Latest / Cultural Wars | America Out Loud News / How modern medicine lost public trust—and how to heal it

Transcript

How modern medicine lost public trust—and how to heal it · Cultural Wars | America Out Loud News

• 0:00
  Informed dissent, the intersection of health care and politics with Dr.
• 0:05
  Jeff Barkey, board certified primary care physician, and Dr.
• 0:10
  Mark McDonald, board certified child, adolescent, and adult psychiatrist.
• 0:15
  All right, Mark, welcome to another episode of informed dissent.
• 0:19
  Hello, hello.
• 0:20
  You know, we whine and complain all the time about everything that's wrong with medicine.
• 0:25
  And there is plenty.
• 0:28
  But today you invited a phenomenal get guest that maybe just maybe has a path forward that we can learn about.
• 0:37
  So tell us about him.
• 0:38
  We've got Dr.
• 0:39
  Aaron Cariotti, a fellow psychiatrist and a good friend of mine that I've known for five years.
• 0:45
  He is um well, he he's he's displays a lot of the courage that I really want to see more in physicians, particularly when we were during the lockdown periods, where he, as his position at the time as a professor of psychiatry at UC Irvine and head of the medical ethics committee there, uh, really took a public stance and fighting against what I consider, and obviously he considers to be the unethical practice of forcing people against their will to take medical interventions like injections and vaccinations.
• 1:14
  And he ultimately lost his job because of it.
• 1:16
  Um, but he's still a happy camper.
• 1:18
  I met him a few weeks ago at a talk, and he's delighted that he's no longer in that position, and he actually has more freedom to do what he wants and do good for the world.
• 1:27
  So it was a good outcome, all in all.
• 1:29
  And most recently, and why we're having him on our show today is that he just published a book, which I have read.
• 1:34
  It's excellent.
• 1:35
  It's called Making the Cut, How to Heal Modern Medicine, written by Dr.
• 1:40
  Aaron Cariotti, psychiatrist.
• 1:42
  Welcome to our podcast, Dr.
• 1:44
  Aaron Cariotti.
• 1:46
  Thanks, Mark and Jeff.
• 1:47
  Great to be with you.
• 1:48
  Yeah, great to be with you.
• 1:49
  Is as I read through your book, uh, first of all, it's incredibly well well written.
• 1:55
  Uh, and it's written, meaning it well written, meaning not that the story is good, although it's good, it's well written, meaning it's very accessible to the average person to read and understand.
• 2:06
  Too often we get books from academics that maybe the information is really important and uh and useful, but it's just so damn difficult to read that most people they'll get through a few pages and then just quit.
• 2:20
  But you capture the essence right in the introduction, and it's very reminiscent of my story.
• 2:28
  We just sort of go through medical school questioning nothing, assuming everything that we learn is the truth, the scientific truth.
• 2:39
  Um, and we don't question anything, and we're not encouraged to question anything.
• 2:43
  And to the extent that we sometimes do, we are scolded.
• 2:46
  And there's so many examples in medicine.
• 2:49
  If you would, I'm gonna read just a very small portion of your introduction that really just captured me.
• 2:56
  Uh physicians pass through medical school as a matter of course without questioning and perhaps without wonder.
• 3:04
  I was one of them.
• 3:05
  I progressed through training as a matter of crisis and was continually astonished by what I saw and did.
• 3:14
  So tell us why you wrote this book and and tell us about this book.
• 3:19
  So the book, uh, making the cut is it's well, it's three things.
• 3:24
  First, it's a memoir of my medical training.
• 3:27
  And with that aspect of the book, I really try to take the reader and put the reader at the bedside or in the operating room and really sort of give you a sense of what it is physicians do and why it's to my mind still so astonishing that we're we're permitted to do the kinds of things that doctors do.
• 3:47
  And so I try to really paint a vivid picture of what it was like to encounter those things for the first time as a medical student before you sort of get used to them.
• 3:56
  Like I'm I'm in the operating room doing a leg assisting on a leg amputation.
• 4:02
  This is the very beginning of chapter five, for example.
• 4:05
  And suddenly the the leg, after they use the bone saw to complete the amputation, the leg comes free in my hands, and it's just sort of I'm holding it and it's it's floating there free of the patient's body.
• 4:17
  I mean, this is a this is a crazy thing to do, right?
• 4:22
  To another to another human being and to another human body.
• 4:24
  Of course, we did it in this case because they had gangrene of the foot, and that's not compatible with with life.
• 4:31
  And so, you know, we we maimed the person in that way for the sake of healing, but it's still to participate in something like that should kind of astonish and shock us, I think.
• 4:45
  And one of the things that happens in the course of our training is we get used to these things.
• 4:49
  We start taking them as a matter of course.
• 4:51
  So, anyway, I wanted to bring back that kind of fresh, vivid uh encounter with treating the human body and with practicing medicine.
• 5:01
  And you did that really well, just to briefly interrupt you, because when I was reading it, Aaron, it it brought back memories of my medical education, my residency education, my fellowship education, my time in the hospital, and some of it was traumatic.
• 5:17
  It didn't the fact that it activated that in me, tells me and should tell the readers, even those who aren't physicians, that this is a very accurate representation of what medical school medical training is like.
• 5:27
  Not sensationalized.
• 5:28
  No, Jeff, you agree.
• 5:30
  I mean, this is we went through this shit.
• 5:32
  Like I and even the jokes, you know.
• 5:36
  Yeah, I'm right.
• 5:36
  Yeah, he equals MD, pass equals medical degree.
• 5:39
  And then my instant next thought was, yeah, well, LP equals R I G, low pass equals residency in Guang.
• 5:45
  Yeah.
• 5:46
  So this is all very real.
• 5:48
  I just had to interrupt you just to point that out that this book is not a sensational or third person account of medicine.
• 5:55
  It's it's very personal, but it's very accurate and it's it's very thoughtful.
• 5:59
  And again, as Jeff said, it's very accessible and very readable, very well written.
• 6:04
  I I really uh appreciate the quality and the time that you obviously put into this.
• 6:10
  This is not ghost written.
• 6:11
  This is not some guy that just dictated it into an AI device.
• 6:14
  This was this was written with a lot of thought and care, every word, every phrase, and it it really does show in the work.
• 6:19
  Well, thank you for that, uh, Mark, and and for your comments too, Jeff.
• 6:23
  That's exactly what I wanted with this book.
