My perspective as a primary care physician is to view RFKJ and MAHA as a (needed) disruptive influence. I would hope as physicians, we could agree that current state of US health is not good. The epidemic of obesity, particularly in children, is horrifying. If we want to continue along the lines of "eat less, exercise more" as our entire approach to stimulating healthy change, I think we'd have to agree that we've given it a try and it just isn't working.
To say that "toxicity" and "poisoning" are too strong words? Isn't that exactly what is needed in an attempt to actually make changes? "Processed food is not toxic and is not poison at small doses" - yes, I guess that is true about most substances. The problem with processed food is that it is highly addictive. For those of us that are susceptible to those addictive properties, it IS a poison! Would you agree that sugar and processed carbs are highly inflammatory? Can we agree that metabolic syndrome is an epidemic brewing just below the surface of our society and erupting with its end-organ effects and outcomes? It think it is very clear they are.
"Big food" has teams of people whose whole job is finding the "bliss point" of processed foods. The best level of sweetness; the perfect blend of cheesy and creamy. Their entire focus being how to hit the human brain with a highly addictive substance! The focus of big food has always been to get as many people eating as much of their foods as possible. They've used deceptive advertising to tout "low fat" and "all natural" as advertising gimmicks. Saying the key is "dose" is not facing up to the fact that huge numbers of people are very susceptible to the brain effects of processed foods. I'm disappointed that any physician would defend the processed food industry and focus on "a little bit is ok!"
If you go grocery shopping, you'll see the gauntlet of processed foods that surround consumers (many of whom are young children/teens, etc). On all "end caps" of the grocery aisles. completely surrounding the check out areas. Drive through eating has become a way of life.
If not for a coalition of charismatic voices, how else do you conceive of some drastic change happening?
"'Processed food is not toxic and is not poison at small doses'" — yes, I guess that is true about most substances. The problem with processed food is that it is highly addictive."
Came here to say this. It has been widely, reliably reported that the Food-Industrial Complex pours untold 'research & development' sums towards making their ultraprocessed products ever more irresistible, all with the aim of increasing consumption and maximizing profits.
I'm all for nuance and, Dr. Mandrola, I would argue that your point about about 'toxicity/poisoning vis-a-vis dosage' is not nearly nuanced enough.
Indeed. Many fast food corporations employ gifted PhD’s and medical experts to get textures and tastes to the highest craving standards…nothing like using our biology against us to sell!
Thanks for the thoughtful, nuanced post, John. Whether or not RFK Jr is confirmed in this post, he represents and leads a growing social and political movement in the USA that sees our biomedical research and clinical establishment as deeply corrupt and self-interested, a perception that was accelerated by the covid fiasco. Many medical leaders are burying their heads in the sand, pretending that everything is fine, that MAHA is a small fringe element, and want to just maintain the status quo. This is going to set the profession up for a bigger fall in the future.
RFK Jr has some baggage and has made some statements that he will have to clarify. But I will be watching the hearings with interest and with an open mind. He may be the disruptive force that US healthcare needs. American medicine is on the wrong track now. Inside govt, he will have to work within the law and engage the medical and public health professions to get anything accomplished. He may be the person that can help heal the deep divide that was accelerated by the disastrous covid response.
Like saying that Covid-19 was designed to spare Ashkenazi Jews? That Lyme disease was manufactured? That African AIDS is a different disease than American AIDS?
He’s a self-promoting sociopath and has no business being considered for head of HHS.
While I'm not a Doc, I'm a heart patient and your thoughts reflect my own.
I'm hesitant to embrace the all or nothing labeling.
My favorite part of this article was the Thomas Sowell reference. I love his writings, and the broad, practical applications they provoke and provide in such broad contexts.
In any case, keep up the great work with the writing and the podcast. Thank you, for all that you do.
RFK and MAHA are inseparable. RFK does not promote “soft thinking;” he lies. You cannot build a functional system that has intentional deception at its foundation. Digging around in the garbage heap that is RFK and pulling out a few nuggets you like is worse than “soft thinking.”
Please share the lies that RFK jr had publicly stated. Please have the evidence to back it up. There has been nothing but non stop lies from Big Pharma and Big Food companies since he was nominated. It’s disgusting to watch formerly trust sources like the WSJ spread lies about him.
I am a housewife, not a doctor. I can tell you right now, food shopping is ridiculous. I forgot to mention in my previous comment, why does steak sauce have sugar in it? I could make my own steak sauce and Katsup, but most people cannot do that. I did find one brand, primal kitchen, that doesn't have sugar. If you add up all the items that have sugar in them that don't need to have sugar in them, it's a lot of things. People cannot always afford fresh food, they rely on canned food sometimes. Why is there so much junk and filler in this? We don't need all this soy, cheap oils. Surely a bit of animal fat is better than something made in a lab. What happened? Why does everything need food coloring in it? This is the reason, I hope RFK is confirmed. At least maybe people will think, just how much sugar do I really eat? A lot of restaurant food has a lot of added sugars. At least think about that.
