Latest / Radically Genuine / 100. Antidepressants During Pregnancy and Postpartum: What You Need to Know w/ Dr. Adam Urato

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100. Antidepressants During Pregnancy and Postpartum: What You Need to Know w/ Dr. Adam Urato · Radically Genuine

• Welcome to the Radically Genuine Podcast. I'm Dr. Roger McFillin. Again, we are very appreciative to all our listeners, especially the new ones that have joined the Radically Genuine Podcast. We really do appreciate five star ratings. So if you're listening right now, please pause, click five stars, then return to the podcast. We've been on the Apple Podcast charts, mental health and health and fitness for the past few weeks. We want to stay there. And uh, If you're a loyal listener, we really do appreciate all your help. The questions that we receive from you, we take seriously. We know that there is a large number of childbearing year aged women who are listening to the podcast and intently trying to get as much information as possible on the use of various drugs, including antidepressants and its potential impact on the developing fetus. We needed to find an expert. The gentleman who's going to be joining us today. I've been following him on Twitter, listened to him on Matt of America podcast. He's one of those voices who's kind of standing out from the crowd, ringing the alarm bells a little bit. I have found him to be extremely honest. somebody who has a thorough grasp of the scientific literature. And so my hope for today is that we get, we answer all your questions. And so we're gonna ask very pointed and clear questions and we're gonna hope that our guests today, is able to give us a radically genuine answer so people can make informed decisions. With that being said, I wanna welcome Dr. Adam Urato. He is a maternal fetal medicine physician. He practices out of his hometown in Frangleyham. Massachusetts. He grew up there. He's attended Harvard. He's a graduate of Harvard Medical School, completed his OB GYN residency at Massachusetts General Hospital, and Brigham and Women's Hospital. His maternal fetal medicine fellowship was at Tufts Medical Center. He's an active clinical practicing physician who takes care of high risk pregnancies and delivers babies. He also writes and lectures on medication exposure in pregnancy. And we certainly want to tap into that expertise today. Dr. Urrado, we are so grateful for having you today on the Radically Genuine Podcast. Adam Urato: Well, it's a real pleasure to be here and I appreciate the opportunity. I also appreciate all the work you've done in trying to get the word out, get the message out through Twitter and through your podcast and sort of inform people, which I think is crucial for us getting the information out there. Sean: appreciate that it seems like you and I may have a similar mission around informed consent, medical freedom, and trying to kind of parse through the current state of our of the medical establishment and how information is disseminated to the general public to bring greater awareness of some of the problems with our published research and the influence of unfortunately, industry. on our government and how our physicians are currently practicing. Now I'm really interested in you the person. Maybe you can tell our listening audience a little bit about your professional journey and your expertise, how that has led to you being more public and outspoken about medication exposure in pregnancy. Adam Urato: Sure. I grew up here locally. I was born at the hospital. I'm in my office today. I was born at the hospital right over there. So I'm a local here in my hometown of Framingham, Mass. And then I attended school, college medical school here locally. And when I went through medical school, I thought originally I might be an orthopedic surgeon because I'm an athlete. I grew up playing sports. I love baseball and basketball. And I thought I was going to go in that direction. my obstetrics rotation, I really got a bug for pregnancy and childbirth and just really enjoyed working with the patients, following them through their pregnancies. And then the miracle of fetal development, being part of that and just being part of the whole process was great. And honestly, I like the action on labor and delivery as well. Um, the, the babies, the deliveries, the, uh, there's, there's a lot of action on labor and delivery, um, and for the most part it goes well. And so I really got the, got the bug for it. Um, I think my interest in medications came as I was going through, uh, medical school, I remember particularly on my internal medicine rotation. And I've told this story before, but one of the first weeks I was on my internal medicine rotation, the chief resident told me, you know, when you do an admission on a patient, you want to fold the paper in half or make a column on the right side. This is when we did not electronic medical record, but we actually wrote notes on paper. And he said, make sure on that, on that right hand column, now you're going to list their medications. And typically it'll be for these internal medicine patients somewhere between 10 to 20 or 25, you know, medications. And I remember. doing these admissions and writing all these medications down and thinking like, do we really know what these meds are doing? Do we really know what the, not only each individual med, but the interaction between them? Always sort of like fascinating, do we know what we're doing here? And why are we using so many medications here on patients? As I got into obstetrics then, I sort of maintained, I think that mentality or that thinking and I think we in modern society are in a bit of a unique situation where I believe, you know, I don't know all of recorded history, but we're probably the most exposed humans in history to pharmaceuticals. And we've come to sort of just take it for granted. but it's a real departure and it's a real change in terms of human development and certainly for developing babies, certainly for pregnant women and developing babies and sort of thinking about what that impact is for just anyone, but particularly in pregnancy became an interest of mine. Sean: Yeah, so let's get right into that because those are the questions of the day. The general public's been pretty much told that depression is associated with a serotonin deficiency and that we have drugs to correct that serotonin deficiency. This has driven millions to antidepressant drugs. Obviously, we now know a lot more that this is more marketing propaganda than any actual science. And in fact, these drugs perturb normal functioning. From what I understand, serotonin is critical in fetal development. And so my first question is do SSRIs cross the placenta and then what impact would you think that these drugs could then have on a developing fetus? Adam Urato: Yeah, you're asking the crucial question. You're asking the crucial question. And so first off, they absolutely do cross the placenta. So when the mom takes these drugs, they go into the mom, and then they go into the baby, they freely cross over the placenta and they cross the blood brain barrier. So they're going into the baby's developing brain as well, as well as throughout the fetus. We touched on something important. There is no proven serotonin deficiency. That was more marketing or a phrase I like to use sometimes is profit driven propaganda, which is really what that was to try to boost sales. There's no proven serotonin deficiency. Serotonin is a crucial neurotransmitter and cell signaling molecule, and it plays a crucial role in fetal development, particularly development of the fetal brain. And The serotonin system is essential for that. So