The Broken State Of The Modern Healthcare System - Doctor Mike

1. 0:00 – 4:07

   Medical Conversations on Social Media

   1. CWChris Williamson0:00

      Dr. Mike, welcome to the show.

   2. DMDoctor Mike0:02

      Excited to be here. Let's, uh, chat evidence-based medicine, my favorite. (laughs)

   3. CWChris Williamson0:07

      (laughs) It's having a resurgence at the moment. What's it like being on that side of the fence?

   4. DMDoctor Mike0:11

      Well, you know, I feel like I was one of the early adopters doing this on social media, because when I was coming about during my residency training, it was mostly people doing it on television, and doing it quite poorly, might I add, in terms of confusing people or selling some miracle cures. So that's why I started social media medical conversations, and now it's just exploded into every different possible niche. Whatever you wanna find online, there's a confirmation bias waiting for you.

   5. CWChris Williamson0:41

      Well, that's the problem, this multiplicity and the democratization of access to health information sounds great in principle, but in practice, what it feels like to a muggle like me or everybody that's listening is just confusion and an abundance of conflicting messages.

   6. DMDoctor Mike1:00

      Yeah, I think it's, uh, encouraged all of us to develop healthier skepticism, which I feel like before the age of social media, we might have been lacking. But now with the rise of AI, people don't right away see a video and assume it's real. In fact, they're more likely to say, "Is this real? Where is this from? Can I see the original video? Can I see the sources and description of where the evidence is coming from?" That stuff gets me excited.

   7. CWChris Williamson1:29

      One of the problems with that is when skepticism runs too far, and when even-

   8. DMDoctor Mike1:34

      That's cynicism, my friend.

   9. CWChris Williamson1:35

      ... credentialed experts, "No, no, they're part of big..." Insert your favorite evil organization of choice. Big ag, big pharma, big-

   10. DMDoctor Mike1:45

       Sure.

   11. CWChris Williamson1:46

       ... food, big earbuds, big whatever.

   12. DMDoctor Mike1:50

       Yep. I think, uh, in that regard, there's negativity, if you wanna find it, everywhere. It's about understanding where that negativity lies and how it impacts people's messaging. So I think just broad stroking or broad brushing certain subjects in health care will always be an incorrect message. So you can't say anything is all good or all bad. You can't say humans are all good or all bad. In fact, that's the first thing we really teach when we institute cognitive behavioral therapy with patients that are struggling with anxiety and depression, because it's very easy to get into this cognitive distortion of labeling things as all good or all bad or, "This is a terrible catastrophe and it's gonna end everything for me. Just because I got this C in my class, it means I'm a failure," and labeling ourselves, when in reality, if we just have a little bit of a pause, go back and think a little bit rationally with less of our emotional mind, we can go a lot further. And that's not easier s- That's a lot easier said than done. That's why we need the help of, uh, some mental health specialists from time to time.

   13. CWChris Williamson2:55

       Are you trained in CBT?

   14. DMDoctor Mike2:57

       Not professionally or not officially, I would say, but I was trained by a family medicine institution that put a huge emphasis on mental health. We have a behavioral specialist in our faculty that consistently trained us, that brought in diff- different psychologists and psychiatrists to conferences, that would actually interview patients at these conferences to teach us how to be better in our interviewing techniques. They would watch our patient interactions, our encounters, and give us feedback on how to be better. Um, so because of that, I have a, a much greater interest and understanding of how, I guess, primary care CBT works. And for me, what that means is a general introduction to CBT, a general introduction of why anxiety happens, how we can fight back against it from an evidence-based perspective, and unfortunately, many of my colleagues don't go that far and have to rely on specialists, and these days with our American healthcare system, the disaster that it is, it's near impossible to find someone in a reasonable amount of time.

2. 4:07 – 8:21

   What’s the Best Treatment for Anxiety?

   1. DMDoctor Mike4:07

   2. CWChris Williamson4:07

      Give me the overview of what you've learned about anxiety, treating it through CBT, what the evidence says, what it doesn't say.

   3. DMDoctor Mike4:14

      Yeah, recently, we've seen the evidence show that the best quality treatments that exist for anxiety and depression, when we say anxiety and depression, we're really quoting from DSM-5, this is generalized anxiety disorder or major depressive disorder, uh, the highest level of evidence goes for a combination of mental health therapy, which means usually cognitive behavioral therapy or some other avenues, plus medications, which are usually SSRIs, but there is a whole range of medications that can work for individuals. Now, if you have, uh, a mild case of these conditions, which we use validated scoring systems and conversations with our patients to figure out, we don't have to institute both simultaneously. It really needs to be tailored to the specific patient you're working with. So there's some patients that their case is so mild that we can just institute bibliotherapy and talking with me as a primary care physician. Bibliotherapy being reading some information, uh, a book on the subject, doing some handouts from that book that is written by a psychologist on the topic. And then the next level of that would be working directly with a therapist, getting someone on board to see them week in and week out, and then medications as, uh, another option as well if their case is that significant.

   4. CWChris Williamson5:32

      What's the book that you prescribe?

   5. DMDoctor Mike5:37

      The most common book that I give to my patients is called Feeling Good by Dr. David Burns, who I'm actually scheduled to have a conversation with the next month, um, kind of on the forefront of the development of CBT and talking about how our cognitive distortions, which are natural emotional reasoning part of our brain that we're all susceptible to, can sometimes go too far and drive these symptoms of anxiety and depression in us, and how that therapy can actually help an individual. And what I like about cognitive behavioral therapy and why I've been on board, uh, f- on it, on the, on recommending it for such a long time is that not only is the evidence for it-... great that it works. But it's also really rational. It's very reasonable. A lot of people think when we say therapy, there's some kind of woo-woo involved in it. And I say "woo-woo" in quotes because it's not really woo-woo. It's just a very practical way of thinking, and it doesn't mean that therapy is not gonna make you feel. It's not gonna remove all anxiety or all depressive symptoms. It, the goal of it is to recapture some control so that when you do feel anxiety, it doesn't take you to that really dark place, that when you do feel depressed, you don't go to that dark place. And it's really a way of giving you back that layer of control.

   6. CWChris Williamson6:56

      Are there some CBT strategies or techniques that you find yourself relying on the most? I'm sure that there's times when a video goes up and the comments begin to light up and, "Oh, God. Here, here we go again." Uh, there has to be something that you rely on for yourself.

   7. DMDoctor Mike7:13

      Yeah. Uh, this is, I guess, less of a CBT principle but something that I force myself to do when I get into dark times is our brains are wired for negativity. There's great books on the subject called literally The Power of Bad or The Power of Negativity, and that's assumed to be the reason why we've survived so long, because we were constantly worried about the risks and threats around us. And now, we live in a safer place in comparison to 1,000 years ago, and therefore, those anxieties are still present, but a lot of times they're overblown. And when you have, uh, a mind that's not moving, meaning that you're not doing much, you're not surrounded by stimulus, you will experience more anxiety than the person who is busy doing something or that is facing a true threat. And what I have to remind myself quite often is the positive things that happen. I'm not great at celebrating my wins, and that's something I've been striving to change for (laughs) a long time. And it's not easy to change, but it's important to have some techniques ready if those symptoms or, um, I guess situations arise where you do feel down.

3. 8:21 – 14:26

   Is There an Uptick in ADHD Diagnosis?

   1. DMDoctor Mike8:21

   2. CWChris Williamson8:21

      It feels like there's a- an adult ADHD diagnosis happening every day on celebrity Instagram. Have you noticed an uptick among your patients, too, or is this just famous people?

   3. DMDoctor Mike8:34

      Um, I think that there is a- a pretty fair uptick in it, whether that's recognition of the condition and more people being aware of it, whether that's patients coming in requesting treatment specifically for said condition and doctor goes along with it without truly doing a diagnosis, whether that's a doctor giving someone ADHD medication in order to help them from a performance enhancement standpoint, which does happen. Um, hard to say what percentages those things fall under. But there's definitely been an increase in the diagnosis, at least, of ADHD, and the treatment for those who struggle with ADHD is amazing, because if you're truly struggling with hyperactivity, with attention deficit, you can't maintain good social relationships, you can't focus while you drive, you can't do well on tests, you can't get a good education. These are things that actually contribute to not just a shorter life, but a life that is less quality, meaning that you have true mental health issues that arise as a result of the undertreatment of ADHD. So the fact that we're treating people who are truly suffering with it is amazing, and we need more of that.

   4. CWChris Williamson9:50

      What does a person on the absolute extreme end of ADHD look like? I think most of the people I- I've... My business partner in my productivity drink, James, had an adult ADHD diagnosis. But, you know, it- it's m- I'm gonna guess that it'll be mild. It'll be enough to be classified, but I'm gonna guess it's mild. What does someone at the absolute extreme end of that look like?

