Fixing Healthcare Podcast

This Fixing Healthcare podcast series “Diving Deep” probes some of healthcare’s most complex topics and deep-seated problems. On today’s episode, hosts Dr. Robert Pearl and Jeremy Corr discuss two imperatives for healthcare leadership in the 21st century: changing the way docs use technology and changing the way we pay for medical care. For more information on healthcare leadership, check out Dr. Pearl’s latest columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a discussion guide: LEADERSHIP + TECHNOLOGY What does the metaphor of the iron triangle represent in medicine? Why is U.S. healthcare lacking effective leadership? What is the “anatomy of healthcare leadership”? How might a leader begin to change healthcare, locally? What would leaders most like to change about the care patients receive today? How do we make the ideal real in healthcare today? What are some technologies that could transform medical care? How could technologies change care for patients with chronic disease? Once clinicians agree with the logic of new tech, how can leaders appeal to them on an emotional level? How can real patient stories help persuade docs to embrace change? In addition to the brain and heart, what is the role of the spine for leaders? How did cohost Dr. Pearl use his spine to push technology forward at Kaiser? What are the biggest problems a leader might experience when implementing new technological solutions? LEADERSHIP + MONEY Do Americans get what they pay for from healthcare today? What are the biggest cost barriers to reforming healthcare? What’s the problem with fee-for-service? What is the alternative to fee for service? How does “capitation” change the incentives for physicians? Doesn’t capitation lead to delayed and denied care? Why aren’t doctors jumping at pay-for-value models? How do leaders use their brain, heart and spine differently to reform healthcare payments? Can leaders make a case for capitation on an emotional level? Why do leaders need a strong spine to advance capitation? What else is needed to move away from fee-for-service as the method of reimbursement? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #75: Diving deep into healthcare technology and capitation   appeared first on Fixing Healthcare.

As a college freshman, Fixing Healthcare cohost Dr. Robert Pearl decided that rather than becoming a university professor as he had planned, he’d go into a field without politics: medicine. He laughs about how naïve he was as a 17-year-old. “Healthcare is about life and death,” said Pearl, recalling his decision, “How could there be politics entwined inside that esteemed world?” Of course, Pearl soon learned that politics and medicine are a tangled mess. In this episode of Unfiltered, Pearl and his cohost Jeremy Corr join ZDoggMD to look at the relationship between medicine and politics and if there’s any opportunity for logic to prevail. To find out, press play or keep reading. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. UNFILTERED TRANSCRIPT Jeremy Corr: Hello, and welcome to Unfiltered, our newest program in our weekly healthcare podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard-hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice, then I’ll pose a question to the two of them based on what I’ve heard. Robbie, why don’t you kick it off? Robert Pearl: Hey, Zubin, how was your Thanksgiving? Zubin Damania: It was thankful. I really enjoyed it. My wife was on call, which meant we didn’t have to go through the full production of the meal. We went to a half meal, which was absolutely great. I had 70% less bloat and 100% more gratitude. How about you? Robert Pearl: I had a great time. I was over at my sisters and had a bunch of folks there. Did you do anything special to communicate your gratitude to others? Zubin Damania: I texted a lot of people that I had been a little out of touch with, and just to convey how important they are in my whole life and journey. Robert Pearl: Excellent. That sounds great. So I don’t know if I ever told you that I became a doctor to avoid politics. Zubin Damania: I didn’t know that. Robert Pearl: Yeah. So I was in college. I was a philosophy major, and my hero, who was a philosophy professor, quite an excellent one, he went on to become the chairman at Reed College, didn’t get tenure because of his political views, and I decided then that I wanted to do something that would have no politics. I mean, healthcare is about life and death. How could there be politics entwined inside that esteemed world? And so that’s truly why at the age of 17 I decided that I’d become a doctor, and I learned stuff later on. Any thoughts on that observation, and what we can do to minimize the politics in medicine? Zubin Damania: Well, you had me at philosophy major. I don’t remember you… You must have told me that, but that’s impressive. If I could go back in time and do it again, I would do philosophy instead of music and molecular biology, although that’s kind of philosophy in a way. Yeah, politics and medicine have been to some degree dance partners for a long time, but I think right now it actually just reflects how politicized everything is, and how everything is so kind of divided. Although, I’ll say this, Robbie, I’m sensing something in the air, and I might have said this at our last conversation, but I really think something is shifting. I feel like people are starting to wake up to the fact that we are really divided over nothing substantial in the sense that we’re all trying to find truth and goodness, and we just have a slightly different spin on it, and medicine maybe will wake up, but as usual, we’re about a decade or two behind the rest of the culture. Robert Pearl: Actually, I think that you’re correct, and I think we saw that in the most recent midterms that there was a lot more people I’ll say in the middle rather than the 20%, at both extremes, who were yelling the loudest and typing with all capitals and explanation points, but there’s a lot of people in the middle, and they want to know the truth. And I think in many ways, I’m not talking about the specifics of the outcome, but the election process itself, and, of course, we didn’t even have any attempt except in Nevada to just get rid of the entire voting and somehow have a different method of selecting candidates based upon maybe some sorcery or something else that could go into its place. Zubin Damania: Yeah. Robert Pearl: But one of the things… Sorry, go on. Zubin Damania: No, no, no. I was just going to say in Nevada we have a lot of interesting things like legalized prostitution among other things, so we are a special state. Robert Pearl: Oh, excellent. That’s right. You were there. Exactly. Legalized gambling, prostitution, so on. Yeah. One of the things that strikes me as I think about the politics is that you would think that the health status would drive the politics, by which I mean if a lot of people didn’t have coverage, then they would be attracted to a party that would be likely to give them the coverage, and we think about people voting their interests. If there was a lot of opioid addiction in a particular geography, you would think that that would be a very high concern, and yet we see almost the opposite. Tell me where you live, and I’ll tell you your view on a problem. Whether for you it’s a particular medical challenge or not doesn’t seem to be the driver as opposed to where you happen to own a home and in many cases grow up. This seems really strange to me. Zubin Damania: Yeah, it does, and again, all things seem strange if you look at humans as rational actors that work in their best interests all the time. And unfortunately I think we’re emotional, intuitive creatures that are the product of our conditioning and our moral sort of taste buds. And I think if your moral taste buds are concerned about say liberty versus oppression or government controlling things, even though you’re desperate for care, and you need it, and it would save your life or your family’s life, I think through that moral lens you’ll see any sort of government “intrusion” into healthcare is something that’s adverse, and you’ll fight tooth and nail. There’s also a tribal component on all sides of this, like you said, where you grow up, and I think where you grow up is to some degree it conditions how you are, but to another degree you’re kind of attracted to those places that are an expression of your own sort of moral matrix. And so I think it’s a variety of those factors, and so people do not necessarily vote, or act, or think in their best interests always, if you look at their best interests from that standpoint. But if you look at their best interests as a morality play, they almost always do it in that way it seems. Yeah, that’s just my sense of this. Robert Pearl: I always love talking to you, because I think about things that I hadn’t contemplated before. About a decade ago, I did some research with a neurologist named George, and George and I looked at brain scans, and we looked at what happens when people get put into situations of great threat or great opportunity, and what we found, George York and myself, was that there’s actually a shift in our brain in terms of perception. In the last show you mentioned the amygdala, the source of great fear, and what you see is that the amygdala first gets stimulated, and then as you mentioned actually in the last show, how the occipital lobes change, and we see things differently, and by see it’s not just a vision. It’s all of our senses. It’s our perception of the world, and maybe some of these pieces are that there are fears or maybe hopes that people have that actually change their perception. And when you move someplace else where there’s different fears, and different hopes, different views of the world because of circumstances, then you change that perception, and maybe that accounts for some of this great shift in how we relate to each other or fail to do so, and maybe some of it is coming together to recognize that we may share in more common fears and more common hopes than we otherwise might realize. Zubin Damania: This is a really interesting insight actually, Robbie, because it made me think of something. You were saying sometimes I’ll prompt you. This prompted me, because there is this idea that part of the reason where… There are many reasons why we’re so divided and politicized nowadays, but one of them might be that your local scenario kind of conditions you and vice versa, but the global village that we have with social media is that now there’s a saying, “Good fences make good neighbors.” When not much about someone else they’re actually all right. The more about them sometimes it’s like, “Hmm, I’m not sure about this.” And when you take disparate ideas from different geographies that are evolved differently to suit that geography, and you place them adjacent to each other, that’s when the all caps starts happening on Twitter, because somebody that you never would’ve really known that well, and you still don’t know them well, but you know them in a social media way, are hitting you with ideas that seem so antithetical to that moral palette that they do generate that fear. It’s that fear of loss of identity, the fear of loss of self, that this is who I am, right? I’m this liberal, or I’m this conservative, or I’m this libertarian, and suddenly you’re met with somebody who’s giving you totally different ideas, and it becomes instantly a kind of like, “Okay, fight or flight. I must defend this,” sort of identity. And what may be happening is we’re getting so used to social media now that we might be starting to transcend that initial shock and start to see what you’re pointing out, which is, “Hey, actually we’re all in this game.” And actually when you start to point out how divided we are, people start to wake up and go, “Yeah, we are kind of getting played by this, the news cycle, and social media, and this kind of thing.” So it is really interesting. Robert Pearl: So let’s try to meld the politics and the health. One of the areas that I’m increasingly concerned about is the LBGTQ population, and how in this environment they’re going to be able to get good healthcare across the nation in all 50 states. Do you have any thoughts about, first of all, the hatred that’s seems to be often directed particularly at trans individuals, and how will they get their healthcare needs met from an optimal medical perspective? Zubin Damania: Yeah. And this is one of those things where… Who said this? It was recently the World Cup, and the Iranian media was questioning American soccer players, and they asked a black soccer player. They said, “What’s it like living in a country where you’re discriminated against?” And obviously this was all politicized because of the whole Iran-US thing. And so this journalist was really trying to provoke this guy to say, “Yeah, we live in a super racist country where people are discriminated against because we keep accusing them of discriminated against women, which they do.” And he said, “Yeah, it is interesting, but I’ll say this, in America, one of the things I’ve noticed is we’re constantly trying to get better. There’s always some feeling that there is a kind of progress, and that makes it much easier to live here and deal with it, and I want to be part of the change.” And