Reacting To The Rise Of Anxiety, Microplastics & Antidepressants - Doctor Mike

Dr. Mike discusses the resurgence of evidence-based medicine and the challenges of navigating health information in the age of social media and AI. He emphasizes the importance of skepticism and the dangers of misinformation, particularly in medical conversations online. Dr. Mike also delves into cognitive behavioral therapy (CBT) for treating anxiety and depression, advocating for a tailored approach to each patient. He touches on the complexities of the American healthcare system, the rise of aesthetic procedures, and the potential impact of GLP-1 medications on obesity. Throughout, he underscores the need for accurate, evidence-based medical advice and the ethical responsibilities of health influencers.

• Dr. Mike discusses the resurgence of evidence-based medicine, particularly on social media.
• The democratization of health information has led to confusion and conflicting messages.
• Encourages healthy skepticism but warns against excessive skepticism leading to distrust of experts.

"When I was coming about during my residency training, it was mostly people doing it on television and doing it quite poorly... now it's just exploded into every different possible niche."

• Early adoption of social media for medical conversations to counteract poor TV representations.

"With the rise of AI, people don't right away see a video and assume it's real... they ask, 'Is this real? Where is this from?'"

• Social media and AI have fostered a culture of verification and skepticism.

• Dr. Mike emphasizes the importance of not broad-stroking subjects in health discussions.
• Discusses the role of CBT in treating anxiety and depression.
• Highlights the need for mental health specialists and tailored treatments based on severity.

"It's very easy to get into this cognitive distortion of labeling things as all good or all bad... when in reality if we just have a little bit of a pause, go back and think rationally, we can go a lot further."

• Importance of balanced thinking and avoiding cognitive distortions in mental health.

"The highest level of evidence goes for a combination of mental health therapy, usually CBT, plus medications like SSRIs."

• Best treatments for anxiety and depression involve a combination of therapy and medication.

"Bibliotherapy being reading some information, a book on the subject... the next level would be working directly with a therapist."

• Different levels of treatment based on the severity of the condition.

• Dr. Mike shares his personal and professional experiences with CBT.
• Discusses practical strategies for managing anxiety and the importance of celebrating wins.

"Our brains are wired for negativity... that's assumed to be the reason why we've survived so long because we were constantly worried about the risks and threats around us."

• Evolutionary perspective on why humans are predisposed to negativity and anxiety.

"What I have to remind myself quite often is the positive things that happen... it's important to have some techniques ready if those symptoms arise."

• Importance of recognizing and celebrating positive events to counteract anxiety.

• Increase in ADHD diagnosis, possibly due to better recognition and awareness.
• Discusses the impact of ADHD on quality of life and the importance of proper treatment.

"If you're truly struggling with hyperactivity with attention deficit... you can't maintain good social relationships, you can't focus while you drive, you can't do well on tests."

• The severe impact of untreated ADHD on various aspects of life.

"One of the major questions that I ask my patients... is whether or not their symptoms are present during all aspects of their day."

• Differential diagnosis to distinguish ADHD from other issues like smartphone addiction.

• SSRIs are still widely prescribed and are a first-line treatment for major depressive disorder and generalized anxiety disorder.
• Discusses the stigma and misinformation surrounding SSRIs.

"The unique thing about SSRIs is it was a medication that we quite didn't understand the physiology of how they work, and yet we saw the positive outcomes."

• Historical context of SSRIs and evolving understanding of their mechanism.

"We have to be honest and transparent about our knowledge of what we know and what we don't know."

• Importance of transparency in medical recommendations and evolving science.

• Discusses the difficulties of practicing medicine amidst misinformation and a flawed healthcare system.
• Emphasizes the need for better communication and adaptability in medical practice.

"Medicine is science, but it's also an art... you have to understand how your patient is experiencing it, their financial situation, and whether they can access those treatments."

• The multifaceted nature of practicing medicine and the importance of patient-centered care.

"Our jobs have become exponentially harder... I ultimately want my patients to have the best experience and to get the best treatment for them."

• The impact of misinformation and systemic issues on medical practice.

• Critiques the US healthcare system for prioritizing profits over patient care.
• Discusses the negative impact of private equity on healthcare quality.

"We have a hybrid system... this hybrid system is incredibly messy."

• Overview of the US healthcare system and its complexities.

