Ketamine Insights

Psychedelic Medicine & Childbirth: A Midwife Shares Wisdom on Patient Centered Care

• Betsy Merbitz • Season 2 • Episode 7

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Host Molly welcomes midwife and activist Betsy Merbitz to discuss the importance of patient-centered care in childbirth and in psychedelic therapies. Our conversation delves into the distinctions between holistic and medical models, focusing on the role of the individual as the primary healer. Betsy describes her work as a Certified Professional Midwife, the importance of holding space, and the historical context of the medicalization of birth. We explore the role of profit-seeking in the creation of our current healthcare systems while bemoaning the lack of accountability built into those systems. 

We note that both psychedelics and childbirth have long histories of traditional and community-based care providers, and we discuss the dangers of excluding them in favor of for-profit models. The episode concludes with insights on how to center patient voices in the emerging field of psychedelic medicine, drawing parallels to the birth community.

In this episode we reference Dr. Neel Shah. Here are two articles about his work. These articles unfortunately do not use gender inclusive language.
https://www.hsph.harvard.edu/news/press-releases/hospital-management-practices-cesareans/
https://www.consumerreports.org/c-section/biggest-c-section-risk-may-be-your-hospital 

We also reference Ayize Jama-Everett, one of the creators of the documentary A Table of Our Own.  The interview I reference is from an episode of the Psychedelics Today podcast, which can be found here.

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[00:00:00] Theme Song: She's sometimes sad, she's sometimes happy. She's doing things to make her life less crappy. Trying the treatment that's new on the scene. Let's sit back and talk about Ketamine. 

[00:00:18] Molly: Welcome to Ketamine Insights, a podcast about mental health and psychedelic medicine from a patient's perspective. I'm Molly Dunn, a disabled writer from Chicago, who's been using ketamine to treat depression for about five years.

Ketamine Insights is a cumulative podcast. Season two builds on the foundation set in season one. So if you haven't heard season one yet, please check it out. 

All right. Today we're welcoming Betsy Murbitz to the podcast. She's a midwife and an activist and a role model of mine, and we're going to discuss patient centered care.

On episode two from season one, we go into this topic more deeply. In that episode, Lynn and I went into the differences between the holistic model and the medical model for psychedelic medicine. The differences between the two are not just technical, they're profound. The holistic model emphasizes the importance of working with a therapist, setting intentions and doing integration work after your psychedelic journey.

But more importantly, in the holistic model, it's the patient who is the primary healer, not the medicine and not the medical professional. Since I started ketamine treatments five years ago, I've leaned heavily on my therapist who's trained in ketamine assisted psychotherapy. He has a wealth of knowledge about psychedelics, which has been invaluable.

I've also occasionally brought in medical specialists to help with questions of drug interactions, unwanted side effects, and stuff like that. These people have also been vital to my healing, but it's me that comes up with the intentions for each ketamine journey based on my needs and abilities. I'm the one experiencing the beauty and sometimes the difficulties during the trip.

It's my inner world that is explored and deeply changed. And it's me, I'm the one doing the exploring and the changing. My inner voices guide the way and it's my strength that keeps me going. I'm the healer in the room. 

So now I'm really excited to Welcome, Betsy. How you doing, Betsy? 

[00:02:21] Betsy: Hey, Molly. I'm so excited to be here.

Yeah. Thank you so much for having me. 

[00:02:26] Molly: Oh my God. I'm really thrilled to have you here. So just for background, can you tell us what you do as a midwife? We'll get more into the profound aspects in a bit, but for now, just like, what does the work look like for you day to day?

[00:02:39] Betsy: Yeah. And, but I, I actually want to pause and say that, you know, what you said in that intro was so important.

It really, really was. And I, I just want to say that actually, if, if you sort of just cut part of the intro and cut out specifically where you mentioned ketamine, that's like exactly what like a midwife would say about birth. And so it was, it was just really beautiful to hear you say that because, because literally like it would be like this, like if I just cut that and like played it for someone, they'd be like, Oh, that's a midwife talking about birth and that's, that's a lot of how we talk about, you know, how to have client-centered care in the midwifery world. Right. Is that it's, it's that person's journey and it's that person, you know, really. Birth is kind of like a trip for a lot of people in many ways. And so, yeah, so I just, I loved that. I love that. I was, I, yeah, that was, that was so beautiful.

[00:03:27] Molly: that's awesome. Thank you. 

[00:03:29] Betsy: Yeah. So maybe I can start with just a little bit about without going like, totally into the weeds about different types of midwives. I'll just say that I am trained I'm what's called a CPM, a certified professional midwife, and that is a certification specifically that's a training in out-of-hospital midwifery.

