The Conspiracy Theories Surrounding Big Pharma: Part 1

**Discussion begins at 4:30**

Today we are talking about all of the conspiracy theories surrounding Big Pharma…  People have long alleged that that pharmaceutical companies suppress cures for diseases to maintain a steady revenue from ongoing treatments. In fact, there is a belief that big pharma is actively working to suppress alternative treatments that could compete with pharmaceutical products.  Further conspiracy theories include assertions that data from drug trials are manipulated to ensure FDA approval and market success, that the government colludes to enforce regulations that favor their interests, and that big pharma influences doctors through kickbacks and promotions, which could lead to biased prescribing practices.  Today we’re going to have our resident PharmD breakdown these and other conspiracy theories.

Transcript

Hey, guys.

Hey.

What's up, guys?

Hi, there.

Can I get a drum roll, please, Megan?

Introducing to the podcast.

Dr.

Andrew.

That's good.

Yeah, Dr.

Andrew.

That's nice, thank you.

Yeah.

Our farm de-consult.

Our pharmacist.

Yeah.

With an F.

Farm assist.

Oh, he's assisting us.

Are you just saying that because you think I live on a farm?

Yeah.

Did you see your lawnmower?

That's the farm farm.

That's farm equipment.

Yeah, basically.

But I mean, there is a real farm right there.

You can see it.

Does that count?

Yeah.

It does.

Yeah.

I was like, I only see these trees.

Well, the winter view, okay?

That's not what they say in the business.

The winter view is farmland.

Thanks.

welcome to the show, Dr.

Andrew, our pharmacy expert.

Yeah.

Farm D's nuts.

I consult with Dr.

Andrew pretty regularly.

He always gives me good medical advice.

Yeah.

He's not down in the basement.

He's a clinical pharmacist.

He did a residency.

He's legit-ness.

Yeah.

You may have seen him at an ER at some point in your life.

You may have seen him at an ICU at some point in your life.

He knows what's up.

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Yeah, they should scroll on down, leave us a five-star review, leave us a comment, share us with your friends and family, share us on your social media platforms, share us in your family group chat.

And yeah, thanks for supporting the pod.

We should start off this episode, though, by giving a congratulations to Kait.

Since episode one, guys.

Board certified.

She has completed her advanced degree, she has completed her board certification in her specialty, and we all lived it with her.

Yeah.

It's done.

Cheers.

Cheers.

Speaking of, cheers.

So is it time for our drink check?

Drink check.

Andrew, what did you make us?

So this is a pistachio milk.

Tastes really good.

Cafe latte.

Yeah, it's so good.

With a little bit of sugar just to make it better.

Like the pistachio.

Dairy free.

I said, why is it so sweet?

And he's like, I put sugar in it.

I've been telling everybody that I come out here and spend the night a lot whenever I come out, and I would be like, man, every morning, Andrew and Rachael make the coffee, and it's so good.

And I'm like, why is it tastes so much better at your house?

And then I realized it's because you have the 30-calorie sweetener.

And you changed my life.

Because then I was like, you know what?

We don't need to save 30 calories.

No, no.

Doesn't count.

Just make your coffee.

It just don't count, Megan.

Yeah.

Wake up, enjoy your morning, just have it.

Yeah.

30 calories is not going to break you.

Definitely not.

30 calories 30 times might, but.

Yeah.

All right.

Is it time?

Should we talk more facts now?

Should we talk Big Pharma?

Big Pharma.

Big Pharma.

All right.

I have a little introduction here, and then I'm going to pass it off to our resident expert to guide this discussion.

Okay.

Oh boy.

Okay.

So guys, today we're talking about all of the conspiracy theories surrounding Big Pharma.

Big Pharma.

People have long alleged that the pharmaceutical company suppressed cures for diseases to maintain a steady revenue from ongoing treatments.

In fact, there's a belief that Big Pharma is actively working to suppress alternative treatments that could compete with pharmaceutical products.

Further conspiracy theories include assertions that data from drug trials are manipulated to ensure FDA approval and market success, that the government colludes to enforce regulations that favor their interests, and that Big Pharma influences doctors through kickbacks and promotions, which could lead to biased prescribing practices.

Today we're going to have our resident PharmD break down these and other conspiracy theories.

Oh.

Bum, bum, bum.

Oh, that was good.

Thank you.

Before you start, what is everybody's thoughts and feelings on it?

