When Less Is More In Healthcare (w/Drs. Rita Redberg & Vinay Prasad)

[@ZDoggMD]

Subscribe to The VPZD Show on your favorite podcast app here: link.chtbl.com/vpzd Links to our other show with Dr. Redberg: zdoggmd.com/less-is-more

[@JCResDoc94]

32:30 like that redistribution argument. can not **wait** to throw that at some fellow Leftists online, those class traitors. to twittr! \^_^/! -JC

[@AuntieEms14]

i give Vinay major props for saying what he said about the FDA. He's 100% right. I also love the idea of asking your provider, "What happens if I do nothing?" I think that's an important thing providers should be asking themselves.

[@misesmedicine]

Let's look at that from the perspective of the provider...."If I do nothing." Well, a) you might offend a fraction of patients and get bad satisfaction scores, and b) You might miss a diagnosis, whether medically beneficial or not, and get sued. When push comes to shove people look out for their own income, family, and careers, and for the past 50 years this has increasingly become dependent upon avoiding the two above outcomes.

[@kairitetra]

What you're talking about in this podcast is one of the major reasons I decided to leave frontline healthcare to work in health policy. The system is broken and corrupt to the core and I will die trying to change it if I have to.

[@ninjason57]

The roots of healthcare corruption run too deep. Pharmaceuticals, politics, businessman, there's just too many hands that want a piece of the pie. Nothing will change as long as the current generation keeps teaching the younger generation to keep the wheel turning.

[@user-cc5od3zk4p]

It’s very profitable for the medical industry to push these treatments on women.

[@DiamondLil]

10 years ago a routine mammogram revealed a tiny lesion in one breast. I had a lumpectomy and they found a very early, nonagressive, slow-growing cancer with no node involvement. After reading about just this topic--over treatment--I decided against both radiation and drug therapy. I have never regretted it.

[@rredding]

Super! For future health, ou may want to look up Dr. Brownstein here on KZbin about breast cancer and how Iodine will help avoiding it. Iodine is not only required for a healthy thyroid, but also for breast, ovarian, prostate and salivary glands. Always to be combined with Selenium intake (one or two Brazil nuts per day, not more is sufficient). Avoiding too much sugar and refined carbs, to keep insulin lie. Cancers LOVE Insulin resistance and glucose overloading! Also vitamins D3 and K2 help avoiding cancer. For healthy persons Boron is great, but when hormone sensitive cancer, better and Boron as it regulates (promotes) sex hormones. If interested in this approach, do your own research! (I am not a doctor and this is not medical advice..)

[@misesmedicine]

There are important case by case details that are important here, and a lot of psychology involved. And frankly anecdotal evidence is not just unhelpful but a major part of the problem. I'm with you in terms of what side you're taking but this is more representative of the problem than the solution.

[@ginabuselli1080]

Even though every woman with breast cancer is different, I had a very similiar experience to yours with breast cancer when I was 31. It was very slow-growing, no node involvement. I, too chose not to have radiation and chemo or drug therapy after my lumpectomy. I am now 47. Doctors and people thought I was nuts not to do chemo and radiation and attacked my decisions every time they could. Stories like ours are not part of a "problem", but rather a part of the cancer discussion that gets silenced. Why aren't women who are diagnosed with slow, non-aggressive, pathologically favorable breast cancers allowed to speak just as much as the ones who unfortunately get diagnosed with aggressive or metastatic breast cancers? Don't all of our experiences and pathologies matter? Yes. They do.

[@jennh2096]

As a hospice nurse, I love this topic! Oh the stories I could tell of over treatment and over testing that led to no better outcomes and often times led to harm being done. Sadly, the general population doesn't understand this. Its a culture of do more and do everything, regardless of whether it makes sense or not.

[@bloodbaymare]

Yes, yes, yes! I'm back on a med/surg floor, but I worked briefly in home hospice for 5 months and it was such a valuable experience. Not enough people understand hospice philosophy and how valuable of a service it is.

[@formerfundienowfree4235]

I agree! so many expensive fruitless end of life "fights" when they could be comfortable and peaceful at home. hospitals do not medicate adequately for pain!

[@oldschool8292]

Thank you so much for choosing to be a hospice nurse. I'm sure in some ways it is difficult but providing the care and dignity for those who can accept that we all have a circle, and that quality over quantity is truly a gift of humanity.

[@TheFtm22]

Listening to this, I am reminded of why I don't get certain things done. I used to get regular mammograms and then they started finding "reasons" to do diagnostics with ultrasounds (expensive and more time at the facility). The last time I had a mammogram, the radiologist grabbed THREE YEARS of past mammograms and decided he found a "reason" for me to get a mammogram with needle biopsy. I asked him why and he said "well, it's protocol". I said " do you think I have cancer" and he said "no, I don't see that at all. We just need to mark this spot so we know it's benign". He meant put a titanium ball in my breast to mark that spot. SO I spoke with my internist and my ob/gyn who BOTH advised against such an invasive procedure without cause. I could speak more but that's sufficient - less is more.

[@brunsomarrr]

WOW! And inserting the titanium ball into your body (permanently), that didn't come up until you asked? WTF

[@TheFtm22]

@@brunsomarrr yep! I have titanium plates in my forearm now after a traumatic injury but that was discussed at emergency and necessary to restore my arm. I called the suggested breast procedure placing an idiot marker.

