacy benefit managers. This is the industry that invented prior authorization. Uh it’s horrible. It’s a horrible thing. And they get paid billions of dollars to make up these prior authorizations that really end up doing nothing but care. The only point is to limit care, limit costs, and limit how much they’re willing to do for you without putting you through a bunch of hoops. Right. And um, it’s it’s not anything that benefits the patient. That probably is a conspiracy, and we could talk about that in another in another episode if we want to go through there. But uh, let me tell you a little bit about this Flexner thing. So, right around 1900, a group of people got together and they were dubbed the Hopkins Circle. Okay, so Johns Hopkins was a successful Quaker businessman who put a lot of money into creating the Johns Hopkins University. Johns Hopkins University had a medical program and it was very important to them. So a bunch of thinkers got together about how do we want medical care and medical training to look in America, and they commissioned a guy named Flexner to come in and do a survey, tell everybody what the practice of medicine and medical training should look like. It’s funny because Flexner thought that he was like the wrong guy for the job. He thought they were they mistook him for his brother, who was a pharmacist. Oh. And like he got the letter on accident. Oh wow. Um, but be nice, yeah. Accidentally get a job I a giant government contract to do this huge to just write a philosophical paper about how colleges should work. He’s a guy who went to Johns Hopkins, so he was known there, and his brother, who is a pharmacist, paid for his trip to Hopkins. But the his passion was education, and so he went back to Louisville where they were from, created a high school, but kind of changed the game as far as education goes. And instead of it just being memorization after memorization, he applied practical learning techniques, problem-based learning, these sorts of things, created this very popular high school. Was it a like a public school or was it like a it was a private high school in Louisville, yeah. And so then he sold off this high school to go study philosophy at Harvard, which was his passion. At some point in that journey, he decided to write a paper called The American College. And this paper described sort of his belief on how college education should transpire.
This guy was a big idea guy.
Yeah, so he’s a philosopher.
Ah, yeah.
The true like doctor of education, right?
Like he liked writing framework.
Yeah, yeah.
Yeah.
So these guys that were wringing their hands about what to do about how do we teach medicine in America, because things were changing, we were getting to know a lot more of the science.
They had to standardize it.
And at the time, all medical schools in America were private, they all had their own ideas about how medicine should go because there’s a lot of traditional things and there’s a lot of modern things, and there was a lot of things that people just made up and found an audience. Because yeah, yeah, yeah.
This is like like penicillin is just being created.
Exactly, yeah. So we’re just learning, you know, all these great things about you know, Adam, the theory of the atom, right? Was like not even really clear at that time. Oh wow, I heard they’re pretty great. Um anyway, the the Hopkins Circle guys commissioned Flexner to write this report. And basically, there were kind of two tenets that codified how we got to where we are in medicine right now. He studied and looked a lot at the German medical society and their medical education, which was very science focused. Again, this is an era where science and art and belief and that sort of thing was sort of becoming mainstream but wasn’t yet.
Okay.
And so he said basically that the treatment of patients in medicine should be science-based and evidence-based only.
Okay.
So if we don’t have science to prove that it’s the right thing to do, you shouldn’t be doing it. Right. Okay.
So was how we practice now.
Yeah, and so that resonates, right? Right. We feel that in the way that we practice medicine now. Yeah. But clearly that ignores a bit of sort of the esoteric side of medicine, but also the patient-focused side of medicine. The other thing that it did was it he described the creation of full-time academic medicine faculty. What he said was medical schools should have faculty that aren’t burdened with clinical duties and operations of dealing with patients, but instead they’re paid by the university to be allowed to do this science, to find the answers to the questions, to build the evidence base so that we can design and make medicine correctly within this science-based framework. All right, this is an excerpt from a paper called The Flexner Report 100 Years Later. So this was in 2010. But it says the most vocal challenger and naysayer was William Osler, who was subsequently seconded by Harvey Cushing. This is Harvey Cushing was his mentee, so they were in coots. He was apprehensive that a generation of clinical prigs would be created. I don’t know what prigs means, but I love it. Individuals who were removed from the realities and messy details of their patients’ lives.
I want to know the details.
Right? Osler believed that the Flexnarians had their priorities wrong in situating the advancement of knowledge as the overriding aspiration of the academic physician. He placed the welfare of patients and the education of students to that effect as more important priorities. Although he reverenced the centrality of scientific knowledge in that regard. So basically, uh Oxner is saying you guys are going to create a bunch of robots who don’t know how to deal with people, who don’t know That’s pretty accurate. Who are only focused on doing the science thing and and can’t manage humans. Right.
That’s why nurse practitioners are the best. So I’m just saying.
Yeah, well there’s something to be said for that, right? So you guys spend a lot of time at the bedside, or at least you’re supposed to have spent a lot of time in the bed at the bedside learning how to deal with people first and then become clinicians capable of doing the higher level diagnostics, etc. So it’s a fantastic model for training that does very much differ from what this was designed to be. And so Osler said all this stuff, but ultimately Andrew Carnegie, the Carnegie Foundation, had basically brought in a person to be on the Hopkins Circle for them. And John D. Rockefeller decided that he wanted to spend some of his money on advancing medical education. So his money was at play, Carnegie money was at play, and their people liked the Flexner report. And so that’s what went out. And now we have this sort of paying for it. Exactly. So you follow the money, right? Follow the money. And you end up in a place where we all feel a little uncomfortable 120 years later, as robots of science and not doing as enough to deal with the human side of medicine. Um, and of course, this generates a medical model that is uh money-making, money-dependent, right? Because if you can’t pay the researchers to do the research, then how do you live? And so eventually the Rockefeller money like dried up, you know? And so it builds into this sort of medicine as a money-making venture, which also kind of has ruined, spoiled the pot.
That definitely seems to have created. I I mean that’s really what the problem is, right? Why people are going outside of like they’re not trusting pharma pharma is because they’re thinking the they’re they’re not here for us. They’re not here to treat the person, they’re here to get the money. And that’s really the the root of the problem is that like people are saying, well, big pharma’s not really out to take care of us, they’re here to just put money in these deep pockets and keep filling them.
Yeah, for sure. So, you know, aspirin is not a a miraculous thing, it’s a it’s a very basic chemical, easily accessible from the bark of the ash willow, I think, or something like that. Yes. Right? So you can get it, but it was ba the bear company, a German company, who decided to isolate it, put it into a tablet and privatize and sell all this stuff, right? It feels icky when you realize that some of this stuff is available to you in another format, but no one’s telling you that. They just tell you go get a bear aspirin. Right. Right? And and then even you you kind of get caught up in the thing about generics and brands, and but sometimes the generic is the brand. Like literally it’s the same tablet, but just with a different sticker on the bit on the box, and now you’re you’re stuck in a situation where do I trust that guy more than this guy?
But right, the same met.
We can pivot a little bit in the theme of following the money, right? Yeah, get into pharma. And I guess the pharma concerns are echoing this the sentiment that we’ve all been sharing, right? They’re doing uh unethical or borderline ethical things to separate us from our money and don’t really care if we’re healthy or not. Right. And and then you can imagine the next step of that being like they’re not even they’re not ready to release the cure yet because treating the disease is what makes more money.
Right.
Right.
So perpetuating, I just think about these guys that like the all of the farm bros and whatever, right, who are in trouble for like jacking up prices.
Why couldn’t she be like, I have this pill that will cure your breast cancer and I’m gonna charge fifty thousand dollars it’s like the HIGV drug that was like seventy dollars, but he he marked it up to 700.
I just feel like if their goal is to confit and they have the you could you could make it so that you could profit off of the cure.