   5. DMDoctor Mike10:16

      Someone who can't sit and concentrate for more than seconds at a time, constantly having to shift their attention because they're unable to control it. And really it's that lack of control that we'll probably come back to throughout this conversation, where people struggle with ADHD who have a severe case of it. And what's interesting about ADHD, it's not gonna be just noticeable to the person. It'll be noticeable to their coworkers. If they're a student, it'll be noticeable to their teachers. They'll get in trouble more. They'd be, uh, labeled as a troublemaker in their class. Their parents would know about it. So a lot of times when we're doing these investigations, especially in adolescents, we give papers that allow us to do a scoring system for the patient, but also for those around them to get a better view of how they're interacting with their outside world.

   6. CWChris Williamson11:05

      What's going on in the brain that causes that to happen?

   7. DMDoctor Mike11:10

      Overactivity. The exact specifics, we'd probably have to get a neuroscientist on board and, uh, give you those details. The difference between myself, uh, as what I like to call an expert of family medicine is that the advice that I give and my understanding of conditions is on a practical basis, how it impacts my patients, how we can help not just the individual patient in my room but also the population of all my patients, of all people who are undergoing treatments or preventions. So the specifics, I tend to not memorize exact molecules and names of chemicals unless they're specifically important to the treatment of my patient.

   8. CWChris Williamson11:49

      I've never heard family medicine before I came to America. What do you mean when you talk about the...

   9. DMDoctor Mike11:53

      It's your GP. It's your equivalent-

   10. CWChris Williamson11:55

       Right. Okay, okay.

   11. DMDoctor Mike11:56

       ... of your GP in the UK.

   12. CWChris Williamson11:56

       Okay, okay.

   13. DMDoctor Mike11:56

       The only difference is I believe that we also do obstetric care, and I'm not sure that in the UK that is something that is done-

   14. CWChris Williamson12:05

       What's that?

   15. DMDoctor Mike12:05

       ... under a GP's guidance. Obstetric care for-

   16. CWChris Williamson12:07

       What's that?

   17. DMDoctor Mike12:07

       ... uh, pregnancy.

   18. CWChris Williamson12:09

       Oh, okay.

   19. DMDoctor Mike12:09

       Gynecology as well.

   20. CWChris Williamson12:11

       I don't know if that's done by your GP. Yeah, maybe that is a specialist. Uh, there's-

   21. DMDoctor Mike12:16

       Yeah.

   22. CWChris Williamson12:16

       ... pregnant women screaming into their AirPods at the moment. Okay, just going back to the-

   23. DMDoctor Mike12:20

       (laughs)

   24. CWChris Williamson12:20

       ... uh, ADHD, have you got any idea what's driving this? Because...It seems there's always kind of a nod toward, "Well, you know, increase in smartphone use and, uh, you know, technology and TikTok and, and shortening attention spans," but I, I don't know whether overusing your smartphone can induce ADHD, that seems like a very specific diagnosis, or whether it creates symptoms that are similar. Uh, uh, have you thought about how you sort of split all of this apart?

   25. DMDoctor Mike12:49

       It's very difficult to tease apart. One of the major questions that I ask my patients that are concerned about the diagnosis is whether or not their symptoms are present during all aspects of their day. So if they have trouble concentrating while in class, but then when they're hanging out with friends or even hanging out at a library or hanging out with their parents, they don't have those symptoms, that signals to me that maybe this is something else going on, that they might not enjoy their time in the classroom, that they might be craving the dopamine rush that they get from their cellphones, especially in the way th- those things are programmed. There probably is something to be said about the epigenetics of it all. So epigenetics is how our interactions with our environment and how we treat our bodies, how it actually impacts our genes, and there's probably something to be said with an individual who is constantly bombarded with this stimulus from our phones of constantly giving that feedback, dopamine rush when you get a like, dopamine rush when you get a comment, and that constant flickering, it definitely has some effect on our neurophysiology. The consequences of it, I think, remain to be seen. I think we need to study more of it because we on the front lines don't have perfect answers to all these questions, and that's why I get frustrated a lot of times on health podcasts because I frequently see guests come on and talk about things that they claim to have all the answers to, and boy, I wish that was the case 'cause I could be helping a lot more patients if that were true.

   26. CWChris Williamson14:24

       Yeah, very interesting. What's

4. 14:26 – 20:14

   Current State of Prescribing SSRIs

   1. CWChris Williamson14:26

      the current state of prescription for SSRIs? Because I saw a study that came out, I think, last year talking about SSRIs, uh, kind of got thrown out of the window a little bit, that it seemed like the impact was only negligible, then that got pushed back against it. What's sort of the, the world of SSRIs at the moment?

   2. DMDoctor Mike14:48

      The world of SSRIs is that they're still very much prescribed, they're still very much first line indicated for major depressive disorder, in some cases, general- generalized anxiety disorder. Uh, I use them quite frequently. Do I use them on every patient? Absolutely not. Um, I think they've been villainized. There's stigma attached to them. There's also, um, misinformation about them constantly on the web. I mean, there's even a, a popular, I guess you could call him a health influencer, Gary Brecka, who I've made reaction videos to, where he talked about how these SSRIs work, and it just was, like, flat out wrong, like-

   3. CWChris Williamson15:30

      What did he say?

   4. DMDoctor Mike15:30

      ... scientifically about how they work. Um, hard to remember exactly the details, but it was about the mechanism of action of how SSRIs work, and the unique thing about SSRIs is it was a medication that we quite didn't understand the physiology of, of how they worked, and yet we saw the positive outcomes. Initially, back, back in the day when these medications were coming about, we thought that depression was a issue with low serotonin in the brain, so then we put out these medications, uh, in trial form where they would increase the amount of serotonin in the area where they work, and what we found is an improvement of symptoms over several weeks, and we assumed it was because of the increase in serotonin. Well, that's been disproven, and yet some people are still repeating that and talking about that. There's now new theories about the fact that when your body sees more serotonin as a result of the medicine, it downregulates its response to the serotonin, which are the receptors that serotonin binds to, and the body actually, over a period of weeks, decreases the amount of reactivity to serotonin, and it's been theorized that that's a possible mechanism by which these medicines work. But we have to be honest and transparent about our knowledge of what we know, what we don't know. When we claim to say, like, "This is how they work. We're 100% confident," we have to be really careful, and this is, I don't wanna single out Gary Brecka here. A lot of people do this. In fact, we as medical institutions, the broader we, did this throughout COVID, and it was a disaster for mask communication, where initially, I remember on my YouTube channel, we talked about how masking wasn't recommended because of reasons A, B, and C, that we were short on masks, we didn't think it would spread, uh, through the air, we thought it was droplet-only driven, and then as time went on, we learned more and we changed that guidance. Luckily, and I guess fortunately for our channel, we were very clear about that early on and said, "This may change," but there were some people in the major agencies, like the surgeon general at the time, who was making fun of people for wearing masks on planes, and boy, did that end up hurting the public message because then people took that information early on and then used it to discredit his message later, and that's problematic twofold. One, because I wish the messaging was different early on on his part, but on the bad actors front, they're acting as if science doesn't change, as if we don't learn new things every day and adapt our recommendations. In fact, if we didn't adapt our recommendations to new quality guidance, we'd be failing as scientists. So I think it's a twofold problem that we need to discuss on both ends, rather than just nitpicking or cherry-picking one person.

   5. CWChris Williamson18:25

      How difficult is practicing medicine in the wake of what happened through...... 2020. Government agencies and the CDC and all of these very famous, well-known medical professionals showering themselves in something that wasn't glory.

   6. DMDoctor Mike18:43

      It was, it's- it's, uh, it's never easy practicing medicine, period. Because medicine is science, but it's also an art. So you have to, at the same time, understand what's happening in a disease process, in the treatment process, but also understand how your patient is experiencing it, how they're understanding the words that you're giving to them, the options that you're giving to them, their financial situation of whether or not they can access those treatments. And that's hard at the outset, but then throw on top of it a trash healthcare system that favors profits and private equity over patients, uh, the mess that we had with COVID and the errors of mass communication, the rise of misinformation through algorithms and social media trends. Now our jobs have become exponentially harder, and I ultimately want my patients to have the best experience and to get the best treatment for them. But that starts with a good line of communication, and I feel like on our YouTube channel, that's what I've strived to do from day one, to make sure that anything that I'm saying comes from a sound financial backing, and then from there, if we make a mistake or if knowledge changes, we admit it openly and honestly so that people know that they're getting the real deal. And unfortunately, that's not always the case on social media, so that's why, uh, we're kind of out there debunking and doing what we do on our pro- uh, programs.

   7. CWChris Williamson20:13

      When

5. 20:14 – 34:16

   Issues With the US Healthcare System

   1. CWChris Williamson20:14

      you said that it's a trash healthcare system that prioritizes profits over patients, as someone who still... I've only been in the US for two years, many people might not understand how the US healthcare system works and goes wrong. Wh- what is there to know about that?