If not for disruptive change - to open the curtain and examine things we've just taken for granted for decades - do we just roll slowly along with "status quo"?. Would we prefer another Becerra?? What were his qualifications? What were his views on anything medical or scientific? What, exactly, did he accomplish?
I think many of us are totally open to something, anything, shaking the status quo. A shakeup like that needs attention, ideas, and a questioning attitude.
Medicine and public health have always been based on the cornerstone of vigorous debate and discussion. Of examining different perspectives and viewpoints. Why do we fear questioning?
Covid came along and half the country hunkered down into the bunker of "misinformation!" Debate and questioning were shut down. How very unscientific is that?! Dangerous.
Looking at the connections of Pharma to government policies is good. The average physician is just not aware of these relationships. Covid, with vaccines, boosters, mandates, paxlovid and Pfizer have lifted the curtain a bit. Examining the number of vaccinations we're requiring - again, what is wrong with that? We focus now on "long covid", but there have always been people with "complex diseases" that are increasing in prevalence but the medical community does not seem interested in asking "why?" We don't know why autism has increased; nobody asking much about MCAS, etc. Any physician has to appreciate the medical impact of vaccinations, particularly for certain infectious diseases. But can't we question some of it? Why do other advanced countries have more limited vaccine schedules?
None of this threatens my role as or identity as a physician. I use my training and license to help manage chronic disease. I appreciate all the advances and breakthroughs of modern medicine (particularly in cardiac intervention and surgery). I don't think physicians need to abandon this important role as our license is needed to diagnose and treat with medication. But I welcome the societal focus and evaluation of these other aspects of good health.
I agree with most of what you said. I am in favor of capitalism and fully understand that the profit motive has led to great innovations and product development. I think many problems we are experiencing are from unfettered capitalism. If companies can take advantage of customers and get away with it they will do so. The pharmaceutical industry is a good example.
Well and we “ask for it” as seen on TV commercials (which I hope if nothing else TV commercials for pharma stop. The cascade effect of that alone would do our collective health wonders).
I agree that it is on us to prescribe or not prescribe medications and/or interventions, but although big pharma has done much for our health, many times it is driven by pure greed and laissez faire profits. Semaglutide for knee arthritis??!! Give me a break! Prevention is best, not unscientific screening. Chips and sodas are not a human right and sure, it’s fine to have it now and then, but why not never? Patients have a capacity to underestimate their bad habits. Sounds harsh, but it’s true, when obesity and lifestyle related diseases decrease, then we can have chips and sodas now and then :-)
I completely agree. I am sharing with you this critical review, part of a series of ten, that we are conducting to evaluate the existing evidence on the ten circadian factors of the exposome (nutrition/attrition, physical effort/sedentary lifestyle, sleep, supplements, sex/procreation, study, impressions, interpersonal and environmental relationships, and financial health), to achieve optimal longevity and maintain good health during the final decade of life.
Hola Dr Valladares, completamente de acuerdo. Le comparto esta revisión crítica, de una serie de 10, que estamos adelantando para evaluar la evidencia existente en los 10 factores circadianos del del exposoma (nutrición/atrición, esfuerzo físico/sedentarismo, sueño, suplementarios, sexo/procreación, estudio, impresiones, relaciones interpersonales y con el ambiente, y salud financiera), para la longevidad máxima y la buena salud en los 10 últimos años de vida.
I respectively disagree with those who deplore the state of the nation's health. In over 40 years of medical practice and now well into retirement I marvel at all the improvements I have seen in both the diagnosis and treatment of disease. CT scans, MRIs, and other advances in diagnostic testing seemed almost miraculous at first and are now taken for granted. Improvement in surgical techniques have been of enormous benefit in orthopedics, ophthalmology, oncology and across almost all other areas of medicine. But the MAHA movement seems to focus on disorders that are mostly due to aging and/or psychological problems and label them a "chronic disease epidemic" in a nation where longevity has progressively increased over many generations. They focus upon and confidently recommend "lifestyle" changes for which they have no proof of efficacy or even any biologically plausible explanation as to how they would be helpful. An orthopedist colleague once told me the most common question he was asked was "how can I prevent my bones from becoming brittle?" His response was "Don't get old."
I agree that an aging population will have many issues simply due to age. But, focus on children! There is an epidemic of obesity, metabolic syndrome, insulin resistance and full-blown T2DM in children! Sugar and processed carbs truly are a poison. Children who are being raised on a high carb, high sugar, high fat "convenience food" diet are in metabolic disarray. NASH (now MASH) is overtaking alcohol or CAH as the leading cause of needing liver transplant.