• 6:26
  And you're right, it was not written by AI.
• 6:28
  It's it's a book that was 20 years in the making, actually.
• 6:30
  So the narrative sections, the parts about medical school and medical training, I wrote immediately after medical school because I just had all these experiences stored up in me.
• 6:40
  And I thought, gosh, I had no idea what I was getting into when I went to medical school.
• 6:45
  Maybe, maybe pre-meds would want to read about sort of what to expect when they arrived there.
• 6:50
  So I wrote those sections of the book, kind of an early draft of the book, about 22 years ago.
• 6:55
  That's why it sounds so fresh.
• 7:00
  How on earth did this guy have such a good memory?
• 7:02
  Well, I didn't have such a good memory, but thank goodness, uh, I took the time to write it down between medical school and residency, those six weeks I had off.
• 7:11
  I just wrote manically and got all these stories down on paper.
• 7:14
  And I never published it at the time.
• 7:16
  I dusted it off only, you know, a couple years ago to try to complete the manuscript.
• 7:21
  And that's where I added the other aspects of the book, which um, besides being a memoir, it's also a philosophy of medicine, you could say, although it's not academic philosophy.
• 7:32
  I try to with that, try to make it accessible and explaining, you know, what is it that doctors do and why is it important to understand that and get that right.
• 7:42
  And then the third aspect of the book is really a critique of contemporary health care.
• 7:46
  Um, and this is this is the part that says, look, in many respects, medicine has gone off the rails.
• 7:52
  This is the aspect of contemporary health care that saddens me, as I'm sure it does you guys.
• 7:56
  I mean, you're talking about these issues all the time on your podcast and trying to address them in your own clinical work.
• 8:03
  And so, based on what I take to be a sound philosophy of medicine, I tried to articulate where we've gone wrong.
• 8:11
  And so the the book is not uh hopefully not pessimistic because I say in the introduction, it's a love star story because I did fall in love with medicine during my training.
• 8:23
  But um, you know, my lover is turned prostitute of late.
• 8:26
  So it's also kind of it's kind of heartbreaking to see what's working for a little hoe.
• 8:31
  Yeah.
• 8:32
  So there is that aspect of the book as well, which is a pretty stringent critique of contemporary health care.
• 8:39
  But I I did want to try to place the reader there at the bedside and give you a sense of what it's like to become a physician.
• 8:48
  And you know, we're allowed to do things in medical school that in any other context would be considered a felony, like carving up a dead body in gross anatomy lab, or practicing unperfected procedural skills on unsuspecting patients.
• 9:05
  So I have this account in one of the early chapters of my first lumbar puncture.
• 9:09
  You know, my hands are sweating, and I you know, a little bit tremulous, and I'm trying to guide the needle through the patients, you know, uh spinal column, basically into the into the subdural space that that little little space where the spinal cord resides where you try to get a little bit of cerebral spinal fluid for this diagnostic procedure and and failing at that, right?
• 9:33
  Um you wrote the resident had to take over the the needle because you just couldn't do it.
• 9:37
  I couldn't, I couldn't get it.
• 9:38
  And so, you know, the adage was see one, do one, teach one.
• 9:41
  And I couldn't, I I saw one, but I hadn't yet managed to do one yet.
• 9:46
  And so there's all those, there's all those aspects of uh sort of the the enormous privileges that society grants to physicians, and which makes it all the more tragic when physicians either take
• 10:00
  Those for granted or start even sort of misusing or abusing those privileges, you know, for the sake of making more money or for the sake of you know efficiency or for whatever reason, uh contemporary health care has in many respects gone down the wrong path.
• 10:16
  And so the the book tries to do all three of those things.
• 10:19
  It tries to say, look, this is an awesome enterprise that we're engaged in.
• 10:24
  It's an astonishing, sort of amazing thing that physicians are allowed to do these sorts of things.
• 10:31
  But you know, with that enormous kind of power and those privileges, uh, there's there's tremendous responsibility for us to get that right and to not be reckless and to always put the patient's needs ahead of secondary interests.
• 10:48
  And I think in many ways, that's been flipped today.
• 10:51
  Um, that other things have started sort of taking a front seat and patient care gets um compromised in the process.
• 11:02
  We all graduated medical school a long time ago, not like within the last few years.
• 11:07
  Yeah.
• 11:08
  Have things changed.
• 11:10
  Are medical students of today and residents of today treated and being and and treating patients differently and learning differently than what we did?
• 11:20
  Uh unfortunately, my experience uh being at an academic medical center for the first 16 years of my career up until the end of 2021 when I uh left the University of California, as you mentioned in the introduction.
• 11:32
  Um I spent a lot of time with med students and residents.
• 11:36
  I taught courses across all four years of the medical school curriculum.
• 11:41
  I was residency training director before I took over the ethics program.
• 11:45
  And so I have a lot of experience with uh medical school and residency training.
• 11:50
  And unfortunately, I don't think things have gotten better, if anything, probably starting around 2015, 2016 and kind of reaching a peak in 2020, things got considerably worse when it came to medical education.
• 12:09
  Yeah, getting infused.
• 12:11
  Yeah, I mean, a lot of it was simply that ideology being infused into the curriculum.
• 12:16
  And so the medical school admissions process focusing on applicants who were sort of ideologically charged in that way, and then those applicants getting in and sort of forcing the hand of sometimes reluctant deans and administrators to um make the curriculum sort of reshape it according to their particular uh ideology.
• 12:39
  And so, yeah, I mean, when you have when you have a very limited amount of time to try to train physicians and to try to help them digest and process a huge quantity of important information, and you start pushing into the curriculum that you know, physicians are responsible for fixing the problem of climate change, let's say, or you know, racial inequality or whatever, and just bracket for a moment what you think about debates on those issues, right?
• 13:07
  That's gun violence, yeah.
• 13:08
  Gun violence, whatever.
• 13:09
  I mean, these I'm not saying these aren't important political issues.
• 13:12
  I'm not saying there aren't important debates to be had about these things, but the purpose of medicine is to train people to heal the sick, and the physician's only responsibility is the individual sick patient who comes to him for care and places himself or herself under the care of the physician who professes to use all of his or her knowledge and skills only and always for the purpose of health and healing.
• 13:36
  That's saying, Aaron, that the doctors at UC Irvine are not capable of solving the crisis in Gaza.
• 13:44
  I'm well, if they are capable of solving the crisis in Gaza, they're probably in the wrong profession.
