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the insurance companies have captured all of it from the doctor to the hospital to the patient to the labs the pharmacies all of it has been captured nobody can fight these guys they’re the biggest gangsters out there they’re the modern-day mob and they control all of healthcare right now Brigham buer is the founder and CEO of ways too well a preventative care and health optimization platform and he began his career in healthcare 25 years ago supporting the nation’s leading surgeons at Eli Lily and Striker so he worked deeply within the pharmaceutical industry for many years and alongside the insurance industry as well and he’s here to share his incredible insights about how this system actually works and what we can do to potentially change [Music] it I’d love to start off by talking about how you got involved in the pharmaceutical industry you know the story is incredible you know I graduated in three years of high school and I thought that that was crazy but your experience in college and you kind of being on this fast track in order to get into the industry is amazing let’s talk about that story yeah man no uh you know what’s crazy is I was literally a d student I barely graduated high school when I met with my guidance counselor and she said what do you want to do I said I want to go to college and she goes Fram College isn’t for everybody and I just thought are you kidding me like I was so mad uh but I was working man we didn’t have money I worked I worked night shifts I was like working my ass off I barely slept I was falling asleep in classes all this stuff so jump forward I get into I go to University of Houston in downtown Houston uh and I had an opportunity to get a job as a drug rep and for me that was a dream job man coming up with not a lot of money and have an opportunity to make a hundred grand right out of college it was like the opportunity of a lifetime so long story short I petitioned with the dean he gives me approval to take 23 hours in summer school I end up graduating in 2 and 1/2 years uh 399 GPA got out got a job with Lily and I was Off to the Races I what originally what I thought was my dream job but then you get behind the curtain and you go oh this is not what I expected uh just because you know when I was selling SE Alis right out of school that was the Viagra 36 hour Viagra that was fun but as soon as I had to like I got unfortunately got promoted and as soon as I got promoted I had to sell mental health drugs and I just didn’t believe in them and I didn’t want to push products and and things I didn’t believe in so I was constantly getting in trouble for not selling the bag and pushing these other products I would just go back to the compounds that I believed in and I would sell those and do really well with those and then come up short on the others now my question is when did this transition happened with using people who are essentially salesmen for these drugs to go to talk to Physicians versus you know maybe a pharmacist or something like that educating doctors I think it’s when the whole system shifted so the system began to shift in the 80s and 90s when the big insurance companies essentially captured medicine and so what the problem with that is like in the 80s a clinician knew your whole family you know they would spend 30 40 minutes with you they knew who you were your family history how many kids you had it was real medicine but then it got captured by Corporate America and big insurance companies and what happened is today a clinician has 6 minutes with you on average they have got to see 40 plus patients a day to make a living because they’re in a co-pay system where they’re literally getting like $40 a visit and they can’t justify their payroll with that so the days of them being able to sit down and talk to a pharmacist for 30 minutes about a new compound were over and fizer and all the big pharmaceutical companies were smart and they got ahead of that and they looked at it and go I think fizer was probably the first to do it they started hiring candidly hot chicks and they’re like we’re going to hire a beautiful girl we’re going to teach her a talk track it’s a 30- second infomercial and all of a sudden you’ve got you know these nerdy pharmacist trying to compete against some smoke show walking into a clinic that’s going to give this clinician a quick elevator pitch and get out of his or her way um and same thing it just became all attractive men and women uh in that Pharm pharmaceutical space um and the same thing in Med device like in the med device space surgical Market they did the same thing that is bananas man and I I think a lot of people don’t realize this I know a lot of people don’t realize this but our physicians because of the way that things are structured they’re not sitting here going through the latest peer-reviewed evidence and really digging through these clinical trials on these various drugs and they’re essentially just getting a marketing pitch but you know not to say that these uh clinical trials aren’t ethical or whatever the case might be but our physicians are not going through this data they’re essentially getting educated by people who are not in the system with them correct like it’s a it’s a it’s a brief 5 to 10 minute conversation at the most and that’s if you’re doing a lunch usually it’s two minutes it’s a quick elevator pitch and like an example would be you know your job as a drug rep is to grow a market share right and so if I come in and I know this clinician’s busy it’s hey Doc let me get your signature hey don’t forget that patient that woman over 4 who comes in she’s tired she’s fatigued that could be the perfect patient for this SSRI thank you have a good day and you’re out and it’s just repetitions repetitions um and you get a call list of that clinician who how many prescriptions they wrote the day before who they sent those prescriptions to what what drug company got the Fulfillment all of it and so you know exactly what they wrote when they wrote it how much of it they wrote and then you would prioritize your day to go out and help that guy to try and shift that guy to write for you instead of the other person and they almost gamify it which when you talk about moving from a pharmacist to like me somebody who played Sports and who’s competitive it became you’re if you’re competitive it’s a game and you’re like man I want to win the game I want to like we were just talking about baseball before we went live and it’s like you want to win and you want to you want to beat the system right uh and it that was the challenge they would have the rankings every day you’d come home and you see the rankings on the computer of how you stack up against the other sales reps in the nation uh and it’s a lot of incentiv ation to push and win and Conquer it becomes less about patient care I hate to say that but it’s not in lie of patient care because when you’re there and you’re in the belly of the Beast you’re being trained by academic people who are brilliant and you’ve got people coming in from Stanford and Harvard telling you why it’s crucial to talk these clinicians into getting active and prescribing these medications as a first response and it’s easy with these incentive systems to become part of that tribe and drink the Kool-Aid um and I was young and naive I was in my 20s you know but it didn’t take long for me to figure out wait a second like when I got into the mental health space and I started having doctors tell me about side effects and issues or this isn’t working you start questioning a lot now the question is and this is crazy how quickly does a an average physician today again we have these top tier we were just talking about Casey me mutual friend Stanford trained how quickly does their education become obsolete there’s a study actually done from Harvard that shows it’s within 18 months of graduating Medical School most of what these clinicians learn have become Obsolete and the Market’s moving so fast with large language models and artificial intelligence and biologics and you know uh all the modern technology that’s going into an operating room like when you think about a surgeon like the that’s the cream of the crop the highest of their school the most educated the most rigorous of training and every 6 months a new technique is coming out which is not just mental it’s physical you’ve got to have the hand eye coordination you’ve got to be able