I'm anti-Big Pharma, but also I use meds.

But like, are you anti-Big Pharma?

Do you believe that they are like hiding cures?

I want to think that they know cures, but I want to assume the reason they don't have the cures is because they just don't have enough evidence to have it be released for humans yet.

Do you know what I mean?

Like, I'm sure there's experience.

Like it's being done.

So you think they discovered it already, but it's not ready yet.

But they just can't release it yet.

But what I do believe, and I think it's pretty much a fact, that like they feed into certain marketing schemes to get people to buy meds that don't do anything.

Like the cold and flu oil.

Oh yeah, for sure.

So I am not anti-big pharma.

I think that's like, I mean, obviously, right?

I do think that if you want to approach it from like a business aspect, I think that like people making money off of illnesses is kind of wrong.

Jacking up the prices, but that's like more ethical versus it.

Am I?

Do I think that they're trying to sell something that isn't right or isn't promoting health?

I do think that there is like a fundamental problem with polypharmacy.

Like, that's my problem with it with it is like, I think too many people are too medicated because honestly, doctors don't have time to sit down and like go through every disease process with them and like talk about preventative medicine and all of that.

But anyway, that's sort of my stance on it.

I'm with you.

I don't think the Big Pharma is hiding the cure for anything.

I do think it's unfortunate that there's so much profiting happening, right?

But yeah, I don't think that they like have the cure for cancer and they've just been concealing it from us because why would they do that?

Like, why would it?

They make money.

They could just make money by curing cancer, right?

Because that would just be more expensive.

But to your point, Kait, I mean, I agree that polypharmacy is an issue, but I think that issue is more so that health care has become too much of a customer service industry.

Oh, yeah.

And it's like people aren't happy if they don't get a pill and then they don't necessarily understand that it's like these side effects are causing more pills or more pills.

So I do think that's an issue.

It's like a cycle.

Yeah.

And yeah, people, for the most part, I don't think, take responsibility for their own health.

Well, people are like, oh, I'm sick.

I need all the meds instead of just like more like just need to be.

I have a runny nose.

Why is this doctor not giving me an antibiotic?

Yeah.

And then you leave a bad review and then the reimbursement goes down.

So we just give you an antibiotic to shut you up and send you on your way.

Right.

You know, that's not right.

That's a whole problem.

I could be a full other conversation.

All right.

We'll turn it over to Andrew.

Our professional opinion.

Tell us what you think.

Okay.

So you guys sort of touched on a lot of different angles of what is a bit conspiratorial, but also sort of I guess market factors.

So when you add the money in and people are able to make money, people are going to do things to maximize that money that pushes the limits of ethics.

Right.

But does that become a conspiracy?

I don't know.

It's hard to say.

Right.

Certainly, your point about what's now a movement called functional medicine has been a bit lost, but is having a resurgence.

Yeah.

Functional medicine is kind of the idea that you treat the patient holistically, you educate them on the reasons that they're ill and that they don't feel well, and then you guide them through all the things that make them feel better.

And that's certainly a valid approach.

But what's interesting is that conversation, that issue actually stems back to what might be one of the better conspiracy stories in medicine, modern medicine.

In 1910, there was a paper put out called the Flexner Report.

Oh, I feel like I've heard of this.

And the genesis of the Flexner Report is interesting, which I'll go through in a moment.

But the punchline basically is that the report outlined a mechanism, a mode, and a philosophy that was to be adopted by all medical schools in the US to represent how American medicine would proceed in the coming century.

And obviously, we were learning a lot about medicine and science and that sort of thing between the 1800s and early 1900s.

So it interacted in a way to sort of suppress some of that functional medicine.

But actually, the money is what caused the situation that we're in now, which is kind of what you guys described.

Yeah, it's like feeding into it so people want to spend money.

I think functional medicine is sort of having this resurgence though because of the way, I mean, this is like sort of off topic, but functional medicine is functional and integrative medicine are sort of having this resurgence because insurance companies have made it so that doctors can only, doctors and practitioners, providers can only spend an X amount of time with people.

And if they go over that time, they're not going to get reimbursed because of that, because insurance companies are deriving that, right?

So like you go to these functional medicine doctors and these integrative medicine doctors, and what they're hearing is that someone's actually listening to them rather than just like, you know, okay, we got to get through this.

I have 20 patients that I have to see and there's 15 that's off topic.

But I think that's sort of like where this like resurgence is going to.