• 13:50
  They should probably go fix the crisis in Gaza and get out of medicine.
• 13:55
  So I, you know, maybe they are, but that's not their vocation if they went to medical school.
• 13:59
  That's not their calling, right?
• 14:01
  And it's not to say that they can't engage in political life, you know, and social issues, obviously outside of their professional life, right?
• 14:09
  But the purpose of their professional life is to be a healer of sick individuals, not to fix society, not to fix international political conflicts, you know, not to fix the the climate or the environment or what have you.
• 14:24
  I mean, all of us as citizens have some responsibilities, I suppose, to deal with those sorts of issues.
• 14:30
  But as physicians, we need to remain physicians.
• 14:34
  So I would say, yeah, that's part of what's happened.
• 14:36
  And again, that ramped up, probably starting around 10 years ago and hitting its peak around four to five years ago.
• 14:43
  And I think we're starting to just starting to turn the corner and come out of some of that ideological hysteria, but it's still very, very entrenched within medical education.
• 14:54
  But I think there's other issues as well.
• 14:57
  So, you know, I was I was subjected to kind of abusive work hours during medical school.
• 15:03
  So it wasn't until I was res in residency that Congress passed the 80-hour work week.
• 15:08
  So I did have rotations in medical school that are 110 hours a week, 36 hour call shifts every three or four nights.
• 15:15
  Join the join the club.
• 15:16
  Shall I get my violin out for yeah, exactly?
• 15:18
  So I'm not I'm not here to tell uphill in the snow stories both ways.
• 15:23
  But and that there were obviously problems with that system when you have you know a surgical intern falling asleep in surgery um or crashing, you know, her car on the way home, that's a problem.
• 15:37
  Uh, you know, because residents are falling asleep at the wheel or or what have you.
• 15:42
  But the alternative seems to be a sort of shift work mentality, where the idea that I've really taken ownership, so to speak, over the care of this patient has been lost, I think.
• 15:56
  And it's a clock-in, clock out mentality.
• 15:59
  When I'm off the clock, don't page me, don't bother me.
• 16:03
  And one of the things that does is I think it diminishes one's sense of responsibility for the care, the total care of this patient.
• 16:11
  I think the hospitalist model in primary care also, while it has its advantages, I understand why we went in that direction.
• 16:18
  Um, there's there's pros and cons to all of these, all of these, there's trade-offs to all of these things, but you know, the idea that you would have a primary care physician that saw you in the outpatient setting that would continue to follow you in the inpatient setting and see you through a hospitalization, then follow up with you when you left, that creates a kind of hot continuity and knowledge of your history, uh, a trust, a level of trust that has not been replicated in the kind of shift work model.
• 16:45
  Just because of the handoffs.
• 16:47
  I mean, I remember even in medical school.
• 16:49
  Yeah, every time a patient is handed off, that is the moment on the chart of medical errors, or as Jeff likes to talk about the atrogenic or doctor-cause medical problems that spikes every time there's a handoff.
• 17:02
  And so, yeah, it's great that your resident is not on his 37th hour of sleeplessness, you know, when you put them in a uh a chamber and caught and you know, uh a driving chamber to see how they would drive if they were behind a little car, they register at the level of an alcohol intoxication that's two times above the legal limit.
• 17:19
  So hopefully they're driving a Tesla in autopilot mode.
• 17:23
  Which would be great.
• 17:24
  Only it's the problem is when they're opening up, you know, the surgical field and and trying to assist the surgeon, they're falling asleep in the patient's body.
• 17:32
  So they're they're they're practicing drunk.
• 17:34
  Hey, you guys, I mean I'm gonna ask you a rhetorical question.
• 17:37
  I'm asking it for our audience.
• 17:40
  You both are psychiatrists, but you're generalizing a lot of these things to the entire field of medicine.
• 17:48
  Why should somebody listen to two psychiatrists that are bagging on medical training and all the malfeasance that goes on?
• 17:57
  Uh, how do you guys how do you know?
• 18:01
  All right, fair enough.
• 18:02
  Um, well, first of all, I went through it.
• 18:05
  So, you know, I am psychiatry is a specialty within medicine.
• 18:10
  And for most of my career up until the last couple of years, I was um seeing basically residents and trainees in all specialties of medicine, both as the ethics committee chair, because we'd get consulted by you know different specialties and different services, but also on psychiatry, I was regularly covering our consultation liaison service and the emergency psychiatry service.
• 18:35
  So I was multiple times a week in the emergency room on the medical wards on the surgical wards in the ICU, um, collaborating with colleagues in other specialties.
• 18:46
  So I also think just psychiatrists are generally smarter and have a lot more wisdom than true.
• 18:54
  You know, that others literally I'm saying this rhetorically.
• 18:58
  Yeah, I know the answer, but I want to I want our audience to hear the answer.
• 19:02
  So they don't think that somehow because you're a psychiatrist that therefore you commenting on what we did during medical training and surgery or any other field is somehow not relevant because it's it's relevant.
• 19:15
  It's so relevant as a matter of fact, Aaron, as I was reading through your book, literally, as I was getting anxiety remembering things about my training that I guess I wanted to forget.
• 19:27
  And I'll give you one example.
• 19:29
  And we all laughed about this, like it wasn't a big deal, but it was a big deal.
• 19:34
  For example, all medical students take gross anatomy.
• 19:38
  You literally dissect cadavers.
• 19:41
  Well, cadaver parts had uh, in at least at my medical school, had a way of going missing.
• 19:49
  And ribs or various body parts that should not be removed, like private body parts were missing and used as practical jokes.
• 20:00
  There's this level of desensitization that happens.
• 20:04
  A little bit of it is necessary because you're literally operating and dissecting a dead body, but too much of it is not healthy.
• 20:12
  Yeah.
• 20:12
  And I don't think we do a very good job of allowing students to be part of the reality of what they are doing and feeling that reality, as opposed to encouraging a compartmentalization and a distancing from what they are actually doing on a real human being that likely purposefully decided to donate his body for medical students to learn on.
• 20:45
  And a lot of that is lost.
• 20:48
  That's so well said, and that's so important.
• 21:00
  For trying to understand medical training and a sound philosophy of medicine.
• 21:10
  My first exposure to a patient was a decontextualized corpse that had, as far as I knew, no family, no history, no social context.
• 21:22
  I didn't know anything about this person other than it was a dead female.
• 21:28
  And to me, that's problematic.