Yes, yeah, but you could only profit until you cure everybody. So that’s the pro that’s that’s the conspiracy theory, is that is that eventually there won’t be any cancer.
Well, there will be people that keep this they can just go invent a virus in a lab. Well, that’s yeah, and leak it. Is that what they’re doing though? That’s what they did for sure. But is that what they’re continuing? Did Pfizer do that? Yeah, I just feel like there could always there’s always gonna be new Yeah, it does feel like that was an oopsie. Yeah Oh yeah, he had one job and he didn’t but like like the whooping cough is now having a I just feel like even if you care that if you girl high school, we got uh oh Hate and I had pertussis.
Yeah, the hundred day cough.
Big pharma kinda goes way back, okay. So you’ve heard of snake oil salesmen, right? Yeah. So the idea was that people would go around and sell patent medicines to what we call patent medicines to people, and this was just whatever they decided to put in it, and they would tell you that it’s for disease. Often they would include things that had pharmaceutical effects, most likely things like cocaine or morphine that make you feel good. Right. Right? So then you tell somebody that this is gonna make you feel better, and it certainly does, but in a different way. But you’re no one is expecting it to be cocaine or or morphine, right? Now that we know what those things are, right? Yeah, picture of opium or whatever it was called during the day. This got to be a big problem, and eventually the US government got involved and created what’s called the Food, Drug, and Cosmetics Act. FDA establishing the FDA. But it was originally only to help combat the idea of putting whatever you want in these patent medicines. And what it was said to be had to be what it was. Okay. So if you said it was tincture of opium, it couldn’t be manure. But before that, it could. Right. Which is like regulation.
That’s too fine.
So that’s the first layer of regulation, which seems important. Yeah.
Very so what’s in it should say what it is.
Yeah. And and in the age of so misinformation was easy when you were basically stuck with talking to your neighbor as like your only source of fact check.
Yeah. Right. So without Google?
Um so the first pass at regulation tried to um address this discrepancy between what people could say and what they could could give you. Right. Which is important. But it didn’t cover everything. In in this same period, though.
People are very anti-FDA right now, too.
Oh yeah? Yeah. Oh, I didn’t know that.
Why are they anti-FDA? Because they think the FDA F it’s the same sort of idea. The FDA is still trying to poison us.
The FDA is in on it. Oh, I see. I’ll talk about that a little bit if you want. In this era, right? Pharma was sort of established, right? Because you need some industries to be able to regulate, deal with the regulations. You can’t just one off. You’re probably not going to one off as a as a guy with a leather pouch going town to town, gonna be successful in fighting and being able to navigate the regulatory environment that was now born. This didn’t require the the companies to do anything with regard to the management of disease. Okay, so there was no connection between does this medicine do what it says it’s supposed to do?
Oh, I see. So they so someone would like cut go and be like, Man, my my nose is really stuffy. And the guy’s like, Well, this is some morphine. Yeah. Uh-huh. Yeah.
This will make you feel good.
Yeah, yeah.
And that was the only rule they had to follow. Like, if I told you it was morphine, it was morphine, and that was it.
Okay, yeah.
So there was So they can make up what it was for.
Yeah.
They could make up the purpose, the intent, the side effects. None of that. None of that had to be real.
Yeah.
Okay. There’s a company, uh, I think it’s Johnson Johnson, invented the word halitosis. You know that word is?
Yeah, yeah. It’s bad breath.
It means bad breath, right? That’s not a medical term. But they just invented Johnson and Johnson made that up. Oh my god.
Oh my gosh. And now we throw it around like a medical diagnosis.
Yeah, yeah. Johnson Johnson invented the word halatosis, published it in all these magazines saying, dude, you have halatosis. You might not know you have halatosis. Oh my gosh. We’ve got the perfect thing for you, Listerine. Not of a fancy cure halatosis.
Wow. That’s how mouthwash came about. Yeah.
They made it up. It is all made up.
What? Oh my god. Blowing our minds.
I’m like, but isn’t halatosis like an actual diagnosis?
No, and it’s it’s not. It just means your breath smells, but everybody’s breath smells like something. Oh my god.
Like it’s objective if your breath is bad. Like I don’t know. Much mouthwash. Dogs love smelly breath. I don’t know.
Like they do.
So like maybe it’s somebody’s thing. That doesn’t mean it’s but they created an entire industry of selling you stuff around a made-up condition.
Wow. And like easy. Yeah, having bad breaths. People still use it now.
Right. And and we’ve maybe maybe, I don’t even know if this is true. I don’t even know if there’s any evidence yet to actually support that Listerine makes you healthier.
Makes you healthy. Wasn’t there an article that said if you used mouthwash, you were less likely to get COVID? Wasn’t that okay when that was happening?
Oh, I don’t know.
That was like a that was like they were telling me March 2021, two types of mouthwash disrupt the COVID virus under lab conditions.
I’d say every time I get even the inkling feeling that I’m getting sick, I start gargling mouthwash like three times a day. And I feel better.
Well, that’s the whole reason why that’s how everyone should drink bourbon when they’re sick because alcohol kills or hot tea.
Yeah.
Yeah. Hot today’s.
Yeah. There’s like a 2023 article from the British Dental Journal. Mouthwash used to not show any long-term benefit on cardiovascular disease mortality beyond the benefits of brushing and flossing. And then the NIH, NH has an article here that actually says frequent use of mouthwash was associated with increased risk of hypertension. So you know, my favorite line is the one that our pharmacist That’s association. That’s not a causation. No, but here’s what here is what our smart pharmacist will say. In the absence of benefit, there is only risk.
Well, oh that is a thing that I like to say. And sometimes the risk is just financial, right? Yeah. Sometimes you’re just throwing money on the floor. Right. Mouthwash, like every day. And that’s fine. If it makes you feel good in your heart. If it doesn’t make you feel good and it doesn’t make your body any healthier.
Or not anti-dental hygiene. Well, I also just watched like a couple. I mean my resources are TikTok, but like dentists on TikTok saying that like whitening toothpaste does literally nothing. Oh the only way to clean your teeth is brushing it. Like the toothpaste doesn’t make a difference.
Well, we have a friend of the pod who has very white teeth and he just brushes with baking soda. Isn’t there some rule on these commercials that you have to spend like X amount of time listing side effects?
Yeah, I don’t know if that’s accurate. There certainly is a requirement for some side effects to be listed. I thought it was like based on frequency of how much they’re observed.
The top side effects.
Yeah. Like if anything exceeds more than 3%, then they have to mention it.
Yeah, my favorite is like the person like you know frolicking a field, and it’s like, this could cause severe cardiovascular death.
Yeah, death.
Stroke.
Yeah, but they say irritating stroke, Crohn’s disease, like dementia. Yeah, it’s ask your doctor for a dosing today. Yeah.
And in my experience, I get more questions from people who are kind of like spooked by the ads. And and the FDA is doing that on purpose because uh direct to consumer advertising of medicines is questionable, as we just went through, right? Right. So selling you something that looks good and and makes you with a bunch of images that look good and make you feel good when you’re talking about like the difference between dying from lung cancer in one year versus six months, like okay, right, but this is not this is not appropriate for the patient to be navigating or bringing up or advocating for. It’s really just a giant waste of everyone’s time.
Yeah. It’s like 20 years ago when the Nexium commercials would come on, they call it the little purple pill. Remember, yeah. Uh-huh. And now we’re like PPIs are not as good as we think they were.
Yeah, well, oops.
Yeah, just exactly all these like new um medications for like type 2 diabetes that have like pretty severe side effects. Like, is it Jardians that has like crazy like metabolic acidose?