to utilize these new tools and modalities and so you’re learning physical skill sets in addition to mental skill sets and it’s complicated so I would say the surgical Market I don’t even believe it’s 18 months I would and Harvard was looking at Primary Care you know which is coughs cold sneezes flu and prescription drugs but when you start getting into these more advanced uh modalities like there’s a lot more that go into it yeah so and just stay staying in that same Lane with Pharmaceuticals and again getting a again a high quality education and then you get into practice and again insurance has things structured in such a way you don’t get a lot of time with patients and you’ve got training as a drug rep from the you know very esteemed masterminds in their respective Fields telling you about this drug and why these Physicians need to use this drug in their practice and so you are really tasked with furthering their education in a way because they don’t have the time or energy to look into this drug and again just to stay on top of stuff because it’s moving so fast you are and and there is that competitive opponent component I alluded to but you are passionate about what you do like if you care about what you do and you take pride in your career which most people in their field of work that are competitive do you want to learn and you want to be the best and you want to be on your game and you want to help that clinician provide care to that patient in an optimal Manner and all the data sets you’re being fed are biased though right and so the data sets the incentive systems all of it is biased and so I’m not here to trash the pharmaceutical industry uh but there are major pitfalls and Ma design flaws in the ecosystem that we have created for the the rep the clinician and the patient yeah what was it like working in the pharmaceutical industry during the rise of seis it was fun H I’m not going to lie did you catch that I like that it was fun man it was wild like I I’m telling you I I said this on Rogan it was like it could be a perfect 10 girl who’s selling toe fungus and I come walking in and they’re like come on Brigham come on back like everyone you were Elvis Presley man like you were a rock star because it was the new blockbuster drug it was fun doctors were taking it themselves they were giving it to their buddies they were giving it to their hunting and fishing buddies and their you know softball team buddies and so everyone wanted this compound and then in addition to that when you launch a new drug you have a huge budget so when I started I was in a small country town of Waco Texas and I had $117,000 a month expense account at 22 or 23 years old I mean I was a kid and I’m like taking doctor I remember one dinner we had a $113,000 dinner one dinner it was wild these guys were ordering crazy bottles of wine and it was a different world and it did change I I I’ve heard it’s changed I’ve been out of it for so long this was I mean at this point 20 years ago um I do know uh what is it the the Pharma guidelines shifted but it’s Pharma self-regulated it’s not the government a lot of people think the government came in and regulated the pharmaceutical companies what the government said is you guys got to clean this up or we’re going to come in and clean this up and the pharmaceutical company said okay let us clean it up ourselves and so they put in place these rules where it’s like can’t spend more than $150 a person for dinner you know all the some some checks and balances to try and tampen down this this insane Rodeo that was going on the wild west yeah and it’s still it still kind of is you know but just in a different way so with that being said so Calis again that was uh an epic moment but what happened you know in that transition again you were kind of instructed to focus on some other drugs yeah I got I got actually got relocated back to my hometown of Houston Texas I got a promotion because I was doing really well and when I got promoted they moved me to the psychiatric drugs and so I had schizophrenia drugs anti-depressants SSR eyes anti- anxieties um and it was just a different world you know then I’m calling on you know primary cares and trying to because again jump back to the time frame I was in this Prozac was the first anti-depressant that a primary care ever wrote you got to think primary cares at the time would refer those out to psychologists or psychiatrists uh and those were the prescribers of of anti-depressants it was a mental health drug um big Pharma taught primary cares how to diagnose treat and prescribe that medicine to the growing market right and they took a market that was Niche and very small and they made it gigantic right and that that’s my qualm now having come out the other end of the belly of the Beast and being away from that and watching what big Pharma has done whether it’s anti-depressants uh you see the same thing with the cholesterol drugs they grew the cholesterol Market Market by petitioning lobbying and funding Academia research and studies to drive down the number on what is appropriate cholesterol levels what’s appropriate blood pressure levels if you look at what all those were in the 80s they were way higher and now we’ve driven down that number artificially in order to write more drugs to encourage clinicians to prescribe first and ask questions later and this is what all is getting exposed with this Maha movement and make America healthy again and a lot of what RFK is out there preaching and beating the drum on so if we look at all the chronic diseases that we’re supposedly treating they’re through the roof we spend more as a nation than any other country on health care it’s the number one budgetary concern to the federal government it’s the number one budgetary concern to each state it’s the number one reason for bankruptcy in America and we look at that and go something is not working man like cuz all of our chronic diseases are at an all-time high we’re going to have the highest rates of cancer this year the highest new cancer rate ever in the history of the United States deaths of Despair we go back to like me talking about ssris and growing this market and more people than ever are on antidepressants anti psychotics and anti-anxiety meds but a dirty secret is more people this year will kill themselves and die of deaths of Despair than ever in the history of the United States more than during the Great Depression and so these numbers sound like wild one of the other things I talked about is we talk a lot about war because it’s an election year and everyone’s like oh my God if we go this way or that way it’s going to lead to war you know and and the fact is over the history of the United States around 1.3 million Americans have died in war and I don’t ever want to trivialize that because those are human lives and I appreciate everyone’s efforts to fight and defend our freedoms but in reality 1.9 million people a year are dying D in the United States of chronic disease more than all the wars we’ve ever fought combined are dying in one year and you go to like opioids we had jelly rolls become a friend he talked about in front of the Senate we have the equivalent to a 747 jet worth of people dying a day of opioids right now like this is insane we are sick as a society and it’s scary man it’s scary the question should be okay so they got those markers lower to get on a Statin what were the results did heart disease go down you know and we actually put up a study for everybody to see who’s watching the the video of this there was a huge analysis done and it essentially found that people being on a Statin their all cause mortality did not change all right sometimes people died sooner right and some there are some instances some studies where they lived a little longer but we’re talking literally and this is not exaggeration days yeah it’s either basically from negative 100 days to to positive 100 days and it’s not talking about all the residual issues right so about a 30% increased incidence of developing diabetes being on a Statin the muscle loss the memory issues and all these other things and so it’s just like are you living longer or are you dying longer are you living longer that’s and losing quality of life because you’re kind of scammed into taking this drug because these markers are changing and again if they lowered that number and more people were not having heart attacks and strokes and dying from heart disease success yeah but that’s