11.1 Consequential Chemicals: RANT + Guest Intro, Adam Urato, Md

[00:00:00] Welcome to Renegade Psych, a nuanced podcast dedicated to informing the American public about the flagrant shortcomings of our healthcare system.

[00:00:08] I'm a board certified psychiatrist and along with my guests break down interesting and important topics into several segments to appeal to both the general public as well as medical and psychiatric students, residents and practitioners.

[00:00:20] My primary motivations are to appreciate nuance in major medical and psychiatric discussions, educate listeners on the undue and widespread influence of big business and healthcare, and provide accurate and reliable information on relevant mental and medical health topics.

[00:00:36] While I'm still young and have a lot to learn in my career, I cannot continue to stand idly by while so many in my field repeatedly fall victim to pharmaceutical interests, misinformation, and manipulation of existing data at the expense of Americans health.

[00:00:50] Whether you struggle with your mental health, work in behavioral health or the healthcare system, or want to better understand our healthcare systems over promise and under deliver status quo,

[00:01:00] My guests and I hope to provide public education on some of the most pertinent, under reported and controversial issues in psychiatry, mental health, and healthcare in general.

[00:01:08] Disclaimer, this podcast is for informational purposes only. The information provided in this podcast and related materials are meant only to educate. This information is not intended as a substitute for professional medical advice.

[00:01:16] While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast nor materials related to this podcast, including recommended websites, texts, graphics, images or any other materials should be treated as a substitute for professional, medical or psychological advice, diagnosis or treatment.

[00:01:30] All listeners should consult with a medical professional, licensed mental health provider or other healthcare provider if seeking medical advice, diagnosis or treatment. Or put more simply,

[00:01:38] You need help like this guy, call your own doctor. Somebody get this guy some help.

[00:01:52] How do we keep letting the same story play out over and over and over again right underneath our noses?

[00:02:00] You'd think we would have learned from Thalidomide, prescribed to pregnant women for nausea and vomiting in the 1950s and 60s, which we later found out caused Focomelia or underdeveloped limbs that looked more like flippers and babies of exposed mothers.

[00:02:16] You'd have thought we would learn from DES, a synthetic estrogen given to women for 30 plus years and taken off the market in 1971 due to increasing women's cancer risk substantially. Or maybe from the OxyContin disaster with Purdue Pharma, espousing the lies that their opiates, unlike any opiate in the history of medicine, were non-addictive and aggressively pushing doctors to prescribe more and more at high rates.

[00:02:46] And the drug epidemic has been spreading for years and years. And we're trying to get rid of it.

[00:02:56] The drug epidemic has been spreading for nearly 30 years and is continuing to get worse. Or maybe it would have been Vioxx, a non-steroidal anti-inflammatory drug that Merck marketed as reducing the incidence of a known insid side effect of stomach bleeds, but tried to cover up the huge elevated risks in heart attacks and strokes that Merck was aware of.

[00:03:16] Merck was aware of based on their clinical trial and the FDA left on the market for nearly five years, prescribed to roughly 25 million Americans and leading to anywhere from 50,000 to 500,000 deaths depending on who you ask.

[00:03:32] Well, today Dr. Adam Urato will tell his tale about Makenna, a synthetic progesterone that followed a similar route as the above medications, that the FDA dragged its feet in banning, ultimately failing the American public at the expense of lining the pockets of big pharmaceutical company executives.

[00:03:53] We see the story continuing and in my opinion worsening, with data becoming more and more unreliable and more and more products and ideas being promoted without adequate evidence of safety and efficacy, including issues with SSRI antidepressants during pregnancy and potentially the COVID vaccine.

[00:04:14] Eerily, there's a parallel with the drugs the FDA and regulatory bodies fail to adequately monitor and the tragedy of all the school shootings that have dominated public media and discourse for the last 30 years.

[00:04:27] How many times does this have to happen in order for something to change? Or will we just continue to allow those in power to pretend like they care, pretend like they're going to do something to combat these problems that are harming and killing Americans and so many others every single day without actually producing actions, solutions and results to these problems.

