Show notes
As a college freshman, Fixing Healthcare cohost Dr. Robert Pearl decided that rather than becoming a university professor as he had planned, he’d go into a field without politics: medicine. He laughs about how naïve he was as a 17-year-old. “Healthcare is about life and death,” said Pearl, recalling his decision, “How could there be politics entwined inside that esteemed world?” Of course, Pearl soon learned that politics and medicine are a tangled mess. In this episode of Unfiltered, Pearl and his cohost Jeremy Corr join ZDoggMD to look at the relationship between medicine and politics and if there’s any opportunity for logic to prevail. To find out, press play or keep reading. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. UNFILTERED TRANSCRIPT Jeremy Corr: Hello, and welcome to Unfiltered, our newest program in our weekly healthcare podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard-hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice, then I’ll pose a question to the two of them based on what I’ve heard. Robbie, why don’t you kick it off? Robert Pearl: Hey, Zubin, how was your Thanksgiving? Zubin Damania: It was thankful. I really enjoyed it. My wife was on call, which meant we didn’t have to go through the full production of the meal. We went to a half meal, which was absolutely great. I had 70% less bloat and 100% more gratitude. How about you? Robert Pearl: I had a great time. I was over at my sisters and had a bunch of folks there. Did you do anything special to communicate your gratitude to others? Zubin Damania: I texted a lot of people that I had been a little out of touch with, and just to convey how important they are in my whole life and journey. Robert Pearl: Excellent. That sounds great. So I don’t know if I ever told you that I became a doctor to avoid politics. Zubin Damania: I didn’t know that. Robert Pearl: Yeah. So I was in college. I was a philosophy major, and my hero, who was a philosophy professor, quite an excellent one, he went on to become the chairman at Reed College, didn’t get tenure because of his political views, and I decided then that I wanted to do something that would have no politics. I mean, healthcare is about life and death. How could there be politics entwined inside that esteemed world? And so that’s truly why at the age of 17 I decided that I’d become a doctor, and I learned stuff later on. Any thoughts on that observation, and what we can do to minimize the politics in medicine? Zubin Damania: Well, you had me at philosophy major. I don’t remember you… You must have told me that, but that’s impressive. If I could go back in time and do it again, I would do philosophy instead of music and molecular biology, although that’s kind of philosophy in a way. Yeah, politics and medicine have been to some degree dance partners for a long time, but I think right now it actually just reflects how politicized everything is, and how everything is so kind of divided. Although, I’ll say this, Robbie, I’m sensing something in the air, and I might have said this at our last conversation, but I really think something is shifting. I feel like people are starting to wake up to the fact that we are really divided over nothing substantial in the sense that we’re all trying to find truth and goodness, and we just have a slightly different spin on it, and medicine maybe will wake up, but as usual, we’re about a decade or two behind the rest of the culture. Robert Pearl: Actually, I think that you’re correct, and I think we saw that in the most recent midterms that there was a lot more people I’ll say in the middle rather than the 20%, at both extremes, who were yelling the loudest and typing with all capitals and explanation points, but there’s a lot of people in the middle, and they want to know the truth. And I think in many ways, I’m not talking about the specifics of the outcome, but the election process itself, and, of course, we didn’t even have any attempt except in Nevada to just get rid of the entire voting and somehow have a different method of selecting candidates based upon maybe some sorcery or something else that could go into its place. Zubin Damania: Yeah. Robert Pearl: But one of the things… Sorry, go on. Zubin Damania: No, no, no. I was just going to say in Nevada we have a lot of interesting things like legalized prostitution among other things, so we are a special state. Robert Pearl: Oh, excellent. That’s right. You were there. Exactly. Legalized gambling, prostitution, so on. Yeah. One of the things that strikes me as I think about the politics is that you would think that the health status would drive the politics, by which I mean if a lot of people didn’t have coverage, then they would be attracted to a party that would be likely to give them the coverage, and we think about people voting their interests. If there was a lot of opioid addiction in a particular geography, you would think that that would be a very high concern, and yet we see almost the opposite. Tell me where you live, and I’ll tell you your view on a problem. Whether for you it’s a particular medical challenge or not doesn’t seem to be the driver as opposed to where you happen