So people who are CPMs are trained to attend births either in a home or an out-of-hospital freestanding birth center. The most sort of common other type of midwife you might hear about is a nurse midwife is someone who goes to nursing school and then gets a midwifery degree as an advanced practice nursing credential. And nurse midwives can attend births in the home and birth center as well as attending births in hospitals. So my certification currently, I cannot get a license in Illinois, the state we're in, to practice as a midwife, but I can in some other states. So that's to say that my current job, I work as an assistant at a freestanding birth center.

And I have in the past also attended lots of home births as a midwife. And lots of people in our society don't even know like sort of what a midwife is or what a midwife does, but midwives in general are primary care providers for low risk people who are pregnant, birthing, and early postpartum. So most people in our country, this is not necessarily the same in other places, but most people in our country think, okay, if you get pregnant, you go see an obstetrician, but that's really kind of a cultural value, right?

So, you know, most. Most pregnant folks, either a midwife or a doctor, could be an appropriate care provider, and there's sort of, you know, pros and cons of, of the different choices. But yeah, so as a midwife, I can provide, like I said, care during pregnancy, birth, and postpartum, and then there are lots of midwives who also provide things like pap tests and STI testing and, you know, assistance with things like contraception and stuff like that, family planning.

[00:05:19] Molly: Okay, so do you normally meet with a person before, like, is it a journey that you take together that you meet with them during the pregnancy and then attend the birth and then talk to the same person? So we, 

[00:05:34] Betsy: because in the same way that somebody, you know, might go to an obstetrician for prenatal care, they couldn't, if they were working with a midwife, they'd come to the midwife for prenatal care.

So yes, if I'm working with a client or like, you know, the birth center that I work with, clients just come for their prenatal care with us.

[00:05:50] Molly: So I was wondering. What did you hear on the podcast in the past that made you think of the role of a birth doula? Yes. Or a midwife? 

[00:06:02] Betsy: Yeah, yeah. And actually, do you want me to take a second and talk about the difference between a doula and a midwife?

[00:06:07] Molly: Oh, yeah, actually that'd be great. 

[00:06:08] Betsy: Yeah. Yeah, because I think that is something also again, especially because midwifery is not as common in our society. Sometimes it's confusing for people, but so, so I just kind of defined or explained, right. What a midwife does, right. They're a primary care provider for people during pregnancy, birth, and postpartum.

And then sometimes like also work with people for other aspects of reproductive health. But a doula is not a medical provider. A doula is a support person. So a doula is somebody who Generally, you know, with birth, but there are actually lots of doulas who provide like, now there's like more like end of life doulas.

And there are people who provide, you know, sort of provide what their abortion doula services. Like there's people who provide doula care and other things besides just like giving birth. And then there's also you know, postpartum doulas who come in your home afterwards, but it's basically somebody who is for, for birth, a birth doula is somebody who usually would meet you maybe a couple of times during your pregnancy, talk to you about like what you're looking for, for your birth, what kind of support you might want during the birth. build a bit of a connection and then be there during your labor and birth and just help you get through it.

And they might use massage or breathing techniques or visualization. But in some ways, I feel like when we talk about the like techniques, it almost doesn't exactly explain it because a lot of times it's really more the like presence and like being, you know, being there and holding space that's really helpful.

And then of course, in the context of like, especially in the context of hospital birth, a lot of support with advocacy, right? If somebody is going into a hospital where they're concerned that maybe their right to informed consent might not be respected, then part of the doula's role might be to help them figure out what are good strategies to access that informed consent.

So, so just to work there, right, doula is like a support person, you know, a midwife is, is a primary care provider. But the reason I think sometimes people mix them up, I mean, there's several reasons, but you know, one reason is that like, in general, both doulas and midwives are going to be people who are trying to provide that much more like, you know, client centered, person centered, you know, type of support for folks, whether they're in the midwife role or the doula role.

[00:08:01] Molly: Okay, cool. That's very helpful. I've wondered about that personally, myself. So, now I was wondering if you could get into like your approach or your philosophy of care and what you see as your role throughout your work with a client? 

[00:08:16] Betsy: Yeah, yeah. Wow, that's such a, that's such a great question. But 

[00:08:20] Molly: And that's a big one.

[00:08:21] Betsy: Maybe, but maybe here, maybe I should first go back to, because I don't think I've really answered the question you asked before of like, kind of what I heard on the podcast that made me think about this role. So I, and I, and I'm like very excited about that. So yeah, so I, you know, when I started listening to your podcast, I was, I was just really excited because it just felt like a lot of what you were bringing up.

A lot of what people are confronting as they're going on ketamine journeys is very similar to what people are confronting when they're giving birth and specifically if they are really wanting to be at the center of the decision making for their health care. A lot of times in more mainstream medical practices, they are not, that is not what they're experiencing, right?

They're experiencing that they're sort of being Only given certain information and then not given other information, or there's an expectation that every single person is going to just receive the same type of care and that they, that there's not going to be any individualization, individualization of care.