   2. DMDoctor Mike20:30

      We have a hybrid system, meaning that there are some people who get government-funded insurance if they're over a certain age. If they fall below a certain poverty level, uh, they get covered, and if they have certain disease states, they get covered. Then there's people who get insurance through their employer. Then there's people who buy individual plans and just get coverage for themselves. And this hybrid system is incredibly messy, and I- I don't yet know if there exists a country that is as big and diverse as the United States that has gotten healthcare right, because I hear complaints from Canada, I hear complaints from the UK, all the issues with NHS that's going on. So I don't yet know who has it all figured out, but definitely the direction that we're going towards is more problematic, and I'll explain why. You're a sharp individual. You're a business person. You understand how companies work. Their sole goal, especially if they're on the stock exchange, is to not just have a profit, but to grow said profit. And the way that this works these days, especially when starting a business, we frequently hear, "Oh, this person made an exit of 10 mil, 100 mil, one bil," and we all envy those individuals. Well, what we're not seeing is the back end of that problem where an exit means that they're exiting to a larger company that is buying that information, that data, that process of however they generate income, and then they're trying to streamline it as much as possible by maximizing profits and getting rid of waste. In some instances, amazing. I love getting my product shipped to me faster. I love being able to access certain things quicker. There are some avenues where this is great, like the on-demand car-sharing option is amazing. Then there's some instances, like healthcare, where it becomes a disaster, because for example, in the United States, we get outraged when we find out police officers have a quota of how many tickets they have to write. We go on the news and we say, "Oh, it's not right, they're just giving tickets just to give tickets because of quotas." No, no, no. The real problem is doctors have quotas of how many patients they have to see in order to get paid. What? What if I have... How many times have I had a patient that was scheduled for 15 minutes that comes in with a stomach ache and then I find out their loved one just died, that they got a recent diagnosis of brain cancer? I'm not walking out of that room in 15 minutes. You have to be a human as much as a doctor, and when you see how often those things happen in an exam room, you understand that putting a quota on healthcare is just flawed from the start. And the sad part is, private equity doesn't care. It's whoever's gonna drive those growth and profits, that's who they're gonna pick, and that's why the things that private equity has jumped into the most when it comes to healthcare are things that are scalable, telemedicine, urgent cares. There's one popping up on every corner, and young people think, "Oh, urgent care? It's awesome. I can go get treated quickly because it's quicker than seeing my primary care doctor where there's a wait." In some instances, true. In some instances, relying on urgent care as your form of primary care is not good long term.

   3. CWChris Williamson23:54

      Why?

   4. DMDoctor Mike23:55

      You're not establishing a relationship. You're not, uh, the doctor doesn't know you well to help give them, uh, the best advice w- for what works for your body, for your mind, the best way to explain, uh, treatment to you, uh, to calm your nerves when you're going through a stressful time. Long term continuity of care is better than just Band-Aid, Band-Aid, Band-Aid, Band-Aid. And unfortunately, the young people of our country, the millennials, the Gen Zers, are- have largely relied on urgent care to get their treatments, to get their primary care, and that's- that's no bueno, Chris. It's- it's led to a lot of disruption in our healthcare system, and I can't even blame them because...If you call a, a good primary care doctor and you ask to be seen same day, that's like, you get laughed at by a receptionist, and when you're sick, that hurts even more.

   5. CWChris Williamson24:45

      Mm. So I'm gonna guess that young people in particular, this has impacted, because medical insurance is expensive if you have to pay for it yourself. Maybe you don't have a job that is offering healthcare cover. Uh, but also, you're so young that you think you're made of rubber and magic, and, "I'm not gonna get sick in any case, and it happens so infrequently that it doesn't really matter." So I'm... it's kind of playing a reverse lottery, that, "I'm not going to bother putting the money in, and once every 500 days when something goes awry, off to urgent care I go."

   6. DMDoctor Mike25:17

      Yeah, and what's interesting about healthcare is we much prefer to do things on a proactive or elective basis rather than a respondive, uh, respondent emergent basis. So for example, if I have a patient that I can schedule for a hernia surgery ahead of time so I can do a surgical clearance for them, I can make sure that they're medically optimized to make their... make sure their blood pressure is under good control, their sugars are under g- good control, they're gonna have better outcomes during that surgery. As the opposite end of that example, waiting for that hernia to become incarcerated, where the, uh, intestines are literally being choked out and you have to go for emergent surgery, the risks exponentially go up. So we wanna plan for things as opposed to react to things happening, and there are certain things that we can do from a primary care standpoint to get ahead of issues and prevent them, to a degree, and institute those things for our patients. And I specifically say to a degree because there's a lot of even physicians and experts online who think that we can prevent every problem and that we should be doing more for prevention, but that's only thinking, uh, from one side of the problem as opposed to viewing it holistically.

   7. CWChris Williamson26:37

      It's interesting that you brought up the UK. I have a number of friends that were doctors that I was friends with as they went through med school, as they went through F1, F2, as they finally got their, finally got themselves signed off. And, uh, I mean, God, if the US, if the US is a mess, the UK is, is something else. They're still using Windows XP. That's the operating system of choice.

   8. DMDoctor Mike26:58

      I mean, we still have pagers. My residents still have pagers, like literally beepers.

   9. CWChris Williamson27:04

      Why? Just because they've been grandfathered in from the old system?

   10. DMDoctor Mike27:07

       Yes, and there was some talk about that maybe in the basement of the hospital, there's bad reception but the pagers work on a different thing so the signal will be better.

   11. CWChris Williamson27:16

       Oh, man. I don't know. It's, it's just this, it's this wonderful cocktail of cutting-edge medical assessments with ancient technology and trying to get these two things to fuse together. Some of the horror stories that I've heard, man, about, uh, a doctor needs to prescribe something or, or get something cleared for a particular patient, and one floor below them is where they need to go in order to get this done. But they go down to that floor below them physically, they go there and ask for it, and they say, "No, sorry, you need to fax us a piece of paper. I can't email it. I can't call you. I can't ask you while I'm here. I can't even fill it out physically on a piece of paper and hand it to you. It needs to be faxed through here so that we've got the record of the fax, and then the fax needs to be filed in a particular place but it needs to be signed off, and the guy that signs it off, he's not actually back in until the morning, so they're gonna have to wait." And you just think, uh... Here's another one, actually. So a good friend of mine, uh, has a, um, fitness business online, and he wrote programs many, many years ago that were just evergreen, and they're still selling away in the background but they were super cheap, PDFs for £12, something like that. I think that while he was doing F1, his first year out of med school, uh, in the UK, I think he was on about £11.50 an hour, so I think that was around about the, the wage that he was getting. So he's, one e-book was, was more than that. Um, a particular patient had been, uh, struggling, uh, passing solids for a while and needed to be, I think is it called decompacted?

   12. DMDoctor Mike28:53

       Mm-hmm. Disimpacted.

   13. CWChris Williamson28:53

       Yeah, so needed to... Disimpacted. Sorry, decompacted. Close enough. Um, disimpacted, which is, uh, put a gauntlet on, get in there, and, and, and pull, pull out what hasn't come out of the back passage of the patient. So sure enough, at 3:00 in the morning, Yusuf rang the specialist. He said, "Look, is this something that can... G- g- do you need to come in?" He says, "I'm not coming in for that. You can do it yourself." So on goes the gauntlet, couple of pairs of gloves. Yusuf spends the next 30 minutes. This woman's in discomfort. Her family are there. Th- th- there's an issue with damage. They want her to be right, she wants him, and he's just doing his thing. And after he, maybe 45 minutes later, peeled off all of the layers of gloves and checked his phone to see that he'd sold a e-book that he wrote nine years ago for 50 pence more money than he'd just earned from doing that one thing, and the attraction for working in that kind of an environment, it doesn't surprise me that the NHS is struggling with talent and that they're losing people and that nurses and doctors are going on strike. And then I don't also, like, completely understand why patients are thinking, "Hang on, uh, y- the, the people that look after our health are striking. That feels like they're playing roulette with our wellbeing." That doesn't seem fair either. And yeah, it's, it's not good. It's not good. I think you're right in saying that no one's got it right yet.

   14. DMDoctor Mike30:13

       It's between a rock and a hard place where healthcare providers find themselves in, because they wanna do the right thing by their patients. And I, I understand your example 'cause it's so clear, of the patient needing that disimpaction, and yet, uh, your buddy was earning more money by selling the book. That's not even the biggest concern for doctors or nurses. That is actually the part we have-... a problem with least. Like, it sounds to the average person, like, "Oh, disimpacting someone that's below us," or... It's not.

   15. CWChris Williamson30:46

       Mm.

   16. DMDoctor Mike30:46

       We wanna help patients.

   17. CWChris Williamson30:48

       Mm-hmm.

   18. DMDoctor Mike30:48

       Do you know what is the most destructive thing? When we actually wanna help the patient for £11 an hour and we can't, because we're forced to see so many patients so certain institutions make more money. Or, we wanna give the patient a medicine but it's not covered by their insurance so we can't help them. Or, after working a full day where we stay late in order to be able to disimpact and help all our patients and get paid not the greatest salary, we still have paperwork to do to prove that we did all of these things on ancient systems that require dozens of clicks to get even the simplest thing done. And that is disheartening way more than it is about not being properly reimbursed for disimpaction.

   19. CWChris Williamson31:34

       Mm. Mm-hmm. Yeah.