we know the SSRIs and other antidepressants disrupt that serotonin system. So if you just sort of walk through the logic, anybody can figure this out and make it simple. Serotonin is crucial for fetal development, the serotonin system. The SSRIs and other antidepressants and pharmaceuticals disrupt the serotonin system. So they're going to have an impact on fetal development. And then the question just is trying to tease out what that impact is on fetal development that's actually occurring. Sean: All right, let's get into that. What is the scientific literature, how does it inform us on the potential impact on the fetus? Adam Urato: So what you can do is you can look easiest at animal models or animal studies, and then there's also the human studies as well. But looking at the animal studies and some of the human studies in general, to me from my reading, some of these areas are controversial because it's harder to study. One of the big reasons it can be hard to study this is that there's no randomized controlled trial. So they've never taken a group of a thousand pregnant women with depression and had 500 take antidepressants and have the other 500 take a placebo and then look for outcomes. That's never occurred. So there's always questions that are raised and I'll get into this, but there's always questions that are raised of whether there's confounding, particularly confounding by indication are the more depressed women, the ones who stay in the medications, they're a different group. And so that explains, I don't believe that, but that's an excuse that's often used. But it is an area that's difficult to study. The other reason it's difficult to study is that the research is full of, I think, suboptimal studies because of this issue of misclassification. A lot of the research, particularly the ones using big databases, are asking the question or they're defining the antidepressant group as women who were given a prescription for antidepressants during the pregnancy. But we know I'm a full-time clinician. I take care of patients basically all day, every day, every week. We know lots of women get prescriptions and they'll even fill the prescription, but they don't take the medication. So what that does is it pollutes the study. And it means that you've got a group that's being defined then as being an antidepressant user, but they're not. And that's going to really mix up the study. So a lot of these large database studies have these kinds of flaws. That being said, if you want the quick, what is this doing to the baby? If you start off early, from my reading of the literature, there are increases in miscarriage. I think it does lead to pregnancy loss. I think there's animal data showing that, I think there's human data showing that. I think they do cause birth defects. Serotonin, as I was saying, plays a crucial role in development. particularly in areas like the fetal heart, the fetal gastrointestinal system, and we do see studies. Again, it's mixed and people would argue and say, oh, some of the studies don't show birth defects, but from my reading of the literature, I think they are implicated in increased rates of birth defects. Moving forward in the pregnancy, we see things like increased rates of preterm birth. That's been pretty well established now. We see elevated rates of preterm birth in antidepressant users. low birth weight is another issue that we see. Moving further along, we see increased rates of the hypertensive diseases of pregnancy, like preeclampsia affecting the mom. All of these, by the way, the first five or whatever, I've just rattled off, you can attribute or think about them as being maybe a hit on the placenta. placenta is crucial in terms of the development of the baby in terms of maintaining the pregnancy, and if there's impact on the placenta, and the SSRIs have been shown to impact the placenta, if there's impact on the placenta you can see things like pregnancy loss, you can see things like preterm birth, like low birth weight, hypertensive diseases as well. At the time of delivery actually we see increased rates of postpartum hemorrhage in moms. This is an area a lot of people don't know about, but serotonin plays a crucial role in platelet function. And we know this from other areas of medicine, when we look at post-operative complications and other surgeries, patients on SSRIs, on antidepressants can have more bleeding. We do see that with postpartum hemorrhage. In fact, the UK has a warning about this. The FDA does not have any warning on this, but there's a warning that's out in the UK regarding antidepressant use and postpartum hemorrhage. Then for the fetus in the new moving forward then from there in the newborn period, there's absolutely a large difference between exposed babies and unexposed to antidepressants in terms of what we call the newborn behavioral syndrome. People call it newborn behavioral syndrome, newborn withdrawal syndrome, poor neonatal adaptation. And what that is the babies come out and in the first 24, 48, 72 hours, they have trouble. They have trouble breathing. They have trouble with jitteriness. They have trouble sometimes with seizures, increased rates of seizures. This all falls into the poor neonatal adaptation syndrome early. Then moving and also persistent pulmonary hypertension of the newborn, other respiratory issues. Moving forward from there, the big question is, what about the long-term effects? What about long-term impact? And this gets very difficult to study because other factors start to come into play. But there are studies showing links to autism, links to motor abnormalities in the offspring, links to language difficulties, slower language development. What researchers are now able to do with various studies is to be able to do MRIs, for example, on the newborns or on the children. And these MRI studies are showing a difference between the babies that are exposed and the unexposed. We're seeing this on these MRI studies. I actually tweeted about this. If people want to look at these nine studies, I'm up to nine on the count of nine studies that have looked at... newborn MRIs or child MRIs to try to figure out what impact the antidepressants are having. There's about nine MRI studies and they basically are all showing a difference in the antidepressant exposed group. They're showing that the antidepressants do appear to have an impact on the developing brain. And I lay those out in my tweet from April 17th that people are curious about the studies themselves and want to look at them. But we're now seeing these changes as well and that's the big question what long-term impact there is. Sean: This is chilling because I know that women of childbearing age are not getting this information. Just to support what you just said, there is a study in psychological medicine that found that babies born to mothers taking antidepressants were more than six times as likely to have neonatal withdrawal syndrome. That includes breathing problems, irritability, agitation, tremors, feeding problems, seizures, and... more than 80% of the reported symptoms were classified as serious. So if we're just using deductive reasoning here, we know that SSRIs perturb normal functioning. They increase the availability of serotonin in the nerve cell of the mother. It affects the entire body of the mother. It breaks the barrier between the placenta Now we have good data and research that is going to suggest that those who are born with mothers who took SSRIs are going to have potential birth defects, you know, neonatal withdrawal, and where maybe they'll see brain changes on, on brain scans. Is that accurate? Adam Urato: Yeah, I think you summarized that well. Yeah, it's a big