There are many societal factors at play: single parent families where parent doesn't have time or energy to do home cooked meals; working moms needing convenience. Many children have full "Starbucks habits" and get calorie-laden snacks on a regular basis.
Fast food and junk food were introduced in the 80s and snacking became a "thing". This is the time frame where the metabolic dysfunction got its start and is now in full swing. The health of our nation really sits within the health of our children.
Focusing on the elderly and aging is not the correct focus for lifestyle. The way we feed and raise our children is.
Public health is responsible for the "epidemic" of T2DM in kids. I raised my daughter on an ultra low fat diet as per health advice of the day... Of course very high sugar to compensate... Exactly the diet guaranteed to give someone diabetes, and it was the result of public health messaging!
I have no idea how old you are but I was born in 1946 and can assure you that junk food and snacking were quite common in the 1950s. So we have had several generations since that time with a steadily increasing longevity curve up through 2021 and we can thank the covid scamdemic for the brief regression that took place then. The demonization of sugar mystifies me and probably anyone else who understands the physiology of the digestion, absorption, and distribution of nutrients.
I was born a bit later, but there was clearly an explosion of junk and fast food in the 80s. Again, my main point was we aren't really talking about the elderly or just older people with chronic disease. As an internist, I spend the vast majority of my time helping our aging population manage these chronic issues. And yes, there are certainly advances that help with certain things.
But the health of our nation is better-reflected in the health status of our children. If you have not noticed the explosion of obesity and the related effects of that, that is where the current focus of MAHA is.
Well, done, John. Interesting comments that run the spectrum. I think a fundamental truth that many of us have observed is the lack of the teaching of critical thinking in our education system. The inability to discern fact from fluff or the goal of acquiring of eyeballs on social media is a fundamental problem that explains much of what’s going on society now. Although clinicians are ostensibly better at evaluating information than the general public, the fact that the lack of formal training to critique medical advances leads to much of what you describe. We need to be able to evaluate clinical research better rather than to depend solely on peer review journals or consensus panels.
I think a lot of the same things as Dr. Mandrola. Here's the problem. These processed foods are addictive. Some people cannot stop eating them. You know most people cannot eat just one chip. Maybe we should just have less of this type of food. I think we need smaller stores with single ingredient foods. I cannot go to a supermarket without tripping over all the processed chips and cakes and junk in the aisles and at the checkouts. I wonder about seed oils. I think it's cheap for them. They don't seem to cause heart disease, the lower both ldl and hdl. Saturated fat raises both ldl and hdl. I would rather have a bit of real saturated fat in foods. I wonder about all these items made with flour. Also most canned food has sugar in it. Why does it have sugar in beans? Why do we need "sweetner" in canned fruit? This addiction to sweet sweet sweet is a really bad thing. Just take the sugar out of most things, it's not needed. People will acclimate to not eating so much sweet.
Dr Mandrola. As always, I concur with several points in your reflection. However, despite the undeniable advancements in science, technology, and biomedical research, medicine began to lose its luster and “humanity” a century before the MAHA Movement. The field split in two starting in 1910, when Abraham Flexner issued his “recommendations” (which became mandatory) to transform American universities. Although initially focused on American education, these reforms quickly became “viral,” evolving into the curriculum now followed worldwide. This reform turned medicine into a matter of science (I would say pseudoscience) with little HUMANITY.
Since then, but especially from the 1970s onward, it has become more evident that there are two independent and disconnected businesses in healthcare: the Health Business vs. the Disease Business. Given the enormous economic returns for a few, medicine is now the latter bastion, uninterested (because it is not beneficial for business) in promoting health and preventing disease within a holistic salutogenic framework—that is, truly caring for a Human Being’s health. Paradoxically, the Health Business “only” produces benefits for the majority of the population but is not recognized in its effects (poorly or insufficiently evaluated scientifically) by the State, Health Systems, or even the population itself.
Let’s not deceive ourselves: only when a healthcare worker or, better yet, transdisciplinary health teams receive at least the same recognition and moral, social, and economic compensation for preventing a severe disease (like a heart attack with three-vessel disease) as the healthcare system receives for the “successful treatment” of coronary obstruction—laden with undeniable science, technology, and innovation in interventions and medication—only then will Preventive Medicine, true Healthcare, cease to be rhetoric. Otherwise, that successfully treated patient will arrive with their wristband, having had their arteries unblocked, taking ten medications, without modifying the true factors causing their coronary disease, which the system is not interested in “curing” or preventing.
