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Oct. 25, 2023 - Epoch Times
47:34
Doctor Explains Impact of Legalizing Psychedelics in California | Anthony Kaveh
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Time Text
The anesthesia is like the canary in the coal mine.
California legislature is working on legalizing psychedelic drugs like mushrooms.
It's hard when they slam the door on you, when you're coming from a place of genuinely just wanting to help patients, not out of a corporation or a political agenda.
Do you think this will make your job impossible if these psychedelics become more and more common and people use them and they think it's medicine?
My guest today is Dr.
Anthony Cave.
He's an anesthesiologist in the Bay Area.
Well, we go to sleep.
Within seconds, it looks like they're about to die.
We have to wake them up.
They fortunately lived.
And of course, they said, oh, how'd the surgery go?
And by the way, it's heartbreaking to tell somebody that we actually didn't do your surgery at all.
Because from the patient's perspective, the lights go out, the lights come back on.
They don't know that there's a whole group of people in here doing CPR trying to bring them back to life again.
They have no idea about it.
He's here to give us an insider perspective on what doctors are facing in the operating rooms in California and the impact of this law on doctors, patients and Californians.
That I grappled with was being the last person that somebody saw before they passed away.
So if people wake up, and they don't wake up fully to talk to the doctor, but they're in the middle of the operation.
If you had the responsibility, you need to hold their hand.
You need to tell them what went wrong.
I'm Siamai Korami.
Welcome to California Insider.
Anthony, it's great to have you on.
Welcome.
Thank you for having me.
We want to talk to you about what's happening in operating rooms in California.
You have a first-hand view of what's happening.
They're going to an anesthesiologist.
Can you tell us what's going on now?
Operating rooms in California and the operating rooms that you work in.
When you're coming in for surgery, you're hungry because you haven't eaten since midnight, you're cold, you're wearing a gown, you might go on a cold table, they might take all your clothes off, you may not know anyone in the room, there might be 10 people in there you've never met before who are going to be there in the most vulnerable moment of your life doing things to your body that No one has ever done before.
In any other place, this would be a criminal charge if someone's cutting into you while you're unconscious.
But in the operating room, this all happens and we take all your memories away.
It's very unique in the world.
And what happens to you when you're in that altered state of consciousness, under anesthesia, with this amnesia that we're inducing with medications, is remarkable because the body can open up like a book.
You need to know what to look for.
It's not always 100% specific what the signs mean.
Kind of like when you have a dream, you know, things come in dreams, you don't always know what they mean.
But the body opens up in ways that gives us a privileged look into the life of the patient that we're caring for.
And things come up that we often don't share with anyone else.
You know, if you're under sedation, you might just blurt things out.
If you don't have a breathing tube, People have told me that they've confided in things with their anesthesiologist that their priest has never heard.
If you have a breathing tube in place and you're unconscious, you're in a medical coma under general anesthesia, the body still opens up in ways in how it interacts with the anesthesia, whether it's through how your heart's beating, your breathing patterns, the brain signals when we're monitoring the brain.
In all sorts of ways, these are signatures for what has happened to the body in the past.
We have this concept called the body keeps score.
So past traumas, maybe you're taking medications, prescription or non-prescription, or illicit substances that you're taking, these have an effect on the body just like that trauma does.
So you have a view, it seems like from the operating room, from your profession, you kind of have a pulse on what's going on in the substance abuse and addiction in the society, in your community, right?
That's true.
When I was a resident in Boston, marijuana was not nearly as widely used, at least in my scope of experience.
As here in the San Francisco Bay Area.
Immediately, I noticed that, wow, patients are responding differently here.
They're needing much, much higher doses than I ever experienced back in Boston.
As one example, now of course, this is anecdotal to an extent, but the preponderance of data that's showing these trends It's certainly validating for marijuana, which is new.
For opioids, there's no question.
When patients come in with opioid addictions...
So this is like meth or other things or...
Well, for opioids, if they're abusing or using opioids on the street, when it comes time to surgery, they're going to need a lot more.
That is very well established because if you're taking oxycodone every day for whatever baseline purposes, when you come in with a real surgery now where there's suddenly a huge pain stimulus, that baseline level of oxycodone that might put you or me to sleep, And overdose us isn't going to touch their pain because that's where they're living at on a regular basis.