[@formerfundienowfree4235]

that's malpractice as far as I'm concerned

[@user-cc5od3zk4p]

The doctor tried the ultrasound routine at the last pap exam. No reason, I never reported any concerns. I was told it was just cautionary. A needle biopsy was also recommended. I told her that I would no longer be screening for anything and to make her money off someone else.

[@user-cc5od3zk4p]

Had a similar situation with the locum. She was typing up the requisition for a breast ultrasound for dense breasts. I told her that, according to my last mammogram, I have fatty breasts as l am post menopausal. There has never been a reason for this test and I told her it wasn’t happening and, to make money someone else. I think I’m done with any screening going forward as it is an exercise in anxiety and frustration.

[@susanfekety4851]

Retired nurse midwife here. I cannot tell you how delighted I was to listen to this. Thoughtful, smart, educated people discussing pros and cons and data, instead of simply regurgitating the reactive party line. Way back in midwifery school we were taught about the risks of overscreening -- I can still hear the voice saying "you will always get an undesireable result on an unnecessary test, which you will then be obligated to follow up." Thirty years of practice in women's health showed me how true these words were. Don't even get me started on pink ribbons and mammogramaramas. Here's to 3.0. Thank you for being there, all three of you!! Brilliant, human, and funny. 👏🏼

[@milhouse357]

Dr. Redberg rocks. Thank you for hosting her.

[@sjwang40]

I trained at Dartmouth where Gil Welch works. I didn't work directly with him but his philosophy definitely permeated the institution. During my training there was a lot of emphasis on avoidance of over testing and over treating. I remember my attendings pushing back on us when we (the residents) wanted various tests and we really learned that a careful history, physical, and serial examination could prevent a lot of unnecessary expenditures. I recently left a community hospitalist job that was eye-opening. Patients would demand all sorts of totally unnecessary testing and treatment, and doctors would also aggressively over-treat and over-test. I worked in a litigious environment which I think was a huge factor. One thing that drove me crazy was that patients would demand their outpatient specialists be consulted during unrelated inpatient admissions, like someone with cellulitis demanding to see their nephrologist for stable CKD. What was extra frustrating was that inevitably instead of coming, waving hello, and billing the patient, the specialist would also order a bunch of unnecessary tests just so they have something to do. Dr. Redberg is a cardiologist and I think she sort of hinted that cardiologists are major offenders (though there's plenty to go around). There are still tons of cardiologists out there ordering yearly stress tests on their patients, nuking people when a less intensive stress modality suffices, PCIing stable or non-culprit disease, unnecessary peripheral interventions, etc Our fee for service healthcare model plus the large grey zone of what is medically appropriate means that our healthcare expenditures doesn't follow a supply demand curve. Instead as we create more specialists and more specialized tests, our spending and the amount of stuff we do goes up rapidly. In a fee for service world, even in areas completely oversaturated with physicians, many of those doctors will find SOMETHING to do - and they will still justify to themselves that it was necessary. So if you have 4 pulmonologists in an area and 4 more join, they'll likely just do more PFTs, more follow up visits, more inpatient consults, more bronchs to make up the revenue. They won't explicitly think they're doing this, in many cases, but all the incentives are lined up. For example if the area is swarming with pulmonologists, the hospitalists would probably feel comfortable consulting pulm for simple COPD exacerbations or mild cases of COVID, where in resource limited (or non-fee-for-service models and grouchy fellows who aren't fee-for-service) they would yell at the hospitalist for being an idiot. What we really need are more primary care docs and probably fewer specialists in many areas. But as a nation we've largely destroyed primary care as a viable career path. PCPs deal with SO MUCH bullshit it's a marvel that anyone does it at all. Look at what residency graduates are doing. Probably only 10% of IM graduates in many academic programs are doing primary care. My graduating class was ~17 I think, and I can only recall two people went into primary care. The rest became specialists or hospitalists. The ED and to a lesser extent the wards also practice a lot of defensive medicine. People WANT more tests. They WANT to feel like more was done. Thus we have little to no risk tolerance and are doing CTAs on everybody, stress tests on everybody, totally ignoring our history and physical, and then wondering why we discover all these incidentalomas like kidney cysts. Another issue is that we don't talk about enough is that our whole nation is built to generate poor health. I'm so glad your guys touched upon this. Our food is terrible. Our physical environments (in most places) are terrible. Most middle class suburbs are endless strip malls. You have to drive everywhere. It's physical unpleasant to be outside of your car in many places. No amount of medical care - appropriate or inappropriate - can overcome our environmental determinants of health. Thank you guys SO much for talking about all of this!!

[@user-cc5od3zk4p]

That was a fantastic comment. Wish there more like you.

[@hettiesimpson]

I'm happy to be a nurse in long term care where we are very cognizant of our residents' level of intervention and advocate for pulling back on unnecessary diagnostics and treatments. All departments work to reduce polypharmacy and I'm proud of that actually

[@lauradrew1814]

This makes me really appreciate my children's pediatrician! My son had some constipation issues and one dr recommended an xray but our pediatrician said it was unnecessary unless our treatment options were unsuccessful. They were successful!