What makes me pessimistic is that people such as, say, Petr Skrabanek, have made similar points more than 30 years ago (a bit provocative, but fitting: “The pursuit of health is a symptom of unhealth.”).
I am not even sure whether most countries have a proper ethical framework for public health such as the stewardship model in the UK.
Any physician that is pro Fauci or pro working for or with healthcare CEO’s or pro working with pharmaceutical companies is an imposter and impersonating a true physician. A real physician first love is taking care of patients:
IPA - Independent Physicians Association
Our Mindset : POPs - Protect Our Patients stance
Our Objective : Regain our voice to advocate for our patients
Who we are
1. Pro Patient - the patient has the right to choose services, treatments or physicians
2. Pro informed Consent - the patient has the right to know IN their level of understanding
3. Pro HIPPA - all patient information is private from shots to pelvic exams, not for media display
4. Pro Physician-Patient Relationship:
a. Patient are our 1st Love
b. Patient come 1st before hospital & insurance companies
c. Pro Life - we use all our knowledge skills to prolong our patients
life
d. Pro Treat - we treat and battle disease and attempt to fight off
death for our patient
5. How Our Philosophy Differs
a. We strictly volunteer so no one could be tempted to sell out or be bought out
b. Our analysis of the dichotomy between business and the medical practice
1. businessmen take an oath to protect profits ---physicians take an oath to protect patients
2. businessmen take an oath to protect the stockholders ---physicians take an oath to protect the baby holders: parents/grandparents
3. businessmen see numbers --- physicians see patients
4. businessmen try to save money --- physicians try to save lives
6. We reject all C.E.O., million and multi-dollar salaries in the field of Medicine and Healthcare industry: THAT MONEY BELONGS TO DIRECT PATIENT CARE
7. We have been forced into 3 types of physicians(doctors): hospital-owned, insurance owned and private practice(the only one who can advocate for the patients)
The field of medicine can not tolerate million dollar salaries, there should be a salary RANGE of $300-500,000 for all healthcare industry oC.E.O’s as well reduction in COO, CFO and CMO accordingly and the savings redirected back into direct patient care.
Our Objective : Regain our voice to advocate for our patients
Who we are
1. Pro Patient - the patient has the right to choose services, treatments or physicians
2. Pro informed Consent - the patient has the right to know IN their level of understanding
3. Pro HIPPA - all patient information is private from shots to pelvic exams, not for media display
4. Pro Physician-Patient Relationship:
a. Patient are our 1st Love
b. Patient come 1st before hospital & insurance companies
c. Pro Life - we use all our knowledge skills to prolong our patients
life
d. Pro Treat - we treat and battle disease and attempt to fight off
death for our patient
5. How Our Philosophy Differs
a. We strictly volunteer so no one could be tempted to sell out or be bought out
b. Our analysis of the dichotomy between business and the medical practice
1. businessmen take an oath to protect profits ---physicians take an oath to protect patients
2. businessmen take an oath to protect the stockholders ---physicians take an oath to protect the baby holders: parents/grandparents
3. businessmen see numbers --- physicians see patients
4. businessmen try to save money --- physicians try to save lives
6. We reject all C.E.O., million and multi-dollar salaries in the field of Medicine and Healthcare industry: THAT MONEY BELONGS TO DIRECT PATIENT CARE
7. We have been forced into 3 types of physicians(doctors): hospital-owned, insurance owned and private practice(the only one who can advocate for the patients)
The field of medicine can not tolerate million dollar salaries, there should be a salary RANGE of $300-500,000 for all healthcare industry C.E.O’s as well reduction in COO, CFO and CMO accordingly and the savings redirected back into direct patient care.
My perspective as a primary care physician is to view RFKJ and MAHA as a (needed) disruptive influence. I would hope as physicians, we could agree that current state of US health is not good. The epidemic of obesity, particularly in children, is horrifying. If we want to continue along the lines of "eat less, exercise more" as our entire approach to stimulating healthy change, I think we'd have to agree that we've given it a try and it just isn't working.
To say that "toxicity" and "poisoning" are too strong words? Isn't that exactly what is needed in an attempt to actually make changes? "Processed food is not toxic and is not poison at small doses" - yes, I guess that is true about most substances. The problem with processed food is that it is highly addictive. For those of us that are susceptible to those addictive properties, it IS a poison! Would you agree that sugar and processed carbs are highly inflammatory? Can we agree that metabolic syndrome is an epidemic brewing just below the surface of our society and erupting with its end-organ effects and outcomes? It think it is very clear they are.
