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Thank you for focusing here on the caregiver. Important topic.

Lets get another combo of degrader, sonrotoclax, and a monoclonal for those who have worked through venetoclax or earlier gen btki!

Dave is asking an important scientific question and Weiss is attacking him for his patients willfully misinterpreting him. I wonder what Weiss would say now that the study is done.

Statin risk is not blown out of proportion - what’s the harm? Well for me every adult in my family who when on statins (all lean and active and fit) got debilitating muscle pain and memory loss and had to stop exercising. I’m sure they’re a good fit for some, but when doctors insist there’s no risk im immediately skeptical

Crazy that nonsense influencers get millions of views and this has only 888 right now. Peter is probably one of the most knowledgeable people in the health environment.

This is very inspiring! Thanks for bringing Dr Patrick Shiong to share his journey with us.

Great discussion!

He begins with his arms crossed. That's literally ALL you need to know about this guy. Then he opens his arrogant mouth and he proves it. His hostility implies he's threatened. It bothers him that a "lowly software engineer" found something that upends his reality. A confident doctor would sit back and smile pleasantly like the Dalai Lama. Instead, he's combative before he even begins speaking. How sad for him. Keep doing what you're doing, Dave. We don't want to take drugs that make us worse so clowns like this can feel like gods.

Don't change the name. People will just slack, and lose their focus! People are WEAK. FWIW, just a layman.😮

Truly distinguished panel. A treasure. Thanks again Richard 🎉

The best way to skate through life is not to bang into the objects you pass.

All I have been reading and hearing that Africa are blessed with herbs and roots, till I met #Doctorojie on TH-cam who helped me cured my hiv virus after I have comfirm positive after 2years i was miraculously cured again this is really good news please I want everyone to see and follow to celebrate and support herbs../

Need to get these products on the market. What is the FDA waiting for? Why is it taking so long? People alive for so many years these should be available for everyone

I remember at 4 months pregnant the Dr advised me to terminate, i did not and a week later a had stroke and was in hospital for weeks. I gave birth to a healthy baby girl full term, but it took time for my body to recover

Fenbendazole put me in remission for 21/2 years.

ABIM is out of touch and tone deaf.

Great book, great inverview. Many thanks.

24:09 how about raising the drinking age as well? I think with the drinking age it provides a loophole for it to get into things like college and even high school campuses, and it does create something similar to the seatbelt effect!

I am a random patient who is fascinated by this dumpster fire. Would a doctor’s union give y’all more clout?

ABIM MOC needs to end. CME’s is the right way for continued education, similar to what’s done with all other professions in the world - lawyers, engineers, surgeons. Nonsense ABIM, old-school tactics of high stakes SAT like exams repeatedly into your grey-haired retirement years - otherwise threats to lose your Credentials unless payments are made, etc… has to end. It’s an embarrassment and insult to physicians. End it now.

Dr. Banerjee is clearly passionate about palliative care and teaching. She's so driven and seems to create whatever she sets her mind to do. We need more physicians like her.

I experienced this extortion last year. I was a solo practitioner Internal Medicine doctor. My insurance contracting had been through a large hospital system ACO ever since that existed. Prior to that I did my own credentialing and was paid much less - one of many problems in the US system. Texas passed a law prohibiting requiring MOC for credentialing - UNLESS ACGME facility. Well Hermann has a large teaching facility and then even larger non-teaching community system, one of the largest in this entire region of Texas. For some damned reason they fought to make us do MOC. I didn't have the energy to fight that fight for all internists so I let it go and kept taking my 10 year boards. I passed IM recertification board 2021 but then last year around this time was told I was going to lose my credentialing with the hospital because of the MOC because passing the board wasn't enough anymore. Also, I needed to pay back fees with penalties. So could I have just walked away from the ACO? Being in the ACO requires being credentialed with the hospital system even though I only practice outpatient. Yes I could walk away but then I would have to completely start over getting on every insurance plan AND you know those bastards will pay me less without a large hospital system behind me. Basically, they had me by the short curlies. I tried appealing to the IM doctors on staff inpatient but they were either grandfathered or specialists. BECAUSE this didn't hit the specialists until THIS year. Between this extortion, the absolute morass of BS that is put on primary care physicians (story for another time), I finally just said F it and retired this year. Officially it is a 1 year hiatus but I can't imagine wanting to put up with this moral injury again. When I worked at MD Anderson the financial hit would have been absorbed by them but the moral injury would still exist. The moral injury is real. It is trauma that others will not understand. If I didn't care, it would be easy. If I hadn't worked my butt off to be the best doctor I can, it wouldn't matter. If I practice again it will probably be in Belize where I can be a great doctor and take care of my patients without dealing with the multitude of layers of crap that do nothing to improve patient care. The US system is a dog covered in ticks, and more are added every year. Thank you for letting me vent. I worked in the ER at MD Anderson for 4 years. Back then it was under Internal Medicine. I have the utmost respect for both of you and what you do.