So now they're going to need much, much more.
If you haven't checked out CaliforniaInsider.com, we highly recommend you do that now because we're going to have a lot of news and videos there.
And on top of what we have there right now, we're building a really big platform to cover what's happening in California so you can be informed.
We're going to have more shows, more videos from all aspects of life in California.
Go to CaliforniaInsider.com and we'll see you there.
And there is some laws that are in the legislature right now.
They want to legalize psychedelics.
What are your thoughts on this?
The legislation that you're referring to is for the natural psychedelics.
And there's unfortunately a lot of misinformation that just because something is natural, it is safe.
Once again, where did fentanyl come from?
It's synthetic, but it came from a plant chemical structure.
All those life support medications I mentioned are powerful at the right dose in the right context at the right time, but they're all lethal at the wrong dose.
Just because something is natural does not inherently mean that it has unbound safety that should be flooded into a market.
My biggest concern is with what happened with marijuana.
Natural plant has been used medicinally for thousands of years.
It's even found in the pockets of mummies.
I mean, not Egyptian mummies, but in the European subcontinent.
There's no question that it likely has some, if not many, health benefits.
I'm not anti-marijuana, I'm not anti-psychedelic, but I'm anti-exploiting vulnerable populations for corporate profit, Using natural therapies as a moniker, because that hurts patients.
I'm the one who needs to tell the patient that something went wrong.
I'm the one that needs to tell the family that something went wrong.
That level of responsibility I don't think is shared with people who are writing these laws, from my experience in communicating with them.
They seem to be a little Disconnected from the clinical reality of working in the trenches and seeing pain and suffering that could have been averted had there been proper information.
So specifically for psychedelics, there is a tremendous amount of evidence for their benefit when used the right way.
When used, the ways that studies have used them.
So for marijuana, the natural marijuana with a THC concentration of 2, maybe 3% is different than the marijuana that we have today that has been engineered to have a THC concentration above 30%.
How can we compare that to the medicinal purposes that have been seen in studies that used a completely different medication?
So my concern is if we say mushrooms that naturally have a certain psilocybin content, Can have medicinal benefits.
They're natural.
Fantastic.
They are very safe in the right context, in that natural form.
But what is to stop legalizing that eventually What is to prevent that from going down the road of marijuana where now we're trying to find mushrooms with higher and higher concentrations of psilocybin, where it's no longer the same natural plant that was studied that had been used in the Americas for hundreds and hundreds if not thousands of years.
When someone can make a profit off of selling something, they may not have overtly addictive properties the way that opioids do, But still represent a harm psychologically when used the wrong way.
And the legislation that you're referring to does not have barriers in place for educating the public or for protecting them from a future roadmap that might look like what's happening with marijuana.
Remember, if patients need double the anesthesia from heavy marijuana use, is it reasonable to assume that there is not A significant change happening in the brain neurochemistry, in the brain's anatomy that might later lead to complications in 5, 10, 20 years?
How can...
The anesthesia is like the canary in the coal mine.
There's something happening in the body because the anesthesia is revealing it at this early stage.
This needs to be heavily in place if we're going to protect patients from this mass widespread legalization of however natural these substances are.
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Now let's go back to the interview.
Now, are people coming to you guys, is there a lot of substance abuse and people coming into your, to get operations?
Can you tell us more about this?
Is this happening?
Well, let me ask you a question.
What is a substance?
That's a good question.
It is a good question.
What kind do we have from meth to cocaine?
Can you tell us what you see?
I can absolutely, and I can tell you that the reason it's so hard and why I ask you that question is because as a society we don't call everything a substance or a drug or a medication because everyone has their own idea for what a drug is.
The most common one right now in California where I practice in the San Francisco Bay Area is going to be marijuana.
And for many reasons, before every surgery I do a thorough interview with the patient I need to know everything about their medical history, right?
Because they're going to be under anesthesia.
Part of that medical intake requires asking about all their medications, any substance use, drugs, etc.
Because like I said, these have implications under anesthesia for your safety.
And terrible, scary things can happen under anesthesia when the full medical history isn't disclosed.
It's probably the number one reason for bad things happening for the majority of elective surgeries.
Because anesthesia is very safe when we know the patient that we're treating.
It's when unknowns come up.