not what happened and then what’s also crazy is of the people who have a heart attack more of them don’t have high cholesterol than the amount that do disproportionate amount of people who have heart attacks have normal normal cholesterol levels yeah but this was because it was never the causitive agent behind heart attacks but it was targeted and a drug it’s a multi- multi multi multi-billion dollar drug class and again it’s just like did it I’m a big fan of results just looking at did it work and so you said something so powerful and I want everybody to really understand this what the strategy was was to expand the market for a drug right so we have a class of drugs we let’s talk let’s stay on opioids right so this was geared for very very specific we we’ll say somebody’s going through chemotherapy chally ill cancer terminal cancer patients was originally what Oxy Cotton was meant for oxy was me for terminally ill cancer patients that were in severe pain and were were headed or on the precipice of passing anyway and they grew that market and what’s Wild is that same family the Sackler family Purdue Pharma that created the opioid crisis that we’re going through still to this day in the 60s and 70s created the volume crisis and made billions of dollars off valume they they took out ads in the New York times saying if your wife has an attitude or a stress give her a valume like forget the martini pop a valum and instead women and men drank the martini and took the valume and they created the valume crisis and then they made all this money they almost got uh federally indicted they managed to skirt past it then they launch a drug with hydrocodone their patents expiring they go oh man our patent’s going to expire there goes our cash cow we’ve got to come up with a new compound so they look and find a new opioid oxy and they add it to the cotton system boom they drop it into the marketplace they call it oxycotton but it’s 8 to 10 times more addictive than the hydrocodone system they had before and not only did they get it into the system they got the FDA to give them a label that said it’s non-abusive non- addictive so all these people thought they were taking a safe drug they were told by their doctor you’re in pain this is breakthrough pain I’m going to up your dosage and now when patients are coming back requesting more drugs the the Reps were trained to explain to the doctor this person’s not an addict they’re not showing addictive behaviors they’re experiencing breakthrough pain we got to write them more of these opioids the problem is the pain the way to fix it is more drugs wow so some of the most Sinister drug dealers out there this went from again very specific hardcore issues with pain to prescribing it for somebody having you know arthritis pain or migraines or again it’s expanding the market but this drug is notably dangerous and this was the craziest part is they knew this this was in their trial data and there were so many early indications but this gets into this issue with like clinical trials and like observational data observational data you can manipulate it any kind of way you want to the degree they’re like okay this is happening actually they just need a higher dose yeah right that’s what it is they’re having breakthrough pain right sounds very similar to like Breakthrough infections and these new things like this thing didn’t work because we need more of it that’s why it didn’t work and it’s just like framing and that’s really what they’re M and I even saw it with the mental health drugs this is when I said I can’t do this and I’m out when I was a rep you know they brought speakers in and we’d sign these contracts do online tutorials about how never off label promote I agree I’m not going to off label promote right it’s all just automated in the computer you got to do it after hours you’re in a rush it’s 9:00 at night you’ve been working all day you got to take this stupid online test and answer these questions and agree on online e signature that I’m not going to off label promote then the next night I’m forced to go to a dinner where some PhD from Harvard is telling me all the ways they’re off lab using this drug then I’m put under a tremendous amount of pressure to hit a number and be successful be able to pay my rent and pay my mortgage and pay my car payment all these things and they’re like you’re sitting there having you know beer with one of your doctors and you’re like do I tell him what that doctor was telling me cuz your doctor’s like I want to use this medicine but I’m not sure where to put it in my practice I used it on the patient that’s in your you know data but where else can I use this and it puts you in this moral conundrum because you’re not intentionally doing something wrong right because a clinician an expert a thought leader is telling these reps here’s where I’m using this and I’m having tremendous success and so reps will go out and begin to off Lael promote and it happens all the time on all different array of drugs one one example I can give you is like a antis psychotic anti- schizophrenia drug I distinctly remember the speaker teaching the Reps to go in and this was like think of somebody who’s suffering from a manic episode they don’t sleep for sometime days or weeks they’re on the verge of a psychotic break they have increased sexual activity increased risk-taking behaviors uh very wild and erratic Behavior that’s a clear patient population right that’s what that drug was indicated for somebody on the precipice of something disastrous what the speaker does is come in from Harvard and go I want you to think about that woman who comes into your practice and says doc I’ve struggled to sleep the last few weeks I find myself waking up in the middle of the night my thoughts racing worried stressed thinking about all the things I’ve got to get done and so I woke up and I started cleaning the house that’s the patient you need to prescribe this me what that’s a totally different this is every mom that’s everybody who has a mom who’s stressed and under especially single moms and people working long hours and that’s Stress and Anxiety is part of The Human Experience like there’s other coping tools and mechanisms and that’s just not what that system was built to do and that’s not what the Reps are taught to do and that’s not what the clinicians are taught to do so it’s not that everyone’s being a bad guy or it’s it’s that everyone’s being Sinister everyone throughout that ecosystem almost has plausible deniability right you got the rep going I’m just doing my job I got to hit a number this doctor told me this is the way to do it and that this works then you got the doctor going well this guy from Harvard came in and said this and the rep’s telling me this and I saw a woman who said she’s not sleeping and I want to help the woman and I’ve got this drug it’s a tool in my tool belt here you go and it happens a thousand times a day and then all of a sudden we wake up 20 years later and we go what the happened like everyone’s on prescription drugs we’re chronically ill and none of this is working right that’s the thing at the end of the day clearly it’s not working but the the way that this system is constructed it is so difficult to change right there’s so many pockets getting filled and there’s a masterful thing and you mentioned this a little bit I this is so exciting to talk to you about this because a lot of people don’t know about this there’s a masterful way that apparent Innovation takes place right you mentioned uh Purdue Pharma knowing that their patent was going to expire and just finding a clever way to be able to continue to distribute the drug without their patent expiring and so actually and I pulled this up because I know I was going to talk to you there’s this incredible meta analysis this was published in the peer viiew Journal of law medicine and ethics and this is supported by the ejs C for ethics at Harvard and what they found was that approximately 90% of all new drugs approved by the FDA in a recent 30-year period were little to no more effective than previous drugs that already existed for patients all right 90% are little to no more effective you got send me this I haven’t seen it but I believe it yeah because I talked about this too on Joe it’s the same thing with surgical equipment right you’ve got to this is the problem with the incentive system and this is what I’ve tried to explain and I’m banging the drum going guys if we