#10 - The Entire System Would Break
SUMMARY KEYWORDS
patients, hospital, food, system, health, doctors, blood sugar, funding, alex, healthy, pharmaceutical companies, surgery, pay, dietary guidelines, low fat diet, served, meetings, medical establishment, heart surgery, people
SPEAKERS
Jack Heald, Dr. Philip Ovedia
Jack Heald 00:00
All right, welcome back. It's the Stay Off My Operating Table podcast. Dr. O, your book is… I realized people can't buy it yet - if they're listening to this immediately after we record this - but your books coming out, what? December?
Dr. Philip Ovedia 00:15
November 11.
Jack Heald 00:19
November 11, 2021, your books gonna be out. And what's it called?
Dr. Philip Ovedia 00:24
It's called Stay Off My Operating Table.
Jack Heald 00:26
Oh, clever. Alright, so I'm reading the preprint. A couple episodes ago, we talked about chapter three, where you said the system is broken. And I was rereading today. And I was just, I was, I was struck by a story you told there at the beginning about Alex, this patient of yours? And his blood sugar problem? Would you just real quickly recount that story for us? And then I want to read a quote from that chapter. And just have you comment on it. So, I guess the, I guess the title of this episode is, the system is broken part two.
Dr. Philip Ovedia 01:08
Yeah, unfortunately, we're going to have a lot to talk about it over the course of this podcast about why the system is broken. But you know, the story I start off chapter three with, I think, is a very good example of what's wrong with the system. And I talked about a patient named Alex who I had done heart surgery on coronary artery bypass free. And it's now the next day after surgery. And I'm sort of doing my free back all my patients with one of the nurses, and I noticed that Alex, his blood sugar was exceedingly high. And I just couldn't figure out why that would be. And I was going through everything in my mind as I kind of walked down the hallway to see how Alex was doing. And as I opened the door, and started to say, good morning to Alex, I saw the plate of food that was in front of them. And it immediately became apparent why his blood sugar was so high. The heart healthy diet, and I put heart healthy and air quotes that he was being served in the hospital in the morning after his heart surgery was pancakes with low fat syrup, a low fat yogurt with granola, a cup of peaches, and then a small serving of scrambled eggs, which probably weren't even real eggs, a little sausage Patty with it, and then the cup of orange juice that went with it as well. And that immediately makes sense. Why his blood sugar was so high. And unfortunately, this isn't just Alex, this is a very routine thing that I see. We literally we know very well, that one of the keys to minimizing the risk of heart rate is keeping patients’ blood sugar under good control. In the immediate time period after the surgery, the first 48 said,
Jack Heald 03:19
Whoa, whoa, whoa. I never heard that. I mean, I'm not a heart surgeon. But there's a there's correlation between their blood sugar after 48 hours after surgery, and they're continuing long term well-being?
Dr. Philip Ovedia 03:38
Yes, there's a very good correlation between the blood sugar control right around the time of surgery and complications that can occur. Infections is very high on that list. So, because of that, we oftentimes
Jack Heald 03:58
I'm doing a facepalm here, this one just this just, I oh my gosh, okay, sorry. Um, please continue.
Dr. Philip Ovedia 04:08
Yeah, and we can go into that a little bit deeper, but it makes a lot of sense, because we know the damaging effects that high blood sugar has body. So, one of the things we commonly do after surgery, after heart surgery is we will have patients on insulin continuously via an IV for you know, the first day or two after surgery, and even patients who aren't overtly diabetic, oftentimes required,
Jack Heald 04:38
And that's just to keep their blood sugar down?
Dr. Philip Ovedia 04:44
That is to keep their blood sugar down. But I routinely walk in the morning after surgery, and my patients are up in eating which is great to see, except the food in front of them is usually a high carbohydrate meal because we have become so focused on low fat, supporting heart health. That we ended up substituting a lot of carbohydrates into that food to make it palatable. And so, we are literally the patient is eating carbohydrates, which immediately get converted to sugar in their blood, while we are giving them an insulin drip medicine continuously to lower the blood sugar.
