"Nature's Masterpiece" Cover Art by Basia Jenkins, M.D.

VOLUME 5 | 2021 2021: THE YEAR WE OVERCOME

WWW.PHYSICIANOUTLOOK.COM PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS

Cover Art Created by Basia Jenkins, MD

F R O M T H E P U B LIS H ER

Embracing Discomfort START BY LISTENING

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Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.

he most important piece you will read in this month’s issue is the one written

by Jade Robey. This impressively mature high school student plans on following in her mother’s footsteps to become a physician. In her eloquently written piece “Lost,” Robey puts into words the disconcerting feelings that so many of her generation have experienced during the isolating phase of the pandemic. She lost an important year of her life but gained a perspective that many of us have yet to realize. She remains undeterred in her conviction to become a healer. It is for the future of medicine that Physician Outlook exists. We need more “Jades” in the world.

The rest of this issue of Physician Outlook is full of content that purposefully challenges you to question the “status quo,” to make you squirm, challenge your assumptions, re-frame your mindset.

As a physician turned publisher, I have come to understand that the only way we can meaningfully solve problems in healthcare is by first listening, and then understanding one another’s perspectives.

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Eric Starkman’s use of this provocative title for his article “ The Dangers and Deceit of MD Lites” could be construed as a form of “click bait” that was likely intended to entice the unsuspecting peruser to read his article. It worked for me.

“MD Lite” is not a ‘sweet’ sounding term for the members of the healthcare team currently known as Advanced Practice Providers (APPs), who were formerly called ‘mid-levels’ or ‘physician-extenders’ (both of these terms are now considered derogatory). I personally prefer the term “Non-Physician Provider,” or “NPP,” a term that I first learned of when I became a dues-paying member of Physicians for Patient Protection.

APP’s include Certified Registered Nurse Practitioners, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, and Physician Assistants.

I came across Starkman’s amazingly refreshing website precisely because of the title, and while I do not condone nor use that particularly sensationalized term of “MD Lite,” I sincerely appreciate the fact

that a layperson such as Mr. Starkman “gets it” and is doing his part to unabashedly educate the public.

Changing one’s title to “Physician Associate” from “Physician Assistant,” or using one’s non-clinical ‘doctorate’ (PhD or DNP) to identify oneself as a doctor to a patient is disingenuous, yet the practice is being promulgated by the administrative hospital and insurance “suits” and the influential powerful lobbying organizations that line their pockets. As we can all agree and attest to, Advanced Practice Providers are extremely important parts of the medical team, but they are not physicians. They don’t have the training of physicians, they did not go to medical school. It is downright deceitful to pretend that they are.

Follow the money

We are currently operating within a healthcare milieu that prioritizes saving or making money while paying lip service to patient safety. We reward C-suite executives (including physicians) with ridiculously gen-

“A rose by any other name would still smell as sweet.”

CREDIT BY IVÁN TAMÁS FROM PIX ABAY

-William Shakespeare

erous salaries and compensation packages.

We hide the fact that over 80 cents of every healthcare dollar spent in the US is spent on administrative overhead. The layperson likes to blame “the doctors” for over-ordering tests, prescribing unnecessary and expensive medications, missing crucial diagnoses, etc. but that is not the whole truth.

It’s complicated and crucial that we stop and listen to the brave whistle-blowers and honest reporters like Eric Starkman, who take complicated issues and break them down so that we can understand them.

One of my favorite whistle-blowers and noise-makers is Dr. Marion Mass, who Starkman recently highlighted, noting how “she doesn’t mince words about healthcare professionals who anger her, even if they work at big and powerful institutions.”

This issue contains her powerful article titled “Medicine’s Sell-Outs (Scrubs Gone Wrong),” where she bravely calls out the behaviors of some of the C-Suite doctors in “suits.” We physicians have plenty of ‘dirty laundry’ amongst our own ranks, includ-

ing the bullying highlighted by Dr. Adam Harrison in the article on his journey from physician to leadership coach.

Dr. Robert Pearl is another one of those doctors who has been brave enough to speak out about some of that soiled laundry in his latest best-selling book “UNCARING, How the Culture of Medicine Kills Doctors and Patients” (the inspiration for Alyssa Dean’s piece on the future of Public Health in the current issue). Pearl undoubtedly bruised the egos of more than a few physician colleagues by pointing out that the ‘prevailing physician culture often breeds a hierarchical sense of individual exceptionalism, heroism and invincibility, which often clash with the individual doctor’s sense of status and control.’ He also offers some solutions for what he believes the future of medicine should look like, and how we change that culture.

He recognizes the importance of preventive care and the role of the primary care physician, who has always been under-valued in our current culture of medicine. However, while Pearl’s Machevelian vision for “broadly available, prepaid, integrated, high-quality healthcare” sounds good on paper, we FIRST need to clean house and demand transparency about those currently in charge of the current healthcare cartel.

The collusive relationship between the layers of middlemen that stand between physicians and patients needs to be fully transparent before we turn over the keys to the castle to this “broadly available healthcare” that Pearl predicts will be the panacea for our ailing healthcare system.

We need some common sense to return to the practice of medicine. Patients need to be an essential part of the equation and taught the value of improving and maintaining their health to make sure that physicians and health systems do not get punished for their poor personal health choices. This will take decades and will involve much needed reform of agriculture and education policies that have ALSO perversely incentivized profit over the individual citizen. 1 It’s time to re-think EVERYTHING.

Unlock The Future Of Healthcare RESTORING THE RIGHTS OF PHYSICIANS AND THEIR PATIENTS. VISIT HPEC.IO TODAY!

Dr. Marlene Wüst-Smith Publisher

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Table Of Contents FROM THE PUBLISHER

Embracing Discomfort,

by Marlene Wust-Smith, MD/p.2 THE HUMANS OF MEDICINE

Rethinking Leadership in Medicine,

by Adam Harrison, MD/p.6 Rethinking Population Health,

by Alyssa Dean/p.10 T H E D O C TO R ’ S B AG

Medicine’s Sellouts - Scrubs Gone Wrong,

by Marion Mass, MD/p.14 Informed Consent and COVID-19,

by Craig Wax, DO/p.16 End Of Life Conversations,

by Joseph Shega, M.D./p.20 The Dangers and Deceits of MD-Lites,

by Eric Starkman/p.22 P L E A S U R E S A N D PA S T I M E S

Capitated Patients,

by Peter Valenzuela, MD/p.25 Lost,

by Jade Robey/p.26 Purple Potatoes,

by Roxanne Bruce/p.28

Cover Art Created by Basia Jenkins, MD WWW.PHYSICIANO U T LOOK . C OM | 5

T H E H U MAN S O F M ED IC IN E

Rethinking Leadership In Medicine

FROM PHYSICIAN TO LEADERSHIP COACH - MY JOURNEY Wri t t en by Ad am H a rri so n, M D

Introduction I graduated from St Mary’s Hospital Medical School, London, in 2000.

Twenty years later I became a certified life, leadership and executive coach. Why did I do this and why am I sharing this with you? I guess I wrote this piece in the hope that it may serve my fellow physicians in some way.

