ICE is Scaring People Away from Hospitals with Dr. Mike

Lemonada. by doing the important work of translating complex medical information and what new research has shown into just practical advice that people can use. He also, which I'm super grateful for, has no problem calling out health myths and misinformation. He's here to break down some of the most leading claims and trends that we see circulating online right now. Secretary Kennedy's impact on our health, how painfully ICE is disrupting families' ability to get healthcare, and the real-world impact of AI in the doctor's office. Dr. Mike, thank you so much for being here. Yeah, thank you so much for having me. I'm really excited. Me too. We've already talked about our share love of New York, which we both call home. And I know that when your family immigrated here from Russia, one of kind of your memories that you've spoken about was watching your dad study. When did you decide to not only kind of be as dedicated as a student and a practitioner, but that you wanted other people to know what we should all know to be able to take good care of ourselves so that maybe we don't show up in your office, or if we do show up in your office, we really know what questions we're asking and why? Yeah, that's a really good point, because the problem that I found when I was watching my dad go through his studies, And then even in my early education, I was finding that people were falling victim to a lot of the same types of misinformation. And where that misinformation came from changed over the time. So initially it was on some late night infomercials. Then it went on to daytime talk shows. I forgot about the late night infomercials. You'd fall asleep, wake up at 2 a.m. watching some miracle cure potion. Well, I remember after my dad had his heart surgery more than 20 years ago, I think, and it was the first time he'd had like enforced rest. And it was the first time he'd ever watched late night television. But what I really remember was how excited he was for like the miracle vacuum cleaner. So thankfully he wasn't susceptible to like, you know, the miracle cure. The marketers are really, really good. I was like, we really don't need to buy that. So people were watching that. Then they would watch the daytime talk shows. in order to gain an audience, they would make sensationalist claims. How Your Zodiac Impacts Your Heart Health was an actual segment on a medical show on ABC. No. I'm a Pisces. What should I know? Well, your stroke risk doubles clearly when you're back. Oh, shoot. So I saw that pattern emerging. And then with social media coming into the fray, I realized that that problem was only going to get worse. Because now you don't have the gatekeepers that were traditionally on network television. As kind of flimsy as those may have been. They still provided some guardrails. Now, anyone can say anything. The more provocative what you said meant that you get more viewers, more people tuning in. And really, this is a result of how information has changed in the last 10 to 20 years. You know, I grew up of the Google generation where everyone can Google anything. And it was thought at that time you had all the information at your fingertips. But now with AI and people asking AI questions and AI adapting to make the person searching like the app better is telling people what they want to hear, oftentimes inaccurately. And as a result, now people are getting misinformation just because it makes them feel better. And with echo chambers online and social media groups, I realized that as physicians, we got to do a better job at stepping outside our comfort zone, dropping this cloak of narcissism of we only speak at conferences, through medical journals. No, no, no. We need to be everywhere. We need to be communicating with the general public. In fact, I'm a family medicine doc. We're inpatient, outpatient, nursing home, hospice. We're everywhere. And by the way, you take care of people of every age. Every age. Exactly. So we got to be there on social media now to be present for the general public, to give them the answers, to directly confront misinformation when it does appear. And I know you've had some great guests on this podcast. We need more of these frontline heroes to come to the front, communicate on a massive scale, because unless we have that, censoring bad actors is not an actual strategy that will work long term. Well, and I know you've really repudiated that strategy, and I want to get to that. But before we do, I just finally started watching The Pit. Okay. So I'm a little behind, I admit. I did grow up, though, you were talking about being part of the Google generation. I feel like I'm like the ER generation. I grew up watching ER. And one of my friends from high school's mother was like one of the medical consultants. She was like an ER doc. And I have these wonderful memories, though, of her being like, oh, they didn't listen to me on that. Or when she was so proud, she was like, that was as close to as accurate as you could have gotten. How important do you think shows like that are, too, to try to help humanize doctors and hopefully to help doctors also see themselves reflected in a very real way? Yeah, it's a double-edged sword in that there's been a lot of shows that have fueled misinformation, maybe even not purposefully. Even something as small as not showing chest compressions being done correctly on medical dramas has entered the actual realities that when people are faced with someone who's pulseless, not breathing. And they're trying to be helpful. They're trying to be helpful. They don't do CPR because they're so used to people running in with defibrillators thinking that that's the only solution when in reality they need to be doing hands-only CPR. I'm now feeling very grateful that before my best childhood friend and I became babysitters and we were kids that we took. BLS courses? We sure did. Let's go. Okay, that's amazing. I haven't thought about that in so long. So if we can work that into culture like we're doing with the pit right now or ER was doing 20 years ago, that's a huge win. So I'm really happy that the pit has come around. The way that they're doing it is really respectful to frontline health care workers, giving them the love that they deserve, showing the difficulties of practicing there. Because that mistrust, the distrust, all of it is at an all-time high, and it's