[00:04:53] It's so demoralizing to be part of such a broken system, struggling to find adequate resolutions, fighting tooth and nail to convince others within the system of its major flaws, prevent them from relaying industry propaganda to their patients or silencing all scientific dissent from industry wisdom as misinformation

[00:05:18] and not always knowing who is ignorant of these problems and who is potentially profiting from these problems. This is why today we have Dr. Adam Urato, a maternal fetal medicine specialist born and raised and now serving his local community in Framingham, Massachusetts.

[00:05:38] He graduated from Harvard Medical School in 1997, completed an obstetrics and gynecology residency at Massachusetts General Hospital in Brigham and Women's Hospital and did a maternal fetal medicine fellowship at Tufts Medical Center in Boston.

[00:05:54] He has over 26 years of experience in the medical field and has current or past affiliations with Milford Regional Medical Center, Tufts Medical Center, Beth Israel Deaconess Medical Center, Framingham Union Hospital, St. Elizabeth's Medical Center and Metro West Medical Center.

[00:06:13] Dr. Urato loves delivering babies and has experience treating conditions like high risk pregnancy and breach position in addition to counseling patients on medication and other exposures during pregnancy.

[00:06:28] We'll talk about his experiences whistleblowing and repeatedly petitioning the FDA to get Micaena removed from the market for more than a decade after its FDA approval and sadly four years after its stage four follow up clinical trials revealed it didn't work at all.

[00:06:46] Then we'll discuss the COVID vaccine from the perspective of it being another pharmaceutical rollout with the tentacles of the pharmaceutical industry spreading into our government, including the regulatory agencies, the corporate media, key opinion leaders in the medical community and professional medical societies, all of which spouted the same propaganda that it is 100% safe and originally 100% effective.

[00:07:14] Pushing parents to vaccinate their children, no matter their age, despite the fact that is not consistent with the vast majority of other countries in our world and likely an effort to sustain a cycle of profits at the expense of Americans health and medical progress.

[00:07:33] Limiting our ability to ultimately figure out which populations from a risk benefit ratio standpoint may actually benefit from the COVID vaccine.

[00:07:45] Lastly, we talk about the true risk of antidepressant use in pregnant women versus what patients and oftentimes providers in training are typically told about their risk profiles that they're safe and the risks of depression outweigh any risks of the antidepressant.

[00:08:02] Adam argues that our job is to educate our patients on these issues and collaborate with them so they can make an informed decision about their health.

[00:08:14] Adam reveals some of the inherent contradictions, illogicalities and inconsistencies in how some of these bad actors confidently and assertively, sometimes in a threatening way, present doctors and the public answers to very scientific questions that only work to promote that cycle of profit without any intention towards American safety or scientific progress.

[00:08:39] This is a unique conversation because of Dr. Urato's past work.

[00:08:45] While many who question the system and the assertions of the pharmaceutical companies promoting their treatments or the government regulatory systems claiming to protect us get demonized, discredited and sometimes canceled, it's hard to do that to someone who sounded the alarm on a harmful drug, Makena, subsequently refused to be silenced, refused to prescribe it.

[00:09:09] He also described this medication against supervisors advice and kept fighting for his patients, his community and the general public and ultimately was proven correct in his clinical evaluation of the drug.

[00:09:24] Trying to say Dr. Urato is not trustworthy or lacks integrity or has some sort of vendetta against the industry or lacks the ability to understand and evaluate the data is simply not believable.

[00:09:39] This must be frustrating to those entities chasing profits because now people feel more compelled to believe the other clinical issues he is actively investigating and informing his patients on.

[00:09:51] Despite all of the travesties he has fought and is aware of within the system, this conversation is refreshing in the demeanor that Adam carries and how he talks about being a happy warrior fighting the good fight, carrying an attitude of gratitude.

[00:10:08] Thanks Adam's mom.

[00:10:10] And Adam appears to operate and behave concordant with these philosophies.

[00:10:15] He's such a jovial and upbeat character, despite his recognition and frustration about how broken our system is.