• 21:31
  And you know, I understand the reasons for that.
• 21:34
  People donate their body to science.
• 21:35
  They may not want to hand over all kinds of other personal information that might, you know, help the person who's dissecting their remains understand them as a full person and not just as a as a corpse.
• 21:49
  But I think the fact that medical training, typically in the very first year, typically early on in the very first year, sort of begins with gross anatomy lab, tends to set the stage for how we understand the human body.
• 22:04
  We understand it as a kind of complex machine.
• 22:06
  We understand it mechanistically if you want to put it in philosophical terms, rather than an organic whole that has integrity and whose functions are integrated in a really sort of beautiful, astonishing way.
• 22:20
  We see it as a collection of parts that can be chopped up and as you pointed out, sometimes stolen and used for practical jokes.
• 22:29
  And I think that mechanistic view of the body and seeing the body as without human, social, familial, spiritual, religious, whatever context that person existed within, tends to desensitize us and tends to develop a kind of callousness in physicians that I think is antithetical to good medicine.
• 22:56
  And you understand why it happens.
• 22:58
  Like if you're a surgeon, to take a scalpel and to cut open someone's body requires some degree.
• 23:04
  This is me putting on my psychiatrist hat for a minute.
• 23:06
  Requires some degree of desensitization or what we call dissociation, right?
• 23:11
  But that can go too far.
• 23:14
  You still have to remember, at least before and after the surgery, maybe not while you're cutting, but certainly before and after.
• 23:21
  You still have to remember and know and relate to this person as a person and not as a machine, not as a sort of collection of parts.
• 23:30
  And so I think it's important for us to think carefully about how do we expose students early on in their medical training to real patients.
• 23:40
  Um, how do we take that experience of gross anatomy lab and put it in a broader context so that it doesn't lead toward the kind of crass desensitization that you know would result in people take stealing body parts to use as part of a practical joke.
• 23:58
  I mean, anyone who stops and steps back and thinks about what this individual did in donating their body to science for the purpose of medical education should be horrified at the thought of doing something like that.
• 24:11
  Um, you know, that level of disrespect for a person's remains is um is extraordinarily callous.
• 24:19
  And yet, you know, within a few weeks of dissecting, some students seem to get into a mind space where they think, you know, they come to think that that might be a good idea.
• 24:28
  Aaron and Mark, we're gonna take a quick break.
• 24:30
  And when we come back, certainly I want to get into solutions, but I also want to hear more examples about what's gone wrong with health care, and maybe why did it go wrong?
• 24:43
  And then we'll talk a little bit about what are some of the solutions that we can actually fix it.
• 24:48
  So we'll be back in just a minute.
• 24:50
  I suspect that it will involve making some cuts.
• 24:55
  We need less medicine, not more.
• 24:57
  That's my paradoxical conclusion.
• 25:01
  Back in a moment.
• 25:02
  During COVID, we got educated on the power of natural virus protection and immune boosting using vitamins A, C, D, zinc, and quercetin.
• 25:11
  The problem, getting them at the right dosage from truly natural sources that doesn't cost an arm and a leg.
• 25:17
  Enter the daily V stack using breakthrough cellular absorption technology.
• 25:22
  We put those vitamins together and supercharge them with a complete multi-mineral complex.
• 25:27
  The daily VStack is basically an oral IV of six products all in one at an affordable price.
• 25:34
  Go to chemicalfree body.com forward slash out loud today.
• 25:38
  Get the daily V stack, protect yourself, boost your immune system, and save 20% on your first order.
• 25:46
  Are you eating like your health depends on it?
• 25:47
  Because it does.
• 25:48
  Most of the beef and grocery stores today come from industrial feed loss where animals are pumped with hormones, vaccines, and now even experimental MRNA technology.
• 25:56
  You won't see it on the label, but it's there.
• 25:58
  Wellness farms, eat like your health depends on it.
• 26:01
  100% grass-fed grass-finished beef from regenerative American family farms.
• 26:05
  Our cattle roam on wide open pastures, eating only natural grasses, never touched by mRNA shots, never given growth hormones, and never injected with unnecessary vaccines.
• 26:14
  Just clean, nutrient-dense beef, the way nature intended.
• 26:18
  Every cut is hand-selected, processed by trusted butchers and shipped directly from the farm to your door.
• 26:24
  No middlemen.
• 26:25
  Order now at TWC.
• 26:36
  Oral hygiene hasn't changed in 50 years.
• 26:39
  Brush, floss, repeat.
• 26:42
  We're told to use fluoride, which doesn't really address the acid creating bacteria.
• 26:48
  That is where the dentist recommended spray dental defense system shines.
• 26:52
  Sprite products contain xylitol, a natural sugar, which helps get rid of those nasty, smelly acid-creating bacteria in our mouth.
• 27:02
  The best way to care for your teeth and gums is by using spray.
• 27:05
  The spray dental defense system has a wide variety of products, toothpaste, mouthwash, mints, and chewing gums that are designed to work together to keep your teeth clean and mouth healthy and smelling sweet all day long to get your oral care back on track in an easy, effective, and very tasty way.
• 27:25
  Switch to spray today.
• 27:27
  Ask your dentist about xylitol and the spray products.
• 27:30
  Sprite can be found online and at all fine natural product retailers.
• 27:34
  Have you been looking for a healthy snack for on the go?
• 27:36
  But all the energy and protein bars are just too sweet and full of sugar, preservatives, and mystery ingredients.
• 27:41
  Well, not all energy bars are soft and sugary.
• 27:44
  Bear bars are a crunchy, savory bar made from just six simple natural ingredients.
• 27:48
  They're plant-based, organic, packed with protein and nutrients, and are low temp dried for a unique crunch.
• 27:54
  Most energy bars are based on chocolate or fruit and are held together with syrups and sweeteners.
• 27:58
  But bear bars are a delicious combination of veggies, nuts, and seeds.
• 28:01
  They're a perfect fast snack for hikes, workouts, and busy moms and dads to learn more.
• 28:06
  Just visit barebar.com forward slash out loud and get the exclusive discount just for America Out Loud Listeners.
• 28:12
  That's B-E-A-R, B A R dot com forward slash out loud.
• 28:17
  In a world of rising prices, you can still grow abundance.
• 28:21
  I'm Doug Evans, author of the national bestseller, The Sprout Book.
• 28:25
  Sprouts grow in three to five days without soil, sunshine, or fertilizer on your kitchen countertop for under a dollar serving.
