Latest / Radically Genuine / 239. Failure Is the Business Model: How the Mental Health Industry Profits When You Get Worse

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239. Failure Is the Business Model: How the Mental Health Industry Profits When You Get Worse · Radically Genuine

• Dr. Roger McFillin (00:01.698) Welcome to the Radically Genuine Podcast. I'm Dr. Roger McFillin. If you can recall back to 2008, the American banking system nearly burned to the ground. And that's not because bankers were stupid. It's because they were quite rational. They made bets that they never would have made with their own money. They leveraged themselves into oblivion. And when it all collapsed, the taxpayer picked up the bill. The profits that they received were private, but the losses were very much public. The people who made the reckless decisions kept their bonuses, and the people who trusted the system lost their homes. Economists have a name for this. They call it moral hazard. And moral hazard is what happens when a person is protected from the consequences of their own decisions. When you can take the risk, but someone else absorbs the loss, your behavior changes. You get careless. You get greedy. You stop asking whether the thing you are doing actually works because it no longer matters to you whether it works, because you get paid either way. The insured driver takes the curb a little bit faster. The bailed-out banker gambles a little bit bigger. This is not a theory about bad people, it's a theory about incentives. But a good person inside a structure where failure Costs them nothing, and over time that person will fail more, notice it less, and they defend the structure that protects them. Now, why am I telling you this? We regulate banks, we audit insurance companies, we held congressional hearings about the bailouts. We at least argue about moral hazard when the losses are measured in dollars. But there's one industry in this country where moral hazard operates with. Pretty much total impunity. An industry where the party makes the decisions Dr. Roger McFillin (02:06.165) And knows vastly more than the party absorbing the risk. An industry where every ounce of downside is transferred onto the most vulnerable person in the room. An industry that has posted the worst outcome record of any sector in American life and has been rewarded for it with more money, more power, and more of your children. And I'm talking about the mental health industry. And today I want to make one. Argument carefully from the ground up. The mental health industry is the purest case of moral hazard in American life. Now, I might add the vaccine industry in that, and you know, I'll try to make a comparison as I try to make my argument here. But it explains why outcomes can get worse as treatment expands. It explains why nobody inside the system ever seems to be accountable when a patient deteriorates. And it explains why the industry keeps growing anyway. Because failure is not a flaw in the system, it is the actual business model. Before I apply this framework to mental health, I want you to actually own the concept. Because once you see it, you'll definitely see it you know, across the board in in our culture. Because moral hazard requires two conditions, just two, remember them. The first is An asymmetry of information. One party in the transaction knows things the other party does not. The mechanic knows whether you really require the new transmission. You don't. The seller of the used cars knows what is under the hood. You don't. Whenever knowledge is lopsided, the party with the knowledge holds the power and the party without it has to trust. The second condition is a transfer of risk. So the person making the decision does not bear the cost of being wrong. The consequences land somewhere else. So in my previous example with the banking industry, on the taxpayer, could be on the policy holder, on the customer. When those two conditions exist at the same time, you get a predictable result. The protected party takes more. Dr. Roger McFillin (04:34.379) Risk exercises less care and faces no correction when those things go wrong. And it doesn't mean because they're evil, it's because the feedback loop that disciplines human behavior has been cut out. Think about how you you drive a rental car versus how you drive your own car. Same you, same value, same character, but different incentives. This is moral hazard. It does not require a villain, it only requires insulation. Now hold those two conditions in your mind. Asymmetry of information, which is the power differential, and transfer of risk. And walk with me into a psychiatrist office. Picture the standard American psychiatric encounter. 15 minutes at best, a symptom checklist, a diagnosis rendered on the spot, a prescription written before the hour is out, follow-up in a month. Which becomes a med check every three months, which becomes a decade on drugs that were studied for six weeks. Now run the two conditions. Condition one, asymmetry of information. Does the prescriber know things the patient does not? Well, the prescriber knows there's no biological test for the diagnosis being handed out. There's no blood work, there's no scan, there's no marker. The diagnosis is a judgment call against a checklist that a committee voted into existence. The prescriber likely knows the chemical imbalance story collapse under scientific scrutiny. The pro prescriber probably knows these drugs can can create pretty significant withdrawal symptoms. And they can be severe, they can be prolonged, and the patient who deteriorates while coming off them will almost certainly be told. It is their illness returning. The prescriber knows about emotional blunting, sexual