I think with trans, with LGBTQ+, and all of that, I think that’s also what we see. These issues were repressed previously. Now the repression is less, and so we’re seeing them come to the fore, and it’s louder in sort of the culture, and so it’s easy to feel that there’s no progress, but I think that even that the conversations are happening is progress, so it’s a lot of it is ignorance. A lot of it is just lack of knowledge, and reactionism, and that kind of thing, and I think it is going to continue to progress. I mean, just look at the bill now that that’s going through the Senate where they’re going to codify protections on gay marriage say. That would’ve been unheard of a decade ago, and so I’m actually optimistic, but you can’t stop working for it, right? You can’t stop being part of the progress. Robert Pearl: Again, another interesting thought that I hadn’t had before about how as soon as you stop pushing forward, you slide back, and that it’s not a question of pushing forward always to make progress. It’s pushing forward even to hold the progress that you have, and I can think of a lot of examples where as soon as people stop pushing, what we see is that everything slides back to where it came from even though I can’t find the rationality for why it started there. Zubin Damania: Yeah, I think it takes a collective effort, and you’ll always get resistance and even understanding the resistance is a good thing. If you can see through other people’s eyes and go, “Okay, what is it that… What is this? Is this fear of other? Is this just misunderstanding? Is this a kind of projection where there’s something about them that they feel isn’t as mainstream, and they don’t want… They’re projecting this onto others.” You wrote your book Uncaring about medical culture, and I think what I loved about that book is that you just shined a direct light on things like emotional repression, projection, denial, the things that we do in medicine that we’re conditioned to do, that are really fundamentally quite harmful to progress, and I think it’s true in broader society as well. We have an epidemic, a pandemic of emotional repression, and avoidance, and projection as a result. Robert Pearl: Well, for any listeners who might not have read the book, let me point out that a part of why I focused on denial is that denial is what makes the medical culture great. How else do you go into the streets during the plague and take care of people knowing that it’s a contagious disease, even though you have no idea what contagion means, because it hasn’t been yet discovered, or how do you go into ERs and take care of patients early in the pandemic when you don’t have protective gear? You have to deny the risk to yourself in order to put the patient first, but I also note that that tendency towards denial can spill over when there are things that we don’t necessarily want to see, and I thought of that this week. I don’t know if you noticed that the Merriam Webster word of the year is gaslighting. Did you know that? Zubin Damania: I didn’t know that, but it doesn’t surprise me. Robert Pearl: Yeah, and there’s actually a lot of studies that have come out that said that it’s very frequent, and actually it’s very frequent in the LGBTQ+ population that we talked about, when they go for care. It’s actually very frequent when women go for care. I think many of the groups that have felt as though there’s a certain level of discrimination, the truth is that in the doctor’s office it’s there as well. The complaints are not taken as seriously. Problems that otherwise might be investigated are assumed to be simply psychological, and, of course, in medicine we deny that psychological is as important as physical, and you go on, and on, and on. Your thoughts on what we can do about it? Zubin Damania: Yeah, I mean, again, this is our culture. You’re right. I mean, and the gaslighting is an interesting thing because I think a lot of it is unconscious, right? People are doing it not intentionally. It’s a kind of pattern of behavior. You try to make people feel like they’re not right in the head because you’re either projecting or denying something about the nature of their care, and I think it doesn’t happen at a conscious level. So until you bring it into the light of awareness, and you actually make it explicit in a way that doesn’t actually threaten the identity structures of the person you’re talking with. That’s the problem is a full frontal assault, and I think this is why in the culture right now, the full frontal assault of progress on people who are more say conservative, it leads to kind of a psychological reactance, and because, again, we’re going to defend our identity structures on all sides of it. So there’s a way to do that I think that is much more compassionate and actually effective. So we have to focus on those strategies. Those kind of alt middle strategies that I talk about I think are more effective ways to bring progress that also is inclusive of people that feel they’ve also been left behind. Robert Pearl: The reason I like the word denial, although I’ll have to tell you that there’s some readers who didn’t like it, but I like the word because of the point you just made. It’s subconscious. We’re not aware of it. We act in ways without being conscious that this is what we’re doing. We don’t see it, and that makes me think about all the problems that if you read the literature, it’s so clear how important they are, social determinants of health, racial disparities. You know, 10% of Americans are still uninsured. It used to be 16% before the ACA, and I don’t hear a whole lot of conversation about that. Last night, I teach in the Stanford Graduate School of Business, and last night our guest speaker was a guy named Dr. Dr. Devi Shetty, who’s been the podcast, and whom I’ve spoken about before, and it was fascinating. What he said is that he believes that India will be the first nation in which the healthcare you receive will not be dependent upon the amount of money that you have. In his mind, in a nation of 1.4 billion people. And the podcast he did with me a couple of months ago is just so inspirational. It’s great, and this reflected it. He worries about all 1.4 billion people and asks himself, “How do we provide care to the last of that 1.4 billion that’s as good as we provide to the best?” And in our country we tell ourselves we provide the same care to everyone, but when you look at the data, there’s not a shred of truth about that, and I don’t hear it being talked about in a broader context of people. I think people look at it very much by what do I and my family get? What do the people that I’m most close with in my community get? And that’s about as far as we look, and we don’t see all the implications. It’s mainly about the system of healthcare, but I think it’s really about the values of the nation. Zubin Damania: Yeah, I think what you nailed particularly explicitly there is the values of the nation, and America really was kind of founded in this kind of oppositional way where there’s almost an unwritten social contract that listen, listen, listen, listen, we all hate rich people for being rich and having everything, but secretly we want to be that rich person, and one day we want to have those things, and we want that opportunity to do that, to live at the top of the hierarchy. And I think it’s an unconscious kind of contract that has existed in the strata of American psyche for a long time, and that’s why something as egalitarian as a universal coverage, or everyone being treated equally in healthcare is something in the American psyche that reacts to that, and to be honest, I mean, my parents are from India. It is a vastly hierarchical, horrifically hierarchical. In fact, when I first visited, I was taken aback by the servant class there that was treated almost akin to slaves. I mean, and part of this is the sort of general caste system, but it’s just all accepted there. And coming from America, it was a shock. It was like, “Wait, wait, you can’t treat other humans like this.” So it’s good to see Devi Shetty actually trying to unwind that, because on some level there’s aspects of Indian culture that are so community focused, and we’re all in this together. And so those things coexist, and so it can be a little schizophrenic at times. Robert Pearl: Well, I think that’s very true what you said, because I’ve been there too, and the disparities are massive, but the idea of asking, of starting with the question, “How do we provide excellent care to all,” I think is a fascinating path. It’s the one that he’s on, and interestingly enough, much of his answer is technology. And he says that because in a poor country there’s not enough resources. If I have a sack of rice, and I give half of it to you because you’re hungry, I only have a half sack left. If I have a computer program that allows me to get great care, and I give you a copy, I still have my computer program. And so it’s a resource that you can give away. It’s like gratitude. I can give you all the gratitude in the world, and I haven’t depleted myself at all. In fact, I’ve actually augmented my satisfaction, my happiness, my fulfillment. Zubin Damania: I think that’s a beautiful way to put it, and it’s very similar to thinking about compassion as opposed to empathy. Empathy is feeling someone’s pain, affective empathy as your own. That does exhaust you, actually, but compassion, which is love and concern in the face of suffering and an unconditional kind of love, that actually fills you with kind of an elevation, and it’s inexhaustible. And so technology, absolutely, so there was ways to scale what we do in medicine that allow the human relationship at the center to kind of still flourish while scaling, and I think you’re absolutely right. You’re absolutely right. And actually, it’s got to be central to our answer, because we have resource limitation across the globe when it comes to high quality healthcare. So how do you scale it in that kind of way? I like that software analogy. It’s actually a very good one. One piece of software can serve infinite numbers of people. Robert Pearl: Absolutely. So let me ask you a slightly tangential question, but it still is this split in society that it’s been bothering me ever since I read the Pew Research study on it about two weeks ago, and I’ve wanted to ask you about it. So in this study, only 41% of people, and this was 12,000 individuals they surveyed, thought that scientific experts are better than others at making policy decisions about scientific issues, and that negative view is held by both Democrats and Republicans. We’ve looked at this question of scientific expertise throughout COVID 19, and we’ve certainly come to the conclusion that those with the scientific backgrounds aren’t necessarily the ones that we should be trusting, and I wonder your thoughts. You’ve been right in the middle of this scrum, if you want to think about it in that way, over this issue of the role of the expert as we look at whether you want to talk about COVID or just healthcare policy in general. Zubin Damania: Yeah, this is something that really, like you said, I’ve been kind of in the middle of it, and this is the thing. I have always kind of worked hard, early pre-pandemic especially to defend the role of expertise in healthcare, because it is invaluable. When you’re talking about recommending a type of surgery, having an interaction with a patient where it’s an interpretive dance of their hopes, dreams, and fears, and goals, and your knowledge. The your knowledge component is a very important part of the equation, right? Now, I think what’s happened here though is… And the fact that Democrats and Republicans are both saying this makes you think also of China. So here you have say let’s say a scientific technocracy, autocracy ruling class that says, “You know what? We can actually literally prevent deaths by locking people in their homes, and the number of deaths that result from that will be less than the number of deaths that happen from COVID.” And to some degree so far they’ve proven themselves correct, because they have the lowest per capita, if you believe their numbers, per capita death rate from COVID, but they’ve had to do these draconian things about policy-wise, and just now people are standing up and saying, “You know what? Enough is enough.” And I think what humans here are saying in America, are saying is, “Yeah, it’s…” or they’re not saying this explicitly, but I think this is the motivation is, “Expertise is great and wonderful, but when it comes to policy, we actually want to determine what our values say in the setting of that knowledge. So it may be that we could prevent all this COVID, but we’re actually more interested in going out to eat, seeing our friends without masks, not having our kids be out of school,” these kind of things. And so that disjunction between values, which are what politics tries to apply, or policy, and scientific expertise I think has manifested now with people saying, “You know what? I don’t trust these guys to make policy.” And so I think that’s what’s happening. Now, I’m curious what you think, but that’s been my feeling. And the problem is they’re throwing the baby out with the bath water, so now they’re like, “Well I don’t trust these guys to tell me I should vaccinate my children