One would think that the AMA should be addressing this issue on behalf of its members.

This is yet another example of what a scam ABIM/MOC is. Disgusting.

This is a classic case of Pournelle's Rule of Bureaucracy combined with The House of God Rule 8 ."Pournelle's iron law of bureaucracy": In any bureaucracy, the people devoted to the benefit of the bureaucracy itself always get in control and those dedicated to the goals that the bureaucracy is supposed to accomplish have less and less influence, and sometimes are eliminated entirely." and They Can Always Hurt You More.

Ea 2 jana kia।।।।bahara loka

Thank you, Dr. Teirstein and Dr. Nabhan. I've been certified by NBPAS since 2017.

NAZLI HAS A FAKE DIPLOMA

Dr Weiss - explain why if LDL was casual, then why don’t we see plaques lining every part of the arteries and the veins and not just at high pressure side of the heart and in high pressure areas? Why is LDL only 0.1% of the contents of a plaque? Also, consider the in the SAD diet, you are hard pressed to find more than 10% of any products without oxidized PUFA. Remember when it was settled science that margarine was our best option. It’s much easier to fool someone than to convince them that they been fooled. The statin studies actually show very low absolute risk reductions without transparency from the very people that have to benefit and with an already decided outcome before the trials even start. And finally, there are other studies that disprove the lipid theory but they are ignored.

At cvs, understaffing is the mainstay of how they run the business. They care nothing of patient safety. Swept under the rug 100%

As a critical care physician myself (adult) I want to make a few comments: First, what Dr. Lankford is doing is admirable. He is fighting for what he thinks is right regardless of the headache, to put it mildly. That is the definition of a man. The interview itself was great. Now my opinion regarding this non compete clauses. It is an absolute abuse of power of the hospitals to even write this in the contracts. The argument is a complete lie: they did not train and developed Any doctor carrers. We already did that during residency and fellowship training at a ACGME accredited hospital. Dr. Lankford is an attending physician. I would assume he is board certified. He is not a doctor in training. He is working not training. Yes, if he was part of a committee he learned a few things regarding day to day operations, etc. the administration did not teach him how to place a central line, intubate a patient or manage a ventilator. That is just not true. He may gone to a few CME lectures and probably learned to use the hospitals EHR which he needs to know to do his job. He is today a much better doctor than when he just finished his fellowship, no doubt, but that is not because administration “trained him” it’s because he has gained experience with his hard work taking care of patients. What he learned, he learned from his patients, from the nurses and respiratory therapists the pharmacists etc that work with him the icu in a team. Not from “formal training “ by the hospital administrators. Yes, there is an expense in the recruitment process. And in the doctor’s salary. The hospitals/employers make at Minimum 4 times the salary of the doctor in direct revenue. If a doctor gets paid $300,000 a year the hospital is making at least $1 million a year in revenue ONLY IN PHYSICIAN WORK AND BILLING. This is not counting the revenue generated by the actual care of the patients: MEDICATIONS, CT SCANS, MRI, surgery, OR, icu bed , etc etc etc. the hospitals charge $15 for a Tylenol tablet, which literally costs 15 cents at Walmart. That’s 10,000% the price. I repeat the charge 10,000% the price of Tylenol. They are probably making 3-5 millions of dollars a year from dr Lankford hard work. No one in the medical field thinks that the hospital is “losing money” here. The US constitution protects the right to work. I can’t believe that hospitals have the nerve to not allow a doctor the right to work, wherever HE chooses to work. It should be illegal to determine in what zip code someone is allowed to work or not work. It should be illegal to FORCE a person to move out a city, house, home. Not to mention, the families. It is completely immoral. The fact that the hospital block a highly trained and qualified physician to take care of the sickest children in the community tells you all you need to know about the hospital administrators. They don’t care about the patients and the community. They care about the money. The fact that they fired a bunch of doctors and burned out dr Lankford to the point that he had to leave his job, tells you once again that all they care about is the money. If the hospitals don’t want doctors to leave, they should treat them well, not abuse them and then force them to stay under the threat of a lawsuit. Unfortunately doctors have no choice but to sign these nom compete contracts. They tell you “it’s the standard contract, we can’t really make a contract just for you because then other docs can sue us for discrimination or preferential treatment . Sorry”. I have interviewed many many times and I always had no choice but to sign. Luckily, I relocated , by choice, to another city and left the hospitals but every contract I signed had the same non compete clause. In my limited experience with friends who “broke the non compete agreement “ , a nephrologist and a critical care doc, both were taken to court by the hospital and both won. They stood their ground and won the cases. As any judge with some common sense can see how abusive and ridiculous this clause is. The hospitals just try to bully docs with the cease and desist letter and unfortunately most doctors don’t want to deal with this and just move out. Again, it is absolutely immoral to force a human being to relocate. By the way, most contracts state that if you quit the job within 3 years, you have to repay the Sign on bonus and relocation expenses so they are already getting their “investment” back. Doctors need federal protection. I hope this case brings awareness and a petition to congress which I will happily sign. Good luck dr Lankford and thank you for fighting back.