And people are actually feel like they're listening.

And then these functional medicine providers are sort of, are they prescribing things that are actually evidence based?

We don't know.

Yeah, the part that you're kind of glazing over there and maybe assuming that people know is that these functional medicine, integrative medicine practices have taken the money out of the equation in the way that insurance companies manage it.

And so you pay for access to this doctor and you pay them cash and you pay them a reasonable fee and they give you their opinion on your whole health.

Right.

And then you go from there.

And in the broader context, the main difference there is taking that money feature out of it and that business mind out of the medical practice.

One of the major health systems in the region here in Maryland, their business office or medical director sent an email basically to all the practitioners and said, if you're not seeing five patients in an hour, then you're underperforming.

And that's completing charts in that time.

So, the patient encounter is six minutes, and the charting is six minutes, and then you're done.

So, if you can't get it done in that timeframe, then you're underperforming and you're going to be penalized.

And they had a massive walkout of frontline providers, which is crazy because in medicine, there's a shortage of providers.

So, they're the commodity.

They can walk and they will find a job within days.

So, it was a very bold move and it ended poorly for the health system.

We're so distracted by the wildlife at the windows.

So, what I'm hearing is that really insurance companies are the issue, which then trickles down to hospitals and maybe Big Pharma is not the problem.

Well, yeah.

It's both.

Right.

They're in bed with each other.

We can go into PBMs at some point, but I don't know if that's a topic for today.

But if anybody wants to hear about PBMs and how horrible they are, those are pharmacy benefit managers.

Those are the people that go in between you, this is the industry that invented prior authorization.

It's horrible.

It's a horrible thing.

And they get paid billions of dollars to generate, to make up these prior authorizations that really end up doing nothing.

But the point of which, the only point is to limit care, limit costs and limit how much they're willing to do for you without putting you through a bunch of hoops.

And it's not anything that benefits the patient.

So that probably is a conspiracy.

And we could talk about that in another episode if we want to go through there.

But let me tell you a little bit about this Flexner thing.

So right around 1900, a group of people got together and they were dubbed the Hopkins Circle.

Okay.

So Johns Hopkins was a successful Quaker businessman who put a lot of money into creating the Johns Hopkins University.

Johns Hopkins University had a medical program and it was very important to them.

I applied to Hopkins.

And you didn't get in?

I did not get in to Hopkins.

I would argue I went to a better...

Yeah, way better...

.

a better school than Hopkins, but Hopkins rejected me.

I just wanted to throw that tidbit in.

That's why I don't like Chapel Hill.

Chapel Hill rejected me twice.

So a bunch of thinkers got together about how do we want medical care and medical training to look in America?

And they commissioned a guy named Flexner to come in and do a survey, tell everybody what the practice of medicine and medical training should look like.

It's funny because Flexner thought that he was like the wrong guy for the job.

He thought they mistook him for his brother, who was a pharmacist, and like he got the letter on accident.

Oh, wow.

That would be nice.

Yeah.

Accidentally get a job off.

A giant government contract to do this huge, to just write a philosophical paper about how college should work.

He's a guy who went to Johns Hopkins, so he was known there, and his brother, who was a pharmacist, paid for his trip to Hopkins.

But his passion was education, and so he went back to Louisville where they're from, created a high school, but kind of changed the game as far as education goes, and instead of it just being memorization after memorization, he applied practical learning techniques, problem-based learning, these sorts of things, created this very popular high school, and then sold it to go to study philosophy at Harvard.

Was it like a public school or was it like a private school?

It was a private high school in Louisville, yeah.

And so then he sold off this high school to go study philosophy at Harvard, which was his passion.

At some point in that journey, he decided to write a paper called The American College.

And this paper described his belief on how college education should transpire.

This guy was a big idea guy.

Yeah.

So he's a philosopher.

Yeah.

The true doctor of education, right?

Alexander, I think.

He spent a framework.

He liked writing framework.

Yeah.

So these guys that were wringing their hands about what to do, about how do we teach medicine in America, because things were changing, we were getting to know a lot more of the science.

They had to standardize it.

And at the time, all medical schools in America were private.

They all had their own ideas about how medicine should go, because there's a lot of traditional things and there's a lot of modern things and there was a lot of things that people just made up and found an audience because, yeah, yeah.

This is like penicillin is just being created.

Exactly, yeah.

So we're just learning, you know, all these great things about, you know, atoms, the theory of the atom, right, was like not even really clear at that time.

