13.2 What's Wrong With Modern Psychiatry, Pt 2 with Josef Witt-Doerring

[00:00:00] Hi, I'm Dr. Josef Witt-Doerring. I'm joined today by Dr. Ethan Short, Psychiatrist. A couple years behind me in coming out of training and all of that. He reached out a couple months ago.

[00:00:16] I guess after seeing my channel, I was really pleasantly surprised to see that we were on the same page about quite a few things.

[00:00:26] I was so excited, so that I said, hey, we should jump on and do a podcast and talk about the state of psychiatric training at the moment as someone who's kind of going through and Ethan finally agreed.

[00:00:38] So that's what we're going to be talking about today. So, Ethan, thank you so much for coming on and speaking with me. Somebody get this guy some help! This disclaimer, this podcast is for informational purposes only.

[00:00:57] The information provided in this podcast and related materials are only to educate. This information is not intended as a substitute for professional medical advice. While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast.

[00:01:07] Norma Trial's related to this podcast, including recommended websites, text, graphics, images or any other materials, should be treated as a substitute for professional medical or psychological advice, diagnosis or treatment.

[00:01:16] All listeners should consult with a medical professional license mental health provider or other healthcare provider if seeking medical advice diagnosis or treat. So, first thing I want to hear about, and know some of it from listening to your podcasts and a little bit of it.

[00:01:29] That we covered the last time we talked, but I really want to hear all about your background. Where you're from, how you got into the medical profession, what it was like,

[00:01:43] You know, really want to know about what it was like working for pharmaceutical company and being on that side of things. And then how and why you stepped away from that and got into podcasting and lightball in the last month.

[00:02:00] Yeah, well, let me start at the beginning. I'll let you guide me if I get off track, but I'll tell you about me because of the high points from Australia, grew up in Sydney, not in the city on the north shore about 45 minutes north.

[00:02:15] And see, you know, both my parents immigrants, moms, Chinese, Malay, dad is Austrian and I grew up mostly because of my dad's Austrian heritage.

[00:02:32] He is like, kind of like a high society Austrian, like kind of fancy in that way. And so he was really into books. We had a huge library, really into philosophy and all of those things.

[00:02:44] And when I was growing up, I started becoming interested in it as well. So I liked philosophy, I like psychology, I was like self help, which was much more accessible than some of the other things.

[00:02:59] That was just naturally drawn to that. I didn't really know what I wanted to do when I finished high school and because I was towards the end, at least a pretty pretty good student. I said, let's just go for medicine.

[00:03:13] I'm in medical school, kind of going through it. Do I want to be a surgeon? Do I don't want to do internal med? I kind of looked at both of those. But eventually I thought well, you know what? I'm still really interested in psychology, self help, philosophy, how humans take.

[00:03:29] Let's go into psychiatry and that seems like a great place. That's kind of meshing with my natural interest. And so I did. And you know, when I entered residency because I didn't really learn much about mental health and in training, you know, some chemical and balance stuff, there are a couple patients with bipolar or a couple patients on meth.

[00:03:55] And so really the main education I got was when I came to the US, which I did because my medical school had a exchange program with a school in Auschner. So I had a lot of US students kind of coming through while I was there and I thought hey this could be a cool place to go to travel and learn at the same time and USO has great fellowships. And so I came over here.

[00:04:21] And it was just an end up saying because I met my wife, but anyway back to the back to kind of going to residency. I

[00:04:30] Quickly learned that all of the things that I thought were important, you know, the philosophy, the psychology and a lot of the things that I was reading about what helps, what helps humans thrive and do well, just simply irrelevant, you know, when I entered psychiatry.

[00:04:50] So super short visits. You know, people just essentially being diagnosed by symptom checklists, people in and out, doctors not really knowing what was going on with their patients.

[00:05:02] You know, not really knowing anything about really the root cause of their symptoms or at least it was just a superficial level. We simply weren't given enough time to do that.

[00:05:13] And honestly, people just didn't seem that interested. And so you know, I'm just in this kind of very confused place when I'm there or I'm just thinking, well my God is telling me that none of this really makes sense like how can you fix mental health problems, like when you don't understand them and you don't understand your patients.

[00:05:34] But because US is so biological and you know, there's that heavy culture that I think comes from academia and all of the clinical trials and the drug research.

[00:05:44] Most of my professors, you know, that's just how they thought about mental illness, you know, sure they could be some social and psychological things but these are kind of the softer and more irrelevant things.

[00:05:55] Most of what we're dealing with on our day to day are these mysterious chronic mental health problems like major depressive disorder, you know, it's just mysterious. It's not much we can do about it. We just have to treat it and

[00:06:07] Man, it's it's terrible if you're someone who suffers from it and at least at the start I said, okay well let's kind of think about that but the longer that I went through my training I just realized that.

[00:06:22] These you know what what they were saying just didn't really make sense on multiple levels in the mind what they were saying, what I was learning about.

[00:06:29] We're mental illness is coming from didn't really mean it seemed to make sense the way we were treating it didn't really make sense and so.

[00:06:37] I naturally started thinking, you know, being being drawn to drug side effects and thinking about you know, what is the downside of the way we are treating these people because maybe there's no downside.

[00:06:50] It doesn't really matter if you give people medications without getting at the root cause but I wanted to know that for sure. And when I looked into that I realized there's actually a lot of terrible side effects, most of the drugs are studied for like three months.

[00:07:03] We have like no long term data on them that's good in terms of long term efficacy and what I was just seeing data day was just people accumulating drugs and higher and high doses and becoming treatment resistant and I'm just like this.

[00:07:16] It looks bad and so it became really disenchanted and then actually wanted to quit but wife and some professors said you're really into this side effects stuff.

[00:07:27] You seem really driven about it, why don't you go and learn more about that so I did some textbooks and such and then decided I would go to the FDA you know I'm going to go and learn about how drug regulators.

[00:07:45] Learn about these risks and communicate them to the physicians, describing them and I'm also going to go to the pharmaceutical industry to see how drug companies. Essentially learn about the safety profile of their drugs and also communicate it through the labeling.