[@user-cc5od3zk4p]

Back in the day, it was a teaspoon of castor oil. It worked great!

[@JA-ur8cx]

We as patients must inform ourselves and be our own advocates. This bleeds into so much of life now.

[@Fair-to-Middling]

My 74 yo step mother was over tested for breast cancer. She had a small lump taken out and a couple lymph nodes during the surgery. These nodes showed no cancer involvement. Well, they then did this lovely new test that gave her a number that told her the chance of it coming back, and this number ended up being a tad high. So, she did the whole thing including chemo. All this without cancer in the nodes! And now she has a secondary blood cancer that is specifically caused by the chemical that was put in her (this was on the warning about it, but no one told her this at the time). I had the breast cancer 20 years ago (with no nodes affected). Thankfully, they didn't give me a number that I would fret over. I chose to have a bilateral mastectomy. No radiation. No chemo. No side effects.

[@eyes-freefitness2501]

This happened to me as well. I refused all treatment in 2008 and it is 2023 now and I’m still here. 1:36:26

[@jndee8989]

This is one of the most important issues in health care in this country today. Thanks for talking about it and hope the message spreads!

[@scanzaroli]

I have worked as a PA in a family practice clinic for the last 10 years, and it never ceases to amaze me how patients insist on getting "something" out of their visit. Patients do not feel satisfied if reassured that they have a virus or sore muscle and can try home remedies or over the counter medicine. If they don't need an antibiotic, blood test or Xray, then they want a prescription for something or they feel cheated. Sadly, I sometimes end up ordering X-rays or blood tests just to satisfy an unhappy patient or to keep them from an unnecessary ER visit.

[@clairemilner1921]

I've been holistically oriented for the past 45 years, so nothing these people have shared is new to me. That said, I'm deeply impressed with the work that they're doing. It gives me hope to know that there are people like Dr. Redberg out there. For years I've refused what I considered to be unnecessary medical testing, and I'm pharmaceutical free at age 76 because I choose to use food as medicine, which has been working beautifully.

[@CricketsMa]

Thank you for a very informative podcast! I’ve intuited that less is more for several years and put a stop to most tests. I’m 80, and don’t need any extra bad news.

[@greenlissy]

It's so great watching the two of you snuggled up on the couch together - I love the way you play off each other!

[@Getitstraightyo]

Why have we not had a VPZD show in nearly a near dude? I loved your guys show.

[@russellmm]

I am conflicted on this one. My wife and I started doing full blown checkups by travelling to Korea (she is originally from there) as their medical cost 1/5th of USA and its excellent. In doing our first checkup in 2018, I found out I had osteoporosis (at age 55) and my wife had a small brain aneurysm in her A-Com artery (a complex location). Doing those proactive tests allowed me to change my lifestyle (as well as meds) to stop the bone loss. Had I not done those tests, I would probably not have found out until it was too late to change the outcome and my life would have been cut short. For my wife, we continued to monitor her aneurysm to the point it had grown so much that they recommened surgery on our last visit in Aug 2021. We ended up flying to Mayo Clinic to get a second opinion and ultimately had the Surgey done at the hospitial we go to in Korea (Asan which is Top 10 in the world for Aneurysms). The surgey (Stint assisted coil) ended up costing us $20K in Korea, and Mayo quoted us about $120K. Using our ACA insurance was not a viable option for us as it would have put us into a low tier hospital. Again, without the preventitive care we chose to do, my wife would have an aneurysm going in her head without us knowing with the risk of rupture increasing each year. Mayo Clinic gave us one good piece of advice. "You know you are going to have to fix it one day. The longer you wait, the older you are and the more risk you face"

[@misesmedicine]

What did you do to improve your osteoporosis, and what evidence do you have to show these efforts were successful?

[@russellmm]

@@misesmedicine I started lifted weights about 4 days a week, started taking Algae based Calcium, and have been receiving a yearly shot of "zoledronic". I get a checkup once every 12-15 month and my osteoporosis has improved "slightly" which is better than getting worse. Of the 3 things I am doing, I suspect the weight lifting is probably the biggest help. I am not exactly sure what caused it to begin with as being diagnosed with it at 55 for a male is highly unusual. I don't smoke, was rarely drinking. I do not think I was taking in enough Calcium though (didn't drink milk) so only got it from foods. In the end, I am in far superior shape now at 59, then I was 5 or 10 years ago. So it was a big wake up call for me.

[@BeaHindebars]

I had my first mammogram at 52, they saw 'abnormalities' and wanted to do a biopsy, I refused and said I wanted to leave it a year, my doctor was appalled and actually said 'do you want to die?' A mammogram a year later showed no change. I'm now 58 and I will not be having any more screening tests of any sort. I have changed my doctor but I have not seen my new doctor and I plan to keep it that way.

[@Fair-to-Middling]

I had a horrible experience with a colonoscopy. I decided then and there, never ever again. The new prep they gave me about killed me and at the very least gave me raging pain in my bladder. That took a couple weeks to go away. I will definitely look into the fecal blood test next time they try to get me to have a colonoscopy. Thank you!

