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Dec. 25, 2024 - Epoch Times
22:22
Dr. Drew: Erosion of the Patient-Physician Relationship
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And a member of the school board came in and said, we're going to lock the schools down.
And I said, why?
Why are you doing that?
Who did you consult with?
Did an infectious disease doctor come in and say, you've got to do this?
No, it's just the right thing to do.
I knew then that there was big, big, big trouble.
Drew Pinsky, popularly known as Dr. Drew, is an addiction medicine specialist and host of the TV series, Ask Dr. Drew.
For decades, he has been studying public health and drug addiction in America.
Exposing its ongoing challenges in nationally syndicated television and radio programs.
The physician-patient unit is so badly encumbered and so badly adulterated right now, it's hard for it to function.
The idea that medicine can be centralized and algorithmized is disgusting to me.
There are a lot of parallels between America's COVID response and the policies that led to the opioid crisis, he says.
There are some of us that can't get over COVID, not the virus, the way our country dealt with the COVID. Just mind-boggling.
This is American Thought Leaders, and I'm Jan Jekielek.
Dr. Drew Pinsky, such a pleasure to have you on American Thought Leaders.
Pleasure to be here.
So, you're going to be giving the keynote pretty soon at this Brownstone Conference, but tell me a little bit more about what you're expecting to see here, what you hope to get out of it.
You know, it's already exceeded my expectations.
Jeffrey Tucker Brownstone is such a genius.
We live in a weird time of almost salons, you know, of these gatherings.
I had the privilege of having been in several David Rubin salons where I met interesting people, learned a ton.
This is the same phenomenon.
Fortunately, I've also interviewed many of the people here, and it's always been at a distance via Zoom.
A lot of it started during COVID where you weren't allowed to travel or come see anybody.
But it was great to meet everybody in person and to hear them and to have them sharing thoughts amongst themselves.
It's been just...
I mean, I just took notes all day long.
I just found it a thrilling experience.
Well, and it's really interesting.
You've been doing something that I've really only been doing, i.e.
being on camera talking to people.
I've only been doing this for maybe five, pushing on six years.
You've been doing it for quite a bit longer.
I've been doing it only, let's see, 35 years.
35 years, to be more precise.
Yeah, a long time.
And you've had quite the evolution in your thinking.
That's what I... Thinking.
Keep going.
Because I've had evolution in what I've been doing.
Fundamentally, I got involved in media to try to do good, to use this juggernaut, this leviathan that is media, to try to help people be healthier, make good choices, be happier.
If there's anything I can use the media to try to climb into, even in environments where I don't belong, if I can reach people that need what I've got, I'm happy to go there.
And so this all started my digital stuff.
I do a thing called Ask Dr. Drew now, primarily Tuesday, Wednesday, Thursday at 3 o'clock Pacific time in Los Angeles.
And we started that during the darker hours of the lockdowns in COVID, particularly in California, which were draconian.
And I just started answering questions live on this stream.
Actually, I think we even started on Facebook Live or something.
I just wanted to just interact with people and try to reduce their anxiety and answer their questions.
And about, boy, a month into it, I started feeling like I was the French underground.
I mean, it felt illicit.
"Les carottes sont cuites." "Je n'aime pas la flanchette de beaux." It's like they were so aggressive with not allowing for any discourse or any opinions It felt weird to me, so I just answered questions as I saw it, and then it evolved into other things.
Even before this, you focused on, for example, opioid addiction.
Addiction in general.
A lot of my life was running a large addiction program.
Right.
That hasn't gone away.
No, it hasn't gone away, but there's movement at least.
I mean, look, the playbook by which the opioid pandemic was delivered, at least the pharmaceutical opioid pandemic, was the exact same playbook that was used in COVID. That's something I'm going to talk about on my presentation tomorrow night.
Tell me a little bit, because we're going to publish this after.
The first opioid crisis in this country was towards the end of the 19th century.
The hypodermic needle, morphine sulfate, methadone, these things were all developed in the latter part of the 19th century.
And the physicians were the delivery system for the opioid pandemic in that era, and it was massive.
The Harrison Narcotic Act that came in in the early part of the 20th century actually is alleged to have jailed as many as 20,000 physicians for their excessive opioid prescribing, and it stopped immediately.