[00:10:22] I don't doubt for a second that his buoyant, pleasant and informative nature is very well received by his patients and they're lucky to have his expertise at their disposal.

[00:10:34] Though sometimes I feel defeated by the system, Adam has helped instigate a newfound hopefulness in me that my impact on my patients is huge from an individual standpoint.

[00:10:46] And he reinforced the idea that we do not work with the mindset that we will change the system but instead engage in the process of the work moving in the direction of changing the system.

[00:11:00] Trying to inform the general public of the scientific answers to these complicated and oftentimes nuanced clinical questions.

[00:11:09] Without further ado, I hope you enjoyed this series and learn a lot from listening.

[00:11:15] We have Dr. Adam Urado, a maternal fetal medicine MD working in Framingham, trained at Harvard, graduated in 1997 and still the chief of MFM at is it Metro West Medical Center?

[00:11:34] I do maternal fetal medicine. That's correct yes.

[00:11:37] And I'm going to go ahead and say that you're an expert on medication exposures in pregnancy and breastfeeding.

[00:11:44] That's the area I focus on absolutely. Yeah, that's my interest of mine in a regular area that I read and write lecture on.

[00:11:51] But you're pretty humble from what I've heard about you so you probably wouldn't label yourself as an expert but I will label you as an expert.

[00:11:58] And beyond that, the things that I have learned about you secondhand, you seem very intelligent, you seem very nuanced and open, not anchoring on any conclusions that you come to and not letting your own bias get too much in the way

[00:12:13] of those conclusions. Very reasonable, conscientious and ultimately you are a man of the people. You are a man of your patients and there is a level of courageousness to speaking out against things that may have some backlash

[00:12:31] and we'll get to that in a little bit but I just I can't thank you enough for what you've done on the clinical side and kind of in the quest for scientific truth in the current culture of medicine and medical research that we find ourselves in today.

[00:12:48] I really appreciate that introduction. That means a lot to me. I appreciate the introduction. I'm not sure I'm completely worthy of it. I do appreciate the introduction.

[00:12:58] I think it's really important that you focus as you were saying on the people and really looking at these questions as what's good for patients and what's good for the public, and then approaching it with some degree of humility as you are saying, we don't know all there is to

[00:13:15] know particularly when it comes to the human brain and the developing fetal brain and how the brain gets wired etc. So I do think it's important to approach these things with humility and absolutely try to put patients in the public first.

[00:13:29] I'm a full time clinician and I was born and raised in Framingham, Massachusetts and that's where I live and work. So I'm taking care of friends, neighbors, this is my community. And so I do think that informs how I provide care.

[00:13:44] And I'm doing this counseling and taking care of these patients essentially all day every day, which really informs the way I think about these things and talk about them.

[00:13:53] Yeah, can you give us just a brief rundown of your professional journey?

[00:13:58] Sure, yeah. As I said, I was born and raised in Framingham and I grew up here. And then I went to Harvard College and Harvard Med and I stayed local. I trained for fellowship between here and Florida at the time I ended up completing my maternal fetal medicine fellowship at Tufts Medical Center in Boston also.

[00:14:16] And then I've been practicing maternal fetal medicine in Framingham since 2005. So we're at 19 years down next year, 25, 20 years practicing in this community.

[00:14:29] And I take care of pregnant women as I said all day every day. I'm doing mostly ultrasound, obstetrical ultrasound and consultations about issues like diabetes, high blood pressure, twins, high risk issues, and also a lot of counseling regarding medication use during pregnancy, which is part of what informs

[00:14:49] and why I'm interested in this topic is because I discuss it all day every day with my patients. I also love delivering babies. It's still a real passion of mine. I love labor and delivery. And I just still really, I really love it.

[00:15:03] I mean, delivering baby whether it's vaginal delivery, C sections, taking care of moms and babies. It's just, it's a great thing. And I feel very fortunate that I've been able to do it in my home community all these years and be part.

[00:15:17] Sounds corny but like the whole miracle of life thing. I really do love it and I'm lucky to be doing it.