[@CreamyJalapeno]

I had my first colonoscopy a few weeks ago. The prep was awful. It made me vomit and dry heave for a few hours after my first 1/2 gallon. It’s going to be hard to convince me to do it again.

[@_taste]

The thing that they don't tell you is that you need to prep for your prep. I did a high fiber diet for a week before hand and then the day or two before I started limiting a lot of what I was eating and then the prep really wasn't bad at all.

[@user-cc5od3zk4p]

My doctor tried to talk me into a colonoscopy. There is no family history, I’m healthy, and FIT testing for the past 7 years has been negative. I told her i didn’t appreciate her trying to make money off me.

[@paigerperry867]

Please have Dr. Redberg back!

[@jodisteed3378]

Provo!!! Thank you for standing up for the right way! Just because we can doesn’t mean we should!

[@pauldemott235]

Regarding statins: I am 64 years old. My blood pressure is 115/75. My HDL is 45; My total cholesterol is 130. I am not on any medication. I do not have diabetes (fasting blood glucose=85) When I put these numbers into the ACC/AHA ASCVD risk calculator it show a 10-year risk of 7.7% chance of heart disease or stroke. This yields the following recommendation, "On the basis of your age and calculated risk for heart disease or stroke over 7.5%, the ACC/AHA guidelines suggest you should be on a moderate to high intensity statin." Are they kidding?

[@chk6111]

You're 64, thus you're automatically "high risk"! Guidelines are simply that, guidelines and in this age of "One Size Fits All" should be looked at with a critical and skeptical eye.

[@user-cc5od3zk4p]

Another reason to avoid doctors unless absolutely necessary.

[@nastypiglosi1788]

The medical industrial complex put my mom on statins and 5 other pills for blood pressure. She went to the ER 2-4 times a year and had two stents put in due to blocked arteries after 12 years of statins. She previously didn't have any heart issues. The pills were slowly killing her. She could barely walk and was trembling like she had Parkinson's. She was also anemic. I slowly weened her off everything the doctors were giving her. Now she can walk a mile a day at age 85. She hasn't been to the ER in 14 months. Nattokinase Bromelain NAD/Resveratrol Fish oil Vitamin K2, B12, iron I had her add more protein to her diet with rotisserie chicken and eggs.

[@nancyprier416]

EVERY hooman needs to listen to this podcast and be responsible for their health and health care $$. Thanks so much 👏🏻👏🏻👏🏻

[@HollyToll]

Thank you for this podcast. I've avoided most testing and my friends think I'm nuts. But I'm healthy and active while they're always at the doctors. It's so good being crazy 🤪

[@rachellucas5269]

Thanks for having Dr. Rita on your show. So much common sense here on such an important topic.

[@lkuriskomd]

This was a great conversation. I am a radiologist now but was a family medicine physician many years ago before specializing. If I were to go back to primary care with what I know now, I would order much fewer tests and prescribe much fewer medications. So much of what is done in the day to day practice of medicine is really not helpful but just makes it look like you are doing something for the patient.

[@briananderson8428]

Great discussion as always. One correction: even though Aduhelm is a rip-off because it costs $55K/year with little clinical significance or benefit, you cannot get in-home, round-the-clock care from even a health aide for 56K/year. At $25/HR x 24 x365, you'd be paying about 220K/year. (And $25/HR is quite a conservative estimate.) And that is for "care" that is not even at the LPN level. I would imagine that in California, in-home "care" starts at closer to $30/HR. By contrast, a bed in a skilled nursing facility is about 10K/month, or $120K/year. Point is: the system is set up to remove those with advanced cognitive problems from their homes (mostly a horrible decision) and insert them into "skilled nursing" facilities, because it's about half as expensive as having in-home 24/7 care. And how do most families come up with the 10K/month...? They sell the parents' home, of course, and grind through the parents' entire life savings. We live in a rapacious US oligarchy (I'd actually say, a kleptocracy in which American politicians get rich off skimming from campaign fund accounts and PACS which are filled by Pharma and other billionaire-level interests.) It's legalized bribery and theft. We are not much more ethical than "third-world" dictatorships in many ways. I know government and health care policy are not the fortes of Rita, Zubin, or Vinay, but I do think you guys consistently overlook the benefits of a completely universal system--inclusive of dental, vision, hearing, and medical. You can tinker all you want with "3.0," but until universal healthcare is the law, you're going to fail because the avaricious, kleptocratic capitalism that is ruining the US is insatiable and run mostly by sociopaths with graduate degrees from (often) elite universities. Would be great, Zubin, if you could interview healthcare economists on this issue. I think you'll find almost all of them are beginning to understand that although universal care may be a bit more sluggish in terms of research, it is far more powerful in terms of responding to the entirety of population-level, as well as individual, needs. Most ethical healthcare economists--particularly ones who did not get their PhDs from American universities--have seen the light. Nothing will happen in a substantial way within the US in the absence of universal healthcare. It is not the sufficient condition, but it is the foundational necessary condition.

[@beckiesibley8138]

Thank you for your common sense approach to medical care. You all are making a positive difference for people who are willing to educate themselves. I appreciate you all.

[@vivaciousom5347]

Less than five minutes in, I love this guest. Less than ten minutes in, I love this conversation. Staying away from doctors is healthy for me. Yes, less is more.