And, you know, in some cases up to and including people who are basically, you know, I would, I would say prevented from accessing informed consent. I would say even including in some cases assault, right, where someone makes it very clear that they don't consent to something and hospitals. Sometimes providers are using bullying to get them to agree.

Or in other cases, like I said, actually like physically assaulting them and doing medical procedures on them that they didn't consent to. So, so, you know, a lot of things happening that are things that I really want us to be able to, to change and prevent. And I think that, you know, when you were talking about a lot of the information and resources that you were providing for people doing ketamine with your podcast, I was like, I felt kind of the same way I felt about doula work specifically that I was like, wow, it's so wonderful that there's like this person like providing all this.

And it's actually also so messed up that people like would have to find that from a podcast, right. That is not built into the medical model that like people would be able to like access that type of, you know, information and resources and like those types of things that, that community members are sort of like, wow, we just have to like provide this to each other because the medical system isn't giving to us. So, so that was what got me really excited and I was like, Molly, you're totally like a ketamine doula. This is so, this is so awesome. And I'm really, really passionate about birth and birth is kind of like a big, you know, most of my, my lane, you might say, but I, I, Overarchingly feel like the problems that happen in birth aren't they aren't really specific to birth, right?

They're they happen, you know to a lot of folks in other areas of the medical system and you know Whether someone's getting like, you know knee surgery or you know Somebody has like, you know a chronic condition or you know, certainly I think maybe even more so in mental health You know, I think there's just a lot of ways that the medical system isn't really showing up for people's needs isn't really designed to really meet people's needs.

And so 

[00:11:17] Molly: Couldn't agree with you more. 

[00:11:19] Betsy: Yeah, right. So, so, like I said, on the one hand, like, so glad there's like people filling in with like these dual roles and stuff like that. And also like, what, what, what we deserve as a community, right, is actually that it would be built into the model itself, as opposed to like people just needing to like, start a podcast to get this information out there. You know what I mean? So, 

[00:11:41] Molly: yeah, and not have to cobble together the treatment that provides. the services that they need. You know, it, it doesn't, it shouldn't be the case that you need to bring in an advocate to have your needs met in a hospital setting. It should be the hospital, if you need to go to a hospital, it should be the hospital providing your needs met.

You don't need, you shouldn't need like someone, you know, yeah. 

[00:12:08] Betsy: Exactly. 

[00:12:10] Molly: Okay. So now, thank you for that. I appreciate you going back because you're right. I appreciate that answer to that question. So now I guess the question about your approach or your philosophy of care, which you went into a little bit just now, but yeah, I'd be interested to see, to hear what you think you're, what you see your role as throughout your work with a client.

[00:12:27] Betsy: Yeah. Yeah. And you know what, like I said, I've sort of been in some different Like maybe you might say different like titles, but always had the same kind of like philosophy. Right. So like in, for many years, I was a doula. Now I am certified as a midwife in Illinois. I practice as an assistant, not as a midwife, but I have practice as in other States, right, as a midwife. But, you know, regardless, I think that it's so, so important for providers to understand that, like I said, very much echoing what you said in that intro that like, Whatever happens to that person in their journey of pregnancy, birth and postpartum, they are the ones who are going to live with that forever.

That is going to be part of the, you know, their life and their story forever. So what they want and what they value needs to be at the center, right? Like, like you as a provider, it does not have the same impact on you as a provider. It just simply does not. So really having that. Understanding and that, that deference right to, to that is, is part of it.

And I certainly think that with birth, there's, there's just so, there's, there's so many things, but obviously when somebody is pregnant and giving birth and during their postpartum, like that is such an important. Time in people's lives, right? This is, this isn't, this is just like something that, you know, for the vast majority of people, like.

This is one of the biggest events of their life. Right. And, you know, they may, they may only do it once, or they may do it, you know, five or six or more, you know, some people do have, you know, more babies, but, but like the birth of every baby is a, is a huge, huge milestone in your life even if you do have several and so coming in with honoring that time as being a really sacred time and that, and in the, in birth in particular, you know, understanding that.

You know, birth in itself is something, you know, a lot of, you'll hear a lot of midwives and you'll say is, is not a medical event or a medical complication. Right. Like, you know, I, I sometimes explain it to people, like, it's true that you're more likely to break your leg when you're running a marathon than when you're sitting on the couch.

But like running a marathon does not mean you have a broken leg, you know, and it's kind of like that with, with pregnancy and birth that like, yes, like my opinion about risk, et cetera, is like, you are more likely to, you know, have something happen to you when you're in the middle of giving birth than, you know, maybe when you're just like walking down the street, but if you are pregnant or birthing or postpartum, that in itself is not a complication or, you know, a medical complication.