I completely agree the only hope is with a class action lawsuit. It’s ridiculous physicians are essentially being forced to pay a fee for a service many did not ask to use (LKA assessments) or to ‘maintain’ something they paid for (the 10 year board exam). A scam should be solved in court.

So why don't they do PSA followed by mpmri followed by psma PET scan then from there possibly biopsy

This is my third pregnancy diagnosed with hyperemesis and I can't begin to explain how horrific this experience has been this time. It's been deathly. This video has been helpful in understanding the condition..thank you.

I am in complete agreement with the positions of the physicians in this podcast and I myself have signed "the petition" and joined the NBPAS. Ironically today, the very day this podcast aired, I received from the ABIM my notice that my subspecialty certification is now revoked as I have failed to participate in the LKA MOC program since its re-institution after the postponement resulting from the Covid-19 pandemic. I remain "Board Certified" in Internal Medicine as I am grandfathered in since I passed my initial IM certification in 1987. As a Professor of Medicine with an IM subspecialty certification at the major medical educational institution located in Seattle, WA, I await the response from our administration to this notification. This will be especially interesting to see what impact this has on my ability to continue to serve in a patient care role given the severe shortage of clinicians at my institution in my subspecialty of rheumatology. As I watch the changes in the medical industry, I become evermore distressed at physicians' loss of autonomy as we have become salaried employees of large and uncaring institutions focused on revenue generation and market share, even in academic medicine. In my opinion, the ACGME, ABIM and other bodies are doing nothing to address the true threats to quality medical care in our Nation. I suspect my retirement will unfortunately be soon forthcoming. Chris Sims Professor, University of Washington School of Medicine

appreciate the hard work... if we ask the same questions we ask of any process affecting patient outcomes, ABIM will be found wanting... A bunch of people came up with this for good intentions and it has morphed into a money making power scheme that is supported by Physicians who prefer to tow the line than resist oppression...

It appears that the only real chance of eradicating MOC is via either a legal settlement or successful jury trial. The reason being is because there are so many high wealth groups in an alliance with ABIM.

Thank you for all you're doing to support this important cause. To me, here are some actionable items that might help. 1. A documentary about the damage the ABIM maintenance of certification process does to doctors and healthcare in general. Having a documentary like that on Netflix or Hulu or somewhere like that can be a game-changer. 2. Consider changing the battleground to simply doing away with the MOC. Maybe we accept that paying the boards and the initial certification is, for now, ok but we aim at least to do away with the maintenance of certification process. Maybe simply grandfather everyone in who is certified but continue the initial certification process.