really disappointing to see. So I want to talk about that broader set of challenges. Though before we do, I do want to talk about something that is more news of the day, painfully. You know, all of America is watching what continues to unfold in Minneapolis as we have the largest immigration enforcement action, certainly in the history of the state of Minnesota and arguably one of the largest in the history of the United States of America. ICE has a larger budget than all other countries' militaries except for the United States and China. ICE recently received a larger budget than even kind of the United States Marines has. And we see that unfortunately, kind of with these large investment of resources, an absence of coupling of real responsible use of force. We have seen not only the ways in which immigrants themselves have been treated, the ways in which people exercising their First Amendment rights have been treated, the ways in which American citizens have been treated, the ways in which we've treated our elderly, our children. And we also, of course, have seen, you know, the killings of two American citizens just in the last few weeks. One of the first guests I had on this podcast, Dr. Nurik, recently posted something that I want to play now and then get your reaction to. In addition to killing people in the streets and terrorizing communities, ICE is also making it so people are afraid to access needed health care. They're afraid to leave their homes. They're afraid to go to work and they're afraid to seek needed medical care. I've received several messages from health care providers over the last few days who work for Hennepin Health Care, which includes the largest public safety net hospital in the state of Minnesota and is essential for serving underserved communities there. They're working desperately to care for patients who are too scared to seek medical care because of ICE activity. They have a pediatric mobile health van that provides health care to children and families who are unable to go into the clinic. And right now they're trying to keep up with exponential demand from the community. So, Dr. Mike, when you hear that, first, how does that make you feel as a healthcare provider? And also, what do you want anyone listening to understand about the very clear ripple effect? Yeah, Chelsea, this is striking at the heart of what I do. Being a family medicine doctor that works at a CHC, I work at a community health center, I know how important it is to remove barriers for people to get care. Because I know that the more barriers that they are, ultimately, the more lives we lose, the sicker people are, children end up suffering. And what this administration has done has been really disappointing in that they make it more difficult during a time when our health care system is already in shambles to deliver even basic care to the general public, to deliver primary care, preventative care, to keep people out of the ER. What we fail to understand is when we don't think about people's well-being from a preventive standpoint, we end up pushing them into the emergency room standpoint because they don't take care of their hearts. They end up having heart attacks, strokes. They get brought in by an ambulance to an ER. What happens when the ERs are so overcrowded and they get to that point because that's where we're headed right now where they're closing them down. People don't have access to get care. Wait times are extremely long. In negative 10 degree temperatures. In negative 10 degree temperatures. It's really this perfect storm of events that's destroying the health of the nation. And really, the promise that was made about a year ago when Secretary Kennedy took over for Health and Human Services, he said he wants to make America healthy again. All that I've seen so far is the opposite. In fact, I think he really just made America have measles again more than anything else. and it's disappointing, it's sad, it's emotional and I see it play out in my patient's eyes every single day. So, and this is also not a problem that's unique to the United States. I recently saw reports from the State Department that in Iran, doctors who are giving care to protesters were being arrested. There's a doctor whose family in Canada has put out messages that he was arrested brutally in the middle of the night, Dr. Golcini, for giving care to those who were hurt during protests. That is unacceptable. We as doctors treat anyone and everyone. We do not judge our patients. If someone that came in, whether they committed a crime, didn't commit a crime, we deliver the same standard of care. That's our Hippocratic Oath. And to be charged for that is absolutely devastating. I just got the chills listening to you. And I do think it's important that we recognize that this is an American problem and also a global one. I feel sad to see the country that I came to that allowed me to immigrate here and create a life with my family, for my father to become a physician here in a second country, learning the language, for me to become a physician here. Now, not just exporting our culture in positive ways, Hollywood, music, but we're exporting the culture of unhealthy foods to other countries, social media disconnection. In fact, when I started on social media, one of the benefits that I was talking about was the ability of social media to allow people to unite, to come together against dictatorships, against fascists, against governments who were not allowing free speech. And also in areas where there'd been an absence of community, right? I remember the ice bucket challenge, right? Including as it relates to our health, right? To help people who might have been isolated because of a medical condition or a diagnosis to find each other for causes that hadn't received sufficient research dollars to be able to raise those funds. Wasn't that long ago. Yeah, it's really sad. We also didn do a great job as a healthcare community as a whole in figuring out that social media could be a tool for us Although you figured that out pretty early I was lucky and fortunate in my timing of when I came into social media and I saw a use for it for my patients. What I realized and my colleagues, I don't think yet realize, is that any tool in healthcare, whether it's therapy, surgery, medication, they all have benefits and harms. We never say one is a miracle cure-all. Even with vaccines, as an example, There