[00:15:23] Yeah, it's so nice to be able to work in a field where your primary goals are to give back to others and help promote healthy habits and help people navigate a very uncertain field of their lives in their medical care.

[00:15:39] Our minds love to focus on problems and I think it's really important that we consciously insert how lucky we are to be able to do what we do and donate our time and our intellectual energy to figuring out more and more this pursuit of truth and scientific understanding that I think should be at the heart of every doctor or physician or providers.

[00:16:04] Why for doing what they do.

[00:16:07] I thought you brought up a great point. I just want to touch on that. I think it's really important to have an attitude of humility, but also an attitude of truth seeking. That's the idea. I'm not trying to win every argument. I'm not trying to beat you over the head with my argument.

[00:16:21] I'm not trying to beat my patients up or anyone for that matter. It's truth seeking. We're trying to figure out what when it comes to medications in pregnancy, what the medications are doing, the effects that they're having, the risks, the benefits, the alternatives.

[00:16:36] And we're trying to do this in a just as you said truth seeking and in a collaborative fashion to try to do what's best for patients, the public, the community.

[00:16:47] And then the second aspect I was going to talk about is that attitude of gratitude that you just pointed to my mom always uses that phrase to have an attitude of gratitude.

[00:16:56] And I think it's really important to remember what we have to be grateful for and stay focused on that. I think it also helps your mental health to have that attitude, the attitude of gratitude.

[00:17:08] Yeah, unfortunately what I see in a lot of patients and honestly friends and colleagues is the expectation that their mind or that part of their brain that just sends them thoughts that they're not necessarily trying to have that it is supposed to be reinforcing or positive when you're

[00:17:26] from everything that I know and have researched in my own personal experience of it. It tends to be very problem focused. It tends to once you cross one thing off of your to do list.

[00:17:37] It doesn't give you a pat on the back it doesn't say way to go Ethan you did a great job and you worked hard to achieve that.

[00:17:43] No, it just moves on to the next thing that you need to do that could be pro survival. So if we don't consciously insert that attitude of gratitude, then yes we can find ourselves living in a very negative focus for the vast majority of our conscious lives.

[00:18:02] Now you seem like a very happy go lucky pretty jovial guy, but you've been at the center of a few bits of controversy in the medical world. I get very frustrated at times, even with, you know, working with either colleagues or ancillary staff not understanding why I practice the way that I do and seemingly getting caught up in the propaganda that is spewed by

[00:18:28] the pharmaceutical companies or you know even government regulatory agencies that are supposed to be there to protect us in our health. How do you maintain your positivity with all of the problems that you've got to be aware of even more problems than I'm aware of at this point in my career.

[00:18:47] I try to be a happy warrior I guess is that term people use. I think it's better to take that approach that I'm going to keep working hard seeking the truth fighting for patients in the public. You know, I'm a small dog in some sense fighting against the big dogs out there with the pharmaceutical

[00:19:07] industry and you know the massive power of the drug companies etc. So I think you've got to have some sense of humor in that in trying to work hard to bring the truth out to patients in the public when you've got a massive industry, the pharmaceutical

[00:19:23] industry that's focused not on getting the truth out but is focused on maximizing profits. And this is an important thing for patients in the public to remember the pharmaceutical industry's goal really isn't getting the truth out and it's not public health.

[00:19:41] That's not that's what they say in the commercials you know we're focused singularly on health. That's actually not these are publicly traded corporations and their main focus is on maximizing profit.

[00:19:53] And so patients in the public have to keep that in mind. And so to get into your question going up against the pharmaceutical industry on a lot of these things over time. It's a it's certainly a challenge for like a little local community doctor right taking care of patients.

[00:20:08] But I think if you maintain good attitude a sense of humor and just keep fighting. I think there's a there's a saying that there's no shame in getting knocked down the shame is in not getting back up.

[00:20:20] And so that's the thing to keep in mind just keep getting back up keep fighting another day and trying to do what's best for patients in the public.

[00:20:29] Somebody get this guy some help.

[00:20:45] Thank you.