make everything about quarterly earnings and quarterly profits and corporate capture and I’m an executive at fizer Lily any of the drug companies but or an executive at striker Smith and nephew Donjoy any of the orthopedic joint companies I have got to hit a quarterly number and a quarterly earning time and time again when I was at striker we said we are a growth company they told us we are a 20% Growth Company same thing every day you got the rankings you knew where you stood against the other reps all this pressure is put on you to go out and hit a number it’s about a number it’s about dollars it’s about cents it’s about profits that’s what the hospital system set up for too every surgeon at that hospital is being told did you hit your surgical volumes we need you to get more surgeries in here so throughout this ecosystem everyone’s pushing pushing pushing and the problem is once you set the threshold you can’t go back now you did 100 joints you got a 20% growth number you got to do 120 joints right the next year and so everything goes that direction and they often put uh not not Innovation but uh growth ahead of innovation right so even a lesser product will get launched into the marketplace so for instance when I was at a med device company they launched a camera prematurely into the operating room because sales were tanking they had reached a saturation Point you’re running out of bandwidth you got to hit a boom to hit your yearly number you got to get this camera on the market you push it through the 510k approval process it never has a human safety study next thing I know I’m standing in surgeries with doctors we’re in the middle of heart surgeries and they hit a ablation device and Boop camera turns off we’re heart surgery and the camera turns off they their their way to optically see what they’re doing on a valve is gone in the middle of a heart surgery because that company needed to hit a quarterly earning right that company refiles drugs and Drug patents and extends patents so like prac they bolted on another molecule to Prozac and called it symc and they just said okay now this drug has an indication for schizophrenia but what’s wild about it is we’re talking about a drug versus a drug when you look at the studies when I was being trained as a rep I remember I was again I was a 23y old kid and I’m like hold on a second the drug works at I think it was like 48% and Placebo works at 39% but the side effects are suicidal ideation violent tendencies in the first two like what why would anyone take this they we could just give them a sugar pill and literally only a handful of people are going to know the difference that’s just mindboggling to me and I’m not a statistician you know I don’t know I don’t I don’t write the rules but it’s crazy to me the FDA would go okay let’s put this on the marketplace and see what happens because it’s the using statistics because they can frame it with relative risk reduction versus absolute risk reduction it looks like well this was actually four times more effective than the placebo and the reality is it was a minor um benefit but also what comes on the back end right so are we looking at fixing one thing potentially treating one thing but causing a series of other things and that’s where the whole real I remember relative risk reduction you just spurred this thought in my head I also remember Lily launched an an osteoporosis drug on the market and under a bone mineral density scan canly it didn’t do people people didn’t get a slow a me a big slow and reduction of loss of bone mineral density with the competitor they did it stopped the loss of bone mineral dens density in elderly women which means it reduced the risk of fracture but what they saw in the study is even though women were losing bone mineral density they didn’t fracture at the same rate as the control group the placebo group versus the control group so our message was doc I know we’re not seeing the scientific evidence under the the bone mineral density scan and it appears these women are still losing bone mineral density but there’s something about the quality of the bone because what we’re seeing is a reduction but it could have been an anomaly in the data that just happened to be a lucky anomaly and at that point you’re this drug company that’s put hundreds of millions of dollars into this drug come hell or high water you’re getting it on the market and that happens time and time and time again and it’s it gets so Sinister I hate to be Doom and Gloom and there’s there’s a lot of positive drugs out there and obviously there’s great medicine and great Innovation that has happened but the system is rapidly being captured and becoming more about money over the last 20 years for sure than it ever was before yeah yeah the a big term for everybody to walk away with today is poly Pharmacy right so it’s not that you know somebody’s getting on one medication it’s usually two three four five six plus medications and they’re just getting stacked on top of one another and a glaring issue is that you mentioned a placebo control study so there testing this drug against a placebo we’re generally not looking at any of these drug trials what if somebody’s on all these other medications and then it’s left up to the doctor who’s not educated on the depths of all these different drugs and Drug trials and it’s basically you’re just an experiment we’re just going to throw this in here see what happens Y and you come back but there’s actually testing that can be done to find out how you react to certain drugs in advance of being put on certain drugs let’s talk about that yeah well and there’s yeah you’re talking about the pharmacogenetic test yeah we had that as part of our practice and I owned a lab and I would go out and educate clinicians this is after I left being a drug R then I went and became a med device R then I got out of that after my brother passed away from opioids and the irony of it was I was out with a toxicology lab educating clinicians on the importance of testing and screening patients for diversion and also before ever prescribing an opioid let’s take a look under the hood and let’s look at this person’s cytochrome p450 marker which is just a fancy genetic term to tell us how you metabolize medications because we all have genetic anomalies and we’ve now mapped out those genomes and we know how before we ever prescribe a drug you’re going to metabolize it are you a slow metabolizer a fast metabolizer a moderate metabolizer or are you an outlier that can’t metabolize this medicine at all and it gives us a tool to be able to properly assess which product is which medication or treatment modality is going to best be suited for your unique genetic makeup and the insurance companies took that away from patients within eight nine months they said no we don’t want to cover that and then beyond to add insult to injury they even took the safety net of Toxicology screening away from the pain doctors that were writing the opioids so essentially the insurance companies also had a huge role to play in the opioid crisis because they took two of the big tools in the the tool belt that a doctor had in this country to prevent abuse and subversion and they were gone and so now the doctor’s taking a shot in the dark all right well let’s ride an opioid and if somebody’s a Ultra slow metabolizer they could OD if somebody’s an ultra fast metabolizer they’re going to burn through that opioid and then be calling you again a few hours later and saying I’m in pain again and then you’re going to be going okay are they addicted or are they really are they one of the people experiencing breakthrough pain you know cuz there is a certain percentage of society that will experience that and then the craziest part is like 20s something per of society can’t absorb an opioid people with Samoan genetics people who like Hawaiians a lot of their that patient population has no ability to absorb opioids but what’s crazy is these opioid companies still lobbied the government and pushed it into the Medicare and Medicaid systems knowing that the folks in Hawaii weren’t ever going to be able to metabolize it but could still become addicted my question would be why wouldn’t insurance companies want a test like that to be available because it just makes sense if it’s about patient care and success with a medication that we’ in advance find out whether or not this medication is appropriate for this person because the truth is regardless