"Big food" has teams of people whose whole job is finding the "bliss point" of processed foods. The best level of sweetness; the perfect blend of cheesy and creamy. Their entire focus being how to hit the human brain with a highly addictive substance! The focus of big food has always been to get as many people eating as much of their foods as possible. They've used deceptive advertising to tout "low fat" and "all natural" as advertising gimmicks. Saying the key is "dose" is not facing up to the fact that huge numbers of people are very susceptible to the brain effects of processed foods. I'm disappointed that any physician would defend the processed food industry and focus on "a little bit is ok!"
If you go grocery shopping, you'll see the gauntlet of processed foods that surround consumers (many of whom are young children/teens, etc). On all "end caps" of the grocery aisles. completely surrounding the check out areas. Drive through eating has become a way of life.
If not for a coalition of charismatic voices, how else do you conceive of some drastic change happening?
"'Processed food is not toxic and is not poison at small doses'" — yes, I guess that is true about most substances. The problem with processed food is that it is highly addictive."
Came here to say this. It has been widely, reliably reported that the Food-Industrial Complex pours untold 'research & development' sums towards making their ultraprocessed products ever more irresistible, all with the aim of increasing consumption and maximizing profits.
I'm all for nuance and, Dr. Mandrola, I would argue that your point about about 'toxicity/poisoning vis-a-vis dosage' is not nearly nuanced enough.
Indeed. Many fast food corporations employ gifted PhD’s and medical experts to get textures and tastes to the highest craving standards…nothing like using our biology against us to sell!
Thanks for the thoughtful, nuanced post, John. Whether or not RFK Jr is confirmed in this post, he represents and leads a growing social and political movement in the USA that sees our biomedical research and clinical establishment as deeply corrupt and self-interested, a perception that was accelerated by the covid fiasco. Many medical leaders are burying their heads in the sand, pretending that everything is fine, that MAHA is a small fringe element, and want to just maintain the status quo. This is going to set the profession up for a bigger fall in the future.
RFK Jr has some baggage and has made some statements that he will have to clarify. But I will be watching the hearings with interest and with an open mind. He may be the disruptive force that US healthcare needs. American medicine is on the wrong track now. Inside govt, he will have to work within the law and engage the medical and public health professions to get anything accomplished. He may be the person that can help heal the deep divide that was accelerated by the disastrous covid response.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821693
Baggage?
Like saying that Covid-19 was designed to spare Ashkenazi Jews? That Lyme disease was manufactured? That African AIDS is a different disease than American AIDS?
He’s a self-promoting sociopath and has no business being considered for head of HHS.
Totally agree.
While I'm not a Doc, I'm a heart patient and your thoughts reflect my own.
I'm hesitant to embrace the all or nothing labeling.
My favorite part of this article was the Thomas Sowell reference. I love his writings, and the broad, practical applications they provoke and provide in such broad contexts.
In any case, keep up the great work with the writing and the podcast. Thank you, for all that you do.
RFK and MAHA are inseparable. RFK does not promote “soft thinking;” he lies. You cannot build a functional system that has intentional deception at its foundation. Digging around in the garbage heap that is RFK and pulling out a few nuggets you like is worse than “soft thinking.”
Please share the lies that RFK jr had publicly stated. Please have the evidence to back it up. There has been nothing but non stop lies from Big Pharma and Big Food companies since he was nominated. It’s disgusting to watch formerly trust sources like the WSJ spread lies about him.
The same standard and investigation should be done to Fauci “I am science”
And we have the evidence - volumes of it - to back your statement up - not the NYT
Read the letters from his cousins to the senate. As for lies, how about https://www.nytimes.com/article/rfk-conspiracy-theories-fact-check.html?smid=nytcore-ios-share&referringSource=articleShare
The NYT is its own lying rag.
I read that letter and Caroline Kennedy is shameful. Her Father would be disappointed in her.
You don’t capitalize “father” unless you are referring to god. Thought you should know.
I am a housewife, not a doctor. I can tell you right now, food shopping is ridiculous. I forgot to mention in my previous comment, why does steak sauce have sugar in it? I could make my own steak sauce and Katsup, but most people cannot do that. I did find one brand, primal kitchen, that doesn't have sugar. If you add up all the items that have sugar in them that don't need to have sugar in them, it's a lot of things. People cannot always afford fresh food, they rely on canned food sometimes. Why is there so much junk and filler in this? We don't need all this soy, cheap oils. Surely a bit of animal fat is better than something made in a lab. What happened? Why does everything need food coloring in it? This is the reason, I hope RFK is confirmed. At least maybe people will think, just how much sugar do I really eat? A lot of restaurant food has a lot of added sugars. At least think about that.
If not for disruptive change - to open the curtain and examine things we've just taken for granted for decades - do we just roll slowly along with "status quo"?. Would we prefer another Becerra?? What were his qualifications? What were his views on anything medical or scientific? What, exactly, did he accomplish?