And I think that It's important to understand that because most of the medical system revolves around disease and illness and injury, right? It's like you're only there for something wrong and it's, you know, there's been many, many people who have written about how, you know, midwifery care has a lot of advantages over obstetrical care for low risk people, partly because we have much, much, much lower rates of intervention.

And I think there's many, many reasons for that. for that. But, you know, I think there's a way that, like, if you are trained as a doctor, fundamentally, right, there's a part of your, your training that is towards illness and injury and disease, and if you are trained as a midwife, you are oriented towards normal pregnancy, and I think that, So I think, so I think that's one piece of it.

But much more so than that, I just think there's, to me, it's, it's just fundamentally important to understand that like, there are ways that the sort of standard of care that I would say from what I've seen, most obstetricians and most hospitals Provide does not follow what I would consider like basic principles of human right to like get informed consent before you know, a procedure happens to you because so many interventions are so normalized that they're just like part of like, Oh, if you go to the hospital, you get this intervention, you get that intervention.

They're, they're not used to people who like would like to like, Oh, like I actually want to understand it before I say yes to it. And sometimes actually like circumvent that process of like the person consenting or not consenting. So, so for me,

[00:16:33] Molly:  I just want to like step in for a sec. 

[00:16:34] Betsy: Yeah, please. 

[00:16:35] Molly: Sorry, I just want to step in for a second and say, in my personal experience, just hearing so many friends with birth stories that are honestly devastating, like, and this is, you know, people with insurance, with access, going to hospitals and getting care that they find, that they find traumatic, and they're not necessarily in bad shape going into the hospital, you know what I mean? And they come out feeling bad about what just happened. And it's, and they have to recover from that while struggling under the stress of having a newborn baby. And it's hard. 

[00:17:12] Betsy: Yeah. Yeah. And I would love to, to talk about birth trauma for a minute. So, yeah.

So unfortunately, yeah, birth trauma is very common. And I think that it's important that when people have done research on birth trauma, People often think, like, oh, probably, like, people are traumatized if they have, like, a life threatening emergency, but if people, like, have, like, a really, like, sort of mostly medically uncomplicated birth, they don't.

And that really isn't true, and actually, the best predictor that researchers can find about who does and does not have birth trauma has to do with consent. Right. It has to do with like, you know, whether the person was actually given the opportunity to consent or refuse interventions or whether they were done to them non consentingly.

And my personal experience and something that I have really seen with my own eyes that is really hard is that, and also I guess maybe like seeing what has happened and then sort of learned about from researchers that's given me like a really full picture is that, you know, a lot of mental health practitioners who work with trauma talk about how shared.

You know, processing collective, you know, witnessing around trauma is such a huge, huge thing and that can be so healing for folks and that I think actually you mentioned this in one of your episodes, maybe when you were talking about trauma for folks after nine eleven. I don't remember which episode that was, but, but many, many, many people when they give birth, if they are traumatized, If they're alive and they're not like, don't have some kind of major physical like disability, that injury that was a result of the birth and their baby is alive and healthy, if they are upset, they are told that they should not be upset that they, that they, you know, that they should just be grateful.

They had a healthy baby. And which of course, for one, that's a horrible thing to say to anyone, right? Like if anyone feels bad about anything, someone's just like, well, you know, you'd like, you know, You should just be grateful that you didn't have a heart attack. It's like, well, you know, I could be grateful that I didn't have a heart attack this morning, but like still like, feel really like upset that like, you know, something else happened.

Right. But besides that, it's the fact that a lot of times, like I said, it is because there were violations of their body that happened. And a lot of times then No one is sort of giving any validation to how traumatic it was that that happened. And then that can then make it much, much harder for them to recover from that, from that trauma, you know, as opposed to like, if they were to say like, Oh, that was traumatic.

And people were to say like, yeah, you know, I could see how that was. I'm so sorry. Let's what, what kind of processing do you need? And I, I, like I said, I have actually seen that with my own eyes that like basically saying you have a healthy baby, so shut up. And like, it's really, really awful that, that anyone, you know, is told that.

[00:19:47] Molly: I mean, it's such a lonely experience. You're by yourself going through the trauma and then to be told it doesn't matter. You should be grateful. That's such a, yeah, that's such as the, and I think a lot of, I think that comes not only from the medical establishment, but it happens to when you go home, everybody asks you, how's the baby, how's the baby, how's the baby, which is important, of course, but the woman just, went through a big experience, even if it wasn't traumatic.

It was big, you know, like you said, it's a major life event. I think, as you said earlier, like the, the provider doesn't have the most at stake and they never will. The person going through it, whether it's psychedelics or birth, is the one that is the most vulnerable in the moment and also is the one that has the most to gain and lose.