Unknowns often come up when I'm asking about what substances or what drugs do you use.
Marijuana is a little bit unique because some people view marijuana as a medicine.
Some people view it as a drug or a substance or as a supplement or as a natural healing thing.
I'm not saying any one of them are wrong.
Unfortunately, marijuana falls in this gray category for numerous legal and political issues that we don't hear about it and we know How much chronic heavy marijuana use increases anesthesia requirements because the changes that are happening in the brain, whether you're young or old, very reproducible and have consequences in the operating room and in recovery after for pain management, management of side effects.
What kind of consequences does it have if you didn't know somebody was taking a lot of marijuana?
The most common side effect is going to be an increased anesthesia requirement.
So I look at you, and based on your medical history, the medications you take, your height and weight, I come up with an anesthesia plan, including doses for how much there's going to be some spread.
It's always one of these curves, and there's an outlier sometimes.
But for most individuals, we give enough anesthesia to reproducibly turn off all those nerves that I talked about so that you can tolerate The surgery and not have any awareness of the situation.
I call my patients the night before surgery because I believe it's the right thing to do.
Patients are scared.
They have questions.
And the more we can build that trusting relationship, like I said earlier, if something bad happens, a side effect, a complication, they know that their care team is caring because at least they've heard my voice.
If nothing else, they say, hey, Dr.
Kaveh will be there with me tomorrow.
If nothing else.
When you're scared and hungry and cold in this operating room, that matters.
I've just heard the feedback that it helps.
What happens when you make these calls, like when you're talking to the patients the night before?
The majority of patients appreciate speaking with their doctor the night before as an opportunity to ask questions, to get to know them, and share their concerns.
One of which is what you're talking about, how much am I going to get?
How do I know that you're not going to give me too much?
We all hear about fentanyl in the news and all that, and fentanyl is one of the many medications that we use regularly in the operating room.
There's a subset of patients that get frustrated, though, and they say, why are you asking me all these questions?
I already told the other nurse or the other doctor, look it up in the system, why are you asking me again?
And it's...
I don't want...
There's a lot to unpack here about distrust often in the medical system, frustrations, maybe sensitive abandonment in the past, but it's...
It's important to recognize that we need to know all this about you because it influences how you're going to wake up.
You had asked about complications earlier.
Well, it's not just waking up after surgery, because of course we want you to wake up, but we want you to wake up comfortable, not without serious side effects like bad nausea or vomiting or unmanaged pain.
Or having potentially risks of cognitive problems after you wake up.
There's many potential complications with anesthesia.
And the more we know about the patient, the more they can be optimized and ready, beginning with the mindset and the trust in the doctors, the more we can minimize those harms.
When I ask about substance use, including marijuana, this does have implications because, like I said, you just waking up at the end of surgery is good, it's powerful, but human beings are more than just zero and one.
It's more than just being alive or being dead.
We want patients to be comfortable and to not have PTSD or have post-operative depression, have unmanaged pain, have their pain from surgery turned into chronic pain that they may then turn to fentanyl or other opioids to self-heal with.
So in medicine and surgery specifically we call this healing the body but breaking the mind.
Because of all the stress going around during surgery and you throw anesthesia, you throw a lot of pain.
So if people wake up and they don't wake up fully to talk to the doctor but they're in the middle of the operation but they can That's going to give them trauma, right?
It can.
It can.
And if people don't tell you guys that they are doing drugs, then you don't give them enough dose, right, to get them?
Is that happening?
That's one of the risks.
How often it happens, we don't know yet, because how many places in the country where we're studying this in the United States is marijuana so readily available?
It's only been a couple of years in most states.
However, early data is certainly showing increased anesthesia requirements.
From a precautionary principle, we don't want to potentially underdose because of the risk that you just mentioned.
But we also know that marijuana, in particular, can have complications with postoperative pain, postoperative nausea and vomiting.
There's other substances as well.
The most dangerous is probably going to be methamphetamines or cocaine because these may actually lead to patients not making it through surgery.
I personally have had a handful of cases where patients were adamant that they had not used anything recently, only to find that we couldn't even start the surgery because the second you go under anesthesia and those nerves begin to turn off, If there's any catecholamine surge or any meth still in the system, these can cause rapid swings in blood pressure and heart rate that can be fatal within just a number of minutes.