"Putting a quota on healthcare is just flawed from the start... private equity doesn't care; it's whoever is going to drive those growth and profits."

• Critique of profit-driven healthcare and its impact on patient care quality.

• Dr. Mike's discussion underscores the importance of evidence-based medicine, mental health awareness, and the challenges posed by the current healthcare system.
• Emphasizes the need for transparency, adaptability, and patient-centered care in medical practice.

• Young people often rely on urgent care instead of primary care, leading to disruptions in the healthcare system.
• Difficulty in accessing same-day appointments with primary care doctors exacerbates the issue.
• Proactive healthcare is preferred over reactive or emergent care for better outcomes.

"The young people of our country, the Millennials, have largely relied on urgent care to get their treatments to get their primary care, and that's no bueno."

• The reliance on urgent care by young people disrupts the healthcare system.

"If you call a good primary care doctor and you ask to be seen same day, that's like you get laughed at by a receptionist."

• Difficulty in getting same-day appointments with primary care doctors.

"We much prefer to do things on a proactive or elective basis rather than a responsive, emergent basis."

• Proactive healthcare leads to better outcomes than reactive care.

• Both the US and UK healthcare systems have significant issues, including outdated technology and bureaucratic inefficiencies.
• Examples of inefficiencies include the use of pagers and fax machines for communication in hospitals.

"If the US is a mess, the UK is something else. They're still using Windows XP."

• Outdated technology in the UK healthcare system.

"A doctor needs to prescribe something or get something cleared for a particular patient, and one floor below them is where they need to go in order to get this done, but they go down to that floor below them physically, and they say, 'No, sorry, you need to fax us a piece of paper.'"

• Bureaucratic inefficiencies in hospital communication.

• Healthcare workers face numerous challenges, including low pay, excessive workload, and burnout.
• Administrative tasks and outdated systems contribute significantly to burnout.
• Financial pressures and profit-driven decisions in healthcare negatively impact patient care.

"The most destructive thing is when we actually want to help the patient for 11 lbs an hour, and we can't because we're forced to see so many patients."

• Overwork and low pay hinder healthcare workers' ability to provide quality care.

"Doctors used to run hospitals and be in charge, and now doctors have become laborers, and the people that are in charge are these financial folks who are thinking about the profits more than anything."

• Shift from doctor-led to financially-driven healthcare management.

• Increase in aesthetic procedures fueled by social media and self-criticism.
• Risks associated with procedures, particularly when performed by unlicensed individuals.
• Medical tourism and its associated risks due to less supervision and cheaper costs.

"Half of Gen Z feel like they're creators or influencers, and when that happens, people want to look a certain way."

• Social media influence on the rise of aesthetic procedures.

"I've seen some pretty horrible infections and complications that happen as a result of medical tourism."

• Risks associated with medical tourism for aesthetic procedures.

• Brazilian Butt Lift (BBL) poses significant risks, including fatty embolism.
• Importance of understanding the risks before undergoing such procedures.

"A risk of a fatty embolism where you actually get a piece of fat lodged in an artery that then travels to a different part of your body and creates a blockage happens like one in 3,000 cases."

• Significant risk associated with BBL procedures.

• Growing trend of leg lengthening surgery despite the extensive recovery and physical therapy required.
• Risks include immobility and blood clots.

"I'm surprised that people are willing to go through that level of recovery and physical therapy and immobility for a period of time."

• High risk and extensive recovery associated with leg lengthening surgery.

• No perfect posture; importance of varying posture to avoid pain.
• Chronic pain significantly impacts mental health and quality of life.
• Pain perception can be influenced by mental health.

"There is no such thing as a perfect posture because if I was sitting here and I was sitting with what people refer to as perfect posture... that's going to cause me pain."

• Importance of varying posture to avoid pain.

"Chronic pain is one of the few types of physical maladies that you don't adapt to."

• Chronic pain's significant impact on mental health.

"Our emotional state greatly contributes to the volume of how we experience pain."

• Mental health influences pain perception.

• The healthcare system faces numerous challenges, including reliance on urgent care, outdated technology, and bureaucratic inefficiencies.
• Healthcare workers are overworked and underpaid, leading to burnout.
• The rise of aesthetic procedures and medical tourism poses significant risks.
• Chronic pain and posture are complex issues influenced by physical and mental health.