And that intervention was so draconian that physicians turned away from opiates for 80 years, or at least certainly 60 years.
And we were sort of cautious about them, afraid to use them, not using them.
In the 60s and 70s, we started seeing the advent of more effective treatments of cancer.
And so we had a lot of people living with cancer and developing more advanced stages of cancer before they died with pain.
And a group of people emerged who said, this is ridiculous.
We should be treating this, which was absolutely great.
For sure, that was true.
And opioids were the answer.
For acute cancer and surgical pain, opioids are the solution.
They were never Ever shown to be useful in chronic pain.
In other words, after about two weeks, opioids, they generally don't work.
They cause headache, back pain, and something called hyperalgesia, which is the intensification of pain.
Everyone was getting strung out on oral opiates because my back hurts.
Well, that was the opioid withdrawal.
And the pain was overwhelming and disabling because of hyperalgesia, all opioid-induced.
So, that's the background where that group that came in that started managing pain in the cancer setting and surgical setting and getting very good at pain, acute pain management and cancer pain management, looked around and said, you know what?
There shouldn't be any pain.
We are the saviors for the American public.
We're going to prevent them from ever experiencing any pain.
I have all these quotes from the pain specialist of the day saying, we considered ourselves a white hat profession.
We were going to rescue the world from pain.
The evangelists from that discipline of pain management, which became a highly ensconced specialty of medicine, psychiatry, and anesthesia, it became a structured, board-certified discipline.
The leaders in that group went out and got control of the regulators, so these evangelists We went out and got the medical societies, the VA, the local departments of health, and the first to adopt was the VA system, who took the position, adopted what these pain management guys were suggesting, which is that pain is more important than any other vital sign.
Forget your pulse.
What's the pain scale?
Pain, the fifth vital sign.
Do you remember that slogan?
Pain is the fifth vital sign.
That was a mandated measurement when you got the pulse, the blood pressure, the temperature, the respiration, and the pain scale.
Top of every physical, every time a doctor interacted with a patient, mandated by the medical societies, the insurance agencies, the medical society, everybody mandated it.
Doctors were trained to give as many opiates as the patient wanted.
If they left with less than 60 pills of Vicodin, you were potentially doing patient abuse.
At the same time as all these regulatory standards kicked in, the lawyers caught wind of this and started again now—this is the legal system stepping in—and suing doctors and criminally prosecuting doctors for undertreatment of pain.
So in North Carolina, Florida, and California, doctors were going to jail again for not using enough opiates.
When that happened, immediately doctors froze, stopped prescribing, sent everything to the pain management teams, and pain management said pain is what the patient says it is, pain control is what the patient says it is.
So if that's true, you don't really even need a doctor.
And in some parts of Florida, that's exactly what happened, for instance, where you could walk into a pain management clinic and just go, yeah, I'm in pain.
I'm a 9 out of 10. I need that Demerol.
I need that fentanyl.
And then you walk out with your bag.
My patients were killed by the hundreds by those practitioners.
Of course, opiate addicts loved that.
And so they were causing opiate addiction on one side and they were killing opiate addicts on the other.
And I got so tired of taking patients off opiates, their pain going away.
It was the same thing with every single patient.
They come in, they go, what's your pain on a scale of 10?
They'd always say 15 or greater, always.
Then three days in, we detox and we take them off.
Three to five days later you go, now, they would not talk about pain anymore, but before that's all they could talk about.
And you'd ask them, what's your pain on a scale of 10?
They'd say 5. With no treatment.
Off, just get them off the opiates.
Well, other than detoxification.
Getting off the opiates, right.
And so this was happening to me all the time.
I was getting these patients off opiates.
Their pain was being managed.
They were not troubled by pain anymore.
But they're drug addicts, so they'd go back to their doctor.
And the doctor would go, why do you listen to those people?
I told you, you're going to need to stay on this the rest of your life.
Dead.
Killed so many of my patients that way.
Drew, just one quick sec.
We're going to take a quick break and we'll be right back.
And we're back with internist and addictionologist Dr. Drew Pinsky.
That is not a story that I'm aware of until this moment.
Now, think about COVID. You have these bureaucrats who are evangelically possessed that they're in the right.
Guys like Scott Atlas and Robert Redfield try to reason with them with data.