[00:08:02] And I'm going to pause the X talking for a while and I know you here yeah. So you went to the FDA already having that skepticism. Yes, I did.

[00:08:17] And so I also like when I went to the FDA most people were like wow you're interested in safety no one's interested in safety.

[00:08:24] Everyone that comes here you know they want to be on the cutting edge of learning about the next new drug that's going to help these conditions and so I was like the first person they'd ever seen who came there was just like I'm really interested in learning about drugs.

[00:08:36] I'm going to have drugs side effects. Yeah, my my mom gave me pride the best medical advice. I mean 15 years before I ever went to medical school or even really thought about it and she was a clinical pharmacist for for the duration of her life.

[00:08:58] And she would always tell me as a young person you do not you know jump the gun at saying that something is safe and effective without having 15 to 20 years of widespread use.

[00:09:14] And you know back in the at that time it didn't mean as much to me as it does now. But that that really is probably the sadious advice that she's ever given me that has carried over into my professional life now.

[00:09:36] But so when you went to the FDA did you go as an open book or did you maybe restrain a little bit when you were trying to get that position in terms of kind of your your beliefs at the time.

[00:09:50] So I am I had to be a little bit restrained but interestingly I was actually recruited to the FDA which is because when I was in residency. I mean this is how unusual it was to have someone interested in drug safety.

[00:10:06] I mean I was really writing to the deputy director of safety of there is a it's a guy called Mark Stone he's still there very senior.

[00:10:14] And because I was doing drug safety research I was just like you know hey mark you know can you just give me your perspective on this any depressed and suicide thing you know this is my read of this article.

[00:10:26] I'm missing anything and so we struck up a professional correspondence throughout my third and fourth year of residency and he was just very helpful and I think quite.

[00:10:37] You know also surprised that someone was so interested in what he was doing and so when I was finishing residency said come and apply to the FDA you know. I was trying you and we'll you know we'll work on safety issues together.

[00:10:52] And so I ended up I ended up there and I did well I also I also went there with an open mind like.

[00:10:59] My views have become a lot stronger over the years and so still at that point I was walking in there just saying I don't really understand clinical research.

[00:11:10] I don't understand how we investigate the drugs. I don't really know the system and so I'm not going to be like I'm you know I just know everything and you know this is a bunch bullshit.

[00:11:20] I'm just in there asking a lot of questions and and you know we disagree with some of the things that that I saw but.

[00:11:29] I'm also you know politically I'd become quite like aware at that time you know after residency I was not a very popular person and I kind of learned what you need to do to survive and.

[00:11:44] You know I had it like a I had like a three month old kid when I was at the FDA and so for me it was like I'm here to learn and most of it I keep my job and.

[00:11:56] And and that's right yeah yeah no that and so that was. You know and so. The interesting thing about the FDA was actually got labeling changed on you know I conducted some research on a drug.

[00:12:12] And we updated the labels to strengthen the causal language and there about some side effects and. When it was happening with me from the inside and I was driving the whole thing everyone was just like yes fine this this makes total sense.

[00:12:25] And they put together you know they. They were really kind of happy with the work but it was so it had to be so sort of like driven you know these these weren't priority topics.

[00:12:41] For the for the group I mean most of what the FDA does is really. And I'm analyzing clinical trials you know to to approve protocols to be safe and also to look at new drug applications to get drugs onto the market.

[00:12:58] And yes they look at yep do you know off do you know off hand with the ratio I know it's a huge ratio of approvals to drugs that are taken off the market every year. I actually don't know how many drugs are taken off the market.

[00:13:17] But I know the ratio of like you know the amount of applications that go in versus how many get approved it's got to be like 20 to one like 5% of applications will.

[00:13:29] Like from from start to finish from idea like hey we're going to develop this drug for this condition to the one that actually like it works after the clinical trials and the day is good that's that's really.

[00:13:42] Quite rare when that happens. Yeah yeah for and I don't know I I'm not in expert on this by any means but at the numbers that are sticking out in my mind or a couple thousand approvals every year versus maybe a couple dozen drugs taken off the market.

[00:14:03] Yeah, anyway. So at what point did the the tied turn or did things shift for you working at the FDA so for some time I was thinking like well.

[00:14:24] This is just real talk down I wasn't getting paid a lot of money at the FDA and while I was learning a lot.

[00:14:32] And I was working on really important projects that the pay wasn't that good and you know I had seen enough since I was there to sort of know that.

[00:14:45] It was it wasn't really a team that was that focused on what I would say like the public health or you know safety issues I mean my my agenda you know things I was interested in.

[00:15:04] And certainly one of the things that they were in and this is I think pretty standard corporate.

[00:15:12] You know corporate places like you have certain things that are measured and in that group it was how many how quickly do you review these applications they all getting done on time.

[00:15:27] Are you essentially you know serving that function and I think I mentioned this last time this is whole thing called the pedoupha the pedoupha which is a congressional. Law which says that industry actually funds like I think it's like 70% of the FDA but they.

[00:15:43] But you have to meet the timelines of the industry and so everyone is kind of measured off meeting those timelines and so the group was really. Really focused on meeting all those timelines and not really on safety issues which really there was no like.

[00:15:57] Real timeline on the amount of safety issues that you work up at all so it was kind of forgotten because that's what's not measured really doesn't kind of.

[00:16:07] Proceed or develop in any way so so that was going on it's like okay and that just is what it is.

[00:16:14] Let's go to Fama you know FDA to farmer is great you can usually make I mean I tripled my salary easily going to go into the pharmaceutical industry was kind of crazy yeah.

[00:16:29] Did you were you aware at the time of all of the former FDA commissioners 11 or the last 12 or whatever it is because I imagine that would have been during that time period where you were at the FDA in transitioning to farmer.

[00:16:45] Where you aware that that was going on as well because it sounds like you had a somewhat similar. Experience where you weren't making much at the FDA and then you went over to farm I'm not going to say that you're reasoning was the same but.

[00:17:03] Where you were at that going on with the commissioners at the time. No but I mean it's just so common I mean it is the thing that you this is the thing that everyone does I mean.

[00:17:13] You go from academia and then some people they want jobs in the pharmaceutical industry and they're really hard to get.