I think many of us are totally open to something, anything, shaking the status quo. A shakeup like that needs attention, ideas, and a questioning attitude.
Medicine and public health have always been based on the cornerstone of vigorous debate and discussion. Of examining different perspectives and viewpoints. Why do we fear questioning?
Covid came along and half the country hunkered down into the bunker of "misinformation!" Debate and questioning were shut down. How very unscientific is that?! Dangerous.
Looking at the connections of Pharma to government policies is good. The average physician is just not aware of these relationships. Covid, with vaccines, boosters, mandates, paxlovid and Pfizer have lifted the curtain a bit. Examining the number of vaccinations we're requiring - again, what is wrong with that? We focus now on "long covid", but there have always been people with "complex diseases" that are increasing in prevalence but the medical community does not seem interested in asking "why?" We don't know why autism has increased; nobody asking much about MCAS, etc. Any physician has to appreciate the medical impact of vaccinations, particularly for certain infectious diseases. But can't we question some of it? Why do other advanced countries have more limited vaccine schedules?
None of this threatens my role as or identity as a physician. I use my training and license to help manage chronic disease. I appreciate all the advances and breakthroughs of modern medicine (particularly in cardiac intervention and surgery). I don't think physicians need to abandon this important role as our license is needed to diagnose and treat with medication. But I welcome the societal focus and evaluation of these other aspects of good health.
"Please share the lies that RFK jr had publicly stated."
- Lyme disease is a highly likely military engineered bioweapon
- Exposure to pesticides cause children become transgender
Couple of gems from the hearing going on right now.
I agree with most of what you said. I am in favor of capitalism and fully understand that the profit motive has led to great innovations and product development. I think many problems we are experiencing are from unfettered capitalism. If companies can take advantage of customers and get away with it they will do so. The pharmaceutical industry is a good example.
Well and we “ask for it” as seen on TV commercials (which I hope if nothing else TV commercials for pharma stop. The cascade effect of that alone would do our collective health wonders).
I agree that it is on us to prescribe or not prescribe medications and/or interventions, but although big pharma has done much for our health, many times it is driven by pure greed and laissez faire profits. Semaglutide for knee arthritis??!! Give me a break! Prevention is best, not unscientific screening. Chips and sodas are not a human right and sure, it’s fine to have it now and then, but why not never? Patients have a capacity to underestimate their bad habits. Sounds harsh, but it’s true, when obesity and lifestyle related diseases decrease, then we can have chips and sodas now and then :-)
Thank you!!
Hello Dr. Valladares,
I completely agree. I am sharing with you this critical review, part of a series of ten, that we are conducting to evaluate the existing evidence on the ten circadian factors of the exposome (nutrition/attrition, physical effort/sedentary lifestyle, sleep, supplements, sex/procreation, study, impressions, interpersonal and environmental relationships, and financial health), to achieve optimal longevity and maintain good health during the final decade of life.
https://bit.ly/EcheverryJ_2024_Falsehod_origin_diabesity_pandemic
Hola Dr Valladares, completamente de acuerdo. Le comparto esta revisión crítica, de una serie de 10, que estamos adelantando para evaluar la evidencia existente en los 10 factores circadianos del del exposoma (nutrición/atrición, esfuerzo físico/sedentarismo, sueño, suplementarios, sexo/procreación, estudio, impresiones, relaciones interpersonales y con el ambiente, y salud financiera), para la longevidad máxima y la buena salud en los 10 últimos años de vida.
I respectively disagree with those who deplore the state of the nation's health. In over 40 years of medical practice and now well into retirement I marvel at all the improvements I have seen in both the diagnosis and treatment of disease. CT scans, MRIs, and other advances in diagnostic testing seemed almost miraculous at first and are now taken for granted. Improvement in surgical techniques have been of enormous benefit in orthopedics, ophthalmology, oncology and across almost all other areas of medicine. But the MAHA movement seems to focus on disorders that are mostly due to aging and/or psychological problems and label them a "chronic disease epidemic" in a nation where longevity has progressively increased over many generations. They focus upon and confidently recommend "lifestyle" changes for which they have no proof of efficacy or even any biologically plausible explanation as to how they would be helpful. An orthopedist colleague once told me the most common question he was asked was "how can I prevent my bones from becoming brittle?" His response was "Don't get old."
I agree that an aging population will have many issues simply due to age. But, focus on children! There is an epidemic of obesity, metabolic syndrome, insulin resistance and full-blown T2DM in children! Sugar and processed carbs truly are a poison. Children who are being raised on a high carb, high sugar, high fat "convenience food" diet are in metabolic disarray. NASH (now MASH) is overtaking alcohol or CAH as the leading cause of needing liver transplant.