   20. DMDoctor Mike31:35

       Because that strikes at the soul of why we're doing what we do. Disimpacting a patient is what we signed up for. Sitting and writing charts for hours at a time after actually helping our patients, and then getting one administrator to make sure that the billing is done and that the billing, like all the fax stuff that you talked about, that is the prime example of why doctors are burning out and nurses are burning out at historic rates. Because it's like, doctors used to run hospitals and be in charge in, on the leadership C-suite teams, and now doctors have become laborers, and the people that are in charge are these financial folks who are thinking about the profits more than anything. And I think that's ultimately, uh, a bad thing for patients, more than anybody.

   21. CWChris Williamson32:21

       Talk to me about the rise of estheticians and cosmetic procedures.

   22. DMDoctor Mike32:27

       I mean, I see it happening... I- I've seen that happening all, all the time. That's not a, a new phenomenon. Uh, I just think that probably social media, Zoom, has fueled, uh, people's self-criticism of what they look like, and there's probably been a spike as a result of seeing themselves on camera more often. These days, I saw some surveys where, like, half of Gen Z feel like they're creators or influencers, and when that happens, people wanna look a certain way, they wanna have more control over the way they look, and it's not necessarily a bad thing. The issue comes up when it's people who are not licensed to do it, who are not well-trained to do it, who are not adequately giving people information about side effects of certain treatments. Like, who am I to tell someone what's right for them? Nobody. It's not my job. It's, it should, I should never act paternalistic to a patient unless they have some cognitive issue or someone's hurting them, like a child and they can't speak up for themselves, or elder abuse, some rare situation. But in general, my job as a physician is to give the best quality of information that I have in a given moment about a treatment, about a topic, so that the patient can decide for themselves. And what happens when someone who's unlicensed or untrained does a procedure, that person may not realize what they're signing up for. And that happens quite often. I see issues with medical tourism, where people, to save some money, go to other countries to get treatment-

   23. CWChris Williamson33:56

       Mm. Mm-hmm.

   24. DMDoctor Mike33:57

       ... where there's less supervision and things are cheaper, sometimes because of less bureaucracy, like all that paperwork you discussed. And that could be good, but it also could be bad because there's less oversight in what's going on. And I've seen some pretty horrible infections and complications that happen as a result of that.

   25. CWChris Williamson34:15

       What

6. 34:16 – 39:35

   Most Dangerous Cosmetic Trends

   1. CWChris Williamson34:16

      are the most dangerous esthetician cosmetic procedures that you're seeing people have more of at the moment?

   2. DMDoctor Mike34:24

      Um, I think BBL is, um, a procedure that people have gotten excited about. I don't necessarily see a lot of the consequences of it, but I've covered it enough from a research standpoint for content online where I've seen that a risk of a fatty embolism, where you actually get, uh, a piece of fat lodged in an artery that then travels to a different part of your body and it creates a blockage, happens like 1 in 3,000 cases. And that's 1 in 3,000 healthy people. You know, if you're going for an emergent surgery 'cause you're having a life-threatening condition, 1 in 3,000 to save your life is good odds. But when you're healthy and you could potentially get this life-threatening condition and lose your life, that's absolutely terrible. So, I just hope people understand the risks, uh, of what they're signing up for and not just getting excited about what they see on social media.

   3. CWChris Williamson35:18

      Where are you practicing?

   4. DMDoctor Mike35:21

      Family medicine clinic.

   5. CWChris Williamson35:22

      Yeah.

   6. DMDoctor Mike35:22

      Uh, at a community health center in New Jersey.

   7. CWChris Williamson35:24

      New Jersey, right, okay. I was gonna say, you may see more of them if you're in Miami.

   8. DMDoctor Mike35:28

      Yeah. (laughs)

   9. CWChris Williamson35:28

      Miami seems to be the, the, the, the hotbed for, for BBLs. What is it-

   10. DMDoctor Mike35:33

       Yeah.

   11. CWChris Williamson35:33

       ... about that procedure? You know, people have had boob jobs for the rest of time. I thought a BBL was just a, a boob job for your ass. Like, w- what is it about the-

   12. DMDoctor Mike35:44

       No, it's not implants.

   13. CWChris Williamson35:45

       Okay.

   14. DMDoctor Mike35:47

       Uh, unlike, uh, with breast augmentation, uh, a BBL requires liposuction, so removal of fat from one part of your body, and then inserting that fat in another part of their body. Usually people will get their waist slimmer and then insert it into their butts. Uh, and when you do that, if you accidentally position that fat into an artery, that's where that complication happens. Whereas with breast augmentation, it's, um, an opening and insertion of, uh-

   15. CWChris Williamson36:15

       Mm-hmm.

   16. DMDoctor Mike36:15

       ... a breast implant.

   17. CWChris Williamson36:16

       Yeah.

   18. DMDoctor Mike36:16

       Which has risks of its own, but, you know, with this specific condition, I feel like the fatty embolism isn't discussed as often as it should be.

   19. CWChris Williamson36:24

       Is that... In order to get the... And I know that you don't do BBLs on the side, or at least I don't, I don't think that you do BB-

   20. DMDoctor Mike36:30

       (laughs) Yeah, no, I don't.

   21. CWChris Williamson36:30

       You're not night, night, night flying to Miami to go and do BBLs. Um, I'm gonna guess that they have to sort of put the needle in at multiple locations, or else you would just have one huge deposit of fat which wouldn't make for a particularly round-shaped ass. Now, again, walking through the streets of Miami...... I've seen what can only be described as a bag of cats inside of a set of leggings. You know that sort of ... It's like this. It sort of looks like paws being pushed out. So, my point being, there are, uh, gradations to the quality of a BBL that you can get in any case. But in order to try and create that round, um, shape, you're going in, and I'm gonna guess that that's what you're getting at, there is blood flow through the glutes, and then as you're going in, if you strike an artery and then you put fat into it, very not good.

   22. DMDoctor Mike37:22

       Yeah. The exact pathophysiology of how it happens, I'm not super familiar with, but the fact that it does happen. And again, a lot of people, especially in Miami, I'm familiar with anecdotal cases of people traveling to South America to get these things done, and I've actually seen some pretty ridiculous things, people getting injected with certain solutions. And, um, I, I believe that there was a case, if I'm not mistaken, in the news of someone getting almost like concrete injected, uh, in the buttocks.

   23. CWChris Williamson37:54

       (laughs) Oh my God.

   24. DMDoctor Mike37:54

       And it's unfortunate that people are taken advantage of because sometimes they just don't know.

   25. CWChris Williamson37:58

       Yeah.

   26. DMDoctor Mike37:59

       And usually it's people who struggle financially that get taken advantage of the most, so. Yeah, I mean, the cosmetics thing is not my expertise, but it's just unfortunate where ... It's another area on social media where people get misguided, and they have wishes and expectations. So, I hope to enlighten them about the risks of what they're going for.

   27. CWChris Williamson38:19

       Have you looked at this leg-lengthening surgery trend that's happening at the moment?

   28. DMDoctor Mike38:24

       Yeah, absolutely, I have. Um, I've seen it, uh, and I'm surprised that people are willing to go through that level of recovery and physical therapy and immobility for a period of time. I know immobility on its own has pretty significant risks of having blood clots and such. So, yeah, pretty surprising the lengths that people will go to, not, n- no pun intended, lengths.

   29. CWChris Williamson38:46

       Have y- Have you seen any of these patients in real life? Have you ever seen anyone that's had this done?

   30. DMDoctor Mike38:51

       No. Mm-mm.
7. 39:35 – 44:46

   What You Need to Know About Posture

   1. DMDoctor Mike39:35

   2. CWChris Williamson39:35

      What should we know about posture? That's something else I've seen talked about an awful lot on the internet recently.

   3. DMDoctor Mike39:41

      Um, posture's become a buzzword for certain people online where they say, "You need to keep this specific posture. You need to do this specific exercise." And it's rarely ever that cut and dry in healthcare, let alone wh- when it comes to posture. The, the probably most correct statement is that there's no such thing as a perfect posture because Chris, if I was sitting here and I was sitting with what people refer to as perfect posture, you know, chest out, shoulders back, down, like neck back, if I hold that position locked in for the entirety of our interview, that's (laughs) gonna cause me pain. So, really, perfect posture is about having a healthy balance of being able to sit up straight like this without overly fatiguing your body, s- taking some time to lean back, to maneuver my legs below the camera in certain ways, and actually not holding a specific posture for too long, because whether you keep this posture while you're gaming or chatting or whatever for a long period of time, or you're keeping this posture, you're gonna run into trouble either way. So, it's about keeping mobility, keeping circulation going. That's really the, the correct way to talk about posture. Look, do people have certain deficiencies in posture, meaning they have a significant scoliosis to a, a severe degree where it could impact their functioning? Yes. But a lot of times people have a very mild scoliosis where they have a abnormal, uh, curve of their spine, and they wanna blame every issue on that, when in reality not every case of back pain is necessarily related to their mild scoliosis curve.