• Pain can become a part of one's identity, leading to avoidance of movements that cause discomfort.
• Over time, identifying with pain can limit activities and reinforce the belief of having a chronic condition.
• Exposure therapy can help by gradually reintroducing movements and reducing the fear associated with pain.

"I began to identify with the label of being someone who had a bad back. I have a bad back, I have back pain."

• Identifying with pain can lead to self-restriction and avoidance of activities.

"After a while, you actually realize that this has become part of your identity."

• The realization that pain has become part of one's identity can be a significant insight.

"What you did for yourself is essentially exposure therapy."

• Exposure therapy involves gradually reintroducing activities to reduce anxiety and pain.

• Mental health significantly impacts physical pain, and addressing psychological factors can alleviate discomfort.
• Dr. John Sarno's work highlights the connection between mental health and back pain.
• Reading about these connections can provide relief and reduce pain for some individuals.

"The general thought behind the idea of our mental health impacting how we feel physically is so strong."

• Mental health has a profound influence on physical sensations and pain.

"The number one thing that patients say when they come in for their follow-up visit is I read the first chapter and that was me."

• Patients often recognize themselves in descriptions of the mental-physical pain connection, leading to immediate relief.

• Communicating the mental health component of pain in an optimistic, non-antagonistic way can help patients feel hopeful.
• Providing actionable steps and avoiding guarded movements can prevent reinforcing pain.
• Encouraging safe movement and addressing mental health can be part of a comprehensive treatment plan.

"Your mindset is contributing to it, and your current mental health state could be contributing to it."

• Acknowledging the mental health component in a positive way can empower patients.

"Avoid guarding if the condition is mild."

• Encouraging patients to avoid overly cautious movements can prevent reinforcing pain.

• Microplastics are pervasive in the environment and can be found in various products and food containers.
• Public pressure is leading some companies to reduce the use of harmful chemicals like PFAS.
• The long-term impact of microplastics on health is still being studied, but awareness is increasing.

"It's not unusual for that to happen in the day and age where we live in."

• The prevalence of microplastics is a result of widespread pollution and industrial practices.

"There was a pretty common claim that there's this chemical PFAS that exists in Lululemon leggings as well as other athletic wear companies."

• PFAS chemicals in consumer products are a concern, but companies are starting to respond to public pressure.

• Historical research biases have led to a lack of understanding of how certain conditions present in women and people of color.
• Symptoms of conditions like heart attacks can differ significantly based on gender and race, leading to misdiagnoses.
• Updating research and medical training to include diverse populations is crucial for accurate diagnosis and treatment.

"When we say the classic signs of a heart attack is an elephant sitting on your chest pressure, that's a white male's definition."

• The classic symptoms of many conditions are based on studies of white males, which can lead to misdiagnosis in others.

"Older Dermatology books have only skin conditions on light-colored skin."

• Dermatology training often lacks representation of conditions on darker skin tones, affecting diagnosis and treatment quality.

• Health influencers and podcasts can provide valuable information but also spread misinformation.
• Some influencers balance evidence-based information with popular trends, while others prioritize viewership and profits.
• It's important to critically evaluate the information provided by health influencers.

"There's some people who are bringing really great information to the forefront."

• Some health influencers provide valuable, evidence-based information.

"You have people full-on that are just in it for viewership maximization of profits."

• Some influencers prioritize profits over accurate information, leading to potential misinformation.

• The debate around obesity is contentious, with new treatments like GLP-1 agonists showing promise.
• These medications could significantly reduce the health burden associated with obesity and related conditions.
• The impact on food companies and societal attitudes towards weight loss and health is yet to be fully understood.

"These medications are not just beneficial from a health standpoint, they're also beneficial to our healthcare system."

• New obesity treatments could reduce the burden on the healthcare system by preventing related conditions.

"Society will react when there is always on hand an option that may take some of the required willpower out of the equation."

• The availability of effective obesity treatments may change societal attitudes towards weight loss and personal responsibility.

• Discussion on whether any industry would benefit financially from societal weight loss.
• Mention of potential initial increase in jewelry resizing due to weight loss and subsequent decrease in demand.

"People's fingers have got fatter, they've had to spend money to get their wedding rings changed and increased in size so there's going to be an initial increase Boon to get the uh jewelry changed again and then after that a little bit of a nose dive because there will be less gold that'll be need to fit ever thinner fingers."