Perhaps you too have “suffered the slings and arrows” of working in toxic environments and are having thoughts of modifying your medical career or even quitting medicine completely. Well, I’m here to tell you that despite us being programmed by the system to remain physicians, there is no shame in having such thoughts, and in actual fact, acting on 6 | 2 0 2 1 VO LU M E 5

them might be the best thing you ever do for your personal well being.

My ‘origin story’ Like the Marvel heroes, we all have a ‘backstory,’ or ‘origin story,’ to use comic book parlance, and mine goes some way toward explaining why I transitioned out of clinical medicine just under two years ago.

I was born into a modest family; my parents were both working class people with a strong work ethic, not educated beyond high school level, but well-endowed with common sense. My maternal grandfather was a bright fellow, so between the various genetic inputs, I was blessed with an above average brain.

I passed my ’11 Plus’ exam (a British selective school entrance exam) and duly attended my local all-boys ‘grammar school’ (public schools where all the boys had to pass the 11 Plus to be able to attend) from the ages of 11-18.

For the most part I enjoyed school, but I did experience some of the bullying typical of same-sex schools in the UK, at different stages of my secondary school (high-school) career. In addition to this, my step-father was strict to the point of being intimidating at times, so I also experienced what might be considered bullying at home on occasion.

Medical school was generally really enjoyable; the only negative experiences of note were the infrequent dressings-down

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by old-school consultants (attendings) who believed in teaching by ritual humiliation, their theory being (if indeed there was one!), that if us students were embarrassed in front of our peers, we may not make the same mistake twice.

The working years As you would expect, the first few years in a hospital were pretty brutal.

Obviously the hours were extremely long and the work was, on the whole, pretty thankless, but the worst part was how I was treated by various surgical consultants.

You see, I had originally pursued a career in surgery, but unfortunately, a succession of jobs in cardiothoracics, or-

thopaedics, general / breast surgery and paediatric surgery, each with at least one apparently malignant narcissistic boss, put me off. It made me think that a career as a General Practitioner (Family Physician) might be more enjoyable as I’d have more clinical autonomy; at least that’s what I thought… my experiences as a GP trainee and then a newly-qualified GP did not support that notion!

As it happened, not all GPs were the friendly, helpful, ‘touchy-feely’ types I’d been led to believe; some were downright cut-throat small business owners who, it seemed to me at least, reserved their wellhoned kind and caring communication skills for their patients, not utilizing them in their interactions with colleagues!

My experience of workplace bullying I think I had my first taste of this particular flavor of colleague maltreatment when I was a house officer (intern), but I was too distracted by the death of my grandmother to pay it much heed at the time. During my junior surgical training program though, I experienced the hot-headed conduct of my consultants on a regular basis. From shouting at me on a ward round in front of 10-12 colleagues and several patients, to producing a dossier of anything I did which they felt was a minor transgression (and then summoning me to bawl me out about it), to being excluded from the OR due to not being on the official training program, to being cursed at over the phone, to being told I was irrelevant because I was only in the department for six months, I experienced most forms of unpleasant treatment at the hands of my bosses. But I was resilient; my early years had made me that way, so I could take it. I didn’t fold, I didn’t break down. I returned to work the next day as if nothing had happened. I didn’t forget, but I have learned to forgive.

The legal and leadership years After a fairly unhappy time working in general practice, I left clinical medicine to work for a medical indemnity (defence) organization, companies which insure UK doctors against medical negligence claims and assist them in responding to patient complaints and action taken against them by the regulators.

I had a primarily medico legal advisory role, but I found this quite frustrating as I became very interested in the legal side of my cases - we had to hand them over to the lawyers when they became particularly meaty, so off I went to law school.

Three years later I qualified as a barrister (a type of lawyer in the UK who mainly advocates for clients in court) but for family reasons I never practiced.

Instead, I used my law qualification to do advisory work for medical organizaWWW.PHYSICIANO U T LOOK . C OM | 7

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tions and this led to me being appointed to medical leadership roles.

It was while I was an assistant medical director that I had a series of leadership coaching sessions and fell in love with the idea of being able to have a more positive impact on the world as a coach than I would if I just practised clinical medicine. This heralded my latest (and possibly final!) career move, into the world of coaching.

A happy ending It didn’t really occur to me that there was a bright side to the conduct I was on the receiving end of all those years ago until quite recently. I was a tutor for some indigenous medical students in Australia last year and one of them came to me for some advice soon after starting her first ever clinical placement. She described being publicly shamed by her consultant in front of the entire medical team she was on after presenting her first ever patient as a student. Her sad story brought the feelings I had experienced as a victim of bully8 | 2 0 2 1 VO LU M E 5

ing flooding back and it was then that I decided I could no longer stand by and watch this happen.

I was training to be a coach at that time and, when I completed my training, I started to look into toxic leadership coaching and now I am committed to doing what I can to help doctors who are suffering the effects of working in a toxic environment (or who are being bullied), develop the skills to successfully deal with their situation, so they can be happier and more successful at work.

My experiences of working within poorly-led, often toxic environments, have also fuelled my desire to work with the medical leaders and healthcare executives themselves to enable them to promote positive cultures within both their immediate teams and wider organizations.

In closing I would like to end this article by reassuring my physician colleagues that: (a) There is nothing wrong (and possibly quite a lot right) with contem-

plating a career change, despite what the establishment has drilled into us through our undergrad and postgrad training; and, (b) There is no shame in being bullied, you are not to blame and you are not alone. You can also learn how not to take it personally, how not to let it affect your confidence and how to become more assertive so you can take the conversation to the perpetrator and call it out.

These and other techniques to successfully overcome the sequelae of bullying will appear in a future article for Physician Outlook magazine. 1 If you would like to learn more about my work or reach out to me for my support, please contact me at: dr.adam@coachingmentoringdoctors.com https://www.linkedin.com/in/ dradamharrison/ https://www.facebook.com/ coachingmentoringdoctors Twitter: @FutureExecCoach Clubhouse: @dradamharrison and ‘HighPerforming Physician’ (Co-founder) YouTube: Dr Adam, Physician-Coach

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T H E H U MAN S O F M ED IC IN E

Rethinking Population Health WITH HIGHLIGHTS FROM UNCARING

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Wri t t en by A l y ssa D ea n

e’ve heard it a million times— the U.S. spends more than 20% of their GDP on healthcare, and our population has a lower life expectancy and worse health outcomes than any other high-income nation. So, what are we doing to fuel this disparity?

We are applying our energy to the debate orchestrated by politicians on how to pay for healthcare. We’ve been doing this for years and we are all OVER it. As we are in an era where people can cultivate change as a collective and collaborate more than ever, now is the time for us to rethink about what we are missing in our healthcare — patient education, active participation, and self advocacy being major topics in particular.

One man very eager to move medicine with his book, Uncaring, author Dr. Robert Pearl accentuates the shortcomings of our healthcare system due to the 1 0 | 2 0 2 1 VO LU M E 5

passed down social characteristics of the physician culture—the set of beliefs and norms that are expressed by physicians.