They're like, you're an outlier.
Get out of here.
We know what's right for the American public.
Birx?
Evangelizes in every state, gets control of the governors and the regulators, now you have lockdowns.
Same playbook.
The exact same playbook.
Again, perpetrated by my profession.
And so, how early did you see that something was off?
With opioids or COVID? With COVID. With COVID, I knew something wasn't right.
As soon as two weeks to flatten the curve, so-called, which to me sounds like a marketing ploy, but okay, we're going to see what's going on.
Two things happened to me.
One, the governor of California came on and said, hey, man, we're going to do this.
We're going to lock us down.
I was like, I can't believe you're doing it.
I couldn't believe it.
It just seemed like such a terrible idea.
He brought in the Navy's hospital ship into Los Angeles Harbor, and I was like, what is he expecting?
I don't see it.
But okay, he's preparing for the worst.
I'm a good citizen.
I'm going to support him.
Even though I think it's a terrible idea, he doesn't need to do it, fine.
So that was when I was thinking, Something wasn't right.
Then I was doing a nightly news broadcast in Los Angeles, trying to help people understand what was going on.
And we were probably a week into that broadcast, and a member of the school board came in and said, we're going to lock the schools down.
And I said, why?
Why are you doing that?
Who did you consult with?
Did an infectious disease doctor come in and say, you've got to do this?
No, it's just the right thing to do.
I knew then that there was big, big, big trouble.
And that was March, you know, March of 2020. I just thought the people, the press, was taking advantage of us to get our eyes, make us panic, enhance their business.
So I made a mistake of starting to run around going, just don't listen to these people.
Just don't listen to them.
The mistake I made, I kept saying, was listen to the CDC and listen to Dr. Fauci.
I've worked with them for years.
They will get us through this.
That was the only thing I really got wrong.
I didn't realize how adulterated they would be.
I was also saying, look, 12 years ago, we just went through another pandemic.
Did you know that?
The H1N1 pandemic was nasty.
It was a terrible illness.
I had it.
I had patients.
It was an awful illness.
Killed 300,000 people.
And you don't know it happened.
And we're going to go from that to destroying the world on behalf of this one?
Isn't there somewhere in the middle we could be?
And that went down for the world as Drew says, this is just the flu.
There was a hysteria.
Look, I was saying at the time that if I had a very seriously ill patient, I stood at the end of the bed and went, oh my god, oh my god, is that going to help?
Is that going to get—or are we going to be, look, we're going to take this, we're going to do the best we can.
It's a serious situation.
Sit tight.
We're going to get this.
That's how you manage people.
You don't scream hysterically.
And you also don't undo all your ethical standards and throw away the Constitution and the Bill of Rights.
That was just the most—that's what I can't get over.
There are some of us that can't get over COVID, not the virus, the way our country dealt with the COVID. Just mind-boggling.
I felt like my world changed in March of 2020. I can't believe what happened.
What would you say are the biggest sort of lessons you've learned over the time that you've watched society responding to these kind of new medical scenarios, right?
You know, most of my learning has been in the last four years because I had a lot of assumptions about how things worked before that.
Something I was fighting against for many years was the insurance companies and the regulators interfering with my ability to take care of patients.
That is constant.
And the COVID experience has re-entrenched my sense of the importance of the autonomy and the sanctity of the physician-patient relationship.
I feel that we have lost that battle, so much so that I'm working now with companies to try to deliver products and services directly to patients and put the autonomy now with the patient, maybe with some telehealth support, but that the physician-patient unit is so badly encumbered and so badly adulterated right now that it's hard for it to function.
And that the idea that medicine can be centralized and algorithmized is disgusting to me.
It's the exact opposite of how we're going to get good health care in this country.
Well, this is very interesting because I've spoken with a number of people at this conference on the show talking about, I guess, the Hippocratic Oath meaning a lot less, or some people would even say being thrown out the window or something like that.
Certainly not being properly understood.
Well, do no harm, risk-reward, gone.
I feel like do no harm is my mandate and risk-reward is what I must consider in every moment of my evaluation with a patient, even advising them to cross the threshold of my office.
There's a risk-reward in that.
Francis Collins said it out loud that, well, when you're in this position, you just focus on one thing, the virus, and nothing else matters.