dysfunction, metabolic damage, dependence. And what's important to know there is they're not really incentivized to go deeper. So they're going to minimize the risks because they don't really hold any accountability for anything might might occur from writing that prescription. Dr. Roger McFillin (07:02.19) So, does the patient sitting across the desk really know this with depth and detail? Because it is the responsibility is on the prescriber. And that's almost never. The patient knows only what they're told. They have a disorder, it's like diabetes. This drug corrects it. You have to manage your condition. You have to take it. The assumption sometimes is for life. This is not informed consent. This is an information. Asymmetry as steep as any in American commerce. So condition one is satisfied. Now let's go to condition two, the transfer of risk. When the diagnosis is wrong, who pays? When the drug harms Who has to absorb that? Who does that affect? It's not the prescriber. There is no malpractice exposure for overdiagnosis in this country. No psychiatrist has ever been sued for telling a grieving widow that she would benefit from taking the edge off. No one loses their license for putting a seven-year-old boy on stimulants because he fidgets in a classroom. That was never decided for him in the first place. The acathesia, the blunting, the weight gain, the sexual dysfunction that can persist after the drug is stopped. The withdrawal that gets mislabeled as relapse. Every single one of those costs lands on the other side of the desk. And that's the patient's side. They absorb them. In fact, the incentives are so perverse. If the doctor doesn't follow the standard of care, they're more likely to be held liable. Dr. Roger McFillin (08:44.29) The prescriber bills identically whether you recover or deteriorate. 15 minutes is 15 minutes, and it is not dependent on whether you're improved. Compare this to a surgeon. If a surgeon operates and the patient is harmed, there is a complication on the record. There is a morbidity and mortality conference. There's legal exposure. Surgery has problems, but the surgeon has skin in the game. There's a feedback loop and it disciplines behavior. Why in the mental health industry? We can have therapists in this too. They're cut out of loop. Psychiatry, cut out of the loop. And then it did something even more elegant. It actually built a mechanism that converts its failures into revenue. So here's how it works: a patient starts a drug and gets worse. Agitated, numb, maybe they're becoming more hopeless. In an honest system, the first question would be whether the treatment is causing the deterioration. But the disease model provides a different answer every time. The patient is not worsening because of the treatment. The patient is worsening because The disease is progressing. The illness is quote unquote treatment resistant. So we raise the dose. We add a second drug. We add a third to manage the effects of the first two. So sit with that for a second. The prescriber's failure does not produce accountability. It produces the next appointment. And what other profession on earth does your failure automatically generate your next invoice? Dr. Roger McFillin (10:33.229) We are taking episodic conditions and making them chronic. We are expanding the definition of normal. And because of the lack of accountability, iatrogenic harm becomes the norm. In fact, it's incentivized to do so. And I want to be precise here because this is not an accusation of malice. Most prescribers actually believe in what they are doing. That's a failure of the system. Because they are not incentivized to understand more about their harms. If they were held accountable, they would. They would naturally do that. That is exactly what moral hazard theory predicts. When the structure protects you from ever confronting your errors, you stop seeing them as errors. The insulation does not just protect your income, it protects your image. The system is designed so that the prescriber never has to metabolize the possibility that they are the cause. And if you go on to social media, you see the defense of this. Dr. Roger McFillin (11:42.669) Now zoom out one level because the individual prescriber operates inside a payment system. And that architecture is where the moral hazard gets industrialized. In an ordinary market, there is one feedback loop older than civilization itself. A person pays for help, then decides whether they actually were helped. If they did not, they stopped paying. That single mechanism repeated millions of times. Is what disciplines quality in every functioning market on the planet. Third prior party reimbursement severs that loop completely. So the patient does not pay directly. So the patient's satisfaction and the patient's outcome discipline nothing. The clinician does not answer to the patient. The clinician answers to the insurer. And what does the insurer require? Not a recovery, not functioning, not a life restored. They just require a code. A diagnostic code from the DSM. This is the price of admission to the entire system. No code, no reimbursement. No reimbursement, no treatment. So what does that mean? You cannot bill for a woman going through a divorce. You cannot bill for a man whose job is crushing his soul. You cannot bill for a lonely teenager who spends six hours a day on a screen engineered to addict her. There's no code for a meaningless life. There's no code for grief that is proportionate to the loss. So the system converts. It takes human suffering, which is real, and translates it into a medical disorder, which is billable. The divorce becomes adjustment disorder, then predictably major depression. The soul crushing job becomes generalized