   4. CWChris Williamson41:22

      I spent quite a bit of time researching lower back pain. I had two bulging disks and flew to Gravenhurst Inn, uh, just two hours north of Toronto to see Dr. Stu McGill, who is regarded as one of the number one back, back pain specialists on the planet, specifically for lower back pain. Uh, very conservative with his management, so he's quite anti-surgery, which I think is-

   5. DMDoctor Mike41:48

      Right.

   6. CWChris Williamson41:49

      ... probably a, probably a pretty good position to hold and has been proven as we've seen Ronnie Coleman or, you know, pick your favorite athlete of choice work their way through some insane amount of pain. Just as a side point, I, from what I know, the reason that surgery is so dangerous is the potential for scar tissue to form around nerves. And you can already have, um, certain areas of the back which are impinging on nerves. But if you've got scar tissue which has formed around it, that causes the most sort of intense chronic pain. And really interestingly, Matthew Hussey, he's a dating coach guy, he had, um, chronic pain, uh, in a headache, and he explained it to me that chronic pain is one of the few types of, um, physical maladies that you don't adapt to. So, everyone's heard the same story of you win the lottery or you lose a leg in a car crash. Within the space of about two years, your, uh, happiness set point has come back to something approximating where you were before. Hooray, we're, we're very robust. Or boo, we're robust against winning the lottery. That sucks. But, uh, chronic pain is a, a permanent reminder-... of the fact that you have this thing which is wrong with you, it is always ticking away, it's always going, it's always firing. And, um, the sufferers of, of chronic pain seem to be, the, the, the outcomes for them in terms of mental health, uh, increase in suicidality risk, all of that stuff, um, not good. So yeah, went to go and see Stu McGill, and he said something very similar when it comes to posture. That sure, a neutral spine, a tall-ish neutral spine is optimal. But the most important thing is to allow yourself to vary that posture as much as you can, which is why, you know, h- whichever the biggest company in the world for standing desks is, has probably absolutely exploded over the last five years, because everybody wants to go from sitting to standing, "I'm gonna have one of those sexy rocking stools I'll go back and forth on, I'll be a BOSU ball like a pregnant woman." You know, all of these different ways (laughs) that people can do things to try and vary their posture. And for me, as someone, you know, I'm patient zero, two bulging discs, L3, L4, and L5 S1, and I have managed to get myself to a place now where I can sit for a 10-hour plane journey and be absolutely fine, I can go on a, a tour where I'm stood upright still for a while listening to some tour guide talk. And, uh, most of that was not putting myself into positions that irritated my spine, not going unnecessarily into, uh, flexion or extension. Uh, shearing forces, so that kind of position you get into when you're in a, a good morning, or you're doing a bent over row where your spine is perpendicular to the ground and the force is going through it like that, for me was very, very painful. So finding out what hurts for you, not doing it, and giving your back enough time to re- recover, and then just thinking about building a, a relatively good posture for the most part, and varying it. I went from a lot of back pain five or six years ago to now I, I don't notice it. I have zero back pain day to day.

   7. DMDoctor Mike44:41

      Yeah. That's an amazing result, and I'm glad you were able to avoid surgery, 'cause

8. 44:46 – 54:17

   How Our Mind Impacts Our Sense of Pain

   1. DMDoctor Mike44:46

      a lot of my patients unfortunately either get talked into it or think that they absolutely need it for their pain, and as you said, those who struggle with chronic pain, it's a devastating condition for them, mental health-wise. And, um, the unique thing about pain is that there's a lot of things that impact pain that we don't realize, so there actually is this, like, pain cycle that we go through of where we can actually condition ourselves to feel pain more often. And sometimes, you know, back in the day we would talk about it as someone malingering, so pretending to have pain in order to get some kind of outcome. But there is actually much more evidence now talking about it from a mental health standpoint, where you turn up your sensitivity to pain because you expect it, and when you expect it and guard against it, you're actually, like, almost, you know when you're trying to hear something a little better, you concentrate just a little bit more? The volume of that sound doesn't change, but you perceive it a little better. So we can actually train ourselves out of expecting pain, therefore decreasing the volume of that stimulus. And on top of it, our emotional state greatly contributes to the volume of how we experience pain. So a lot of times I get into this situation with my patients where they come in for a physical malady, back pain, neck pain, elbow pain, and we might do a workup, we might not, we might just get enough information off the history and physical exam, where we end up talking about their mental health is impacting their perception of the pain. And some people get, understandably, angry and say, "Are you just saying this is in my head?" And that's absolutely not what I'm saying. The answer is that i- if you're having true pain, it will feel worse if you're in unhealthy mental state. Because if you have a torn hamstring, whether or not you're at work or at a party, (laughs) it will still be a torn hamstring. But if you have a mild injury there that hurts only when you're at work, but you forget about it when you're hanging out with friends and you're able to do whatever you want when you're relaxed, that signals to me that it's not an anatomical issue per se that's the problem, it's the perception problem of it. And there's many instances where mental health therapy, focusing on how they're feeling, what's going on in their social relationships, is a treatment for physical pain. And that's a very unique, uh, field of evidence that I've kind of had a, a lukewarm reception to on social media.

   2. CWChris Williamson47:29

      I can understand why. Um, again, speaking as someone who has had a pretty serious injury that absolutely was contributed to... Is that ca- is that psychosomatic? Is that, uh, what that, where that word works?

   3. DMDoctor Mike47:41

      Yeah, that could be a form of psychosomatic, yeah.

   4. CWChris Williamson47:43

      Okay. Well, uh, my mindset definitely contributed to how much pain I was in, whatever that means.

   5. DMDoctor Mike47:48

      Yeah.

   6. CWChris Williamson47:48

      And, you know, I, I began to identify with the label of being someone who had a bad back. "Oh, I h- I, I have a bad back. I have back pain." And then you begin to avoid doing movements that put yourself in pain.

   7. DMDoctor Mike48:02

      That's guarding.

   8. CWChris Williamson48:03

      Yes, that's probably, that's probably not too bad, especially if it's close to the actual incident, especially for, uh, for-

   9. DMDoctor Mike48:09

      Yeah, if it's acute, yeah.

   10. CWChris Williamson48:10

       ... for a lower back, yeah, exactly. Um, but after a while, you actually realize that this has become part of your identity, and, you know, you, you go into do CrossFit class and you look on the whiteboard and you realize it's got hip hinging in it, and you say, "Oh, no, I can't. That's not, that's, I, I, I have back pain." As if, you know, this is your family name or something, or the country that you're from, "I have back pain." Which is fine, you can say, "Look, I'm going to adapt to this thing," but trying not to identify with it, and I understand completely why people would feel attacked and upset if their doctor was to say to them, "You and your mindset are making the thing that you're feeling worse." Because they're gonna say, "Hey, fuck you. I didn't choose to have this. This pain is real. You can't tell that it's real. You're disregarding the fact that it's..." And I go through this all the time, and I did, and...... you spiral out, and I can see why that would be the case. But, I also know that as I gave myself more proof in the real world, i.e., allowing back pain to dissipate, allowing myself to not be in so much discomfort, and then realizing, "Well, maybe it's not quite as bad as I first thought," and just one tiny little micro-step away from. And now, if someone says, "Hey, what's your back like?" "Works pretty well. I try not to squat because that's probably a bit of a high-risk movement for me." But I don't, I, I don't identify myself as someone who has back pain or is a bad back. And, um, yeah. That's difficult. That must be a hard thing to try and deliver, um, delicately to a person who's in pain.

   11. DMDoctor Mike49:41

       Yeah, it's tough. You have to be very present and very focused on the visit, and you're not getting it done in that 15-minute timeframe that we're often allotted. Uh, what you did for yourself is essentially exposure therapy, and there's certain conditions where exposure therapy works quite well, where we gradually work you up into reducing, let's say, social anxiety or phobias, and we gradually expose you to a level of stimulus where you're comfortable, and we continually challenge you a little bit. But we don't challenge you so far. It has to be an acceptable level of challenge. So, much in the same way, you know, it's fun to shoot three-pointers, you miss sometimes, you make it sometimes, but no one's standing on the other court, full court away, lobbing shots the whole time. That's not fun, because the level of challenge is just way too high. So you wanna have a level of success, or a chance at success. And once we could find the right level for the individual, we can help them have some exposure therapy. There's a great doctor, who unfortunately passed, by the name of Dr. John Sarno, um, who is actually a physical medicine and rehabilitation doctor from NYU, that really pioneered the, the knowledge of how back pain, and pain in general, is related to our mental health. And while not everything in the book is 100% accurate, 'cause there were some theories in there as to why it happens or how it happens, maybe they're not perfect, but the general thought behind the idea of our mental health impacting how we feel physically is so strong, and I really recommend folks to read his book. Uh, one is called The Divided Mind, another one is called Healing Back Pain. Really great reads. I recommend them to patients so often. And the number one thing that patients say when they come in for their follow-up visit is, "I read the first chapter, and that was me, and I started thinking about how that could be happening, and right away my pain went down a certain level of threshold." That's amazing. If I can do that without medication, that's such a win. And some people might say, "Oh, well, that's placebo." Oh, man, if I'm getting placebo off reading a few pages of a book, I'll take that placebo all day.