are side effects of vaccines. We talk about them. We warn patients about them. We're on the lookout for them. So everything has some sort of tradeoff. Now, social media certainly has harms. We see that playing out. Teenage anxiety, depression, body image dysmorphia, like all these things are true harms. But what are the benefits, like the community you're talking about? What are ways that we can have conversations like this on social media in order to make use of this tool where we maximize the benefits and limit the harms as opposed to just broad brush villainizing the platform or the technology as a whole? You know, I do want to return to kind of the make America healthy moment that you mentioned earlier. Also, when? Like when was America healthy? When were we ever healthy? I know. And when you were talking about kind of make America have measles again, I was thinking about something that I – I can't remember if I first like tweeted or said or then said, then tweeted. In the first Trump administration, it's pre-COVID, and I was like, I really feel like he's trying to make America germy again. Yeah, yeah. And it really feels like that on steroids. Yeah, yeah. We're cutting research dollars for vaccines that could prevent cancer. I know. And I just – I am someone who likes to exhibit charitable thinking, not just on an individual level, which I encourage my patients to do, but also on a broader level to see, okay, what is this group that's doing something I disagree with? Where are they coming from? Is there some sort of charitable aspect here? I can't even find one. I struggle to find what you're hoping to achieve when you're removing dollars from research. And I've had debates. I've actually went into debates surrounded by people who completely disagree with me. Yes. Recently, right? You were surrounded by 20 people that were anti-vaxxers. Yes. Was that your idea or did someone invite you to do that? It was our idea. I saw that they were doing this with political movements, right versus left, center versus right, what have you. And I said, why don't we do this for vaccines? But instead of having it anti-vaccine activists, have real parents who are scared, real nurses who don't know if the treatments that they're giving are valuable to their patients. And they brought this group together. We had a really great conversation, even with the people who disagreed with me. Not everyone's minds were changed. But it showed as a platform that we as doctors are trying to do our best. We don't have all the answers. I said, I don't know on the show multiple times. And I think it brought us closer together. During the exit interview, some of the participants said that they're a little bit more open-minded now. I actually repeated the same process surrounded by Maha activists or Maha supporters. and same outcome. Even in their post interviews that they're doing now on their reflections of their conversation, they said that they feel that doctors are trying to do their best. And perhaps it's the system that's failing them. And that's absolutely true. So that's why I find it a bit strange because I've been criticized by some people in the medical community for even engaging in those debates. I don't know how you feel about it. Do you think it's valuable to sit with people you disagree with? I think it is really valuable to sit with parents or healthcare providers in the way that you did, I think it is less valuable to give kind of platform to the people that we know who predate the Maha movement, who for years, sometimes decades, have proven themselves to be impervious to any evidence or any research, many of whom, particularly in the kind of hardcore anti-vaccine movement, have made millions and millions of dollars in kind of profiting off of people's fears and anxieties. I think that is quite dangerous. I think it is also really important to always give space and place to parents who are asking questions, who you don't in any way doubt, like their motives, their purpose, their real commitment to their children's health and well-being. Yeah. Yeah, I think just highlighting to the general public, even forgetting the people in the room and just thinking about the people who are watching these conversations, just to allow them to see how much hypocrisy exists in that community. They say that they're skeptical of conflicts of interest with pharma companies and health care workers, but they're no longer skeptical about their own parties or their own participants when they receive money for wellness tests, miracle supplements. So it's like, why is there a different structure, a different barometer that you're using to judge this game? And even zooming out a bit more, realizing that when the healthcare community makes mistakes, which it does, we're not perfect. We're still human. Science evolves. We're going to backtrack on some information. In fact, if you look probably 50 years from now, the things that we're doing now, half of it's going to be wrong or updated. That's part of the nature of the game. But you have to ask us why we're making those changes. Are we seeking to improve or are we covering our butts? And in reality, we make changes all the time, like peanut allergies is a big one that is talked about. We used to recommend that we avoid allergenic foods in young children. And what ended up happening? Allergy rates started exploding. And we realized that actually early introduction of these allergenic foods to young children actually decreases rates of allergies. I definitely put like the powdered peanut. Yes, exactly. At four to six months, we start the introduction of solid foods one at a time to make sure children get exposure to this. Obviously not peanuts themselves because that's a choking hazard. But we've made that change and we've called ourselves on our failure. When's the last time that anyone in this administration – when is the last time that RFK came out and said, hey, I know I said these statistics about diabetes, but I was way off the mark. Like way off the mark. Or I made this claim about Tylenol and autism and I was way off the mark. It doesn't happen. and they don't own up to their mistakes. And I want the general public to see that because I feel that human angle is a lot more valuable for people to see than pointing out data points. Well, and that hopefully through those human conversations, the data points can be brought in organically. Yeah, yeah. Just