So it's hard. It feels very similar in that way that like there's there's a vulnerability and also an important, it becomes more and more important to, to listen and to have that holding space, as you said, I think like, because personally I had no appreciation for what that meant until not even until psychedelics, but, but until just recently, when I had an experience with a holistic healer who really didn't.

I don't do much, honestly, except hold space. And I still had a really profound experience. And I was surprised at what came up from my body just being around someone who was holding space. And so I was wondering if you could talk about like, what, what does that mean to you? How, maybe you can't explain how exactly you do it.

I'm sure you could write a book about it, but like, what, what does it mean to hold space? 

[00:21:27] Betsy: Right, right, right. I mean, and I think. It's funny. I, yeah, I feel like it's almost like a, could almost be an existential question. Right. Of like, and I, I will say, I feel like I've had that experience both yeah. With like receiving and giving where I'm kind of like, I feel like I didn't do anything, but the, you know, the other person was like, wow, that's amazing.

Or I feel like, I'm like, I feel like they didn't do anything, but I'm like, wow, that was amazing. You know? So I think either one, either one could be the case, but you know, I think that especially in the context of birth, like, you know, people having someone there Is more important than having that presence of someone is sometimes more important than them, like doing a lot of things.

And like you said, in your intro that, that could have been about birth, even, you know, it's like, it's like the birthing person is on that journey. Right. Like the, the birthing person is the one going through that labor and that, you know, really profound and intense transformational, you know, process. And the.

The other people there can't do that for them. And like, sometimes we can do like I said, like techniques or things like massage and stuff that can be, you know, can be helpful or can be supportive, but there's still a big difference between like being able to like offer a certain technique and being able to like, be like, just having that sort of overarching sense of like, no, the primary thing I'm doing is like.

Just being here, you know, and, and a lot of people when, like, if you, you know, when you talk to people about their birth stories and stuff, like, you know, a lot of people will, will share how they just felt like, wow, that person's presence was just like really comforting. And even if they're like, I don't even remember, like what they, you know, what they did.

You know, another thing I'll share is that, you know, a lot of, some doulas will talk about how they'll say like, yeah, you know, when I first started as a doula, like I would like do a lot of things, you know, and now like. You know, when I got more experience, I actually almost like did less. And, you know, and even some people share like this and it was like, my early clients were like, wow, you were such a great doula.

And then sometimes like later on, my clients were like, wow, I had such an amazing birth. You know what I mean? And like, and like, like almost like in their memory, it's less of like, I don't really know what that person did. But you know what I mean? But they're like, but they're like, I had this this powerful experience.

So I think that there's a way that in our society, we really like sort of under appreciate or undersell like, just the power of like, Being in the space with someone and maybe, you know, offering small things that kind of show we are like tuned into them. Right. But that on a fundamental level, we're not like trying to manage or assess or fix anything.

Right. But we're just like being like, we're here, we're here with you. 

[00:24:07] Molly: So interesting. Like it, it reminds me of like in, I'm thinking about the word accompaniment and, and like, as not just like presence, but an enthusiastic acceptance of whatever it is that you're experiencing sort of a presence that's supportive.

And also, like just letting you take the lead. I think that's the way that I felt in the when my therapist sits with me during an actual infusion and just sits and is just quiet the whole time. And I know that if something occurs to me that I want to remember, if I'm able to speak it out loud, I can speak it out loud and he'll write it down and we'll talk about it later.

And that's comforting to know that there's someone there to do that. And I'm not in the room all by myself, but it's also, there's something else that's, that's helpful about his presence, even if I have an eye mask on headphones on listening to music, you know, he's across the room, I've got a blankets over me and all that stuff.

There's still a holding space that's really valuable. 

[00:25:13] Betsy: Yeah. And I love the way you say that, that you're sort of like, Well, here's this like specific task that he's kind of like useful for, but you're like, but that's actually not right. But you're not like, Oh, I guess I could just like bring a recording device.

You know what I mean? You're like, like I could just leave a recording device on or something. It's like, it's like, no, there's something, something more than just like the specific thing. And I, and I do think there's a way that like. It makes us feel like more of our needs are met, even, even if like realistically or practically, there's not like a lot of other needs we're asking them to do, if that makes sense, you know what I mean?

You're like, if somehow there was like something really random that you needed, there is a person who could provide that, even if like realistically, the only thing usually that he does is you're like, Hey, if I say something out loud, like write it down, you know what I mean? But it's like, you feel like, Oh gosh, there's a person looking out for me.

And I love, yeah, I love what you said about that. Like, Like accompaniment being presence with that sort of like enthusiastic like support like that recognition that it's your thing that you're at the center Right, but that it's yeah, it's that person. Yeah, 

[00:26:15] Molly: it's such an interesting thing like I, there's a, I don't know.

