Return to Healing: Common Sense Health Care

Andy and Alan
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The authors of A Return to Healing give you tips and advice about how to improve your health and negotiate an often deceptive health care system.  And it all comes down to common sense!

  1. Sep 13

    The Medicalization of Aging

    Age has become a diagnosis meant to be treated, not a time of your life to enjoy living.  More medicines, more specialists, more tests, more fear.  We have transformed age itself into a disease as we measure and "fix'" everything we can find, a windfall for the medical industrial complex, but a tragedy for the trusting souls who are tossed into the medical fire.  Alan and Andy use data and their collective 75 years of experience to show how errant this approach is. Slow medicine, a focus on function and symptoms, a leap away from tests and specialization are the ingredients of successful aging.  We talk about all of this and how patients can get back on track, even if the medical system will likely continue to steamroll its older victims. In addition to our own book, Return to Healing, we highlight some other books that have explored the issue of slow medicine and the medicalization of aging: Byock, The Best Care PossibleSweet, Slow MedicineLazris, Curing MedicareHadler, Rethinking AgingMcCullough, My Mother, Your MotherIt's important to know that your later years need not be spent chasing numbers and falling prey to the fearmongering of specialists and drug company propaganda.  Work with your primary care doctor and let the medical system back off and help you to live well and long. "The greater the ignorance, the greater the dogmatism."  -William Osler, MD www.returntohealing.com

  2. Aug 30

    How to Age Well

    We grapple with the question many people ask: how do we age well, live longer, live better?  That is why many people go to the doctor, why they check their numbers and take medicines, why they buy that apple watch to monitor nearly everything!  But as we discuss, none of that is the ticket to longevity.  And is longevity the only barometer of aging success?  We argue it is not. We discuss that how long you live healthy and independent is, to most people, even more important than how long you live.  Independence, mental acuity, the ability to engage in activities and be with people important to you is part of what we call quality of life, and how long you can maintain that is crucial.  Our country does the worst in the world on that score.  While we have among the lowest longevity of industrialized countries, we have even a lower health-gevity, how long you can remain healthy.   Taking a medical path to wellness when you are old is often a way to make things worse.  We discuss why this is the case, and what's really important including your social interactions, your family, your diet, your mobility, and your happiness.  Drugs don't fix any of that, lowering your cholesterol and blood pressure can make those worse without helping you live a day longer, but paving a path towards wellness through your own devices is always the best way to go.  There is science behind this, and a lot of experience, and we'll lay it all out. "The greater the ignorance, the greater the dogmatism."  -William Osler, MD www.returntohealing.com

  3. Aug 24

    AI and primary care: how to use it responsibly

    AI in such mediums as Google, Chat GPT, and Claude is becoming a device through which doctors and patients can make diagnoses, prescribe treatments, and distill symptoms down to diseases.  If you are dizzy, what can be causing it, is it an emergency, how do you fix it?  What if you are having chest pain?  Are all your medicines necessary, can there be interactions?  In some ways AI can answer simple questions, but like most protocols and many doctors, it will typically suggest a conservative approach with more tests and visits, sometimes a trip to the hospital, because it cannot fully understand you as a person and the nuances of how your symptoms may not be diagnosable through the algorithms and the large studies it can access.  Primary care providers who know you well, who know the data well, who understand how to apply that data to you and how your symptoms may not fit in protocolized boxes, are far more likely to find the right diagnosis in conjunction with you.  That's something a computer or protocol or even physician-held calculator can't do.  This is why good primary care is not replaceable with AI.  We  run through several examples of this and show where AI is useful and where it can be lacking.   "The greater the ignorance, the greater the dogmatism."  -William Osler, MD www.returntohealing.com

  4. Aug 17

    Vaccine Nuance: Politics vs Science

    The Trump Administration has elected to decrease the recommended vaccine schedule for children, and the political boxing gloves came out immediately.  The mere notion of vaccine reduction, and the fact it occurred in Trump's administration, made the issue a left vs right slugfest. But hold on, these changes have been suggested by some of the most prominent scientific minds in our nation, and they mirror what's already been done in Europe based on ample evidence.  They are not anti-vax; they promote certain vaccines with proof of efficacy and dispute the need to recommend others that do not.  Today we not only discuss the science of vaccination, and dispel the utility of their being anti-vax and pro-vax camps, but also go through many vaccine controversies and take our own fact-based center road.  Science should not be imbedded in politics and should not be driven by specialty medical societies and drug company ads.  We need sense, and every patient needs a good primary care provider to discuss what the internet and the media has turned into political infighting. "The greater the ignorance, the greater the dogmatism."  -William Osler, MD www.returntohealing.com

  5. Aug 9

    Saving Primary Care

    We are two primary care physicians with 75 years of collective experience. We both are passionate about what we do, we get to know our patients well, we dig into issues and don't accept protocol robotic medicine, we typically offer a counternarrative to specialists, we are patient-centric and believe that patients deserve the truth about illness and treatments (no matter how nuanced and messy that is) and that they should make the final decisions, and we stress wellness far more than over-medicalization.  But our way is being pushed aside in favor of a number-based, specialty-oriented, over-aggressive dogma that makes the patient into an asterisk and pushes tests/procedures/medicines over holistic changes.  More and more corporations and health systems are using nurse practitioners to create an illusion of primary care but whose real job is to make money for the hospital or corporation.  More and more primary care doctors are either creating concierge practices that can help just a few who have money, or are being squeezed into 15 minute visits that negates their true purpose.  And virtually no medical students pursue a primary care profession.  We discuss all of this in detail in our book Return to Healing, and here we provide experience, statistics, and insight into what's going wrong and how we need to fix it.  Without robust primary care we will keep paying for corporations, hospitals, and specialist doctors to spend more money without any improvement in health or longevity, as every study and all our experience has shown us. "The greater the ignorance, the greater the dogmatism."  -William Osler, MD www.returntohealing.com