[00:17:20] But the way that you can get them is if you have FDA experience and so if you can kind of take a hit for a few years and work at the FDA and kind of learn drug development.

[00:17:30] And drug regulation then you become extremely valuable because pharmaceutical companies they want to know.

[00:17:37] What are they going to think about this at the agency you know what would you you know what would what would your teammates have thought especially fits within the division like if you go to vision of psychiatry and to a company developing like.

[00:17:50] Any depressants or something like that when you've been at the FDA you might have reviewed like five or six different any depression applications you've been in.

[00:18:02] You know hundreds of hours of meetings hearing you'd division or leadership talk about every single nuance of any depression drug development and even the things just like. And then you know there's a lot of personality quarks of the people reviewing things that the stuff that's.

[00:18:18] Yeah, that's what comes to mind was the was the carry over of your personal relationships yeah go workers that you know then then you have the ability to reach out to them and say hey what is what are you all thinking about this drug that my company is.

[00:18:35] Or marketing or doing research and development. Yeah, so well and and anyway, so you become really valuable just because you have this wealth of insider knowledge and drug companies I mean the.

[00:18:49] You know, I don't I mean they're smart so they go you know if we're going to develop the struggle we need the best possible chance of kind of you know scoring you know getting it getting it through this guy is going to be able to guide us he knows how the other team thinks.

[00:19:03] And then the other thing is. With familiarity.

[00:19:11] Like you said those relationships so if I, you know, if I used to work there and now my name is on you know I'm the lead medic and the lead person in clinical development for the drug company my name's right on the.

[00:19:25] The docie as it goes in there to my old colleagues they're going to say well I know you know so if he's a straight shooter he was he was great in fact he's also really nice guy you know was over here holding my hand when you know my child was sick telling me it would be okay.

[00:19:42] And so there's a you know people don't like to think that they're biased and you know I'm going to always be very objective but you just can't like it's just it's simply not possible.

[00:19:54] Especially when you have these intimate relationships with people in your work so closely to get you just become biased you just like. I know him he's a good guy and then you may look over things and the drug companies like to capitalize on that.

[00:20:11] And so I mean my agenda I mean I, I'm not going to say I'm that much better than everyone else of course you know money was a piece of it you know I had a growing family I wanted to buy a house you know.

[00:20:22] Had had all the dreams that everyone else does and so I mean I knew people made three times as much there but I also knew I wanted to work in a drug company so I could see actually how they.

[00:20:36] How they reviewed safety data I wanted to see their processes what their contractors were like what the oversight was for the people who you know yeah for for the whole safety infrastructure and so.

[00:20:51] That was just something that I wanted to do in my life and and so I got one of those drugs those jobs again through like a personal relationship you know my the guy who hired me at the FDA used to work.

[00:21:03] And so I was working with someone who was now like the head of drug safety at a pharmaceutical company it was just like you should go to yo so if he's really really keen on drug safety.

[00:21:13] It's actually driven for it and so they teed up a job for me and I just jumped over there and.

[00:21:19] And then I was I actually when worked in an oncology company so that was even more unusual I didn't go straight to psychiatry I was doing on because oncology is the largest drug development market at the moment.

[00:21:31] That's a market right there I was going to say I mean every you know everybody wants those three extra months of life or think they do right. It's not three it's sorry not three extra months 50 percent. Yeah, so it's exactly how to lie with statistics right you know.

[00:21:52] I'm sorry. Yeah and. And so I did that and I think you'd ask me what was it like working in a pharmaceutical company well you know I. I think.

[00:22:13] People on the outside often think that within drug companies it's a whole bunch of these these these evil people with these agendas and their purposefully being misleading but.

[00:22:24] Honestly, it's just like residency it's just like being in any kind of corporate environment is just like being at the FDA humans we are really social creatures.

[00:22:37] We know what our boss is want to hear we know what is going to be received well we know what is going to make.

[00:22:47] Make waves and possibly result in more work for us and be complicated we know what things are going to be shocked down and and really we a lot of the times you just want to.

[00:23:01] And not be the person who's bringing problems up you want to be the person who's making problems go away and so.

[00:23:12] You know I often think of the pharmaceutical industry you know I don't think it's that dissimilar from like banking and and where you have these incentives and you have commercial incentives and.

[00:23:25] I think you're a agenda that that you feel is we want to make doctors see this drug this this drug in the best possible light and we are going to.

[00:23:37] You know be partisan to our drug and you kind of push it as far as you can until the FDA just goes hey well, because that's not that's not really legit and that. A agenda to make doctors see things in the best possible light and to minimize.

[00:23:57] You know the risk to the extent that you can I mean is it's felt it is it's everywhere it's in the presentations that they give publicly it's in the articles I mean none of the words there happen by chance I mean these are huge groups of people and I was a part of it all looking over journal articles and presentations how can we like tweak this word or that word how could we say it in this way.

[00:24:21] Oh you know this this journal article they've come back and they're unhappy with this wording let's try and reword it in a way where we still kind of.

[00:24:30] You know we don't say it as bad as it really is but maybe this is more acceptable I mean every single like piece of it is. carefully carefully orchestrated and so I got to see a lot of that I also saw just how.

[00:24:51] poor the safety surveillance system was and this is you know these things happen you know they're more complicated and institution becomes you start to outsource things so far my outsource to like Indian physicians and things like that because they're cheap, but they still

[00:25:12] have MDs. They can do the work, but that aren't cost as much. And the quality of the follow-up after these problems happened, I mean, I always found that people were really at least in the

[00:25:30] drug companies that were really motivated to just prove any causal adverse reactions. Like if something came through and it was bad and they said it was caused, you know, people would put on their thinking caps and say, well let's think about all the reasons why this isn't causal,

[00:25:46] but you know, if someone had like a suicide attempt and you got some crummy report from maybe a contractor, Pharmacovidial and Sophosir who just said, I like lead you to underlying depression,

[00:25:57] but there was no comment in that file about, you know, I talked to the family and, you know, this is common for them. This is their fifth suicide attempt and you know, they had a contextual