Yeah. Okay. Okay. We're going to go on to the next question before I get into like the whole idea of followship. I've learned, so I wanted to talk a little bit about kind of the dangers of medicalization and I've learned a lot from you and your writing about the history of the medicalization of birth.

And I think people don't realize how. you know, unique and recent people going to the hospital to have a baby is and also the, you know, the kind of conflation of illness and pregnancy, which is, which is kind of strange. You know, depending on how you look at it, I think it's like ubiquitous in American culture, the conflation, but it's also kind of straight.

If you can manage to get outside of that point of view, it doesn't make a lot of sense. I would like to give you a chance to talk about the negative consequences of medicalization around birth. And, and what similarities there might be so like, I see, like, for example, we've spoken on this podcast about the dangers of medicalization, the disempowering of clients, kind of treating psychedelics as if the chemical is the most important aspect and not the the psychedelic experience itself also concentrating on the outcomes as opposed to the process.

And I see a lot of similarities. And I was wondering if you could talk just a little bit about like the negative consequences of the medicalization that you've seen within like the birthing community or the birth and culture, I guess. 

[00:27:55] Betsy: Right. Right. And there's. There's, there's so much there, right? And so it's like, there's sort of so many different, different places I could go with this, with this question.

So I'm gonna, I'm gonna try to think of like, what are the ones that are kind of the most connected maybe to, you know, to, to ketamine and stuff. But I think that certainly in, you know, in the, in the U. S. and this, you know, stuff that's been, been researched and been looked at and stuff is that you're, you're sort of like, Personal health profile is actually less of a predictor of whether or not you'll have a cesarean compared to your hospital's policies.

So like the best way to like, identify, like, who's going to be like likely or less likely to have a cesarean is to actually, you know, is to look at the trends of like the hospital and the provider that you're working with, as opposed to looking at like anything about you and. So, you know, so when we're, when we're talking about birth interventions, like we can't actually separate it from things around policy and, you know, the corporate, you know, hospitals and, you know, profit and all those things, because those things are having a huge impact on people's lives.

Right. And they're, they're, they're having a huge impact on, you know, what are essentially like things that people think of as being like, their individual medical care, but are actually like policies that are being put in place by, by hospitals, often by, you know, like maybe like a hospital administrator, someone they certainly have never like talked to or interacted with, that then are going to be having this really big, big impact on, on their life and their wellbeing.

[00:29:32] Molly: And I'm just going to mention That's such a profound, I just want to stop there and say like, what a profound fact that is. Like whether or not you have a C section, correct me if I'm getting this wrong, whether or not a person has a C section is more. Reliant on the policies of the and the practices and kind of the trends within the hospital they go to than their personal medical history, 

[00:29:56] Betsy: right? Exactly, and I mean and a great if you're if someone is like listening to this and they're like What is this person talking about and like a great person to maybe we can like link this person is Neil Shah. Dr Neil Shah, he has he has great research about this and he and he's been he's been it's it's been It's great because he's a doctor so he can, he can speak to the doctors and he, he has really been, this is what a lot of his research has been on is like about how, like, yeah, like what hospital you walk into is going to like make a huge difference.

And, and obviously I'm not saying right. That's somebody who's like individual health. history doesn't make any difference. I'm just saying that like, when they look at population level trends, what they're seeing is that these institutional practices are much bigger predictors. So, and 

[00:30:46] Molly: I want to tell a little story here too, about like a personal story that kind of reflects that reality.

I have a friend who went to business school, before she went to get her MBA, she was a nurse, and after the MBA, she worked at a consulting firm that went into hospitals and helped them do the things that consulting firms help with health care systems. And she turned to me once and said, you know, to my face, like, I got to get out of this. I got to get out of this. This is not... she hated her job. And she said to me that part of what her job is, is, you know, like helping build efficiencies within the hospital system. 

But as a nurse, she was, she saw the people behind the, the policies that were being made at this executive level. And she literally said to me, you know, the decisions that are being made in the rooms I'm in now are meaning that patients are sitting, you know in their own mess for hours at a time and not being cared for and, and it was breaking her heart.

She couldn't live in that detached world because she had been a direct caretaker and she knew what, what, what it meant on the ground, but those were not the realities that were informing the decisions that she now saw as an MBA advising on healthcare systems from a system wide approach. 

[00:32:14] Betsy: Right. And so it sounds like the, you know, someone with an MBA and a health background would be someone who would really understand that when you are in the healthcare system, providing that direct care, you really, as an individual want to provide really good care, but the system is set up to be providing profit and these, these other things.

And, and I do want to make clear, cause I know I am saying a lot of really negative things about your, our healthcare system that I of course know that there's. Many, many, many individuals who care very deeply about their work. And so I, you know, I'm talking definitely about a system, but I, but I also want to say that I think of it very similar to other systems like racism or sexism or things like that, that yes, it is a system and we, we are all part of upholding it.