concern. I think one of the reasons that women aren't getting the message on this is that, so when I think of this problem, I think there's two separate questions that need answering. And I think what happens is that, so I'll go to these two questions. Question number one is what are the actual chemical effects that the antidepressants or other medications are having on the mom and on the baby? So this is an important scientific question. And it's a question in fact, that the moms themselves ask me. every day, they ask me regularly, like, what impact does this drug have on the baby? So that's a scientific question about what the chemical impact is on the developing baby. There's a separate question. The second question, or separate question is, should an individual patient come off of their medication when they're pregnant? What tends to happen is that people, when you start to try to talk about question one, the scientific question of whether or what the impact is of the chemical on the mom and baby, people want to immediately jump to question two. I have this occur regularly. I start to talk about, you know, I like to use the phrase that chemicals have consequences. Medications are chemicals and chemicals have consequences. In order to do informed consent, which I know, Roger, you and I talked about, and you make that an important issue. In order to inform consent, we have to know what those consequences are, what the chemical effects are. But when I start talking about this, you'll have people jump immediately and say, if you ask the question, what are the chemical effects here on the developing baby? People will sometimes interrupt you and jump and say, a friend of mine stopped all of her psychiatric medications when she was pregnant, and then they'll describe some awful outcome. And so... That's, nobody wants an awful outcome. And nobody wants to, that's not where anybody should be at on this. We need to support patients. We need to help patients. We're not trying to make women feel guilty or guilt trip or any of that, but we need to be able to answer question one and give a good answer to it. What some of my colleagues are afraid of is that if you give an accurate answer or a truthful answer to question one, which is what are the impacts that these chemicals are having on moms and babies, that you will have patients who need them or will have trouble withdrawing from them who then get into trouble. And so they steer clear often of question one of that, of what the impact is. So that's the good reason I think that some people want to stay away from that question. The bad reason or the bad thing that's occurring is that pharma, the pharmaceutical industry is the huge, you know, 600 pound gorilla in the equation is the huge player here. with all of their billions of dollars. And they do not want the public thinking of medications and chemicals and asking these questions of what consequences the chemicals are having. And so they end up funding researchers and regulators and journalists and the whole sort of medical establishment ecosystem to try to direct the questions and direct the thinking in a certain direction. away from asking the question, what are the consequences of these chemicals? What are the side effects and towards other things? And that's the bad reason for why a lot of women aren't hearing this. They're not getting the message and why we as a society are kind of taking our eye off the ball on this. Sean: Well said, I mean, I'm really concerned about your psychiatric colleagues and other medical professionals because they are certainly not aware of these risks. In the course of my career, I have seen psychiatrists recommend to pregnant women to go on psychiatric drugs. And some of those statements that are supporting the reason to do it is to protect them from postpartum depression, which is an insane recommendation. to put a woman who might have had a history of depression to go on a drug that's going to affect the fetus as under this idea that it is protective against postpartum depression. Now, I have thrown myself into the scientific literature on this, generally speaking for SSRIs, if they are one protective against depression or they actually can treat depression. And I think we can very clearly state at this point that if it imp… If it improves the wellbeing of anybody, it is very short term for only a small percentage of people. And we have no evidence that it protects against postpartum depression or protects against psychosis or suicide or something that we would really be concerned about with a mother who is experiencing postpartum depression. My question for you is, as a trained medical professional at the highest level, you're a Harvard graduate. You know, how are your colleagues being able to make recommendations that to me appear to be negligent and are clear malpractice under some disguises if they have scientific legitimacy? Adam Urato: Yeah, I think it is problematic. I share your concerns. I mean, I think that in the in the broader picture, in the broader picture, I think that, again, going back to the pharmaceutical industry, that there has been a lot of a sort of conventional wisdom that's been rolled out by pharma on this. And I think it's for a very, you know, good reason, not good reason for them. But the companies, drug companies want to make money. And one of the biggest groups that they're selling to are young women of childbearing age. And so the last thing that they want is for this to be first and foremost in a young woman's mind, that look, if you get on one of these things, you may have trouble coming off of them. And then you get into the whole question of what impact they're going to have on pregnancy. So I think that the pharmaceutical industry has sort of push this, like I said, conventional wisdom of safety and trying to get people to not focus on the downside. They've rolled out this kind of- go ahead, Sean, sorry. Sean: Sorry, no, go ahead, finish your thought. Now I'll have a follow up question. Adam Urato: they've rolled out this model of sorts where the woman has a, then this is not, not accurate, but I'm going to just tell you their model, that the woman's got a serotonin deficient. She's got a problem with her brain chemistry. The SSRI, the antidepressant goes into her, corrects that brain chemistry abnormality, basically setting her up now better to be able to carry the pregnancy, have the pregnancy, it creates a better environment, leading to healthier outcomes for moms, healthier outcomes for babies. This is sort of the conventional wisdom or the profit-driven propaganda model that's been put out there, and it's completely untrue. As you know, I try to tell my patients, and when I lecture on this, I use the example, it probably sounds silly to people, but imagine the prenatal clinic or the OB clinic just right next to the chemical manufacturing facility. So these drugs, SSRIs and other medications, they're coming out of chemical plants. So picture a big chemical manufacturing facility, however you wanna picture that. And then right next door to that is the prenatal clinic, the OB clinic. So they're taking the meds fresh out of the chemical facility and then they bring them over. to the prenatal clinic and then they're injecting them into the bump or they're having them take them orally or whatnot, it really is a stark sort of example of, look, this is a chemical exposure. This is actually what's going on from a chemical standpoint. Instead of this sort of pie in the sky model of the woman has a brain chemical imbalance that this is correct. And then everything is, you know, hunky dory if you can get it corrected. I think also, by the way, along with this, and then I'll