And the most dramatic case that I can think of in the last year was where literally the patient fell asleep and we had to wake them up as fast as we could because they couldn't support.
Remember I said the heart turns off?
Well, the combination of anesthesia and residual meth can cause the heart to not beat and cause the blood vessels to collapse and you don't give blood flow to the heart or brain, leading to heart attacks and strokes depending on where it happens first.
It can be catastrophic.
Those are extreme examples.
Certainly opioids.
So the patient could die, in a sense, coming to get an operation, coming to you guys to get an operation for whatever it is, knee surgery or whatever, and then they could...
No question.
Those are extreme cases where absolutely those can lead to death.
I had a patient once who I suspected had been struggling with multiple mental health challenges for years, based on how they look, based on how they spoke, and they denied using any substances, which is always a very tough spot.
Sometimes we do year-end tests, sometimes we don't, but it puts the provider in a difficult situation because you don't want to judge.
But you also have a responsibility.
This is one of the hardest, hardest situations.
Usually what I do is I ask everyone else to leave.
I shut the door and I have a heart-to-heart.
And I have to be a little brutally honest that I understand there could be stigma.
I know there's a lot that goes into you being here.
You've taken time off from work.
You have a plan for someone to help you recover.
I don't want to postpone your surgery unless I absolutely need to, unless your life is at risk.
Is there any chance that you may have used X, Y, and Z in the last week that might jeopardize your health or safety?
What would I tell your family or your loved ones if something happened?
Nope, nope, Doc, I haven't used anything.
Well, we go to sleep.
Within seconds, it looks like they're about to die.
We have to wake them up.
They fortunately lived.
And of course they said, oh, how'd the surgery go?
And by the way, it's heartbreaking to tell somebody that we actually didn't do your surgery at all.
Because from the patient's perspective, the lights go out, the lights come back on.
They don't know that there's a whole group of people in here doing CPR, trying to bring them back to life again.
They have no idea about any of that.
So first of all, it's hard, because all of that commitment, it may have taken weeks or months to lead up to this point, and then completely canceled.
Not like cancel culture canceled, but canceled literally, right?
And then they say, well, you know, yeah, I did, I did, you know.
Last week.
I thought it would be out of my system by now.
These are tough situations to be in.
I had a patient once who came in for a very minor knee surgery and they denied using anything.
There was a paper chart that said something about meth use.
You have to do a lot of detective work.
Non-judgmental.
I want to be very clear.
It's not about shaming.
It's not about judging.
These are not productive.
I'm all about growth mindset, being compassionate.
But when I see something like this, I need to speak up.
I can't read this.
It would be unconscious-able if I didn't speak up after reading this and not approach the patient.
The patient says, nope, haven't used anything.
That was from years ago.
So once again, you know, close the doors.
Same conversation we had.
Do you have kids?
What would I tell your spouse, your kids?
And they said, okay, yeah, it was actually a month ago.
Like, really, only a month ago?
A month and a week make a very big difference.
Oh, it was actually a week ago.
Well, at that point, we're done.
But it takes a lot of time to go from years to month, yeah, to just last week.
That patient was rescheduled.
They came back again, because I said, we can't do the surgery, no.
They came back again, and same conversation.
Have you used?
Because I recognized them.
They recognized me.
And this shows addiction.
I don't mean this to be a joke, but I have to say no, did you use?
Nope, I haven't used anything.
Really?
When people are awake and they have these substances in their body, sometimes you can tell based on how they're speaking to you, off of their heart rate, their blood pressure, jitteriness, etc.
This individual, this patient, I was concerned about having something in their body.
And after five minutes of questioning, asking about the family again, once again, not in a blaming way, but in a truly curious way, because I need to know for your safety.
While I was driving across the border and I had a little bit and I had to take it before I got checked in my vehicle.
When was that?
Three days ago.
And it breaks your heart because this individual needed the surgery.
They've been in pain needing the surgery for months.
And yet their brain is diseased in the way that it can't reason.
I can't take this medication if I want the surgery.
I need the surgery because I've been living in pain.
I can't work.
I can't provide for my family.
Yet, you see how they can't abstain.
They literally cannot abstain for two weeks.
I was calling a patient the night before surgery and I left a voicemail because it didn't pick up.
A lot of people think I'm a telemarketer.
