Show notes
Galileo, Darwin and Einstein: three historical figures who changed the way we view the world. Galileo broke the myth that we’re the center of the universe. Darwin proved that humans evolved slowly, not through sudden divine action. Einstein’s theories of relativity led to new ways of looking at time, space, matter, energy and gravity. Each of these critical thinkers helped humanity take massive leaps forward. But have some of their lessons been lost on the medical profession? In this episode of Fixing Healthcare, sans cohost Jeremy Corr who was out with illness, Dr. Robert Pearl joins ZDoggMD to probe the left and right brain for answers. Are doctors convinced they’re *not* the center of the universe – or least the center of health and medicine? Borrowing from Darwin, if life is evolutionary and *not* divinely given, then how much of the end-of-life care doctors provide does more harm than good? And if time and space are *not* static or objective, should the scientific method be the final arbiter for medicine or should we follow a different master? To find out, press play or peruse the transcript below. * * * 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 Robert Pearl: Welcome to Unfiltered, our newest program on our weekly, Fixing Healthcare Podcast series. As usual, joining me today is Dr. Zubin Damania, known to many as ZDoggMD. Unfortunately, Jeremy has lost his voice, a terrible problem for a podcaster. As such, I’m going to have to do his part of today’s show as well as mine. For 25 minutes, Zubin and I will engage in unscripted, and I predict, hard-hitting conversation about art, politics, entertainment and much more. We’ll apply the lessons we extract to medical practice. I’ll then pose a question for the two of us to consider that Jeremy might have asked, to conclude the episode. Zubin, are you ready? Zubin Damania: Oh, I’m ready. It looks like all your years of being an understudy for Jeremy… Jeremy, they’re finally coming to fruition. You finally get to step up into the lead role. Robert Pearl: Excellent, excellent. So, let me start Zubin, by clarifying another of the many rumors about you that I see on social media. So, is it true that they asked you to be the king after the death of Queen Elizabeth, but you turned them down? Zubin Damania: I turned them down because honestly, I didn’t have a circular enough family tree to have the requisite recessive genes to be a monarch. I was too out bred, honestly, that was part of the problem. Robert Pearl: You could have had a poison ivy, poison oak kind of family tree, I think. Right? Zubin Damania: Exactly. I mean, all seriousness though. The loss of the queen was like the loss of a common mythology. We were talking about the hero’s journey the other week, and this idea that we have this shared identity. Most people in living memory do not remember not having Queen Elizabeth as the monarch of Great Britain. So, it actually is a grieving process for everybody in a way. Robert Pearl: Well, anyone under the age of 70 wasn’t alive, and probably they don’t have very many remembrances until at least age 10. So, anyone under the age of 80 can’t remember a time before that. Probably anyone over the age of 80 might have forgotten some of the things way back then, so we’re left with the fact that no one could remember a time without Queen Elizabeth. Zubin Damania: I think that math is correct. Yes. I believe it. Robert Pearl: So, anyways, we heard from lots of listeners that they enjoyed the conversation we had about Amazon’s acquisition of One Medical, and the implications it has for American medicine. Since then, as you know, CVS acquired a company called Signify, and the company employs 10,000 physicians to provide in-person and virtual at home care. United Health, which already employs over 50,000 doctors, signed a 10 year agreement with Walmart. In your opinion, Zubin, how nervous should physicians be and what do you recommend they do now? Zubin Damania: Well, I mean, I think this is clearly an epiphenomenon of how we’ve actually failed to do the job of healthcare that Americans actually want. So, private industry is stepping up, and with the probable some degree of hubris that they can do it better than physicians. But the truth is, they have the resources, the drive, the time horizon and the incentive because they’re paying, their footing the bill for their own employees. So, I would be concerned quite a bit if Amazon, if CVS, if these guys are all partnering to do this, that they’re going to at least have a shot at succeeding on some level. That’s going to put the pressure on regular physician groups and multi-specialty groups to step up as well. This is something that’s probably been a long time coming and probably overdue. Robert Pearl: I mean, I’d argue that we have refused to take the lead, and as long as there’s a vacuum and a void, someone else will come into it, so why not be one of the big businesses in the United States? Zubin Damania: Yeah. I mean I think that’s the bottom line. Especially with the Amazon thing, it’s interesting because again, Iora Health are partners at our clinic in Las Vegas, to see it go full circle back to Amazon, I’m just… Again, if they get it right, they really have a very powerful