against mumps, because the way they managed COVID I felt was incompatible with my values. What are they telling me about mandates for childhood vaccines?” So it’s really causing all this collateral damage to public health now. Robert Pearl: No, I really love that, because as you know, I’ve been focusing a lot the past year on these rules of healthcare that I believe many of which need to be broken, and we have maybe the strongest rule, which is to save a life at any cost, and at any cost means any cost. If kids lose a year of school, that’s a cost to save one life, or two lives, or three lives. Now, we could spend a lot of time debating this issue. It’s certainly been debated by Talmudic scholars across history, but I think at some point we have to accept that death is a reality that we can’t overcome, and we probably need to take a broader view of what that means. What’s the impact to people’s lives of missing a year of education? What’s it going to mean for them and their families? How many people are going to die even though we won’t know exactly who they are as a result of that because of their family’s socioeconomic situations? Those conversations never penetrate into medicine. Zubin Damania: Oh, you nailed it, man. And again, it gets to get to that root of what you wrote about in Uncaring. It’s our denial, which again can be an adaptive denial. It’s unconscious about that death is something that is inevitable, and that it’s not necessarily the worst enemy, and it has to do with your values. So Dr. Monica Gandhi, an infectious disease specialist at UCSF, who’s been on my show several times, is coming again on Saturday. Early in the pandemic, we started doing a series of shows where we were really trying to talk people off the ledge a little bit and talk about these issues. And she said to me, and she said this on camera eventually, but initially she told me off camera that she had lost her husband, who was roughly her age, late forties, early fifties to cancer right before the pandemic, and he was a cardiologist, worked super hard. Who knows if it was radiation exposure or what, but he had a head and neck cancer, and he died, and she has two young sons, and she’s raising them alone now, and the pandemic hits, and she’s watching people, the medical system treating death like it is the worst possible thing in the universe relative to actually living your life. And it became a kind of passion for her to say, “Listen, we all look at risk differently. Here’s how you can look at risk here rather than just save a life at any cost.” And that was part of her motivation. And again, she was woken up by this tragedy that hit her and her family, and sometimes it takes something that horrible to pull the rug out of under your denial, and you shouldn’t have to have that, right? We ought to be cognizant of this as a society and as individuals in healthcare, but it’s not been part of our sort of process. Robert Pearl: Let me ask you one last question. It’s one question that I got asked. I was keynoting a large event a couple of weeks ago, and at the end you know you have the Q&A, and an individual stood up, wasn’t a physician, and asked me whether with more and more doctors becoming employees, whether we’re seeing, and he used the phrase, “Loss of motivation to drive change,” whether medicine is just similar to everyone else with quiet quitting, and burnout, and a sense that dedication to work isn’t worth the effort and the energy, or whether the traditional purpose and mission of medicine still persists. You have probably the broadest network of millions of people who follow you and communicate with you. What do you think? How would you answer that question? Zubin Damania: That’s a great question, and from the standpoint of say an independent physician, you might ask that question. From a standpoint of an employed physician, you might not know anything differently, but this is my take. Hey, remember when we didn’t have a lot of employed physicians? How much change, progress, innovation, and transformation did we get? Zero. It’s the same thing that they’re all conditioned by their incentives, by their training, by inertia, by fear. And the employed physicians have a different set of conditioning in inertia and fear, but I don’t think it’s vastly different than the old way of doing things in terms of generating innovation. I think if you want to find the roots of our failure to innovate or to feel invested in the change, I think it goes right to medical school, which you’ve talked about. I mean, we’re basically trained to, we’re conditioned to memorize facts, half of which are eventually shown to be untrue, but they don’t tell you which half, because they don’t know, and then you’re conditioned to obey authority in the second two years, and you’re afraid you’re going to hurt someone, and you don’t want to rock the boat. And so it doesn’t matter. You come out with that conditioning. You’re really trained that way. So employed or not employed, at least if you’re an employed physician, you have this network of support, and you have an organization theoretically that could support you, or it could be seen to be trying to harm you or control you, but a lot of it is our own perspective until we kind of wake up to what we’re repressing, denying, projecting, and so on in our own conditioning, our system is going to be very unlikely to change, because our organizations are epiphenomenon of who we are. Robert Pearl: My answer was that, no, what I see is physicians are just as motivated to want to make medicine better, just as motivated to want to do the best for patients. They’re frustrated by the system. They’re frustrated by the inability to make change happen, and sometimes when you’re frustrated you lose the energy needed to try to drive change, but I still believe, and maybe I’m being too optimistic, which is why I asked you, or maybe just too idealistic, that the people who go into medicine are motivated by the right reasons, and that given the opportunity, they would push hard on the block, the cart, whatever you want to be saying it to be, to move it forward, and to make it accelerate at an ever faster rate. Zubin Damania: Oh, I think you’re absolutely right given the opportunity, and when they see these little cracks. We all think about our best day in medicine, and it’s always this kind of connectedness. It’s always this kind of autonomy, tools, teams, trust, and the patient. And it just kind of is a flow state, and I think if you give people more opportunities to actualize those flow states, show them bright spots where these things are working, and kind of just point directionally, because we all kind of know where we kind of generally want to be. We just don’t necessarily know how to get there. I think things will start. It’s inevitable. The change is already happening. It’s like what we said earlier in the thing. I sense the shift in the air. I think the same thing is happening in medicine. There’s huge intractable seeming problems, but it’s always that way before the caterpillar spins the chrysalis and the transformation happens that you could never have predicted. So I think I’m with you on the optimism. I may be less of an idealist in this sense that it’s going to be a lot more brutal I think, and people will feel a certain way about it that’s very negative, but I think it’s inevitably going to go in a good place if we keep on the direction. Robert Pearl: I love it, because I’m more of an idealist. I think people have all the right motivation. I’m a little bit less of an optimist, because I think the hurdles are so tall that it’s going to take a massive amount of energy to make change happen, but with that, let’s turn it over to Jeremy for his question to us, and I can’t wait to have the next opportunity to be able to learn from your experience, and to have new views into the world. Zubin Damania: Likewise. Jeremy Corr: When it comes to politics, many voters on both sides of the aisle seem to think that the elected officials on their side are fighting for them when it comes to healthcare, while believing the other side is making healthcare worse for both them in society, whether it’s the issue of abortion, Medicare, drug pricing, transgender issues, et cetera, and I would say that the hot issue on everyone’s mind right now is freedom of speech versus censoring what some people consider disinformation or hateful speech on social media. What I really want to ask though is for a reality check from both of you. When there is so much money in politics via campaign financing, lobbying, et cetera, coming into both Republicans and Democrats from big pharma, health insurance companies, health tech companies, et cetera, is either side really fighting for the best interests of lower and middle class voters when it comes to healthcare issues, or are they just focusing on keeping these big and influential healthcare companies happy? Zubin Damania: Oh, I’d love to defer to Robbie first on this one, because I’m dying of curiosity to hear your take. Robert Pearl: I think, Jeremy, you’re raising two separate issues. I think the first issue is relative to the healthcare system, and a professor that I teach with, Robert Burgelman at Stanford, talks about medicine as being a super unmoving industry. Nothing changes over time, and he doesn’t understand why that is the case, and I think you’ve described the reason, which is there’s so many people in it, around it, impacted by it, making money from it for whom change is not what they want, and they have the power, and they have the money to be able to make stability be the example that sits within it. In contrast, I think that within the healthcare itself, that the politics, that the money is not the force that’s restraining change. I think that it’s within the people itself, it’s the difficulty of making that change happen, and I think it’s the amount of time that it takes, and I just think that it’s too much. And that’s why I’m a big believer that the change will come not through the political process, because I think that will be blocked by the money forces that exist, but it’s going to come actually through the economics, and that’s why I’m a big believer that it’s going to be the retail forces that will drive it, the Amazons of the world and the CVSs of the world, the Walmarts of the world that are going to make the change happen. I think they’re going to drive it not necessarily out of some commitment to improving the health of people. They’re going to drive it out of a profit motive, but I think that it will create a more positive change for the country, at least that’s my optimism, and that I think that once physicians get behind it, and nurses get behind it, and patients get behind it, and they can see an improvement to happen, that there will be what Zubin has talked about, this very major shift suddenly, and what seemed impossible and then seemed possible now will seem inevitable. Zubin Damania: Yeah, and I think Upton Sinclair, I think it was, who said, “It’s impossible to make a man believe something if his salary depends on him not believing it.” And I think in medicine for many people, our salaries depend on us not believing, not changing to some degree, and that includes big legacy players like pharma, and insurance companies, and those kind of things, and politics just feeds right into that, and money is all the currency, the lifeblood of that. But once, like Robbie says, once the realities of the economics start to click in, and you do have these sort of disruptive agents like Amazon kind of pushing things like our old Turntable/Iora Health Model that’s now part of Amazon, when those are normalized, and consumers, the patients are able to vote with their feet a little bit, you’ll start to see change, and it will pull in especially the younger generation of healthcare professionals, who have been kind of hungry for this kind of change. They want to do the right thing. They are idealistic, and given an opportunity to practice in that kind of world, they’ll take it. So it’s actually very, very, very encouraging. I think the shift will happen. Now, the last pitch I’ll give is personal, and I always say this, and I’m sure I can feel this is probably not true, but I can feel Robbie rolling his eyes at me. It is that people have to wake up too to their own transformation. They have to see that this sort of egoic striving that we’ve always been conditioned to do is a bit of an illusion, and once we see past that, we do emerge a world where that is actualized in a way that it’s very hard to predict, but it’ll definitely be better than what we’re going through now. Jeremy Corr: We hope you enjoyed this podcast, and we’ll tell your friends and colleagues about it. Please follow Fixing Healthcare on Apple Podcast, Spotify, or your favorite podcast app. If you like the show, please rate it five stars and leave a review. If you want information on healthcare topics, you can visit Robbie’s website at Robertpearlmd.com or visit our website at Fixinghealthcarepodcast.com. Follow us on LinkedIn, Facebook, and Twitter at Fixing HC Podcast. Thank you for listening to Fixing Healthcare’s newest series, Unfiltered, with Dr. Robert Pearl, Jeremy Corr, and Dr. Zubin Damania. Have a great day. The post FHC #74: The tangled mess of medicine and politics appeared first on Fixing Healthcare.