[00:26:06] stressor like if it was just like suicide attempt, you know, not enough information due to the underlying condition. No one would say like hey, go get more information so we couldn't make sure this wasn't due to the drug, they would just say, hey, you know, the doctor said

[00:26:20] it was due to depression, kind of move on. And so you kind of see these things happen and just for a while I was just like, man we've got to sue the FDA and this is going to feel like a segue

[00:26:33] or companies. One day one of these days there's going to be a failure to warn lawsuit against a drug company. I don't think they've done this yet. They're going to subpoena the safety

[00:26:46] the individual case safety reports. These are the reports every time a safety and a serious safety incident happens and they will just see, they'll see what I've seen. Just how poor the quality is, how little physician oversight there is and actually working up these problems that are having

[00:27:03] happening with the drugs and how the drug companies are just so easy to go along with reports that just say unrelated. And I also think the contractors are really happy to give them things that are

[00:27:13] unrelated because they they know it's going to go down easier. But that is from all my time in industry at the FDA. The system is broken with the lack of effort to actually really look into safety

[00:27:28] problems. They just kind of they're just unrelated. They so they unrelated, not enough information, but they never go that extra step to follow up and really do a proper clinical evaluation. There I mean, it makes no just logical sense to have the regulators disincentivized

[00:27:53] to do those follow-ups. I mean, whether you are working at the pharmaceutical company with you know that on that safety team or safety side of things or you're at the FDA trying to be the one that regulates, there's there's so much disincentivization or or incentivization to not

[00:28:16] report those things and it makes probably the most important stage of clinical trials a complete farce. I mean, nobody is these stage four clinical trials are completely nominal and when what I've seen at least from afar is when a company knows that either their drug doesn't

[00:28:38] work or it's not as safe as they're claiming it is, they're going to do what they can to stretch it out to the the length of their patent and then they don't care and then at that point it's like,

[00:28:50] well okay we spent all this money on research and development. We spent all this money on the clinical trials and the marketing and now at this point we've recouped enough of that and yeah our drug is

[00:29:03] going to go off brand and go generic so maybe we'll squeeze another five years you know, Sarah Quill depaco with an added indication for their medication and they're able to get a few more

[00:29:17] years of exclusivity with it but just on a very fundamental level the system will never work when it's designed like that without an independent regulatory agency. I was going to say earlier it's telling that you and I just breezed right past FDA get 70% of their funding from big

[00:29:40] farm up because it's something that is such deeply ingrained knowledge for us but when we say those things to the general public people are very surprised people are very kind of taken

[00:29:53] back like no that can't be true you must be a conspiracy theorist if if you actually believe that but that information is publicly available it's out there nobody's been in the law you know

[00:30:06] went through Congress and it's been renewed like five or six times I think we're on Padufa five now it kind of goes up every two years for renewal. That that reminds me of have you heard of the

[00:30:19] national resident physician or short-a-jacked something about the doctor shortage that has been around since the 90s and they kind of scaled back on how many medical schools they accredited and that being the ACGME thinking that there is going to be a surplus and then that doctors were

[00:30:45] going to be ordering more unnecessary tests to make sure that they made enough money so they scaled back and then of course you know within a decade we were seeing big shortages especially in rural areas for physicians in America and so, Congressionalty we started seeing these national physician

[00:31:05] shortage reduction acts is what it's called every two or three years every election cycle this new bill will come out and then it just kind of goes by the wayside and disappears behind the sunset

[00:31:19] nothing ever comes of it we're unlike the 12th or the 13th one now and it's all just lip service it's hey we're doing this thing and I think there's been one isolated um one of those bills that

[00:31:37] actually added like a thousand residency positions and you know that I mean it's tough it's tough to think that we can do anything about it sometimes but I do like to think that this platform right

[00:31:56] I don't have to have written 150 really well-known articles or papers I don't have to have a full-blown academic life you know you and I are in the position now and you've got I mean you're in a really

[00:32:10] unique position with your background to be doing this but even somebody like me who you know just Joe Schmo from Kentucky who went to medical school and did his residency and is just a logical

[00:32:27] thinker I don't I don't consider myself you know super intelligent but I can talk about these things yeah I mean you know it's crazy is no one is talking about it and I mean that like if

[00:32:42] I mean if you have a brain and eyes that work and you work in psychiatry like you know that you should know that something isn't working you should know you should have questions about

[00:32:54] why do I keep on putting people on these meds and they're not getting better how many people have I seen where I just put them on a drug and they sailed off into the sunset and they'll find

[00:33:02] versus the people we start on them and then hired those new drug hospital treatment resistant depression, ACT like unless you've been so I think brainwashed or you know low lulled into the the whole kind of all mental illness is mysterious and chronic and you know we can't really

[00:33:23] understand it like you should see that it's not working and so I welcome you know Joe Schmo from Kentucky Kentucky or a PA or an NP or anyone that has there or psychologist anyone who has a stake in

[00:33:36] helping people with mental health problems I think needs to be talking about just the the absolute dumpstifier that is psychiatry right now yeah I mean I think it's just something that you know

[00:33:57] you you seem compelled to do and in same here what point did you have to step away from the pharmaceutical industry when did you winded the light bulb go off and you're like you know what

[00:34:12] fuck this I can't I can't do this yeah so it was a year it was a year into the pharmaceutical industry and um I just you know that the whole time actually so this is the other thing the whole

[00:34:25] time I was at FDA and I was in in farmer had a private practice that was like slowly growing I started as general psychiatry and then as I you know you know I wanted to help people with drug

[00:34:40] drug side effects and so I became well known as a tapering doctor and more and more people came this way and it hit a point eventually where I was like well you know I'm actually getting a lot of these

[00:34:51] patients maybe maybe I don't have to live a lie anymore because at that point I mean I knew that you know I wasn't going to do well in the pharmaceutical industry like I because to do so I mean

[00:35:07] you've got to just be a team play you've got to go with the flow you know play nice in the sandbox be kind of political kind of understand it and then you're gonna do great you have to be smartest

[00:35:16] well obviously have a business mindset just really good at working with people is like the main thing and I mean I care too much I mean I'm not trying to say this in an arrogant way I mean but this