because if you approach a conversation right away with a disagreement with a data point, you're basically putting a stone in between you and someone who you're trying to have a productive conversation with. And I don't mean, again, as you said, productive in the sense of I'm trying to persuade them. We're trying to learn about one another and truth seek together. And ultimately, both people are trying to do that. I think the outcome is better for all of us to grow. Dr. Rick, is that why you on your podcast also sometimes have people that you may not agree with? Absolutely. I think it's a must for us to put ourselves outside of our comfort zone. In fact, I invite people on who I disagree with and genuinely sit there to allow them to try and convince me of their point. Because if they have some new data or strategy that I haven't thought about, that will make me a better doctor. That's why in science, we seek to disprove our theories. Because if we strive to disprove them over and over again, and they can't be disproven, we have a stronger theory. But a lot of these steak oil salespeople, the grifters, they're just looking for evidence that agrees with them. And that's the exact opposite of what science is. That's why during the pandemic, we perhaps got a little bit too much follow the science and it became follow the scientist. When in reality, it's question yourself always. Try and disprove yourself always. That's what good science is. Being a healthy skeptic. And we've lost that and we've instead become cynics or completely gullible. you know i am curious you know dr mike you you spoke earlier about how you know you really started your journey as a kind of public health communicator although that's probably not what you would have called yourself a dozen years ago um you know in a way because you wanted people to understand just more what your experience was like as a medical student. And yet you quickly realized, not to kind of frame you as a Cassandra, but you did quickly realize that the threat of misinformation had changed because of just all of the different ways in which people now could access information. Curious about kind of the conversations from then, almost I guess 15 years ago now to today with your fellow healthcare providers. Do you think more and more, you know, doctors, nurses, nutritionists, physical therapists, you know, anyone who kind of has a real expertise now kind of has a better sense of maybe just needing to understand what might be percolating on social media, whether they themselves actually want to do what you're doing? Yeah, I don't think we need to put out a call for every medical professional to be present on social media. It's a unique skill. We can only have one, Dr. Mike. I think there's room for a lot of us to thrive. I think the more that people show themselves as individuals, talk about their personal experiences, the more empathy they're able to show, the more connections they're able to form with their communities. I think that's really valuable. What I do see lagging behind, and it gets me really worried, is our big health agencies not supporting this movement, specifically the American Medical Association. They represent all the doctors in the United States. And I would love to see more activity, not just for them posting, but also getting colleagues involved, supporting those who are doing the right things, bringing them aboard. Because when I see RFK Jr. make a tweet and he gets 10 million views with misinformation, and then the American Medical Association comes out and writes a tweet that gets 10 views or 10 likes, it's almost as if they didn't do it. And if that's the organization that's representing us, we're in trouble. So I want to urge them to take seriously the moment where we find ourselves, which is we're losing trust. And the more you lose the general public, the more politicians change and politics change, the less effectiveness we can have on a public health scale. In fact, I used to say on my channel, look, I'm not political. I'm clinical. Absolutely not. I'm political. Health has to be inherently political. I'm just not partisan. I'm not taking one side over another. I'm talking about the science. So whether you're right, middle, center, left, I'm talking to you from a scientific perspective. And that has to be political. So when I see the AMA, like a week after RFK Jr. came out with these drastic changes to the childhood vaccine schedule, have an opportunity to go on a major talk show. Kelly and Mark, their CEO is going on to talk about longevity. Why are we not taking advantage of a nationwide TV opportunity to counter this narrative? And it's this political fear of feeling biased. We can't have that fear. It's too late. Bias towards patients, right? Yeah, bias towards telling the truth. Honestly, like you work with the American Heart Association, as do I. I was just at their Go Red for Women red dress event a few days ago. We're teaching people CPR. Why are we doing this? because the number one killer, men and women, is heart disease. What has Secretary Kennedy, who is Make America Healthy champion, done to lower that number? I don't know. You tell me. What, Dr. Mike? Nothing. In fact, I mean, he put pull-up bars in airports. I haven't seen one, and I've been traveling a lot. I've been keeping my eyes out. This is the disconnect from someone who doesn't practice medicine and doesn't live in the real world and lives in an ivory tower. None of my patients can do a pull-up. None of them. My goal as a physician is to get them motivated to even get to do one pull-up. And he thinks he's solving the crisis by putting a pull-up bar where people can't even use the thing. So it just shows how his solutions to problems that are complicated that we spend millions trying to research, we don't have an answer for. And we honest about that In fact during my Or we have a set of answers We don have like one magic bullet Yeah one clear answer I remember one gentleman during my debate was getting quite angry at me that I wasn all in on lifestyle changes to address the chronic health epidemic we have. And I am. But I say we need to study them in order to understand how to create a program that helps society get moving, get exercising, eating healthier. He's like, why? Just get moving. I'm like, that's great. Come into my office at a community health center to people that have three jobs that are running