Dr. Jonathan Fisher was practically born into medicine. All six of his siblings became doctors, following in their father’s professional footsteps. Jonathan, himself, became a Harvard-trained cardiologist, working in some of the nation’s leading medical institutions. But, in the process of making his family proud, he was becoming anxious, depressed and burned out. He was losing an important part of himself. To make matters worse, when Jonathan finally sought the help of a therapist, he experienced profound shame and felt like a failure. Nowadays, in addition to being a practicing physician, Jonathan is an advocate. He has devoted much of his career to solving clinician burnout. He is a mindfulness and resiliency expert who runs the Ending Clinician Burnout Global Community and co-hosts the annual summit of same name. In this interview, hosts Jeremy Corr and Dr. Robert Pearl ask Dr. Fisher about the rules of American medicine that must be broken in order to free clinicians from the shame, anger, frustration and dissatisfaction that cause rampant burnout. Interview Highlights On learning the ‘unwritten rules’ of medicine “I remember my surgery rotation in third year. We had a very well respected general surgeon, resident and a fellow, and I felt like I was in the military, which was a very bizarre thing … I found myself having to walk quite erect, almost like a group of ducklings following this senior surgical resident. [We had] to speak in exactly the way that he spoke, to present in a way that was expected. This was the first time I remember this jarring sense that there were certain rules that were established, rules of behavior if we were to fit in and to excel.” On seeking professional help for the first time “I was a resident at the Brigham and I called [the therapist’s office] and I tried not to over-identify myself. And when I first went, I wore a coat so that I could cover part of my neck, and I wore a hat so that nobody in the neighborhood, other residents, would know that I was going to see a therapist. There was a lot of secrecy and there was a lot of shame that was there. I knew very little about the impacts of shame, which really literally means to cover up. That’s the origin of the word. There was so much covering up that I was doing that, eventually, I was unable to feel positive feelings.” On burnout vs. depression “There’s an overlap between burnout and depression, but one is a workplace phenomenon, often driven by a certain set of known factors that Tait Shanafelt and others have described beautifully, whereas depression is more of a psychological diagnosis. What I find interesting is … there are overlaps there with the clinical spectrum of depression as well as anxiety … If you look at Medscape’s poll from last year … 70 to 80% of all doctors across 29 sub-specialties reported depression at some point in the last few years.” On ‘the healthcare system’ and its role in burnout “People say, ‘Well, you have to change the system.’ I point out that a system is nothing more than a collection of individuals. If our individuals don’t have the presence of mind and the ability to impact change and influence the thoughts, feelings, and actions of other people, then we won’t have a generation of leaders who can make the changes that people so desperately want.” On the role of clinicians in ending burnout “I think part of the problem we’re facing in healthcare is that we’re all siloed. We may be siloed in our own institution thinking that we’re doing it best. We may be siloed in our own specialty thinking that we’re better than others. And we know the jokes that the orthopedists tell about the internists and the cardiologists tell about the neurologists, and it’s funny. At the same time, these silos are what are going to keep us from healing our healthcare system. All of these divides need to be bridged. We need to begin the bridging. And so, that’s really the motivation for my work.” On the problem with ‘moral injury’ “If we use a narrow term like moral injury, it’s a focus on one person, which is the healthcare provider who is injured. I would say that there’s a connotation there, that there is an injurer. Once we have that connotation, there are elements of blame, of blaming the system. I’ve watched this for 10 years. Well-meaning doctors who have no recourse, spend hours of their time talking about us versus them, us versus the system … I think the popularity [of the term] comes from a sense of hopelessness and, frankly, bitterness, which oftentimes is appropriate, but after a while becomes dysfunctional.” READ: Full transcript with Jonathan Fisher * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #73: The ‘rules of healthcare’ that cause burnout appeared first on Fixing Healthcare.

This holiday season, Fixing Healthcare hosts Jeremy Corr and Dr. Robert Pearl are mixing things up with a look back in time—way back, in fact, to the first episode of the first season with Dr. Zubin Damania (aka ZDoggMD). Since this interview in 2018, Dr. Z has become one of this show’s most popular returning guests. Zubin Damania is a UCSF- and Stanford-trained internist and founder of Turntable Health, an innovative primary care clinic and model for Health 3.0. As a way to address his own burnout and find his voice, he started producing videos and live shows under the pseudonym “ZDoggMD.” His persona became a grassroots movement, reaching more than 1 billion people across a wide array of different media. Today’s program will be the first of three Fixing Healthcare flashback episodes airing throughout the holidays, each featuring ideas to fix American healthcare from some of the nation’s top leaders. The purpose? To quote Dr. Pearl: “My hope in replaying these ideas is to help listeners once again realize how much could be done to transform American healthcare and improve people’s lives. And simultaneously, help them recognize how far we are from delivering the excellence in healthcare Americans want, need and deserve.” Helpful links: Season 1 explainer: ‘Welcome to the toughest interview in healthcare’ Episode 1 recap: ‘ZDoggMD has a plan to fix American healthcare’ The full transcript of this episode with Zubin Damania ZDoggMD’s website: Health 3.0 * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #72: Fixing Healthcare flashback with Zubin Damana (ZDoggMD) appeared first on Fixing Healthcare.

In this episode of Coronavirus: The Truth, Jeremy Corr and Dr. Robert Pearl discuss the latest buzzword of the Covid-19 era: Triple-demic. Earlier this month, the CDC alerted physicians about the triple threat of Covid, seasonal influenza and RSV (respiratory syncytial virus), warning that the threat of multiple infections (and resulting respiratory disease) was greatest among young children and the elderly. Is the triple-demic a legitimate public health threat and what should listeners do about it? You’ll find that topic and all the other [time stamped] questions from today’s show  here: [00:52] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [05:18] Listener question: “Is the price of Covid vaccines going up next year?” [08:50] Why do government and insurers seem willing to pay for so many complex services and facilities to treat people once they have a heart attack, stroke or cancer, but reticent to make the investments needed to reduce the incidence of these frequently avoidable problems? [09:44] There’s still a lot of debate about myocarditis after vaccination. Any new research? [11:00] What is a “triple-demic” and should we be worried about it? [13:18] If everyone wore masks and washed their hands this winter, we could avoid millions of infections and thousands of deaths. So, why are Americans less likely than others to do? [14:38] Listener question: I was recently vaccinated with the old booster and I was wondering about the new bivalent one. Is there data that says I should take it? [16:30] What’s the latest on Long COVID (since it was featured in last month’s episode)? [17:47] What are the risks of Covid-19 relative to kids now? [18:59] What’s new in healthcare beyond Covid-19? [21:52] How much risk should patients/consumers be willing to accept vs. their social obligation to keep others safe? [23:13] Are parents of children with diabetes still cutting corners with insulin due to high prices? [26:05] How does racial bias play a role in the care doctors provide patients? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #67: Should Americans be worried about a ‘triple-demic’? appeared first on Fixing Healthcare.