anxiety or ADHD. The lonely teenager becomes childhood bipolar, major depression. ADHD usually somehow combined with three different drugs. Not because anyone sat down and decided to lie, because the payment system makes the conversion mandatory. Distress becomes disease before help is even permitted. Dr. Roger McFillin (13:53.38) Little story, when I started for Center for Integrated Behavioral Health, and a number of times throughout the course of my my work there, I've tried to intervene with third party payers, insurance companies, and create a new system. And I would in that system I'd say I want to get paid more for positive outcomes and less when those outcomes do not meet the standard. And so I was willing to create a system where we could measure progress, including patient satisfaction, where the longer the treatment was provided over time without any perceived benefit, then we could decrease the the level of imp of reimbursement. And I know what people are saying out there, well, that would de incentivize people for chronic conditions. That's cause you assume all these conditions must be chronic. And that the treatment that's been provided is helpful. So there's two things that you have to remember. One, I believe we're turning conditions that are better served by other interventions or should be temporary or not require professional care at all. We should not be intervening there. And we have to also be aware that once something becomes prolonged without any effect, it is a sunk cost. Right. So we're not incentivized to get people the real help they need. This is why, you know, diagnostic inflation is corruption because it creates the system where more and more people enter into this transactional relationship and then become rewarded just for saying yes to the diagnosis. So the clinician gets paid. The insurer gets a a clean claim. The patient gets access and an explanation and a script. But nobody in the entire chain is rewarded for looking at a suffering person in the eye and saying the most honest sentence in all of healthcare. You know, you're not sick, you're you're human and your life is asking something of you. So there's no code for that sentence. So it almost never gets said. So zoom out again. Dr. Roger McFillin (16:13.419) Above the prescriber, above the payment system, sits the industry itself. And here is the moral hazard that fuses with something even darker: regulatory capture. The pharmaceutical industry has paid out billions upon billions of dollars in settlements. They've concealed trial data, hidden suicide risk, illegal off-label marketing to children. There's ghost-ridden journal articles. That are misrep misrepresented to the public. there's matter of court records, so none of this is conspiracy theory. And here's the question that matters Did any of it threaten the enterprise? Dr. Roger McFillin (16:58.489) These are facts. Did a single one of those settl settlements ever get put, you know, into the public sphere that put the company's existence at risk? Dr. Roger McFillin (17:12.195) Never. Not once. The fines are actually priced in. They are a line item, a cost of doing business for the pharmaceutical industry, calculated in advance and weighed against the revenue of the drug. When the profit on a blockbuster drug runs into the tens of billions and the settlement runs into the hundreds of millions, the settlement is not a punishment. It's a licensing fee for the harm. This is moral hazard at industrial scale. The corporation makes the reckless bet, the patient absorbs the loss, the shareholder keeps winning. Now, in a functioning society, this is exactly the point where the backstops are supposed to engage, right? The regulator, the professional guild, the scientific literature. These institutions supposedly exist for one reason to hold risk on behalf of the public, to be the skin in the game that the industry refuses to have. So let's look at the backstops. The FDA. The agency that approves these drugs is substantially funded by user fees paid by the very companies whose product whose products it reviews. Crazy, right? Dr. Roger McFillin (18:37.476) The regulator's budget depends on the goodwill of the regulator. The clinical trials submitted for approval are designed, funded, and controlled by the manufacturer. Six week trials for drugs that will be taken for sixteen yards make it make sense. Sixteen sixteen years of drugs for something that we looked at for a small amount of time. Police. This doesn't sound radical. Does my position sound radical? The guidelines that these committees tell your family doctor what to prescribe are populated by academics with financial ties to the manufacturers. The professional guilds defend the diagnostic paradigm with everything they have because the paradigm is the revenue. The DSM itself is a profit center for the American Psychiatric Association. Every institution that was built to absorb risk on behalf of the public has been converted. Into a mechanism that absorbs risk on behalf of the industry. The backstops did not fail, they were purchased. And I want you to notice what that means for you. The individual standing at the bottom of this structure, every layer above you is insulated. The prescriber is insulated by the disease model. The payment system is insulated by the diagnostic code. The manufacturer is insulated by settlements. It can afford The regulator is insulated by user fees. The guild is insulated by its own guidelines. There is exactly one party in this entire architecture with full exposure to the downside. That one party who absorbs every consequence of every failure at every level. That is you. That is the patient, the child, the family. The risk rolls downhill through every layer