There is a fundamental problem that was only barely referenced: The governance structure of the ABIM. There is no diversity that matters in the board executive staff or in the governing boards of the institution. Where are the general internal medicine physicians who practice in small, single specialty groups? They make up the majority of ABIM diplomates, but they are nowhere to be found. The only thing you will find are subspecialists who are department chairs or medical school associate deans. People who - at most - see a couple of patients a month. There are actually more non-physicians, than physicians who actually practice Internal Medicine, on the ABIM Board of Directors. This is the result of the fact that leadership and board positions are inherently incestous. They just pick their buddies. Their is absolutely no transparency; and - as I said - they pick their buddies who will not "rock the boat" and make sure the luxury travel and accomodations are maintained. The Board of Directors approves the CEO's salary, and the CEO picks who is on the board and authorizes the significant reimbursement they receive. Dr. Baron warned about government involvement with physician certification. However, at least there is actually accountability through the ballot box with the government. That is better than the ABMI "clique" that only looks out for each other. The executive leadership, and Board of Directors should be selected by the vote of all the ABIM Diplomates. The final point is that the ABIM - like all medical professional organizations - is heavily aligned with the most predatory forces in medicine: corporate medicine (and non-profits are actually far worse than the for-profit organizations.) The fact the chair-elect works for Northwell Health means he will always advance the interests of "integrated healthcare networks" against those of actual physicians. As Dr. Baron made clear, the ABIM works for the mega-hospitals, and private equity; not patients or physicians.

Where’s Ethan??? 🤣

Unbelievable. This is not something any nurse or doctor should have to face. The job is hard enough. To be burdened with legal, financial, and emotional stress because an employer is vindictive is crazy. I have been in the hospital five times in the past 15 months and I hate to think the people who took care of me are treated like trash by the administrative staff.

This was two years ago. I wonder how this discussion would go now that the study is over with?

The fear of the detractors of the LMHR study is that if high ldl in them is proven to not be atherogenic, more people will want to stop taking statins, severely reduce carbohydrate intake while replacing them with fatty red meat. Once this is established, cardiologists will be forced to treat people based on “their” physiology rather than unhealthy population normality. In addition to that, they will have inform their patients about “their” potential to dump the carbs, gain a lean mass, and get off the drugs.

No medication is harmless. Nobody knows all of the possible implications to taking this drug. If I eat a lot of fatty red meat, I want my body to respond to what I eat proportionally, which is well proven to be higher ldl. No study proves causality, and the mechanism for high ldl causing CVD is not known. Associative studies across entire populations with no controls can never inform on risk or causation.

Dave has a reluctance to share his personal decisions to guard against criticism, but no doubt will be love against him if he does share such information. I received this as prudent, not a clandestine attempt to withhold data or information. When Dave questioned the cardiologist regarding whether or not Apo B was a net negative on its face, in other words, Apo B is a pathogen similar to foreign virus in the body, the cardiologist simply referred to “settled science” that elevated levels of Apo B increase the risk of heart disease. When Dave refers to studying High levels of Apo B in healthy metabolisms, the cardiologist responds with, “we don’t know they are heathy.” There is an extreme reluctance to even suggest that high levels of AOP in an otherwise healthy metabolism is actually a positive functioning situation which might be a net improvement of overall health, because of the immune properties Apo B, that the cardiologist is unwilling to accept as a possibility. I, for one, am acting on that hypothesis; that high levels of Apo B in a fat adapted metabolism in a lean individual is a net positive scenario resulting in a reduction in all cause mortality.

“We Know That” is not a scientific approach.

I’ve been practicing for nearly 31 years. I board-certified and then recertified twice. I’ve never been sued (thank God!), and have a personal goal of 80 hours of CME per year. I feel that I’ve proven my professional competency through a lifetime of good practice. Despite that, I am now having to take the LKA in lieu of an all day secure exam. While the ABIM insists that their questions are relevant to my practice, I have discovered that many of the LKA questions deal with patient care in the hospital setting or medical treatment decisions that would be made by specialists and not by me. I haven’t taken care of a patient in the hospital since 1999, yet I encountered inpatient care questions on the LKA. Difficult and irrelevant questions for an outpatient doc like myself. Yet these questions are used by the ABIM to gauge my competency? Not fair!

The myth, the legend, the idol of generations professor taleb

Watching this was painful! Weiss came in knowing that all he had to do was dance around the ring and avoid any punches! And that is exactly what he accomplished! He comes across as both arrogant and confused. Could not articulate any coherent conversation! He was the same way on Gil Carvello interview. Acted like he couldn't get his thoughts together! Til corrected him on his salt consumption, but, neither of them clarified if they were talking about sodium only or salt amounts! He said he was low carb, but, was anywhere near low enough to make that claim. I can't help but wonder, is he related to Chris Gardner?

Exciting great new frontier for cancer patients and doctors!! Thank you for taking the time to share! Is there a hypothesis as to why the microbiome makes such a difference? Fatty acid metabolism into smaller fragments (short-chain fatty acids, rather than too long of fatty acids)? Could this be an example of metabolomics? Wanting to learn. Thank you :-)