let you ask your question, Sean, along with this, I think it's important to note that, you know, if you look at the advertisement, a lot of products try to show you where the product comes from to appeal to people. So they'll use, for example, orange juice makers will show orange trees. You never see that with the pharmaceutical industry. They don't want you to have your eye on the drug coming out of a chemical plant. And so we take our eye off the ball that their commercials are full of rainbows and balloons and beaches and whatnot. And that goes along with this sort of model that they've rolled out of correcting a deficiency that's really not there and then making everything better for mom and baby. And that's actually not the case. That's not what the studies show. Sean: So in an informed consent environment, by the time a patient or a client comes to you, I mean, the baby's probably already in development, but in a normal environment where somebody is going on an antidepressant drug, it's happening probably years before they may come to you. So isn't the challenge just the receptivity to the information based on lifestyle stages and where people are? Um, especially with children or adolescents going on these drugs, when you talk about fetal development and pregnancy issues, you know, as a parent, they may say like, Oh, that's not going to be a problem. And they're not thinking about five, 10 years down the road, cause they don't think their adolescent will continue to be on these medications. And then there's the other question of planned pregnancy versus unplanned pregnancy, like how do you, how does one navigate that in terms of making an informed consent decision? Adam Urato: Yeah, Sean, that's a super important point that you just raised. And it's one that I try to hit on, is that this whole discussion that we're having now about antidepressants in pregnancy really is not, it should be a discussion that's occurring not at the time of pregnancy. This is really a message that needs to get out to broader society and to women of childbearing age. because a lot of the patients that I see that I counsel on this on a daily basis, a lot of them have been on their antidepressants since they were in college. So they had some episode in college, something that was causing them stress, emotional suffering, something bad. And then they went on one of these and then they've been on it for the last five, six, eight, 10 years. And so really we need to, as a society, be focusing this talk on women of childbearing age and how we should be approaching mental health in women of childbearing age as far as this goes. I mean, actually, we should be thinking about this for everybody as far as whether medications should be used. But in particular, when you're talking about fetal effects, just as you said, John, for a lot of my patients, they can't come off of them. They've tried to, or they've had great difficulty because of withdrawal and whatnot. And so it really is a conversation or a discussion that needs to occur. occur at a different time and there needs to be more public awareness of this. Sean: Doc, I've gotten this question from men. Could an SSRI impact male sperm and in consequence then have an effect on their developing fetus? Adam Urato: Yeah, for sure. It does. It's been shown. There have been a few trials that have looked at that. There's one by an author, Akashay, aka S-H-E-H, I believe is his last name. If you look up Akashay and sperm or Akashay and antidepressants, you can find this. I think his was interesting because I believe it was actually a randomized trial where they were looking at men who were put on the SSRI not for depression, but I think for premature ejaculation, and then a group that was a control group. So they were able to do it in a randomized control fashion, which actually takes the issue of confounding by indication off the table. So nobody can say, well, the guys who had faulty sperm, it wasn't the antidepressant, it was because of their depression. It wasn't a depression study, it was actually looking at it for another reason. But what they found was that it does. The SSRIs do impact male sperm. It alters their morphology. It alters their motility and some other parameters. So there have been several studies on that. Again, I don't want to sound like a broken record, but again, you can make this easy for people if they just understand these are chemicals. I tell patients sometimes, I tell students when I lecture them on this, is look these up on Google. Look up the chemical compound like when you were in chemistry class. the C, O, H, the double bonds, the nitrogen, the fluorine, whatever, you look at these things, these are chemical compounds. When you put a chemical compound into a biological system, you get a chemical effect. That's what chemicals do, they create chemical effects. And so when you put it into a man, it's gonna have chemical effects in the man. It'll particularly affect rapidly developing biologic systems like sperm formation. Now you're pouring a new chemical into sperm formation, you get impacts like that. Another rapidly developing biological system is the fetal brain. And you put serotonin, you put SSRIs into that, you're gonna get effects from that. It's a chemical effect. Sean: Doc, I know a lot of the listening audience right now is probably shocked because this isn't mainstream information and a lot of people were not provided informed consent. There seems to be a credibility crisis in the medical profession right now, certainly post COVID, where we've kind of pulled back the curtain and revealed a lot of pharmaceutical fraud and conflicts of interest that are influencing how we approach modern medicine. Now you mentioned this earlier, I think statistically there's something like a 27,000% increase in the diagnosis of autism since the 1970s with a almost what seems to be a dramatic incline in the early 90s. We're also seeing exponential rise in the identification of what's called ADHD. So certainly like populations of people who are having a difficult time focusing and concentrating you had that with increasing rates of chronic health conditions and mental health conditions, the question that I think is being posed by even some politicians, Bobby Kennedy, for example, is what is leading to this? I know correlation does not equal causation. And there is a there is a growing concern about the vaccine schedule. I think from listening to you today, one of the things that you might be saying is that these drugs and the use of psychiatric drugs and medications in the general population potentially could be influencing a lot of these problems we're seeing in children and adolescents and young adults. Adam Urato: Yeah, no, I think you're touching a couple of really good things there. And this also goes back to something that Sean had asked about. You know, when we look at this question of, do we want women of childbearing age, or society in general, but do we want women of childbearing age? Are we going to have healthier societies if more and more of our women of childbearing age... are being treated with increasing numbers of chemicals, of synthetic chemical compounds. That's what drugs are, that's what medications are. If you just step back and think about that, like you picture two different societies, you can have one society where your young women, your pregnant women aren't being exposed as much to synthetic chemical compounds. That's society one. Or society two is where you expose lots and lots of your young women of childbearing age, your pregnant women, your newborns, your early children, you expose lots and lots of them to lots and lots of synthetic chemical compounds. Which society