of the system and lands on the person with the least information, the least power, and the most to lose. This is not an accident of the system. This is the system. Now I want you to take this somewhere most critics of psychiatry never go. Because everything I've said so far, you could hear versions of elsewhere. Follow the money, regulatory capture, farmer settlements. Fine, fine, okay. But moral hazard theory has one more application, and it's the deepest one. It applies to the patient's own psychology. Dr. Roger McFillin (21:00.814) It applies to what the disease model does inside a human being. Now stay with me here because this requires precision. I'm going to give you the caveat up front. What I'm about to describe is not the patient's fault. Nobody chooses this consciously. Moral hazard never operates through conscious choice, it operates through incentives silently, beneath awareness. This is true for the banker, it's true for the prescriber, and it's true for the person holding the diagnosis. Here's the claim. The disease model of mental suffering is itself an insurance policy. And like every insurance policy ever written, it changes the behavior of the insured. Think about what a psychiatric diagnosis actually offers a suffering person. It offers an explanation that requires nothing of you. Your suffering is not your marriage, your avoidance, your unlived life. Buried grief, abandoned integrity. Your suffering is a chemical event, it's a brain disease, it's genetic. Something happened to you the way weather happens to you. And that framing insulates you. It insulates you from the hard conversation you have been avoiding for 10 years. It insulates you from the change that recovery would actually require. It insulates you from the terrifying sacred confrontation with your own life. And moral hazard theory tells us exactly. What insulation produces? Passivity, risk avoidance, diminished care. The insured driver takes the curve faster. The diagnosed patient stops turning the wheel at all. Why would you fight for your life if your suffering is a malfunction that only a professional can manage? Why would you face the feared thing in your in your life if your fear is a disorder rather than a message? Dr. Roger McFillin (23:01.552) You know, I've practiced clinical psychology for quite some time. You know, I've sat with hundreds of human beings in their darkest moments, and I'm going to tell you the single most consistent pattern I've observed over those years. The people who transform, who recover, are the people who take risk back. They face the feared conversation. They tolerate the discomfort instead of numbing it. They make the change they had been medicating. Their way out of making. They stop outsourcing their inner life to a prescription pad and start treating their suffering as information about how they are living. So recovery is skin in the game phenomenon. It's always been. Every wisdom tradition in human history knows this. You do not heal by being insulated from your life, you heal by entering it. And what does our system do? It systematically removes the skin from the game and calls it compassion. It hands a 15-year-old girl an identity card, says her sadness is a lifelong brain condition. And then it acts surprised when she organizes her entire personality around being ill. It teaches a generation that distress is dangerous, that discomfort requires professional management, that you are fragile. And fragility, once taught, is obedient. It performs exactly as instructed. And the clinical literature has a name for this. It's called learn helplessness. I would call it something simpler. It's the predictable behavior of a person who has been fully insured against the demands of their existence. The policy pays out in relief and it collects its premium in vitality. One more time, because this matters. The patient did not build this insulation. The patient was sold it. We've been manufactured this. By professionals who you're told to trust, by an industry that profits from the dependency it creates. If you are listening to this and you recognize yourself, I am not blaming you. I'm telling you that you were the mark in someone else's business model. And I'm telling you this policy can be canceled. Dr. Roger McFillin (25:20.432) So now let's test the theory because moral hazard is not just a story, it makes a prediction, and the prediction is falsifiable. The prediction is this: a system that is shielded from the consequences of its failures will expand while its results deteriorate. Growth and failure at the same time feeding each other. So read the record. We are living through the greatest expansion of mental health treatment in human history. More prescriptions than ever, more therapists than ever, more screening. More awareness campaigns, more school programs, more apps, more diagnoses. By the industry's own logic, we should be the most mentally healthy society that has ever existed. Instead, psychiatric disability has climbed for decades. Youth suicide rose through the very years we saturated adolescents with screening and treatment. Anxiety and depression rates in young people are at levels no prior generation recorded. The more we treat, The sicker we get. Now think like economists for a moment. In any market with a functioning feedback loop, this performance record means extinction. A car company whose cars got worse every year for 50 years would not exist. A restaurant that made its customers sicker with every meal would be closed by Friday. What happened to the mental health industry when its outcomes deteriorated? It got more funding. More screening mandates, more awareness months, more insurance coverage. The worse the results, the bigger the industry. The