   12. CWChris Williamson51:54

       Yeah. Well, what do you, what are you... W- when we're talking about, uh, pain which is enhanced by your mindset, what is that? That's, that's the exact inverse of what you've just said. Okay, so if we've accepted that some people's pain can be made worse by their mindset and, but you're not going to accept that someone's pain could be made be- that's somehow less valid? No.

   13. DMDoctor Mike52:15

       Exactly. So, like, when someone... Y- you mentioned that patient that would feel discounted or unheard or like they're making it up, uh, in their mind. How we go about talking to them, it's actually in an optimistic way, not antagonistic, where we'd say, "Hey, what I'm saying is your mindset is contributing to it and your current mental health state could be contributing to it. If it is, this is under a level of control in some ways where you can make this better. So there is a bright light here. I'm not saying I have no idea what this is and throwing my hands up and saying, 'You have to figure this out.' I'm saying that there is a way actually out of this." And usually when you give patients actionable steps, especially if they're not trying to se- i- if you're not trying to sell them some miracle formula or do anything ridiculous, they get really excited about it. So, one of the main things that I tell my patients is avoid guarding if the, uh, condition is mild. Like, if I have a patient who I'm not worried about hurting their back by standing up off a chair, I tell them, "Don't stand up gingerly." Like, we oftentimes get into this habit of if we hurt our backs, let's say, two weeks ago, we get up like this. Like, we're waiting for the pain to hit us. And when you're gonna get up like that, the same thing happens as if when you're walking into a dark room and you're a little bit scared and someone whispers near you, you jump because you're on edge. You're already primed to be in that mindset. If anyone whispers to you on a street of New York City, you wouldn't even hear them. You wouldn't even care. But when your mind is in that primed state that any sound is gonna make you jump, you're priming yourself every time you're guarding your back. And look, there are times where I tell my patients, "You have to take it easy and we need to do some serious activity modification." But a lot of times with back pain, it's about restarting movement safely, getting them working with a, a therapist, a physical therapist who knows what's going on, and if there is a mental health component, which is very common, I recommend talking about that as well.

9. 54:17 – 1:01:21

   Have We All Got Microplastics Inside Us?

   1. DMDoctor Mike54:17

   2. CWChris Williamson54:17

      Are there actually microplastics in everyone's testicles? I saw that article. I saw it. I was worried. Have I got microplastics in me?

   3. DMDoctor Mike54:27

      Um, probably. I mean, i- it's not 100-

   4. CWChris Williamson54:30

      In the testicles?

   5. DMDoctor Mike54:31

      Um... (laughs) I don't know if specifically the testicles. I didn't read the study, uh, fully to know exact, like, details of it. But it's not unusual for that to happen in the day and age where we live in, where people pollute, companies pollute, there's these chemicals that we've used for waterproofing that last way beyond what normal chemicals last in the environment, very similar in our own bodies. So-I think that absolutely is a real scenario, and just like how we talked about, um... (laughs) I feel like I'm villainizing capitalism here, and I'm not anti-capitalism by any means, but a lot of these private equity companies, they find a product that works, this waterproof, uh, water bottle or jacket or whatever article of clothing, they're gonna mass-produce it without thinking about the effects on society as a whole. Because again, their main focus is on the profits. And I'm not anti people making profits, but you have to think about what's happening with these chemicals. And, you know, with public pressure right now, I think a lot of companies are waking up to make some changes, and it's not full, but it's a step in the right direction for sure.

   6. CWChris Williamson55:44

      I saw you do a video about Lululemon leggings and whether or not they're dangerous.

   7. DMDoctor Mike55:49

      Yeah.

   8. CWChris Williamson55:49

      What's the, what- what's the conclusion from that?

   9. DMDoctor Mike55:51

      Well, now we don't even-

   10. CWChris Williamson55:51

       Are Lululemon leggings killing everyone?

   11. DMDoctor Mike55:54

       (laughs) That would be funny. Um, no, there was a, a pretty common claim that I saw that there's this chemical P-F-A-S that exists in Lululemon leggings, as well as other athletic, uh, wear companies, and whether or not that's harmful for us. And then as I researched that video, I realized how pervasive the use of PFAS are in our lives, that the reality is, even if you're a minimalist, you still have exposure because of food containers, because of the trash that people get rid of and how it transfers to wastewater and how it's present in our oceans. So hiding it fr- from it is not easy. There are some consumer things you can do to check if your products do contain, uh, these chemicals, but now luckily, Lululemon, we reached out for them, uh, to them for comment, they said they're no longer using those chemicals in their products, probably from social pressure.

   12. CWChris Williamson56:53

       Mm.

   13. DMDoctor Mike56:54

       Just the fact that, uh, people are up in arms about it.

   14. CWChris Williamson56:58

       How interesting. I had Dr. Shanna Swan on the show, she wrote the book Countdown, which was about sperm rate decline, uh, over the last few decades. Really interest- a bunch of interesting things from her, first one being that I would have thought that we would have had tons more data about testosterone levels than about sperm levels. Not true. Apparently sperm counts have been tracked for much lon- which kind of makes sense, I guess. Wh- The sperm count level is much more important to the continuation of the species than the testosterone level. It's only recently that bros like me and you have maybe been concerned about whether, whether we're in the high 800s or the low 500s. Um, so tha- that was the first thing. Second thing being, to your point about avoiding and the difficulty in avoiding microplastics, that you can get, um, farmer's market raw milk, glass bottle, from the farmer. Farmer's gonna hand it to you and you think, "Oh, fuck you plastics, you can't get me. My testicles are sweet and pure." What you don't realize is that what they used (laughs) to pump the cow was a, a tube attached to the udder, warm milk, and it's heat plus these plastics that are really, really not good because they seem to be able to sort of liberate some of these molecules from, uh, the, the binding, uh, going through these plastic tubings. What's in the plastic tubings? All of the, uh, materials and all of the compounds that you're worried about in any case. So yeah, it is so difficult. I g- is it, what's it packed in, what was it collected in, what's it been transported in, what's the heat that it's been in throughout, throughout all of this time? Speci- what's the lid on the top of that bottle made of, and what's the hi- It is, it is unbelievable. So I, my friend George, who I'm traveling with, this is not, for the people listening at home, I now realize we're an hour and a bit in, this is not my normal studio. I'm currently in Lake Norman in, in North Carolina. Um, George, the guy that I'm traveling with has a question he asks which is, "What is currently being ignored by the media but will be studied by historians?" And I think that microplastics and the ubiquity of those are definitely going to count as one. It's beginning to catch a little bit of steam now, but it's still very much in the sort of micro-niche influencer fringe, and I, uh, I'm not seeing it really break out into the mainstream just yet.

   15. DMDoctor Mike59:19

       Yeah, we have so many things that pose risk to us on a given day, it's hard to know where our attention should fall.

   16. CWChris Williamson59:27

       Mm.

   17. DMDoctor Mike59:28

       So I very much hope more scientists are focusing on this. It's difficult for me... Like, think about it this way. I think it was, uh, Lay Norton that actually said this on my podcast, uh, in a different way, but same example. If I'm looking to pick up the biggest weight as possible and there's different size boulders around me, and those boulders represent risks I can reduce for my patients, like, basically beneficial things I can do for them, most of the boulders are focused on really the fundamental things of healthcare, which means making sure that you're not carrying excess weight, you're consuming at least a varied plant-based diet with good sources of protein, fish, chicken, meat, all that good stuff, um, exercising, sleeping correct, uh, mental health check-ins, social relationships. Those are the big boulders. And then the plastic, while it could be a big threat down the line, I- I- I- I don't know if I have the capacity to tackle microplastics right now, unless we get more information, uh, in the next, uh-

   18. CWChris Williamson1:00:37

       Think about how many testicles you'd need to be around if you were going to tackle the microplastics. It would be-

   19. DMDoctor Mike1:00:42

       Well, I don't remember how much that study, uh-

   20. CWChris Williamson1:00:44

       Swimming in-

   21. DMDoctor Mike1:00:44

       ... said is actually present.

   22. CWChris Williamson1:00:46

       ... swimming in testicles. Uh, but no, I-

   23. DMDoctor Mike1:00:48

       That's also why I approach medicine the way that I do, in saying that there's so much we don't know, like, there's so much we don't understand. Our grasp of subjects is so novice level.And while we are advanced as a society, 'cause we compare ourselves to puppies and kittens, we say, "Look how advanced we are as a species," there's so much we don't know.

   24. CWChris Williamson1:01:10

       Yeah.

   25. DMDoctor Mike1:01:10

       So that when someone comes on and acts very confident that they have the key to everything, I think that's great for their work. I don't think that's necessarily great for the average person.

10. 1:01:21 – 1:05:34

    Are Health Influencers Helpful?

    1. DMDoctor Mike1:01:21

    2. CWChris Williamson1:01:21

       Speaking of that, you mentioned before some of the independent influencers in the health space. What is your perspective on the ascendancy of health podcasts and health influencers?