is gonna be healthier? Like most people hear that and they say, you know, Adam, the common sense there says maybe not exposing them to all of these synthetic chemical compounds is a healthier approach. Like that's common sense to most people. And in fact, that's common sense to most of my patients. Most of my patients sort of take that approach or will ask in that way. There's a hesitation that pregnant women have about what's going into them. And I think that's healthy. I think as a society, this is gonna be a big broad statement, but as a society, and this touches on what you're saying, Roger, I think we have a failed regulatory system in our society. We have a failed information system in our society. And the reason it's failing is principally because of the influence of corporate cash. So an ideal society, if you think about it, you'd have drug companies or producers trying to make something here, they're here, and then they're trying to sell it to the public, and that's here. But then you'd have this really important layer between the drug companies and the public. And that layer would be things like regulatory bodies, like the FDA, things like journalists, journalism, medical reporters. You'd have key scientists that would be searching for the truth. You'd have your academic medical societies like the American Psychiatry Association, the American College of OBGYN. In an ideal society, you'd have all of those groups. FDA, CDC, ACOG, American Psychiatric Association, the journalists, you'd have all of them working on behalf of the public to try to accurately inform the public and protect the public. But that's not the way our current society functions. Those groups in our modern society in large part, not 100% but in large part are working for the pharmaceutical industry. They're pharma funded. The FDA commissioners, after they leave FDA, they go to work at Pharma. The CDC heads, after they leave CDC, they go to work at Pharma. Pharma is funding the academic medical centers. Pharma is funding the professional medical societies. So what you end up with is, instead of this layer of protection for the public, what you end up with essentially is... No one standing up for the public no one working to inform the public except for dr. Roger McVillain Roger McVillain and Sean informing the public here on this podcast Sean: God help us. Adam Urato: We're missing this layer that we should have and when I was younger in my career I'm not that old now when I was younger I used to really get upset about this like all of these people behaving unethically, but It's not a big conspiracy. And I don't know if they're completely behaving unethically and a lot of them are, but what it is it's more of a natural outgrowth of the way the money can flow. In our society, people making products are gonna make money because they're making a product. They can use, then use that money to influence the media, to influence the professional medical societies, to influence the regulators. to get them on their side. And so what you end up with is in this sort of struggle between the drug companies, the people making the drugs, the people making products versus people cautioning the public, standing up for them, it's a totally lopsided battle because that one side is being funded by the product that they make. Whereas the people who are arguing don't take something, who's funding them? There's no Sean: Yeah. Adam Urato: product. I'm not selling anything here today, right? I just want to get the word out, but there's no, I'm not selling anything. So it's this lobsided battle. And right now in our society, that lobsided battle is being won by pharma. And so you've got the pharma influence on regulation, media, key opinion leaders, academic medical societies, academia, that's all leading them to basically parrot pharma's message to the public. Sean: I think you speak to the illusion of evidence-based medicine. And there are even academics, Dr. John Ioannidis is one of them, a Stanford professor, he's a medical researcher. I wrote about him this previously in my sub stack. He asserts that as much as 90% of the published medical information that doctors rely on is flawed, meaning that they tend to be misleading, they overstate benefits, and they're frequently just outright incorrect. And that speaks to, I think, the complicated mess of our medical system, where it includes the role of the pharmaceutical industry and everything that they do to be able to influence the flow of information. We're in this like unique time where the mainstream media is so bought by the pharmaceutical industries that a lot of this information cannot become mainstream. So it is up to, I think it's up to two people. I hope I'm not one of them. Two groups. You actually are one of them. Right. There is independent podcasts that are now replacing the mainstream media. So these conversations are critical. And it's so important that the listening audience shares this episode because we're getting critical information. The second piece is we do need our physicians to be gatekeepers here. I don't trust the government. We're not going to rely on the regulatory agencies because they're looking at a golden a golden retirement by jumping into the pharmaceutical companies afterwards. And we talked with Kim Wizzak on this podcast before, who's been a consumer advocate on the FDA advisory committee. She speaks clearly about how fraudulent the entire process is. And Adam Urato: Yeah, Kim does great work. Sean: she does great work. We can't trust... If our medical professionals are blindly trusting that there's an illusion of safety and evidence based on this system, then we're not protected. We're not protected by our physicians and we have to rely upon them to be able to act independently. And they have to act independently based on high ethics and scrutiny of science. Right. That's what makes science actually the term science. Like it's an empirical investigation of replication. And so when you have government agencies and the medical establishment saying insane things like trust the science or like the science is established. If the general public and our practicing physicians accept that as truth, then we are I think we're looking at a deterioration of our of our culture and our society. Adam Urato: Yeah, I absolutely agree with that. Sean, you're going to jump in. Sean: Yeah, actually, I actually wanted to get back to some questions about, um, about moms and babies. Um, uh, just the, this week, there was an article in the Washington post about a multi-generational, um, impact of like human gut microbiome and stress and how it could affect the children. And it got me thinking to like the field of nutritional psychiatry, how they've been looking more closely at, uh, microbiome. And we know that antidepressants actually have an effect on the gut. So I guess my question is more in this area is like, how does that antidepressant influence the maternal microbiome? And is there any relationship between these changes in fetal development and in long-term, you know, gastrointestinal health of the child? Adam Urato: Yeah, very good question. Serotonin actually plays a crucial role in the gut formation, the serotonin cells in the intestines. And so people tend to focus on the brain, because that's obviously where a lot of the action is for human beings, but the gut is a crucial area as far as the serotonin system goes. So... it does look like there can be effects of the SSRIs on the gut. I don't know that much. I'm not as far as being an internal medicine physician, but I do know that there's been associations with things like, I think it's called microcolytis and other side effects or complications with