Yeah, yeah.
You can just like that uh euglycemic DKA. Yeah. How about that’s like asymptomatic MTIs? Yeah, right.
You get in a car wreck after you took that stuff, and then all of a sudden you’re in a metabolic cra you’re crashing in a metabolic crisis that nobody can figure out. Right. Because you were taking your diabetes medicine yesterday and they didn’t feed you the day before because you were in surgery all day.
Yeah, and then or like the GLP1 agonists that people are taking, those are the also diabetic, but also known as, you know, uh Ozempic.
Now they all have a million off-label uses too. Yeah, that too. Like now these meds are gonna like save our kidneys, treat our SIEDH, like help with some weight loss, treat our cardiovascular health.
Make you feel good.
Eat a vegetable. Like we should just we should just like all be on like an SGLT. And there it is. Yeah, sprinkle it, sprinkle it but yeah.
So you’re bringing us right back to the functional medicine question, right? What is causing the disease? How do we fix the behaviors that are making us ill? And eating fruit could probably be the answer for some people, right?
Also, just like go outside. Like people need to go outside and take a walk, like get off the social media, get off your devices. Like, I think that like the true problem lies in that, like people just don’t want to do the work, right? So then the medicine takes out the work.
A little I think a little bit of it, a lot of people is like uh just poor education.
They just don’t know. And I’m not saying that the the benefit of like medicine is not there. There is benefit to medicine. There are people that live in chronic pain. I take an SSRI every day for my anxiety. Like that is something that I need help managing with a medication, but you can also talk about adjunct therapy that like top therapy coping mechanism. Right, exactly. That is not is not as profitable, right? So I think that the idea is that yeah.
And when you follow the money, the money talks, the money is what gets the commercials on the TV, the money is what gets in front of you because then somebody can sell you something. Right. When it’s like exercise more is the answer, no one’s selling you anything. And and so they don’t get the air time, basically.
Right. And then I think about like just TikTok alone has made me think I have like 20 different skin disorders. And like that just gets in your head, and then people think they have this, and then they go to get a diagnosis, and then they get mad that they don’t receive that, and it’s just like a cycle.
But then you can go other the other side of that is like functional medicine is saying take all of these supplements, and it’s like again, the supplements you could probably just get from like yeah, I’m funny that you want to hear about the supplements.
Okay. The FDNC Act in the 1920s was not the end of regulation for medicine. Okay, so I kind of I don’t want to leave you guys like horrified that that’s the say the state of play right now.
Okay, there’s an ending. Just beat your ingredients.
Um I mean, it it comes on the heels of an absolute travesty, which is a medication called th thalidomide, which was marketed for um nausea and vomiting in pregnancy. Um turns out to have caused um severe deformities. Severe deformities in in the children born of pa mothers who were taking it.
So did they have flipper babies? No exactly.
That’s it. Exactly. And so ultimately it wasn’t until after this w that they amended the Food, Drug, and Cosmetic Acts to require that you prove your medication is both effective for the disease state that you say it is, and also safe for the general population to be exposed to. Yeah. And so before that it was free game as long as you were saying that thing is real. But now there are truly rules that require the science to be there. And while you can see where that makes sense in that context, it also sort of builds on this issue of the Flexner report, right? The science has to be there, or we can’t say it’s medicine.
Right.
Okay. And so, uh, to your point about supplements and and natural products, now we have an even stronger divide between those who can prove that their medicine does the thing that they say it does, and those other things that are natural products that people have been using for 5,000 years and probably helped a few people along the way.
Right.
But that doesn’t get past the FDA, that doesn’t get past, that doesn’t get a commercial. So, yeah, bringing it into the natural medicine side of things, um, it’s definitely true that we have lost some perspective on these traditional medicine things, right? So they say that Ayurveda is a medical practice of holistic health that’s been practiced in India for over 5,000 years.
Yeah, I know what it is. So they says this sounds up Kate’s alley.
Yeah, so Ayurveda medicine has is a tradition that dates back over 5,000 years. Okay, we have evidence of writings and uh true anthropological data that says these people were doing this and are still doing this 5,000 years later. Yeah. Traditional Chinese medicine is probably as old, but you know, it does blur the lines between science and art and and the natural world. What’s interesting now, though, in America, I guess, to me is the management of these things and the regulation of these things is is hinged only on the communication about what they do. Okay. So they’re these natural products are typically regulated like foods, more so than they are regulated like uh medicine. And so you have to you you can’t make it in a factory that’s covered in rats, but beyond the food safety aspect of it, there’s not much requirement. So it’s actually managed by the FTC, the Federal Trade Commission. And these are the people that you know let Bernie Madoff do whatever he wanted to do, etc. etc. etc. And now they have this like probably one-room office of people who manage the language around natural products. Uh, I’m sure it’s well funded.
Yeah.
But uh, and their job is to uh police what you can say about a natural product and how it works. They’re not allowed to use language that implies or or states that it treats disease. They can say things about how it might improve gut health, but they can’t tell you it supports adrenal health. Yeah, but it can’t treat they can’t say this treats your IBS. Right. Okay. And that’s just because they don’t have the research studies behind it, or like well, it’s entirely based on the marketer’s choice to market it as a medicine or as a natural food product. They jump through if they market it as a profit as much. Okay.
Yeah, and and so get it on the market faster, I assume. Right. Research is like so expensive, right? Yeah, so expensive. So expensive. And if it’s not funded, so if you look at the fine print, you look at these articles that are like funding medicine that doctors were prescribing, like Jardians. We’re talking about Jardians. Yeah. Jardiance just recently just went through all of these random control trials to see, like, does it benefit CHF patients? Right. You look down at the bottom, and there’s always a place that you should say, like, well, you know, where is it funded? Where are my potential biases? And like it’s the drug companies that are paying for the medicine. The drug fun companies are paying for the research, and the drug companies are already wealthy. But you then you have these tiny little companies that like are saying the this you know herbal product has been used for centuries for but the research is not there because there’s no funding for it. And it’s because the the who’s gonna who’s gonna fund a project like that? It’s so it’s hard enough to fund research if you don’t have a drug company that’s backing the research.
Right. Andrew can speak more to this because he’s the one who kind of mentioned this to me in a previous conversation. But say you you’re like, you know what, we know that vitamin D is good for osteoporosis, right? But if you’re if you are selling this as a supplement, you don’t necessarily have to have the same quantity of vitamin D as maybe you would have had to have if this was like a a drug, a regulated drug, and you’re like, this is how much vitamin D you need to have a benefit. So it’s like they can kind of the supplements can kind of fudge the the dosing. The doses. Yeah, right, right. And the contents of their medication. And you don’t have to like defend it.
Think about like fiber supplements. If you were taking fiber supplements, like just to add fiber to your diet, like the actual benefit amount of fiber is like 20 gummies, like to actually versus if you just eat three pieces of broccoli. Yes, right.
Right. Right. And and so the regulations only say that the gummies have to have fiber in them.
Yeah.
But on the subject of fiber, right? So one aspect is the the patentability of a specific chemical that does a good job at something versus you can’t patent oat fiber. Okay, and you can’t be the exclusive seller of oat fiber. Because it’s just oat fiber, right? And and so you go out and you try to prove this thing so that oat fiber is good for you. You pay, I don’t know, forty thousand dollars, four million dollars, whatever the scale is, to prove that oat fiber is good for you. And so at the end of the day, everybody just goes out and buys Cheerios and you can’t sell it, right? So there’s a component of that involved in natural medicine research too, because this stuff is non-patentable. You can’t be the exclusive seller.