Very unfortunate.
So I leave a voicemail.
Usually when we get the number, it calls from a random number.
We don't know.
We don't pick up that.
And then if they do pick up, they're often like, who is this?
I'm like, Dr.
Kaveh.
How'd you get my number?
Sir?
Don't call me again.
So I sent a text as well.
Because the text, at least, I have a moment.
So this individual didn't pick up, but they responded.
They called me back a little bit later.
And they called back saying, who is this?
Who is this?
Mind you, I'd already sent a text and left a voicemail.
Who is this?
I can't talk right now.
Sir, you called me.
I'm going to be your anesthesiologist tomorrow.
I wanted to make sure that I answered your questions.
I explained to you the process so you know what to expect.
If you don't know what to expect, you can't be prepared for surgery.
We prepare to give speeches.
I prepared to talk to you today.
If you don't prepare for something as big as surgery, how can you have the best optimal outcome if you're not prepared?
So anyways, I can't talk right now.
Dr.
Cavell, beer, hung up.
I'm like, that's kind of weird.
Unusual.
This is an outlier.
Well, he shows up the next morning and is asking who to give away all of his belongings to.
It's a young individual, young man, to the point where the patient's next door Usually before surgery, elective routine surgery, you're not concerned about giving away all your belongings in case you, quote, don't make it.
Especially if it's a minor surgery, you're a young patient, no health problems.
So people are getting weirded out.
Who is this person next door?
So the nurses call me and they say, hey, a little bit of a heads up.
There's a little bit of drama going on here.
I end up talking to them and they are like I'm describing the physical symptoms on the vital monitor with the heart rate, the blood pressure.
You see the jitteriness, how they're speaking.
I had to ask the same question.
It's always uncomfortable because, once again, you don't want to come from a place of judging or being on a pedestal from an ivory tower.
I'm just being level with you because I'm responsible for you.
I want to take the best possible care of you.
I need to know what might be in your system.
So yeah, they had cocaine.
When I called them, they were in the middle of it.
That's why they were probably so...
Kind of out of it.
Yeah, to say the least.
And they left, and they left me a tip.
Give this 20 to the anesthesiologist.
You saved my life.
I'm not even kidding.
I'm not even kidding.
But there's a lot that goes on.
Like I said, the vulnerability, the stress before surgery.
People act in ways.
You didn't get a drop of anesthesia from me, right?
This is just the stress of anesthesia, leading people to do what we might call quirky things.
I'm not making fun of them, but just recognizing that human behavior changes under stressors.
So imagine what happens when they get the first drop of anesthesia.
What comes up with all these stressors?
That's what it's like before anesthesia.
With anesthesia, there's a lot that can open up.
You don't want to make fun of it.
You want to obviously be there and listen and be compassionate.
It's hard in this medical system to do so because it's like a meatpacking factory.
Pardon the analogy.
It's like a mill.
You have to constantly go.
There is no...
Can you explain to us what it looks like?
Imagine a production line for Coke or any type of soda.
This can comes in, they pour stuff into it, then they seal it, they pressurize it, and it goes out.
It keeps going.
Then you get a six-pack, whatever, and you shrink wrap it and you send it out the door.
Unfortunately, the way the medical system is set up now is in such a way that incentivizes quantity over quality.
So in a day, we may have, for example, I may have five cases.
It's literally them coming in, I fill them up with anesthesia and put a breathing tube and then we pressurize it, they do surgery, they wake up and then ship them out.
And it's disheartening.
Not just for me feeling, forget me feeling tired and whatever, not eating, not peeing.
You know, we have a phrase in residency that they train us when you're going through residency.
They say, it's like the golden rules.
They say, eat when you can, pee when you can, sleep when you can.
Because that's what it's like, especially in one of the more intensive specialties.
But forget us.
Once again, we don't want a pity party here.
The patient, they're coming in so scared and they're getting maybe five minutes with the nurse.
Maybe they're meeting their anesthesiologist for the first time that day.
Two minutes with the anesthesiologist who's going to be taking care of their life for the next two or three hours.
And then going into the operating room, like I said, hungry, tired, scared, cold, wearing this gown with their behind showing if it's not tied up properly.
It's like a very scary environment, you know, all bright lights, this cold table.
And then you just feel so depersonalized.
You feel like you're just a meat bag.
How can we be compassionate?
How can patients feel they're getting the love and care that they deserve when this is in the environment, when this is what they're coming into in the most stressful, mysterious, scared moments of their life?
It's hard for everyone, right?
It's not fair to patients, but unfortunately, this is all the incentive of a greater system, and it's why doctors often feel burnout, because we know it's not helping patients.
Like I said, fixing the body, but Hurting the mind, healing the body, breaking the mind, this isn't a paradigm that anyone wants to practice in.
Why would we want to?
We try our best, of course, but we can only do so much as an individual, which is why speaking up with legislators, speaking up with local officials, and it is hard when they slam the door on you.
When you're coming from a place genuinely just wanting to help patients, not out of a corporation or a political agenda, right?
It's the power of being in the trenches and I wish I could bring someone from Sacramento or bring someone from the Board of Supervisors into the ER with me one time, into the OR. One time I did, and they were just flabbergasted.
It wasn't a politician.
It was a journalist.
He came in with me, and I had to do so much red tape.
You wouldn't believe it.
So much red tape.
But I really wanted him to see what it's like.
And his eyes were just completely, just stayed open.
They were held up, and he couldn't believe what was going on.
Because, like I said, no one remembers what happens in those settings.
We take away their memories.
So we need to have more people be aware, especially decision makers, so their decisions can reflect the reality of clinical practice, of the reality of the patient's suffering for their constituents' suffering.
Do you think this will make your job impossible if these psychedelics become more and more common and people use them and they think it's medicine?
Psychedelics have very powerful medicinal properties when used properly, but they run the risk of serious negative adverse Consequences as well, if used inappropriately.
The set and setting for psychedelics is more important than probably any other substance that we know of.
These aren't just medications to be given willy-nilly.
They need to come with instructions.
If you look at how psychedelics, for example, mushrooms have been used in the indigenous communities over the last hundreds of years, they were not used the way that they're being used now or that they were being used in the 60s.
Certainly not in rave-like settings with loud music and flashing lights and dancing.
I don't want to go into the topics of cultural appropriation of these powerful medicinal plants, but there is something to be said for how they've been used historically and how different it is than how we're proposing to use them now without any education, any guidance.
The current legislation is for decriminalization, which has a limited scope, and this has been my back and forth with Sacramento, But my concern is that if we don't build in the protective mechanisms now, what is to stop this from going down the path of marijuana?
What is to stop this from looking different than what's happened with cigarettes and vaping and all the other highly targeted advertising that's gone to vulnerable communities around these potentially powerful but also potentially harmful substances?
Have you had conversations with the legislature on this?
For psychedelics, yes.
And unfortunately, we've had to agree to disagree on the proper road for decriminalization, with all respect to them.
I think their hearts are in a good place.
Did you meet with them?
What was the meeting like?
These are phone calls that Are challenging when a physician who has been in the trenches tries to communicate with somebody who might be sitting behind a desk with no disrespect to them.
I operate a ketamine infusion clinic.
I am an advocate for using alternative means that are evidence-based to help patients when safely possible.
And there is a role for psychedelics.
I'm not anti-psychedelics.
I'm not anti-marijuana.
But like I said, anti-abuse potential, either personal or corporate abuse.
Just look at what's happening right now with marijuana across California with illegal growers.
With all sorts of undocumented strains just floating around out there that people are putting in their bodies under the false pretense that it's natural, it's safe, it's legal.
Certainly nothing that's legal would be harmful for us.
Forget alcohol and nicotine and vaping.
Forget these cannabis-based vaping products that are doing things that have never been done before in human history to the marijuana plant that we're putting in our body.
But when I try to explain my concerns for psychedelics, like ketamine, ketamine being synthetic, the ones in the legislation being natural-based, there is seemingly a lack of concern for the potential adverse effects.
A powerful example is that if you have depression, you don't just go to the pharmacy and get Zoloft or Prozac or Wellbutrin, you need a prescription.
You need to see a doctor.
There has to be some guidance on how to move forward.
Delegalization is well and good, but what is the next step?
What are future bills going to do to help protect the patient and the consumer And there isn't much talk on that.
I've been told it's out of the scope of the current legislation, which I can see potentially, yet it's still very frightening for me, for someone from the perspective of seeing people who have had bad experiences with psychedelics inside the operating room, outside the operating room, in underground settings, and they come to me looking for a healing session, for example, with ketamine.
There is a harm there, and it needs to be done responsibly, and I don't We know if the sponsors for this legislation have that experience with patients who have had adverse reactions and what the plan is to protect.
All the people that are going to be exposed to advertisements for this in the future.
Why do you think this legislation is coming about?
Is there money to be made?
Is there money behind this or is this...
What do you suspect?
I don't know.
There must be something.
Has there been money in marijuana?
So there's going to be an industry.
So your suspicion is that there's going to be an industry that will be born out of this when it gets decriminalized and legalized, right?
There is both a pharmaceutical industry that is being heavily, heavily, heavily invested in, and there is going to be a natural industry that will likely be heavily invested in.
We don't know how it's going to play out, but my fear is that the targeted vulnerable populations are probably going to be in the crosshairs as they have been traditionally, whether for menthols, whether for alcohol, or for marijuana.
As I was driving to the airport this morning in Oakland, There are just so many billboards there for particular substances that you and your audience probably know exactly what I'm thinking of.
It's just so many billboards in those particular communities.
It breaks my heart because I work in Oakland and I see a lot of this.
How can you be compassionate and see this going on and not feel for what is this legislation doing?
What message is it giving?
Now, how does all this make you feel?
How do you think it would make...
How would it make you feel if you had the responsibility?
You need to hold their hand.
You need to tell them what went wrong.
If something went well, you once again, everyone rejoices, but when something goes wrong, you...
No, everyone steps out of the room.
Everyone backs away.
It's just you who needs to explain what happened.
And it's a life and death.
Can you explain to us what is it like?
Because most of us don't know.
What does it take to have that conversation?
If somebody...
To look in someone's eyes...
And have to tell them what happened?
To have to feel that shame coming up in them?
Like somebody passed away or somebody...
That would be an extreme example, which happens, absolutely.
In the critical care unit, of course, after complicated surgeries.
One of the hardest things that I grappled with was being the last person that somebody saw before they passed away.
Because when you're doing anesthesia, you're at the head of the bed.
The patient's looking up at you.
You push medications in their IV for them to fall asleep, and then you have to place the breathing tube.
The last person they see is you.
The last person they will ever hear a voice from, will ever see, is you.
And maybe they'll survive the surgery, but if they die in the intensive care unit still unconscious, you are the last person.
Hopefully it wasn't your fault, but there is still a lot of burden that one carries.
When I was mentioning burnout earlier about physicians, these are part of things that go into that.
When I go to sleep the night before a big case and I don't know how the patient's going to do, I'm thinking about their case.
When I go to sleep the day after something happened, yeah, we think about it a lot.
You can't just close it and walk away.
It's hard to be compassionate.
Of course you need to have boundaries, but it's difficult just to walk away from something like that because bad things happen even with the safest anesthetics, the safest surgical techniques, which it's so incredible that we have these powerful tools that so many scientists have helped us engineer.
It's safer than ever before, but it's still not without risk.
So when people don't tell you guys, and so we've essentially, to sum it up, what I gather is that we've legalized some drugs, and people think that they're medicine, and they kind of want to do them all the time.
And then they don't tell you guys when they're coming into the operating room.
And there's a risk for you guys to...
To give them not enough dosage to create complication.
There could even be catastrophes out of it, right, for you guys?
That's absolutely correct.
And there's also a risk of even non-catastrophic but still life-altering things happening.
If you have surgery, let's say knee surgery, But that acute pain from the knee recovering turns into chronic pain so that you need a cane for the next couple of years.
Maybe you get a blood clot because you're not moving that knee around so you have to be on blood thinners for six months or maybe even longer.
Maybe you get an infection because you weren't able to move that knee around because the pain has become so debilitating.
You get depressed over it.
Mind and body are connected and pain is one of those links that are very strong.
Now, do you have any recommendations for our audience when they work with you guys, with the doctors?
The most important, the only silver bullet in medicine is your ability to advocate for yourself and your ability to heal.
No medication that I can prescribe will be as powerful and as effective as what you Can do to heal yourself?
For the majority, not all cases.
When I say this on social media, inevitably people say, oh, I'm just going to think that my lumbar fracture is going to diffuse itself and fix itself.
Or, oh, my broken bone is going to fix itself.
I'll think that.
And, of course, there's going to be jokers out there, right?
So, putting that aside, of course, Western medicine is incredibly powerful.
Life-saving in ways that we've never dreamed of before.
I mean, we couldn't even do surgery until the 1860s, before the advent of general anesthesia and its adoption.
We couldn't even do elective surgery.
So Western medicine is very powerful, but it leaves so much lacking.
And the majority of what it's lacking are the majority of the healthcare costs that are unsustainable and the burden of suffering and pain that patients have to live their lives with.
To address that portion of the pie, not the clotted artery that needs to be emergently stented to prevent a heart attack, or the stroke, or the broken bone fixing issues.
Those, of course, others can help.
But the inner healing potential is what is going to be the solution to the majority of the problems that patients face, will continue to face, and will bankrupt our medical system and our society as a whole, emotionally as well as financially, Unless we acknowledge that we need to empower patients with the right knowledge and that they need to advocate for themselves.
There is an utter lack of responsibility and agency in medicine because we have taken away power from patients.
Look at drug ads.
You just ask yourself, if all these drug ads with people looking happy in them, if they were half as effective, As it would appear, would we still have a mental health epidemic?
I mean, everyone on these advertisements is so happy.
Would we still have a diabetes problem?
All these people are eating all their pastas and, you know, injecting themselves with these medications.
You'd think we would have solved the problem by now with all the money.
Remember, who's paying for those drug ads?
It's us.
It's the patients who are paying for the drug ads.
These are all disempowering the patient.
When you prescribe a medication to a patient, even if it's a safe medication, You know that you're changing their brain chemistry?
Because just the act of being given a medication appears to influence their lifestyle choices and their modifiable risk factors.
Perhaps because this blood pressure medication will take care of my blood pressure, maybe I can eat that cheesecake after all.
Once again, not for everybody, but there is enough associative evidence that suggests that being given a prescription changes lifestyle factors.
Nothing that we do or that we are told is without a consequence.
If I tell you that you have genes that will make your depression harder to treat, you will reflect back on your depression ratings and they will appear worse to you than had I not told you that information.
When we do studies and we purposely lie about genetic information, The results are different.
Exactly.
And in the ways that you would predict they would be different.
At Stanford, they've done a handful of studies, very, very well done studies.
I'm so happy they've done this because it shows how the mindset affects what people do.
Now, what about the legislature and California leaders?
What do you recommend to them as a doctor that's being vocal about these issues that you see in the operating room?
Please come to the ground level where we're treating patients.
You can see what we do well.
You can see what does not work well.
This shouldn't be a foreign proposition.
If you're responsible for your constituents, shouldn't you know at least a little bit firsthand what they're suffering from?
I live in the Mission in San Francisco.
I'll be honest.
It's not a fun place to live.
I see so many mental health problems.
I'd have to call 911 for myself.
Enough times that it's not, how can somebody live here and still believe that we're doing a good job?
And yet I hear a lot of rhetoric that we're doing a great job.
I would respectfully disagree, having been there in the trenches, just like how I would disagree for how we're tackling so many opioid epidemic issues, how we're dealing with marijuana, potential psychedelic legislation, and just importantly, how we're taking care of patients.
Perhaps disempowering them.
There's a very real concern about victimization that might lead to disempowerment.
It's a very loaded topic, and it's not appropriate to say there's 100% correlation because there likely is not.
But there is a lot of concern as a physician that I have for patients that feel that they can't take agency over their body anymore because external sources have taken away their inspiration and hope.
Well, how about if you're making legislative choices, come with me for one day and have an interaction with a patient like that.
Try to guide them through a time when they need that empowerment the most.
They need that self-advocacy the most.
And see their pain and their suffering when they feel like they really don't have it.
Of course, there's so many societal issues that go into public health.
There's no question about that.
But you need to be in the ground level and see what the consequences and the good benefits are of the legislation that you've proposed.
You know, you can't just sit far away.
That's the issue that a lot of doctors have, a lot, not just me, with legislation around health care.
Because they're just not there in the trenches.
Stay up overnight with me as you're seeing people on the brink of death.
You know?
Dr.
Anthony Cave, anesthesiologist, it was great to have you on California Insider.
Thank you.
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