some of the SSRIs on the gut of the mom. As far as babies go, there is at least one study and maybe more that have looked at the question of are there gastrointestinal problems children after exposure to SSRIs and utero. And the they at least one study that I know of did find that they did find that there were more gastrointestinal visits or complaints or problems in the offspring when the moms were treated with SSRIs. So, so that could certainly yeah, that can certainly happen. I think it's one of these things that and this kind of goes back touching a little bit on what Roger was saying. It's that When these things get rolled out, these things being interventions or pharmaceuticals, let's focus on drugs, when they get rolled out, they get rolled out as a corporate rollout and that gets rolled out and the messaging is always going to be that they're incredibly safe, that they're highly effective and that they're gonna be important and good for health short term and long term. The purpose of that rollout is to get you to use the drug or pharmaceutical. But what the course of these things is almost always the same. The trajectory historically is almost always the same, which is that after they've been rolled out, you learn that they're not as safe as they were originally billed, and then you start finding all of these things, like you just touched on Sean with the gastrointestinal stuff, you find out that the safety really isn't there. And then the efficacy, how effective are they? You often find out they're not that effective as the way they were originally built. And then when you look, are they actually having good effects on short and long-term health? You find out over time that they're not. But from a financial standpoint for the drug companies and for the investors, the key is that they get the rollout done to get the initial launch of it. where you get the bump in the stock price, you get the profits running in, by the time it goes bad, by the time you realize that the pharmaceutical or drug wasn't nearly as safe or effective as you were told, they're already gone off with all the money at that point. So the public needs to be aware of this, that when something new, when the drug companies are rolling out something new, they're always gonna tell you it's safe. it's effective and it's gonna be good for your health short and long term. What's gonna occur then is that as you start using it in human beings, you're gonna find that there are safety problems, that there's effects and consequences that you didn't realize. And that's because these are chemicals and chemicals have consequences. And so you're gonna find that, I like to tell patients, when I was a fellow, I did a lot of study on smoking in pregnancy. So I like to tell patients like, you wanna learn the lessons from cigarette smoking. when the tobacco companies rolled out cigarettes and when they were businesses booming, they were telling people these things were not only safe, but that they were good for your health. There's a bunch of ads like more doctors smoke, I think it was camels, more doctors smoke camels than any other brand, a doctor, a lighten up. And then there's another ad where the woman says they got a picture of a tea and it says, this is the tea zone here for taste and for something else. And it turns out it was actually for tumors, what the t-zone was for, right? It was tumors. It wasn't taste or, or Sean: I'm sorry. Adam Urato: whatever else they were trying to sell. But the cigarette companies were masterful and there were even, there were even key academic opinion leaders. I believe this is an article on this where they went maybe before Congress or before one of the regulatory agencies and testified that the cigarettes were good for the throat, things like that, like craziness, Sean: Insane. Adam Urato: they were being paid by the drug companies. But. It's always the same trajectory. It's a big corporate interest trying to make money. They're gonna roll it out, tell you it's safe, effective, good for your health. And then because it's a chemical exposure in humans, over time you're gonna find out it's causing all sorts of chemical effects and it's not as good for you as initially built. Sean: Yeah, you provided some good example of that in a previous podcast. I think it was the Madden America one about synthetic hormone that was being used in pregnancy for many years and it turns out it's not effective at all to prevent preterm birth, right? Correct. Yeah. Adam Urato: I've been arguing against McKenna now for like two decades. So that got launched in 2003. We already made that mistake in the 40s, 50s and 60s with a drug called diethylstilvestrol. We treated moms with a synthetic estrogen, told everyone the ad, that's actually the ad that I've got on my Twitter page where we said Desplex for all babies. That's how it was advertised. Have healthier, bigger, stronger babies with Desplex. DES. It turned out to be a disaster. Didn't help moms or babies and caused problems, significant health problems. So that was DES back in the 40s, 50s, and 60s. Now, 2003 comes along and one very confounded, very flawed study, the Mies trial, showed that this drug McKenna might prevent preterm birth. It was an awful study. The FDA initially said the drug shouldn't be approved, but then the way things worked there, it was approved in 2011. starts to get rolled out, it's being used all over, and we're injecting moms every week with a synthetic hormone. That didn't work, it didn't work. It was one of these trials that was given accelerated approval, so it required a second study to be done, when the second trial came back in 2019, showed absolutely no benefit, did not prevent preterm birth. But even with that, you still had key opinion leaders professional medical societies not arguing to pull it off the market. I had been arguing against this for years. In 2019, when the confirmatory study failed, when it was shown not to work, I called SMFM, the American Society for Maternal Fetal Medicine. I said, look, we got to jump right on this, guys. The drug doesn't work. It's a synthetic hormone. We don't know what it's doing to the moms and babies. And it doesn't work. We got to get it pulled off the market. But they continue to not advocate for that. and they were funded by the maker of the drug. By that point, the pharmaceutical company that was making the drug McKenna had paid, I think in 2018, this is on dollars for docs on the website, they had paid something like 5,800 doctors and researchers and medical centers. They were pouring parts of their profits into the medical establishment to continue that. approach to preterm birth. And this gets back to the issue we were talking about, how the drug money corrupts the folks that should be standing up on behalf of the public in order to continue the use of the drug to continue the cycle of making the money, which can then be poured back into the medical establishment system. That was a quick summary of McKenna. Sean: Yeah, yeah. Thank you for that. Adam Urato: The FDA did pull it off. The FDA did finally pull it off earlier this year. This year, thank goodness. Thank goodness. Sean: only took a couple more years. Adam Urato: Well, this is what drives me crazy. I'll wrap up with this, because I know this is not a McKenna podcast, but in March of 2019, we knew that the confirmatory trial failed, and then it took more than four years to actually get it off the market. So we continued to inject pregnant women with a synthetic hormone. that wasn't benefiting moms and babies and was likely causing some harm as the chemical exposure does, we did that for four more years until the FDA finally got it off the market. Sean: Speaking of