Oh, yeah. There’s no way to really bet whereas with a private med, you can be the only one to patent that med. Yeah, the formulation of it. Right.
And in the 70s, in order to uh push forward some of this research, the FDA created these patent exclusivities, this brand drug pat patterns. Yeah, so the branded branded drugs have a 14-year life. So once you file with the FDA that this is the chemical that I want to study and sell, you got 14 years of exclusivity. Nobody else can do that, nobody else can sell that in America until that 14 years is up. When that 14 year what if you spend 10 of those years in research, you get four years to sell it before a generic comes out. So that’s why we don’t have brand name, so we have various timings for when brand name drugs. Brand eloquist. It should be eloquent right now. Yeah, exactly. And it’s coming. And and that was designed to protect profits, but in the theory that protecting those profits would advance research and allow more funding of research, because if you can dream up, you know, this benefiber study, then everybody can just go buy it wherever and you don’t make any money and then you lose. So nobody’s gonna do the research. And that’s where we are with natural medicines. Not that they don’t help you, yeah, not that they’re not good for you, but um, it’s just that there’s no money in the research, right? So the research doesn’t exist.
Right, exactly. Yeah.
So is that a conspiracy or is this marketing and business acumen in a capitalist society? I don’t know. You can sort of lean one way or the other and you can call it both um easily and get and and be totally justified. Back to the Flexner issue, okay. Doctors by design now, we chose this, have been trained over the last century to only support things that show evidence.
Yeah, right.
And so now they’re working in a world where they’re told you can’t use this if it’s not proven. Um and you shouldn’t advocate for this if it’s not if it’s not proven. Right. But they they miss the part about there’s no proof because it doesn’t make sense to get proof, and if it’s ubiquitously safe, so if vitamin A putting it on your skin is never harmed anyone in the history of any anything, right? There’s not really a downside in many cases. And and so people who are aware of this can advocate for it and do it, but there’s not gonna be a commercial, and there’s not gonna be uh a published paper, and so the consumers and the physicians are are sort of at a at an impasse in a way.
I guess I feel like I get everything you’re saying makes sense. I think that also people have this misnomer of that like it’s just a supplement and so it doesn’t have any side effects, right? But then we see patients, yeah, but you know, patients come into the hospital and they they take no meds or just on supplements and they’re like bleeding from every orifice or whatever. Like I just feel like these things are not benign, and they do have some of them do have side effects, and we don’t unlike a commercial for your drug where you hear your 30 side effects.
What’s the one that can cause Stephen Johnson’s syndrome? Like there’s certain supplements. St.
John’s wort? Yeah.
And think St.
John’s wort with in conjunction with an SSRI can cause like serotonin syndrome. There we go. Right syndrome. Very good.
Yeah.
Very good, doctor.
You do have to like research, but yeah, it’s not clear on a bottle of St.
But sensors, no, yeah, and sensors not really research, like you’re saying.
Yeah. So there’s some that are well known and well established. Um, there’s definitely Kaba.
What is it, Kaba? I’m just saying that’s my point, Kate. When I when I roll now, Kate did tell me to start taking a pre and probiotic, and it and I did not believe in them. And it did change my digestive health. Okay. So I guess I’m not like anti-supplements. I just think that’s what drives me crazy is that there are people, and I get your point, that it’s not that like what I’m like, there’s no evidence, I’m guilty of what you’re describing, right? Like I I’m very much in like a where’s the literature, where’s the evidence? It doesn’t exist for the reasons you’re saying. But I just think it’s Or it doesn’t exist because it doesn’t work.
Yeah. Okay. So and and people suppress that. Yeah, yeah. And they feel a certain way about something.
Yeah, maybe they have an applauseable effect, but it just I just feel like this isn’t regulated. Some people put themselves in these supplements, they think that it’s like curing their issues, right? We see we see patients who take themselves off their proven medications because they think they can just treat themselves with supplements, which are just are not all benign.
Then they’re like in the hospital and an MI because they took themselves off their three anti-hypertensives. Yeah, like, yeah, but humoric’s not gonna cure your high blood pressure. Like that’s just a poor education, too. It’s just weird. Right. Where like you know, the misinformation from door to door has sort of come back now because social media is so prevalent.
Yeah, and social media inf misinformation is a huge problem I have a lot of thoughts on. But yeah, to me, the biggest problem with social media information is that for the majority of history with these platforms, each voice is given an equal weight. Then you’re just left by voice count to know who’s real and who’s who’s right and who’s wrong. Yeah. And things that are popular or or resonate in certain ways with people will be promoted, but you’re left to kind of interpret on your own whether it’s promoted because it’s right or promoted because it’s popular. Yeah. And those aren’t equivalent.
Right, exactly. Like no, not at all. We know that.
We digress a little bit. There are definitely some people trying to fix some of the issues that you talked about, Megan, which is like how do we distinguish something that has some medical benefit from something that is just thought about or been used forever? Okay, and and we believe in our hearts that this is what’s good for us. So, for example, Spain separated the term. They use a term natural medicine versus phytotraditional product. And so the idea there being that you distinguish something with some degree of medical basis from something that’s just a historically traditional used natural product that might, you know, be used in a medical or Ayurvedic or traditional Chinese medicine kind of a pattern. It’s definitely important to distinguish those things that might benefit you from you know just getting a pile of grass and trying to eat it to help you feel better. Like that doesn’t do it.
When when because I like consume a lot of information in relation to like holistic medicine, holistic, not medicine, I would say holistic wellness, right? I’ve listened to podcasts about Ayurveda.
Are you Veda? I Your Veda.
I your Veda. Yeah, I’ve listened to podcasts. And I and in those podcasts, I’m listening to this and I’m like, this is not not at all evidence-based. It’s very much like energies and like you know, yeah. Like, and I I do think there is like a part of that, right? Again, when I say like go outside, touch some grass, use the light and the like of the day to sort of like help balance your hormones or whatever. But people are again are trying to like this supplement is exactly it’s almost like supplements that are now the polypharmacy instead of medicine being polypharmacy. And again, I think that’s that’s not the shift that you want it to take either.
Right.
Instead of people trusting like this is the medical doctors that are like evidence-based, science-based, whatever, they’re trying to, like Megan said, you know, take themselves off of it, but then instead they’re just taking all these supplements and said, How is that any better? Yeah, right. Like what what does it go? Yeah, there’s been like benefit and risk to everything.
Yeah, sure. What I find fascinating about sometimes people, for example, supplement called your red yeast rice, which helps lower cholesterol. That’s because there’s a chemical in it that works exactly like a statin.
Oh, and it’s also like taking a Brazilian nut once a day lowers your cholesterol too, right?
Is that the same thing?
Oh, Brazil nuts are high in selenium. Oh, yeah, yeah.