to own a home and in many cases grow up. This seems really strange to me. Zubin Damania: Yeah, it does, and again, all things seem strange if you look at humans as rational actors that work in their best interests all the time. And unfortunately I think we’re emotional, intuitive creatures that are the product of our conditioning and our moral sort of taste buds. And I think if your moral taste buds are concerned about say liberty versus oppression or government controlling things, even though you’re desperate for care, and you need it, and it would save your life or your family’s life, I think through that moral lens you’ll see any sort of government “intrusion” into healthcare is something that’s adverse, and you’ll fight tooth and nail. There’s also a tribal component on all sides of this, like you said, where you grow up, and I think where you grow up is to some degree it conditions how you are, but to another degree you’re kind of attracted to those places that are an expression of your own sort of moral matrix. And so I think it’s a variety of those factors, and so people do not necessarily vote, or act, or think in their best interests always, if you look at their best interests from that standpoint. But if you look at their best interests as a morality play, they almost always do it in that way it seems. Yeah, that’s just my sense of this. Robert Pearl: I always love talking to you, because I think about things that I hadn’t contemplated before. About a decade ago, I did some research with a neurologist named George, and George and I looked at brain scans, and we looked at what happens when people get put into situations of great threat or great opportunity, and what we found, George York and myself, was that there’s actually a shift in our brain in terms of perception. In the last show you mentioned the amygdala, the source of great fear, and what you see is that the amygdala first gets stimulated, and then as you mentioned actually in the last show, how the occipital lobes change, and we see things differently, and by see it’s not just a vision. It’s all of our senses. It’s our perception of the world, and maybe some of these pieces are that there are fears or maybe hopes that people have that actually change their perception. And when you move someplace else where there’s different fears, and different hopes, different views of the world because of circumstances, then you change that perception, and maybe that accounts for some of this great shift in how we relate to each other or fail to do so, and maybe some of it is coming together to recognize that we may share in more common fears and more common hopes than we otherwise might realize. Zubin Damania: This is a really interesting insight actually, Robbie, because it made me think of something. You were saying sometimes I’ll prompt you. This prompted me, because there is this idea that part of the reason where… There are many reasons why we’re so divided and politicized nowadays, but one of them might be that your local scenario kind of conditions you and vice versa, but the global village that we have with social media is that now there’s a saying, “Good fences make good neighbors.” When not much about someone else they’re actually all right. The more about them sometimes it’s like, “Hmm, I’m not sure about this.” And when you take disparate ideas from different geographies that are evolved differently to suit that geography, and you place them adjacent to each other, that’s when the all caps starts happening on Twitter, because somebody that you never would’ve really known that well, and you still don’t know them well, but you know them in a social media way, are hitting you with ideas that seem so antithetical to that moral palette that they do generate that fear. It’s that fear of loss of identity, the fear of loss of self, that this is who I am, right? I’m this liberal, or I’m this conservative, or I’m this libertarian, and suddenly you’re met with somebody who’s giving you totally different ideas, and it becomes instantly a kind of like, “Okay, fight or flight. I must defend this,” sort of identity. And what may be happening is we’re getting so used to social media now that we might be starting to transcend that initial shock and start to see what you’re pointing out, which is, “Hey, actually we’re all in this game.” And actually when you start to point out how divided we are, people start to wake up and go, “Yeah, we are kind of getting played by this, the news cycle, and social media, and this kind of thing.” So it is really interesting. Robert Pearl: So let’s try to meld the politics and the health. One of the areas that I’m increasingly concerned about is the LBGTQ population, and how in this environment they’re going to be able to get good healthcare across the nation in all 50 states. Do you have any thoughts about, first of all, the hatred that’s seems to be often directed particularly at trans individuals, and how will they get their healthcare needs met from an optimal medical perspective? Zubin Damania: Yeah. And this is one of those things where… Who said this? It was recently the World Cup, and the Iranian media was questioning American