Dr. Pearl is a board-certified plastic and reconstructive surgeon, currently a clinical professor of surgery at Stanford University and faculty member at Stanford Graduate School of Business. He was also the leader of Kaiser Permanente for over 18 years— one of the longest standing integrated managed care systems in the US. I think we can conclude that he doesn’t lack the credibility to speak out.

With his experience, his passion for transforming our healthcare system is unique in a way, as his perspective combines the business side of our healthcare system with the insider knowledge of clinical care as a physician. In Uncaring, Dr. Pearl provides personal, heartfelt stories to further demonstrate the internal discrepancies of our healthcare systems.

He allows us to see the subtlety of how the issues of physician culture manifest in reality.

This book is his way of awakening not only physicians to their own harsh realities, but for patients to understand how to ignite change on their own level as he believes it will help push the culture of medicine and healthcare in the right direction—patient centered, value-based, and team oriented.

Like Dr. Pearl, I too have a unique perspective. Although instead of having the physician or business perspective, it is as a patient and with a public health viewpoint. Academically, I have been conditioned to analyze the health of people and their community, evaluate their resources, and examine their behaviors in order to implement the best courses of action for improving their health. From my perspective, it is not only the resistance to

change on the part of the physicians imbedded in the culture of medicine or the business model of the healthcare industry that is hindering our transformation, but rather it is that we are simply not applying these learned public health concepts to disease management on an individual level. Is there a way for healthcare and population health to come together?

Implementing healthy community approaches relies on the understanding that environments and systems influence health behavior, and that social determinants of health influence a person’s life and are the force that drive health outcomes. Simply stated, a public health perspective provides the ability to understand the environmental dimensions that make up an individual or community. Analyzing the neighborhood and built environment, health and healthcare accessibility, social and community

context, education level, and economic stability allows us as public health professionals to see a person’s story and recognize why they are the way they are, and why they do the things that they do— making it easier to identify what needs to be done to activate behavior change to improve their health, and their life.

Concepts such as these are what public health professionals have been using at the population level for so long, but what we have yet to successfully accomplish is to bring these concepts down to the level of the individual. The key to creating cultural change at the community level—starts with changing the behaviors of an individual. How do we change behavior? By understanding someone’s circumstances, and this brings up many challenges for those of us who approach issues from the Public Health framework.

I want to put this into perspective for you. Let’s take Bob, who has diabetes for example. Applying a public health approach would look like: Does Bob have access to healthy food? Does he shop at Dollar General because he is low income? Does he have transportation to get to the grocery store?

How is Bob’s health literacy on the subject of diabetes? Does he know how to check his blood glucose, really? Does he even know what diabetes is?

A physician doesn’t typically have the time to examine these factors, or coordinate alternatives. They look at the diagnosis, diabetes, and tell the patient, “you need x to help it.” The physician culture (in a nutshell) is that they are the most unwilling to change this. However, Dr. Pearl’s placement on these failing social characteristics only go so far. It is my belief that what is worse isn’t their inability to change, but the fact that we’ve come so far in taking health care away from the individual. What we are lacking now, is the people to fill this gap. This doesn’t mean Pearl didn’t find a devastating issue within our healthcare system, he most definitely did, but just as important is the lack of self-sufficiency we as patients possess.

Let’s take a look at public health from the 1980s to the 2000s—a time that was referred to as the era of Health Promotion and Disease Prevention that focused primarily on individual behavior and disease detection in populations. The action framework for this time placed more emphasis on individual control of decision making, and when examining CDC data, heart disease was falling from the 80s to 2000s. Today, it is starting to rise again. Is our new focus away from individual heath a contributing factor? Being self-sufficient in your own health is almost a taboo subject to consider today as we’ve become so dependent on the authority of physicians, government entities and the emphasis placed on the efficacy of pharmaceuticals — none of which actually help change patient behavior.

Heart disease is our nation’s number one cause of death and kills more than 600,000 Americans each year. What is WWW.PHYSICIANOU T LOOK . C OM | 11

being done to change this? Who is to blame? Pearl places blame on the cardiologists for not accommodating patients at all hours and that it is the delay in care that puts patients at higher risk for death.

Others blame the fact that medications need to be more affordable and accessible.

I blame the lack of education that people have in order to make different lifestyle choices. I blame the lack of compliance with a steady medication regime. Most importantly, I blame the lack of ability people have to engage in managing their own health, like using a blood pressure monitor to make sure it is within normal range or knowing healthy food alternatives that’ll help make them feel better.

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This lack of education is what is referred to as health literacy--the capacity of an individual to understand basic health information and services to make appropriate health decisions. Individuals with low health literacy, like described above, lack the skills and are in need of just basic health education to understand and retain medical information, understand their illness and how to prevent a future recurrence, be active in self-care and medication regimes, and engage in follow-up treatment. Did you know that one’s health literacy is directly linked to their health outcomes?

I know physicians do not consider this, as they do not take the time nor have

the time to educate. I know Dr. Pearl would agree.

Today, nearly 36 percent of adults in the US have low health literacy and a majority of them are considered lower-income. If we continue with the way we are doing things now, what will happen in our future? Bridging the gap between public health concepts and healthcare can be done, but we need more collaboration at the most primary level with professionals who pick up the slack of what is not being done—health education and the guidance of being active in your own care.

Fundamental to the future of healthcare is adoption of new pathways where health educators and health coaches are given TRUE power to improve overall health outcomes and activate patient autonomy. With 70-90% of the most prevalent chronic diseases being due to poor lifestyle choices, adoption of a teambased approach that effectively engages patients and the community at large in sustained behavioral changes is what is needed. Building strong partnerships between community-based organizations, hospitals and health systems, and local health departments will help communities cultivate healthy changes on a much broader scale.

Imagine—patient education workshops with health educators and health coaches guiding patients to a state of self-care disease management with the collaboration of a primary care physician leading the team. With this effort, we have the ability to bring back patient autonomy, prevent a heart attack, and take pressure off of our overworked physicians all while lowering healthcare costs and creating a stronger return on investment for not just communities, but the country.

Hey, Dr. Pearl. We hear you. Physician culture needs to change, but we also need health coaches as part of the medical team, as well as tools to make patients more engaged and active in their own healthcare. It is only then that we can create a truly organic, sustainable and affordable healthcare system. 1

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T H E D O C TO R’ S B AG

Medicine’s Sellouts SCRUBS GONE WRONG

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Wri t t en by M a ri o n M a ss, M D

ne critic of the Bucks County Courier Times Guest Opinion on Feb. 18, “American health care’s staggering administrative overhead” correctly pointed out that there is more than one driver of the relentlessly escalating costs in our system.

For this fifth installment of our series, our sick healthcare system and how to heal it, originally published Bucks County Courier Times on May 21, 2020, I air dirty laundry about my own profession — our ranks are riddled with sellouts, some of whom have abandoned their scrubs to become corporate leaders of our system’s dysfunction and accessories to its escalating costs.