away from ICE, that have issues with their family, that have an abusive husband, face intimate partner violence, and you tell them, just go lift. It's not realistic to what is happening in the real world, which is why I'm so happy that over these years in doing social media, I never let the clinical side of my practice go because I understand the problems that real people have. I don't have a $100,000 a year concierge business where I just treat celebrities and allow them to take peptides or whatever nonsense that I'm selling in the moment. We're talking to real people who need real help and are facing true challenges because our government is letting them down. Amen. I find the obsession with peptides fascinating, I have to say. And also, I find it really troubling that people seem to not understand what really is, I would say like really regulated by the FDA and what is not? And I would also throw in supplements, right? I think most people think like, oh, the FDA regulates these. I'm like, no, they don't actually. I mean, supplements and peptides are slightly different classes because with peptides, for many of them, what they're doing by marketing them is they're using research loopholes in order to allow the general public to have access to them. So talk about that a little bit, please. And just to create the comparison with supplements, they're putting verbiage on the marketing of those supplements to make it seem like these are cure-alls, that these are alternatives to pharmaceuticals. And in some instances, when someone's vitamin D deficient, someone has iron deficiency anemia, they're trying to get pregnant, there are uses for supplements. And doctors are not all anti-supplement. We're anti-marketing gimmicks. Prenatal vitamins are great. Exactly. So we're anti-marketing gimmicks with supplements, which is what the majority of the industry is. Wait, but the peptides, where do you think this recent, I feel like I had never heard anyone talk about peptides a year ago. And now like the Wall Street Journal is writing about it. Well, we have fancy health influencers that get an academic institution behind them for something not related to the peptide stuff. And then on their own, they start making claims. They start seeing successes. I feel like you're talking about someone very specific. I am, but you know, I'm trying to not get a lawsuit thrown my way for any specific reason. Fair enough. and I'll tell you where this hurts the most. Like, if they want to scheme rich people into thinking that they're going to live forever, you know, whatever, like, you want to do that, that's fine. Who I want to protect are the people who are having real problems by not having access to medications, not having access to healthcare, who think that, oh, I can't see my doctor, so let me just pay this snake oil salesman. And I actually have a personal experience with this. Just two weeks ago, I have the picture on my phone. I have a patient who has prostate cancer. And when he went to see an alternative practitioner in the nearby area, instead of telling them that he should get treatment for his cancer, they recommended anti-aging protocols, using all of these peptides, NAD drips, trying to essentially scheme this person and hurt him because he's not getting the treatment that is evidence-based that could prolong his life. by making a dollar off of him. And it's the most disappointing thing. Luckily for me, I have a good relationship with my patients. They're able to at least question those things and bring them to me and ask my opinion on them. I hope I changed his mind. But at the end of the day, that idea of the fountain of youth, Ponce de Leon, is still in all of our minds that perhaps there is something out there. Perhaps there is this false hope. And it's just absolutely disappointing to see scientists get on this bandwagon. Do you think we should be doing more research, though, into peptides? A hundred percent. To discern whether or not, like, maybe there is a there there for some people. Yeah. Even you mentioned, am I for research on peptides? Yes. But guess what we need to do research on peptides? Money. And Secretary Kennedy is cutting the budgets for research for peptides. One of the premier researchers on ultra-processed foods, Kevin Hall, doing the best work, metabolic labs, the most stringent protocols, putting people in scrubs while they're in the research studies to make sure they're not biased based on how their clothes are fitting. This is a person who is a leader in studying how ultra processed foods impact us as humans and no longer working because Secretary Kennedy pushed him out. If he believes in what he believes, do the research. Let's study these things. Don't make sweeping recommendations that are not accurate or applicable. Even his stance, oh, we're matching our vaccine schedule to Denmark, makes no sense because Denmark is not the U.S. 2% of the population that we have here, different risks, different diseases. But then on top of it, if you're going to mirror Denmark's vaccine strategies, how about the largest study ever done seeing if vaccines and autism are related? And it was disproven in Denmark. So why are you choosing one thing out of Denmark but not the other? It's an absolute hypocrisy. So it's not just about highlighting every negative thing that Secretary Kennedy has done, which we can probably spend three podcasts on. It's not enough. But let's talk about what we can do that we're not doing to give people an alternative path forward. What do you think we don't talk enough about? The fact that if we're cutting research, how are we going to find out why autism is going up? How are we going to find out where we can use supplements more often responsibly? These are topics that people are passionate about. They want people to exercise more. Fine. Let's trial new programs in different areas of the country to find out how to individually motivate someone. Let's do research. People are saying they want to get folks off of GLP-1 medications long term. Well, let's find ways to start the medication, get people to a healthier weight, change their lifestyle habits as a team using a dietician, a nutritionist, a physician, a nurse to get them to have a healthier lifestyle so that they're not reliant on a medication. These are all avenues of research that we cannot do because we're blocked from doing that research by Secretary Kennedy. That's the