• 28:34
  Take control of your food and your future.
• 28:36
  Visit the sprouting company.com/slash out loud and use the code out loud for an exclusive offer.
• 28:44
  Grow food, not fear.
• 28:47
  A man's country is not a certain area of land of mountains, rivers, and woods.
• 28:53
  But it is a principle.
• 28:55
  And patriotism is loyal to that principle.
• 28:58
  I'm happy to report that American patriotism flows freely once again.
• 29:07
  America Outloud Doc News is that place to awaken your heart, soul, and mind to the outlook.
• 29:19
  Okay, we're back in form dissent.
• 29:22
  Dr.
• 29:22
  Mark McDonald, my co-host and our guest Aaron Cariotti, MD psychiatrist who wrote a phenomenal book called Making the Cut, How to Heal Modern Medicine.
• 29:36
  Welcome back, Aaron.
• 29:38
  Thanks, Jeff.
• 29:39
  Mark.
• 29:40
  So tell us a little bit more.
• 29:42
  What were some other examples about what's wrong with healthcare today?
• 29:47
  Yeah.
• 29:48
  So there's a lot.
• 29:49
  I spend quite a bit of time in one of the later chapters talking about the problem of iatrogenesis, which is a fancy way of saying disease or injury cause.
• 30:00
  Caused by medicine itself.
• 30:01
  What?
• 30:02
  And I draw heavily on the word doctors will make mistakes.
• 30:06
  Yeah.
• 30:06
  Well, it's, you know, it's it's not just, I think it's not just medical errors either.
• 30:11
  When people hear that word and they're aware of the problem of you know, medicine inducing disease, they often think of physicians making mistakes.
• 30:21
  But actually, one of the things that I try to get at is it's not just physicians making mistakes, but it's the healthcare system itself, when it grows to a certain industrialized size and scope, it can't help but start to do more harm than good.
• 30:38
  And this is a thesis that goes back 50 years to a very interesting writer named Ivan Illich who wrote a book back in the 1970s called medical nemesis.
• 30:47
  And I draw heavily on Illich's work in one of the later chapters where I talk about the problem of iatrogenic disease.
• 30:54
  And it's really, it's not just a problem of individual physicians making mistakes, although that's a that's an important piece of it that we need to figure out ways to address that and to minimize medical errors, obviously.
• 31:05
  Um, but it's also the health healthcare system itself, the way the system is set up.
• 31:10
  What we have now is a system that has been infected by the ideology that I call managerialism.
• 31:17
  And it's an ideology that affects institutions in our society outside of medicine.
• 31:22
  But within medicine, basically what it is is the idea that everything can and should be controlled by so-called experts from the top down.
• 31:31
  And it matters little whether those so-called experts are government bureaucrats in Medicare, Medicaid, or a single payer healthcare system like they have in the United Kingdom or in Canada, or whether the person at the top is you know, the CEO of some corporate conglomerate that swallowed up the all the local hospitals and local clinics and is trying to dictate care from the top down.
• 32:00
  So, just as one example of how this works, I talk about the kind of metastatic metastatic proliferation of so-called medical guidelines, and you know, that now number in the tens of of thousands.
• 32:13
  And they're the word guideline is sort of a euphemism because in many cases, these guidelines are tied to reimbursements, right?
• 32:23
  So if you deviate from the guidelines or you deviate from the metrics, then you're not going to get paid, or you're going to get paid less, or your reimbursements from the insurance company from Medicare are going to be docked significantly.
• 32:36
  And so, in this kind of context, you have outside entities dictating a one size fits all approach to medical care, right?
• 32:45
  Everyone who has a certain blood pressure needs to be on a certain type of medication.
• 32:49
  Everyone who has certain metrics or certain numbers on their uh cholesterol, their lipids needs to be on a statin or whatever the sort of uh dictated cookbook recipe form of medical care might be.
• 33:07
  And it's it becomes very hard to sustain a practice working outside of that system.
• 33:13
  But essentially, what I argue is one size fits all is bad for patients, right?
• 33:18
  Because every patient is different and we need individualized medical care.
• 33:23
  And, you know, I talk about the problem of over prescription of medications and you know, the problem that basically people are outsourcing responsibility for their health to third parties rather than recognizing that I have I have quite a bit of agency and I have quite a bit of ability to affect my own health through changes in my lifestyle, through changes in my diet, through other things that are within my control.
• 33:49
  And I need a physician who's going to work with me to sort of optimize those aspects of treatment.
• 33:54
  Medications are important.
• 33:55
  I prescribe them routinely, but uh I think especially elderly people today are on so many medications, you know, our livers were not made to handle, you know, 12 to 16 medications a day.
• 34:10
  We're just not built for that.
• 34:12
  And if if we perceive that most people over the age of 65 need a regimen like that, I think medicine has somehow lost its way, right?
• 34:23
  We veered, we veered off course.
• 34:26
  Um but so the problem just to distill it down, distill a complex set of problems down uh to sort of one simple category is this idea of the managerialist revolution of medicine, where doctors become a kind of glorified data entry clerk, right?
• 34:46
  We have electronic medical record systems that were not really built for optimizing patient care.
• 34:52
  They were built as data gathering machines so that external third parties could mine that data for information that they think might be interesting.
• 35:02
  So medical records are no longer what they used to be, which is about doctors communicating with one another about their patients and communicating with themselves to remind themselves about the patient's history.
• 35:14
  They're not really that anymore.
• 35:15
  So you patients end up going to a physician who's staring at a computer screen, checking a bunch of boxes and often asking a bunch bunch of questions that have very little to do with the patient's chief complaint or their real issue or the underlying cause of their real issue.
• 35:29
  And patients sort of feel uncared for and unheard.
• 35:33
  I call it turnstyle medicine.
• 35:36
  Um if you go to a hospital or you go to a large sort of corporate clinic, I'll pick on Kaiser just for the sake of you know, illustration, but Kaiser is not alone and sort of uh being guilty of this model of medical care.
• 35:51
  Turnstile medicine is basically built on the principle of efficient people moving.
• 35:57
  So the analogy is Disneyland.
• 35:59
  Disneyland is exquisitely designed by engineers to move move as many people through as many turnstiles, as many rides, as many food lines, as many bathroom breaks as possible during the course of the day, right?
• 36:11
  And they make money when you when they do that, right?
• 36:14
  Hospitals are built on the same principle of efficient people moving.