Oh, wow, I heard they're pretty great.

Anyway, the the Hopkins Circle guys commissioned Flexner to write this report.

And basically, there were kind of two tenets that codified how we got to where we are in medicine right now.

He studied and looked a lot at the German Medical Society and their medical education, which was very science focused.

Again, this is an era where science and art and belief and that sort of thing was sort of becoming mainstream, but wasn't yet.

Okay.

And so he said basically that the treatment of patients in medicine should be science-based and evidence-based only.

Okay.

So if we don't have science to prove that it's the right thing to do, you shouldn't be doing it.

Right.

Okay.

So it was how we practice now.

Yeah.

And so that resonates, right?

Right.

We feel that in the way that we practice medicine now.

Yeah.

But clearly, that ignores a bit of sort of the esoteric side of medicine, but also the patient focused side of medicine.

Esoteric jokes.

Right.

She's a poet, really is.

The other thing that it did was it, he described the creation of full-time academic medicine faculty.

What he said was medical schools should have faculty that aren't burdened with clinical duties and operations of dealing with patients, but instead they're paid by the university to be allowed to do this science, to find the answers to the questions, to build the evidence base so that we can design and make medicine correctly within this science-based framework.

I was going to read this sort of excerpt.

This is from a paper.

I love reading excerpts.

You had to do it in an accent.

Yeah, I don't think that's going to work.

All right.

This is an excerpt from a paper called The Flexner Report 100 years later.

So this was in 2010.

But it says, the most vocal challenger and naysayer was William Osler, who was subsequently seconded by Harvey Cushing.

This is Harvey Cushing was his mentee, so they were in cahoots.

Cahoots.

Osler believed that the focus of such positions would be too narrow.

They would live lives apart with other thoughts and other ways.

He was apprehensive that a generation of clinical prigs would be created.

I don't know what prigs means, but I love it.

Individuals who were removed from the realities and messy details of their patients' lives.

I want to know some details.

Right.

Osler believed that the flexinarians had their priorities wrong in situating the advancement of knowledge as the overriding aspiration of the academic physician.

He placed the welfare of patients and the education of students to that effect as more important priorities.

Although he referenced the centrality of scientific knowledge in that regard.

So, basically, Oxner is saying, you guys are going to create a bunch of robots who don't know how to deal with people, who don't know...

That's pretty accurate...

.

who are only focused on doing this science thing and can't manage humans.

Right.

That's why nurse practitioners are the best.

So, I'm just saying.

Yeah, well, there's something to be said for that, right?

So, you guys spend a lot of time at the bedside, or at least you're supposed to, have spent a lot of time at the bedside learning how to deal with people first and then become clinicians capable of doing the higher level diagnostics, etc.

So, it's a fantastic model for training that does very much differ from what this was designed to be.

And so, Osler said all this stuff, but ultimately, Andrew Carnegie, the Carnegie Foundation had basically brought in a person to be on the Hopkins Circle for them.

And John D.

Rockefeller also was interested in philanthropy as-

Rockefeller?

These people on the Titanic?

Rockefeller is tied to the Titanic.

I think Carnegie too.

They didn't go on it because-

Yeah, that's another episode.

All these people are-

That's coming later this month.

Yep.

Yeah.

So, Rockefeller also decided that he wanted to spend some of his money on advancing medical education.

So, his money was at play, Carnegie money was at play, and their people liked the Flexner report.

And so, that's what went out.

And now, we have this sort of-

Someone's paying for it.

Exactly.

So, you follow the money, right?

Follow the money.

Follow the money.

And you end up in a place where we all feel a little uncomfortable 120 years later as robots of science and not doing enough to deal with the human side of medicine.

And of course, this generates a medical model that is money-making, money-dependent, right?

Because if you can't pay the researchers to do the research, then how do you live?

And so, eventually, the Rockefeller money dried up, you know?

And so, it builds into this sort of medicine as a money-making venture, which also kind of has ruined, spoiled the pot.

I'd just like to insert here that a prig is a self-righteously moralistic person who behaves as if superior to others.

Oh, I'm going to use that word all the time.

I'm going to use it a sentence now.

I can think of some prigs.

Can't stand prigs.

Raise your hand if you've ever been victimized by a prig.

We all rose our hands.

Four out of four.

That's really interesting.

That definitely seems to have created...

I mean, that's really what the problem is, right?