[@justjules6975]

I’m 22 minutes in and I can tell you I avoid the GI unless I feel horrible because the first thing they do is schedule both scopes for any complaint I have. I do appreciate that he was the one who realized I had diabetes and Afib! 7 seconds of Afib was caught on a 30 day holter monitor and my cardiologist immediately wanted to put me on amiodarone to which I said hell no. On rate control and aspirin until menopause. Due to a bleeding issue I’m not on blood thinners yet.

[@PetsNPatients]

Close friend's brother in his 60's was fine, went in for screening colonscopy ....got a puncture and died from sepsis.

[@julielukert5097]

How tragic 😥

[@allisonfalin8854]

Absolutely on the imaging tests...It drives me mad. Where has the physical exam gone?? And what do they do with all those gallbladders that get ripped out for no good reason. I do take MHT and genetic testing showed no hereditary risk of cancer, however, I still get to go for an annual tomosynthesis and MRI at the 6 months split. Whatever, I will do the thing and continue on knowing that I am doing all the things to mitigate risk that my family did not with diet, exercise, staying lean, lowering stress, no smoking and no ETOH. This was a really great discussion.

[@lydiajoymcdowell-davis3390]

Dr Prasad! Your statement about consolidating wealth through funneling money to devices instead of home care was so insightful. "Make it make sense" and ya did.

[@karenkaren3189]

I worked in the ICU off and on from the late 70’s to the early 2000’s. Swan Ganz catheters were widely employed during the earlier part of my career. They were invasive, not so easy to use. Delivered all sorts of information but it was never clear to me that for my patients, they were worth it. The exception would perhaps be in the CCU.

[@joestergios6557]

Such a great discussion and guest. How we got to be 2x the per capita expenditure as compared to any other nation is worth exploring. Problem is people are not receptive to this. They worship their relationship with their doctors. Mukhergee's Emporer of All Maladies is a great read- so many eye-openers and probably the last thing the AMA wants you to read.

[@ohsweetmystery]

Thanks for the recommendation!

[@brianmartin4035]

Fantastic podcast, one of your best guests, thank you for sharing!

[@sabrinalavdisarnold825]

I have a loved one battling breast cancer. After chemo, surgery and radiation, her doctor wants her to take 4 months of chemo pills. She's 67 and ready to enjoy life again and doesn't want to take them. It's such a dilemma of what to do. As a support person, you want your loved one to have the best chance at recovery but we don't have the data on what actually works and what's the doctor covering their butt.

[@grainofsand4176]

A deep thankyou to All of the healthcare workers of this community. Im not in this field, but I suspect it is an exhausting job, with sporadic gratitude from suffering (potentially griping, unstable) patients and the pay increasingly does not reflect this. Thankyou💜

[@nikhtose]

A slamming conversation. Dr. Redberg is a treasure! Thanks for cutting through the over-treatment wave. Have suspected as much as an uneducated patient (do I really need a heavy statin for LDL 117, overall normal? NO!). One more spur to the "be the steward of your own health" creed. VPZD nails it again!

[@teeesabelesky1909]

This is such a great episode!! So glad to hear you guys speaking to this and you guys have a voice!! Keep it up!!

[@user-cc5od3zk4p]

Great podcast! Thank you all!

[@barbbrazes869]

This an excellent discussion!! Much admiration and appreciation for this important info!! Love the thought provoking episode!!!

[@dacisky]

I need a cardiologist like Dr. Redberg ...Would you have her on just to discuss statins? I quit taking them years ago,due to side effects and now have two Doctors trying to brow beat me into taking them,which I refuse to do..Anyway,great show.

[@user-cc5od3zk4p]

Fire them. They work for you and don’t suffer the consequences of those horrible drugs. They killed my dad and a good friend.

[@marie6508]

I was 40 years old, just had a baby a year earlier and was told I needed a mammogram.... because I was 40. I got the mammogram and there was artifact on the screen. Of course they don't tell you this at the time. So I was told that I needed another mammogram because it wasn't clear. So now I am panicked thinking there "May" be something. What would I do for my baby if I had cancer? How would I take care of my kids? I was stressing and anxious. So I had to go-to ANOTHER mammogram weeks later and was sat in a waiting room with a bunch of other women. I felt herded in like cattle to get the mammogram along with all the other women. The mammogram was negative. Turns out the original mammogram was done poorly. I have no history of breast cancer in the family. No smoking. No other is issues that would make me at traditional risk for breast cancer. Never went back after that experience.

[@jamesleem.d.7442]

A very important performance today. Dr. Redberg, why can't I be one of your patients?

[@brooke_ann]

I love how they are still always sitting right next to each other

[@cjkaon]

I love that you're bringing attention to how much harm medical intervention can do. With guests like Rita, though, my bigger question is how to determine which tests and treatments are worth doing and when. It's easy to be a hater (and dude, I love me some hating on the medical industry), but there's gotta be something useful that all these doctors are running around doing. How do I figure out what aspects of medicine actually improve life and well being?