So there are people who would take red yeast rice and say this is what I’m doing for my cholesterol. But if you were to isolate the chemical in red yeast rice, which I I forget what the name of it is, and give it to them as a pill, they would decry it, even though it’s exactly the same amount of medicine that they’re getting. Because now you’re calling it a chemical instead of red yeast rice. And so there’s a psychology of like drug versus natural, which doesn’t always make sense in the setting. Um and there’s also another pitfall with natural medicine that let’s say it’s red yeast rice that has this. But what if you take the plant root and grind it up and put it in a capsule? It doesn’t have any of the active ingredient in it, but you can still call it red yeast rice. But it’s not gonna do it, but it doesn’t do the thing, right? So what if it’s ginseng, ginseng leaf, flower, root all have different chemical profiles. But they can all be called But they can all be called a ginseng supplement. Oh right, so yeah, so you kind of have to inform yourself be clear about what you’re seeking, what you what the appropriate part of the plant is, how much you want, you know, is it enough? You can take ALA for your nerves, but if you take the wrong amount, does it help? Maybe if it doesn’t work, is it because it doesn’t work for you or because you didn’t take enough? Yeah, right. So um all of those things are often left to the consumer to navigate, which is kind of scary. But actually, a lot of us pharmacists, doctors, nurse practitioners all know and can help guide that. So if you want to take cinnamon, you got to take the right amount. If you want to take red yeast rice, you gotta take the right amount. Um, St. John’s wart, we talked about earlier, again, works like an antidepressant. That’s fine, does its thing, but it has to be taken in the right amount, the right part of the plant, the right time of day, et cetera, et cetera. So a lot of times doctors and pharmacists and nurse practitioners and all these wonderful people that are on your care team are aware of these alternative strategies to pharmaceuticals, but they don’t necessarily bring them up because of various biases or time limitations or whatever it may be, or they don’t think you’re interested. Right. So if you let your care teams know that’s something that you feel passionate about or you want to try the lifestyle, I want to do everything I can to avoid getting a medicine. Right. They can guide you through that journey and they can use these natural products to do it, but that’s not the reflex uh answer in those. Right. And some of it comes back to that conversation we had about being told they have to see five patients in an hour or they get fired. Um, you know, you don’t have time to go through all those things, but if you’ve if you make it known that that’s what you that’s your preference, uh myself and others can guide you to certain supplements that might benefit that that might be helpful and maybe avoid a medicine, or maybe just I think the problem is that there’s varying we’ve kind of touched on this too, but there’s varying degrees of health literacy patient, yes, literacy and motivation, I guess, right?
And so it’s not really fair. It might you might say, like, you know, half the patients we see don’t really want to take a lot of accountability and and do these non-pharmaceutical changes that we intervention or effort.
I call it I call it the life hack mentality. Like there’s a lot of people who think they can beat the system, they can do XYZ real quick thing, fix and it it they’re gonna life hack their way through all the hard stuff. Certainly, as a if a patient comes in with the conversation of I want to do this in a way that I maximize my health and I am doing the least amount of medication that I have to, right, in order to be the healthiest I can be. Those conversations can be had, but they’re not automatic, and you need to advocate for yourself in that if that’s how you feel. And I think you’ll be surprised to find out how many prescribers, clinicians across the board will engage with you on that journey, but it’s just not necessarily a reflex.
Yeah, no, that’s a fair point. I agree. Good takeaway for the people out there.
I know I like you know, on about the FDA and how I guess there’s a concern that they’re in on in on the scheme to separate you from your money, and that that health is a secondary priority. I just want to kind of break down some of the processes on how drugs get through, maybe tell you some interesting tales about how some recent things with drugs have gone wrong and gone right, and and let you kind of hear how the inner workings go so that you can kind of see there’s not as much room for conspiracy as you might think. For example, in order for a drug to get to market, okay, we kind of talked about the legal landscape and they have to do all this to prove that it’s it is what it is and that it’s safe and that it’s effective. And so throughout this, what happens is the manufacturer of the drug sends the materials to the FDA, and the FDA uh employs uh committees of folks with specific specialties, so they gather groups of supposed experts or interested parties, and generally they also have lay persons on these committees as sort of an interested party, right? So to kind of represent the people who aren’t patient, yeah, exactly. And so they let them sit on these committees and then they drug company sends a huge packet of information about their drug, what it is, what it does, how it worked, what the studies are, and this gets diffused out to the entire committee, and they all have a certain amount of time to review it and get back. And so while these people are paid by the FDA to do this, um, it’s certainly not enough to be their full salary. It’s basically volunteer work, community service with you know, basically lunch money attached to it. But what this does is it gives perspective from real users, allows the drug company to have a dialogue, but gives some uh very precise oversight uh into the approval. And so drugs don’t just come to market because you know bear paid their fees and they can now market aspirin to anybody. However, you know, this isn’t a flawless process. Um, so we talked a little bit about thalidomide, what happened there, but that was before there was regulation requiring that things were um the baby one. Yeah, the where the flipper babies um were the result of a drug not having been tested appropriately on the right populations to say it was safe.
Being used to treat pregnant women’s nausea, but not tested on pregnant women.
But isn’t that isn’t that like a big like aren’t women of childbearing age left out a lot in these studies because of their risk of being pregnant? Yes, yeah, yeah, that’s the problem.
And then that makes sense why it would be a harder population to study, but yeah, mark it as a nausea medication. I wouldn’t mark it as like a morning fitness medicine that hasn’t been tested on pregnant women.
Yeah, it seems crazy now because we’re kind of used to that. But before there was no rules, so that if it were it did work for that and it was very effective, but it also very much harmed the fetus. So that was a definitely a good example of getting it wrong, but that helped us establish what is now the regulatory environment that protects us. But even still, some drugs have gotten through that have caused problems. And these are the ones that you hear about like uh the lawyers are putting on their daytime TVs ads saying, you know, if you were harmed by this drug, we’ll help you sue. So, one good example is a medication called Viox, which is a very potent um anti-inflammatory drug in the family, same family as ibuprofen.
Cox 2 inhibitors.
There you go, yeah.
Cox 2, no pain, I used to say two cocks, no pain.
Oh dear. So anyway, Viox is a very potent anti-inflammatory, works great for aches and pains, arthritis, marketed for that. But after it was approved, widely sold and used because of its great efficacy on arthritis pain, it was found that uh the patients were having heart attacks and strokes at an extremely high rate compared to non-users. And so uh Viox and one other drug in the class were both pulled from the market by FDA rule because of the fact that they were eventually found to be more harmful than good in the general population.
Yeah, the only one that’s left, I think, is Celebrex.
Celebrex, right. So if we want to nerd out for a second, it when you compare Celebrex to Viox, Viox has a specificity for Cox 2, somewhere in the order of like 20,000 to one, and Celebrex is like 2,000.
Oh, okay. Interesting.
And so it’s it’s a it’s a scale uh that’s not really comparable, even though we consider Celebrex to be in that class. But yeah, somewhere between 2,000 and 20,000 is the line at which it causes more problems cardiovascularity than it’s is helpful. So but but Celebrex has been studied extensively because of this in that regard and looked at over and over and over again, and and we truly believe that it’s okay. So I don’t want to leave that uh lingering in anybody’s mind that that’s unsafe. And so with that, obviously we see that the process of proving things um in the scientific way, sending them through the FDA committees, getting all this scrutiny is good and important and helpful, but it’s not without risk of getting it wrong.
Well, also, like, yeah, exactly. You can you can try and replicate what a drug is going to do in the greater population, but there’s only so much you can regulate, and there’s only so much that you can actually do with controlled studies rather than when it actually does get into the greater population. And then you do have a bigger pool to study like what are the side, what are the the bigger side effects and and things like that that you won’t be able to do in a study.
Yeah, exactly. And so the FDA has this built in. Um, actually, uh there are considered to be four phases of drug approval uh studies. So phase one is like, does it do anything in a test tube? Does it do anything to people? And then there’s phase two, phase three, they get broader and broader, and then phase four is actually called post-marketing analysis. So you approved phase four is now a requirement in that drug companies have to continue to monitor, at least, at least passively monitor what’s going on with their drug. And so, for example, if you have a bad outcome with a drug and you call the drug company, the drug company is obligated by law to report this all the way to the FDA. And the FDA collates all of these reports, and that’s how they build a database that says, Wow, we got 7,000 calls last year about Viox causing a heart, you know, with heart attacks. And maybe we should look into this, right? So maybe we should do something. You know, there’s mechanisms, but you’re right. Uh it’s not until you get sometimes the side effects are so rare that until you give it to 100,000 patients in a real world market at post-marketing event, you’re not gonna see the three cases of something really terrible happening.
