Alan and Andy both lived through COVID not on the sidelines but in the center of it all. Both took care of patients directly, Alan in a hospital for weeks at a time in the epicenter of the pandemic, Andy in multiple long term care facilities. Andy also wrote a book about COVID communication and studied the virus and public health responses in other countries. So what do we think about Anthony Fauci's leadership, and about the Congressional hearings? Well, this is a 45 minute podcast, and we could have spoken for hours, so that's what we think about him.

There are two issues we discuss. One is whether Dr. Fauci committed criminal acts. This is what he was being investigated for, and after being pardoned and then still pleading the 5th over 100 times, it is likely we will never know. Clearly the nation deserves to know, and that may or may not happen.

But to us, the second issue is more crucial. Did he do a good job during COVID, and even more significantly, did he cause harm. The United States suffered the worst outcome in the world during COVID; the most deaths from both the disease and from our response to the disease, a response largely orchestrated by Dr. Fauci. Under his leadership Dr. Fauci dictated our response to COVID in an atmosphere that turned its back on science. Dr. Fauci made multiple policy declarations automatically taken up by our nation's leaders, none of which had any scientific basis of reality, as we knew then, and we have truly come to terms with now. He did not instigate a single scientific study nor did he take advice from other nations who were conducting research and opening their societies, all with fewer deaths. He advocated censorship of those who disagreed with his policies or who suggested other policies. And in the end, he did not educate doctors or the American public about how to best protect the most vulnerable from COVID, how to open society for those less vulnerable, and which drugs likely would rectify the manifestations of the virus (which we already knew about before the virus hit our shores but which he never advocated) and which were experimental. Needless to say, Alan and Andy believe that his leadership during this crisis was non-scientific and dangerous. And if we're going to learn anything before the next crisis, it is crucial we stop politicizing this man and his actions, and have a full accounting of his actions and what could have and should have been done differently. Science is about discourse, study, disagreement, trying new things when what we're doing isn't working. None of that occurred under Dr. Fauci's watch.

So as we think about Anthony Fauci we must reevaluate what we expect from our medical leaders and from the medical system. To us, it's not about him not remembering what color tie he is wearing, or even if he was responsible for the lab leak. It's about our medical leaders and our medical system. In these arenas he failed us miserably, as does our medical leadership on a daily basis.

We are hearing more and more about amyloid, a protein that can be deposited in the organs of humans and cause great harm. Or is that too simplistic? We now have very expensive and poorly tested drugs that will reduce amyloid load in the heart and brain. Because the drugs are available, now amyloid has become testable and has reached a level of great importance. But just how accurate is it that we need to look for amyloid in these organs and if we find it we must treat it with drugs barely old enough to have any validity? Is amyloid really the cause of disease, or is it an innocent side product of that cause, or is it even a way for the body to protect itself? We just don't know. We do know that the one study showing its impact in heart disease was financed and designed by the drug company that makes the amyloid-busting medicine, and the study is so flawed that even we can tear it apart. And we know that the drug that treats amyloid in the brain has never been shown to improve cognition but does cause a huge number of brain bleeds. How do we assess new technology and new ideas in a scientific manner when specialist doctors and drug companies leap on them as being the next coming of God? We'll discuss the facts we have and the uncertainly that exists, and show how amyloid is much like other miracles in modern medicine: the next great discovery until it's not. The end of this podcast was struck with technical issues, so please pardon the abrupt ending!

The cardiology community is quite adamant about their newest guidelines, whether it's about pushing LDL cholesterol below 70 or driving systolic blood pressure under 120. The patient's age, wishes, symptoms, and even the full breadth of science behind these dogmatic declarations is irrelevant; protocols are above all that. We will discuss the truth behind the dictate that lower blood pressure, especially once it slips below that magic threshold of 120, is always helpful. In fact, as most studies show, it's dangerous much of the time. While guidelines reduce complex human beings to simplistic allorhythmia, some doctors are pushing back, and we will look at their critiques. In this podcast we discuss why lower blood pressure is often the wrong choice, how the guidelines are more about pushing drugs than helping people, and why specialist doctors so often fall into the pit of treating people robotically rather than within the nuanced world of medical science that values care and compassion, that is patient-centric, and that is tempered not only by a few drug company studies by rather by the full spectrum of medical literature sprinkled with the lessons of experience. That was Osler's message, and through the lens of hypertension we'll see how far off the rails our medical community has drifted.

This week we discuss medical TV shows, such as House and the Pitt and Grey's Anatomy, as well as medical moments on non-medical shows. Studies suggest that the message of these shows--the doctor as hero, the benefit of aggressive intervention, the fact that there is always a hidden diagnosis behind every complaint--is potentially dangerous. It certainly feeds into the narrative that the medical industrial complex seeks to ferment, the idea that lifestyle changes are either useless or dangerous, and that a deep dive into high-cost health care will save your life.