There are many societal factors at play: single parent families where parent doesn't have time or energy to do home cooked meals; working moms needing convenience. Many children have full "Starbucks habits" and get calorie-laden snacks on a regular basis.
Fast food and junk food were introduced in the 80s and snacking became a "thing". This is the time frame where the metabolic dysfunction got its start and is now in full swing. The health of our nation really sits within the health of our children.
Focusing on the elderly and aging is not the correct focus for lifestyle. The way we feed and raise our children is.
Public health is responsible for the "epidemic" of T2DM in kids. I raised my daughter on an ultra low fat diet as per health advice of the day... Of course very high sugar to compensate... Exactly the diet guaranteed to give someone diabetes, and it was the result of public health messaging!
I have no idea how old you are but I was born in 1946 and can assure you that junk food and snacking were quite common in the 1950s. So we have had several generations since that time with a steadily increasing longevity curve up through 2021 and we can thank the covid scamdemic for the brief regression that took place then. The demonization of sugar mystifies me and probably anyone else who understands the physiology of the digestion, absorption, and distribution of nutrients.
I was born a bit later, but there was clearly an explosion of junk and fast food in the 80s. Again, my main point was we aren't really talking about the elderly or just older people with chronic disease. As an internist, I spend the vast majority of my time helping our aging population manage these chronic issues. And yes, there are certainly advances that help with certain things.
But the health of our nation is better-reflected in the health status of our children. If you have not noticed the explosion of obesity and the related effects of that, that is where the current focus of MAHA is.
Well, done, John. Interesting comments that run the spectrum. I think a fundamental truth that many of us have observed is the lack of the teaching of critical thinking in our education system. The inability to discern fact from fluff or the goal of acquiring of eyeballs on social media is a fundamental problem that explains much of what’s going on society now. Although clinicians are ostensibly better at evaluating information than the general public, the fact that the lack of formal training to critique medical advances leads to much of what you describe. We need to be able to evaluate clinical research better rather than to depend solely on peer review journals or consensus panels.
I think a lot of the same things as Dr. Mandrola. Here's the problem. These processed foods are addictive. Some people cannot stop eating them. You know most people cannot eat just one chip. Maybe we should just have less of this type of food. I think we need smaller stores with single ingredient foods. I cannot go to a supermarket without tripping over all the processed chips and cakes and junk in the aisles and at the checkouts. I wonder about seed oils. I think it's cheap for them. They don't seem to cause heart disease, the lower both ldl and hdl. Saturated fat raises both ldl and hdl. I would rather have a bit of real saturated fat in foods. I wonder about all these items made with flour. Also most canned food has sugar in it. Why does it have sugar in beans? Why do we need "sweetner" in canned fruit? This addiction to sweet sweet sweet is a really bad thing. Just take the sugar out of most things, it's not needed. People will acclimate to not eating so much sweet.
Dr Mandrola. As always, I concur with several points in your reflection. However, despite the undeniable advancements in science, technology, and biomedical research, medicine began to lose its luster and “humanity” a century before the MAHA Movement. The field split in two starting in 1910, when Abraham Flexner issued his “recommendations” (which became mandatory) to transform American universities. Although initially focused on American education, these reforms quickly became “viral,” evolving into the curriculum now followed worldwide. This reform turned medicine into a matter of science (I would say pseudoscience) with little HUMANITY.
Since then, but especially from the 1970s onward, it has become more evident that there are two independent and disconnected businesses in healthcare: the Health Business vs. the Disease Business. Given the enormous economic returns for a few, medicine is now the latter bastion, uninterested (because it is not beneficial for business) in promoting health and preventing disease within a holistic salutogenic framework—that is, truly caring for a Human Being’s health. Paradoxically, the Health Business “only” produces benefits for the majority of the population but is not recognized in its effects (poorly or insufficiently evaluated scientifically) by the State, Health Systems, or even the population itself.
Let’s not deceive ourselves: only when a healthcare worker or, better yet, transdisciplinary health teams receive at least the same recognition and moral, social, and economic compensation for preventing a severe disease (like a heart attack with three-vessel disease) as the healthcare system receives for the “successful treatment” of coronary obstruction—laden with undeniable science, technology, and innovation in interventions and medication—only then will Preventive Medicine, true Healthcare, cease to be rhetoric. Otherwise, that successfully treated patient will arrive with their wristband, having had their arteries unblocked, taking ten medications, without modifying the true factors causing their coronary disease, which the system is not interested in “curing” or preventing.
b. Our analysis of the dichotomy between business and the medical practice
1. businessmen take an oath to protect profits ---physicians take an oath to protect patients
2. businessmen take an oath to protect the stockholders ---physicians take an oath to protect the baby holders: parents/grandparents
3. businessmen see numbers --- physicians see patients
4. businessmen try to save money --- physicians try to save lives
6. We reject all C.E.O., million and multi-dollar salaries in the field of Medicine and Healthcare industry: THAT MONEY BELONGS TO DIRECT PATIENT CARE
Well said. I think this recent BMJ essay describes well where health care is at with prevention: https://www.bmj.com/content/388/bmj-2024-080811
What makes me pessimistic is that people such as, say, Petr Skrabanek, have made similar points more than 30 years ago (a bit provocative, but fitting: “The pursuit of health is a symptom of unhealth.”).