[@Statinstories]

Dr. Redberg's empathy and courage (and also my present PCP's) for people who have wound up with painful, debilitating chronic diseases or clusters of symptoms from statins--often after strongly expressing their skepticism regarding any benefit at all from that medication for themselves as individuals. Dr. Redberg correctly points out that in the cases of a statin prescribed for primary prevention, these people, who were so often in great health, have been made sick by a drug that's NOT been proven to make their lives longer. As one of the many people, including a number of physicians I know, who've been brow-beaten into statin treatment, I confidently state that though statins may not make our lives longer, they do make them SEEM much longer. As time flies when you're having fun, time slows and drags when you're insurmountably fatigued, in pain, now have labile blood pressure...and so many people have been convinced that this is not so and thus refuse even to acknowledge what's happened to you. (Feels like the attitude of the asbestos factory owners who, stating that asbestos is chemically inert, for decades claimed it to be safe enough to use as land fill in our town's river marshes, safe for kids to play frisbee with flat pieces they've pulled from the marsh mud.) Dr. Redberg shows remarkable empathy (as does my wonderful present PCP) for the many people who have wound up with painful, debilitating chronic diseases or clusters of symptoms from statins--often after strongly expressing their skepticism regarding any benefit at all from that medication for themselves as individuals. Dr. Redberg correctly points out that in the cases of a statin prescribed for primary prevention, these people, who were so often in great health, have been made sick by a drug that's NOT been proven to make their lives longer. As one of the many people, including a number of physicians I know, who've been brow-beaten into statin treatment, I confidently state that though statins may not make our lives longer, they do make them SEEM much longer. As time flies when you're having fun, time slows and drags when you're insurmountably fatigued, in pain, now endure frightening bouts of labile blood pressure--all known adverse effects from statins. Meantime so many people have been convinced that this is not so and thus refuse to so much as acknowledge what's happened to you. Who or who regulatory agency is legally required to report the adverse effects of prescription medications?

[@lisab7220]

I agree that looking at all-cause mortality should be considered when doing studies. I encourage you to look at the study by Danish researcher Professor Christine Stabell-Benn that looks at Covid vaccines and all-cause mortality.

[@elizabethmares2938]

I pray that they will look at the study. They talk the good talk but need to also apply what they say when it comes to these MNRA vaccines! But so far they turn a blind eye to it ( and to all the side effects!). I can’t figure out why!!!

[@ninjason57]

From my experience as an ER doctor a lot of waste comes from a sense of entitlement our culture has when they come into the hospital. People expect everything possible to be done for them solely based on their subjectivity without any thought to the cost/resources. The threat of litigation is also to blame because why not order a test that's available to "cover your ass" just in case there is a slight chance you might miss a diagnosis and be sued potentially ruining your career? There's also the problem of having doctors see too many patients in a short period of time; instead of spending more dedicated time with each patient to obtain a detailed history and physical exam it's just much easier to order a bunch of tests to have objective evidence rather than rely on expert recommendations based on experience and knowledge. Our culture is also terrified of death acting as if it was curable; we prolong the quantity of life rather than the quality of life. I believe end of life care accounts for between 10% up to 25% of all healthcare costs. Healthcare business is also obsessed with patient satisfaction; telling patient's the truth that will help massively with preventative care eg. weight problems, dietary problems, poor hygiene habits can end up upsetting patients to the point where they give negative reviews which isn't good for business; so we beat around the bush and order more tests to try and come up with an alternative explanation and/or order more prescriptions to treat the symptoms without addressing the underlying cause to spare their feelings and maintain "happy customers". These are just some things off the top of my head. I'm sure there's more that are to blame.

[@user-cc5od3zk4p]

Patients are quick to criticize. We have a duty to ourselves to maintain health and take proper preventative measures. It does put doctors in a difficult position.

[@sdjohnston67]

It's very unfortunate how care providers today can be ignorant of lifestyle changes that can have very positive effects on particular issues. Example: osteopenia. Resistance training can increase bone density over time. No pills. There is a massive lacuna in understanding of diet and exercise and how significant these can be to improve health.

[@rey3472]

Osteopenia. Sarcopenia. Treatments for those conditions were developed and successful 60 years ago. But, those treatments are not politically correct.

[@wednesdayschild3627]

I had 4 stents age 55, woman after heart attack. My only risk factor was 237 cholesterol. Everything else was perfect. I exercised the day before. Some things are just mysterious. I think there are unknowns.

[@zaq_hack4987]

I have to say it is very disappointing that this episode only has 24k views at this point. This is one of the most important podcasts on medicine and personal health choices perhaps ever recorded. **ALL** interventions have trade-offs. We need to think of all of our health choices as weighed on scales: Even if the other side has teeny, tiny weights, we need to understand that the other side of scales are never empty. Worse, sometimes, there are "invisible weights" that we don't discover until much, much later. We never ask, "What happens if we do nothing?" Our great bias, as humans, as researchers, as patients, and as doctors, is to put something (anything!) on the scale while completely ignoring the weights already in the balance. "We have to do SOMETHING!" is what we all think and hear from others, but ... how many people has that harmed? A wrong action in business might be corrected. You see celebrity business leaders or articles in Forbes, Entreprenuer, WSJ all saying, "A Bad Decision Is Better Than No Decision At All." This is a very American, rah rah, go-get-em sort of mantra. However, most business decisions can be changed down the road. They may be expensive or cost reputation, but they are rarely life-or-death. Our bodily health is not the same. The impatience of our culture makes us ... well, bad patients! However, more people need to slow down when it comes to choices about their health and lifestyle. There are no "free lunches" in medicine any more than there are anywhere else! Like the poor lady Dr. Redberg talked about who ended up with the heart transplant from a "test," we don't see both sides of the scales. We completely ignore the downsides of various interventions and only look at the maximum upside. "Oh, people who take this have X amazing outcome!" If it turns out that only 5% of people have that amazing outcome, we still look at that intervention with maximum optimism (usually). "Oh, that's the outcome I want! I'm gonna try to hope and pray my way into that 5%!" Americans are incredibly bad at choosing to do nothing. (Well, unless we're talking about voting ...)