When I was training residents, If they couldn't come up with their risk-reward analysis on every decision they made, I would crucify them.
And the thing that if they ever said to me that was the most intolerable, if I'd asked them why they made that decision, and the answer is, I just had to do something, no way.
I'm not going to be kind to that, let's just say.
Because that's how you harm patients.
It's the opposite of do no harm, and it's the opposite of a risk-reward consideration.
What about this element of disclosure of risk?
How does that fit in?
No, that is informed consent.
That is the basic job when you offer a treatment for somebody.
You have to make sure that it's done with the patient.
It may have been before my time that doctors would just do things and the patient would trust it.
I was trained that it's a co-decision and every single decision is made with the patient and the treatment is agreed upon with the patient based on my ability to communicate the risk-reward analysis to them.
I've recently become aware of this.
Actually, it was talked a little bit about in today's meetings about the increased commoditification of the human being and the rise of this utilitarian bioethics.
I haven't been following this closely at all.
I've been reading about it.
I'm curious if you've followed that.
I don't, but Brett Weinstein said something very, I thought, prescient today when he talked about the public health being the opposite of health care.
You know, a master in public health is somebody trained in a system of transference of the well-being of one person to somebody else or the whole, and that is anathema to health care.
I can't even imagine that we allow that.
Let alone train people to do that.
Except that public health, I mean, there is a place for public health, right?
Looking at things from a broader perspective.
And provide that information to the doctors and to the local communities so they can make the decision where they can weigh these things and make a good decision.
I see.
So it's this, what is it, subsidiarity principle, right?
Yeah.
It's the mandating.
It's the decisions from on high.
Alexis de Tocqueville, when he ran around this country, he's a French aristocrat, was here ostensibly to evaluate our penitentiary system, as it was called at the time, because it was so effective.
And he, on the DL, actually wanted to figure out why democracy, which he thought was the new movement worldwide that was inevitable in all countries, why democracy was working in America.
So he wrote a two-volume book called Democracy in America, and he concluded that the reason democracy worked here was because of the mindset, or it was practiced all the time, but most importantly, it was a local practice of democracy.
Local.
Decentralized.
That's why this country works.
Centralization.
Federal government was never supposed to be in my life.
Supposed to deal with interstate commerce, make sure the states got along, the common defense, that's it.
Maybe protect some rights.
Okay, done.
So, have you thought about, at least in the medical context, how to challenge that, I guess?
That's why we're here, trying to figure it out, trying to...
Again, I've been working with companies that are trying to get services and medication things directly to patients in a cost-effective way.
That's been my latest thing, because I don't know what to do with the practice of medicine generally.
It's just...
You know, the young folks are being taught to look at the computer and just fill out forms, do an algorithm, look things up if you don't know.
I mean, I don't know how you develop judgment.
I don't know how you think about a risk-reward if all you're doing is following an algorithm on your electronic medical record.
It's really disturbing.
A final thought as we finish?
I can't believe I live in the world I live in, much like Jeffrey Tucker said in his opening remarks today.
But I'm so grateful that we're here, we're having these meetings, that there are this many people that interrupted their lives and came to Pittsburgh and are sharing ideas and interested in making a difference.
Even if we're radical outsiders, at least we can try to move things in a healthy direction.
I'm a little bit optimistic.
We'll see.
I mean, I'm tired on the drug addiction front.
I've been screaming about that for years.
Same thing with other serious mental illnesses.
We treat brain diseases differently than other diseases for no good reason.
If somebody's on the street with a heart attack, we treat them.
If somebody's on the street with a seizure, we treat them.
If somebody's on the street with schizophrenia, we leave them alone.
It's stigmatizing, it's draconian, it is medieval, and it has nothing to do with modern medicine, and these people should not be involved.
Unfortunately, it had echoes in the COVID epidemic.
And a lot of what happened there, I have shared similar frustrations.
And we have to find ways to restore sanity and decentralize, much as Alexa Dockville suggested in 1829, that it's the local practice, the local relationships that make things work in this country.
Well, Dr. Drew Pinsky, it's such a pleasure to have had you on.
Thank you.
Appreciate it.
Thank you all for joining Dr. Drew Pinsky and me on this episode of American Thought Leaders.
I'm your host, Janja Kellek.
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