Sensible Medicine

I recently recorded a conversation with Michael Easter from the TWO/PERCENT, a Substack and podcast. Michael offers “practical, accurate, and useful health, performance, and mindset information,” and in a space where there is a lot of drive, I find him remarkably thoughtful.Our conversation is on the podcast feed. Below are my notes for our conversation with links to many of the things we discussed.Adam Cifu, MDSensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.I am skeptical of wellness celebrities and influencers. They annoy me because they tend to pick, choose and extrapolate data to fit their agenda. Because good medical advice is mostly personal and boring, many influencers cross over to data-free sensationalism to hold an audience.Michael Easter is a rare exception. On the TWO/PERCENT he somehow manages to be a sane, thoughtful – I might even say Sensible – health personality. I got to know Michael when he invited me to be on his podcast to talk about my article on the cult of the healthy lifestyle. Before talking to him, I dove into a bunch of Michael’s work and was impressed by its quality. I should have known that a person who would invite someone who had come out against the healthy lifestyle on his show dedicated to the healthy lifestyle was someone I’d like.My Questions:For people who don’t already follow you, tell me about the 2%. Where does that come from and how to you extrapolate its meaning?* Tell me a bit about yourself, how did you end up here?* In my intro, I mentioned that I think you are a rational “health influencer.” How have you managed this?* Is it a challenge to keep things fresh while telling people to stay active, eat less, and don’t do stupid things?* How do you see the balance of educating and inspiring?I wanted to talk to you about a couple of recent posts that I thought epitomized your approach.The benefits of silence was a post about introducing silence into your life. This is something that really doesn’t need data, but you went deep into the data, and then acknowledged how aware you are of the possible confounding. (People’s whose houses are on loud streets die earlier. That might be the noise but they are also poorer and are exposed to more particulate air pollution…).* What got you interested in that topic?The downsides of blood tests and full-body MRIsThis was a discussion with Dr. Bobby Dubois about the potential benefits and harms of screening tests. I’ve written a ton about this, but I was so impressed with the clarity of the conversation and, although you guys came out pretty negative on the topic, you were honest about the potential benefits and the reasons people find these attractive.* You seem to have a lot of respect for the audience. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

The podcast delves into the emotional weight of making tough medical decisions as a patient. It highlights how these choices often outweigh the pressures faced by physicians. Case studies showcase the complexities involved, emphasizing the need for patients to navigate this challenging terrain with the support of their doctors. The interplay between patient autonomy and physician guidance takes center stage, revealing the bravery required in these high-stakes situations.

Dr. Margaret McCartney, a Glasgow-based general practitioner and PhD holder, passionately advocates for evidence-based medicine while challenging the efficacy of disease screening. In this discussion, she critiques the misconceptions surrounding early medical testing and reveals how conflicts of interest can skew healthcare recommendations. McCartney underscores the importance of rigorous evaluation in medical practices, calling for better regulation and transparency in the UK healthcare system. Plus, her love for cycling adds a fun twist to her serious insights!

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

I had the pleasure of being interviewed by Michael Easter. Michael is behind the TWO/PERCENT Substack where he offers “practical, accurate, and useful health, performance, and mindset information.” I’ve listened to, and read, a bunch of Michael’s content. Not only is it enjoyable but it seems, well, sensible. Our conversation was inspired by my Coming Out Against the Healthy Lifestyle post. I hope you enjoy our conversation and maybe find another substack to follow.Adam CifuSensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.Our conversation covers:* Why Adam wrote the post and the rise of the cult of the healthy lifestyle.* The benefits, realities, and limits of adopting healthy lifestyle changes.* How the belief that all health can be improved with better diet and exercise can lead patients to wrongly believe they are responsible for all of their health issues.* Why criticism of modern medicine is on the rise.* How “medical reversal” highlights the need for evidence-based practices.* The rise of longevity and why many longevity practices often lack robust evidence.* Why personalized healthcare is essential for effective treatment.* Problems with over-medicalization.* How finding the right doctor can be a challenging process. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Andrew Foy, a practicing cardiologist in Pennsylvania, dives into the implications of political events on healthcare and the principles of medical conservatism. He critiques the commercialization of health and addresses the complexities surrounding vaccine policies, urging a more evidence-based approach. The discussion touches on the societal factors contributing to chronic diseases like obesity, while advocating for improved drug safety systems. Foy also examines the financial conflicts within medicine and the need for transparency in public health decisions.