Most physicians entered the field and remain in their scrubs to care for patients.

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Some, still in their scrubs, have lost their way and exploit weaknesses in our third-party payer system for their own gain. “Sellouts” is not too harsh a term for them. Their behavior has bred distrust, making the work of more-honorable scrubs harder.

In his book, The Price We Pay, Dr. Marty Makary of Johns Hopkins discusses physicians who over-test and over-treat to make a buck. When thousands of physicians were surveyed for the book, they estimated that 11% of all procedures were medically unjustifiable.

Some physicians have become enthusiastic shills for the pharmaceutical and medical device industries. According to data assembled by ProPublica, the average remuneration from these

industries for all physicians is $3,400.

Most fall far below that mark; but the average is pulled upward by 700 who take in more than $1 million each year, and by approximately 1,000 others who are each paid more than $100,000 annually to tout products.

During the COVID-19 crisis, the behavior of two ex-scrubs, executives in the Mount Sinai Health System in New York, exemplified the sellout’s mentality. In 2017, they had received eye-popping compensation packages; but as the pandemic of 2020 exhausted and demoralized the scrubs inside their hospitals, the infamous two retreated to the safety of Palm Beach, Florida.

Sellouts are found also in powerful, well-heeled advocacy organizations.

Many Americans may think of the AMA as the policy voice for most physicians. That ceased to be the case long ago. The percentage of physicians aligned with the AMA has declined drastically — at best, it is somewhere around 15% of all American physicians.

The record will show that the organization’s executives stopped representing the interests of the rank and file some time ago.

The public would likely be far more interested to know that the AMA is also a moneymaker through the royalties it collects for the coding system physicians must use to identify ailments and therapies when communicating with insurance carriers. The AMA’s prosperity is thus directly linked to that of the health insurance industry.

As of late 2019, it was reported that the AMA’s top dog is paid in excess of $2 million annually.

Another organization purporting to speak for physicians is the Federation of State Medical Boards, which bills itself as “representing state medical boards in the legislative, policy development and spokesperson arenas.” The FSMB “urges state legislatures to provide... adequate resources to properly discharge their responsibilities and duties.” In other words, the FSMB leans on statehouses (by extension, the taxpayer) for more money. The FSMB’s head, Dr. Humayun Chaudhry made over $816,000 in 2017. His customary workload for the FSMB is three hours per week.

Yes, medicine’s sellouts, the “scrubs gone wrong,” are another of those driv-

Sellouts is not too harsh a term for them. ers of the high cost of American healthcare. But in putting a spotlight on them, we must not forget that they are merely part, and not even an especially large part, of a complex web of relationships that have developed over the decades to feed a system that is only coincidentally concerned with the care of the sick.

The sellouts’ colleagues should call out the bad behavior. It has poisoned the public’s trust while contributing to the dysfunction of a deeply troubled system. 1 Marion Mass, M.D.; Bucks County pediatrician; co-founder, Practicing Physicians of America.

Member of this Bucks County Courier Times editorial board. No conflicts of interest.

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T H E D O C TO R’ S B AG

Informed Consent and COVID-19 DO NO HARM

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Wri t t en by C ra i g Wa x , D. O.

To vax or not to vax,” that is NOT the question. The real question is do you have the opportunity to exercise informed consent and an individual right to choose. In other words, patient-centered medical ethics demand that you have the right to understand and choose each unique intervention separately based on its own merits and risks. This especially and urgently applies to COVID-19 treatments and mRNA and DNA experimental interventions. Without knowl1 6 | 2 0 2 1 VO LU M E 5

edge, understanding and acceptance, there can be no informed consent. It is my observation that there has been neither full disclosure nor true informed consent with regard to this experimental medical intervention being called a vaccine.

Hippocrates of Kos, the legendary Greek physician, born 460 BCE, was one of the earliest physicians who taught “medical beneficence,” the Hippocratic oath and to put the patient first and to “do no harm.” His

work, teachings and writings inspired informed consent, which empowers patients with complete decision-making authority.

In 1947 following World War II, the Nuremberg Military Tribunal established and ratified the Nuremberg Code. The trial found that the Nazi government, under Adolph Hitler, instituted a policy of conducting clearly cruel and unnecessarily painful experiments of dubious scientific merit on non-consenting prisoners like

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Jews, poles, gypsies, homosexuals and the handicapped. Part of the verdict defined “permissible medical experiments,” cemented the foundation of Informed Consent and began international jurisprudence and biomedical research ethics for the modern age.

In the early days of WWII in 1940, the US FDA, at the time a relatively new agency, approved a drug called DES, diethyl-sylbesterol, a syntheric form of the female hormone estrogen, for the indication of preventing

miscarriage, premature labor, and related complications of pregnancy. At the time, and for years, it seemed to be effective and safe in pregnant women.

However, by 1971, more than 30 years later, it was clear to researchers that the daughters of women who used DES were at a 40x greater risk of developing cancer of the cervix, uterus and vagina.

Prescriptions came to a screeching halt, regulations were passed by FDA against use of the drug, and the lawsuits continued for a generation. This

is only one example of how our regulatory agencies have rushed to judgment and been wrong before.

Now, in mid-2021, at the tail end of the global viral pandemic of COVID-19, government, politicians, corporate entities, higher education institutions and media entities, empowered by FDA emergency use authorizations, are overwhelmingly endorsing, and even mandating, COVID-19 mRNA and DNA interventions. Sadly, we may have hyperspaced back to WWW.PHYSICIANOU T LOOK . C OM | 17

1940, erased formal medical informed consent, along with your right to choose.

I know a 31 year old man whose wife was pregnant for the first time; an exciting, stressful and pre-joyous event. She was encouraged by CDC, media and her obstetrician to get the COVID-19 mRNA intervention during her first trimester. The first Moderna shot was minimally noticeable except for fatigue. The second shot was at 12 weeks of pregnancy. Three days later, an ultrasound revealed the fetal heartbeat had stopped. They got the devastating news that they now had to have their nonliving child-to-be removed by surgical procedure… traumatic. No one can say for sure whether the mRNA shot did or did not end this baby’s life, but the timing is suspicious, and should be raising red flags, cause for concern, and further investigation.

It’s curious that the government does not seem interested in these critical questions when it comes to protecting public health, if that is indeed their true intention.

Correlation does not always mean causation, but all these events should be reported to the CDC’s Vaccine Adverse Event Reporting system, known as VAERS. Was the loss of the pregnancy reported to the injection clinic or VAERS directly? No. Most people, in addition to not getting all the facts necessary for true informed consent, are not instructed to report all side effects and observations to the clinic or VAERS. It has been reported that only 1-10% of potential side effects of any drug or procedure ever get reported at all.