inversion is the smoking gun. Only a system with no skin in the game can grow on its own failure. The deterioration is not evidence against the theory. The deterioration is the theory confirmed. Now, before I turn to what we do about it. Let me take the three objections head-on because I know they're coming. Objection one. So you're saying Dr. McPhil and people are faking it? Like suffering's not real. These conditions don't exist. No. I've never said that and never will. The suffering is real. Moral hazard is not about faking anything. It is about incentives shaping behavior beneath awareness. The banker was not faking the mortgage bets. Dr. Roger McFillin (27:48.454) The banker was operating rationally inside an irrational structure, so is the patient, and so is the clinician. Objection two, doctors do face malpractice risk. True, for errors of commission. Miss a tumor, and you'll hear from a lawyer. But psychiatry's signature errors are errors of expansion and following the treatment protocols. Overdiagnosing, overprescribing, medicating normal human behavior and experience. This there's no legal exposure for any of that. No one's been sued for handing out too many diagnoses. The system punishes the doctor who under-treats and protects the doctor who over-treats, which is exactly why over-treatment is what we get. Objection three. Fine, but you're a psychologist. Surely therapy is different. Am I letting my own guild off the hook? Well, no, and this is important. A therapist who is paid by the session week after week, year after year, with no defined goal and no endpoint is running the same structure at a different dose. So the the scam here is the therapist gets paid for retention, not recovery. Endless supportive therapy that accommodates a patient's Avoidance that soothes that soothes them with ever challenging them, that makes the patient comfortable inside a life that needs to change, that in itself is its own moral hazard. My field industrialized the shoulder to cry and called it treatment. And if I only aimed this critique at the prescribers, you should definitely trust me less. The incentive problem does not care which degree hangs on the wall or what. iotrogenic harm is produced, right? It applies to all things, including the work that I've done in my career. So, what do we do? Because I refuse to hand you a diagnosis of the system without a treatment plan. And here is the beautiful thing about the moral hazard framework. It's it does not just explain the disease, it also prescribes. Dr. Roger McFillin (30:12.198) The cure. So in every other domain where moral hazard has been confronted, the fix is always the same move. You reconnect decisions to consequences. You put skin back in the game. So let's do that layer by layer in reverse. So let's start with the clinician. Three reforms. First, Outcome transparency. Surgeons publish complication rates. Hospitals publish infection rates. Why does no mental health clinic in America publish its recovery rates, its functioning outcomes? The percentage of its patients successfully tapered off drugs. If your clinician cannot tell you what fraction of their patients actually get better and leave, you have learned something important about whether getting better and leaving is the actual goal. Second, Real informed consent, not a signature on a clipboard. It's not even a clipboard anymore. It's something you electronically sign automatically before ever seeing the doctor. But a real conversation. Before the real prescription is written, the patient hears the whole truth. There's really no test to confirm this diagnosis. We don't really know what these drugs are doing. The chemical imbalance myth was a lie perpetrated by fraud. The drug carries risks of dependence, withdrawal, emotional blunting, sexual dysfunction. Here's what we know about long-term outcomes, which isn't a lot, which is really problematic, because we don't know what's going to happen to you. We can't guarantee it. You'll likely get worse. Remember condition one of moral hazard, asymmetry of information. Informed consent is the direct dissolution of that as asymmetry. It transfers the knowledge back, which is precisely why the industry has resisted it at every turn. Third, treatment with an exit built in, time limited, goal defined. From the very first session, the question on the table is what needs to be true for you to no longer need me. A clinician whose success is measured by the patient's departure has skin in the game. Dr. Roger McFillin (32:39.066) Not just their departure from kicking them out or not getting better, their departure from no longer requiring them. A clinician whose income depends on the patient's return does not have the incentive to get them out the door. And you know how therapists love the easy client, the verbal, highly verbal, highly intelligent, dealing with day-to-day normal life problems. And then you're brought into the world. It's really that simple. Right? Incentivize improvement. And the the greater the struggle, the greater the impairment. The higher the skill level of the clinician, the higher the reimbursement should be. Pay for functioning, not diagnosis. Imagine reimbursement tied to whether a human being returned to work, returned to school, restored relationships, reclaimed life, not whether a code stayed active on a chart. Now, this is staying within the current system, right? Obviously, I would prefer there's no insurance system at all. There's no taxpayer, payer, government-funded. system that the incentives and the liability are met between two individuals entering into a contract. Like if we didn't give the government so much money, we'd have a lot more money in our pockets. See, people think about things in terms of