• 36:17
  The idea is get them in, get them processed and get them out, whether or not they're actually healed, right?
• 36:24
  Uh, so efficiency becomes the highest aim rather than health, rather than care that's individualized and tailored to the needs of the specific patient.
• 36:34
  So that's the problem.
• 36:36
  And if that's the problem, the solution has to involve decentralization, essentially.
• 36:43
  You know, we can get in, you know, later in the conversation into my proposals for what might be done about this.
• 36:49
  But I I characterize the problem as one of excessive bureaucratic centralization and control.
• 36:56
  Uh, very often that is captured by financial interests, you know, from big pharma to medical device manufacturers to, you know, others who stand to profit when we are sick and don't stand to profit so much if we recover and become healthy and no longer need their medications or no longer need whatever it is that they're selling us.
• 37:19
  Well, Aaron, this is not just your opinion.
• 37:22
  I mean, the this is what the statistics show, depending on what statistics you look at, anywhere from the third to fifth leading cause of death in the United States is medical error in the work that physicians and hospitals and so forth do, obviously, not well.
• 37:39
  If you look at the statistics, I can't remember exactly, but the United States is the leading consumer of pharmaceutical drugs.
• 37:48
  Yeah, statins alone are a trillion-dollar industry in the United States.
• 37:55
  Disease is very profitable.
• 37:59
  You can't watch a sporting event, you know, it's football season now without a half a dozen pharma ads pushing whatever drug, many of which I haven't even heard of, not to mention whatever vaccines that they want to push as well.
• 38:14
  This is consumerism of healthcare.
• 38:17
  They're trying to sell disease to you or the cures, and they're happy that you're ill because it's very profitable for you to be ill.
• 38:26
  So this is, you know, it's certainly your opinion is in here, but these are the facts of the situation.
• 38:32
  I see patients all the time and work really, really hard to get them off medication.
• 38:38
  The older they are, the more likely it is that they're on a dozen different medications, and we no longer physicians most, not all, but most have lost the curiosity to ask questions like why.
• 38:52
  Yeah, why do you have high blood pressure?
• 38:54
  Why is your thyroid not working?
• 38:56
  Why do you have type two diabetes?
• 38:58
  What are you doing about your lifestyle?
• 38:59
  And we've been trained to look for the right prescription to put somebody on to cure whatever symptom or whatever disease that they have.
• 39:07
  I think that's exactly right.
• 39:09
  I think there's things that medicine still does very well.
• 39:13
  We're very good at acute trauma, let's say.
• 39:16
  If God forbid you get hit by a truck tomorrow, go to the nearest emergency room, let the trauma surgeon, the orthopedic guy patch you back together.
• 39:25
  But then as soon as you can, when you start the rest of the recovery process, try to get out of that, get get out of that system, right?
• 39:32
  Because the the chronic uh sort of rehabilitation and and the chronic disease issues that are the most of what medicine does, we're not very good at that.
• 39:44
  It's clear that we're losing the battle against chronic illness.
• 39:48
  And I think not all of this can be laid at the feet of physicians.
• 39:51
  I mean, there is environmental toxins, there's problems with our food supply.
• 39:54
  There's other things that need to be attended to in order for us to start making some real headway.
• 40:00
  On the chronic disease epidemic.
• 40:03
  And I also, I happen to like most physicians.
• 40:06
  I think there are some physicians who are sort of greedy and heedless and thoughtless and kind of dumb.
• 40:12
  But most, I think, do want to help their patients.
• 40:16
  I agree.
• 40:16
  At most try to put their patients' needs most of the time ahead of their own.
• 40:21
  But they're working within a system that is uh sort of fundamentally corrupted.
• 40:29
  And within that system, it's very hard right now to practice good medicine, even for people who start realizing, hey, this is not working very well.
• 40:39
  And I want to try to do things differently.
• 40:41
  It's a real challenge to know how to extricate yourself from that system in order to provide the kind of care that people actually need.
• 40:49
  Because we're not trained to do things differently.
• 40:51
  That's right.
• 40:52
  We are trained in the disease model of healthcare in every field.
• 40:57
  We're also trained to believe that every other specialist knows what they're talking about.
• 41:03
  You know, there's so much information to master.
• 41:05
  And the medical training that we go through is assessed mostly by multiple choice exams.
• 41:13
  Um, in some cases by certain sort of oral exams or demonstrating procedural skills and so forth.
• 41:18
  But most of the time, it's get the right answer on a multiple choice exam.
• 41:22
  It's not ask inconvenient questions, you know, raise your hand and say, wait a minute.
• 41:28
  I'm not sure that's correct.
• 41:30
  It's not, it's not an actual scientific mentality.
• 41:33
  A scientific mentality uh is skeptical.
• 41:36
  A scientific mentality says our knowledge is always evolving and it's going to change, it's going to look different in 10 or 20 years than it looks today.
• 41:45
  And there's certain things right now that we're getting wrong, right?
• 41:48
  That's how science advances.
• 41:49
  It advances by new hypotheses, by conjectures and refutations and by testing.
• 41:54
  And physicians are not really trained to do that.
• 41:57
  Some of them go on to become reasonably good clinician scientists, but that's in spite of their training, or in addition to their training, I might say, not because of their training.
• 42:06
  The training you actually get in medical school does not train you to ask questions.
• 42:11
  It does not train you to challenge conventional thinking, but that's precisely the opposite.
• 42:16
  But that's precisely what we need right now in medicine, because it's obvious that we're failing.
• 42:21
  So the first step is to recognize honestly that we're failing.
• 42:25
  And there's a big fight about that now publicly, right?
• 42:27
  With the Make America Healthy Again movement and people in certain positions of power in our health and human services public health agencies getting enormous pushback, uh, just trying to make reasonable tweaks to the system that funds research, the system that approves drugs, uh, the system that makes public health recommendations, the CDC and so forth.
• 42:53
  And so these these interests are deeply entrenched.
• 42:57
  And I think on the positive side of the ledger, there's a lot of people that are recognizing now that the emperor has no clothes.
• 43:05
  There's a lot of people after COVID that are asking questions that never asked before about vaccine safety and efficacy, about medicine and public health in general.
• 43:15
  And I think that's a positive development because the only way the system's going to reform is if more people within the system and more people that make use of the system, more patients and more providers start recognizing that there's a serious problem and that we need to reform things.
• 43:33
  You were in charge of the ethics department at the University of California Irvine.