Why people are going outside of like they're not trusting pharma is because they're thinking they're not here for us.

They're not here to treat the person.

They're here to get the money.

And that's really the root of the problem is that like people are saying, well, big pharma is not really out to take care of us.

They're here to just put money in these deep pockets and keep filling them.

Yeah, for sure.

So, you know, aspirin is not a miraculous thing.

It's a very basic chemical, easily accessible from the bark of the fever, the ash willow, I think, or something like that.

Yes.

Right?

So you can get it, but it was the Bayer Company, a German company, who decided to isolate it, put it into a tablet and privatize and sell all this stuff, right?

It feels itchy when you realize that some of this stuff is available to you in another format, but no one's telling you that.

They just tell you, you go get a Bayer Aspirin.

Right.

And then even you kind of get caught up in the thing about generics and brands, but sometimes the generic is the brand.

Like literally it's the same tablet, but it's just with a different sticker on the box.

And now you're stuck in a situation where, do I trust that guy more than this guy?

Right.

The same magic.

We can pivot a little bit in the theme of following the money, right?

Get into pharma.

And I guess the pharma concerns are echoing this, the sentiment that we've all been sharing, right?

They're doing unethical or borderline ethical things to separate us from our money and don't really care if we're healthy or not.

Right.

And then you can imagine the next step of that being like, they're not even, they're not ready to release the cure yet because treating the disease is what makes more money.

Right.

So perpetuating.

I just think about these guys like the all of the farm bros and whatever, right, who are in trouble for like jacking up prices.

Why couldn't she be like, I have this pill that will cure your breast cancer and I'm going to charge.

50,000, it's like the HIV drug that was like $70, but he he marked it up to 700.

I just feel like if their goal is to stop it and they have the, you could make it so that you could profit off of the cure.

Yeah, but you could only profit until you cure everybody.

See, that's the conspiracy theory is that.

Is that eventually there won't be any cancer.

You'll run out of patients somehow if you cure everything.

So you're perpetuating, the whole reason why they're not giving up the cure is because they're perpetuating the disease.

Well, there will always be more diseases.

They can just go invent a virus in a lab.

Well, that's...

Yeah, and leak it.

Is that what they're doing, though?

That's what they did, for sure.

But is that what they're continuing to do?

Did Pfizer do that?

Maybe it was Pfizer all along.

Did Fauci know?

I don't believe it.

Ticks causing cancer.

To be clear, I just think it was mishandled in the lab.

I am not blaming Big Pharma.

But yeah, I just feel like there's always going to be new.

Yeah, it does feel like that was an oopsie.

Yeah.

Oh yeah, he had one jab and he didn't.

Like the whoopie cough is now having a...

I just feel like even if you care that...

Well, girl, high school.

Kait and I had pertussis.

Yeah.

The 100 day cough.

Again, we could do a whole COVID episode.

I don't want to do a COVID episode because people...

I want to do a COVID episode.

People did die.

There's our two sons right here.

Miss Candle in the lab.

Okay, go ahead.

All right.

Big Pharma kind of goes way back.

Okay.

So you've heard of snake oil salesman, right?

Yeah.

So the idea was that people would go around and sell patent medicines, what we call patent medicines, to people.

And this was just whatever they decided to put in it.

And they would tell you that it's for disease.

Often, they would include things that had pharmaceutical effects, most likely things like cocaine or morphine that make you feel good.

Right.

Right.

So then you tell somebody that this is going to make you feel better, and it certainly does.

But in a different way.

But no one is expecting it to be cocaine or morphine, right?

Now that we know what those things are, right?

A picture of opium or whatever it was called during the day.

This got to be a big problem.

And eventually the US government got involved and created what's called the Food, Drug and Cosmetics Act.

FDA.

Establishing the FDA.

Food, Drug and Cosmetics Act kind of created the FDA in a sense, and it's kind of their birth.

This, but it was originally only to help combat the idea of putting whatever you want in these patent medicines.

And what it was said to be had to be what it was.

Okay, so if you said it was tincture of opium, it couldn't be manure, but before that, it could.

Right.

It was like regulation.

That's fine.

So that's the first layer of regulation, which seems important.

Yeah.

What's in it should say what it is.

Yeah.

And in the age of...

So misinformation was easy when you were basically stuck with talking to your neighbor as like your only source of fact check.

Yeah.

Right.

So without Google.