  6. Aug 2

    What to say about Anthony Fauci: Viewing the Past after the Congressional Hearing

    Alan and Andy both lived through COVID not on the sidelines but in the center of it all.  Both took care of patients directly, Alan in a hospital for weeks at a time in the epicenter of the pandemic, Andy in multiple long term care facilities.  Andy also wrote a book about COVID communication and studied the virus and public health responses in other countries.  So what do we think about Anthony Fauci's leadership, and about the Congressional hearings?  Well, this is a 45 minute podcast, and we could have spoken for hours, so that's what we think about him. There are two issues we discuss.  One is whether Dr. Fauci committed criminal acts.  This is what he was being investigated for, and after being pardoned and then still pleading the 5th over 100 times, it is likely we will never know.  Clearly the nation deserves to know, and that may or may not happen. But to us, the second issue is more crucial.  Did he do a good job during COVID, and even more significantly, did he cause harm.  The United States suffered the worst outcome in the world during COVID; the most deaths from both the disease and from our response to the disease, a response largely orchestrated by Dr. Fauci.  Under his leadership Dr. Fauci dictated our response to COVID in an atmosphere that turned its back on science.  Dr. Fauci made multiple policy declarations automatically taken up by our nation's leaders, none of which had any scientific basis of reality, as we knew then, and we have truly come to terms with now.  He did not instigate a single scientific study nor did he take advice from other nations who were conducting research and opening their societies, all with fewer deaths.  He advocated censorship of those who disagreed with his policies or who suggested other policies.  And in the end, he did not educate doctors or the American public about how to best protect the most vulnerable from COVID, how to open society for those less vulnerable, and which drugs likely would rectify the manifestations of the virus (which we already knew about before the virus hit our shores but which he never advocated) and which were experimental.  Needless to say, Alan and Andy believe that his leadership during this crisis was non-scientific and dangerous.  And if we're going to learn anything before the next crisis, it is crucial we stop politicizing this man and his actions, and have a full accounting of his actions and what could have and should have been done differently.  Science is about discourse, study, disagreement, trying new things when what we're doing isn't working.  None of that occurred under Dr. Fauci's watch. So as we think about Anthony Fauci we must reevaluate what we expect from our medical leaders and from the medical system.  To us, it's not about him not remembering what color tie he is wearing, or even if he was responsible for the lab leak.  It's about our medical leaders and our medical system.  In these arenas he failed us miserably, as does our medical leadership on a daily basis. "The greater the ignorance, the greater the dogmatism."  -William Osler, MD www.returntohealing.com

  7. Jul 31

    Amyloid: The New Magic Bullet for Specialists and Drug Companies

    We are hearing more and more about amyloid, a protein that can be deposited in the organs of humans and cause great harm.  Or is that too simplistic?  We now have very expensive and poorly tested drugs that will reduce amyloid load in the heart and brain.  Because the drugs are available, now amyloid has become testable and has reached a level of great importance.  But just how accurate is it that we need to look for amyloid in these organs and if we find it we must treat it with drugs barely old enough to have any validity?  Is amyloid really the cause of disease, or is it an innocent side product of that cause, or is it even a way for the body to protect itself?  We just don't know.  We do know that the one study showing its impact in heart disease was financed and designed by the drug company that makes the amyloid-busting medicine, and the study is so flawed that even we can tear it apart.  And we know that the drug that treats amyloid in the brain has never been shown to improve cognition but does cause a huge number of brain bleeds.  How do we assess new technology and new ideas in a scientific manner when specialist doctors and drug companies leap on them as being the next coming of God?  We'll discuss the facts we have and the uncertainly that exists, and show how amyloid is much like other miracles in modern medicine: the next great discovery until it's not.  The end of this podcast was struck with technical issues, so please pardon the abrupt ending! "The greater the ignorance, the greater the dogmatism."  -William Osler, MD www.returntohealing.com

  8. Jul 31

    The Hypertension Controversey

    The cardiology community is quite adamant about their newest guidelines, whether it's about pushing LDL cholesterol below 70 or driving systolic blood pressure under 120.  The patient's age, wishes, symptoms, and even the full breadth of science behind these dogmatic declarations is irrelevant; protocols are above all that.  We will discuss the truth behind the dictate that lower blood pressure, especially once it slips below that magic threshold of 120, is  always helpful.  In fact, as most studies show, it's dangerous much of the time.  While guidelines reduce complex human beings to simplistic allorhythmia, some doctors are pushing back, and we will look at their critiques.  In this podcast we discuss why lower blood pressure is often the wrong choice, how the guidelines are more about pushing drugs than helping people, and why specialist doctors so often fall into the pit of treating people robotically rather than within the nuanced world of medical science that values care and compassion, that is patient-centric, and that is tempered not only by a few drug company studies by rather by the full spectrum of medical literature sprinkled with the lessons of experience.  That was Osler's message, and through the lens of hypertension we'll see how far off the rails our medical community has drifted. "The greater the ignorance, the greater the dogmatism."  -William Osler, MD www.returntohealing.com

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The authors of A Return to Healing give you tips and advice about how to improve your health and negotiate an often deceptive health care system.  And it all comes down to common sense!

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