[00:35:30] is something that's kind of I've always bothered me like I need to understand how things work and when there's like a system that doesn't work and it feels like it's like a lie and it kind

[00:35:39] of it's like an itch a half-to-scratch and I just knew what I was doing didn't make sense and God it just bothered me so much that eventually I was just like I'm out I cannot be a part of a machine

[00:35:54] that is saying it's doing one thing but really we all know what it's doing I mean it's designed to sell to sell drugs and even though a lot of people kind of rationalize it's themselves and like

[00:36:04] I know we're gonna say this one thing that we're really in it for the patient and somebody want to like do right by the doctors and given the best information to help people it really is about selling drugs

[00:36:13] and maybe some people could just be like yeah I get it but this is just like the way what the way the world works and I can kind of you know compartmentalize those two things I couldn't do it

[00:36:23] and so events like I just I need to be doing something where I can speak my truth be authentic be open about my ideas because at this point I mean I had been bottling them up for at least five

[00:36:39] years you know couldn't really say I'm in residency you can really say I'm in the FDA and I always admired people who could speak their mind you know join among creative David Healey you know people

[00:36:49] like Mark Horowitz these other people who were outspoken I just got man I need to I need to be a part of that I know I want to work in alignment with my beliefs and my values and I don't care if I'm

[00:37:02] going to walk away from hundreds and hundreds of thousands of dollars and you know opportunities in the future where I'm easily going to make north of seven figures if I just kind of stick here for another

[00:37:12] set you know another five to ten years and go up in seniority I just like can't do it and so that's what drove me out in 2023 actually last year in May I left the pharmaceutical industry

[00:37:30] about about a year ago yeah maybe three for a year yeah that's wild that's wild so you literally you left and then I mean those were some of your first episodes was very very shortly after that if

[00:37:43] I if I remember because I think I told you this I don't think we talked about it on a recording but when I was starting my podcast I was scouring for different podcasts to see what was out there

[00:37:58] and what was and you were releasing on a daily basis and if I remember correctly they were relatively short and so me standing in front of like a webcam you know really get a

[00:38:12] that so that it started in December of 2022 just like me just talking to my webcam and so probably about six months after doing the YouTube channel I was coming more and more well-known

[00:38:24] as like a type ring doctor or someone who could handle complicated type ring cases and that's the YouTube channel actually allowed me to leave the pharmaceutical industry because it brought leads into the business that I would never would have seen and otherwise yeah yeah yeah

[00:38:40] I'm selling my ghetto face you got the microphone you know yeah yeah it sounds like kind of on a very kind of basic fundamental personal level that the truth is something that drives you

[00:39:00] at least seeking the truth because honestly we work in a field where I don't think by the time you and I are gone from this world that we're going to have all the answers but I think

[00:39:15] something that you and I see is that we're not just not getting to the truth we're veering further and further away from it and I think that's something that drives me absolutely insane

[00:39:28] along with the fact that you know I don't remember what I had told you but you know my mom the clinical pharmacist had passed away when I was in high school and I've never been a really

[00:39:43] religious person but I think we all understand that there are things that are right morally and things that are wrong and I think the moral injury that I experience in our field is probably drives

[00:40:01] me a little bit more than the truth-seeking even I mean they're both very important but it just really pains me to see and know that so many people are suffering because of these

[00:40:17] invalidities in our data and research and how things are marketed. I'm curious to hear about where you know I really do think that that comes from my mom's very very strong sense of right and wrong and you know considering those factors with how you live your life but

[00:40:37] what do you make? What was your parents' influence on kind of what drives you on that deeply personal level? That's so interesting because I mean although I really do care deeply about the

[00:40:52] people who are heard I don't if I would have be honest with you I don't know if that's by primary motivation. I hope it doesn't make me sound like a monster. It's the I mean if I were to say something

[00:41:09] I mean my dad was an outsider in Australia. I mean he grew up you know like we're I mean we're an old family in Austria like you know with titles that were kind of removed like back in the day

[00:41:27] like after the Second World War when they abolished all of that not high nobility but we did you know a titled family not a half spur not a half spur but some people in my family married into

[00:41:38] that family so it's I mean all of that stuff means absolutely nothing to me and nothing in Australia where I grew up but in terms of culturally we come from a long line of academics at least

[00:41:51] my father's so you know very involved in the national libraries arts things like that and also my dad as a person if I would say is very he's kind of an anti authority type of person he

[00:42:06] always kind of was skeptical I was doubted things I was thought for himself and he's kind of a pain in the ass honestly but I just described my dad perfectly yeah I mean you really you really really did just

[00:42:21] describe my dad perfectly yeah okay yeah and and so some of it is probably genetic some of it's probably you know what I saw but I really need to understand how things work and I always

[00:42:34] question things and if I don't understand like you know why does this clinical trial justify the way we treat people to this day I think a lot of people is like ah whatever you know the expert

[00:42:47] say that I am obsessively driven to understand every single step of the process of how things happen and my wife looks at me sometimes she goes how can you be so like how can you still be

[00:43:02] about this stuff how can you still be reading about this stuff like why there's so many books on this one topic there and there's got to be an obsessive component about it where it's just like

[00:43:12] I smell the bullshit and then I just really want to understand it and that's why I love YouTube so much because it's just like a way for me to just be like this is my thoughts on this and I kind of

[00:43:26] do these deep dives into it I mean that's what I'm thinking about you know I went like when I'm out for a walk and people were like where are you you know why my wife's like why are you talking to me

[00:43:34] these are the things that are bouncing through my mind yeah yeah it's it's wild when we when we are in those moments of conscious disengagement you know each of us can only understand our own

[00:43:49] experience internally I mean to the fullest extent like you and I are in professions and your wife that we try to understand everybody else's internal milieu or internal dialogue that's going on

[00:44:03] but we really only know what's going on in our brain but I have the same affliction that I'm sure sometimes you wish like I wish I could just turn it off I wish I could just be on that walk and

[00:44:16] engage in a conversation that doesn't that isn't as serious as the things that you and I are trying to talk about and put out on the airwaves yeah I'm just walking around just going why doesn't

[00:44:31] anyone else see this am I crazy you know I was going to go I think that's been in my head for like the last five years like like what I don't have a hear about this I feel like but I've kind of made