• 43:38
  Yeah.
• 43:39
  What happened?
• 43:41
  Well, I like to say a good way if you want to go sideways with your employer really, really quickly.
• 43:47
  A very efficient way to do that is to sue them in federal court.
• 43:51
  So I'll give you a brief version of the story.
• 43:54
  So yeah, I was spending about half my time in the department of psychiatry teaching, doing clinical work.
• 44:00
  And by the way, that's where I attended medical school and residency.
• 44:03
  Oh, at UCRM.
• 44:05
  Yeah.
• 44:06
  Well, I mean, I was there for 20 years, if you include residency and have great love and respect for a lot of people at the institution.
• 44:15
  But uh things really uh my eyes really opened up to some serious problems, especially during COVID.
• 44:23
  And it began, so I was I was spending about half my time in psychiatry, the other half was I was directing the medical ethics program.
• 44:29
  And I was on a committee at the office of the president that oversaw all the UC campuses, all five of the campuses, not just UCI, but you know, UCLA and UCSD that had hospitals, and we developed all the COVID policies up until the vaccine mandate policy.
• 44:44
  So I spent the first year of the pandemic, you know, nights and weekends overtime developing our ventilator triage policy, developing our monoclonal antibody allocation policy.
• 44:58
  We had some scarce resources, and you know, gosh, what do we do if there if the demand outstrips the supply?
• 45:04
  Difficult ethical problems.
• 45:06
  And then suddenly the vaccine mandate policy came down from on high, and our committee was not consulted.
• 45:13
  And I was very puzzled by that because it was clear to me that a policy that was going to override the principle of informed consent was certainly going to be the most ethically controversial policy that the university enacted during COVID.
• 45:27
  It was going to get the most public pushback of any policy.
• 45:30
  And so I said, why are we talking about this?
• 45:34
  And it was radio silence.
• 45:36
  So to try to get a conversation going, I published a piece that year in the Wall Street Journal entitled University Vaccine Mandates Are Unethical.
• 45:43
  I co-authored it with Jerry Bradley, a law professor at Notre Dame.
• 45:46
  And we made the ethical and legal case that these mandates were problematic.
• 45:52
  And I focused on universities because they were the first institutions to mandate the vaccine before businesses and government agencies and so forth started getting in on the vaccine mandate business.
• 46:02
  So I passed that around to the committee and to the office of the president or general counsel.
• 46:07
  And the response I got was basically, no, we're not going to talk about this.
• 46:11
  But then because I had gone public, there were people at the university reaching out to me, students saying, I'm going to get kicked out of school, I'm going to lose my scholarship.
• 46:19
  I'm not a religious person, so I can't in good conscience submit a religious exemption, but I have moral or ethical objections to this vaccine.
• 46:27
  I mean, students who were trying to be scrupulously honest, right?
• 46:31
  Which I had a lot of respect for.
• 46:33
  Um, a lot of people found found religious convictions suddenly so that they could submit, and I don't fault them for that.
• 46:39
  You know, God bless them.
• 46:41
  Um I had nurses that I had worked side by side with throughout the whole pandemic, who had been there for decades that were going to lose their job.
• 46:50
  And they're, you know, they're asking me now, what do I do about this?
• 46:53
  And I'm projecting ahead a couple of months to January when I was going to teach the ethics course and talk in lecture two about the principle of informed consent enshrined in the Nuremberg Code, enshrined in the World Health Organization's declaration of Helsinki, the sort of landmarks of 20th century bioethics.
• 47:12
  And you know, the lecture where I talk about moral courage, you know, that you have to do the right thing, even in what it might cost you if if patients are going to be harmed, you have to step out and say something, even though you're at the bottom of the hospital hierarchy as a as a med student.
• 47:25
  This is important.
• 47:27
  And I just couldn't imagine myself in good conscience saying those things.
• 47:32
  If on my watch, in the position that I was in, I hadn't tried to change the policy.
• 47:37
  So I basically got to the point where I said, I'm not just going to write an article in the newspaper criticizing this policy.
• 47:43
  I'm gonna, I'm gonna try to change it.
• 47:45
  So that's why I filed the lawsuit in federal court, challenging the vaccine mandate.
• 47:50
  Um, I made the argument on behalf of people with natural immunity because I thought that's an argument that we could win legally, not because I thought those are the only per people who should be exempt.
• 48:00
  Um, but I I thought we had a good legal argument uh that these were unconstitutional under the 14th Amendment.
• 48:06
  I ended up losing that case, although interestingly enough, had I filed it a year later, there was a new Ninth Circuit precedent after my case was decided at the lower court.
• 48:18
  Uh Ninth Circuit precedent in a different case that I probably would have won under.
• 48:23
  So, you know, some of it was timing when I filed that lawsuit.
• 48:27
  There was basically no federal judge that was willing to, you know, scrutinize the facts and ask questions about these vaccines and you know, do they stop infection or transmission?
• 48:37
  Did the the argument, you know, do it for the sake of others?
• 48:40
  Does that hold any water?
• 48:42
  Um, does the 1905 Jacobson, the Massachusetts precedent really apply in these cases?
• 48:47
  None of those legal, ethical or scientific fact-based questions was really sort of on the table at the time.
• 48:57
  Nobody everyone was sort of going along with the program, including the federal judges.
• 49:01
  So I didn't end up prevailing in that case, but I also don't regret having done what I did.
• 49:08
  Um, I think it was the right thing to do.
• 49:10
  I would do it again.
• 49:11
  I would go back and do it again if I was in the same position again.
• 49:16
  And, you know, there's nothing better than waking up with a clear conscience every day and you know, being able to tell my kids, yeah, when this whole thing went down.
• 49:25
  Um, you know, I did try to do something about it.
• 49:27
  You know, I may not have succeeded to the degree that I wanted to in setting it a precedent in in federal court that would, you know, also apply to all the other mandates.
• 49:37
  That that was my goal.
• 49:39
  I actually could have submitted a religious exemption myself and probably have gotten out of, you know, having to take the shot.
• 49:45
  Um, but that then I wouldn't have had standing to to bring the case.
• 49:49
  And I I brought the case because I wanted to change those policies, not just because I wanted to, you know, get an exemption myself from having to take this product.
• 49:59
  And
• 50:00
  At the time it was a purely ethical argument.
• 50:02
  Um, it was it was based on my understanding of this principle of informed consent that I had taught medical students every year.