At the ADA Research Convention several members trying to pass out information were forced out after the police were called. They were ADA leaders who wrote an editorial blasting the current Presidential administration for cuts in research funding. Everyone agreed with their stance, just not their tactics. The press labels this as censorship. But is it? The ADA is primarily funded and controlled by the pharmaceutical industry, the very industry that funds and sponsors the very research it seeks to continue. It has historically pushed drugs over lifestyle, dispensing with any data that suggests that their policy statements are erroneous, which typically they are. They invented prediabetes and are responsible for pushing normal sugars so low as to cause potential harm. And if doctors question their views or provide contrary data--of which there is an ample quantity--they seek to suppress it. So where is the medical censorship, and do we really care about a small scuffle between leaders of an organization that needs a real revolution to make it relevant to care.

Both Andy and Alan have been reported to their respective medical boards, both have had to hire lawyers, both have had to fight for their right to speak and to practice medicine. The Board of Physicians is an extrajudicial entity, operating in each state to monitor and discipline physicians. Most courts have said that doctors do not have the right to free speech or free choice. Even if what doctors do and say is based on good data and their own experience, even if what they do or say is done is done to save lives or improve the medical system, if their actions or words clash with specialist and drug company protocols the doctor can be disciplined, censored, even lose his/her license to practice. Such Boards were established at the dawn of modern medicine, intended to assure that all doctors follow the script written by the AMA and corporate foundations after the Flexner Report enshrined the AMA as the singular regulatory entity in healthcare. During that time, doctors who, for example, did not endorse Eugenics or racial medicine could be disciplined, as too could all African American and women doctors. Today's doctors are tied to a corporate-specialist orchestrated set of protocols that often fall in the face of good data or appropriate patient care, especially for older patients, but none of that matters to the Board. Doctors have no recourse when the Board declares them to be in violation of specialty protocols, and most Board members are specialists. This is yet one reason primary care doctors are handcuffed and often cannot use their common sense, experience, critical thinking skills, and research to care for patients, especially when such behavior challenges protocols. Profits always trump patient care, and the Boards seek to assure that caveat is never challenged.

Alan and Andy work in different medical environments. Alan works in one of the poorest neighborhoods in the county, one with many who are uninsured, undocumented, who have to work multiple jobs, who have limited food options, and who had the highest COVID mortality in the world. Andy works in a middle class environment filled with tech-heavy white collared people, where good nutrition and exercise is common, smoking rates are among the lowest in the country, and the COVID death rates were extremely low. In many ways, as Alan and Andy discuss, COVID put a microscope to how our nation's health inequities and profit-driven health priorities impact different people. The haves tend to prosper, the have-nots are neglected. Sometimes, as the Dartmouth Health Atlas shows us, the haves can be harmed by excessive specialization and medicalization; areas of the nation with the most specialists have a generally lower life expectancy, likely from over-reliance on doctors rather than lifestyle. But the decision of our health care funders to finance high-cost low-yield medicine at the expense of health equity, nutrition, and basic care has led to a slanting of outcomes that is entirely preventable, where the have nots suffer from the very opposite problem: inadequate care and life style betterment. We discuss how to fix this American made mess!

We reviewed what several physician podcasts have to say about the new cholesterol guidelines. We spoke about the guidelines in our March podcast, and also discussed in a later podcast how the local cardiology group in Columbia Maryland reported Andy to the Maryland Board of Physicians in an effort to censor him or take away his license because he dared put published studies in his practice newsletter questioning the value of reducing cholesterol in the elderly, what they labeled as dangerous misinformation. In this podcast we reviewed what some of these podcast doctors are saying, many of whom sat in scrubs as they insisted that lowering cholesterol is an absolute good without problems and will save lives. Others questioned the guidelines and the value of measuring cholesterol. We believe based on articles we have read and written that cholesterol is not itself a major contributor to heart disease, but reather is a substate that sticks to blood vessels and increases heart attack risk IF A BODY IS INFLAMED FROM SUCH THINGS AS A POOR DIET, LACK OF EXERCISE, STRONG FAMILY HISTORY, OR INFLAMMATORY CONDITIONS SUCH AS DIABETES and if they are young. LIfestyle changes prevent heart disease, and statins can help in some people but not based on their cholesterol. Studies done on older people have not shown benefit of lowering cholesterol and suggest that there is value in higher LDL cholesterol on logevity in people over 60 years old. We discuss all of this and more!