of the data from a clinical trial even you’re a unique individual and there are always outliers and there are always people on various ends of the spectrum with uh Effectiveness and with side effects and so why wouldn’t an insurance insance company want this to be available to patients and doctors no that’s a great question and the they it’s a little conduted and complicated of an answer and it’s so nuanced it’ll take a second to explain but there are certain modalities that the insurance company has not monetized and they don’t really make money on so they’re loss leaders lab testing the insurance companies don’t own labs they don’t have Kickbacks on labs they don’t have reimbursements or rebates on Labs so it’s just money out the door right so they like Labs surgeries a lot of those things it’s an obstructionist mindset as an insurance company and so if I deny a pharmacogenetic test if I deny a cancer screening if I Lobby my women’s health initiative to push back the the women’s uh Health clinicians to push back the timeline and the dates at which we test and Screen a woman genetically for the potential of having a child with an abnormality because of their age right the goal standard was 30 if I can push this number back with clinicians to 35 I save billions or millions or hundreds of millions of dollars to my bottom line and we go back to that quarterly earnings quarterly revenue and then you think well wait a second like an example I usually give is what if somebody’s pre-diabetic and we know if we let them transition to diabetes there’s a Sevenfold increase in the cost of care till that person dies as an insurance company wouldn’t you want to practice practice preventative medicine and stop the transition but the dirty secret is the average person switches employers every 2 to 3 years in America and they become another insurance company’s problem so with a lot of these big ticket item tests if I can delay the screening and I can make it a pain in the ass for this patient to get accessibility to it they eventually give up and then a few years later there’s somebody else’s problem so that’s one component the another big dirty dirty secret that I’ve been ringing the bell on is that the insurance companies are literally making money off of the drugs and medications you take so when we say the average American now over the age of 40 is on three or more prescription drugs or something like it’s it’s a insane number um why would you as an insurance company want that to happen or allow that to happen the answer is the insurance companies have colluded with the pharmaceutical companies and this is factual there’s a middleman called a Pharmacy benefit manager has anyone ever talked to you about that please do yeah so these pbms a lot of people have never even heard of it a PBM covers almost 90% of the prescription care that comes through this country so if you’re filling a drug at a pharmacy it funnels through your Pharmacy benefit manager and so many people go I don’t have one you do it’s owned by your insurance company United siga Etna Blue Cross Blue Shield went out and bought these middlemen that were established again in the in the 70s and 80s these middlemen were established to drive down the cost of prescription care drugs they were put forth to go negotiate with the big pharmaceutical companies and say no we’re not paying you $1,000 for that drug for this to get on Medicare and Medicaid and for this to be approved to this nation you need to give us better pricing within a decade the insurance company said wait a second we could buy those guys and they did and so the big five insurance companies went out and bought the big three Pharmacy benefit managers and the three Pharmacy benefit just three of them cover almost 90% of the prescription care coverage in America that’s an important thing to know because that explains why the cost of prescription drugs have gone up over the last 20 years that explains why the insulin price is at an all-time high because what they did rather than negotiating down the rate they went to the to the pharmaceutical companies and said why don’t you charge me $100 more for the insulin and then give me a rebate of $100 to my Pharmacy benefit company and then you go well hold on cuz they’re still paying the bill why would they want to run up the cost and I’m showing you the magic trick because once you see it you know it and you’ll know when it’s happening so the magic trick is like somebody like me I employ 350 people the employee is not paying for that I’m paying for that at the end of the year the insurance company comes back to me and says Brigham Joe Bob cost us $11,000 a month in prescription drugs that’s $122,000 a year we have to make that money back and we have to charge you a premium we have to up your co-pay you’re deductible you’re out of pocket expenses all of that but they never paid the 12,000 they paid half of that they paid $6,000 cuz $6,000 went in a rebate to their holding company the pharmacy benefit manager and then it gets even dirtier I owned a pharmacy this is the only reason I know this your doctors usually don’t know this most clinicians I talk to are like what I didn’t know this only reason I know this is I owned retail pharmacies that build Insurance you come in you want to fill a drug like metformin I try and use Simple Math let’s just say this is close numbers but metformin is like $2 cost a pill I mean a month and I would sell it to you for $4 a month I make $2 you get a great quality product for $4 you come in I swipe your card it’s Blue Cross Blue Shield I have a gag Clause it’s illegal for me to tell you that I can sell you that drug for $4 the computer tells me I have to charge you $10 I’m not allowed to tell you the cash price because Blue Cross has me under a gag Clause I have to charge you the $10 Blue Cross claws the $6 back puts it in their Pharmacy benefit manager bucket the pharmacy benefit managers which are supposed to be driving down the cost of prescription drugs are literally making billions of dollars a year year in profit while the big insurance companies that own them at a separate cost center are also making billions of dollars like over $300 billion dollars is what United made last year they’re not doing that by providing you with great care and covering lab tests they’re doing that by depriving people of quality Care by creating obstructions to lab tests to diagnostic tools to surgical procedures but then they’re monetizing it goes even worse insult to injury not only are they not giving you accessibility to the ability to prevent the chronic disease they’re monetizing your chronic disease and they’re making billions of dollars off you being on these drugs and so then you go wait a second what about when somebody has a heart attack or a stroke think about this most of the cost of care happens after you’ve transitioned out of the private payer system into the Medicare Medicaid system where you’re not their problem you’re our problem you’re now this chronically ill person who’s been on these medicines for years and the heart attack that began to manifest in your 20s is now happening in your 60s and you’re having a heart attack and you’re having open heart surgery and we’re paying for that taxpayers paying for that the insurance companies have already rode you all the way to the bank and kicked you off to us and that’s what’s happening in this system and that’s why it’s this colossal failure I’m just I’ve never said this word out loud before I’m flabbergast I’m flabbergasted man and it’s I mean to be honest it’s brilliant it really is if profit is the is the goal it’s it’s brilliant you know it’s really constructed in a way that and now okay so the pbms were essentially kind of like a union for the people in a sense but insurance companies gobbled them up and use them as another feeder into into their system got it and so if again like it’s crazy that in that moment when the when the patient is trying to get that metformin and they could potentially pay $2 paying quote cash but they’re like oh I got to actually pay my co-pay which is $10 yeah they just don’t even know that that exists and the pharmacist cannot tell them correct that’s crazy and then I could even do I own blood Labs I own the toxicology Labs I own pharmacogenetic same different game right I I would try to negotiate a predeter people go why don’t I know what my lab test is going to cost it’s crazy I don’t know what my surgery is going to cost that’s