Right. Because it’s like releasing it to the public is kind of a study in and of itself.
At least it should be, right? You should be held accountable to make sure that it does what you said it was gonna do. Yeah. And and that’s part of it now.
So I I mean, I guess all these people who are arguing, yeah, big pharma’s trying to keep everyone sick, why they wouldn’t release enough information. They wouldn’t pull the drug, right? Because wouldn’t it make them they’d be like, oh, we’ve got heart attacks, moneymaker, you know, right?
It could be.
That’s there’s more like the FDA, it’s also like this whole regulation, like it’s not just pharmacy that they’re like the FDA regulates, right? It’s like the food and drug administration. So, like all the things that are in our food right now, what is linked to the chronic diseases and why are we still why is glycosphate? It is illegal in Europe to have glycosphate uh in their food, but it’s still being processed in our food. Or if you take like Heinz ketchup, you look at the ingredients in uh in America and you look at the ingredients in the UK, it’s completely different. Because all of that stuff is in the food, it creates a chronic illness, which then creates more people down the line using so more consumerism from the cholesterol, like I’m I’m just saying hyperlipidemia, hypertension, that sort of thing, diabetes. People are getting sicker. And why is that happening? And is it happening because big pharma still needs their money? It’s not just so much like, oh, they have the cure to cancer because that would be profitable, or you know, the HIV drugs are pro profitable and they’ve done a great job helping with the you know, more undetectable levels of the virus. Yeah, yeah, exactly.
But like that’s I think that’s more of the like So the level of villainy that you were describing and and collusion that is possible within people who are making our food making us sick and pharma being in on it, it is I think giving people too much credit. I think it’s much more simply a matter of doing things cheap and fast, causes corners to be cut, causes things to be added to food to make it cheaper and faster. And capitalism, the unfettered, unethically bound pursuit of making as much money as possible is driving all of it in the sense that the person who put the glyphosate in the food doesn’t care about the downstream effects of it because their shareholders, their profit margins are based on how much of that profit gets eaten by a wasp or whatever before it gets to market. And they don’t beyond that, they’ve sold it, they’re done. And I think it’s just a matter of those compartmentalized business decisions being the priority as a as opposed to caring about people’s health and wellness and food supply as a as a holistic experience.
But I I guess the question is why is it regulated in Europe? And it’s not just food, it’s the beauty products, it’s our makeup, it’s our perfumes, it’s everything. Yeah, well why is it regulated in Europe and then why is it not regulated in the United States, and how much is that related to follow the money?
Yeah, I I totally agree that regulations they always at expense.
Yeah.
And so if you’re a company who is selling wheat that’s covered in glyphosate, right? Mm-hmm to keep the weeds down or whatever it is, yeah. Whatever it does, it’s it’s it’s the weed killer. Weed killer.
They spray. It’s like legit proven to cause cancer.
Yeah. So let’s say a company is faced with a regulation that would cause them a billion dollars to fix. Right. Okay. If the regulation was enacted that they couldn’t do what they’re doing anymore. And in order to return to their production levels that they’re currently are, it’s going to be a billion dollar difference. It is to their advantage to spend $500 million on lobbying to prevent the regulation from being changed.
It’s cheaper for them to go that way.
It’s cheaper for them to lobby. And so when you follow the money, that’s what you find out is that these companies are making the decision that they can spend their money and prevent regulation so that they can prevent improving things. And but really it’s not even that. It’s not that sinister. It’s just that it’s a billion dollars to not lobby or 500 million to lobby, right? And it’s that black and white. And unfortunately, you know, while if we were running our household, we would make the decision that makes us healthier and happier. But when you’re running a business that’s solely based on getting the most money, then the answer is obvious. Right. On the scale that it is. We’re gonna go. Yeah, unfortunately, it’s just a business and and healthcare is a secondary outcome. Right. You know, healthiness as a general goal is a secondary sought, which is uh sad to think about, frustrating. But there are a couple cases though where drug companies have kind of realized that their drug doesn’t work and have pulled it from the market somewhat compulsory from the FDA, but um ultimately it’s considered a voluntary move by both companies. But a drug called Zygris. Yeah, Zygrison. Mm-hmm. It was used to treat sepsis, and um it had a very narrow criteria that it might help these certain people who were dying to die anyway. Who were dying from sepsis?
What was Zygris? Vitamin C for the Richmond, yeah, yeah, yeah.
Not the vitamin C, but something called activated protein C, one of the complement, whatever. It was continued to be studied in the post-marketing phase for turns out that there was no efficacy. And so patients didn’t get better, didn’t survive longer from sepsis, and uh the company just decided to stop making it and stop selling it. And then uh more recently, a a drug called rhylusole, I believe it’s called, for ALS. And it turns out that uh it didn’t seem good to make it make a difference in the broad population. So again, the company made the the conscious decision to say that in the absence of benefit there’s only risk, and so we’re not gonna sell this thing anymore. There is evidence that ethics and healthiness does come into factor at at times, right? Um, and there are checks and balances in the system that can kind of protect you somewhat, but it is definitely easy to believe that people are actively choosing to make people sick to make more money.
Oh, I think that well, yeah. I think it I mean, I guess in the recent years, right? Like the post-COVID era that we’re living in, the spotlight is heavier on this, I think, because it COVID was so for whatever reason, it became this like really controversial area. Like either you believed COVID was real or like it was a government conspiracy. And then like in the post-COVID era, people are less likely to believe medicine and believe the media or believe the FDA or that people are doing, they’re trying to do what’s best for the greater public because there’s this all this dis you know dissension between I don’t know, the the population and you know what happened during COVID. There was a lot, yeah, there was a lack of trust now. Yeah, exactly.
But and I’m not saying that lobbyists are just giving Congress money to make a decision that favors them. Yeah. There’s certainly it’s a savvy business where people go in and they have these very artful discussions.
They can’t possibly be all bad.
Yeah, and so you know, you can spin it that if you pass this regulation, then the food supply is going to drop by 25% for the next five years while we while we spend the billion dollars that we need to spend to fix it.
Right.
And you’re like, oh well, I can’t let the food supply drop, I gotta vote against this. And then, you know, but ultimately the outcome is is that regulation doesn’t happen and glyphosate continues. Right. Right, but it’s a troubling pattern for sure. If I tell you that you can try cinnamon for your diabetes and your foot falls off, now I’m in trouble because cinnamon wasn’t the only answer.
But even now you go to the doctor, you’re not on any medications, your A1C is borderline. Um, they don’t prescribe a diabetes medication when your A1C is borderline. They give you counseling to be like, go home, maybe cut down on your carbs, maybe exercise a little bit more. Like they are not doctors, are also not being told push these drugs, push these drugs, push these drugs. It’s also So again, it falls on the patient to have some sort of responsibility for their health, but the but then the patient then goes back, their A1C is so borderline, you know, and their doctor’s like, okay, let’s start you on this job.
And the doctor’s assessment is we tried that. Yeah, right. Exactly. So that’s not the patient actually did anything different for behavior over exactly.
A lot of doctors in primary care specifically that are like prescribed first. Like they’re like, I feel like they’re too quick to prescribe things.
Yeah, for sure.
It might be also coming back to like the legal side of that.
Like, are they afraid they’re gonna be sued?
Yeah, exactly.
I would say from your healthcare providers here, from your friendly neighborhood pharmacist, don’t come for us, right? Right. The system. The system is the issue.