And we, you know, we, we all have been, you know, have, have ways that we are constrained by it, but there's also ways that like. If you are someone in that system, such as a healthcare worker, and you do have some amount of privilege in that system, there are, you know, there are also times where you are making choices that I think we do need to just have responsibility around that.

I would love to also just, because I think that's actually a great dovetail into like, maybe I could take a second now and talk a little bit about like Rockefeller and like some of the history and stuff. So yeah, something that I really like to help people understand when they're thinking about, especially people who might be thinking about like the if they're considering like hospital birth versus like a home or birth center birth to understand that.

So, yeah, so in the 1800s, you know, the vast majority of people giving birth were giving birth usually, you know, in their homes. And just in terms of the landscape of like different types of healers, you know, there were lots of midwives. There were more like other types of, I guess what we would now call quote unquote, like holistic practitioners.

There's not necessarily a great word for them. I don't ever call them midwives. Holistic providers alternative, because they're only the alternative because of who has more money and wealth. But there were, there was actually a lot more community based healers, like, you know, herbalists and people like that.

And, you know, Rockefeller, right. Who was the oil tycoon made a lot of money in oil, you know, after he had made a lot of money there. He was kind of thinking about like, what are other ways that he could really maximize profit? And he kind of like. looked around and was like, Oh, you know what I think I'm gonna do?

I'm gonna do healthcare. And so he really used his power and influence to move the healthcare system. To, and again, not that it was like somehow perfect or anything before that, but just like he, to truly try to eliminate a lot of different types of healers, to make sure that the only type of healthcare people could access was the kind that was going to be the most oriented towards.

profit. So things like pharmaceuticals and surgeries are much more effective for profit than things that are more local, more community based. And so a lot of the history of this has to do with something called the Flexner report. He was again, eliminated many different types of community based healers.

He also made, Was responsible or one of the contributing factors to a closing of many, many black medical schools. So really limiting healthcare for black people. So, a lot of, a lot, a lot of harm that was done. This was around the turn of the 20th century, the early 1900s. And so this is when then doctors started a really organized effort campaign to eradicate midwives and to move birth from the home to the hospital. So that's when you start to see this, the statistics starting to shift of numbers of people having birth at home versus in the hospital. And it's really important to know that at that time, and this, again, it's Many people have researched this.

This is something that's well known history. It was much more dangerous to give birth in the hospital than at home. Like when they look at the rates of how many, how many birthing people and how many babies survived, you know, it was, it was much worse to go to a hospital and much safer to be at home for many reasons.

And this is what I really want people to understand about our culture around birth. Home birth versus hospital birth now, because I think a lot of people just assume hospital is safer, hospital is better, and I just want people to know, so just so you understand, right, the, the, the, the shift from home birth to hospital birth had nothing to do with science, nothing to do with research, nothing to do with outcomes, right?

It was about profit, right? It was about You know, creating a type of birth system that would be more profitable. And so obviously people making the decision now in the 21st century are going to want to look at what's going on with data and different factors now. But in terms of our cultural perceptions and some people's cultural sort of like, Oh my God, home birth, like just to understand the, the reason that it has become normal to give birth in the hospital was so that Rockefeller could make more money, like this is what was, you know, what's going on.

And, you know. Also, at this time, again, people, you know, may just wanting to think about the fact that at that time, medical schools were mostly accessible to wealthy white men. Right. And like I said, then there were these black medical schools, many of which got closed at this time. But so midwives were much more disproportionately women, much more disproportionately immigrants, much more disproportionately BIPOC folks.

So. The, it was essentially like that power and influence that white men were able to access in our society that, and then also that, like I said, that concerted campaign and effort by Rockefeller was one of the reasons that they were able to amass that power and, you know, essentially like they did really concerted smear campaigns that midwives were harmful, midwives were dangerous. You can see there's like these advertisements about midwives being dirty and ignorant and again like I said none of it actually based in any data of what was happening at the time and there were doctors at the time who spoke out against it, right?

There were doctors at the time saying we should not be going after midwives. We should be actually trying to make hospital births safer. safer because we're like actually killing a lot of people with disease and, you know, like transmitting diseases among people in hospitals because of lack of sanitation practice and stuff like that.

So, so that's some of the history, right. Of like why we think of birth in the hospital with an obstetrician as like the norm. And, you know, again, why ironically we might call like home birth with a midwife as like an alternative. It is, it's You could say it's true it's an alternative because it's statistically less common, but it's, it's not, it, it didn't get that way by some sort of like, Scientific review of the data of how we're going to keep the most people alive.

It was actually the opposite, right? It was like putting profit, it was killing people for that profit. And I do just want to add one other thing, which is that another driver to try to get pregnant people into the hospital was so that. medical residents would have people to practice on, right? Like that, that, you know, the more bodies they could get into hospitals, then the more that they could have a space where people who were training to be doctors could access their bodies.