Jack Heald 05:23
Wow. There's got to be some enterprising legal Beagle out there who can say, oh, you came up with an infection after heart surgery, and they fed you carbs. Let's see if we can get that fixed. I'm sorry, I'm, this stuff just drives me nuts. Okay. If you don't mind, I want to read a quote that I pulled right from this chapter. It just, I think it encapsulates the lunacy of this system. And then just gets you to maybe, maybe just expand on it. So, here's the quote, this is from Chapter Three of stay off my operating table. Hospital compensation is built around disease treatment, not prevention. food companies and pharmaceutical companies are deeply embedded in medical education. Together, they all built the system around recurring treatment of disease, everything relies on those institutions, food companies and pharmaceutical companies, on them funding on their funding and guidance. The entire system would break. If we shifted priorities from treatment to prevention, the entire system would break if we shifted priorities from treatment, to prevention. Holy smokes.
Dr. Philip Ovedia 07:08
Yeah, that was a very eye opening, revelation to be on. And it struck me deeply because it's not something that really get focused on.
Jack Heald 07:23
So, unpack that for us. We've got food companies, we've got pharmaceutical companies, we've got the medical education system, we've got funding for research, and we've got hospitals built around. treatment, not prevention. just unpack that whole, how's it all fit together? Yeah, it's knowing the pieces and then explain how they all fit together?
Dr. Philip Ovedia 07:44
Yeah, one of the things that has occurred over the past 50 or so years, is medical research, medical education, are both very expensive price, it costs a lot of money to educate a doc, it costs a lot of money to do the science that goes into establishing the care that we deliver as doc. And in the United States the research part of it used to be largely funded by the government. But the amount of funding that was available to the government has decreased over time. And it sort of makes sense that the ones that stepped in for that you're a capitalistic society. And so, the pharmaceutical companies that were ultimately going to benefit from science, stepped in and took over the funding of the science for the large part. But unfortunately, that ends up having an influence on the science that it's done, and on the science that ends up getting funded, and ultimately published, and then goes into the recommendations that get passed along. Now the pharmaceutical company, and the food industry took it another step forward. And what they started doing was providing a large amount of the funding that goes to the organization that doctors are part and the doctors rely on for their continuing education once they graduate school. We're all familiar with the medical meetings doctors travel around, or now virtually attend these meetings to keep up to date on the latest science and developments around us. And it turns out that societies that put on those meetings are largely funded by the pharmaceutical and the food in and as one would probably Expect, they then get to influence the types of things that get presented at those meetings. And the journals, which are sort of an offshoot of those meetings in those societies, these things all, indirectly or directly influenced by where the funding from, that is a big problem in our medical system,
Jack Heald 10:30
I can see a way to explain how all of this is utterly benign. You know, I'm a pharmaceutical company, of course, it makes sense for me to, to sponsor these meetings of the American Association of whatever. But I believe in Health and Science and blah, blah, blah. What the, the story that you're describing is far darker than, it's not just this, this benign, arm's length relationship between those who deliver medical care. And the pharmaceutical companies and the food companies in the medical establishment, I mean, the medical education establishment, you're, you're describing something that it's almost as if the whole thing was designed to keep people coming back in paying for their products, whatever those products have to be, regardless of the health, that lack of health, that those products, the consumption of those products resulted. I don't have any problem saying this, because I'm not a doctor, and they can't beat me up. So, so the food companies and the pharmaceutical companies, they explain the food companies, the pharmaceutical companies things, I can see that we're in this time, when we don't, all our institute, institutions are violating our trust consistently, but the food companies is a little less obvious, do they actually get involved in medical education funding?