Discover the common pitfalls in systematic reviews and how to avoid them. Examine the critical evaluation of vaccine safety signals, especially regarding myocarditis in young men. Dive into the complexities surrounding COVID-19 research, including challenges in determining the infection fatality rate. Learn effective strategies for conducting systematic reviews, emphasizing the importance of a focused search strategy. Plus, gain insights on managing timelines to keep your research relevant and impactful.

Discover the intriguing connection between fish oil and atrial fibrillation through a listener's story. Explore how various health conditions elevate AFib risks and the critical role of penicillin for asplenic individuals. Delve into the complexities of hormone therapy for post-menopausal women amid healthcare ethics and physician biases. Learn about groundbreaking advancements in medical technology and the urgent need for transparency in clinical trials. Finally, unravel the controversial ties between hormone-based birth control and breast cancer, enriching the dialogue on treatment choices.

The woman with palpitations.The man with whom you used to joke and trade barbs who now sits silently, absent, while you talk to his wife.The woman whose depression dominates every visit; her depression being the one problem she refuses to address.The man whose joy and charisma makes every visit an absolute pleasure, despite his painful disability about which you can really do nothing.The man who never complains. Well, not never. The two times he did complain he ended up with emergent bypass surgery and a diagnosis of acute myeloid leukemia.The woman whose concerns are always uninterpretable. You wonder if the problem is your lack of cultural competence, that her language skills prevent her from articulating her problem, or maybe that her ineloquence keeps her from even knowing what she is experiencing.The woman who asks how you are doing because she recognizes that caring for her, with her dreadful prognosis, is hard.The man who, forever unsatisfied with his health, never accepts your advice, dismisses consultants, yet never misses a visit, praises you as the greatest doctor, and brags about you to his friends.The man whose world is spinning.The healthy 27 year old who is sure that her tension headaches are from a brain tumor.The man who berates the front desk staff, makes inappropriate remarks to the medical assistant, and has made racist comments to your nurse, but in the exam room – alone with you -- is the perfect gentleman.The man who laughs when you pull down his sock to examine his edema and a wad of cash and a dime bag of cocaine fall on the floor.The 75-year-old daughter who accompanies her 95-year-old mother to visits. You know that the older woman’s death will liberate and devastate the younger woman.The man who always exaggerates his symptoms because he is terrified by his own mortality and worries that he won’t be taken seriously.The woman who seemed impossible when you first met her but now brings you joy when the urgent care doctor calls and asks, “How have you taken care of this lady for 15 years?”The woman who doesn’t seem to like you and never seems to trust your opinion but, after 20 years, refers her daughter to you.The woman with six years of dyspnea and no diagnosis.The man you agree to see after he was “fired” by a colleague. His care, and your relationship with him, become an inspiring, and even rewarding challenge. He fires you after a year.The woman whose relapses, lies, and prescription forgeries angered and exhausted you for a decade now sits in a wheelchair, caregiver by her side, vacant.The woman who comes to see you for a new patient visit because her husband, your former patient, insisted that she start seeing you after he died.The man who hanged himself three weeks after he saw you. He had complained of fatigue.The man who apologizes because he sees it has been difficult for you to give him the news about his recent scan.The woman with painless jaundice.The patient who fires you, deservedly, because you made a rookie mistake.The man who brightens your day when you see him on the schedule but honestly, if you didn’t know him, you would probably move to the next train car if he got on.The patient you secretly hoped would change doctors and then, when she does, you feel bad that you failed her.The man who steps off the scale, places a thick wallet, two rings of keys, and a Glock on the exam table before getting back on the scale.The man who wrote a thank you note that he had his wife mail to you after his death.The man who fought you until the end, always wanting more treatment, even after every doctor told him we had nothing left to offer.The woman whose diagnosis you could never make, until you got a pretty good idea of it ten years after she died.The man who just has a cold. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe