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Nov. 11, 2024 - Epoch Times
22:58
Why the US Has Worst Health Outcomes in Western World: Aseem Malhotra
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We have well over 60% of the adult population now overweight or obese.
I would take it further and say that 88% of Americans have abnormal metabolic health markers.
You spend $4.3 trillion on healthcare, highest health expenditure in the Western world, with the worst health outcomes.
So why is that?
Dr.
Asim Malatra is a world-renowned cardiologist and a best-selling author of several books.
We sat down together to discuss his new film, First Do No Farm, which examines many factors contributing to the West's chronic disease epidemic.
There is a false perception out there that medicine is an exact science, like, say, physics or chemistry, when in fact it is a social science, the science of human beings.
It's constantly evolving.
This is American Thought Leaders, and I'm Jan Jekielek.
Seemal Hatra, such a pleasure to have you back on American Thought Leaders.
Yeah, and it's great to be here.
America is my second home.
So you've been a medical doctor for over 20 years, a cardiologist for over 10 years, and you've only recently found a treatment for heart disease?
It's been a long journey and process and a deep dive into understanding what is at the root of heart disease, what is the greater truth, and how can we manage it, prevent it, and even reverse it, Jan.
It's taken me time because the current paradigm in that understanding of heart disease is flawed and Trying to overcome that or to change people's minds or to change the medical approach to heart disease, it's not something that happens overnight.
Let's talk a little bit about how people view medicine today, frankly.
This is something that really comes out in the film.
Tell me about where people might be going wrong in this area.
Yeah, I think to understand the problems of modern medicine you have to go back to square one, and that is understanding what medicine is.
There is a false perception out there that medicine is an exact science, like, say, physics or chemistry, when in fact it is A social science, the science of human beings.
It's constantly evolving.
And to add to that, the father of the evidence-based medicine movement, Professor David Sackett, Canadian epidemiologist, now deceased, And this has actually been proven.
He said 50% of what you learn in medical school will turn out to be either outdated or dead wrong within five years of your graduation.
The trouble is nobody can tell you which half, so you have to learn to learn on your own.
Now, most patients or members of the public hearing that would probably be maybe quite surprised, to say the least.
But we have to start from there.
Because part of the barriers to the truth or changing medical practice is really busting that myth that it isn't an exact science.
One of the public figures whose face became one of the most famous around the world It was Anthony Fauci.
And he said when it came to the issue of managing COVID and even around the COVID vaccines, he said, trust the science.
And that didn't make any sense to me because medicine isn't an exact science.
Part of the challenge is that, of course, you want to treat doctors as authorities.
We need to.
You're putting your life in someone else's hands.
So this reality plays into exactly what you were talking about.
Yeah, absolutely.
My role and my job, as well as being a clinician, a practicing cardiologist, obviously, is making sure that doctors can be the best possible doctors they can be, and also to deal and cope with the current challenges we face in healthcare with this chronic disease pandemic.
So we have to understand the roots of it.
And part of the problem, and there are many problems with the system, is that modern medicine is not practicing In a way that it could or should be.
You said a chronic disease pandemic.
Expand on that for me, please.
Well, the biggest drivers on stress on the healthcare systems around the world, especially the Western world, is people suffering from conditions such as type 2 diabetes, heart disease, high blood pressure, which are now increasingly at a very rapid rate.
And interestingly, Jan, as well, the most common chronic disease right now, the number one in the Western world is actually mental health problems, whether it's people suffering from anxiety or depression.
The heart and the mind are interconnected.
That's in the world writ large or the Western world?
In the Western world.
In the Western world in particular.
That's the number one.
Yes.
Astonishing.
Yeah.
I mean...
So that is fascinating because, one, why is that?
But two, also it links to the physical disease.
We know that chronic stress, for example, as we point out in the movie, is a driver of heart disease.
And to give people context, having chronic stress, which, to be honest, most of us are under because of the way we live.
And that's why it comes back to also understanding what does it mean to be human?
How should we be living our lives to the best of, you know, to optimize our health?
Stress is the same as a risk factor for heart disease as being a regular smoker of 20 cigarettes a day, or having high blood pressure, or having type 2 diabetes.
But people are generally not dealing with it.
But now you're talking about chronic stress, because of course stress is a positive feedback mechanism.
Of course.
Chronic stress, absolutely.
Stress in small doses occasionally is of course probably good for us, but the chronic stress is the problem.
There's a patient that features in the film, Tony Royal.
Why don't you just lay out his case for me?
Yeah, one of the most interesting patients I have ever come across in my life because his story is fascinating, but his case study in many ways epitomizes everything that is wrong with the healthcare system, but also what we can achieve if we get things right.
So Tony saw me, I think first came to see me privately almost 10 years ago.
His background was he was an international airline pilot with Virgin Atlantic.
He was actually very active.
You know, he was running marathons, that kind of thing.
But he noticed over time that his weight was increasing, especially the belly fat was getting a bit worse.
And then in 2014, if I remember correctly, he experienced chest pain.
Luckily, not when he was flying.
He'd come back from a flight in South Africa and went to his general practitioner and ultimately got diagnosed with having a possible heart attack.
And then it was confirmed when he went to hospital.
And there was one of his major blood vessels, one of the coronary arteries, had an almost complete 100% blockage.
That was treated with a stent.
Luckily, not left with significant heart muscle damage from the heart attack.
And he was then put on a cocktail of medications, which is a standard practice in cardiology and in medicine.
You know, a couple of blood thinners for his stent, a beta blocker to slow their heart rate down, and a high dose statin drug, which is a standard practice.
And the other thing that he mentioned in his story is that he was given very little useful lifestyle advice.
He was basically told to diet and exercise, which he was kind of doing anyway.
He was following the standard dietary guidelines of following a low-fat and a high-carbohydrate diet.
And he was exercising.
He was running.
So he was like, well, he was trying to understand what's happened here.
How has this happened?
But about a year afterwards, he started to feel very unwell, lasting for several months.
He thought maybe he had another condition.
He was getting fatigued.
He was having muscle pain.
He was having brain fog, erectile dysfunction.
And he obviously couldn't fly after having a heart attack anymore.
So he went back to his previous job, which was being a maths and physics teacher.
So quite good with numbers.
But he started looking at the literature on the drugs he was taking a little bit and figured out he thought it was a statin giving him these symptoms.
So he stopped the statin.
Within a few weeks of stopping his statin, suddenly his life has transformed back to what he used to feel like.
His energy levels are back.
His brain fog has gone.
His libido has come back.
And he's like, wow, I'm not going to stay on the statin anymore.
And started to look at the benefits of the drugs he was taking in absolute terms and found out that those drugs weren't that effective the way he was led to believe.
And simultaneously also came across some of my work on the fact that people can effectively manage their weight and their health markers for heart disease from going on a low-carbohydrate Mediterranean diet.
So he adopted that and within three months he actually lost around 15, 10 to 15 kilograms in weight without restricting calories.
Waist circumference came down.
Everything got better and he felt great.
And he comes to see me in my clinic having done all this himself.
And I was a little bit shocked to be honest when he walked into my consultation and told me a story that he, without telling his doctor, he came off all his pills.
Having had a heart attack and a stent just over a year earlier.
And he asked me, the main reason I came to see Dr.
Malhotra is, I'm thinking about doing Ironman competition next.
And I was like, wow, okay.
So we had a conversation, he told me a story, and we went through the medications he was taking, and then ultimately he decided that he wanted to stay off all his meds, and I supported and respected his decision, even though we had a conversation where I said maybe he should carry on with aspirin, maybe he should take the statin drug and go on a lower dose.
But he decided after a couple of weeks that he was feeling so good, his life has transformed, he'd never been in better shape from changing his lifestyle.
And that case of Tony Roll was ultimately written up in a medical journal and even hit the front page of the Daily Express newspaper in the UK and was covered on the Daily Mail online as well.
And the headline was, Ditch the Pills to Beat Heart Disease.
It's really an extraordinary story.
I'm not saying everyone can do this.
I'm not saying everyone should do this.
But it's where someone normally is now who's had a heart attack, usually they are on medications for life.
And that's the understanding and thinking of the patients and the doctors, that this is the best way to manage it.
This guy has busted that myth.
We're just going to take a quick break right now, and we'll be right back.
And we're back with cardiologist and best-selling author, Dr.
Asim Alhatra.
It's very interesting that you say that you were suggesting to him to take a lower dose of the statin, because I typically associate you as the doctor who doesn't recommend them.
So tell me a bit about that.
My approach to this isn't about recommending statins or not recommending statins.
It's about being an advocate for true informed consent, what I call, which has become very controversial, ethical, evidence-based medical practice.
So me being an advocate for that has made me very controversial, apparently.
But what does it mean?
It means giving patients information in a way they can understand and then helping them make a decision, and every patient is different, but a decision according to their preferences and values.
So if you look at statins, for example, in someone like Tony Rawls' case, who's had a heart attack, or is at high risk of another one, when you break the data down from drug industry-sponsored studies, which we have to take with a pinch of salt, but let's just say for argument's sake it's true, right, the benefit of a statin over a five-year period, based upon their trial data, shows that there's a 1 in 39 chance it will prevent you having a further heart attack, and 1 in 83 chance it will delay your death or save your life.
Patients are not told that.
So for Tony, that information was made available.
He understood it.
And he felt, actually, I don't fancy those odds, but also felt that he was empowered with an alternative through a lifestyle that was going to help him.
And that's the decision he made.
And I supported his decision.
Many patients, when they're given that information, think also the same as Tony.
But it isn't standard practice for doctors to communicate that information because we're not conditioned or trained to communicate information in that way, despite the fact that we should According to the best principles of ethical evidence-based medical practice.
What normally happens is doctors are conditioned to tell patients about benefits of drugs using something called relative risk reduction, which may be, in somebody like Tony Rawls' case, 30% less likely to have another heart attack if you take a statin.
But when you translate that information into the absolute risk reduction, it's only a small percentage, 2.5%, for example.
Explain to me the difference between those two.
Yeah.
So in very basic terms, let's just take, I think, a very simple way of looking at it is this information comes from what we call the randomized control trial data conducted by usually the drug industry, where you have two groups of people who effectively feel like clones of each other.
You know, let's just say we do a trial of 100 men, Okay.
And they are middle-aged, so they're 50 years old.
And we have two groups where they are stratified according to the same risk factors.
So they may be the same number of people with type 2 diabetes, the same number of people with high blood pressure in both groups.
And then you follow them up.
And let's say over a five-year period, the people who take the dummy pill, not the statin, there are two out of 100 that suffer a heart attack.
Right?
And the people that took the statin, and that 100 people you follow up who take the statin, the clones of this first group, only one of them suffers a heart attack.
So you've reduced the risk of a heart attack by one in two over 100.
So it's 50% less likely.
But you've only managed to prevent one person having a heart attack having treated 100 people.
And that's the absolute risk reduction.
So the relative risk reduction is 50%, but the absolute risk reduction is only 1 in 100, 1%, also known as the numbers needed to treat.
So you have to treat 100 people to prevent one person having a heart attack.
This just isn't my opinion, Jan.
2009, in a World Health Organization bulletin, Gerd Gigorenza, who is a director of health literacy at the Max Planck Institute in Berlin, which is actually where Einstein trained, right, a very reputed guy, he said, it is an ethical imperative that every doctor understand the difference between absolute risk reduction and relative risk reduction, To protect patients from unnecessary anxiety and manipulation.
So in my view, what he's saying is that if doctors are aware of that information and they don't tell their patients that, then they are in effect not practicing ethical medicine.
And I agree with that.
I don't think it's deliberate.
It's a conditioning.
It's a way doctors are trained.
But actually, this goes obviously into the documentary a little bit.
That conditioning, in a way, has occurred...
For a large degree, for the purposes of benefiting the pharmaceutical industry, not benefiting patients.
Well, but let's go to doctors for a moment.
Like a doctor, you're kind of turning a little bit of the doctor-patient relationship a bit on its head.
You think of the doctor as saying, hey, yeah, I think you need this medication.
And you kind of just do it.
I'm not used to hearing, well, here's your pros and cons, because there's also this other piece, right?
The other piece is that there's these side effects, like you described, that happen at some frequency.
Tony Royale probably wouldn't have done anything about his treatment if he hadn't experienced the particular side effect that got him to start doing his research, right?
Absolutely.
I think the way to understand and explain it is that doctors themselves put a blind faith into medical journal literature.
And the reality is, and this is what I've uncovered over years, having also been one of those doctors that was that You know, blindly following, like a biblical truth, what's published in the New England of Medicine, or JAMA, or The Lancet, is that that information is basically flawed, corrupted by vested interests.
So those doctors who are still following the traditional paradigm are well-intentioned, absolutely, 100%, but they don't realize that they're being manipulated.
So what is the old paradigm exactly when you describe it here?
The old paradigm is just partly even doctors exaggerating in their own heads what modern medicine is and what it can achieve.
It's a lack of maybe critical thinking and curiosity.
It's a lack of really deeply understanding that medicine is an exact science.
It's a lack of understanding that according to somebody I call the Stephen Hawking in Medicine, John Ioannidis at Stanford University, the most cited medical researcher in the world, a mathematical genius, Not realizing that, which is his work, that most published research findings are false.
And that the greater the financial interest in a given field, he wrote this, the less likely the research findings are to be true.
This is not common knowledge amongst most doctors.
And in my view, explains much of what's wrong with the healthcare system and why we have not combated this pandemic of chronic disease in the population, which is making people miserable, sick, and increasing death rates.
You know, you look at the United States, prior to COVID, there was already, like, you'd knocked off two to three years of your life expectancy.
I mean, that's extraordinary.
You're going backwards.
And you've got more people sicker.
So let's talk about what's called the social determinants of health.
Yeah.
So the social determinants of health actually is probably the big issue when it comes to what influences your risk of disease and your longevity and your quality of life.
So let's define it.
It's the conditions in which you are born, grow, live, work and age, and the drivers of those conditions.
So what am I saying is that disease, whether it's mental health, whether it's risk of cancer, whether it's heart disease, that actually even starts from birth.
Just to give you an extreme example, if you are a child that is a victim of severe psychological or physical abuse, or even sexual abuse, that can automatically knock off 10 to 20 years of your life expectancy.
Because the stress associated with that affects genes that control the aging process.
And of course, if you're aging quicker, you're going to be more risk of disease.
If you are somebody that works in a high demand, low control, low paid job, very similar, effectively a death sentence because of the stress associated with it.
So we have to shift the paradigm in understanding health as well.
And certainly estimates suggest maybe 35 to 50 percent of actual overall health is socially determined.
And of course then the other things that link to that are then going to be poor diet, more risk of alcoholism, for example, if you're growing up in deprived areas, more risk of being a victim of violence.
This is important, Jan, for me as a doctor's perspective, because actually trying to improve individual and population health for the purposes of having a progressive functioning society, and even for the economy, right, because if people are sick, you're going to be less productive and the economy is not going to function properly, is understanding this.
I think most politicians don't get this.
Most doctors don't get this.
In my view, every single politician, whatever their remit is, whether it's education or housing, needs to put at the forefront of what policies they're going to introduce that's going to be conducive to people's health.
What's more important in people's lives and their health, Yan?
Seriously, though, what's more important?
I'm biased as a doctor, but what human being on this planet Who is sane, okay, who is rational, would not say that the most important purpose of their life is to optimize their mental, physical and social well-being, right?
Sustained, authentic happiness, good quality of life.
That's what it's all about.
It's very simple.
So we have to understand what affects that, and then how can we create structures and systems and environments where everybody can be the best version of themselves and everybody can flourish.
In fact, it was Nelson Mandela that said, peace is not the absence of conflict, it's creating environments where everyone can flourish.
Well, I have to say, I absolutely love the film.
Why don't you tell me where people can watch it?
Yeah, so we made this independently.
We wanted to be free of any commercial influence.
You know, we weren't funded by a supplement company or an organic food company or certainly not a drug company.
And it's online available for people to download for $9, $9.99.
We have to put obviously our own resources and time and efforts into that, so we just really want to recoup costs more than anything else.
But for me it's about creating impact and change.
And the website that people need to go to is nofarmfilm.com.
So N-O-P-H-A-R-M film dot com.
Okay.
Well, Dr.
Asim Malhotra, it's such a pleasure to have had you on again.
Thank you.
It's great to be here, Jan.
Thank you all for joining Dr.
Asim Malhotra and me on this episode of American Thought Leaders.
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