most disappointing part of it all. You know, Dr. Mike, I hear all the time from individual patient activists, from health systems, from startups, from kind of big companies, from students. You know, truly, I feel like everywhere that I might be in a conversation these days around health, AI. Oh, yeah. You'll say like, oh, well, AI is going to solve a lot of these problems because it'll help, you know, Dr. Mike be more efficient so that he has more time. AI, which I never really understand this, but it's like going to do the research for us. I'm like, no, but you still actually need researchers. Where do you find, since you chuckled, optimism and where do you have real caution in this just broader kind of universe of kind of AI and health? Full disclosure, I have a little bit of an AI negativity bias. Okay. I don't like it because I'm more of a human first clinician. But do you think AI can help you be more human first? So even with this negative lens, I have to remind myself that there are pros and cons to every tool, like I just said with social media. So I have to remind myself of this. And there are ways that AI can improve the doctor-patient alliance. They can allow me to perhaps not have to be tied to the computer documenting the visit. It can help with that. It can help me search the records so I can find the colonoscopy report and not have to do 15 clicks. So there are ways that AI can do this. However, my big concern is that when you pair AI with private equity and healthcare, you start creating a lot of profit motives and not so much healthcare improvement motives. So I've seen this pattern play out with telemedicine as an example. Telemedicine, fantastic tool for patients to get access when they're far away from a specialist, when they don't need a physical exam, and it's just a discussion about medication dosages. But then I've also seen people overuse this, overprescribe through it, use it for visits where it's not appropriate, where we need a physical exam. I struggle when someone has abdominal pain to have a virtual visit because how can I have a proper exam with just a conversation? So I don't want private equity to take over AI in healthcare and start squeezing out the profits. My concern is that the future generation will lose the ability to actually oversee AI because it does so much of the work for them. So we need to constantly not let our guard down to say, oh, this calculator can do it for us, so why learn addition and subtraction? It's just a tool, but we still need to master the art of being radiologists, of being a pathologist. So as long as we don't lose that art, which it's very tempting to, I think we'll be okay. But we need to constantly remind ourselves of that and fight for that. And Dr. Rick, what do you think patients need to know? Like how do you try to help patients either in your office or online think about what questions they should be asking as it relates to AI and their healthcare decision-making? I think asking AI what questions to ask your doctor is a great place to start because there was this notion with physicians, especially when I was going through my residency training where they had these mugs that said, your Google search does not replace my medical diploma, right? And doctors would have this idea, like, how dare you question me? No, no, no. I want my patients to question me. I want them to ask AI questions. I want them to bring those questions to me. That means you have a curious, engaged, empowered patient. And that's so much better for their outcomes. The worst thing that happens during a visit is when a patient comes in and tells me they're taking, you know, that little blue pill and that little white pill. It's tough to deliver great care when you don't have complete information. But when a patient joins that team, that's where you get the best outcomes. And I certainly am hopeful that what we've seen, whether in radiology or oncology or Alzheimer's, you know, all these areas where there's such exciting kind of new work coming out is how AI in partnership with researchers or as directed maybe, it's a better verb, by researchers is surfacing more diagnoses more quickly that can then hopefully be more action to help patients lead longer, healthier. your lives full of greater kind of thriving. And also, I think your concerns are more than valid. And I would, in other times, say this is exactly what a federal administration should be doing and paying attention to. All right. So, fact or fiction. We talked about melatonin earlier a bit. But taking melatonin long-term will help your sleep improve and also can increase your risk of heart disease. Does it help your sleep improve and increase your heart disease risk? Oh, yeah, this is a good one. There was an interesting presentation that was done where it linked those who were taking high doses of melatonin or taking melatonin long-term with higher rates of heart failure. That is not a causative proof that one causes the other. They just found this association to exist. Maybe sounds like exactly where we need more research. Exactly. and even when we use melatonin as an example, people, I think, misuse it often because they don't quite understand how it works. It's really good for resetting a circadian rhythm. So if someone is jet lagged and they're not used to the time zone that they're in, perhaps that could be a good way to restart your body's natural circadian rhythm in the correct way. But people taking it long-term, taking ultra high doses, I mean the normal dose that we would use in a medical setting is one milligram two milligrams maybe three people are taking 20 milligrams I was on a TV station and the person behind the camera said I take 20 every night This is not what is This is supra physiologic doses where we don even know what the harms of that is because we're not studying them at such high toxic doses. And it maybe wouldn't be ethical actually to study it at that high toxic level. Yeah, exactly. So we would need to be trusting the researchers that they're examples of what could go wrong there would be right. So very scary stuff when people overuse these supplements. Everyone needs to drink eight glasses of water a day. This is something I think from my generation of education. And it's a place to start. I don't like attacking that one too bad because eight glasses of water is pretty good. That's not a hard and fast number for everyone. If you