like, I can't afford it. Well, you can't afford it because you give up so much of your income. We have prices that are skyrocketing the devaluation of the dollar. I digress. Dr. Roger McFillin (34:24.86) But I'm trying to give you a solution here that fits within the system. So basically, reimbursement tied to return to school, return to work, restored relationships. The customer is happy because they feel so much better. The moment you pay for outcomes, every incentive in the building rotates 180 degrees. These chronic conditions stop being a revenue stream and they become a cost. And restore the oldest feedback loop there is wherever it can be restored. Direct payment arrangements, community-based models, peer respite, structures where a person decides for themselves whether the help actually helped, walks away when it does not. I am aware that not everyone can pay out of pocket. I'm not offering this as a universal answer. I'm pointing out that every layer of separation between the person and the accountability makes the moral hazard worse. We should be engineering separation out, not in. Now let's take a look at the industry. Liability with teeth. Fines calibrated to threaten the enterprise, not to decorate its balance sheet. Executives personally accountable for concealed data, like prison time, the way they would be in any other fraud. An FDA weaned completely off industry user fees, so the regulatory answers to the public are in the public's best interests. They protect the public. Guideline committees with zero financial conflicts. No managed conflicts at all. No disc not disclosed conflicts. Zero. And mandatory long term post market surveillance because a six week trial tells you nothing. Dr. Roger McFillin (36:22.394) None of this is radical. All of it is standard accountability that we demand from airlines, from automakers. We just decided somewhere along the way that mental health care was exempt from this. Now the deep, the deepest layer, the person, because you can reform every institution I just named and still lose. If the culture keeps teaching human beings that they are fragile machines, we lose. The real alternative is a return of risk, agency, and responsibility to the individual. It is a model of care built on a different premise. Distress is meaningful rather than diseased. Anxiety is information. The crisis is often a demand for a different life, and that drugging the messenger leaves the message on read. Dr. Roger McFillin (37:20.974) It it approaches the person as capable, that we can build tolerance for discomfort instead of this illusion that it is a better life to numb it out. Dr. Roger McFillin (37:40.126) We can ask, what is your emotional pain asking of you? And it requires saying a sentence out loud that our entire therapeutic culture is built to avoid. Safety is not the goal of a human life. It never was. A life organized around the elimination of risk is not a healthy one. It's not a better one. It's a small one. And a system that promises to insulate you from your own existence will keep that promise and it will collect your vitality as the premium. Recovery begins at the exact moment a person takes the risk of taking their own life back. Every clinician who has ever witnessed real transformation knows this. Trust me, the industry knows it. It just can't bill for it. So let me bring this to a close today. In two thousand eight we watched an industry privatize its profits and socialize its losses and we called it a scandal. We wrote books about it. We made movies about it, and we said never again. For fifty years, another industry has been running the same structure. Privatized profit, socialized risk, except the losses are not measured in foreclosures. They're measured in childhood, spent sedated in withdrawal syndromes nobody warned you about, in permanent sexual dysfunction, in human beings taught to fear their own inner lives, in a generation convinced that their suffering is a malfunction and their fragility an identity, where 35% of people are identifying with a mental illness, that is insanity. And we've been bailing out this industry for half a century. And the currency is our children's minds, it's generational. Dr. Roger McFillin (39:41.016) I believe that Dr. Roger McFillin (39:46.834) Human our own humanity, our collective humanity, we're at an inflection point, merging with machines, technology, and pharmaceuticals. And if we're not careful here, we'll all call it health care. And that's very dystopian. The system will not put skin back in the game voluntarily. Insulation never dismantles itself. So it starts with you because once they have the power, they're not giving it back. So you have to ask questions, demand outcome data, demand real informed consent. Refuse the conversation of your pain into a product and refuse above all the story that you were too fragile for your own life. Be honest when individual clinicians, physicians treat you like cattle. Stand up, use your platform in your community with your own social media. Talk to your neighbors. There needs to be a push from the market side. That's the only way we're going to change it is through education. Dr. Roger McFillin (41:02.941) You're not a diagnosis, you're a human being and you're suffering or your problems that you're experiencing with yourself or a family member. They're not a disease to be managed. It's it's a summons to pay attention to that signal and make needed changes. So please take the risk of your own life back. Because no one else is going to absorb it for you. That's always the lie. And start taking the power back from these clinicians, from this industry. And we need to create incentives for human flourishing. Sovereignty and freedom. Awaken. Thank you.