• 50:09
  Uh later, I began to develop a lot more concerns about the safety and efficacy of this product.
• 50:15
  But even if the product had turned out to be a lot more efficacious and had a lot better safety profile, I still think it's wrong to force it on people.
• 50:23
  Yeah, still would have made the made the same argument and made the same case because people need to be able to decide these things for themselves.
• 50:31
  I assume you feel similar about the mandates for childhood vaccines to attend school.
• 50:36
  100%.
• 50:37
  How about the military?
• 50:39
  Absolutely.
• 50:40
  Just because you joined the military doesn't mean that you become a guinea pig for the government's medical experimentations.
• 50:47
  And there's special carve-outs in federal law that allows the president to unilaterally basically override the right of bodily integrity and the right of bodily autonomy that every other United States citizen enjoys.
• 51:02
  And I think that's profoundly wrong, right?
• 51:05
  You sign up to serve your country in the military.
• 51:07
  It's a beautiful and brave thing to do, and we owe all those people a debt of gratitude.
• 51:13
  The very least that we could do is not harm them with medical experimentation.
• 51:19
  And I mean, the results of what we've done in this regard have been one disaster after the next.
• 51:25
  We keep injuring uh military men and women with experimental products because they're an easy population to test them on.
• 51:35
  Yeah.
• 51:36
  And they have no say in the matter.
• 51:38
  And I think this is just a profoundly egregious violation of inalienable human rights.
• 51:44
  Uh human rights that you don't give away just because you join the military.
• 51:48
  If anything, we should be doing more to protect those people because of the sacrifices that they're making on our behalf and the risks they're subjecting themselves to if they're called to go into battle and to get engage in um you know in wartime military service.
• 52:06
  So I just think that's just so profoundly wrong.
• 52:10
  I think it's a I think it's a smear on the national conscience that we permit uh unconsented medical experimentation on members of the United States Armed Forces.
• 52:24
  What happened to your employment at UC Irvine?
• 52:28
  So even before my case was decided, interestingly, um, they placed me on what they called investigatory leave, then a month later on unpaid suspension, and then a month after that, they fired me.
• 52:39
  I was not allowed to go back on on campus.
• 52:42
  Um, I had to go back escorted by security just to get my stuff from my office and move my belongings out.
• 52:49
  I had been at the university for 20 years, served as 16 years in the school of medicine, was a full professor in the department of psychiatry, was director of the medical ethics program, wasn't allowed to say goodbye to my colleagues, wasn't allowed to say goodbye to my students or the residents who were under my supervision.
• 53:06
  Um, the university uh, you know, allegedly fired me for noncompliance with the vaccine mandate, but I believe it was retaliatory because you know, I heard from several other faculty members that they accommodated them, you know, with working remotely during the pandemic.
• 53:21
  And I I was already like 60% remote work from telemedicine, that the teaching had all gone online.
• 53:28
  So I could have easily gone down to part-time.
• 53:30
  I could have easily gone a hundred percent remote.
• 53:33
  They could have accommodated me in the way they accommodated other faculty members.
• 53:37
  But you know, as I said, if if you want to go sideways with your employer, just challenge them, challenge one of their policies in federal court.
• 53:44
  And you know, that they you know, they they basically, and this this was not even decided at the level of the UCI dean's office.
• 53:53
  I think this was the office of the president of the entire university of California that made that decision.
• 53:58
  And my department chair and even my dean, um, who I, you know, these were people that I respected.
• 54:05
  I believe they respected and still respect me.
• 54:08
  Um, I don't think they wanted to do this, but I don't think they had any choice in the matter.
• 54:14
  Wow.
• 54:14
  What a what a story.
• 54:16
  Um, you're not alone, but certainly you were public with what happened.
• 54:20
  As I recall, there's a video of you being escorted off campus or something.
• 54:24
  So that was a lot of people keep telling me that.
• 54:27
  I think that video was um a professor, I believe a professor of anesthesiology at UCLA.
• 54:34
  Oh, you know what?
• 54:35
  You're right.
• 54:36
  Yeah.
• 54:36
  People often mix us up, but the there were not very many people fired from the university under this policy.
• 54:43
  Most people caved in and complied or submitted an exemption in the end.
• 54:47
  Yeah.
• 54:47
  Um, but yeah, and his name is escaping me at the moment.
• 54:51
  But yeah, very brave physician at UCLA who took a strong stand.
• 54:58
  And um, yeah, there was, you know, he was he was escorted by security off campus.
• 55:03
  They had to muscle him out of his office.
• 55:05
  And, you know, good for him.
• 55:07
  Um, it's absurd what happened to us.
• 55:10
  It's absurd that they forced this product on many people, uh, some of whom were injured and permanently harmed by it.
• 55:19
  Um, most of whom, if they were, especially if they were under the age of 65, didn't really stand to benefit much from it, even in the most optimistic early data that we had on the vaccine.
• 55:30
  Um, you know, the clinical trials data from Pfizer.
• 55:34
  Um, we're just about out of time.
• 55:36
  We're talking to Dr.
• 55:36
  Aaron Cariotti, uh, MD psychiatrist, wrote a phenomenal book, Making the Cut, How to Heal Modern Medicine.
• 55:44
  Aaron, how do people find your book and find you if they want to follow your ongoing work?
• 55:50
  So the books available, Amazon, Barnes and Noble, wherever you buy, uh find your your favorite bookstore.
• 55:57
  Um, you can find me on Twitter at Aaron Carioty MD.
• 56:02
  I have a substack called Human Flourishing, so Aaron Cariotti.substack.com, or just look up Aaron Cariotti, Human Flourishing.
• 56:10
  And that newsletter is uh has all of my articles and new announcements.
• 56:17
  I've got two more books in the pipeline coming out in the next year or two.
• 56:21
  So that's a good way to follow my work.
• 56:23
  You're also a practicing psychiatrist, correct?
• 56:27
  I am.
• 56:28
  Yeah, I'm in Orange County, California.
• 56:30
  And so Aaron Cariotti.com, my website has contact information if people want to reach out to me regarding professions.
• 56:38
  Aaron, thank you for joining us on Informed Descent.
• 56:40
  Appreciate it.
• 56:41
  Thank you both.
• 56:44
  You've been listening to informed dissent with Dr.
• 56:46
  Jeff Barkey, board certified primary care physician, and Dr.
• 56:51
  Mark McDonald, board certified child, adolescent, and adult psychiatrist.