So the first pass at regulation tried to address this discrepancy between what people could say and what they could give you.

Right.

Which is important.

But it didn't cover everything.

In the same period though...

People are very anti-FDA right now too.

Oh yeah?

Yeah.

Oh, I didn't know that.

Why are they anti-FDA?

Because they think the FDA...

It's the same sort of idea.

The FDA is still trying to poison us.

The FDA is in on it?

Oh, I see.

I'll talk about that a little bit if you want.

In this era, pharma was sort of established because you need some industries to be able to regulate, to deal with the regulations.

You can't just one off.

You're probably not going to one off as a guy with a leather pouch going town to town, going to be successful in fighting and being able to navigate the regulatory environment that was now born.

Going door to door and selling vacuums, that's a thing.

No.

What?

Look it up.

That's how people look it up.

That's how my mom got a vacuum in the 90s.

Yeah.

They just sold it?

Yeah.

Like selling Girl Scout cookies, Tupperware parties.

Anyway, this didn't require the companies to do anything with regard to the management of disease.

Okay.

So there was no connection between, does this medicine do what it says it's supposed to do?

Oh, I see.

So someone would go and be like, man, my nose is really stuffy.

And the guy's like, well, this is some morphine.

Yeah.

This will make you feel good.

And that was the only rule they had to follow.

Like I told you it was morphine.

It was morphine.

And that was it.

Okay.

Yeah.

So they could make up what it was for.

They could make up the purpose, the intent, the side effects.

None of that had to be real.

Yeah.

Okay.

There's a company, I think it's Johnson and Johnson, invented the word halitosis.

You know that word?

Yeah, yeah.

It's bad breath.

It means bad breath, right?

That's not a medical term.

But they just invented that.

Johnson and Johnson made that up.

Oh my God.

Oh my gosh.

And now we throw it around like a medical diagnosis?

Yeah, yeah.

Johnson and Johnson invented the word halitosis, published it in all these magazines saying, do you have halitosis?

You might not know you have halitosis.

Oh my gosh.

We've got the perfect thing for you, Listerine.

It's not a fancy word.

Listerine will cure halitosis.

Wow.

That's how mouthwash came about?

Yeah.

They made it up.

It's all made up.

What?

Oh my God.

Blowing our minds.

Yeah.

I'm like, but isn't halitosis like an actual diagnosis?

No, it's not.

It just means you have breath smells, but everybody's breath smells like something.

Like it's objective if your breath is bad.

I don't know.

So much mouthwash.

Dogs love smelly breath.

I don't know.

So like maybe it's somebody's thing.

But they created an entire industry of selling you stuff around a made-up condition.

Wow.

And like, yeah, having bad breath is fine.

People still use it now.

Right.

I don't even know if this is true.

I don't even know if there's any evidence yet to actually support that Listerine makes you healthier.

Wasn't there an article that said if you used mouthwash, you were less likely to get COVID?

Wasn't that a thing when that was happening?

March 2021, two types of mouthwash disrupt the COVID virus under lab conditions.

I would say every time I get even the inkling feeling that I'm getting sick, I start gargling mouthwash like three times a day and I feel better.

Well, that's the whole reason why I tell everyone should drink bourbon when they're sick because alcohol kills.

Yeah, or hot tea.

Yeah, hot toddies.

So, yeah, hot toddies.

I mean, yeah, now that I'm actually looking this up, yeah, there's like a 2023 article from the British Dental Journal, mouthwash usage did not show any long-term benefit on cardiovascular disease mortality beyond the benefits of brushing and flossing.

And then the NIH has an article here that actually says, frequent use of mouthwash was associated with increased risk of hypertension.

So, you know, my favorite line is the one that our pharmacists-

That's an association.

That's not a causation.

No, but here's what our smart pharmacist will say.

It's the smokers that are using the mouthwash?

No.

In the absence of benefit, there is only risk.

Oh.

That is a thing that I like to say.

And sometimes the risk is just financial, right?

Sometimes you're just throwing money in the floor.

Use the mouthwash like every day.

And that's fine if it makes you feel good in your heart.

It doesn't make you feel good, but it doesn't make your body any healthier.

We're not anti-dental hygiene.

Well, I also just watched a couple, I mean, my resources are TikTok, but dentist on TikTok saying that whitening toothpaste does literally nothing.

The only way to clean your teeth is brushing it.

The toothpaste doesn't make a difference.