not the hospital that’s not the lab that’s your insurance company because I would go negotiate with insurance companies and go can we set a rate on this blood work and they go no you’re not going to be in our Network we don’t want another company in our Network okay so this gets complicated too I I’m then forced to bill you a number and if you’re not in network the insurance company pays you 30% of Bill charges so imagine this if I bill you the $300 I’m trying to get paid you’re going to pay me a 100 bucks I lose money on your lab test so in order for me to be profitable I have to inflate my bill Master to three times to get the insurance to pay me what they should have paid me the fair reimbursement for the test so now I have to bill you $900 then the insurance company screws the patient because they put in the contracts with the labs and the pharmacies and the hospital systems that you were required by law to go after the patient for any short payment I didn’t want to bill you the $900 I had to because the insurance company’s going to play a game and pay me oneir so I have to build 900 to get paid 300 but the way that works is now I got to go after you for the 600 even though I didn’t need the 00 I never asked for the 600 I know you’re not going to pay me the 600 because patients never end up paying the bill they refuse to do it but then I have to harass the patient to get them because I have to show a reasonable effort to collect or I can get literally federally indicted I can go to jail for violating laws in the in this country because that’s how much power these lobbyists have and these insurance companies have so they forc these Labs pharmacies and hospitals to basically pressure and Chase down patients for the difference when if they would just agree to pay a fair rate we could all ride off into the sunet and sing Kumbaya you pay me a 10% return on everything I do and the patient gets a good treatment I get my money in a timely manner but it takes 90 days to get reimbursed from the insurance company you have to fight these people tooth and nail they typically give you 30% of the charges and then I have to go after you the patient by law and then you the paent go call your doctor and go what the hell man you ran a test that cost me $900 and my insurance company’s not covering it how did you why didn’t you ask my insurance company and it’s like because it’s your insurance company playing games because once they’ve pissed you off you’re not going to call them you’re going to call the doctor and you’re going to yell at your doctor and go why did you run this test and now when that happens two or three times your doctor throws up their hand and goes I’m not running that test anymore right and now they’ve shut down effectively your accessibility to care as a patient and that’s why we started ways well and that’s why I got into Cash pay and that’s why I got into compounding pharmacies and our model now is like we’re out of that ecosystem because that ecosystem whether you have United Signa Etna congratulations you have a first class seat on the Titanic like it doesn’t matter which seat you’re in because they’re all going the same place yeah racing towards the iceberg yeah man um this also with with all that getting put on the patient speaks to the bankruptcy issue in the United States that most people have no idea about can you talk a little bit about that yes the number one reason for bankruptcy in America is healthcare costs I mean it’s terrible because there’s there’s and so and then as you get older what we were talking about with the prescription drug coverage you know a lot of programs have what’s what’s called a donut right so the insurance company will say hey we’ll cover Grandma Mima whatever your your elderly person’s first $10,000 of medicine okay but the average elderly person’s on four or more prescription drugs and the pbms have inflated artificially the price of those prescription drugs so a drug that was $100 is getting rung up at $200 if you got four of those that’s $800 bucks you’re out of your prescription plan in a matter of months and now your grandma has to come out of pocket for the next5 to $10,000 depending on the plan and so a lot of these elderly people say I don’t I’m on you know I’m on government assist I don’t have the money like I’m on Social Security I can’t afford $800 a month in prescription drugs because remember what I told you earlier once you’ve given the insurance card they now have to charge you the insurance Price so on every drug there’s a multiplier effect and the snowball gets bigger and bigger and the debt gets bigger and bigger and the liability gets bigger and bigger and patients are drowning whether it’s their Hospital charges their prescription drug charges their test in their lab testing like imagine a poor person who’s elderly you know with a terminal illness that’s just trying to stay alive and they’re getting hit from every direction with this bull that is killing them literally and and figuratively financially crushing these people but these insurance companies are laughing all the way to the bank yeah right I got to ask you some clarity on this because this is an interaction that millions of people have every single day it’s the interaction with their healthcare provider their their physician and that relationship is dramatically changed in the last few decades and it’s largely because of insurance companies and we think it’s something else we even think it’s the doctor you know it’s trying to make more money just you know but it’s really the insurance company so we’ll just use for example we have the capacity now for some incredibly comprehensive blood work to get done right our blood work can tell a story really it’s not just these kind of rudimentary points that you know a standard uh blood panel recently is like your triglycerides HDL LDL you know and this but we can find out so much more particle size of the part you know the LDL particles we can look at hormones and relationship to these things and all this is available but because of insurance companies and this is the thing and this has been a argument people have even shared over the years like okay we found out about getting this test done how do I get it done my doctor won’t do this for me you got it right yeah so what’s going on there how have insurance companies impacted the relationship between doctors and patients drastically drastically and it’s not the clinician’s fault I I can tell you it’s not clinicians are not bad people they want to help you they came into this to be a steward to society most of them were the same as me you come out your bride eyy your bushy tail you think you’re going to make a difference and the system chews you up and spits you out and after they’ve done it for a decade and they’ve been yelled at by their patients yelled at by the insurance companies threatened by the insurance companies they get scared and they get gunshy31 bu the insurance companies and I would go out and I would edate educate clinicians in the state of Texas about the importance of getting proactive and predictive and I would say hey why are we waiting for these people to get chronically ill to act we can use blood work as a leading indicator to get ahead of chronic disease and if if we want to stop the five chronic diseases that are killing mankind the best way to do it is to stop them from ever evolving in the first place and that was my pitch and I got thousands of clinicians in the state of Texas to begin to get proactive and predictive and to to test blood work within 3 months I’m not kidding you clinicians were calling me hey man I got a letter from United saying if I keep pulling blood work they’re going to terminate my contract hey I got a letter from Blue Cross Blue Shield Brigham saying if I keep pulling this comprehensive blood work they don’t think there’s medical necessity they’re telling me I should only be doing a basic lipid panel what do I do and my answer is you’re the doctor you tell them to f off they didn’t go to med school and then they put you under clinical review and now your doctor’s getting stuck on the phone for an hour with another doctor that’s on their payroll that is pushing back on oh this kid’s 25 years old or 30 years old I don’t think we should have been doing this I I fundamentally disagree with your clinical decision I’m going to put that in this chart if you violate this again we’re going to cut your contract and if you lose that