soccer players, and they asked a black soccer player. They said, “What’s it like living in a country where you’re discriminated against?” And obviously this was all politicized because of the whole Iran-US thing. And so this journalist was really trying to provoke this guy to say, “Yeah, we live in a super racist country where people are discriminated against because we keep accusing them of discriminated against women, which they do.” And he said, “Yeah, it is interesting, but I’ll say this, in America, one of the things I’ve noticed is we’re constantly trying to get better. There’s always some feeling that there is a kind of progress, and that makes it much easier to live here and deal with it, and I want to be part of the change.” And I think with trans, with LGBTQ+, and all of that, I think that’s also what we see. These issues were repressed previously. Now the repression is less, and so we’re seeing them come to the fore, and it’s louder in sort of the culture, and so it’s easy to feel that there’s no progress, but I think that even that the conversations are happening is progress, so it’s a lot of it is ignorance. A lot of it is just lack of knowledge, and reactionism, and that kind of thing, and I think it is going to continue to progress. I mean, just look at the bill now that that’s going through the Senate where they’re going to codify protections on gay marriage say. That would’ve been unheard of a decade ago, and so I’m actually optimistic, but you can’t stop working for it, right? You can’t stop being part of the progress. Robert Pearl: Again, another interesting thought that I hadn’t had before about how as soon as you stop pushing forward, you slide back, and that it’s not a question of pushing forward always to make progress. It’s pushing forward even to hold the progress that you have, and I can think of a lot of examples where as soon as people stop pushing, what we see is that everything slides back to where it came from even though I can’t find the rationality for why it started there. Zubin Damania: Yeah, I think it takes a collective effort, and you’ll always get resistance and even understanding the resistance is a good thing. If you can see through other people’s eyes and go, “Okay, what is it that… What is this? Is this fear of other? Is this just misunderstanding? Is this a kind of projection where there’s something about them that they feel isn’t as mainstream, and they don’t want… They’re projecting this onto others.” You wrote your book Uncaring about medical culture, and I think what I loved about that book is that you just shined a direct light on things like emotional repression, projection, denial, the things that we do in medicine that we’re conditioned to do, that are really fundamentally quite harmful to progress, and I think it’s true in broader society as well. We have an epidemic, a pandemic of emotional repression, and avoidance, and projection as a result. Robert Pearl: Well, for any listeners who might not have read the book, let me point out that a part of why I focused on denial is that denial is what makes the medical culture great. How else do you go into the streets during the plague and take care of people knowing that it’s a contagious disease, even though you have no idea what contagion means, because it hasn’t been yet discovered, or how do you go into ERs and take care of patients early in the pandemic when you don’t have protective gear? You have to deny the risk to yourself in order to put the patient first, but I also note that that tendency towards denial can spill over when there are things that we don’t necessarily want to see, and I thought of that this week. I don’t know if you noticed that the Merriam Webster word of the year is gaslighting. Did you know that? Zubin Damania: I didn’t know that, but it doesn’t surprise me. Robert Pearl: Yeah, and there’s actually a lot of studies that have come out that said that it’s very frequent, and actually it’s very frequent in the LGBTQ+ population that we talked about, when they go for care. It’s actually very frequent when women go for care. I think many of the groups that have felt as though there’s a certain level of discrimination, the truth is that in the doctor’s office it’s there as well. The complaints are not taken as seriously. Problems that otherwise might be investigated are assumed to be simply psychological, and, of course, in medicine we deny that psychological is as important as physical, and you go on, and on, and on. Your thoughts on what we can do about it? Zubin Damania: Yeah, I mean, again, this is our culture. You’re right. I mean, and the gaslighting is an interesting thing because I think a lot of it is unconscious, right? People are doing it not intentionally. It’s a kind of pattern of behavior. You try to make people feel like they’re not right in the head because you’re either projecting or denying something about the nature of their care, and I think it doesn’t happen at a conscious level. So until you bring it into the light of awareness, and you actually make it explicit in a way that doesn’t actually threaten the identity structures of…
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