sweat more, you might need more. If you're a larger person or smaller person, you might need different amounts. So on average, look at the color of your urine. It should be pale colored, pale straw colored. And if that's generally the case with some fluctuations here and there, because with life, your body adapts quite well, you're in a good spot. But if you're consistently, your skin is dry, your lips are dry, your urine is really dark, that could be a sign that perhaps you need to be hydrating a little bit more often. Is it true we need to drink more water in the winter? Yeah, you do experience more loss, fluid loss, especially from your mucous membranes. When we pump the heat up, it dries out the air, less humidity. We get cracks in our lips, our noses. In fact, some of the theories as to why we get sick in the winter more often is because there's more areas in our mucosal membranes for bacteria and viruses to get in. Also, when the air is drier, germs have longer hang time. So you can walk into an empty room not thinking about it, and someone sneezed there 30 minutes ago and the germs can still be hanging around. Just hanging out. One last question about water. We all should be adding electrolytes to our water. Oh, this is the biggest scam to sell you something. Unless you're training for a long period of time and you're sweating excessively, the need for electrolytes is almost absent because, especially in the United States, we over-consume salt as a general rule as part of the American Standard Diet. So you need to be really careful about adding more electrolytes than you need. Some of these companies actually twist the research, encouraging the average person to have a huge amount of sodium. And that's really risky for those, especially who have underlying conditions like congestive heart failure. They can become fluid overloaded, put a tremendous strain on their kidneys. So no, not everyone needs electrolytes. I see this so often of someone going in for a 20-minute lightweight workout and they're pounding electrolytes. You did not lose enough electrolytes to need repletion. But if you ran a marathon... Yeah, that's what I'm saying. So So for athletes, I mean, I trained for a professional boxing match. I was drinking electrolytes because I could squeeze the electrolyte. Do you still box? Yeah. Which is not healthy competitively, so I wouldn't recommend it. But if you want to take a class, you want to hit the heavy bag, that could be really good for the cardiovascular system. We have a protein crisis in America. We're not eating enough protein. That's what, you know, also RFK Jr. has recently said, are we not eating enough protein? Well, what we are seeing a pattern of is people over-consuming refined carbohydrates, added sugars. And that's absolutely a good target to get people perhaps to swap over to healthy sources of protein. Sure. Protein is satiating. It helps you feel fuller along with fiber. So it's not necessarily bad to encourage people to consume protein. But acting like we have a crisis where people are under-consuming, that's not exactly an evidence-based statement. One thing I certainly have heard is that if your fever breaks, you're no longer contagious. Yeah. So it's going to be dependent on the infection that caused the fever. It's going to be different person to person. Generally, I think this is a safe rule to understand that if your fever breaks for 24 hours, the risk of contagiousness goes down. But not instantaneously. But not instantaneously. And there are certain conditions like with diarrheal illnesses where it could be even longer than that, that you're contagious. So it really is going to depend condition to condition. So ask your doctor. Yeah, exactly. That's where a great communication with your doctor goes far. And my patients call me all the time with questions like this and we welcome it. We're passionate about it. So don't be afraid to ask those questions. Oh, wait, can we talk about fevers for a little bit longer? Yes, absolutely. I don't know why as peoples we've gotten anti-fever. When I was in the hospital, patients who are otherwise healthy, who had a mild elevated temperature, were reflexively given medications to lower their fever. Like Tylenol. Like Tylenol, ibuprofen, whatever. And I just don't understand why. And in fact, some great researchers that are head of infectious disease programs, Dr. Paul Offit, who does great work. Love Dr. Offit too. He talks about how, why are we medicating fevers and those who can tolerate a fever, who can rest with the fever, when the fever is part of our body's immune system that helps our immune system work better and hurts the infection's ability to replicate within our bodies. So I would ask- Let's not interfere with our bodies. Yeah. And also high fever should be treated. Yeah. So that's why there is a balance there. But for me, I'll give an example as myself. not advice to anyone specifically on an individual level, but me as someone who's an otherwise healthy 36-year-old person, if I have 101 fever and I know I'm sick and I know the cause and I have the flu, I don't reflexively go to lower my temperature. If I need to rest, if let's say we zoom this out to one of my patients, their heart is frail because every time your temperature is elevated, your heart rate also goes up. So if we're concerned about something, we can treat, but it has to be with a treatment in mind. Why are we treating this fever? So just blindly treating fevers, I think, is the issue. Not treating fevers as a whole, but just blindly reflexively treating fevers can be problematic. This, though, is why it's so important that hopefully... You have a good primary care doctor. We have a good primary care doctor, which you know, sadly, is not true for many Americans. Which is RFK, let's go. Let's solve a problem. Let's solve a problem. Why don't we have enough primary care doctors to treat America? Yes. Well, I agree, clearly. And why also don't we have enough nurses? and kind of enough just people to be able to do the work to actually help us be healthy. Sure. Maybe make America healthy, period. Yeah, yeah. And then keep us healthy. And it's like he'll take out some obscure chemical out of Skittles, titanium dioxide. And like, is that why Skittles was a problem? No, kids are over-consuming added sugars, candies, and we need to change this from a nutritional standpoint, not remove a single chemical in order