This Fixing Healthcare podcast series, “Diving Deep,” probes into some of healthcare’s most complex topics and deep-seated problems. On today’s episode, hosts Dr. Robert Pearl and Jeremy Corr discuss the “Anatomy of Healthcare Leadership,” a new way of looking at the skills and qualities needed to transform American medicine. According to Dr. Pearl, leaders must apply logic and creativity (a function of the brain), they must show passion and express empathy (via the heart) and they must also demonstrate courage and resilience (using the proverbial strong spine). Later in the show, Corr gets Pearl to describe his leadership journey and the nationally recognized success he experienced for nearly two decades as CEO at Kaiser Permanente. For more information on healthcare leadership, check out Dr. Pearl’s latest columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a discussion guide: THE ANATOMY OF HEALTHCARE LEADERSHIP How can strong leadership defeat the “middleman mentality” in healthcare? What proof is there that U.S. healthcare lacks effective leadership? What kinds of healthcare problems will be hardest for leaders to address? Can healthcare leaders really change how healthcare is paid? What are the benefits of “capitation”? If capitation is the solution, why is it so rare in healthcare today? How does the middleman mentality slow healthcare’s financial reform? Why would anyone who’s profiting from healthcare’s dysfunction want to drive change? Where should aspiring healthcare leaders begin? Why has the trio of cost, quality and access been so hard to achieve? How can aspiring winning over the people who deliver care? What is the “Anatomy of Healthcare Leadership” and how can it change medicine for good? How can leaders apply logic and creativity (their brains) to the challenge? How can leaders apply passion and empathy (their heart) to the challenge? How can leaders demonstrate courage and persistence (the spine) to the challenge? PEARL’S LEADERSHIP JOURNEY What was the arc of Pearl’s journey from plastic surgeon to CEO? How were healthcare problems similar/different early in Pearl’s career compared to today? How did Pearl become the CEO at Kaiser Permanente in 1998? What were his goals for the organization at the time?  What are the three biggest leadership lessons he learned as CEO? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #71: Diving deep into healthcare leadership appeared first on Fixing Healthcare.

Dr. Devi Shetty returns to the Fixing Healthcare podcast this week—making his first appearance on the show since 2019. At that time, listeners wrote in and posted messages on social media, expressing astonishment at Dr. Shetty’s accomplishments and outlook on healthcare. Shetty is a heart surgeon, trained in both London and the United States. Today, he owns and operates 11 hospitals in India and a new facility in the Cayman Islands. The cost of care in his health centers is as low as you’ll find anywhere in the world. Yet the quality of care is a good as you’ll find anywhere in the world. This success was made possible only by breaking the traditional rules of healthcare. In this interview, hosts Jeremy Corr and Dr. Robert Pearl ask Dr. Shetty about the rules of American medicine that must be broken in order to replicate the success he (and his hospitals) have achieved. Interview Highlights On breaking the rule of expensive healthcare “If a solution is not affordable, it is not a solution … But sadly, after spending $10 trillion (on global medical care), less than 20% of the world’s population has access to safe, accessible, secondary and tertiary level healthcare … So we have to break the rule and we have to do everything possible to make healthcare accessible, affordable, and safer for the patient.” On putting a price on human life “A typical doctor like me, I see about 50, 100, 130 patients every day in my clinic, apart from one or two surgeries. And good number of my patients are the little children sitting on their mother’s lap. I examine the kid, I look at the mother and tell her ‘Look, your child has a hole in the heart. She requires open heart surgery.’ She has only one question. The question is not about the scar, about the recovery or how to take care of the kid later on in life, nothing. Only one question, ‘How much it is going to cost?’ And if I tell her that it is going to cost, say, 100,000 rupees, which she doesn’t have, that is a price tag on the child’s life. If she has 100,000 rupees, she can save the child. This is what I do from morning till evening, putting price tag on human life. This is what every doctor in all the developing countries do from morning till evening, putting price tag on human life. This is not acceptable, Robbie. If society has given legally, officially the right to put a price tag on human life to people like us, we have failed as a society. This can’t go on.” On caring for Mother Teresa “I was privileged to be living in Kolkata at that time, and Mother happened to have a cardiac ailment. I was a senior doctor (of heart surgery) in the city, so it’s just a coincidence or God’s blessings that I had the privilege of being close to Mother when she needed the doctor’s help. And I’m grateful to God for the opportunity.” On insuring India’s poorest farmers (for the price of a pack of cigarettes) “There was a drought in the state of Karnataka, where I live. So, farmers lost their capacity to pay for the healthcare. At that time, we approached our government …  we told the government that if the (state) cooperative society members pay 11 cents per month, that’s approximately the price of one packet of cigarette or Beedi … that money he pays for his health insurance. And initially we had about 4.5 million people paying 11 cents per month. The insurance pays for the surgeries, starting from a routine surgeries like gallbladder, hernia, cesarean section to heart operation, brain operation, everything is cover … Over 1.5 million farmers had varieties of surgeries and about 130,000 farmers had a heart operation. All this was done with 11 cents per month. Poor people in isolation are very weak, but together they’re very strong.” On disrupting the cost of healthcare We are living in an amazing country, which supports innovation and supports a new way of doing things. I have no doubt that within the next five to 10 years, India will become the first country in the world to dissociate healthcare from affluence. India will prove to the world that the wealth of the nation has nothing to do with the quality of healthcare its citizens can enjoy. I have no doubt about it.” On inspiring the next generation of healthcare rulebreakers “I’m convinced that when you strive to work for a purpose, which is not about profiting yourself or your own personal interest, if the purpose of our action is to help the society, mankind on a large scale, cosmic forces ensure that all the required components come in place and your dream becomes a reality. I have no doubt about it. I have noticed this so many times, whatever we could do in India, if you really sit back and analyze it scientifically, lot of things couldn’t have been done, but it happens mainly because of the impact which is going to touch millions of people.” READ: Full transcript with Devi Shetty * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #70: India-based doctor breaks rule that great healthcare must be expensive appeared first on Fixing Healthcare.

In world where it’s almost impossible to tell if someone is lying or delusional, where is line between an unintentional error in perception and intentional misrepresentation? This question is proving to have profound consequences in medical practice. In healthcare, where the difference between facts and opinion continue to blur, tribalism and factionalism are a growing concern. In this episode of Fixing Healthcare, cohosts Jeremy Corr and Dr. Robert Pearl join ZDoggMD to probe the many problems with medical misinformation in America. When both physicians and patients crave simple answers to complex problems, ultimately, is it our fears that drive our perception of what’s real? To find out, press play or peruse the transcript below. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. UNFILTERED TRANSCRIPT Jeremy Corr: Welcome to Unfiltered, our newest program in our weekly Fixing Healthcare podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. I’ll then pose a question for the two of them as the patient based on what I’ve heard. Robbie, why don’t you kick it off? Robert Pearl: Hey, Zubin, welcome to this month’s show. Zubin Damania: Ah, it’s always a pleasure to be back, brother. Robert Pearl: With Halloween coming up, do you have a custome in mind? Zubin Damania: I’m going to go as a burned out physician who just doesn’t know what to do. In other words, I’m just going to go as myself circa 2009. Robert Pearl: Excellent. Yeah, I was planning to be a crazy knife bearing surgeon. I think reality and fiction often overlap and intersect, and I think we both have the same thoughts right now. Zubin Damania: Both characters are truly terrifying. Robert Pearl: I don’t know about you, but I feel like there’s a dark cloud over the world now with economic uncertainties that exist, the war in Ukraine, the evermore problematic American political system. Would you care to cheer me up? Zubin Damania: Yeah, I’ll cheer you up this way. I agree that it feels that way for sure. And actually the only way I cheer myself up is by realizing everything that we think is absolute reality like that is just all a thought matrix we live in. So we do the best we can in that relative world. But in reality, right here, right now is just absolute stillness and peace and perfection. And so those two things exist simultaneously. And if you can tap into both and feel into both, then it’s much less depressing because you realize in the end everything’s going to be okay because it already is. Robert Pearl: I love your Buddhist tranquility, but I’m still concerned that as our nation divides wider and deeper, something I’ve thought about a lot is trying to figure out where the line is or how do we establish the line between unintentional errors in perception and intentional misrepresentation. I often find it difficult to ascertain where the people are saying what they truly believe, but it’s just wrong, versus when they’re lying. Any thoughts of how you discern the difference? Zubin Damania: So this degree of discernment has become increasingly difficult because there is an aspect of self-deception that humans are really good at. We’re increasingly good at it when we’re divided into these tribal groups and social media creates a virtual belonging for us, this meaning crisis is solved by belonging to a group. So in a way when what we may think is misinformation from the standpoint of one virtual group may be absolutely believed as true from the standpoint of another. And therefore, if you were to say, create a law that says we’re going to fight misinformation this way by these criteria, there’s always going to be groups that say that’s total crap, because from our standpoint, we’re actually telling the truth. And actually humans have evolved to self-deceive potentially to some extent because in order to fool others in a tribe, in order to get away with something, we’re so good, we’re such good lie detectors as humans, that discernment that you’re talking about, that in order to fool people, we have to believe what we’re saying. And so to some degree, that degree of self-deception then projects in a way that it’s very hard to discern, does that person actually believe what they’re saying? Even though objectively I can measure things and say this is not true. And I think that’s where we are. We’re in this sense making crisis. How do you even know what’s true anymore and who believes what? So I share your frustration with that. It is very hard, but I think you have to get at the meta crisis underlying it, which is this meaning crisis, the sense making crisis and the tribalization. Robert Pearl: A few years ago I did some research with a neurologist, George York, and we looked at the literature on perception. What we found was fascinating. In times of great fear or opportunities for pleasure or wealth, people’s brains shift what they see. You put individuals in headsets and you ask them to ascertain where the two images that have been rotated are identical, and 95% of the time they’ll get it right. But you put them in a group of three others who are in on the experiment