    3. DMDoctor Mike1:01:32

       It's kind of been a mixed bag. Um, there's some people who are bringing really great information to the forefront, who are discussing nuanced, complex topics. There's individuals who fall and sh- have this little middle ground of talking about that, but then also straying into weird non-science, evidence-based areas. And then you have people full on that are just in it for viewership, maximization of profits. And look, like, more power to you, but m- my job is to give people accurate info, and if you're gonna be one misleading them, I'm gonna be out there trying my best to correct it.

    4. CWChris Williamson1:02:10

       Who are the people that you like the best? Who do you think, or who, who do you follow, who do you recommend to your patients?

    5. DMDoctor Mike1:02:18

       You know, he's doing less content these days, but I really liked Zubin Damania, uh, known as ZDogg.

    6. CWChris Williamson1:02:23

       Mm-hmm. Mm-hmm.

    7. DMDoctor Mike1:02:24

       He was doing some really great content, especially surrounding, uh, moral injury, as he called it, of like burnout when it comes to, um, being fed up with our current healthcare system and it needing to change. I thought that was fantastic. Um, I also really like, uh, people who make content on social media that not necessarily is, uh, podcast-focused, but long-form content, like Mama Doctor Jones. She does some great obstetric and gynecology content. I actually have a series where I try to include evidence-based doctors of, answering like one specific question or talking about their experiences in healthcare from different specialties. And I think it's cool to have a variety of that, so I applaud those who stay true to the evidence, uh, and don't sell out as people often say.

    8. CWChris Williamson1:03:13

       Where did Zubin go? He was on fire during-

    9. DMDoctor Mike1:03:16

       Mm-hmm.

    10. CWChris Williamson1:03:17

        ... COVID. I, I mean, I, I-

    11. DMDoctor Mike1:03:18

        Even before COVID. He, he was doing social media before I was. I remember meeting him when I had my little viral moment of popularity 10 years ago in a hotel room, and we did (laughs) like a live stream that went out on Facebook. That's how long ago it was. And, um, yeah, I don't know. Uh, I, I check in with him every now and then.

    12. CWChris Williamson1:03:35

        I should. I, I need to, yeah. He did really, really good stuff. I was just thinking then when you spoke about, uh, the obstetrics and gynecology, that there is an entire world of healthcare that guys are just absolutely blind to, like the entire-

    13. DMDoctor Mike1:03:55

        Oh-

    14. CWChris Williamson1:03:55

        ... sort of perimenopause-

    15. DMDoctor Mike1:03:57

        Even guys healthcare is blind to.

    16. CWChris Williamson1:03:59

        How so?

    17. DMDoctor Mike1:04:02

        When we did our preliminary research for a lot of the conditions that are common in society, we studied males. We excluded women from our research. So like when we say the classic signs of a heart attack is an elephant sitting on your chest, pressure, et cetera, that's a white male's definition of what it feels like to have a heart attack. And that's why-

    18. CWChris Williamson1:04:23

        Is it different if you're a Black male?

    19. DMDoctor Mike1:04:26

        It's certainly different if you're a woman, and what ends up happening as a result is women come into the emergency room with slightly different symptoms. They describe it differently. They do it more in a narrative style description of what happened, and because older doctors especially weren't trained in that, heart attacks are missed, people lose their lives, and we need to do more of that when it comes to healthcare. Even, uh, you, you mentioned for, uh, a Black person, the fact that our dermatology books, uh, like the older dermatology books have only skin conditions on light-colored skin, which is a problem, because not all my patients have light-colored skin, and conditions present differently in those individuals. And as a result, I'm not as good as a doctor if I'm not trained in that, uh, environment. We need to do a better job in researching these subjects, because what ends up happening is we, without proper education, won't be as good in treating our patients. That's the bottom line.

    20. CWChris Williamson1:05:32

        What about scented candles?

11. 1:05:34 – 1:09:03

    How Harmful Are Scented Candles?

    1. CWChris Williamson1:05:34

       How dangerous are they?

    2. DMDoctor Mike1:05:36

       (laughs) Uh, fire risk if left unattended, for sure.

    3. CWChris Williamson1:05:39

       Mm-hmm. Mm-hmm.

    4. DMDoctor Mike1:05:40

       Um, burning many of them in an enclosed environment, also not a great idea. But interestingly enough, as I was researching that, what I found is burning the candle itself does not release as much harmful chemicals as the initial lighting of the candle and the put out of the candle.

    5. CWChris Williamson1:06:07

       Why? Have you got any idea why?

    6. DMDoctor Mike1:06:10

       So, it's because of the combustion or something. Someone's gonna fact check me and say that I'm doing it wrong, but, uh, it's basically if you don't have complete combustion, you create more soot-

    7. CWChris Williamson1:06:25

       Oh, interesting.

    8. DMDoctor Mike1:06:25

       ... and as a result, it's an incomplete combustion that causes this-

    9. CWChris Williamson1:06:29

       Wow.

    10. DMDoctor Mike1:06:30

        ... unique chemical reaction.

    11. CWChris Williamson1:06:31

        Dude, so people can go back and look at this. My first ever, uh, studio, which was my old bedroom in Newcastle upon Tyne, I'd got into a Yankee Candle, a little bit of a Yankee Candle phase. I liked the smell of them, I thought they were nice. I had a good rotation going. Um, one of the things I hadn't counted-

    12. DMDoctor Mike1:06:49

        What was your go-to scent?

    13. CWChris Williamson1:06:50

        I think I, uh, shamefully, I think I loved this sort of spiced apple thing that was only a Christmas release, uh, and I would, I tr- kind of lived Christmas all year round. Um, they had a cotton something, cotton one, which was quite nice, but anyway, the, uh, soot that collected on the ceiling made my low-ceiling bedroom look like it was covered in mold, and I got...... absolutely flamed, appropriately, on the internet for months and months and months, so badly that I had to pay for decorators to come round, to repaint the ceiling just because of how badly, uh, uh, th- uh, th- I was having the piss taken out of me so much that I couldn't bear to do it anymore. And so I had my entire bedroom ceiling repainted, uh, in an attempt to get away from that. Which was, which is good but now people can go back and, and look at that. So that's real. I see that. And there is a bit of me that thought, as I looked at the ceiling, "If that's what it's doing to the paint, it's got to be doing something to my precious boy lungs." And, uh, yeah. Yeah. I don't know. I th- th- Austin, my current home base, is kind of one of the ground zeros for a lot of forward thinking concerns about health and microplastics and fluoride in your tap water and whatever you've got that's coming out of your shower head, and we can dechlorinate the water by using ... And one of the things that's been next on the chopping block was, uh, candles. So-

    14. DMDoctor Mike1:08:20

        Mm-hmm.

    15. CWChris Williamson1:08:20

        ... it was inevitable, I think, that they were going to come for Yankee Candles eventually, but I was, I was out ahead of it. I'd already quit my, my addiction a while ago.

    16. DMDoctor Mike1:08:28

        (laughs) Yeah, I mean, I, I think it falls into that, uh, boulder rock situation. I think it's still a pebble in the grand scheme of things. And I also think that if you're chasing perfection when it comes to health, you're actually doing your health a disservice. Because chasing perfec- perfection in health is not just an illusion that's impossible, it's a toxic illusion. Because it comes along with anxiety, stress, constant worry that you're not doing enough, and as a result you end up harming your health more than helping.

    17. CWChris Williamson1:09:01

        Yeah. Speaking of the

12. 1:09:03 – 1:24:01

    Future Implications of GLP-1 Drugs

    1. CWChris Williamson1:09:03

       big rocks, the debate around obesity is, um, surprisingly contested for something that seemed to be a bit of a slam dunk for what it does to people's health. Uh, what are your ... Or what do you think is going to be the future of obesity, given that we're maybe just about to turn a corner with GLP-1s and the ability for most people to choose to be the weight that they want to be?

    2. DMDoctor Mike1:09:30

       It's very interesting. I'm not sure how this will play out, because these medications are not just beneficial from a health standpoint, they're also beneficial to our healthcare system. Because if we can prevent heart attacks and all of the strokes and the situations that can arise as a result of carrying excess weight, we would be also improving the burden on our healthcare system. So that's one. Uh, two, we're gonna be definitely harming the profits of some food companies. I think they're gonna be pretty angry. I've seen them do some unique things, actually. There's one that just launched, uh, a GLP-1 focused meal plan where, like, they're in the supermarket and saying, "If you're on one of these medicines, Wegovy, Ozempic, Mounjaro, eat our food 'cause it's made specifically for you." And I guess it's more protein rich-

    3. CWChris Williamson1:10:23

       Yeah.

    4. DMDoctor Mike1:10:23

       ... so that you're still consuming enough protein.

    5. CWChris Williamson1:10:26

       Mm-hmm.

    6. DMDoctor Mike1:10:27

       But it's funny watching them try and adapt. Uh, but at the same time, I'm also wondering how society will react when there is always on hand an option that may take some of the required willpower out of the equation. I think it's fair to say that.