• Explanation about potential niches within the food and drink industry benefiting from new gastrointestinal environments.

"Suddenly some niches within the uh food and drink industry will because you just have a you now have a new gastrointestinal environment so uh high density low volume uh I think uh if you can make protein companies are making those Foods they're not going to be selling as much of the foods period so their pric agreed."

• Discussion around the difficulty of identifying industries that would profit from weight loss, with mentions of sportswear as a possible niche.

"The only thing the only other thing I could think of would maybe be companies that make sportsware stuff because sportsware is a kind of clothing I'm aware that I'm like niching down again so I'm breaking a rule but um Sports is a kind of clothing that people who are more in shape tend to wear."

• Discussion on the effects of weight loss medications, including both positive outcomes and side effects.

"Largely people lose weight, their numbers improve from a cholesterol standpoint, their sugar control improves, they're happier, less musculoskeletal issues."

• Mention of the moral and social challenges posed by weight loss medications, especially for the body positivity movement.

"I think that it's going to make a very interesting moral challenge it's going to create a moral challenge for a lot of the people who have been a part of the body positivity movement."

• Discussion on the accessibility and cost issues related to weight loss medications.

"The medication's very expensive insurance is largely aren't covering it for weight alone I've had plenty of patients struggle to get uh coverage for it where they have to pay for it out of pocket or pay a company out of pocket to try and get access to the medicine."

• Critique of private equity's role in creating problems and then selling solutions in the health and wellness industry.

"We created hyper palatable foods that were junk Foods processed foods that were very tasty nons satiating so we're always hungry want more of them they're addicting that was largely driven by private Equity then we created a medicine to solve the Obesity epidemic."

• Discussion on the potential future scenarios where private equity might create more health-related problems and solutions.

"Are we now seeing private equity in telling people well look if you really want to take care of your health you really got get get your testosterone up and if you want your testosterone up you got to look like this person look at the muscle you can maintain their erections whatever and you need to have this level so let me give you some testosterone now they're selling you testosterone."

• Discussion on the spread of medical misinformation through social media and its consequences.

"Medical misinformation at the moment is it feels like it's picking up it feels like you've got a big Harvest to get stuck into."

• Mention of the responsibility of health influencers to provide accurate information and the challenges they face.

"The problem of short videos I I wonder whether this is a bigger problem on Tik Tok and uh reals and on YouTube shorts than it is on the slightly more long form stuff just that when you do pull you know a a Gary Breer clip of a protein shake stays in your body for 75 years this is how long it takes for your your body to process it or whatever."

• Discussion on the role of health influencers and the importance of providing accurate, nuanced information.

"I want to prove to people and why I started the YouTube channel is that you can make science Nuance sex without overselling it."

• Mention of the ethical considerations and potential pitfalls for health influencers.

"There was times where selling out was so easy I was in debt as a med student I was in debt as a resident making the $10 an hour as you mentioned earlier working 80 to 90 hours a week it was tempting to take some deals where I would talk about a powder and how it's going to give you all the nutrients that you need it's tempting to take those deals I understand why people do but for me the the the reason of why I started this doesn't let me do that."

• Discussion on the speaker's personal experiences and ethical considerations in practicing medicine and being a public health influencer.

"I never planned to be popular on social media um I didn't want to do it uh by giving up anything I I still practice medicine and I don't say it often but I practice for free three days a week two to three days a week in my hospital because I love what I do I work at a community health center."

• Mention of the speaker's approach to balancing personal medical practice with public health influence.

"The patients that I saw um during my residency they're my patients and I built them up sort of as my portfolio of patients I've seen them I'm treating them there's some babies that I've delivered that I'm still reading and now they're 6 seven years old it's pretty amazing."

• Discussion on the future of the health and wellness industry, including potential regulatory changes and advancements in medications.

"Logically I think that as more people take them it it should come down if it's up to the pharmaceutical companies no but hopefully we have some regulation put in place where we can fight back against that and there's uh all sorts of not necessarily clear corruption but just like gray zones where due to a lack of transparency companies can get away with some really problematic things behind the scenes."

• Mention of the potential for future conversations and collaborations with other health influencers.

"The invitation is open and uh I'm very excited to have that conversation because I think people will benefit from it."