and all three of the others consciously report a wrong answer to particular problems, and two thirds of the time the unknowing subject will give the incorrect answer. Now people might say, Oh, this is just going along with the crowd, but interviews of the subjects later confirmed that what they actually saw were the wrong images. And this to me is the question, the tribalism that you’ve spoken about many times and you’ve discussed on your podcasts and other shows. How do we understand this and what can we do to minimize it? At least from my perspective, I don’t think it’s a good thing to have tribalism in healthcare. Zubin Damania: Yeah. So I think what you’re pointing at is the fact that we don’t so much perceive reality as constructed. And that construction is a complex interplay between whatever’s input to our senses and whatever we’re constructing. In fact, our occipital lobe, according to Professor Donald Hoffman, is so big and such a huge user of energy in the brain that it would be overkill to actually just re-represent what the senses are telling us. But it’s just about right to construct a world. So since we are humans, we’re contextual creatures, we’re social creatures where as we talked about the last time, we’re right brain and left brain creatures both. And that right brain wants to see things in their context and it sees these other creatures that are in our group or in our tribe constructing things a certain way and it influences our construction. This is absolutely true. It’s probably the explanation for a large component of the placebo effect in medicine too. That therapeutic alliance, that sense of being heard is bigger than even if you can tell them, Hey, this is a placebo, but we find it works for a lot of people and we’re going to sit with you. And even that just saying that has a therapeutic effect. So I think that tribalism, first of all, it’s recognizing that this is actually how humans are. That objective reality is a very tricky thing. And so if we’re constructing reality from these inputs, then let’s try to understand the ought to, what ought a good healthcare system, good society, good set of ethics look like? And I think that’s where we might agree a lot more than we disagree. We’re always arguing over the is like, well what’s going on? What is this? What is that? No, but what would we like? And I think once we start to align around that tribalism, we might be able to build that corpus callosum between the tribes. Robert Pearl: So let’s dive a little deeper. Let’s look at doctors who recommend treatments that prove lucrative to themselves but have been shown to add little clinical value for patients. Do you think they promote them out of conscious greed or do you think they actually see them as valuable regardless of what the literature concludes? Zubin Damania: Ooh, another great example of us constructing our reality and our sense of morality and ethics from first principles. And the first principles in this case are, we want to do good, but we also need to survive. We have the Maslow’s hierarchy we have to provide and so on. We’ve done all this training and now they’re telling me that maybe the colonoscopy that I trained to do for all these years, that’s the bread and butter of the generation of cash for my specialty in gastroenterology. Now there’s a study saying, well maybe it’s not as good as we thought as a population wide screening tool. Probably works on some individual level, but as a population, okay, what are you going to do? You are going to immediately, unconsciously, and to some degree consciously react and say, yeah, wait a minute now, you did the study wrong, there’s things you didn’t look at, you haven’t seen the patients I’ve seen. When a patient comes and says, You saved my life by detecting that precancerous polyp, you haven’t had that experience and you’re just a egghead and a data analyst and you’re missing the big picture. I think that’s all absolutely believed by the person. I think deep down there is a doubt that what if this is true and I must defend against that and so on because there is an existential risk to the income. And Upton Sinclair said it’s very difficult to have a man believe something when his livelihood depends on him not believing it. And that’s just how humans are. We’re constructing this reality. So how do we address that? Well that’s a difficult thing because a straight on attack throwing data at people is not going to change what’s happening. You need to shift in the overall sort of paradigm. And that’s very difficult to do. Robert Pearl: Does this phenomenon you’re talking about, explain the 180 degree contrasting views of people about vaccines. Zubin Damania: A thousand percent. So those vaccine views are based, I think increasingly on our morality and our moral taste buds. The six moral taste buds that Jonathan Haidt talks about, care versus harm, liberty versus oppression, sanctity versus degradation, fairness versus cheating, authority versus subversion, loyalty versus betrayal. Those are the six. How you feel those taste buds will determine how you look at vaccines. And one of those is loyalty versus betrayal. Let’s say you are conservative and you have loyalty to group and then the group is saying, we don’t trust these vaccines because it just so panned out that Trump wasn’t a big proponent of the vaccine. Well now that tribal loyalty has to conflict with the care versus harm, but they’ll feel care versus harm as, oh we’re actually harming young people by giving them myocarditis with these unnecessary vaccines. So, that’s how they’ll spin it. Now on the left they’ll say, Hey, care versus harm, I don’t want to kill grandma, I don’t want people to die. So we want vaccines. And their loyalty versus betrayal is, well, I’m loyal to these ideas of “the science,” which is increasingly a politicized feeling. So they will fight tooth and nail for a vaccine, even if in say a 13 year old boy there’s a risk of myocarditis, they’ll very much downplay that as, Oh, the risk of COVID myocarditis is worse. But really there isn’t great data to say one way or the other. So they won’t accept the uncertainty there. And I think that’s entirely moral matrix driven. They’re all trying to be good. And once you see that the tendency to be judgemental towards in group and out groups tends to soften a bit. And then you can just determine, okay, so how can we do the most good here? How can we build some bridges? And I think it’s existential a risk to us that we have to do that now, we have to start looking from that morality standpoint. Robert Pearl: I don’t know, it sounds like it’s a pretty big gap to close between people who see a intervention as being so life saving and people who see it as so problematic. I just rarely have seen a gap as big as this one. Zubin Damania: It’s really heartbreaking because previously, and actually this is spilling over into childhood vaccines. So now we’re seeing this hesitancy towards childhood vaccines, which was there at a small level before and now it’s increasing because again, the tribalization, the politicization and you can blame all kinds of people and you could probably blame some people more than others for this, but it is an increasing factor. And I think things like social media, the Zuckerverse and all this other stuff have really fed into this because their monetization models benefit from division, they benefit from the outrage and the headline clickbait stuff, but unfortunately, so okay, Robbie, I’m feeling into how you’re even phrasing these questions. You are very discouraged right now. That’s clear. You’ve said it explicitly, but you can also feel it in your tone of voice and I think many people are, I think many people who are smart people who’ve worked in healthcare feel as you do. I see them when I go talk and things like that. And all I can say is I happen to tend on the optimistic side because the only way out is through. And I think if we fail to destroy ourselves, I think we will increasingly wake up to what’s actually happening. It just is going to be ugly for a while. So we have to keep talking about it. We have to keep pushing through making the implicit that we think we understand more explicit so people can go, Oh this what’s really happening. But it is hard. Robert Pearl: Yeah, it’s particularly hard I’ll say as a scientist, you see data, you see logic. If people have problems with the specific information, you repeat experiments. There are ways you could explore questions, but when at the end of that process you still have two seemingly unconnected, completely contradictory conclusions, then that becomes hard to put in a scientific model for which the healthcare world has tried to achieve for 5,000 years. Zubin Damania: Yeah. And this is where the fundamental of schism between our science-based consensus reality that we’ve, like you said, 5,000 years of growth of the scientific method, and the way humans actually instantiate these hive mind group thinks that are powered by their moral taste buds and loyalty. And part of it, Robbie, I think is the meaning crisis in a bigger sense. We used to have a common mythology. You and I have talked about the hero’s journey. That’s a common mythology across cultures, but we’ve lost some of the sense. And so now we find our meaning in tribe, in group, in belonging. And when that becomes paramount, then the consensus reality starts to fracture because then we’re creating our own consensus reality within the group instead of within the collective as science has done since the enlightenment and prior. So it can feel very frustrating to a science minded person and it definitely has felt frustrating to me. Robert Pearl: Multiple times a month I get a call from a CEO of an artificial intelligence company and the calls are almost all exactly the same. They tell me that first of all, they’re the best engineers that exist in healthcare. Then they tell me that they have an application that will save three hours a day per physician, but they can’t understand why no one is buying it. Now I tell them that they’re delusional, although I say it in much nicer languages. Zubin Damania: Good for you. Robert Pearl: I say the problem they should be having is managing the line out the door. But we just talked about ourselves as scientists. In practice, we’re just as liable to be misled as anyone else. How do we as physicians minimize that risk? Zubin Damania: Yeah, this is great because again, we feel in the scientific community that we’re immune to this stuff, but we’re as susceptible like you said. And I think part of it is how we’re even training ourselves, educating ourselves. Do we talk about these issues of group think and cognitive bias and errors in thinking and even the kind of cardinal signs of conspiracy thinking, or cardinal signs of misinformation. We don’t even train people on that because sometimes we can turn that back on ourselves. Some of them are things like cherry picking data. Well, we in science do that well if we have an emotional investment in something. I gave the example of say colonoscopy. If you’re emotionally invested in something, you’ll cherry pick the data to support what you believe. So the fake experts, pulling up an expert that really doesn’t have a lot of business talking about this, but they have some credentials. The moving goal posts. No matter what information you present someone, they’ll say, well, but then what about this? And they’ll move the goal post further. The conspiracy thinking, the logical fallacies. If we trained ourselves on that stuff or had it as part of our curriculum, even in elementary school, junior high, high school, boy, we’d have the tools and the agency we then restore our agency, because right now it’s almost like we’re zombies walking towards the abyss. We don’t even know it. In science, outside of science, once we actually can see clearly the trajectory, I think there’s much more chance that we’re going to be motivated to do different. Robert Pearl: So let’s dive even a level deeper. You live in the Bay Area and I’m sure you’re well aware of Elizabeth Holmes and the Theranos debacle. Zubin Damania: Yeah. Robert Pearl: We had Tyler Schultz on our Fixing Healthcare podcasts a couple years ago. And of course there were numerous TV shows and books about what happened. As you know, the attorneys are battling over possible retrial. But I’m fascinated by the question, how much of the deception did she know versus how much was a subconscious shift in her brain that made