[00:44:42] peace with that now I feel like I finally understand yeah I find that for for my those moments for me of of conscious disengagement when the mind just really has the opportunity to invade I find that if I don't practice some form of mindfulness or meditation essentially practicing

[00:45:07] not going down those rabbit holes when I'm not doing anything it's kind of the way that I describe it to my patients then I can really get into a little bit of a spiral after a couple

[00:45:21] of months of not actively consciously practicing that because it is I mean it it sounds like you and I have a lot of shared experience in that realm of just it's just blows my mind that other

[00:45:36] people don't even within our profession don't see the basic motivations behind some of these things and aren't more skeptical of it but again to go back to what I was saying I also don't know how

[00:45:51] everybody else is kind of internal dialogue works and you know my wife I'll ask her what do you think in so nothing I'm like what do you mean you're not when when I stop talking my mind starts going

[00:46:05] but that obviously can't be the experience for for everybody so I wonder how much of it is just people just don't have that same experience and therefore they just don't have as much content to

[00:46:22] that there are aware of to really care that much about yeah I mean it doesn't bother some people and I think this these were the things that I came to to peace with you I'm in that you know my

[00:46:33] things that bother me don't bother other people and it's that there's a lot of folks out there who were just like hey like I trust I trust the experts I trust my professors they were nice to me

[00:46:48] I have no reason to doubt them I've no reason to doubt any of these people and so I'm not got our need to look into it I am practicing in a way that's in alignment with my peers

[00:47:02] and you know it feels safe to me to practice in this way and honestly I would much rather think about this great date I'm gonna plan with my wife or my kid or what I'm going to get my

[00:47:13] do with my kid for my birthday and they're living in another world which sounds kind of nice honestly when I say it like that you know but yeah but it's not the world that I'm living in where I'm

[00:47:23] kind of tormented by all these these things and kind of driven to think about it you know when I probably should be spending time with my family so well it is it is nice to hear that I'm not the

[00:47:35] only one that's tormented obviously I know that but it is I think it always offers a little bit of reassurance to hear that others are kind of having a similar experience and similar struggle

[00:47:53] what do you make it we talked a little bit about this I kind of switch gears here how do you talk to your patience about this or maybe you don't I don't know but what do you make of

[00:48:04] the amount of information that we are exposed to now versus 20 years ago versus 200 years ago and versus cave dwelling days and how that I guess affects what we do and how you counsel your

[00:48:21] patience yeah I mean so my practice is really unique because we we only take people off drugs and so everyone's already they've sort of come to me primed for like I want off the

[00:48:38] merry-go-round and so the the main way I see information overload affecting me and my clinical practice is that in the psychiatric drug injury space websites like surviving any depressive in bends or buddies frequently visited and it scares the shit out of people they

[00:49:01] feel like if they've been hurt by one of these meds they're going to be sick for 10 years and that's just not the case and so I have to tell people to really

[00:49:18] to cut that out and I you know I bring them and I go see a lot of this stuff you're probably going to be okay in fact the odds are you're going to be completely fine in 18 months and let's just

[00:49:29] let's do this type of let's get you through it and stay off the internet and so I don't know if that really kind of got at what you were interested in but at least for my practice that's how I see

[00:49:42] information overload affecting my clinical care yeah I just think it's a it's a problem without any obvious solution I mean it's easy to say put your phone away it's a lot easier to say it than

[00:49:59] do it and it's a lot easier to counsel a patient than to actually expect that they're going to put their phone away or limit the amount of information that they're receiving. I think on a societal

[00:50:11] level that the amount of information we all receive is really ultimately harming us I mean on a positive spend you're able to come up with new innovative ideas but if we're so scattered

[00:50:25] by all of the wealth of information as opposed to an an Albert Einstein who had access to a lot of information but also had limits to that you know I wonder if this everybody has said this

[00:50:42] for all of time right the next generation is screwed and you know we're really getting to this close to the apocalypse but sometimes I do wonder if if we are getting to a breaking point just with the

[00:50:58] amount of information where yeah maybe we could come up with new innovative ideas but there's so much going on that it's hard to actually apply yourself which requires conscious direction in every given moment to working through the thousands upon thousands upon millions of dedicated steps to create a

[00:51:22] really new innovative idea or treatment well that's that's what I can comment on and and I'm glad you kind of set it up that way. I really struggle with this and I've had to do quite a lot of things

[00:51:36] I use the accessibility feature on my iPhone to essentially block my email all social media until midday and so what that means to me because I usually start working around

[00:51:49] five early riser and so it allows me and I don't book anything until 10 a.m. so it always allows me five hours to essentially not go in my inbox which I tend to do when I'm working or go on any

[00:52:06] social media and so that's what I've had to do because I think you have to be honest with yourself and when I got honest with myself I had to say yeah I'm like addicted to my phone like if I sit

[00:52:22] if I take my phone somewhere and sit down I could like scroll for 15 minutes and like easily do that when I could have been doing something else and when you always have that thing that you can grab

[00:52:36] to kind of satisfy the bottom you don't allow that bottom to get to the point where you just like I'm going to go shoot some hoops with this basketball or hey I haven't seen my neighbor in a while

[00:52:48] I'm kind of bored right now I might you know give him a call and say hey bring your kids over to the pool or you know and so I think the bottom sort of drives like a lot of healthy and

[00:52:57] pro social things as well like like exercise going out in nature and so when you when you always getting these hits from the phone to kind of suppress that it's it's no good and I know

[00:53:11] before we officially started I told you I bought that light phone because I was in such despair that I was so controlled by my phone and I you know one it was hard to work and to like I just

[00:53:24] knew I was I wasn't reaching out to people to socialize as much as I knew I should have but yeah it's scary it is scary how how addictive phones can be oh and I mean I've got my phone sitting

[00:53:40] over here close by not not directly on me but whether it's in your pocket and out of sight if you feel it vibrate or if it's across the room and you see it light up I think we like to

[00:53:54] think as as humans that we have a lot more control over what goes on up here than we do and the minute that that lights up the minute you feel it vibrate that flow of information through