Every medical drug, modality or procedure has risks, benefits, and alternatives that must be disclosed for the individual patient to consider. Not only has this not been done for these mRNA and DNA interventions, but colleges and universities have joined the chorus of government, politicians, corporate entities, and mass-media in promoting only the perceived bene1 8 | 2 0 2 1 VO LU M E 5

fits. Billboards in Atlantic City promoting the vaccines tout “Safe, effective and free.” Other states are even offering financial rewards to patients who are vaccinated. The truth is that government incentives are a moral hazard. They not only are paying for the vaccines with taxpayer dollars, but are committing such moral hazard by subsidizing, advertising, endorsing and even buying the favor of injection, like in the Maryland and Ohio vaccine lotteries.

With all the overreaching federal and state government unconstitutional arm-twisting and threats, informed consent is not possible. It is contrary to informed consent to tell you that your family can’t be together, visit elderly relatives or celebrate holidays until you’ve been “vaccinated.” This arm-twisting is immoral, unethical and illegal when it comes to medical procedures authorized only for emergency use, particularly in cases with completely new and experimental technologies. These tactics are, in fact, forms of coercion and extortion.

Independent physicians are finding success with inexpensive home treatments that work against COVID-19 when started early. The government-media complex completely ignores early treatment, natural immunity by exposure, and herd immunity, even to these final days of the pandemic. They often attempt to block and discredit such treatments, often referring to them as “misinformation.” Experimental mRNA and DNA vaccines such as these would not otherwise be able to obtain emergency use authorization were these treatments to be validated, acknowledged, and available.

Young college adults have miniscule, literally one in a million, risk of serious hospitalization from COVID-19. It is up to you and your teen or young adult to decide if the increasingly clear health risks from the experimental vaccines are worth the minimal benefits. Those with previous COVID-19 history have a ten-fold

Mandates, enticements and inducements are illegal, immoral and un-just... risk of side effects and complications if they get the vaccine. As of today, per colleagues Dr. Peter McCullough at Baylor and Dr. Harvey Risch at Yale and myself, giving these vaccines to those with previous COVID-19 is contraindicated, that is not to be done.

Emerging data and experience contraindicates the FDA’s emergency use authorization.

Let me reiterate. It is not vax vs anti-vax, but mandates and coercion vs. informed consent and individual choice. Mandates, enticements and inducements are illegal, immoral and unjust, in the grand scheme. We must say NO to mandates and yes to informed consent and individual choice.

Here’s what YOU CAN DO right now: All colleges and universities have a posted policy of individual exemptions for their edicts. Please pursue individual medical exemptions and religious exemptions with each school in writing. Use the media, social media and your voice. When that fails, submit an appeal with physician or clergy consultations. If they resist, then talk to legal representation and initiate state and federal lawsuits, with the warning of class action if relief is not immediately granted. This will get their attention. Colleges and universities are aligning against students’ and parents’ individual rights, inappropriately acting as arms of the pharmaceutical industry and government when their focus should be on providing students with mechanisms for principled debate and quality education. We must hold them accountable, individually and together.

Our youth depends on us. Let’s lead by example!

Based on a speech given April 21, 2021 at Rutgers University - New Brunswick, NJ. “Say NO to Mandates!” Rally 1

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T H E D O C TO R’ S B AG

End Of Life Conversations

OUR PATIENTS ARE READY, ARE YOU?

T

Wri t t en by J o s eph S hega , M . D.

he SarsCoV2 pandemic may have forever shifted the way we work, where we live, and how we think about our bigger-picture values and priorities. As we’ve grappled with the reality of losing more than 600,000 lives in the U.S. alone, it’s also forced a collective reckoning with our own mortality.

According to a 2020 nationwide study commissioned by VITAS Healthcare, more Americans, particularly young Americans, are thinking about their wishes and values when it comes to endof-life care. That shift makes sense. One in five people surveyed reported having someone close to them who became seriously ill or died since the pandemic started and did not know what their loved one’s end-of-life wishes were. Additionally, while the majority of respondents (69%) acknowledged that talking about end-of-life planning is important to them, only slightly more than half (56%) had actually discussed their end-of-life 2 0 | 2 0 2 1 VO LU M E 5

wishes with others. Though more than a quarter (29%) said the pandemic had increased their likelihood to write down their end-of-life wishes, this didn’t necessarily translate into action.

What’s more is that nearly a quarter of people surveyed (22%) said they expected their healthcare professional to initiate the dialogue. In other words, our patients are increasingly open to having these difficult, yet essential, conversations.

They’re waiting for us to break the ice.

Starting the Conversation We know that many patients avoid conversations about death and dying.

Frankly, they’re not the only ones.

According to a 2018 study published in the Journal of American Geriatrics Society, 99% of physicians agree that endof-life conversations are important, but most of us (71%) report we don’t have

the formal training to adequately equip us for this crucial moment in a patient’s care journey.

Fortunately, keeping a few strategies in mind will help both you and your patient approach this important conversation with trust and relative ease.

Offer compassionate curiosity.

Open-ended conversation starters are a great way to naturally steer toward endof-life planning. Consider opening with, “How has your health changed over the last year?,” “What matters most when you think about your health and what you want out of your care?,” or “What does a good day look like for you?”

These conversations also offer great opportunities to learn about a patient’s cultural identity, including their religious beliefs, traditions and rites surrounding death. A simple question reveals so much: “What does comfort mean to you or your loved one?”

Lean into listening.

We all tend to have preconceptions and biases about a patient’s ethnicity, age, national origin, gender, sexual orientation, or religion. Of course, no healthcare professional wants to feel ignorant, incapable, or imposing—especially during such a difficult period in a person’s life. Limit your assumptions about how these factors affect a person’s preferences for care. Instead, use your existing knowledge to ask better questions.

Then incorporate the answers into your care of the patient and their family, demonstrating that their needs and preferences are heard.

Here, it’s important to practice reflective listening. Confirm you really hear what they’re telling you by repeating back their words: “I hear you saying that what’s most important to you is…” Show them you’re picking up on non-verbal cues that may signal their emotional reaction to the conversation, too – “I can see you’re distressed about this. Do you need a moment before we talk a bit more about what this means?”

Bear in mind that the needs of the patient and the needs of the family may differ, requiring increased sensitivity when discussing care options. Recap the discussion before aligning on any next steps.

Do your homework.

Once you better understand who your patient is and have identified their care preferences, do some additional research.

Consider how their generational status may intersect with their national origin or ethnic community. If a patient grew up overseas, explore the regional politics and major events of the time to understand their perspective more fully.

For instance, those who grew up in Vietnam may still be thinking about endof-life in the context of Communism. Because they didn’t have hospice care, they may be unfamiliar or even distrustful of the concept and explaining it in a way

that’s clear – and giving them the opportunity to ask questions – can help demystify or destigmatize end-of-life care.

Again, avoid making assumptions, no matter how well-informed or well-intentioned you are. With a little research, it’s easier to anticipate and address issues before they arise. Plus, your knowledge can help a patient feel confident in what they might otherwise see as a risky decision to elect hospice care.

Seek support when you need it.

If you’re facing a language barrier, it’s best to enlist the support of a translator service to make sure your message is getting across clearly, accurately, and with appropriate cultural sensitivity. If a patient seems hesitant to discuss certain needs with you, consider inviting another member of your team to be present during a visit. In some cases, patients may be more willing to open up to someone who feels familiar to them. You might even reach out to a local medical association or cultural organization for guidance.