    7. CWChris Williamson1:10:49

       There's a lot of ick around it, surprisingly so, uh, I think. Um, I've had a number of conversations. Johann Hari's new book, Magic Pill, he came on. Scott Galloway came on, he spoke about it. Uh, Dr. Mike Israetel, who you just had on your show, he came on, he spoke about it. The internet really, especially maybe my corner of the internet, the personal development bro, high agency, sovereign individual thing, um, very concerned about it. Uh, and I'm cautiously optimistic, but it seems to me, based on all of the smart people that I know who would not typically, uh, fall for the, he says, uh, as he recommends something that's about to destroy the entire world, uh, would not typically fall for something that wasn't robust, uh, and that they hadn't done the research on. They are basically saying that this is going to be as big of a revolution as the smartphone was, um, but for healthcare. That, you know, we've been promised ... And I understand why, uh, Fen-Phen and all of these previous iterations of drugs that had wild, crazy side effects, super toxic or dangerous or, you know, had long term, uh, risks, I understand why people are not too confident about this one. But it does seem like a difference in kind, not just a difference in degree. And, uh, yeah. F- flight companies, the airlines predicting lower fuel costs because of a lighter populous to transport around, confectionary companies trying to drill their margins because they're expecting to do less sales volume, the hip and knee replacement companies expecting to do lower sales volume, and the most interesting one, jewelers, because they've had to spend money. People's fingers have got fatter, so they've had to spend money to get their wedding rings changed and increased in size. So there's going to be an initial increase boon to get the, uh, jewelry changed again, and then after that a little bit of a nosedive because there will be less gold that'll be needed to fit ever thinner fingers.

    8. DMDoctor Mike1:12:45

       I, uh, I have a question for you. I had a world-renowned food expert on, it's not a published interview yet, Marion Nestle, she's a PhD professor, um, she asked me a question that I want to pass on to you and see what you think. Is there any industry that will make money on us as a society losing weight? And I couldn't think of one, so if you do, I'm gonna be impressed.

    9. CWChris Williamson1:13:20

       Certainly some niches within the, uh, food and drink industry will, because you just have a, you now have a new gastrointestinal environment, so, uh, high density, low volume. Uh, I think, uh, if you can make protein-

    10. DMDoctor Mike1:13:41

        But if those companies are making those foods, they're not gonna be selling as much of the foods period, so-

    11. CWChris Williamson1:13:47

        Agreed.

    12. DMDoctor Mike1:13:48

        ... lower their prices.

    13. CWChris Williamson1:13:49

        Ag- agreed. If you have e- I'm thinking more disruptive, you know, a single small startup or a, a number of small startups that get to come in and disrupt Mars or whatever, and they make something which is, which is-

    14. DMDoctor Mike1:13:59

        Let's make it more industry focused as opposed to company.

    15. CWChris Williamson1:14:02

        Yeah. Uh, it's really gonna be hard. The only thing, the only other thing I could think of would maybe be companies that make sportswear stuff, because sportswear is a kind of clothing, I'm aware that c- I'm like niching down again, so I'm breaking a rule. But, um, sportswear is a kind of clothing that people who are more in shape tend to wear. Um, and yet they're gonna make... Oh, did they do that thing? Is it more expensive to buy bigger people clothes? They probably flattened the price, right? That would be a huge social campaign if the 3XL was twice the price of the small, that's definitely gonna be, uh, like fat tax, uh, accusations thrown around. I don't know. I, I think it's really hard to think of one.

    16. DMDoctor Mike1:14:44

        'Cause even with sport- sports stuff, like is there a world where people go to gyms less because they're lower weight and they're not worried about their weight?

    17. CWChris Williamson1:14:51

        Well, what are they doing? Here's a question. What are people doing with their time? Where does their time go if they lose weight? If they lose more weight, what is it that they're doing which is different?

    18. DMDoctor Mike1:15:01

        Yeah, I, I don't know. And I, I'd love to see something better than my anecdotal answer on it, because, you know, I have patients on the medication, but that's not representative of the entire population.

    19. CWChris Williamson1:15:12

        What have you s- what have you seen? What have the results been and the responses, good and bad?

    20. DMDoctor Mike1:15:20

        Uh, largely people lose weight. Um, their numbers improve from a cholesterol standpoint. Their sugar control improves. Um, they're happier, less musculoskeletal issues. A large percentage of those people either have had issues with side effects, like nausea being the most common. Uh, some, the nausea is mild, persistent, but manageable to them, and a valid enough trade-off. Um, I haven't had anyone personally as a physician where a patient had such a bad side effect that they had to stop it, but I am aware obviously that does happen.

    21. CWChris Williamson1:15:59

        It's fascinating, man. I, I, this is-

    22. DMDoctor Mike1:16:02

        Yeah.

    23. CWChris Williamson1:16:02

        ... this is the most, I think, interesting development that we're going to see over the next few years.

    24. DMDoctor Mike1:16:07

        Yeah. I, I agree. And I think it's largely representative of how society has been reacting as of late. And a lot of people who are smarter than me come on my show and point out that when I'm concerned about a new problem, they're like, "Ah, Dr. Mike, there's always been new problems. There was horse manure problems and now we have cars, and then there was pollution problems, now we have electric cars." And we constantly are problem-solving. When problem-solving itself begins to be owned by private equity ...

    25. CWChris Williamson1:16:43

        Mm.

    26. DMDoctor Mike1:16:45

        It becomes so weird in that, look, like we created hyper-palatable foods that were junk foods, processed foods that were very tasty, non-satiating, so we're always hungry, want more of them, they're addicting. That was largely driven by private equity. Then we created a medicine to solve the obesity epidemic. Is there a world where these private equity companies are creating apps that are making us hyper-addicted and shortening our attention spans, where now more people are requiring to take ADHD medicine? Maybe. So are we now seeing private equity in telling people, "Well, look, if you really wanna take care of your health, you really got get- get your testosterone up. And if you want your testosterone up, you gotta look like this person. Look at the muscle. You can maintain their erections, whatever. And you need to have this level, so let me give you some testosterone." Now they're selling you testosterone. So, like, how many times is private equity gonna create a problem and then sell you the solution?

    27. CWChris Williamson1:17:46

        That is a very good point. Yeah. I am the-

    28. DMDoctor Mike1:17:51

        It's like, uh, starting a fire in someone's house and then offering to put it out for a fee.

    29. CWChris Williamson1:17:55

        Yeah. Yeah, yeah, yeah. And charging them for the water. Yeah. I don't know, man. I'll be very interested to see what happens over the next few months with, with GLP-1s. I think that it's the, it's going to make a very interesting moral challenge, it's going to create a moral challenge for a lot of the people who have been a part of the body positivity movement. And I think that that's one of the most interesting sort of social elements to this, that when, uh, maintaining a heavier weight becomes a choice, uh, i.e. you have more control, more direct control over whether or not you maintain that heavier weight, I think that it's going to, uh, put many people into a Catch-22 situation, uh, that, uh, a lot of people who have been very pro-body positivity and, um, uh, you know, promoting, uh, bigger lifestyles, I think that they're going to be faced with a very difficult decision because so many of the members of that community that were, uh, their compatriots are going to elect to not do that. And I wonder how many people that were a part of that movement were doing it because they tried dieting, it really hadn't worked, so I'm gonna be a part of a group of people that accepts me as opposed to one that villainizes me or says that I'm, I'm, I'm wrong or, or undisciplined or whatever. You don't know. Fuck you. I tried to diet. Like it, it, a huge percentage of diets don't work for people, and I get that. Um-... but when you can just take the shot twice a week and you can dial in your weight to the, you know, poundage that you want by just increasing the dose or decreasing the dose, I-

    30. DMDoctor Mike1:19:39

        I also want to point out, that's not exactly realistic. Most people still don't have access to the medications, and-
13. 1:24:01 – 1:33:23

    Doctor Mike’s Chat With Steven Gundry

    1. CWChris Williamson1:24:01

       Speaking of medical memes, how was your conversation with Steven Gundry?

    2. DMDoctor Mike1:24:05

       (laughs) Great, uh, great intro to that. Um, it was bittersweet. (laughs) I was excited to talk to him, because, you know, he has these best-selling books that are influencing millions of people. He goes on a lot of podcasts, and he says things, and people "ooh" and "ahh," not challenged as often as he should be, and I did, and I had a great cardiologist, Dr. Danielle Belardo, on, who challenged him on a lot of his notions. And largely what I found is h- he's a person who's excited about innovation, but lets the lack of experience and mass communication lead him to make statements that land with the audience in ways that he probably doesn't understand that they do. Like when you say to a parent that grapes are so problematic, might as well give them a Hershey's, you're making a statement that's encouraging mothers to feed their children processed sugar as opposed to a fruit. And that's a problem. And he might be talking about how fruit is now raised in the nutrient content has changed, and the intricacies and all that. Great, talk about that. But the way that the message is delivered, I think ultimately misleads people in their understanding of what science and healthcare is.

Episode duration: 1:37:04