synthetic hormones, Doc, since I have you here being an OBGYN, when it comes to oral contraceptives, synthetic hormonal birth control, what are you informing your patients about this, about potential risks? Adam Urato: Yeah, so it's a great question. I know it's getting more press now. In my role as a maternal fetal medicine physician, I'm usually not the primary person who's counseling them about contraception. I typically work more in a consultative fashion. So it's usually the primary OBs that are doing that. But my messaging on that would be similar, which is that you've got to be aware that it is a synthetic chemical exposure. And so I would take the same approach to that. My focus is, as you could probably tell by my discussion with McKenna, my focus is on medications more, you know, generally, as well as antidepressants and psychiatric medications. But I look at them all, I try to get patients to understand this. Like, again, going back to what I've said several times, whether it's a synthetic hormone to be injected into pregnant women or an oral contraceptive or an SSRI, these are... synthetic chemical compounds, and they're going to be injecting you or you're going to be taking them, they're going to have chemical effects. And so it's really important for patients to be aware, like, well, what are those chemical effects going to be? Is it safe? Is there a track record with it? Is it going to improve my health, short term and long term, and really weigh that? That's why I was saying about the whole thing with informed consent, Rogers. I like your take on that, which is that that's what this is all about, making sure patients have that information on this. Sean: Doc, I want to transition a little bit to postpartum depression. So first, I just want to throw out the question, what are the multitude of factors that you would say would influence postpartum depression? Adam Urato: So you have a lot going on after you have a baby. There's a lot going on. I mean, there's the actual, people tend to focus on the hormonal or biological aspect of it. And that is there. Certainly, there's changes in the hormones. You're no longer carrying a baby at that point. But there's also a lot of life stressors that start to occur at that point. Now you're caring for the baby. There's changes in the relationship, typically. between the mom and her partner, if there's one in the picture, and then also in the families. So that's a time often of great stress for people. And that probably in some combination with the biology of it can lead to suffering or depression or however you wanna phrase that for the patient. Sean: sleep deprivation, I would imagine is also a big piece. Adam Urato: Absolutely, yeah, I shouldn't have left that out. Absolutely, for sure. Sean: So here's my question. I've done some research on this. There's scientific published literature that these SSRIs or other psychiatric drugs that are prescribed for depression can decrease empathy. There's also very known emotional blunting. So I think we could all accept that there's a biological need for us to experience our emotions in many different ways, especially when it comes to bonding or connecting. So my thought is in this, knowing that the data on the increased risks of SSRIs, which include potentially fatal outcomes, the emotional blunting, the decreased empathy. Again, when we use deductive reasoning, I always come to the conclusion that taking an SSRI would, I think, increase the likelihood of an adverse negative event. And rather than actually treat postpartum depression. I want to get your thoughts on that. Adam Urato: Yeah, no, I think you're raising a really important point about more broadly, specifically to postpartum depression, but also more broadly about the impact these drugs have on our emotions, on our bonding, you know, on our function and whatnot, you know, the way we get along with humans, the way we get along with each other, the feelings that we have, all of these things have been developed in the brain over millions of years and the way moms bond with their babies is the same kind of thing. Does taking a synthetic chemical compound and antidepressants, synthetic chemical compound that changes the brain chemistry, can that alter things like bonding and other things like that? Sure, I think that that's possible to occur. And could that have impact? Absolutely. Are there concerns about that? Absolutely. Yeah, for sure. I think there was just the FDA just approved a new postpartum medication to be taken for four weeks. I tweeted about that because it didn't look particularly effective to me. And then the safety really concerned me because FDA put a big black box warning on the label that said women taking this new antidepressant for postpartum depression, women taking this should not drive because they can have mental impairment and they may not realize that they've got mental impairment. That's what the black box says and it's focused on driving. Sean: Mm-hmm. Adam Urato: Driving's important but the other big thing that's going on with this drug that's being used for postpartum depression is the woman's caring for a newborn. She just had a baby and that's nowhere to be found on that black box label. And my guess is, and I'm speculating here, but my guess is that they realized that if they approved a drug and then put a black box, a drug for postpartum depression, and then put a black box label on it that said, women taking this should not take care of their children for the 12 hours after they've taken that, people would be in an uproar. Sean: Mm-hmm. Adam Urato: They'd say, well, this is ridiculous. You're telling new moms not to take care of their children for the 12 hours that they're on their drug. But so they realized they couldn't put something like that on there, so they focused on driving. This really sort of befuddled me. Sean: Yeah, it's like the boilerplate language for like don't operate heavy equipment or drive after taking the medication. Adam Urato: That's right. Sean: I mean, to me, it's criminal behavior. And the drug is Zylresso. It's a it's an IV treatment for PTSD. And it would are I'm sorry for postpartum depression in adult women. It was just recently approved. So I was gonna ask for your thoughts on that. But additionally, a new drug for RSV, a vaccine for RSV was recently where it is provided by a single dose injection into the muscle at between weeks 32 to 36 of the pregnancy. Are you aware of this new drug, this new vaccine? Adam Urato: Yeah, yeah, this is the RSV vaccine. There's definitely concerns with that. And there was concerns with the FDA approval of that. The trials themselves show increased rates of preterm birth with exposure to this vaccine that was shown in the trials. In fact, GlaxoSmithKline, which had a similar product, a similar vaccine, that showed increased rates of preterm birth with their product and they stopped their trial. But they didn't just stop their trial, they just stopped development of it. I think they felt, look, this is a signal here, this is a problem. But at the same time, a similar product goes in front of FDA and then gets approved. And so I think that was concerning. That advisory committee meeting took place a few months ago and a few of the panelists did raise that same concern. that it looks like it may be linked to preterm birth. More broadly, I think that patients are concerned because what's happening now in pregnancy is moms are routinely being offered or encouraged to get Tdap vaccine for tetanus, diphtheria, pertussis. influenza vaccine, the COVID vaccine, now RSV vaccine, and then GBS, group B streptococcal vaccine is probably next in the pipeline. And then there's likely more to come. And