It’s okay to ask for help if you feel overwhelmed – or even just uncertain.

Your Next Move Every patient is different, and there is no one-size-fits-all approach to end-oflife care. However, these strategies will help ensure you have a meaningful and productive dialogue. When that happens, your patient feels they are an active and informed participant throughout the planning process. Giving patients a voice – and demonstrating that we hear them – is vital as we support them on their care journey while they are healthy, and ultimately when the time comes to refer them to hospice or palliative care settings. 1 PHOTO CREDI T: JOS EPH S HE GA, M.D

P HOTO BY TIMA MIROSH N IC H E N KO F ROM P E XE LS

Ask patients what they would like to know and invite their permission to share more – “How much information about the progression of your disease would you like to hear?” Also appreciate the value of strategic silence so the patient can process the conversation content and corresponding emotions.

These dialogues might also provide insight into a patient’s home life and their family’s values. For example, in most Asian cultures, adult children often feel obligated to keep their aging parent at home and provide all the care they need.

This is a chance to explain how comfort-focused hospice or palliative care can support their caregiving relationship, especially as a patient’s symptom management needs intensify.

The key is to have these conversations early, non-judgmentally and regularly over the course of the patient’s illness to help everyone – the patient, their loved ones, and even you – feel more comfortable

with and confident about the subject at hand. When we speak about things routinely, they begin to feel more routine.

WWW.PHYSICIANOU T LOOK . C OM | 21

T H E D O C TO R’ S B AG

The Dangers and Deceit of MD Lites NO SUBSTITUTE FOR EXPERIENCE

W

Wri t t en by Eri c S t a rk ma n

hen I was a cocky young reporter fresh out of journalism school, I complained to my father that my editor at the Toronto Star was an idiot. My father, the senior partner of an accounting firm, wasn’t interested in having me elaborate.

“How long has your editor worked at the Toronto Star?” my father asked.

“He’s been there about 10 years,” I said.

“How long have you been a reporter at the Star?” my father asked.

“Six months, but,” I stammered.

“No buts,” my father interrupted. “Your editor has been at the Star 10 years and you’ve been there for six months. Your editor may be an idiot, but he still knows a lot more than you.

There is no substitute for experience.”

That conversation with my father played in my head the entire time I read, Patients at Risk: The Rise of the Nurse 2 2 | 2 0 2 1 VO LU M E 5

Practitioner and Physician Assistant in Healthcare. Though my own experiences with physician assistants had already enlightened me to avoid them, Patients at Risk made me angry as it drove home just how deceitful and corrupt U.S. healthcare has become.

The deceit are the studies purportedly showing that NP and PA patient outcomes are statistically the same as medical doctors. According to Niran Al-Agba and Rebekah Bernard, the MD authors of Patients at Risk, all of the studies involved NPs and PAs who worked under the supervision of doctors.

The authors insist there are no credible studies evaluating patient outcomes involving NPs and PAs working without medical supervision, which they are doing with increasing frequency.

The corruption is that hospitals and other healthcare facilities are increasingly foisting NPs and PAs on pa-

tients without patients knowing it. The trend in healthcare today is to refer to everyone who interacts with patients as “healthcare providers” and they all wear white coats. At some hospitals, even the orderlies and housekeeping staff wear white coats, so it’s impossible to distinguish the real doctors among the white coat brigades.

Nurse practitioners and physician assistants aren’t real doctors. They can’t, don’t, and never will provide comparable medical care. They’re MD Lites – Less training. Less knowledge. Less skills.

Common sense dictates that NPs and PAs cannot perform at the same levels as doctors. It takes 10 to 14 years to become a licensed physician in the U.S. Doctors aren’t allowed to diagnose, treat, or prescribe independently until they have racked up 15,000 to 16,000 hours of clinical training. Even with all this prior training, studies show that it

IMAGE BY EN RIQU E M E SE GU E R F ROM P IX A BAY

takes an additional 10 years of experience for cardiologists, endocrinologists, and internists until they are statistically more likely to make the correct diagnosis than their counterpart specialists with less experience.

NP and PA training education programs aren’t uniform across the country, so patients don’t even know how many years of training their NP or PA provider has, but it’s a fraction of what licensed physicians have. NPs and PAs undergo less than 1,500 hours of clinical training, some getting licensed with as little as 500 hours. There are NP schools offering 100 percent of training online and they guarantee acceptance of all applicants. Medical schools have about a 40 percent acceptance rate. Call me a snob, but when it comes to my healthcare, I want a doctor who had the elite smarts to get into medical school, preferably one in the top tier.

Rebekah Bernard Hospitals and other healthcare businesses love NPs and PAs because they can pay them less, but bill insurance companies at nearly the same rates as doctors. Another benefit is NPs and PAs order more tests and prescribe more drugs than physicians, so — Ka-Ching!

— they deliver ancillary profits. U.S. hospitals increasingly are being run by ethically challenged MBAs and accountants who regard patients as ATM machines, not humans deserving of quality medical care.

Al-Agba and Bernard dedicate their book to a 19-year-old elite athlete and straight-A student named Alexus Jamel Ochoa-Dockins, who likely would be alive today if she hadn’t been misdiagnosed by a nurse practitioner at Mercy El-Reno Hospital in Oklahoma.

The authors walk you through the misdiagnoses and treatments Ochoa-Dockins received after she arrived in an ambulance complaining of chest pain. They explain why the NP so widely missed the mark, and the legal case that ensued. The authors educate readers about the thought process doctors employ when making their diagnoses and how it differs from NPs and PAs. I found it quite fascinating. I also found it fascinating that NPs and PAs aren’t held to the same legal standards when their misdiagnoses result in injuries or death.

Juries are instructed that the standards of care expected of physicians don’t apply to NPs and PAs. Funny how the faux physician industry isn’t demanding equality when it comes to malpractice claims.

My first experience with a physician assistant was at Stanford Health in Palo Alto. My appointment was to see an accomplished specialist who trained in the US and UK and had seen me previously.

The hospital bait-and-switched me, but as I perceived Stanford as only offering first-class care, I didn’t object.

The PA cavalierly prescribed me a drug without addressing my concerns about possible side effects. I was alarmed that she didn’t check with the specialist before prescribing the drug. I went online

Nurse practitioners and physician assistants aren’t real doctors. They can’t, don’t, and never will provide comparable medical care. and found that while the drug was most commonly used to treat my condition, in a very small population the drug was known to trigger a virulent cancer. My Stanford primary care doctor spent considerable time explaining to me the pros and cons of the drug, and I opted not to take it.

Worse Pills, Best Pills, a watchdog publication following the prescription drug industry, several months ago prominently listed the drug on its “Do Not Use” list. As an aside, I saw another specialist who put me on an alternative drug that hasn’t caused any side effects since I began taking it years ago.