model in their hands. If they can scale it for chronic disease that the Iora model and for the consumer, the younger people, the One Medical model, I would be very nervous right now if I were in the traditional healthcare system. I think doctors can no longer just say, “Oh, you know what? I’m just going to keep my head down and hope it all settles out.” It’s like, we have to lead, because if we don’t, it really will be the technocracy that leads it, and it won’t be the best for, I think, the physician/patient relationship moving forward. So, we do have to start to lead, because we’ve really dropped the ball, like you said. Robert Pearl: This morning, Zubin, I published an article in Forbes on leadership, or at least what I see is its lack in healthcare today. So, the listeners should be aware, you probably haven’t had a chance to read it, but I’d like your thoughts on the following paradox. From my perspective, the challenges in healthcare are massive: lack of affordability, lagging quality burnout, healthcare disparities, we could go on for the entire show today, just listing the ones that are there. Yet most of the efforts I observe that people and companies inside healthcare are doing, they’re focused, Zubin, on a small opportunity often, an incremental improvement. Do you see the need for a massive change? If so, who should and who do you think will lead it? Zubin Damania: Well, what I think is happening is this is indicative of our societal shift in general towards this micro thinking, reductionism, left-brain scenario. There’s a lot of misunderstandings about left brain, right brain schism, by the way, Robbie. Like Iain McGilchrist, a psychiatrist, neuroscientist in Great Britain wrote a great book called Master and His Emissary, about the actual debunking some of that mythology. The mythology that the left brain is the rational clear thinker, sees strategically and so on, that’s not true. The left brain takes wholes and breaks it into parts. It always thinks it’s right. It has righteous anger, it’s a reductionist, and it is isolated from the whole, and that’s what it is. It’s a grasping tool. Zubin Damania: It’s the right brain that sees things holistically as a bigger picture, and sees parts in their context. In medicine, I think what we’ve done is we’ve tried to, oh, well we can improve this little thing, or we can build this little widget a little better, and we build this little widget, and you forget that this is a multidimensional interdependent organism that is healthcare. Who is going to lead that? It has to be the part of that organism that does the operating end of it, and that’s physicians and clinicians and people in that space. They really haven’t. What happens is now you have this technical reductionism, where you have people working on these different parts, and they talk about, “Oh, now I’m wearing a Fitbit, and here’s this data.” It’s like, how does that data plug into the bigger picture, and what are the hopes, dreams and fears of the patient that you’re getting that data from? How does this relate to outcomes that matter to them, and that also save money in the economic game and so on? Zubin Damania: It has to be, I think, physician leaders in partnership with business leaders, in partnership with economists, in partnership with businesses, because they have so much skin in the game. What is it? Half of all the spending in the country on healthcare is from our large employers, employers in general. We have to look at it more with a right brain, left brain collusion, more of a balance. We haven’t done that. It’s just like the rest of society, we reduce and reduce and reduce, and it becomes this technocracy. Robert Pearl: Are you saying that the right brain, and again, speaking really metaphorically not anatomically, but that the right brain is the more logical of the two hemispheres? Zubin Damania: No. It’s more that the right brain sees things more in context. It is actually more emotionally intelligent according to McGilchrist. He lays out in 1,000 pages why this is so. It actually was the master in the original relationship, and as societies and individuals evolve over time, the left brain, which was the servant, it actually evolved to help the right brain break things into parts and manage little tasks and things like that, it actually started to think it was the boss, and that by breaking things into parts, you could recreate wholes from the parts. It doesn’t work that way. It’s the emissary suddenly usurping the role of the master. This is metaphor, but it’s also based on studies off split brain patients, on people who’ve had strokes in different sides of the brain and seeing what happens. Zubin Damania: For example, people who’ve had right brain strokes, where parts of the right brain are knocked out, they tend to not see things contextually. They’re very concrete, they live in abstractions, they’re unable to function in society. Whereas left brain strokes, people tend to overcome them. Often you lose speech or language, and language is a very reductionist thing too because it breaks things into parts and subject and object. But you still function actually reasonably well. So, it’s really quite fascinating that… He points out to western civilization, as society