[@notalktoni4096]

A few years ago my husband went to the dentist, which stresses him out, and they took his blood pressure. It was something like 400/200. He said the tech thought he was going to freak out when she saw his bp. By the time he left, it was somewhat better.

[@rockmama2474]

This discussion raises my already high opinion of my PCP! I have asked for a couple of screenings over the years and we discussed how the results would be very non-specific and possibly cause concern - and what goes along with it - where there should be none.

[@tammyschilling5362]

I love this conversation and what it shows about all of these tests. I think you're missing the obvious problem which is the concept of 3rd-party payer systems (whether that party is the government or insurance companies). Once you take the consumer out of the loop, they stop looking out for themselves, both financially and physically. People who have HSA accounts do a much better job at managing their health care consumption, because they have to pay for it directly (until it reaches a catastrophic number where the insurance would kick in). So they call around and ask what a test costs at various places, whether a test is necessary, what the bad outcome would be without it, etc. Forget getting the FDA, or any other government agency, to give a rip about protecting people. It never has and never will. Go straight to the person who will suffer and educate them to ask: What is the best thing that could happen? What is the worst thing that could happen? Has this treatment been shown to actually improve outcomes in X, Y, Z way? You're trying to change a system, but you can't. What you could do is come up with a handful of very good questions for people to ask about each health interaction and it wouldn't cost any more than the cost of publicizing and sharing those questions. And you don't need anyone's permission to do it (not the FDA, medicare, senate, etc). You could start to effect real change literally today.

[@jenniferalbrecht5101]

As always, thank you! 💗

[@lburrsshinyhunts2253]

“The cost of Cologuard is around $500. Part of that cost may be covered by some insurances depending on your plan, co-pay, and deductible. Diagnostic testing is subject to deductibles and coinsurance. Screening colonoscopies are not subject to copays and deductibles and usually have no out-of-pocket costs for patients”. (Oh the irony)

[@irenegriffin3050]

And if Cologuard detects something, then the colonoscopy becomes diagnostic and insurance may not pay at all if you have a high deductible. Between over testing and the ridiculous cost of testing (combined with greedy insurance companies) it's a horrible situation!

[@sdjohnston67]

Another big problem is how incredibly weighty every utterance from the practitioner can be to some people. For some, when their doctor says something (anything) it becomes in their mind as though God has spoken directly to them. The slightest offhand remark can result in long term daily habits or obsessions lasting years, based on a misunderstanding or failure to see the context. Care providers need to be aware that some patients are like this.

[@deniseramsour1129]

Sociological thinking in this conversation. Thank you

[@vegasstevo]

Delightful show packed with good info.

[@theroamingsavage8813]

Phenomenal conversation, fantastic video quality, EXTREMELY engaging topic.. Thank you for this.

[@ElishevaLe]

I very much appreciate this conversation. I have been seeking out professional critique on screening and testing as I came of age where mammograms are recommended and colonoscopy is on the horizon. I have listened to and read GERD Gigerenzer who talks about how to communicate risk to the public. I really really wish that these risks were communicated more clearly to the public.

[@ElishevaLe]

At 1:19.... I will ask why a test is being recommended. If it is for protocol reasons, I'll skip. If it is specifically indicated I'll consider it....

[@cw3354]

We love shirts that shows your biceps and muscles!

[@LilCraftyNook]

This brings up a good point , thinking about Kaiser and “preventative medicine”. I used to go for every little thing but now I don’t. I think we have been sold a bill of goods that we HAVE to have all this care!? Most diseases are metabolic and therefore can be circumvented with a decent diet. My friend who is my daughters age has a very suspicious growth in her colon and had it screened for cancer. Any GI issue like that would have to be from what we eat and drink, wouldn’t you think? (Genetics is only part of the picture)

[@joanna0988]

I would add stress to that list of causes. I work for lawyers and they have quite a high rate of heart attacks and strokes.

[@christinaduross2240]

Please consider that in men at high risk like African American men, PSA is helpful. And US Preventative task force did add an amendment. The randomized study that lead to the tasks force recommendation was in a cohort with a majority of men with European ancestry. In Black men, the prostate cancer is aggressive and onset is early.

[@TheGibby13]

Excellent as always!

[@zenpig6605]

Great video! One of the issues here is that we western people have a tough time taking responsibility for our own health care. working out with both resistance training and aerobic conditioning. eating a healthy home cooked, well rounded diet, getting plenty of sleep , getting outdoors everyday, (hopefully in nature). along with stress reduction such as a daily meditation practice. Don't know if it will let me "survive" longer, but I certainly am Living better. cheers

[@tallard666]

Gosh, I'd like a transcript of this episode. Sooooo much interesting information!