[00:54:06] the brain it gets to that conscious part of us last and in that conscious part of us says I'm gonna check the phone or I'm not gonna check the phone but before all of that happens

[00:54:17] my mind has already come up with all of these possibilities of what could it be and because it's problem focused it tends to gravitate towards maybe the more you know

[00:54:30] serious issue like if I know that my wife is out to dinner with friends and I'm at home and it's been two hours even though that's a very reasonable time for her to be out at dinner

[00:54:43] but then I see my phone go off across the room and it's I can't even see who's texting me or who's reaching out or if it's even a person reaching out or just a news flash

[00:54:53] the mind goes to well I hope she's okay hope something didn't you know didn't happen and God forbid if you have if your loved one has ever been in any sort of accident or

[00:55:04] you know some bad situation that you're likely to go there a little bit more easily yeah yeah it's these things they they really tap and they they they're expertly designed to be used and to be super addictive yeah well I mean should we jump into some crazy stuff

[00:55:33] what do you think about COVID what about the vaccine yeah what are your political leanings I talk I talk about everything so I mean if you if you wanted to you know I'm happy to

[00:55:45] to kind of shoot from the hip and talk about some of these things honestly like I'm I'm like so obsessed with psychiatric drug safety people ask me they're like you know what do you

[00:55:56] think if like Rand Paul Peter McCullough you know you know these people I'm just like honestly like I don't even know who some of them are because I'm just so deep in the one thing that I do but

[00:56:08] you can go for a yeah try try try try if you almost have to be right I mean it's that that overwhelms me to feel like I need to have a well developed opinion as a physician

[00:56:21] about COVID and about the COVID vaccine and then I mean if you really want to have a well developed opinion you're gonna have to spend weeks of your time reviewing different sets of data and the

[00:56:36] motivations behind them trying to parse out who funded what but you know I guess I guess I'll lay it out there because I've laid out my basic takes on it you know I was in residency when

[00:56:50] COVID hit and from the get go I was just very skeptical that we were creating this vaccine in a matter of months that was supposed to be 100% safe and effective and utilized by every single

[00:57:04] person on the planet without any sort of nuance and I think that was those are usually my biggest red flags you know I can read a set of data and have a pretty good idea of if it's complete hog wash or

[00:57:23] if it might be legitimate I'd always try to keep a little bit of skepticism there but with that it was just the vitriol with which the information was being presented by our government that

[00:57:37] that just sent so many alarm bells off in my brain and then mandating that everybody got it was I don't know it just all it seemed a little too good to be true. Yeah I hated it I mean I

[00:57:55] hated being forced to get a vaccine which I had to do because I wanted to keep on working and as I I guess it's probably okay I know other people who've gotten it so I did get the first round

[00:58:07] tell you what didn't help me you know I still I feel like I've gotten COVID like well I definitely got on COVID at least two times I feel like it's probably happened numerous times

[00:58:16] after that because I don't even test anymore. I actually moved states I used to live in the DC area when I was working at the FDA and when COVID was going on I made my own personal I was just looking at the restrictions and the lockdowns and how

[00:58:34] baddy everyone was coming becoming over there I'm just like I'm out of here I'm going to Utah like I do not need people telling me you know what to do where I can go and all these things

[00:58:45] that is it's an I want to make for me and my family and so I mean it it put like just the whole public policy about the thing just just sent I mean essentially sent me blind across

[00:58:59] the country I'd never even been to Utah just like I don't want to be here anymore. Yeah yeah yeah I think that whole situation really opened my eyes and maybe moved me a little bit more towards considering

[00:59:16] some of the quote unquote conspiracies out there and you know where does the actual truth lie because it obviously doesn't lie and you know there's a vaccine that's 100% safe and effective

[00:59:28] that we created in a matter of a few months but I also don't necessarily think it lies that in the fact that this vaccine is not good for anybody. Sure and again I haven't looked really

[00:59:44] deep into that data but I do remember a good number of studies that were showing that a lot of the people in the ICU's were not vaccinated and I don't know if that was as a promotion for

[00:59:59] everybody to get the vaccine or not but then you know most Americans don't realize that there's nobody else in the world that I know of that is vaccinating infants against COVID and really not very many countries who are vaccinating children even under the age of 18 and mostly not

[01:00:20] young adults either but there's so much vitriol behind that how that information is presented here that if you find yourself at a dinner party and some I was really passionate about it

[01:00:33] they might put you in that box you know right off the bat regardless of your training and medical experience yeah they're crazy I mean I just kind of like I know it's I mean that was an

[01:00:48] interesting time in America which is still kind of going on to this day and has kind of made me dread election year and but I don't think the media has ever been more kind of polarized in that

[01:01:04] time and we've gone out of George Floyd like straight into COVID I mean it was like I mean you couldn't talk about anything you know at Thanksgiving dinner you know in fact people

[01:01:16] were just uninvited you know even before the flights could happen you know oh yeah oh yeah no I've I've been called a Marxist I've been called a a Trumpist even though I'm I'm very far

[01:01:34] from either of those things but I tend to find myself in these in these discussions always just being that skeptical voice and you know really probably just being the outcast trying to really

[01:01:46] my my intention I think is to bring everybody back closer to the middle closer to you know what the likely reality is behind things but we just avoid Thanksgiving last last Thanksgiving we went

[01:01:59] skiing you know we just amally we just amally skiing yeah there is there is one candidate that I do like to promote and I'm not promoting him because there's a hundred percent

[01:02:15] confirmation that you know he is in it for the right reasons but to me Robert F. Kennedy is the only candidate who's actually talking about things that matter to me talking about reforming health

[01:02:29] care and reforming the way that we calculate safety and efficacy of different treatments and would he actually do those things I don't know but I'm so tired of hearing these other two talk about

[01:02:44] who's more demented who's losing it more I mean and they're talking about these more you know I know they're important issues abortion gun control but they're just talking about the most polarizing

[01:03:00] issues right just like the mind orders information you know into black and white or all or nothing it's I'm pro life for I'm pro choice when the reality is that most of us recognize that there

[01:03:15] is a massive amount of gray area that we all 80 90 percent of us live in but the rhetoric on the national scene is you've got to be one or the other and it just drives this division and I'm to the