Yeah, and and that’s yeah, it’s yeah, it is a system issue. But I like the take that um Andrew says about like speaking, well, I think it’s part of like, you know, yeah, you gotta speak up, you gotta ask questions, you gotta be your own advocate. You gotta take some accountability, you gotta take some accountability, but also like know that your healthcare team is actually like working training. We’re on your side. We’re not yeah, we’re not trying to like, you know, say do this or else. It’s like we’re trying to work with you. And if you approach this as like a team and we’re we’re coming together to work as a team towards a unified goal, is the goal is everyone wants everyone to be healthy, right? Yeah, like that is a good approach to take.
And that to me is the spirit and and the energy that insulates patients from the effects of kickbacks. Okay.
So tell us about that, because I was interpreting it as there’s like a financial benefit.
I thought it was illegal to take kickbacks.
Yeah, so there definitely was a system in place for a long time. The drug companies would do things like if you had X number of prescriptions of our product or the top prescriber of our product in this region would get invited to the conference in in Grand Cayman. Right. There was definitely some ethical issues with you know providing somebody a free trip to Grand Cayman, oh yeah, being the top prescriber of your branded product. Right. Okay. So like that is MLM. That’s troubling. Yeah, exactly. Main or and and a lot of that level marketing. They learned some of that as those tricks from the pharmaceutical reps, right? Yeah, but there’s a lot of things that kind of insulate the patients from that nowadays. Uh one of them is the fact that ethics training um is a big part of medical training. So the Department of Veterans Affairs in the US is a large healthcare system that treats military veterans, and they are the single largest oh, they’re experimented on well, yeah, that’s that’s that’s a scary rabbit hole we’re not gonna go into. But ultimately, they’re the biggest provider of graduate medical education, meaning residencies, oh yeah, um, med school rotations, nurse practitioner program rotations, PA training. They’re the biggest in the US and probably in the world by the fact that the US is just so big. But a component of onboarding for every one of these people is to do this training that’s very clear about you know accepting financial kickbacks, accepting money for basically any act. And the other side of that is that anybody that works in the VA, um, if they were to invent something, actually it becomes the property of the government. So it’s kind of interesting that uh, you know, but what it does is it kind of uh insulates us from some of that um and and makes sure that most providers, prescribers have gotten at least trained in ethics. Not all of them choose to follow it, but at least there’s a broad base of of very clear training, and it anything over ten dollars becomes like a reportable in the government in the government.
Yeah, no more uh free lunches from the drug companies, right?
Yeah, those have dried up a lot. As a result, a lot of private practices nowadays, because I I’ve interacted with a lot of drug reps in years of going to conferences and things like that. A lot of them really pigeonhole those lunches to like Doctor’s Day. They come in and they allow the drug rep to come in and give us a free lunch for everyone. And like it’s not, and really you’re just leveraging their their budgets, but you’re not allowing them to come in every week and give you a refresher on how their drug is the best, etc. And so they’re they’re using some of this and they’re doing it less. And then the other thing is the Sunshine Act. Um, the Sunshine Act was passed, I think, in the 2010s, but you can go out and on a website every time that a drug rep interacts with a licensed prescriber, they have to record that person’s identifiers and they report however much whatever that was is worth. Oh wow. And so you can look up your own names and see how much money drug companies have given you.
Up your shit. Oh, there’s always a sign-in sheet.
Yes, why there’s a sign-in sheet with your license on it. So you can go out there and you can look up your prescribing your prescriber teams and see where they sit on the Sunshine website.
Wow, that is that’s cool, and that’s public.
That’s public. You can do it right now for anybody.
I usually dodged the um services.
Uh I worked with a professor at the University of Kentucky who was a pharmacist, but he was in oncology and he would do a lot of speaking for new branded oncology drugs. And so he would go around and he would be the presenter at these drug dinners and things that still do exist.
Yeah.
But his line was always that he’s so conflicted, like conflict of interest standards, because he speaks for everyone, he’s so conflicted that he’s not conflicted anymore. Basically, by speaking for everyone, he he has washed his bias in the sea of money that he receives. Yeah. From everyone. Yeah. But obviously, that’s you know he’s in everyone’s pockets. You gotta take his word for that, right? You can look up this information, you can know about it.
I only got $15. I’m only working, but your wife is raking it in here.
Oh, yeah. Yeah, so while there are in theory something of a kickback, right? You can get invited to dinners. It’s generally not allowed to be kind of illegal. It’s illegal for it to be tied to prescribing trends or practices.
There’s no checks getting sent to them.
So you’re exactly. So you’re going to a dinner that is telling you why Zorelto is it’s all happening, is affected people anyway. And and they have a little bit of a marketing spin to it, but that’s also heavily regulated. And then you leave and go about your business, right? Is that really changing your prescribing? And is that $15 dinner that they gave you gonna make an impact?
But I feel like I’m gonna be honest, if I’m like, do I want to prescribe eloquence or Zorelto? I’m not thinking back on the Chick-fil-A I got last week, right?
Exactly.
And it’s not very research-based.
Like not easily swindled. Yeah, Megan, and when they squashed a swindle full of full of the literature. Is the is this part of the literature?
When they squashed the thing about getting trips based on how many prescriptions you write, like that, that was a problem. But the patterns now of like getting a getting a Jimmy John sandwich kit once a month, once a year is not influencing anyone’s prescribing.
Right.
Um, and I think the general vibe is that people are really pushing back on on all of this optics-wise. The prevalence of academic medicines, the Sunshine Act, those people who are having to put on their CV and all these things and say where they’re getting their money from. Um, and conflicts of interest uh documentation is much more prevalent, right? You’re always asked now, whenever you publish something or present something, what to disclose a conflict of interest. Right. So it’s it’s a part of the conversation. I think there’s enough, we’ll say, sunshine on it now that there’s really not an environment of a kickback anymore, in the sense that it used to be. And you’ll hear people say that that, and they were right, they are right that it did happen, but it’s really not happening anymore. It’s and and in some ways, all these all these medical graduates who are coming out have all had this ethical training that we talked about, have all been exposed to this stuff. Yeah, and it’s just a system that’s like too there’s it’s too big now. One whistleblower would surely come out if if it was a thing. Right. Right. And and it’s and it’s just not, it’s been squashed, and we don’t we don’t live in a world where that’s relevant anymore. I mean, I don’t even have any branded materials in the pharmacy anymore. We used to like all our pens, all our sticky notes, all our everything was like meds, levelquin branded, and and all their but like we can I can’t even find I I think we have to pay for all of our pens and paper now. It’s pretty terrible.
Damn it.
In wrapping up some of this discussion, I think what I wanted to do is talk about how just a few quick tips on how patients can sort of advocate for themselves and their interactions with their clinicians, and we touched on this before, but some maybe some ways you can protect yourself against some of these what we think might be conspiracies. And everyone should be asking, Why are you giving me this medicine?
Yeah, right.
And asking it in a way that is genuine enough to say, Are you giving this to me because you believe it’s the right medication for my condition? Or is there some other factor that makes you lean that direction? Right. And if you’re not satisfied with the answer, then keep asking.
Right? Right.
And that’s totally fair. Nobody would fault you for asking those questions. So that hopefully would uncover a bias or somebody saying, Well, you know, I heard from a drug rep last week that this is brand new, and yada yada yada. And then, you know, you can tease out those motivations. I think I said it before, but ask the question what do you recommend I do to deal with this condition that I have? And that should be positive posed in a way that’s broader than medicine. How can I be healthier? How can I feel the best with this condition that I have? Right. How can I slow the progression of this disease as much as I can so that my limited days on earth are as healthy as possible?