[@mtd94556]

Excellent show!!!!!!!!

[@ventiawebber9291]

This principle is largely true for pre-natal care as well.

[@janice4335]

Just discovered you guys. You are WONDERFUL 💗

[@brunsomarrr]

I love how many times Dr Redberg says, "Well you should do a study..." 😆 What a concept!!! Thank you Drs. 🙏‍

[@oanagody1]

Loved this. Now use this lens on the MRNA vaccine technology (the good, the bad, and the BIG unknowns).

[@joanna0988]

Yes please. My husband (age 36) is having severe muscle cramps since his 2nd shot and keeps being told it's because he's dehydrated or working out too much.

[@swangirl63]

I was given Armour Thyroid after a TSH test and got an arryhthmia which is a side effect of the drug, put on a Holter monitor for 2 days and it showed a stage one heart block, was given a dual chamber pacemaker and stage one morphed into a complete heart block, now after six years I have pacemaker induced heart failure from 100% ventricle pacing.

[@cw3354]

I needed that translation for normal people hehehehe. That's why we love you ZDogg!

[@robbyr9286]

Thank you for having Dr. Redberg on the show & your informative yet goofy style.

[@JayCaseGT500]

Funny. I was very aware of over treatment as a student and "human". My grandma had a Physician that wanted a monthly blood panel cbc. She was totally healthy. No changes in the way she felt. I politely stopped that. She had a small bowel obstruction. I kept refusing contrast dye. They insisted it would make the block more visible. ok. still doesn't change much. She didn't get the contrast and sure enough...nothing changed. They saw the blockage, treatment was the same. TLDW-I hope this MD felt the same way about C 1 9. She's a badass.

[@joanna0988]

My mom who is in her 50s had a very bad reaction to the contrast dye. It also didn't help visualize her fibroids that much and she suffered for 3 weeks after her scan.

[@MikeLive1285]

A commercial for prostate cancer treatment came on when they were talking about prostate cancer lol.

[@udontknowme6525]

Weight gain for folks on statins could be related to their association with increased insulin resistance as well (unless of course that might also be explained by the “gluttony” reasoning as well).

[@wednesdayschild3627]

Antidote here. My husband and I lost weight on statins. Imo the side effects of statins are way overblown. They are a cheap medicine that help with heart disease.

[@dacisky]

@@wednesdayschild3627 The positive effects are overrated the negative effects are underrated. Just cause you got off easy on side effects,does not mean everyone does. I'll never take those things again.

[@user-cc5od3zk4p]

Those cheap and easy drugs killed my dad. Statins should be illegal.

[@user-cc5od3zk4p]

You nailed it.

[@ChrisCapoccia]

the big problem with over-screening is the normal psychology related to "watchful waiting" that actually drives over-action. That said, I also have a relative who is probably overly comfortable with waiting on healthcare treatment

[@matthewsimmons4700]

Doc how about a session on pre hospital care over and under treatment!!

[@TheIgnacio777]

Wow, wow, wow!!! Fantastic podcast, THANK YOU!!!! How can I get Rita to be my cardiologist????

[@ohsweetmystery]

Insurance is the entire reason health care costs are so high. There is absolutely no incentive to create low cost solutions.

[@cjkaon]

Definitely agree with what you were saying about how different the vibe of the conversation is without Marty. Marty's cool, but sometimes the conversation benefits if there's one person with a calmer, more deliberative personality.

[@AnneGorman]

Excellent talk. Thank you.

[@tapdancer7702]

WAIT - our medical staff are overworked, under paid, short staffed, AND we're giving harmful excess care!?!?!??

[@formerfundienowfree4235]

bingo!

[@jenmolly8794]

100%. Why at this point in time are not studies done to prove benefit? When asking my doctor they really do not have a good answer

[@HungGarEarthBender]

34:26 the synchronicity of the 2 bros is on point

[@ZDoggMD]

OK that was just scary 😂

[@HungGarEarthBender]

@@ZDoggMD I’m here for it. I thought this was an amazing conversation. I’m sharing it with many colleagues.

[@Amethyst_fairy81]

My 44 yo husband was dx with it. Brother, father had it. Brother young. He was intermittent unfavorable grade 7. We did brachytherapy so far so good

[@warner476]

Great discussion. Thanks

[@wendyfilice7274]

Fabulous information. Thanks 👏❤️

[@darkpriestnevan]

Love this stuff. amazing.

[@formerfundienowfree4235]

for me it's colonoscopies. I just find them brutally invasive not without risk and I'm just going to live with the odds of 96% chance of not having colon cancer, while also trying to eat well, exercise drink green tea pop an aspirin now and then, dandelion root etc...people don't understand that they have a right to accept the risk. My philosophy is different than most people I understand.

[@tdobsevage7732]

Thanks!

[@ZDoggMD]

Dang! Thanks!

[@Floccini]

Can I recommend that you all read Robin Hanson on medical care? He takes the issues that you discus and tries to build a theory of why do we choose to get treatments that show so small and questionable benefits.

[@healthcareplanforus1246]

Great discussion.