I am not even sure whether most countries have a proper ethical framework for public health such as the stewardship model in the UK.
Any physician that is pro Fauci or pro working for or with healthcare CEO’s or pro working with pharmaceutical companies is an imposter and impersonating a true physician. A real physician first love is taking care of patients:
IPA - Independent Physicians Association
Our Mindset : POPs - Protect Our Patients stance
Our Objective : Regain our voice to advocate for our patients
Who we are
1. Pro Patient - the patient has the right to choose services, treatments or physicians
2. Pro informed Consent - the patient has the right to know IN their level of understanding
3. Pro HIPPA - all patient information is private from shots to pelvic exams, not for media display
4. Pro Physician-Patient Relationship:
a. Patient are our 1st Love
b. Patient come 1st before hospital & insurance companies
c. Pro Life - we use all our knowledge skills to prolong our patients
life
d. Pro Treat - we treat and battle disease and attempt to fight off
death for our patient
5. How Our Philosophy Differs
a. We strictly volunteer so no one could be tempted to sell out or be bought out
b. Our analysis of the dichotomy between business and the medical practice
1. businessmen take an oath to protect profits ---physicians take an oath to protect patients
2. businessmen take an oath to protect the stockholders ---physicians take an oath to protect the baby holders: parents/grandparents
3. businessmen see numbers --- physicians see patients
4. businessmen try to save money --- physicians try to save lives
6. We reject all C.E.O., million and multi-dollar salaries in the field of Medicine and Healthcare industry: THAT MONEY BELONGS TO DIRECT PATIENT CARE
7. We have been forced into 3 types of physicians(doctors): hospital-owned, insurance owned and private practice(the only one who can advocate for the patients)
The field of medicine can not tolerate million dollar salaries, there should be a salary RANGE of $300-500,000 for all healthcare industry oC.E.O’s as well reduction in COO, CFO and CMO accordingly and the savings redirected back into direct patient care.
IndPhysiciansAssoc.gmail.com
Ms. Ruthie Fajardo Co-Lead Organizer IndPhysiciansAssoc.gmail.com
Rev. Dr. Don J. Tynes, MD, FACP
dtynes@med.wayne.edu
IPA - Independent Physicians Association
Our Mindset : POPs - Protect Our Patients stance
Our Objective : Regain our voice to advocate for our patients
Who we are
1. Pro Patient - the patient has the right to choose services, treatments or physicians
2. Pro informed Consent - the patient has the right to know IN their level of understanding
3. Pro HIPPA - all patient information is private from shots to pelvic exams, not for media display
4. Pro Physician-Patient Relationship:
a. Patient are our 1st Love
b. Patient come 1st before hospital & insurance companies
c. Pro Life - we use all our knowledge skills to prolong our patients
life
d. Pro Treat - we treat and battle disease and attempt to fight off
death for our patient
5. How Our Philosophy Differs
a. We strictly volunteer so no one could be tempted to sell out or be bought out
b. Our analysis of the dichotomy between business and the medical practice
1. businessmen take an oath to protect profits ---physicians take an oath to protect patients
2. businessmen take an oath to protect the stockholders ---physicians take an oath to protect the baby holders: parents/grandparents
3. businessmen see numbers --- physicians see patients
4. businessmen try to save money --- physicians try to save lives
6. We reject all C.E.O., million and multi-dollar salaries in the field of Medicine and Healthcare industry: THAT MONEY BELONGS TO DIRECT PATIENT CARE
7. We have been forced into 3 types of physicians(doctors): hospital-owned, insurance owned and private practice(the only one who can advocate for the patients)
The field of medicine can not tolerate million dollar salaries, there should be a salary RANGE of $300-500,000 for all healthcare industry C.E.O’s as well reduction in COO, CFO and CMO accordingly and the savings redirected back into direct patient care.
IndPhysiciansAssoc.gmail.com
Ms. Ruthie Fajardo Co-Lead Organizer IndPhysiciansAssoc.gmail.com
Rev. Dr. Don J. Tynes, MD, FACP
dtynes@med.wayne.edu
In the loving memory of the Fajardo's Medical Practices Ms. Ruthie Fajardo
Lead Organizer