As a retired physician I find so much wisdom in this episode! This should be watched by everybody who will ever have contact with Western healthcare, especially American healthcare. It is a shame it has only 14K views so far.

Its not the doctors job to determine what meaningful life is. Its the doctors job to give patients realistic expectations of treatment and let them decide.

I’m now a metastatic breast cancer patient with low er+, low HER2 and low mutations, which gives me way fewer roads to try in traditional western medicine. I’m gathering data for plant therapy (RSO & cbd oil) plus mushrooms and energy and faith healing. I know it may sound crazy to some but when you don’t have any good options at the oncologist’s office you start thinking outside of the box.

I quit my folfox treatments for colon cancer after 6 rounds instead of 12 due to neuropathy that I had hoped would not be permanent. I do have it mildly but glad I did not do the 12. Survival numbers were no different for patients who did 6 instead of 12. 6 years later im still here.

As a cancer patient, this was particularly interesting to me. Thanks for posting

One ethical course of action for doctors in light of these incentivized treatment options is to fully inform the patient of these incentives. As an occasional patient, I am going to ask my doctor for an itemized list of these incentives. We patients need to organize and push back on this corruption.

Why isn't anyone paying attention to nursing home patients and polypharmacology? Are all 10 pills really keeping them alive longer?

Andddd this is why as an APRN, first dx with idc and dcis at 28, i literally had a heated (unintentional) with my onco... then found the best hema /onco at El Camino. Love this content... 10 years on lupron and exemestane.... broken bones, inability to work, picc line hidden under a long sleeved shirt... which ended up ok because it allowed me to become a nurserentrepreneur

As a family physician and also a cancer patient currently undergoing chemo for low grade serous ovarian cancer, I found this episode fascinating. I had a very difficult decision to make regarding treatment because there is little good research regarding treatments for my cancer. I read every study I could get my hands on and very few were good studies documenting real benefit. I decided to do chemo then Letrazole because the evidence is a little better showing longer progression free survival and overall survival compared to just chemo or just Letrazole. There is a study currently comparing my regimen to Letrazole alone but still enrolling patients so it will be awhile before data is available. I didn’t do the trial because of some marginal kidney function issues and didn’t want to have more CTs than necessary. It is important to clearly define the endpoints in studies and make sure the sample size is large but in rare ovarian cancers, that can be difficult. Great episode even if I watched 2 years late!

Excellent discussion about respecting (patients) "where they are and where they come from." Especially important in cancer care. Extremely intelligent physician including emotional intelligence.

Can confirm. The tiny little things make a huge difference. When i was 17 and diagnosed, the thing that's changed my life most was my doctor writing a letter for me that allowed me a chance to study medicine

When I was in medical school many treatments were new, expensive, and did not seem to work well. I have been a physician for 50 years and many of those patients are cured. We are always learning and our motives are better than many doubters believe. That thought is painful since I have worked very hard, and will stand proudly before God.

When I first began menopause, my gynecologist at the time actually said that “all women” at that stage should be on estrogen replacement-no exception. I asked him, why not just pass it out at the DMV? He gave me a sour look, and I soon found a new dr. Didn’t make sense to me that any one drug should be administered to everyone by default.

My aunt just passed due to cancer, she was diagnosed only a few weeks ago and it was really advanced. She refused treatment because they would have lost not only her tongue but part of her jaw for a start, just imagine her having had to go through chemotherapy and radiation too... I would have made the same choice for myself.

You guys have the absolute best discussions

Wonderful show. Factual ,Very insightful , balance views and heartwarming .. and inspiring. As a newbie NP both of your experiences and knowledge - ,truly inspire me to improve my interaction and decision - making skills with our patients and to truly put our heart ❤️ on what really matters the most - our patient.

THE LOVE OF MONEY IS THE ROOT OF ALL EVIL AND WE LIVE IN A FUCKED UP WORLD.

I really enjoyed this discussion. I wish I could go back and have conversations with doctors who said wonderful and bad things to me. I really thought Dr Prasad had many insightful things to say.

My 8 yr old nephew fell ill the hospital thought he had covid19 Tested neg they did a MRI and took bone marrow! Found he has blood cancer😥, Lymphoma, he is now having kemo therapy this past wk, It's so sad we prey he gets better... We can't see him in real just face time, he has perked up since the kemo. 😥

Re: "reductionist thinking in medicine." The major reason this exists is because a pharmaceutical gets a drug approved if it is shown in studies to be better then placebo/ current treatment. They fund most trials. Theyre financially motivated to get a drug they've invested tens- hundreds of millions on through phase 3 trials too. Which is why you see a lot of drugs not working as well as early and late studies show. Industry led drugs are 20% more likely to be positive than non industry ones.

Thank you, Doctor. This is one excellent and thoughtful discussion on a subject most of us will deal with.

Thank you for keeping it real! 👍👏👏👏👏👏

The way dr z has his mic positioned it looks to me at least like he is about to play piano haha

Sorry guys, but one of the key things I heard here is your "for profit medical system" is a major part of the problem. I'll disclose my bias, I'm from New Zealand

I totally agree that many treatments and tests should be individualized. I personally would be able to find a lump if I had one which I did and went through Chemo, modified mastectomy and then radiation and now HER2 and Estrogen blocking treatment. I have had my treatment modified based on my response to treatment and I appreciate Dr. Leon's care. As well as my surgeon, Dr. Seydel, doing a modified mastectomy versus the radical that was recommended based on my cancer stage because the chemo eradicated all cancer large enough to show up on my post chemo PET scan. I so appreciate getting to keep all but two of my lymph nodes.