contract you’re out of business as a doctor you’ve got medical school loans you’ve got a mortgage payment you got that Porsche payment you know these guys and girls are just trying to make livings and their livelihoods on the line and then if they do do the test and the insurance denies it we go back to the conundrum of now you’re going to get a bill because they’re making me Bill you the insurance companies have captured all of it from the doctor to the hospital to the patient to the the lab Labs thees all of it has been captured nobody can fight these guys they’re the biggest gangsters out there like they are the mob they’re the modern-day mob and they control all of healthcare right now hand inand with big Pharma and so it is drastically impacted the patient relationship and makes it really hard for those conditions to provide true care yeah they’ve taken all the tools out of their tool belt yeah they have to operate in a very very uh vanilla space and standard of care it’s standard of care and you have to stay within those barriers or you can get wiped out very quickly and we could go back to the opioids and this is a prime example think of this I’m a clinician in the 2000s early 2000s I got a a rep coming into my practice talking about breakthrough pain I’ve got professors from Harvard and Stanford that are now exposed today that we know were on the payroll for the Sackler family coming into my practice hosting dinners explaining how I’m being a shitty clinician if I don’t get serious about breakthrough pain and helping treat chronic pain okay I have an alternative to this if I believe that these drugs are addictive which by the end of it people did you had an alternative which is a for especially for Orthopedic procedures or joint pain you had topical pain creams well insurance companies quit covering those so it’s the same thing patients would have had to pay cash out of pocket if you give the patient a choice between paying $180 for a pain cream out of their pocket that’s non addictive non-abusive or writing them a prescription opioid that’s going to make them high and fix their pain and it’s covered by the insurance they’re going to go that path okay then you look at the tools in your tool belt to prevent abuse toxicology pharmacogenetic testing those are gone those are taken out of your PO out of your tool belt by the insurance companies so every check and balance and safety net was ripped away from those clinicians they were forced to write these opioids because they didn’t really have another option they’re trying to treat pain and help patient to the best of their ability they’re being pressured peer pressured and influenced by their peers who are on the take getting paid at Academia and then we see the exact same thing we think you would learn the same exact hijacked system occurred again and we’re just now what I guess four years later going yeah man that was kind of messed up now all of us are like I don’t I don’t think I trust these guys anymore essentially from top to bottom you know this system is constructed in a way where these very very powerful entities are profiting from our Collective sickness our Collective ignorance and you also mentioned in that story with the Sackler family and the FDA being involved in helping to get it approved right they had somebody in the FDA who also later went to work for them as well three years later he left to go work there with a big huge salary people don’t realize recently the last like 10 FDA commissioners went to work with the pharmaceutical industry yep or came from the pharmaceutical industry and so all this obvious Insider information and just this kind of collective coercion of this system and you know we transitioned into the funding the medical funding from pharmaceutical companies being the really major part of the fda’s budget but it was for it started off the scientific review budget because we need more people and better approval process we get drugs to people who need it right so that’s why we’re going to start taking money from the pharmaceutical industry yeah and we’re talking to the tune of billions of dollars annually but as soon as you open that door now again it gets very sketchy because the pharmaceutical industry is funding The Entity that’s supposed to be the Watchdog and looking out for patient well-being us yeah right and so this sit this situation is dire to put it bluntly with that said and this is my question for you because you’ve seen this from top to bottom this system is not broken it’s that’s a misnomer it’s not broken it is set up like this for this to be yeah the way that it runs how on Earth can we find real health care how can we find success with our health how do we go from this designed sick care system to a real Health Care system for ourselves and our families is there a way forward yeah I think there is and I always like to end on a positive note too so I’m glad you asked that and it’s I love what you just said because when I testified in front of the Senate and I know you had mentioned you were going to be there too but you had a conflict I literally said that exact thing I said so often I hear the health care system’s broken the health care system’s broken it’s not broken it’s rigged and we’re the ones fitting the bill and the price is more than money dollars and cents it’s being paid in Americans lives loved ones friends families Brothers and sisters I know I lost my brother to the opioid crisis like I know what these people are doing and it’s dark and it’s Sinister and when they control 50% of the fda’s budget and most of the heads of the FDA are Swap and spit with big Pharma and Big Industry and they’re moving back and forth you’re just moving chess pieces on a board and so what I implore people to do is to begin to think of the existing Health Care establishment in the insurance establishment like car insurance it’s there if you wreck the car is there for something catastrophic but if you are going to put you and your loved ones Health and Longevity and and future livelihood and lives in the hands of these people you are going to be sorely disappointed and we as people have to take sovereignty and accountability over our health and the blessing is 80 something per of this is preventable through lifestyle diet nutrition and exercise and if we can take a little bit of sovereign a little bit of accountability and by ourselves time we have to hope knowledge is power and through media platforms like this through your podcast and the rogans of the world we are now waking up and we are discussing this as freethinking free people and that’s the beauty of this country like this where else could we go take a on the senate floor and drop these bombs on our on our you know elected officials and basically read them the riot act about what we’re seeing and make it public this was broadcasted to the public I don’t know if you know but over 2,000 people made the trip they had to have an overflow room Americans are pissed they aren’t buying it anymore they now know the magic trick we’re asking the questions and just like in medicine we can’t cure what we don’t diagnose and we can’t diagnose if we don’t take a look and so we are getting to the root cause of the disease and now I feel like we’ve diagnosed the root cause as a society as a public as freethinking individuals the question becomes what’s the treatment and how do we get us back to being healthy and it wouldn’t take that much CI means talks about this if we just pivoted Healthcare to focus on metabolic disease and we took all of these extreme expenditures that are outling out there and we focused on just addressing metabolic Health overnight we could change the trajectory of chronic disease and if we just changed the incentive systems to where the FDA was not allowed to move back and forth between the Private Industry and back to government service because when you’re in that cross-pollination ecosystem I have to question if you’re serving the people or you’re serving the pharmaceutical company that’s going to give you a job in 6 months right and we know that now as a society it’s being exposed it’s being talked about and we the people can make change through our pocketbooks through our decisions through our discussions through educating our friends our loved ones through podcasts like this like that’s the first step and we’re there we’re in it the next step is going to be people drive policy and policy drives politics so if we can drive policy