Dr. Philip Ovedia 12:32
The first thing we need to realize is that the food industry and the pharmaceutical industry are intertwined. A lot of the same entities own have interest in both of these things. So, you know, that that is one thing to realize, the food company, I would say the food companies were sort of pulled into the health field, maybe unintentionally. So again, back in the 1970s, the 1980s, when we were dealing with this epidemic, of obesity and heart disease, and the vision was that we needed to launch food guidelines, tell people how to eat in order to improve their health. And I think that mission was initially it was designed to be beneficial. And so, the US dietary guidelines were planned, and then they were released, but it was going to require a major change in the foods that we ate. You know, at the time, the thought was that going to a low fat diet was going to benefit our health. And so, the food companies were then approached, essentially, by the government and told we have to make more of these low fat foods we have to make foods that are going to fit within these guidelines that we think are going to benefit people's health. And the food industry, of course, did what any business would do in that situation, they responded to the changing market, and they started making all these low fat foods. And unfortunately, it turned out that making all these low fat foods, and instead making them high in carbohydrates, and high more processed foods has not benefited our health. But now, we are at a place where it is hard for that system to change direction. And quite frankly, the food industry just has its business interest now aligned to keep that system going. I think I've mentioned in a prior episode, no, but I'll say it again, the food industry is not concerned about keeping people healthy. It's not their mission. It's not their job. The food industry is there to get people to buy more, and to increase their bottom line. And unfortunately, the way that that is done, not only doesn't benefit people's health, health, but it's actively harming our health.
Jack Heald 15:16
So, let's, let's do a thought experiment. Because this sentence, the entire system would break, if we shifted priorities from treatment to prevention just stopped me on my tracks, let's just do a thought experiment. And let's work through the various things that need to change, and then talk about how it would break the system. And start anywhere you want, let's look at one thing, let's say, You're King for a day, and you can fix this thing. And then let's talk about what it's going to break.
Dr. Philip Ovedia 15:56
Right. So, let's look at hospitals, or hospitals. Even though most hospitals are considered to be non a nonprofit organization. The reality is, is that hospitals need to do all the things that other businesses need to do, they need to pay to keep the lights on and pay the employees, and all of the expenses that go into running a hospital. And the only way that a hospital is going to make income is by having patients in the hospital bed. So, if we shifted our system, and all of a sudden everyone was healthy, we would have a lot less need for hospitals, and hospitals would be losing a lot of money. Doctors currently get paid largely based on doing things. So, these are things like procedures, these are seeing patients in their office. And the more things they do, the more that they get paid, is the way that the system is currently set up. And so again, if patients are healthier, don't require doctors to do as much for them, there's going to be less money to pay the doctors the doctors are going to get paid less under the current system.
There have been attempts to change this, there have been things introduced to try and get physicians, for instance, paid more based on the quality of the care they deliver, and the health of their patients. But those efforts have floundered. Again, it's a very large system that we're trying to change. And things don't change quick, right. So unfortunately, all the incentives in the current system really work against patient being held. And even another sort of corruption of the system that plays a part in all this is that the patient's themselves don't necessarily have any direct incentive. Because we've developed this system where everyone pays for insurance, somehow whether it's their employer is paying for them, or they're paying for it directly. But you know, your insurance costs are pretty much fixed you pay your monthly premium into your insurance plan. And so, if you as the patient and are spending a lot of money to take care of your health, largely, we're not, you're not seeing those costs directly there are copays, things like that, that people do have some influence from it. But a lot of it gets dealt with within the insurance system. So even the patient doesn't have the direct financial incentive to remain healthy. Now, hopefully, people want to be healthy, and they feel better when they're healthy. And that would be a good incentive to remaining healthy. But, again, patients are within this whole system that is not designed around them being healthy. And it causes a lot of the problems that I see every day.
Jack Heald 19:33
So, if, if we the patients actually felted in our pocket books more when we were engaged in unhealthy practices. That might be an incentive. Yeah, patients, I guess, but it still wouldn't do anything to the system itself. Which, which is I'm struggling to come to grips with that very first story about Alex of his plateful of hardcore high carb foods, I can remember when I visit friends or family in the hospital and see the meals they were being served, being horrified that that the quality of the food that they were getting in a hospital was so bad. I mean, I'm not a nutritionist, but you know, gee, I know, well, I know not to eat some of this stuff.
Dr. Philip Ovedia 20:32
Yeah and the reality is, is that that food that gets served to them in the hospital is dictated by the US dietary guidelines. So, you know, the food that gets served, the hospital has to be within those parameters.