Great conversation! I loved the metaphor about how we may be viewing the body in similar fashion as "looking at old maps {from the old days}".

The interface we think we understand seems to be limited to tangibles. Maybe most of life is intangible, so medicine seems clunky and incomplete for no clear reason. My husband of 41 yrs has advanced kidney cancer, which is in remission for now. We would not sacrifice the intangible, sacred quality of the end of life for the distraction of harsh medical treatments that should work but don’t.

Is this where it all started for vpzd?

A few observations I have made that concern me: in 2021 doctors were recommending taxol and carboplatin chemo plus radiation for uterine cancer patients with deficient MMR (mismatch repair) proteins even though those treatments were shown to be ineffective. 3 years later they are combining the same treatment with Keytruda which is showing positive results. Why not Keytruda alone? 2. I need a tetanus booster but recently found I can only get it combined with diphtheria and pertussis vaccines. I have zero risk of diphtheria or pertussis. 3. There is a new shingles vaccine. However there is a slight risk of Guillain Barre disease. So even though I think vaccines are valuable, I won’t get either of them. Finally I get frustrated when doctors talk about relative reductions of recurrence for a treatment. Oftentimes it is meaningless e.g., a reduction of 6 percent to 4 percent is a 33 percent reduction. Sounds great but if you end up with life long neuropathy is that reduction worth it?

Some of us who are by no means anti vaccine ( my child got them all ) have safety concerns and want access to good data about absolute risk vs relative , NNT and ingredients in the vaccine and placebo. Without this information we cannot assess risk vs benefit. My truly wonderful primary asserts that the current shingles vaccine is 97% effective. In vaccine math that is equivalent to an absolute risk reduction from 3% unvaccinated to .08 vaccinated. (According to Wikipedia the efficacy rate of a vaccine is calculated as follows:3.0- .08/3=.97 or 97%. ) I rely on my excellent doctor to guide me towards sound medical decisions . This is some of what contributes to vaccine hesitancy, not necessarily , “crazy sauce”.

at last we are hearing the truth!!!

Timely topic. interesting. Thx, Z! Well done.

My father died from the chemo for angioimmunoblastic T-cell lymphoma... There the main problem seemed to be that it is quite rare and there are lots of unknowns. The strategy seemed to be to destroy the bone-marrow and replace it with a stem-cell transplant. It seems like it might work in this case, but the risks are tricky... (But there were few studies, not sure if that have since increased)

*34:44** @ what point do you put out the press release* - incentives & unconscious (usually) dirvers of behavior

KZfaq block comments telling people the truth about venture capital influence in all this

thanks for this - i totally agree, my dad underwent chemo/radiation and it was messed up. i am premed and hope to change this culture . i think the whole covid thing kind of ties in to this too - just a bunch of chickens running around with their head cut off. i have yet to find literature to support wearing masks but from the feel of our clinic, which requires full time masking, everyone is miserable, now many looking for other jobs - kind of tying back to the whole PTSD associated with ICU. most protocols are made and enforced by management, with no medical or science backgrounds.... so thats fun. anyways seriously thanks so much for this show - i seriously would be done with medicine otherwise... sorry i feel kinda lame ranting but where else lol. oh and not to be too much of a groupie, but thanks for the humor, good lordie i wish more docs had this... you the bomb

47:00 thats it, pts dont just feel better; theyd feel guilty if they got sick! bc they like you. or, as it would be said in mainstream cms "less likely to sue" - JC

Last time I was this early people still had original last time I was this early jokes

Thoughts on Pneumonia vaccine?

Thank you.

Lemons not poison

Thank you. 🙏

Fucking GREAT interview!

Fantastic!

Love this

I dont know if this too off topic but what is the best way to extend limited oxygen supply ... would deep breaths and lowered heart rate extend time? or would oxygen still be used up at a consistent rate making the change of breathing pattern pointless

Judy is not fake but the ones who speak some truth, are the very ones they discount , or call fake im learning this to be true.

Hmm wondering does Welsh say what the probability is if family history even without BCA 1/2.

Is there a legitimate field of study with biology and quantum physics?

I can not believe theses people can think they can fight cancer w these drugs big Parma have been playing this game for 50 years

Lancet study 4 x dosage given to late. Pulled back clandestinely. Pr Raoult in "IHU Méditerranée" yt channel "bilan" WAY less death

Oh how the mighty has fallen. I still remember when you pushed the Pfizer pen so hard trying to discredit anyone else who went against the narrative. What I did miss was the APOPLOGY FOR YOUR SINS. 😊

*40:00** **_"give me a cut, just wanna wet my beak"_** - oncology criminals poisoning people on purpose bc they are evil and bad* (paraphrase) - JC

What's up with the ad hominem attacks and appeals to authority?

Dr. Z's strange fascination with the audio business at the start of this clearly made both the interviewee and I both feel a bit out of place. What in the world was that included for?

👍

Z dog with the epistemological tinfoil hat! Ones and zeroes?

Going to answer the questions on twitter about your producer's threats to protesters? Because there's a LOT of unsubscribes headed your way the longer you refuse to address the issue, which is stupid from multiple angles.

Prasad has become a professional bomb thrower. I lost all respect for him after his article in the Atlantic. He speaks from both side of his mouth. It seems to me, he is a guy jealous of Atul Gwande and he's throwing "bombs" left and right to gain recognition. It's a shame Dr. Z is giving this idiot credibility.

😂👍 you dopes are hilarious