through the people through our voices we can fix these things but short term I tell people man you can in one hand and wish in the other and see what fills up first man because 400 trillion to one those are the chances you’re alive right now today are you going to put it in these people’s hands are you going to let these people make these choices for you because we know where they’re going to take you if you go and you eat the average American diet live the average American lifestyle and you see the average American doctor you will die of the average American chronic disease we are a chronically ill Society we have got to take accountability and Sentry and quit worrying about when somebody else is going to fix our problems roll your sleeves up and go fix your own problems and there are outliers like cancer and these things that could Blindside us but you know what the number one risk factor to cancer is other than smoking is obesity and metabolic disease everything goes back to our metabolic health making better choices getting Outdoors spending time with loved ones trying to really address it from the root cause up and we can make change with time I mean maybe I’m overly optimistic but I really believe for the first time ever Americans are awake like we’re not blind anymore we’re awake they’re people are pissed I mean I saw it and they’re excited they’re excited for change they’re excited to make change and and improve this and I I hope we can I really am I’m I’m optimistic that we will yeah and often times unfortunately it takes some something catastrophic for us to change and to wake up and the last few years and all the chaos it really was a catalyst for a lot of people like you said waking up and you’ve got some resources for people as well you mentioned ways to well a couple of times can you talk a little bit about some of the resources and access that you’re yeah yeah ways to well a lot of and and we’ we’ve done a a in-depth job of explaining the why so now when I explain what we’re doing at waste W will probably make more sense to your listeners my thing all along was we’ve got to get proactive we’ve got to get predictive and we’ve got to get personalized we know what chronic diseases are killing Americans we know the root causes of those chronic diseases and we know how to prevent those chronic diseases and it is not something that just The Joe Rogan and the Aaron roders of the world can afford you are talking about less than a hundred bucks a month on average to drive your health span and I know that’s a lot and I’m not trivializing that but with a lot of my friends who go I don’t I can’t afford that I go I know how much beer you drink I know what car you drive I know all the tennis shoes you bu yeah it’s like this is your one shot at this you won the lottery you’re alive we’re here are we going to let them destroy our body this this like think what people spend on cars mattresses houses those are temporary things this is the one body you get for the whole time you’re here on Earth and you spend 100% of your time in it like let’s honor that let’s take accountability and sry and take back our health from these people and how you do it and it doesn’t have to be waste well there’s hundreds if not thousands of companies out there I would tell people go out and try a cashpay clinic do your research don’t just blindly walk into a clinic and go to the first one that’s right down the street from you you how much time do you spend finding what restaurant you’re go to dinner with your wife on a Friday night or I have friends that’ll interview 20 people to do a project on their house but sign up with the first doctor their insurance company sends them to we should be interviewing doctors like how important they are because they’re probably the most important Ally in your health care journey and you need that resource you need that tool in the tool belt and you need an ally that’s open-minded Progressive and in the know about what’s going on with the various treatment modalities and so at ways dwell because we’re not in the insurance ecosystem we can make decisions side by side with the patient for what’s best for the patient not what’s best for the Insurance’s pocketbook or big Pharma and so ours is very conversational it’s a dialogue and part of me is because I’m not an I don’t like Authority I’m not an authoritarian guy and so I wanted to provide an Empower and embolden patients and so the ways dwell approach is our clinicians are trained to be your friend your Ally and a resource to knowledge not a dictator telling you take this take that take this no no we’re not doing that it is here are the pros and cons here are where you are metabolically metabolically here is where you are on visceral fat subcutaneous fat here’s where you are on your biomarkers here are some recommendations of diet lifestyle nutrition here are some tweaks we can make here are some pharmaceutical intervention options here are some peptides and things that other people aren’t talking about in traditional medicine because insurance doesn’t cover those things things but there are literally hundreds if not thousands of tools in the tool belt that open themselves up to patients when they’re not in that insurance model whether it’s cancer screenings that look at over 200 types of cancer and can identify it at stage zero which has a 99% success rate whether it’s blood work that does a true Deep dive into you at the biological level whether it’s the genetic test that you and I were talking about earlier whether it’s you know like finding if you have metal allergies or any sort of metal toxicology in your blood work uh microplastics all of these are screening tools that we can identify stem cell treatments there’s so many tools that you will never hear about if you’re in the insurance model not because you’re doctor he or she is a bad person it’s just not an option for them because they’re working within an ecosystem that tells them what they’re allowed to do and so that’s that’s the gist of it if we can if we can allow patients to have line of sight then again we can fix what we can see yeah but if we’re not looking we can’t improve what we don’t measure and we can’t measure what we never look at in the first place and that’s what the systems built to do so that’s that’s the gist of it that would be my elevator pitch on why people should go find a cash pay clinic and I’m a big believer that’s how I started this I found a p cash pay Clinic I myself was in that system on the cusp of diabetes obesity my dad’s diabetic my brother’s diabetic my sister’s diabetic my stepmom’s obese diabetic had a bariatric procedure like that was where I was headed yeah uh and thank God I went out and found a p cash pay clinic and got proactive and took control over my health and took myself out of that sick care system and it changed my life yeah yeah man this has been awesome this has really been awesome we’ll put the links for everything in the show notes everything we talked about and man this I didn’t even know that this going to impact me this much today and uh man I just appreciate you so much truly and I you your story is incredible just all sometimes if we just sit and think back on all the things that we’ve been through and accomplished the risk that you’ve taken you know the Investments that you’ve made to create this life and now you’re impacting all of these people and really helping us to think differently about this and even just doing the numbers I love it when somebody can do the numbers you could potentially save money just because of the whole co-pay phenomenon you potentially save money doing a cash pay system a lot of times it is cheaper for patients and I really appreciate you having me on man because you Dro knowledge bombs on me I like I’ve done a lot of podcasts over the last year because of Joe and people seeing me on Joe but man I learned a lot just talking to you you you are a plethora of knowledge and you were dropping some knowledge truth bombs on me today so I learned a lot so thank you for having me hey if you like this video make sure to check out this video right here we trace the coursework at medical schools at leading medical schools that’s 80% 90% pharmacology where they literally treat you from day one and train you from day one that heart disease EST sta deficiency that diabetes and pre-diabetes is a metform deficiency that depression is an SSR deficiency
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