her see reality different than it was? Of course no one including herself probably knows the answer. So your opinion is as valid as anyone else’s. What are your thoughts? Zubin Damania: I love my opinion being as valid as anyone else’s. That’s really empowering, also completely terrifying. Yeah. So with her it’s fascinating. There clearly had to… Again, again, and let’s just pretend that I know what I’m talking about because again, you can’t get in someone’s mind. This is a fallacy in itself, the mind reading policy. But I’ll say this, just looking at this in human nature, self-deception is powerful. She had every motivation to self-deceive and every motivation to then, by self-deceiving, actually be able to easily deceive others because she believes what she’s saying. And she’s got to convince George Schultz, she’s got to convince pretty smart people who’ve been around the block and she managed to do it and it got to be that she believed it herself. And yet you can actually have this cognitive dissonance where you believe that stuff and you’re still trying to cover things up and yo know there’s stuff going on and that’s totally squirrelly and all that can coexist. And I think with her, it’s a great example and I think there are a lot of people in the startup space and the tech space who are going through that. In a way they know, oh this business model’s never going to work. It’s a pipe dream, but if we just keep believing it, we’ll create a Steve Jobs reality distortion field and people will just go along for the ride and at some point things will work out. And that false optimism it’s actually a very left brain. The left brain is very optimistic because it just thinks it’s right and it can self deceive all day long. And then the right hemisphere goes, wait a minute, but it’s quiet. So I suspect there was something like that going on. Robert Pearl: Yeah, people’s desire to see the world differently than if they could be impartial. It’s just so prevalent. What about Anna Sorokin, the probably fake heiress made famous on the Netflix show, Inventing Anna. Here’s someone who’s spending money, throwing a hundred dollar bills around, convincing the world that she is incredibly rich when she’s basically on the verge of bankruptcy. Look at how many people, I don’t know if you watched the show, but how many people she was able to deceive. She’s in prison right now, but I don’t even know if she knows whether she’s a real heiress or a fake. Zubin Damania: It’s a great story. And again, it speaks to we create reality in our minds, in her mind, whatever she believes. And that reality distortion actually feeds out to other people, because we’re social. So it doesn’t surprise me at all. In fact, there have been con people throughout history that have pulled this off and continue to pull it off. Say what you will about, say a cryptocurrency, take two stances on, it’s a real thing, it’s deflationary, all these great things about cryptocurrency. And then, but you could also say, well this is a group think led by a few really loud people on social media that has taken people as the Dutch tulip bulb craze did. And if that’s true, then that’s a same self-deception. These people actually believe this. I know a lot of them and maybe they’re right, but if they’re not right, this is a huge self-deception and on a social level. Robert Pearl: We should probably spend an entire show on cryptocurrency. Zubin Damania: I know. We’ll get canceled for sure man. These guys are vicious, they’ll kill us. Robert Pearl: Because it’s a lot more than just the scarcity and fear of missing out on the soaring of the dollars as it was in the Netherlands during the tulip bulb inflation rate of the time. But the crypto has its own notion that somehow there’s this evil force out there that is manipulating the media, that is controlling our lives and that we the populous need to take it out. And we’re going to do that by using the blockchain technology that underlies cryptocurrency so that every voice becomes equal and equally important. So it has this aura of media three or whatever you want to label it to be, that drives not just the economic analysis of the various currencies, but the value, the mission, the purpose, the higher meaning for these dollar bills. Zubin Damania: Yes, yes. And what’s interesting, so there’s a moral crusade involved, there’s a deep set of beliefs, there’s a sense of belonging. You see it with the crypto bros on Twitter and all these guys that are, and mostly guys actually that are doing this thing. And I tell you, I know a lot of them, they are truly passionate about the woes of our current economic system. And what’s interesting is money is such a human construction anyways, it’s like when the dollar’s not backed by gold, what is it backed by? Well, the faith of the US government. So what is cryptocurrency backed by? Well the faith of the masses that believe it’s worth something. So it’s fascinating and I have to say this, and I’ll say this to immunize myself against, attacked by the crypto bros. I have no idea what the answer is. I’m not an economist. It’s just a fascinating unfolding and a social group think unfolding too on all sides of it. Robert Pearl: I don’t know if you’ve ever heard of a teacher named Ron Jones. He taught-. Zubin Damania: I haven’t. Robert Pearl: Oh, he taught at Cooley High School in Palo Alto in the 1960s. And he was a history teacher and his focus at the time was on fascism and Nazi Germany. And to teach the ethics, the values, the things that happened at the time, he started his class a movement that he called the Third Wave. On day one of the module he insisted that students stand when they spoke with him and always begin with Mr. Jones to demonstrate strength through discipline. On day two he said they had to salute with a cuffed hand to the opposite shoulder to show strength through community. On day three told the class that they were special and that certain others who didn’t belong were trying to pretend to be members, but they had to be stopped. And this was stray through action. By day four, the in group had gone from 30 students to 200 and harm was being inflicted on the out group. And, of course, they had to stop the project. In three days he had taken literally hundreds of students and gotten them to get behind a movement which had no value and was oppressing others. I think that’s the same phenomenon we’re seeing now in so many of these tribal areas that you’re describing. Zubin Damania: Yes. Again, and I believe all of it, it’s a social group think kind of thing that you can push through, especially if you have a charismatic leader and you don’t even need that honestly. Now with social media, the charisma is all virtual and you can do all kinds of things. Yeah, Robbie, that’s why just understanding even the nature of how we think and what our minds do and what even is consciousness is, I think a fundamental piece to avoiding falling into these traps. And even then you’ll fall into these traps. In fact, in these spiritual circles where you have these gurus, man, these things can devolve into cult-like craziness with all kinds of abuse and misbehavior among the teachers very, very quickly. Even in these groups that are purporting to be enlightened and awake and oh, we understand the nature of reality. Yeah. Okay, let’s see how that goes. Because again, we’re humans. Robert Pearl: There’s an expression that where the pie gets smaller, the table matters deteriorate. As the pressures are about to mount in healthcare, how do you see tribalism playing out? Zubin Damania: Healthcare is going to implode at the current rate of growth because it’s going to drag down everything. It’s a self-limiting process right now. It’s got no future in this current configuration. And when that becomes apparent, I think either the early adopters of the next phase of healthcare, whatever health 3.0 that I call it, I think will start to run with it and it’ll just go, or again, it’s going to be a bunch of Al Bundy’s sitting around the table with their hands down their pants burping, and the table manners will have degraded to that level because they’ll all be clawing for whatever’s left and it’s going to be really ugly. And I think we’ll see maybe some combination of that, I think. But again, as the eternal optimist, you’re already seeing these bright spots emerging. You’ve pointed them out, I’ve pointed them out. I think that’s just going to become essential and that’s just going to be the next phase. But yeah, who knows? Who knows? Robert Pearl: I have to say you’re not doing a great job of cheering me up today. In fact, I would say that I’m a bit more optimistic than you because I actually think there’s a range of technological solutions that actually could be the answer. But we’ll say that also for the next show. An idea that our view is right has killed hundreds of millions of people across history. One of my favorite anecdotes, and it’s a tragic historical story, comes from the 14th century. I don’t know how familiar you are with this history, but in 1349, the world was in the infamous black plague. And the leading experts from the government, science and academia of Western Europe came together to devise a plan to save the population. I realize by this time the black plague gets spread from the Eastern Mediterranean through most of Eastern Europe. It had killed hundreds of thousands of people over the previous three years. And those coming to the conference decided that they wanted to stop it from ravaging Western Europe. And they said that research had demonstrated that the plague was derived from fleas, which was correct. And then they made the assumption that since dogs carried fleas, by eliminating dogs, they could eliminate fleas and end the plague. So edicts were passed to each nation to kill all the dogs. But of course, as we know now, the fleas that carried the plague weren’t the ones in the back of dogs, but the ones carried by rats. And without dogs roaming the street, the rat population and the flea population soared. By three years later, nearly one in three people in the world had died of the plague. I wonder if 50 years from now people will look back at how we treat various diseases at the conclusions that we have reached in areas maybe such as maybe cancer or even heart attacks with similar disbelief about how ignorant we were. Zubin Damania: A thousand percent. They’re going to, there’s no doubt that they’re going to. They’re going to look at this and there’s a great scene in one of the Star Trek movies, I think it’s Star Trek four, where they go back in time to the 20th century and Bones, the doctor is seeing a patient who shows up in the hospital because they’re trying to rescue Checkov who’d fallen and had a head injury. And they’re trying to drill burr holes in Checkov’s head to relieve the pressure. And Checkov is like burr holes. You’re drilling big holes in his skull, man. Barbarians. And he’s applying this 23rd century or 25th century medicine to this and he’s just like, these people are barbarians. Woman comes up and says, I’m on dialysis doctor. And he gives her a pill and says, take one of these and call me in the morning. And the next scene she’s walking and fine and everything’s perfect. And I think that contrast of what the future paradigm of medical care is and what we’re doing now it’s huge chasm between it. And that’s why I think we really need to almost think completely differently. What we’re doing with this, oh, there’s a drug that finds a receptor and it does this or cancer is this. It’s like, no, no, no, no, it’s way more complex than that and we need a complexity science that fits that. And then where does the mind fit into that? Where does the placebo effect fit into that? Where does expectation, the fact that we create our reality fit into that? How do we merge those things? I think we’re going to look back and go, dude, this was primitive at best. Like, Gilligan’s Island primitive. Robert Pearl: My sense, Zubin, is that in medicine, both physicians and patients crave simple answers to complex problems, that it’s our fear that drives and alters our perception, that all of us are at risk of embracing approaches that can seem reasonable, but ultimately prove worthless. How can people as patients, as doctors, as caregivers, as nurses, minimize the probability of falling into that trap? Zubin Damania: I think we have to start change shifting a culture and the way we talk about things can’t be, take a pill and call me in the