How can we optimize our health literacy?
So those are the questions that are totally fair to ask, that don’t get asked enough. A lot of the times the answer is not going to be medicine, it’s gonna be putting in some work, yeah, changing your behaviors, making time for self-care in therapy appointments or exercise regimen, or move your body, move your body, right? And so all those things are part of it, and those need to be conversations that everyone’s having at every juncture when they’re offered a new prescription.
Yeah.
And so, in doing that, um, you’re insulating yourself from some of that. And then, you know, feel free to shop around for doctors that give you the approach that is not medication focused, if that’s how you feel you’re best treated. But ultimately, we all know, even those of us who sell medicine for a living, know that medicine is not always the answer for every ailment. And so if you get a prescriber, somebody in your care team who you feel like is only pushing medicines and not pushing whole health, then they’re doing it wrong. Yeah, flatly wrong. There is no room for medication without behavior change, without healthy activities, right, health behaviors, and all of that should be part of it. And even if medication is the answer, right? So um, if I’m telling you to just take your your diabetes medicine, but never telling you to write to check your blood sugar and write it down and do all the things and get the patterns and get the data and work on the next phase of getting better, then I’m not doing it right. Yeah, and it’s not just about so I can take in your medicine every day, yeah. And I really should be the the health focus. All of us in medicine, I think, are willing to have those conversations, but we don’t have them enough, and part of it is because we’re just not asked.
And the time and the time, yeah, yeah, sure.
And it’s proven that if you promote health behaviors at every opportunity, then people they will eventually stick. And so uh the bit the best example of this is with smoking cessation. Nobody’s like, How dare you tell me to stop smoking, right? Like everybody kind of accepts that you’re gonna be told that. But it’s proven that by at every single encounter, if so they started doing this in emergency department, they studied whether or not if every patient that came in as smoking to an emergency department got counseled for one minute on smoking cessation, regardless of their complaint, did it make a difference? And it made a huge difference in people’s behavior change by just bringing it up. And and so it’s not wrong for someone to to mention uh obesity or overweight as a as a risk factor for future poor health, and it’s definitely fair conversation.
Well, I mean, I just feel like yeah, I’m I’m pro-body positivity, but also I think there comes to a point where you have to like uh there’s body positivity, and then again it goes back to like taking responsibility for your health, right? And bodies weren’t created to be bodies were created to be in motion. I guess that’s why I’m always like, go outside, move your body, da-da-da. We aren’t we are.
I think we see it when people stop moving. That’s the like I’m just thinking about that too with my older family members. And I’m like, you gotta just keep moving because if you stop moving, that’s when it’s right.
So I guess like the focus should be on like continuing to to move your body, use it the way it was designed to be used. And like that doesn’t mean sitting on the couch, you know, watching TV or on your phone or whatever. It’s it’s and and it goes back to like we are we’re in a mental health crisis. You know, we can go to the doctor and the doctor can prescribe us SSRIs and prescribe us all these like you know, things that that are are seem to help mental health. But also one of the biggest things that um that helps mental health is like socialization. And where’s where is our society right now in socialization? We are so isolated because we can’t move outside of our phone and our social media platforms. It’s it’s actually isolating us worse. So again, it’s like the the point is like yeah, you there’s there’s all these different aspects of like it’s not just weight, right? It’s it’s moving your body enough, you’re moving your body in a healthy way, and your BMI is higher than what you think it is, and your labs all look really good. How much of that is going to be tied to a chronic disease? We don’t know. All we know is that obesity coincides with hypercholestremia or high cholesterol. But how much of that is related to the sedentary lifestyle and the people that are actually out there moving their body and don’t fit into what we see as like societal norms, societal you know, skinny thinness. I guess like that, that, and I think that’s sort of the the nuance that now we’re like trying to figure out as the elder millennials, the women specifically, who were just targeted in diet culture and actually like anorexia and these now, these skinny, skinny girls were also actually very unhealthy as well because it’s yeah, it’s a different illness, and it’s and it created more problems in the future. So I think it’s the same thing. Well, how how are we learning? How can we still learn that like body positivity is a thing, but also there needs to be a line that we talk about in how to prevent chronic illness, and I think that’s a line we’re still trying to find.
Yeah, certainly weight shouldn’t be mentioned as a as an isolated thing. Um and it’s good to have conversations about that as a goal. I it’s not that every time somebody’s mentions weight they’re being a body chamer.
Right, exactly.
Right, and and that there’s probably a the pendulum that’s maybe swung a little bit too far in the sensitivity department and the formalization of functional medicine as a as a school of thought is is helping that as well. People are getting exposed to those concepts in training if they even if they’re not fully practicing functional medicine doctors, but um it’s a holistic approach.
I I don’t know, I’m not anti-functional medicine, but I am anti again the like people that are like you there’s no place for modern medicine. I’m like, come on, throat, how you gonna treat that’s what I like you’re gonna do like problems. Yeah, yeah, I like that. And I also think that like there has to be a way to marry your two beliefs. Like if you oh the if you have a belief of like there’s only one way, well the other way has been proven to be. They’re both yeah, they’re they they both work and they can work synergistically, I think.
In many cases, yeah.
Yeah, you just have to be able to, you know, figure out and and navigate that with your provider, like what you what you were saying earlier, ask the questions, navigate it with your provider to see what you can do to bet to optimize you know both therapies.
Yeah, and don’t be a hypocrite, right? Don’t show up to the hospital and want all the medicine and then go home and not do any of it.
Right, exactly.
You know, and have like balance is appropriate, an open mind is appropriate.
Yeah.
Um being informed is appropriate, but and in any context, being judgmental of something because of its name, its origin, its natural or unnatural is not appropriate.
Right. Uh I’m like, do I think big pharma is hiding the cures for things? I think it’s just a business. Uh-huh. And they’re trying to make money. They’re looking for weaknesses that are there. And it’s like our job to advocate for ourselves, to pick and choose what will be the right thing for us. I don’t think they’re hiding the cure for anything.
No, I don’t either. It’s just we are a capitalist society. I am pro-capitalism. Okay. Or capitalism. Oh, you I don’t think healthcare should be a good thing. No, I agree. I do think people are like healthcare is a human right, also. It’s like, yes. Also, people had to go to school for 20 years, take out $500,000 in student loans. They worked hard, and then for everyone to just make it.
Like everyone talks about all doctors make so much money.
You know who makes so much money? The freaking CEOs. Yeah. People should not be making should not be billionaires off of whatever. But I I feel like when I just get like a triggered by social media who’s like coming for like providers and stuff. Yeah, we’re like, like, yo, everybody’s doing the best they can do. Yeah, yeah. Problem. Yeah. You didn’t give me a problem. I just got really negative. Um, no, yeah, I think you guys are right. I think that probably higher up, you know, politicians, hospital CEs, follow the money who are probably making some profits. Don’t check that out on your healthcare providers. I would say in front of the middle health providers, we’re really all just trying to help you and do the best we can. Do the best we can. Yeah. Uh, and I think that Andrew gave some really good tips. Yeah, I don’t think that big pharma is like hiding cured for cancer.
It would be a race to make the most money off of it as possible, even if they found it. Right.
You know, the capitalists couldn’t afford to hide it. Yeah, yeah. So not much of a conspiracy, just kind of a broken healthcare system. And I don’t know how to fix it. But uh yeah, it was very enlightening. Yeah. Thank you. Thanks for having me. Uh we’ll have to do another one of these some point. All right. Thanks for joining. We’ll see you next week. See you next week. See you next Tuesday.