As an example of the benefits of seeing an experienced doctor, about a year ago I went to see a physician at One Medical about a foot problem. The doctor, with decades of experience, observed something else about me that gave her concern and chose to focus on that. At One Medical, doctors are required to rigidly adhere to a schedule and my allotted time was 15 minutes. The doctor made a decision that proved to be correct – she treated the medical condition needing the higher priority. My foot problem curiously went away.

One Medical relies heavily on NPs and PAs, and I’m doubtful that had I seen one they’d have the experience to sway from the medical issue I came in for. In fact, I’m doubtful that doctors in the early stages of their careers could make such bold medical decisions. One Medical has grown aggressively since I joined the company years ago and the ratio of doctors to NPs and PAs seems to have widened since then, which worries me. That said, One Medical still attracts some top-flight doctors who did their residencies at top-tier hospitals. (More on my experiences with One Medical can be found StarkmanApproved.com.)

WWW.PHYSICIANOU T LOOK . C OM | 23

This article was re-published with permission from the author, Eric Starkman. It first appeared on his website www.StarkmanApproved.com and on LinkedIn. 2 4 | 2 0 2 1 VO LU M E 5

P HOTO BY KL AUS N IE LSE N F ROM P E XE LS

Patients at Risk opened my eyes to some other issues.

I’ve always perceived the Robert Wood Johnson Foundation, the largest health-focused philanthropy in the country, as a pristine organization. Robert Wood Johnson was the founder of Johnson & Johnson.

Turns out, RWJF is a big proponent of nurse practitioners. In 2009, the RWJF gave $4.2 million to the Institute of Medicine to develop policy recommendations on the future of nursing. Eleven of the 18 “Future of Nursing” committee members had close relationships with the RWJF, and several committee members had close ties to the American Association of Retired Persons, which receives funding from the RWJF. If the RWJF is giving the AARP funding, that gives me serious concern.

The AARP isn’t the do-good organization for seniors the public perceives, but rather an aggressive purveyor of dubious financial and other products. As Al-Agba and Bernard note, nurse practitioners write more prescriptions than physicians, which is good for J&J’s drug business. It’s not a giant reach when you consider that J&J is a major producer of opioid pain medications and was ordered to pay $572 million for its role in the opioid crisis.

Physicians need to wake up and staunch the ever-increasing diminishment of their training and expertise by greedy healthcare CEOs driving down healthcare costs and quality so they can pocket obscene sums of money for running supposed “nonprofits.” A good starting point might be taking a page from Intel, whose “Intel Inside” logo on PCs years ago created an awareness and public perception the company’s chips were superior. I propose developing an arresting white coat logo that says, “Real Doctor Underneath.”1

WWW.PHYSICIANOU T LOOK . C OM | 25

PL E ASU R E S A N D PA S TIM ES

Lost

CHILDREN OF THE PANDEMIC

I

Wri t t en by Ja de Ro bey

remember heading to my grandparents house the second week of March 2020 and my mother bringing a bag of what masks she could garnish for them, holding back tears unsuccessfully as she told my grandparents, “Things will get worse. Not much is known. We will need to separate.” I thought, “How do adults not know?”

My Spring Tennis season ended abruptly. March, April, and May became one simple, everyday loop. During those last months of the 2019-2020 school year I would wake up to Zoom classes that became “optional” as students’ grades could no longer go down. I realized quickly I was just going from screen to screen for school and every face I saw was flat and cold. School work became oddly senseless. They mailed my Tennis Varsity letter and certificate. Then the school year was over. There were no closing ceremonies.

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Summer 2020 and the world was like an aquarium, except, we were the fish trapped inside the tank and fate was the six-year-old child tapping on our glass to annoy us and rattle our emotions. Arizona surged in June and July and the hospitals bursted over into parking lots.

All my life I loved learning and achieving. I hated failure and gauged failure with grades and goals. I naturally drive to achieve, but that summer a cloud of uncertainty lingered over my planned academic camps and summer felt of impossibilities. Everything planned was cancelled except for a few virtual options that meant just more screens. I had had the momentum of having a plan and every day that plan and my momentum derailed. The why was a corrosive reality that made me feel additionally disoriented and sad.

Selfishly, I clung to the grief of having

had a plan derailed, not to be petty or unaware of horrific losses around me but to feel something resembling what once was normal. I think I became lazy and unmotivated but that would mean I maintained a respect for the rat race I had been caught in relative to suffering globally. I would not be “building a future” that summer. I would just watch time lapse. Surviving the pandemic was the only plan. Summer was not restful, carefree or filled with creative opportunities to get ahead. It was just a wasteland.

My mood lifted to think school could start in the Fall of 2020. The start was delayed and eventually after a brief and awkward month on campus, I opted for online to stay viable to play basketball. Up to the day before the season started, we thought we would play, then decisions cancelled everything.

Betrayed or deceived or just begrudged

P H OTO C RE DIT: JA DE ROBE Y

we were expected to understand, we sunk into ourselves. Of course, no one wanted petty things over others’ safety.

We all wanted desperately for things to be ok or ok enough to taste some luxury within safety for play. Was I being selfish or trying to permit self care? I was tired of the constant responsibility of thinking so hard about being careful. “I understand, Mom,”I continued to try as she came home from the burdened hospital. When we were suddenly allowed to play basketball we cohorted, hungry for human contact, hoping for wins to feel like we won anything.

Online school became again a pixelated akathisic sedative. A bit of mental grace became, unbelievably, studying for the SATs. Briefly, it was like I was alive again with goals as I held my fist full of highlighters. Is it the success culture that defines me or is it my nature that craves measurable success?

Countless times over the summer and fall of 2020 I would find myself thinking about everything I had not been able to do. I realize it was a luxury to lose a year when others have lost loved ones and abilities from complications of COVID or even lost jobs, homes, and basic needs. Still, in my head I was consumed by the idea that I had lost direction, momentum, and time. I arrived in Spring of 2021 during the sustained second surge in Arizona, still unclear and nearly panicked by the sudden need to be somewhere else already. I only had to move forward, but I was sad my 14, now 15 and soon 16 year old selves would not have that last bit of childhood to enjoy in peace before the timely readiness of maturation that would say I could handle the rigor of being an adult or a physician like I had thus dreamt of. I feel like I left something in another room but the room was now locked.

The New York Times published an article on May 4, 2021 citing the work of Dr. Suniya Luthar concerning the mental health impact of the pandemic on teenagers. She cited resiliency as an important life lesson and, specifically, she and colleagues at Authentic Connections have researched “high achieving” students. According to Dr. Luthar, high achieving teens often become stressed, anxious, and lost when thinking about their futures. Consequently, in a paper published by Luthar et al. in the Journal of American Psychologists, high achieving teens suffer depression and anxiety at rates 3-7 times higher than the general population. The cause of this heightened stress and depression, Luthar says, is the “pressure to succeed.” That crucible is external AND internal and what Luthar and others do not understand is high achieving students also thrive under a lot of that pressure. Furthermore, the “lost year” and the year that comes after adds a misery of having lost valuable time and momentum that actually squeezes even harder on a perceived delicately poised system. The impossible stakes got more impossible and the disorientation of a life or death compromise in the back-

drop and as a punchline make traditional achievements seem petty. Enter in the existential crisis a teen did not have time for.