I'll tell you my patients have great problems with this, they're concerned. And going all the way back to the start of this podcast, they'll ask like that crucial question one, what are the chemical effects here? What are the effects this is going to have on me and on the baby? And honestly, from an immunological standpoint, we just don't know. There's so much we don't know about pregnancy biology. And we don't know what oftentimes what one of these does in terms of actual pregnancy reproductive biology. And then looking at the combination of five vaccines or however many are gonna be in the pipeline, along with the other medications moms are taking, we just have no idea really what the impact of this is. And again, I'm gonna step back to the 35,000 foot view. If you step back at what we're doing, and again, picture the prenatal clinic just outside of the chemical manufacturing facility, right? You say, In our modern society, they bring them fresh off the chemical line, right into the prenatal clinic, they inject them, every week they come in, they get injected with a new one, then they're doing the meds right off the line. Is that really the best way to get to healthy moms, healthy babies, and a healthy society? I mean, most people would look at that and say, that might not be, and that might not be the best way to get towards maternal and fetal health, towards improved maternal and fetal health. And they would balk at that. And I'll tell you, my patients are the ones who teach me on this because they have reservations about this. Why do I keep getting new shots and things being thrown at me? And of course the medical establishment says, because this is the way to be healthy, but the medical establishment is being heavily funded by pharma. So then you get into that same problem again of the message that's getting out there. Sean: We live in such dangerous times. I think this is the first time in, I think, probably recorded history, certainly modern history, where we have a wide group of people who are just resisting the medical recommendations and resisting their doctors medical recommendations, where mothers and patients are having to do all the research themselves because it's just a catastrophic loss of trust. And it's been an experiment over the past 30, 40, 50 years, and one that is yielding extremely poor outcomes on the health of the Western world. We've kept you a long time, Doc. One of the things I just want to share to the audience is I think you've gotten to this point in the episode, you know how important this information is. And this is a mission of informed consent. We cannot consent unless we have all the... adequate information. So I really am asking everybody, if you know some you know a woman of childbearing age, please share this podcast. I think I'm going to make a committed effort over the next few weeks to do two things. One is to get this episode really heard, but also to try to bring attention to Dr. Erato and all the work that he's doing. Doc, how can on Twitter, what is your Twitter handle? It's X now. that people can get this information that you're putting out. Adam Urato: It's at Adamurata1. And that's basically where I put I'm a full-time clinician. And I take care of patients all the time. But when these studies come up or come out or I see something that I think really needs to get out there, I try to put that out on Twitter. I try to tweet about her on X, as you said. And so that's probably the best way to sort of stay up on this. I did just want to add. One thing that happens with this whole discussion is that people will sometimes, in jumping to that second question, say, well, does this mean that when patients come in, you tell them, you make them feel bad or feel guilty, and that's not at all what this is all about. As you said, Roger, it's about informed consent. And I'm working in my home community. I work in my home community. I take care of people I know. I see them in the coffee shop. They're my neighbors. And when they come to me, whatever the issue is, I try to review with them risks, benefits, and alternatives, try to figure out where they're at, and then support them with what they decide to do. And for many of my patients, they will decide to stay on their medication, reduce the dose, maybe, maybe not. But whatever they decide to do, I'm gonna be working with them, I take care of them. And so this isn't about this whole discussion, I think some people feel is directed towards like, attacking moms or making them feel guilty or... or not, or putting the baby's health over the mom or all this sort of thing, but that's not what this is. It's trying to inform the mom, make sure she's got the right information, and then support her in her journey and how she decides to move forward. Sean: One other thing I'll direct our listeners to is Dr. Rada did a really good job and provided a free online course. There's a link in the show summary I did look I logged in this morning and I took your entire online course I thought was fantastic. It broke it up into a very digestible nuggets that I actually appreciate it. So thank you for doing that and putting the time into it. Adam Urato: Sure, no thanks very much for that. I'm glad that you enjoyed it. Sean: Yeah, Dr. Hirata, I think you ended on a very important point and it's regarding like personal relationships. In some ways medicine has become a bit impersonal, especially when we have such large hospital-based systems that we have and not always being able to see the same provider. But when you work in your hometown and you grew up there and you were born in the hospital in which you work at, I think it speaks volumes about how committed you are to your community. and how important that community-based physician traditionally has been in being able to make recommendations that are in the best interest of that individual, making sure they have all that information because you are accountable to them. And somehow I think we've gotten to a place in society where we become accountable to a licensing board or a large medical organization where there's fear of acting outside of some of the established guidelines that are provided. So I think that's what makes you unique Dr. Iorado is that it's very clear, I think, from this podcast, how you are highly ethical and you are communicating information that has been critically evaluated and it's based on a commitment to the patients that you work with. And so I'm glad that we can provide you a larger voice and just certainly hope that this podcast really gets spread far and wide. Adam Urato: Yeah, no, I appreciate the opportunity. And that's absolutely true. I mean, I'm going to be living presumably with these kids that are developing now. I've been taking care of patients in my home community for about 20 years. And so these moms I take care of, they then have the babies that are often in my neighborhood. They're in my community. And so it is important to do that right. And then the last thing I would just add, which I think you just touched on there, is it's really important for physicians to be able to speak out on this stuff. There's this whole movement now to try to silence dissent, basically, this whole focus on misinformation. And I really see that as a mechanism of trying to silence dissent and basically trying to stop people from being able to do this sort of thing, what we're doing, which is to speak out. So I think it's very valuable what you're doing with your tweets, with your podcast. And I really appreciate the opportunity to come on today and talk about this with you guys. Sean: Thank you. Dr. Adam Urato, we want to thank you for a radically genuine conversation. Adam Urato: Thank you guys.