We have a friend of the pod who has very white teeth and he just brushes with baking soda.

Isn't there some rule on these commercials that you have to spend like X amount of time listing side effects?

Yeah, I don't know if that's accurate.

There certainly is a requirement for some side effects to be listed.

I thought it was like based on frequency of how much they're observed.

The top side effects.

Yeah.

Like if anything exceeds more than 3%, then they have to mention it.

Yeah, my favorite is like the person, like, you know, frolicking a field and it's like, this could cause severe cardiovascular death.

Stroke.

Yeah, but they say it.

Like, devastating stroke.

Crohn's disease.

Dementia.

Yeah, it's.

Ask your doctor for a dosing today.

Yeah.

And in my experience, I get more questions from people who are kind of like spooked by the ads.

And the FDA is doing that on purpose because direct to consumer advertising of medicines is questionable as we just went through, right?

So selling you something that looks good and makes you with a bunch of images that look good and make you feel good when you're talking about like the difference between dying from lung cancer in one year versus six months.

Like, okay.

Right.

But this is not appropriate for the patient to be navigating or bringing up or advocating for.

It's really just a giant waste of everyone's time.

Yeah.

It's like 20 years ago when the Nexium commercials would come on, they called the Little Purple Pill.

Yeah.

And now we're like, PPIs are not as good as we think they were.

Yeah.

Well, oops.

Yeah, exactly.

All these like new medications for like type two diabetes that have like pretty severe side effects.

Like, is it Jardians that has like crazy like-

About metabolic acidosis?

Yeah.

You can just like-

Euglycemic DGA.

How about-

That's like asymptomatic.

UTIs.

Yeah.

Right.

You get in a car wreck after you took that stuff, and then all of a sudden you're in a metabolic, you're crashing in a metabolic crisis that nobody can figure out.

Right.

Because-

And like-

You were taking your diabetes medicine yesterday and they didn't feed you the day before because you were in surgery all day.

Yeah.

Or like the GLP-1 agonists that people are taking, those are also diabetic, but also known as ozempic.

Right.

The GLP-1s are associated with higher risk of aspiration with surgery.

Because of things like the slower gastric emptying.

Yeah.

Now you're having to make sure you're really screening these people because-

Well, and I just think because diabetes is such a large population, a lot of my parents' friends take all these random meds, and they have no idea what they're taking.

They're just taking it because it's like, oh, I saw it on the ad and then my primary care said it would be good for me.

And they have no idea what's actually going on with their body.

Now they all have a million off-label uses too.

Yeah, that too.

Now these meds are going to save our kidneys, treat our SIADH, help with some weight loss, treat our cardiovascular health.

Make you feel good.

Eat an vegetable.

We should just all be on an SGLT-2.

And there it is.

Yeah, sprinkle it, sprinkle it, but yeah.

So you're bringing us right back to the functional medicine question, right?

What is causing the disease?

How do we fix the behaviors that are making us ill?

And eating fruit could probably be the answer for some people, right?

So just go outside.

People need to go outside and take a walk, get off the social media, get off your devices.

Because I think that the true problem lies in that people just don't want to do the work, right?

So then the medicine takes out the work.

I think a little bit of it is that a lot of it is just poor education.

They just don't know.

Well, and I'm not saying that the benefit of medicine is not there.

There is benefit to medicine.

There are people that live in chronic pain.

I take an SSRI every day for my anxiety.

That is something that I need help managing with the medication.

But you can also talk about adjunct therapy, that life-hacket, like talk therapy, coping mechanisms.

Exactly.

That is not as profitable.

So I think that the idea is that.

When you follow the money, the money talks, the money is what gets the commercials on the TV.

The money is what gets in front of you because then somebody can sell you something.

When it's like exercise more is the answer.

No one's selling you anything.

Nobody wants to do that.

So they don't get the airtime basically.

Right.

And then I think about like, just TikTok alone has made me think I have like 20 different skin disorders.

And like that just gets in your head.

And then people think they have this and then they go to get a diagnosis.

And then they get mad that they don't receive that.

And it's just like a cycle.

But then you can go, the other side of that is like functional medicine is saying, take all of these supplements.

And it's like, again, the supplements, you could probably just get from.

Yeah, I want to hear about the supplements.

Okay.

The FDNC Act in the 1920s was not the end of regulation for medicine.

Okay.

So I kind of, I don't want to leave you guys like horrified that that's the state of play right now.

Okay.