evolves it shifts to a more left brain dominant space before it collapses. He goes to a lot of history and different big civilizations and what ends up happening. They become these huge bureaucracies. Bureaucracy is the domain of the left brain. What you really need is a corpus callosum that connects the two, that actually brings balance, where master and emissary are in harmony. We’re losing a little bit of that balance it feels like, definitely in healthcare, but in society in general. Robert Pearl: I love that analogy. Let me take it a step further. It seems to me that the context of medicine is the unaffordability for the patient. It’s the fact that we don’t do as good a job on prevention, avoids the complications from chronic disease, as we might. It’s looking at the technology that we value, like the operative robot and the technology that we tend to minimize, even now, like telemedicine. It seems to me that maybe what you’re saying is that as physicians, we are really trained in the left brain, multiple choice questions and four answers, and that we need to have a lot more of this sophisticated understanding of the right brain. Zubin Damania: That’s it exactly. I think you nailed it. I think in medicine we really are left brain oriented through our education. That right brain, that’s why we ought to be screening physicians, not so much on MCAT scores and these reductionist pieces, but on emotional intelligence, creativity, imagination, those pieces that are very right brain, left brain synergies. Like you said, I think taking a patient out of his or her context, is problematic. Their social determinants of health and all of that are a big piece of it, that’s their context. Their family, their community, their culture, all of that rolls in. Then it’s the same with medicine. If you take a piece of data out of context of the bigger picture, it doesn’t mean anything. Zubin Damania: In fact, it leads to more reductionist poking and iatrogenesis and cost from causing harm and those kind of things, where we’re doing things to people instead of for the larger person. So, I think it is a very good metaphor actually, a good model for where we might be going wrong. It’s not limited to medicine, but I think medicine is the best example of it, because it’s such a human enterprise. When you start to see it go out of balance, people know it. They may not be able to articulate it, but saying, well here’s a model that might actually put it in words, in some kind of structure, it might be helpful for people to go, okay. So, how can we overcome that? Robert Pearl: Do you have a view how it’s going to happen? Is it going to be an individual like yourself who started a program in Las Vegas? It had to close in the end. But today, might have been successful. Is it going to be a medical group led by some CEO? Is it going to be some type of medical society? How do you see this, I’ll call it massive change, disruption is what a business student would call it, happening, a transformation of how healthcare needs to be provided? How are you going to get ahead of the curve, rather than letting these other organizations like Amazon and CVS beat us to the punch? Zubin Damania: Yeah. That’s a great question. Disruption in the classical tech, say a tech company or something disruption, it really is a very… It’s almost like a single site mutation. You do this one thing better and you do it cheaper, and initially the quality isn’t as good. Then over time it gets better, and really suddenly that other big old school legacy company is out of business because you’ve disrupted their model. In healthcare that more reductionist left brain disruption can’t happen. It has to be a holistic, multifocal, almost like a caterpillar turning into a butterfly, every organ transforms. That means all the entities that you listed, I think, have to be a part of it. They all have to wake up a little bit to, okay. What’s the problem? Because a problem well defined is already half solved, as they say. Zubin Damania: Then each of us starting to work on solutions, but connecting with each other so that we never miss the big picture, because otherwise we’re just spinning our wheels in the dark. Like the old metaphor of the elephant, trying to figure out what is this creature, and blind people, these blind wise men, each touching a different part of the elephant and not understanding that it’s an elephant, until they actually talk to each other. So, that’s what we haven’t really done a lot of, is connecting across these different spectrum. Like you said, the medical societies and the big healthcare organizations and the small healthcare organizations, and the on the ground doctor and so on. Robert Pearl: Listening to you, Zubin, I’m reminded of something that I read about three historical figures who change the way we see the world, because I think what you’re describing is that doctors need to see things different, see them in context. These three people, pretty famous, Galileo, Darwin and Einstein, and how their discoveries contradicted how humans see the world and ourselves. Galileo broke the myth that we’re the center of the universe. Darwin proved that we became human through slow evo…
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