[01:03:29] point where I'm like you know what are both of the political parties are they meeting behind closed doors and just like hey we got to make sure we keep tabs one of the two of us needs to be in

[01:03:40] power yeah so anyway that's that's my plug for for Bobby Kennedy yeah I mean it's hard for me to not love him in in the space that that that I'm in you know being skeptical of the pharmaceutical

[01:03:56] industry because honestly I think Trump is pretty close cozy with them and I think Biden is as well and so I don't see anyone actually addressing my my issue which is healthcare so

[01:04:12] yeah I mean if I'd probably vote for him if I thought that vote would make a difference in my state it won't you know and but yeah I suppose it won't make a difference in my state either yeah

[01:04:23] I who knows maybe maybe I'll just do it anyway I mean I hope he builds up some um builds up some some momentum because you know yeah I mean with with those two options and I mean

[01:04:35] it is sounding like he said it's sounding super repetitive honestly like I just don't really care to hear it anymore and then you have someone like Robert F. Kennedy who's well spoken and um passionate you know really passionate like authentically it's just to me it seems really

[01:04:54] authentic you know all of the issues that he talks about but it is really him and it is his voice and I mean I mean you can't say that for Biden like it's just like like what is like where

[01:05:07] like I don't know I don't even know right yeah right we don't we don't know if he knows where he's at some times and then I heard uh heard Trump talking about sharks the other day and I could not

[01:05:18] follow what kind of point he was trying to make but I mean some of the some of the things that that that that come up between those two I'm just like can we can we please get Robert F. Kennedy

[01:05:31] on a debate stage with these other two that is forced them to talk to like a normal person right you know it's like right yeah so I thought that was a shame that they wouldn't have him up up there

[01:05:46] because I'd like I'd certainly like to say him up there yeah absolutely absolutely I mean I remember a time where we would have multiple candidates up there within a debate and then as the

[01:05:59] election rolled on you'd whittle down the candidates and you'd end up with you know one v1 or maybe three individuals in the debate but it I don't know it just doesn't seem like anybody

[01:06:12] that there is that incentive for either of those major political parties to do that at this point no I don't say I mean the whole thing's pretty disappointing honestly you know yeah just to

[01:06:27] give if you give my my honest hike of the whole thing have you ever thought of um have you ever thought of leaving the country again no again I guess but leaving this place this place kicks us honestly

[01:06:42] it is done so much for me in terms of opportunity and I mean there's I mean there's a lot of bullshit that goes on here and and things like that but it is I think it is the best place to

[01:06:58] to um to build a business learn how the world works make an impact at a global level felt that way within the pharmaceutical industry for sure I mean it is the land of opportunity

[01:07:11] I mean if you are going somewhere in your driven and you want to really do something I mean couldn't think of a better place I mean US is not perfect obviously it's skewed towards capitalism and things like that but if you are someone who

[01:07:25] likes that like business building and all those things man this place this place kicks us I mean it's I think is so much better than Australia I know I shouldn't say that but I would never go anywhere else

[01:07:37] yeah and I mean if you're running a taper clinic then yeah you're always going to have business yeah yeah yeah so um all right one I'll give you one last question to get out of the uh at all the serious stuff

[01:07:52] so you are um exiled to a deserted island for the rest of your life and you get to take one artist or band one book in one game with you oh shoot let me think um one artist one

[01:08:16] artist will band who would that be um well if you're going to put me on a spot like this I really like M&M you know I find it for a long time okay yeah I probably bring um I probably bring that out

[01:08:38] I think that's something that I wouldn't get sick of and uh I think it's really funny as well so there we go brings them M&M out and then one book let's see what would I want to read you know I

[01:09:09] like catch 22 a lot I mean that was again I'm I'm probably sound like a broken record because like everything I talk about is like inept government and you know things like that and that book

[01:09:23] is just it's it just Dev tells us so nicely with that so I like that one and then um let's see what's the last thing one game what game would I bring uh that would be age of MPI's to definitive

[01:09:34] edition you know that's that's the one okay what is that what is that on that's uh it's a PC game and it is a real-time strategy it's kind of like red alert or command and conquer but it's okay

[01:09:49] you know you go start in a dark ages and kind of end up kind of right when gunpowder comes on the scene and he sort of control armies and all that definitely it would be age of MPI's for sure

[01:10:03] nice yeah nice nice well my my list isn't too different I mean my first thought with the artist was was too pop but not a not a very big catalog unfortunately still relatively large

[01:10:18] include you know everything even posthumously it's a good list like so funny because like I was actually thinking about saying too pop because if I think about the two first the two artists that I

[01:10:27] got CDs full first it was two pack and M&M and um I think that's just funny that you said that because that was actually was actually the other one I was thinking about yeah my first two were

[01:10:40] Nellyville and uh in in sync yeah and I hate to admit that publicly but you know you'll still catch me singing along to some in sync too yeah but my other artist is totally

[01:10:52] I mean on the other I couldn't be any more different I couldn't say is uh but I would imagine it would maybe be kind of peaceful on a deserted island as James Taylor okay yeah I think for the

[01:11:05] book I'd have to get some some sort of a stoic book um in charidian or meditations by Marcus really is just because I mean it'd be tough to be on a deserted island by yourself or I guess

[01:11:19] maybe you include the one artist or band as they're with you so yeah do you want to be on stuck on an island with him and him for the rest of your life or

[01:11:29] same kind of a change just same kind of a brisive you know from from the interview yeah yeah so and then yeah the game I'd probably have to go with something on an old school Nintendo

[01:11:40] I thought of some obscure game that probably nobody's ever heard of called uh school and the only reason I thought of it is because never beat it yeah so it's it offers that that challenge but you know close second for the game

[01:11:56] would probably be anything in the grand theft order series I mean that would be that that entertained you for a long time that's for sure oh yeah oh yeah um well anything else any other uh questions you had or or thoughts or anything?

[01:12:17] not Ethan it's been great yeah we'll have to we'll have to do it again sometime somebody get this guys some help! Thanks for listening for more social media content check us out on all social media platforms

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