to get a PR win over it. But that's what it seems like this administration is more interested in, in getting these PR wins, staying in office, staying in power, as opposed to actually making meaningful change. And helping protect communities, whether we're here in New York City or back in Minneapolis. All right. Last one. There has been a lot of reporting recently about, like, blue light and, you know, are we reading on Kindles at night? Is that good for us? Is checking our phones before we go to bed part of why maybe America isn't sleeping enough, which there seems to be good agreement on that we all need kind of more sleep and higher quality sleep. What are your own habits before bed? What do you tell your patients? Is this really where we should be spending as much kind of time, energy, and focus as we are right now? Yeah, this strikes at the heart of what's known as sleep hygiene is an interesting way to put it. And probably the area where I've been the biggest hypocrite in the sense of I tell people- Thank you for being so honest. Yeah. To say, hey, you shouldn't be on your phone before bed. You shouldn't be doom scrolling. and I have done that way too much in the last few years, whether it's reading bad news on social media, seeing what's going on with my friends' lives and feeling bad for them. And that's antithetical to good quality sleep. If you're gonna spike your anxiety immediately before the time you're supposed to rest, repair, and digest, you're not gonna be rest, repair, and digest. You're gonna be fight or flight mode. And it makes it hard to fall asleep. And even if you are able to fall asleep, you'll have worse quality of sleep. And that's where blue light comes in. So with blue light, you get a drop in that melatonin hormone that we've talked about earlier with supplements. So that actually has been proven. We see a drop in the melatonin, the amount of sleepiness that you experience. But even when you do go to sleep, you don't go through all the phases of sleep as you would had you not been exposed to blue light, to caffeine, to all these disruptors of sleep, alcohol, marijuana, that people routinely use to aid in them falling asleep. Oh, I'll just play on my phone until I get sleepy. No, it's actually not a good way to create a healthy relationship with sleep. And the biggest tip that I give that I've been starting to institute more and works quite well is if you are trying to fall asleep and you lay there for 15, 20 minutes and you can't, get out of the bed. It's annoying because you're like, well, I'm close, maybe I'll get it. If you create an association with anxiety of difficulty of falling asleep in the bed environment, the next time you get into the bed, you won't associate it with restful sleep and it makes the problem worse. So get out of the bed, try and get sleepy elsewhere so that you can have that frustration elsewhere and that when you return to the bed, you know, that's my place of comfort, almost like Pavlov's dog. Remember that here is where you sleep. So that's a good strategy. Is it working for you? Yeah, actually it has. And I'll go on my couch, I'll read something, I'll try and spend time in low light environments. And then when I go to bed, I fall asleep right away. And I feel like that works quite well long-term. But it's not almost intuitive. It feels weird. Like, why am I leaving the bed when I should be falling asleep? But I think laying there and just getting more and more mad that you're not sleeping is not a good strategy. Getting angry before bed just seems, even at yourself or the world, seems not so healthy. Have you ever had an issue with doom scrolling? No. This is probably not healthy either. But when I wake up in the morning, I used to listen to the radio. I grew up listening to NPR. My mom always listened to NPR when she was getting ready. In the morning, I would listen to NPR or the BBC World Service. I stopped doing that because I have kids and I didn't want them to hear candidly like all of the terrible things happening. and so like we still get newspapers but on the weekend so often like on the weekends i'll be reading the newspaper early in the morning um or not on the weekends i'm reading the news early in the morning um and so i wake up to the doom yeah so it's not i'm good about not doing that at night yeah but it's probably also not the healthy you probably like get up and take some deep breaths and yeah a cup of coffee first that's my next so that i want to strive towards maybe this can be a February resolutions. It's like, I can't really be a February resolution. Try to have some space between when I wake up and when I kind of super saturate my neurons. There's definitely something valuable to going for a walk, spending time away from technology for the first few minutes upon waking. There's definitely something there. And that's my biggest struggle right now. I've put it into the world. I'm going to try to hold myself accountable. Whenever we're next in common conversation, you're going to ask me how I'm doing. I'll be honest. Yeah, deal. And I'll do the same. Okay. Dr. Rick, thank you so much. Thank you so much. This has been a joy. Thank you. Great. Yeah. Keep up the great work. Onward. Thank you. You can learn more about Dr. Mike at Dr. Mike on YouTube, Instagram, and TikTok. He's also got a great podcast called The Checkup with Dr. Mike. Thanks for listening and talk to you next week. That Can't Be True is a production of Lemonada Media and the Clinton Foundation. The show is produced by Catherine Barnes. Mix in Sound Design by Ivan Krayev. Kristen Lepore is Senior Director of New Content, and Jackie Danziger is VP of Narrative and Production. Maggie Kral-Schore is our Managing Director of Partnerships. Executive Producers are Jessica Kordova-Kramer, Stephanie Whittles-Wax, and me, Chelsea Clinton. Special thanks to Erica Goodmanson, Sarah Horowitz, Francesca Ernst-Kahn, Caroline Lewis, Sage Spalter, Barry Lurie Westerberg Emily Young and the entire team at the Clinton Foundation you can help others find our show by leaving us a rating and writing a review and if you can think of someone who might benefit from today's episode please go ahead and share it with them there's more of That Can't Be True with Lemonada Premium subscribers get exclusive access to bonus content when you subscribe on Apple Podcasts you can also listen ad-free on Amazon Music with your Prime membership Thank you.