There's an ending.

Just say your ingredients.

Forget the rest.

I mean, it comes on the heels of an absolute travesty, which is a medication called thalidomide, which was marketed for nausea and vomiting in pregnancy.

Turns out to have caused severe deformities in the children born of mothers who were taking it.

So did they have flipper babies?

Yeah, exactly.

That's it.

Yeah, exactly.

And so ultimately it wasn't until after this that they amended the Food Drug and Cosmetic Act to require that you prove your medication is both effective for the disease state that you say it is, and also safe for the general population to be exposed to.

Yeah.

And so before that it was free game, as long as you were saying that thing is real.

But now there are truly rules that require the science to be there.

And while you can see where that makes sense in that context, it also builds on this issue of the Flexner Report, right?

The science has to be there or we can't say it's medicine, okay?

And so to your point about supplements and natural products, now we have an even stronger divide between those who can prove that their medicine does the thing that they say it does, and those other things that are natural products that people have been using for 5,000 years and probably helped a few people along the way.

But that doesn't get past the FDA, that doesn't get past, that doesn't get a commercial.

So yeah, bringing it into the natural medicine side of things, it's definitely true that we have lost some perspective on these traditional medicine things, right?

So they say that Ayurveda is a medical practice of holistic health that's been practiced in India for over 5,000 years.

Yeah, I know what it is.

This one's up Kate's alley.

So yeah, so Ayurvedic medicine is a tradition that dates back over 5,000 years.

Okay, we have evidence of writings and true anthropological data that says the people were doing this and are still doing this 5,000 years later.

Traditional Chinese medicine is probably as old, but it does blur the lines between science and art and the natural world.

What's interesting now, though, in America, I guess, to me, is the management of these things and the regulation of these things is hinged only on the communication about what they do, okay?

So these natural products are typically regulated like foods, more so than they are regulated like medicine.

And so you have to, you can't make it in a factory that's covered in rats, but beyond the food safety aspect of it, there's not much requirement.

The FDA and the F, so it's actually managed by the FTC, the Federal Trade Commission.

And these are the people that, you know, let Bernie Madoff do whatever he wanted to do, et cetera, et cetera, et cetera.

And now they have this like, probably one room office of people who manage the language around natural products.

But I'm sure it's well funded.

Yeah, no.

Yeah.

But, and their job is to police what you can say about a natural product and how it works.

And they're not allowed to use language that implies or states that it treats disease.

They can tell, they can say things about how it might improve gut health, but they can't tell you it.

It supports adrenal health.

Yeah, but it can't treat, they can't say this treats your IBS.

Right.

And that's just because they don't have the research studies behind it or like?

Well, it's, it's entirely based on the marketer's choice to make it, to market it as a medicine or as a natural food product.

They jump here if they market it as a product.

Exactly.

Right.

Profit as much.

Okay.

Yeah.

And exactly.

And so.

Hit it on the market faster, I assumed.

Right.

Research is like so expensive, right?

Yeah.

So expensive.

So expensive.

And if it's not funded.

So if you look at the fine print, if you look at these articles that are like funding medicine, the doctors are prescribing, like Jardians.

We're talking about Jardians.

Yeah.

Jardians just recently just went through all of these, you know, random control trials to see like, does it benefit CHF patients?

Right.

You look down at the bottom and there's always a place that you should say like, you know, where is it funded?

Where are my potential biases?

And like, it's the drug companies that are paying for the medicine.

The drug companies are paying for the research and the drug companies are already wealthy.

But even then, you have these tiny little companies that like are saying this, you know, herbal product has been used for centuries for, you know, X, Y, and Z.

But the research is not there because there's no funding for it.

And it's because who's going to fund a project like that?

It's hard enough to fund research if you don't have a drug company that's backing the research.

Uh, Kait, what can the people do?

What can they do?

Yeah, you know what, Megan?

Yeah, we're mixing it up.

You know what I want you to do?

Instead of scrolling on down, what I'd like you to do is pick up your phone right now.

Pick it up.

Yeah, pick it up right now.

Look it up.

I'm doing it right now.

And if this if this episode resonated with you and you were like, you know what?

This person would really like to listen to this episode.

Will you just text that person right now?

Send them the link to the episode.

We'd love for them to hear it.

And then after you do that, just scroll on down, leave us a five star review.

Then leave us a five star review.

Thanks for joining.

We'll see you next week.

See you next Tuesday.