As the daughter of a doctor I am often asked, “Are you going to be a doctor like your mom?” and I have simply always responded with, “That’s the plan!”

If one wants to be a physician, one plans to be a physician. It takes planning. The ever impending future is creeping at our doorsteps each day posing as a threatening naysaying demon challenging years of verbal contracts and mental mapping.

After COVID strikes down a year in the infrastructure, how does one’s plan take shape again?

To have knowledge of something means you have power in a situation and that power means you have control and to be in control is to have security.

I want so much from this coming summer; friends, family, relaxation, camps, athletics, experiences, and moving on. I wonder if I will ever catch up to feeling satisfied and happily on my way. Then more upsetting, I realize, there are hundreds of thousands of orphans derailed globally. Death of ambition is nothing by comparison. A lost year is nothing to stay confused about given health and the safety of loved ones.

I am trying to find an original design for myself. I know being lost means being brave to be found in new ways, maybe even finding new destinies. I know so many more suffered unspeakable losses and the situation is ongoing globally. But the “children of the pandemic” are not as lost as we seem and we will find our ways back. 1 https://www.nytimes.com/2021/05/04/ opinion/coronavirus-mental-health-teenagers. html https://www.apa.org/research/action/ speaking-of-psychology/affluence Nearly 40,000 children and climbing have lost a parent to COVID -19 -https:// jamanetwork.com/journals/jamapediatrics/ fullarticle/2778229 WWW.PHYSICIANOU T LOOK . C OM | 27

PL E ASU R E S A N D PA S TIM ES

Purple Potatoes THE NEW BLUEBERRY

W

Wri t t en by Rox a nne B ru c e

ait… What?!?! Perhaps you read in the FACHT July Newsletter about the nutrition value of purple potatoes, but if you didn’t, let me catch you up. Purple potatoes, which for the purpose of this article I’m talking about potatoes in the solanum tuberosum family, are rich in vitamins and antioxidants. Their vibrant dark purple skin and stunningly brilliant purple interior contain some of the same nutrients that we see in purple-skinned fruit like blueberries and blackberries. They even come with awesome names like Purple Majesty, Congo, Adirondack Blue, Purple Fiesta, Vitelotte, and Purple Peruvian. So, why purple potatoes instead of blueberries?

Why not!

Purple potatoes have roughly 87 calories from a 3.5 oz serving with 2 grams 2 8 | 2 0 2 1 VO LU M E 5

of protein and 20 grams of carbs. Don’t forget the 3.3 grams of fiber and vitamins like manganese, copper, iron, potassium, vitamin B6, and vitamin C. If that isn’t enough to convince you to try these spuds, how about a glycemic index lower than that of their white and yellow counterparts. This doesn’t mean that they are perfect for every person, but it may open opportunities for those who thought they could never again eat a potato due to the high carb count.

The rich polyphenol antioxidants called anthocyanins in those purple spuds are what bring it up to the level of a blueberry. Research studies show a possible link to benefits from anthocyanin to include improved vision and eye health, healthier cholesterol levels, and even a positive effect on cancer. With all these

possible benefits, it’s worth adding them to your shopping list. If you can’t find them at your local store, consider talking to a small farm near you. Most are open to trying to grow new things, especially if they know there is a customer ready and waiting to shop.

Now that purple potatoes are on your menu, how should you prepare them? Well, you can prepare them just like any other potato. They really are a one-to-one exchange in any recipe you already have. That said, I have found a few fun ways of preparing them that bring on the WOW factor. The two biggest crowd hits have been purple potato chips and lavender-colored mashed potatoes.

A female friend was having a princess party for her daughter. The daughter insisted on a “royal meal” in golds and

MICROBIOTA TRANSPLANT FOR CHILDREN WITH AUTISM

purples. The mom reached out to me and asked what I thought might work well.

Enter oven-roasted chicken legs and purple mashed potatoes for the win! That mom also rocked the meal by adding a little edible glitter to the mashed potatoes and a healthy helping to the icing on the cake, but we will talk about edible glitter sometime in the future.

My second favorite purple potato recipe, I tried out on a friend who adored potato chips, but they were completely off of his “can eat” list due to his blood sugar levels increasing. I took 1 small potato and cut it paper-thin. Fried it in canola oil at 425 degrees Fahrenheit until crisp.

I then removed them from the oil and placed them on a rack to drain. To really make them hit home with flavor, I dusted them with an extra-fine mix of garlic

powder and sea salt. One small potato when fried and crispy fit heaping in a 1.5 cup bowl. My friend was thrilled that he got to enjoy potatoes again.

Thank you for spending a few moments with me enjoying these beautiful spuds. I look forward to joining you again next time and talking to you a little more about some of the wonderful things that are happening at farms.

My specialty is marketing, and my thesis focused on small farms and how they work with various online platforms to reach customers. Farming and food have been in my life since I was a child and I love sharing the knowledge of farm-fresh foods with everyone. I can honestly say that farm goodies are the one thing that unites all industries. Everyone needs to eat and drink! 1

Imagine moving from a diagnosis of “severe” autism to no longer meeting the criteria for autism spectrum disorder (ASD). The recently completed Microbiota Transplant Therapy (MTT) Phase 1 study indicates such results are possible and sustainable.

We need your help to move this research forward!

Prof. James B. Adams, PhD (autism researcher and autism dad)

Donate Online https://gofund.me/d58ef380 WWW.PHYSICIANOU T LOOK . C OM | 29

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Publisher: Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Managing Editor: Roxanne Bruce VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Marketing/Social Media Intern: Samantha Petzold, Pennsylvania State University and Riley Snowden, Pennsylvania State University; Madison Smith, Pennsylvania State University and Molly Matthews, Hobart William Smith; Contributing Authors: Roxanne Bruce; Alyssa Dean; Adam Harrison, MD; Marion Mass, MD; Jade Robey; Eric Starkman; Joseph Shega, MD; Peter Valenzuela, MD; Craig Wax, DO; Cover Art: Basia Jenkins, MD. Published By “Physician Outlook Publishing” (ISSN 2768-6019) Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues. The views expressed herein are those of the authors and/or those interviewed and might not reflect the official policy of the magazine.

Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@physicianoutlook.com “Physician Outlook is a registered trademark” WWW.PHYSICIANOU T LOOK . C OM | 31

About The Cover Artist asia Jenkins MD is a retired private practice anesthesiologist, wife , mother , indulging grandmother and a loyal friend.

She is passionate about empowering and lifting other physicians , patients , and physicians who are taking back medicine .

One of her creative outlets has been her garden . She dreams in flowers , colors , textures, and all year blooming .

Her soul soars when her hands are in the earth , when her face feels the warmth of the sun and freshness of the air, and when the birds are singing .

Her goal has been to create a habitat for birds and an oasis for rejuvenating our spirit .

She loves capturing the special moments in the garden and also creating flower arrangements as unexpected gifts for friends .

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