Jack Heald 20:47
Well, surely, there's chiefs of staff out there who know these guidelines are, are garbage and can tell their tell their care providers, hey, don't wait, don't do this. I don't know how a hospital works. I'm just thinking, surely there's somebody who can say, hey, we're going to feed our patients food, that's actually good for them, we're not going to beat them this crap, or is that a problem?
Dr. Philip Ovedia 21:11
Yeah, you know that that is a problem, because most physicians, most hospital administrators don't recognize that that food that they're serving is actually contributing to their patients being unhealthy it is accepted. For the most part that the US dietary guidelines are supporting are the healthy way to eat. This is why I'm on the mission that I'm on. We need to change these fundamental beliefs, if we're going to make any advance.
Jack Heald 21:47
Suppose there was a doctor who did say that, who knew that I mean, like you are you able to, to dictate what your patient can or can't eat, when they're sitting there in the hospital, is that something that you have the authority to do?
Dr. Philip Ovedia 22:01
I'm not, not to the extent that I wish I did I can order. You know, and so there is a certain menu of choices that I have, when I'm ordering I don't order the food for my patients, but I did I do put an order in as to what type of diet they should be on. And there are some types of diets that are served within the hospital, that are supposed to be designed to support different health conditions. But again, the prevailing thought in medicine is that patients with heart disease should be on a low fat diet. So, the heart healthy diet, is a low fat diet, which therefore has to be carbohydrate diet, they don't really have a low carb, what I would consider to be a low carbohydrate dietary option in most hospitals.
Jack Heald 22:58
What you're telling me is that they the hospital, cafeteria, the people who provide food, I don't know what to call it in the hospital, just give you a couple of choices from column A, and a couple of choices from column B. And that's just the way it is.
Dr. Philip Ovedia 23:18
Right? Because again, they have to the food that they serve has to be within the framework of the US dietary guide. So, there's a little bit of leeway in in some of the things you can have a little bit more salt, or a little less salt, you can have low fat versus kind of lower fat or the standard sort of low fat dietary guidelines meals, but for instance, I couldn't order meals that mirror the way I eat in the hospital.
Jack Heald 23:54
And it's just simply not an option,
Dr. Philip Ovedia 23:57
it's simply not an option and a little bit of another sort of inside information, I guess, that I'll give out is I don't eat in the hospital, I do not go to the if my only choice is eating from the hospital cafeteria, because realize that the employees and the visitors are getting served the same food patients are like, and if my only choice is eat in the hospital, we're not eat, I don't eat I fast. And that's one of the that's one of the advantages of my sort of metabolic health. lifestyle is that I can fast for the 12 hours or 16 hours that I might in the hospital, hey,
Jack Heald 24:46
Okay, I'm slowly becoming your convert, and I don't mean this facetiously. I've been suspicious about the medical establishment for a long, long time. I am now understanding more of why I have to take care of myself. The thought of actually having to go into the hospital to be taken care of. It sounds like that's a really not good place for most of the things that people end up in the hospital for. All right, I'm, I'm so depressed now I want to end this. Oh, okay, well, let's wrap this one up, doctor. Oh, I wish this was a happier one. But that sounds like the gospel of getting metabolically healthy has a tremendous amount of force and power behind it. Even if the medical establishment, the pharmaceutical companies, the food companies, and the education. institutions are arrayed against us.
Dr. Philip Ovedia 26:00
Yeah. And to sort of wrap it up on a more positive note. No, physicians as individuals are not aiming to harm patients. They're unfortunately stuck within this. Yeah, but more and more there are physicians like myself who are coming to realize these things, and coming to realize that there are better ways to take care of their patients. And we are trying to push for the changes that need to occur to get this system. more focused on keeping people healthy, keep people healthy.
Jack Heald 26:39
Well, I want to remind our listeners, that D. Ovedia has a telemedicine practice as well. You don't have to have a heart attack or need a quadruple bypass in order to have his care. Go to his website OvediaHeartHealth.com and just check it out and start yourself on the road to metabolic health. I've started that myself and darned glad I have. Thank you, doctor.