morning. It can’t be just steal heels and just cut this out and you’ll be better. It’s got to be realistic. It’s got to be relationship based. If you’re going to help a patient on their own hero’s journey, as their mentor, as their helper, you have to actually help them create that reality. And some of it is mind created, which means setting expectations, your bedside manner, your connection with them, your relationship, how you treat your peers and your colleagues actually, they pick up on that and your colleagues pick up on that, which changes how they treat the patients and the general level of stress and connectivity and connectedness. So all of that I think has to happen. And actually I think in many ways nurses can lead that because they’re right there with the patient in that relationship. Sometimes we can be a little detached. Robert Pearl: I love it. And when you start leading the parade, I’ll be marching right behind you. Jeremy, your question for us. Jeremy Corr: So we’re hearing that the COVID vaccine is likely going to be added to the vaccine schedule for children, which would make it a requirement for them to get to attend public schools. We’re also hearing the CDC is pushing ahead on getting the Omicron boosters approved in children as young as five, while not allowing the clinical trial data to be public. Many respected experts such as Marty Makary and Vanay Prasad have been very critical about how all of this is being handled. One of the most respected vaccine scientists in the world in Dr. Paul Offit is even raising red flags about the lack of transparency and how government agencies and big pharma are cutting corners to get this approved. What are both of your thoughts on what is happening, what is the long term harm of what is happening in terms of vaccine hesitancy for the tried and true vaccines that are already part of a child’s vaccine schedule and people’s faith in the CDC, FDA, NIH overall and increase the levels of tribalism in the country? And also, to sum it up, if you were to be asked to be the next head of the CDC, FDA, NIH, et cetera, what would you do to restore public faith in the organization? Zubin Damania: I love these easy questions. These are softball. Okay, so I’ll take a stab at this one. And I’ve had Paul on my show, I’ve had Marty on my show, I’ve had Vanay on my show, I’ve had people who are more aligned to give mandates for childhood vaccines. This is my take on this, a vaccine mandate implies a couple of necessities. One is that the thing that you’re mandating, because you’re trading off again these moral values. One is liberty versus oppression. So you’re saying, okay, I’m going to take away this liberty to decide whether or not to take this vaccine because the greater good of care versus harm and fairness versus cheating is important. So by vaccinating a five year old against coronavirus in school, we’re somehow going to prevent other children from getting sick or teachers from getting sick. There’s going to be a community benefit. And so the argument for the community benefit is not that it prevents transmission because it barely does if at all, maybe initially, but then it wears off. That’s just the nature of a respiratory virus like Coronavirus. The argument would be, well, we prevent schools from having absenteeism, you prevent other issues like the rare death or disability healthy child from COVID. But the question then is, well, do you mandate that? And when the majority, actually the vast majority of children have had exposure now to coronavirus or vaccine, mostly coronavirus, is it necessary to do that? And what’s the cost of doing that? So the psychological reactance against the loss of autonomy for parents is real because of our tribalized split society. So the actualization of this mandate may be that you create more vaccine hesitancy for other childhood vaccines, which are absolutely essential for the collective good, where you need a certain level of vaccination to prevent transmission like measles and mumps, et cetera. So that’s my take is I think mandating this for children right now is not going to accomplish an improvement in overall public health, but may have the opposite effect even though the intention is good. Jeremy Corr: And then to ask you to sum up the other parts, what are your thoughts on the whole lack of transparency with the clinical trial data and even like Paul Offit raising the flags about them wanting to approve that? Zubin Damania: I think that to a degree everything’s been politicized. So yes, it’s in the best interest of whoever’s in power right now to actually have lower case numbers and so on and have people vaccinated and they believe in that. And I think that’s fine. I think the lack of, it’s very easy to tell Pfizer and Moderna, Hey, you have the money, you have a lot of government money. Do a good human trial on these, because this is not flu vaccination, this is a different virus, it’s a different scenario, flu vaccination, and Paul Offit makes a good distinction between the two. You can’t just then say, Okay, this is going to… And because the main question is hospitalizations, severe disease and death. And we don’t have good evidence with a BA.4-5 vaccine in humans, that those issues are actually improved. You may reduce infection for a transient period of time, but then is that worth a mandate, especially for children? So it is concerning I think, in my mind. But again, it’s also concerning that there are people saying, Oh, this thing is causing cancers and it’s causing infertility. It’s not. So it’s just empowering, I think people to be even more divided about this. Robert Pearl: My sense, Jeremy, is that if we had all the data, we would find that the vaccine is safe and it does help reduce the rare 220 children have died under age five from COVID in a couple of years. So it’s not that it’s going to be negative or somehow data’s going to be hidden, that’s going to say that there actually is tremendous risk. But I’m a big believer, and if I led any of these agencies, that’s what I would do in telling the truth. And I think that what people are reacting to and intrinsic in your question is that a mandate doesn’t make sense in this particular circumstance, or if it does, I can’t fully explain it. And what I mean by that is the following. A polio mandate makes sense. Why is that? Because polio is a horrible, terrible, lethal disease that is easily spread amongst children. And a vaccine, from my viewpoint, not the old oral ones, but the current variety is safe and the problems are so much less than the consequences for children who get sick. Similarly, measles is one of the most contagious diseases, and there are well defined significant problems that children have who develop the disease, including one of my great grandparents, not grandparents, but children of my grandparents who died actually from measles as a young child. So those diseases have a logic. What’s missing in this situation is the logic of mandating it in young children, their risk is very small and you could mandate a lot of things that would have a more beneficial effect than this particular vaccine. Is it possible that the vaccine mandate would improve the health of the nation? It’s possible, worth debating, but that type of question is different than a mandate of the child who’s going to get the vaccine because we mandate vaccines for the individual, not for the bigger society. Now, experts can disagree upon how effective those vaccines are, whether that mandate for the individual is appropriate given the risks of the vaccine. In this case, risks are very low, but the benefits are equally low. And I think sitting in people’s minds and the critics you’ve described is this idea of why is it being mandated? What is the truth? Is it really being mandated for the people receiving the shots, or is it being mandated for other reasons? And that’s where I have the problem, because I’m not aware of vaccines that we mandate outside of a healthcare setting that is designed to protect other individuals surrounding them. And that’s why I think the skepticism and the lack of confidence in these agencies exists. And every time you cut a corner, you create a problem in medicine and that leads to more negative than positive, more harm than benefit. Jeremy Corr: We hope you enjoyed this podcast and will tell your friends and colleagues about it. Please follow Fixing Healthcare on Spotify, Apple Podcasts, your favorite podcast platform. If you like the show, please rate it five stars and leave a review. If you want more information on healthcare topics, you can go to our website, robertpearlmd.com and visit our website at fixinghealthcarepodcast.com. Follow us on LinkedIn, Facebook, and Twitter at Fixing HC podcast. Thank you for listening to Fixing Healthcare’s newest series Unfiltered with Dr. Robert Pearl, Jeremy Corr, and Dr. Zubin Damania. Thank you very much and have a great day. The post FHC #69: An unfiltered (uncensored) look at ‘medical misinformation’ appeared first on Fixing Healthcare.

In this episode of Coronavirus: The Truth, Jeremy Corr and Dr. Robert Pearl discuss new research out of Scotland that finds as many as 40% of people experience lingering Covid-19 symptoms months after infection. Is this data reliable and, if so, what does it mean for the long-term treatment of this disease? You’ll find that and all the other [time stamped] topics discussed during this show here: [00:49] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [03:23] Are employer and government vaccine mandates gone for good? [04:48] Are other nations dropping Covid-19 restrictions, too? [06:43] Are U.S. healthcare providers still under “one-size-fits-all” restrictions? [08:58] Do Americans respect/heed CDC guidance? [09:41] Is Paxlovid worth taking for people with Covid-19? [11:54] What’s the latest on “Long Covid”? [15:04] Does Covid-19 infection alter the timing of women’s periods? [17:28] What’s the latest research on Covid-19 and kids? [20:48] Beyond Covid: Are people more optimistic and fulfilled? [22:00] Is polio making a worldwide comeback? [24:56] What is the primary care shortage doing to America’s health? [27:39] How bad is the medical debt problem in the United States? [30:14] What does the Amazon acquisition of One Medical mean for medicine? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #66: What’s the latest on long Covid?   appeared first on Fixing Healthcare.

This Fixing Healthcare podcast series, “Diving Deep,” probes into some of healthcare’s most complex topics and deep-seated problems. On today’s episode, hosts Dr. Robert Pearl and Jeremy Corr explore how the middleman mentality is killing American medicine, and then contrast it with how some of the nation’s largest retail companies (including CVS, Walmart and Amazon) are planning to expel the middlemen of medicine with an effective long-term strategy. Whether you provide medical care or receive it, you’ll learn much from this deep dive into the future of healthcare. For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a discussion guide: THE MANY MIDDLEMEN OF MEDICINE What is a middleman? What did healthcare look like before middlemen? When and why did middlemen enter the picture? What is the ‘middleman mentality’? What are examples of it in healthcare today? Are middlemen medicine’s biggest problem? How does the middleman mindset harm patients and doctors? Why do middlemen love “fee for service” payments? How have insurers and insurance purchasers (employers) responded? What might effective leadership look like in healthcare? Where does change begin? AMAZON, CVS, WALMART: PLAYING THE LONG GAME Retailers are making major news in healthcare. Why? What are biggest, boldest healthcare acquisitions in recent months? Based on the past few years, are giant retailers doomed to fail in medicine? What reason is there to believe Amazon, CVS or Walmart can succeed? What is the short-term strategy for these retailers in healthcare? CVS and Amazon paid billions for primary care companies that are losing money. Why? What’s the middle game for these retailers? Why are they all interested moving from fee-for-service to capitation? How do their latest acquisitions and partnerships tie into Medicare Advantage? What does the long game look like and how long will it take to plat out? How will the winner be determined? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #68: Diving deep into the medicine’s middlemen & the future giants of healthcare appeared first on Fixing Healthcare.