And when I, When I'm teaching people about hospital birth and when I'm like talking to people about hospital and especially like people maybe who are doulas who might be newer and are sometimes like really confounded when they see things that are clearly harmful or not beneficial to patients. I'm like, if you think of it as a system that is set up to make, create good birth outcomes.

You will just like be baffled and bang your head against the wall when you, when you watch what happens in the hospital, if you believe that it is a system that was set up so that doctors and you know, residents could have access to pregnant and birthing people's bodies to practice on. And you believe it was set up to make profit when you walk in, you'll be like, yeah, this all makes perfect sense.

You know, like that's just, that's just the reality. And it sounds very harsh, but, but that has been my experience of many, many years of going to many, many, many births. 

[00:39:18] Molly: I think like, you've really brought us directly to where I wanted to go next, which was like, structurally, the systems are set up to center one person or another one group of stakeholders over another.

We've done an episode on this podcast before about Psychedelic conferences and the psychedelic culture that's emerging and how it doesn't center patient voices. It doesn't center people with mental illness who need psychedelics for medicine. It does rely on those people. There would be no psychedelic renaissance if it wasn't for the fact that Congress people and other members of just our greater society have a lot of compassion for veterans with PTSD.

And they allowed research to go forward because of the promising, you know, the cures that were coming out and the help that that veterans with PTSD were were getting from psychedelics and like, So the Renaissance relies on the compassion that society shows this group of people, but it's not embodying that compassion itself necessarily.

And it's and in that way, it's exploitative, right? It's saying, we're going to use this sympathetic group of people to build an industry that makes a lot of money and calls itself health care, but often doesn't listen to the people who are supposedly being cared for. And I'm not saying it's not impossible to get a good outcome in that context, but it's not fucking ideal.

It's not great. I've been in those situations and gotten ketamine infusions in clinics where I wasn't listened to and it's, and I've been in dangerous situations and I felt like I was roofied without, without So, you know, I'm sitting there with a needle in my vein and drugs going into me and not having any ability to speak up for myself.

And no, and there's no negative consequences whatsoever for the people who provided that bad care and provided that traumatic, like, you know, frankly, very traumatic experience for me. And so I guess what I want to talk about next is like, How do we build in, like if we could start over when it comes to birth, which is kind of where we are with psychedelics now, you know, like it's beginning.

This culture is growing and now's the time, like now's the time to center the people who are most vulnerable and the people who have the most to gain and to lose. And what are the structural ways that we can, because if you rely on patient testimonies and anecdotes. To be the voice of patients, you're not, like, that's, we have more to offer than anecdotes and testimonials.

And I think, like, we need to, in some way, create systemic structures that center patient voices in the psychedelic movement. Because if we don't, we'll constantly get pushed to the side, us patients will constantly get pushed to the side to hear the louder voices in the room, which is, you know, going to be money and.

And mostly money. And I just to say one last thing I see at these conferences, you know, the venture capitalists are invited to speak. And I'm like, you guys, people like me aren't invited to speak. The venture capitalists, I promise you in this culture will be heard. Like their voices don't need an extra platform.

But people like me who can't even afford to attend the conference aren't invited to speak, aren't given discounted tickets, aren't, you know, and I, I just, Right now the system is set up to be the opposite of centering patients. We're not even invited into the room. And I, and I'm wondering, like, how do you, how do you structure a new movement to listen to the people who are most important?

[00:43:09] Betsy: Right. No, it's a great question. And I'll just say like, you know, there's like the easy way, right, which is like abolish capitalism and subtler colonialism, right? That would be like the easy way. And I mean, I say that jokingly, but I do, I do feel like it's important to name that, like, A lot of the harm, you know, that I talk about in the birth world is, it is actually inseparable, right, from things like racism, and capitalism, and settler colonialism, and all of that.

And I do think that's important because I do think it impacts like how we organize for this and I, I've been thinking a lot about like when I was first trained in birth work as a doula, which was mostly by like white middle class cis women, you know, there was sort of a lot of emphasis on things like advocacy and things that I think of as kind of like individual and Very little analysis of how, like it's the, actually the overarching power structures that are what, you know, are enabling this and causing this.

So, so for me, there is a way, like in, in birth work that, you know, I really try to say to people like, yeah, if you're real about like changing birth outcomes, you actually have to be real about like ending, like racism and capitalism. Like actually, like you, you actually can't, you, you can't like just like say you're gonna do one and not do the other because this is actually how we got here.

So I think that's part of it, you know, obvious that like. When, and understanding it with an organizing lens, like, I think that, you know, outside of birth, like, I'm definitely somebody who, You know, really just values like struggles for, you know, liberation and how we can organize, you know, for, for power and thinking of it as like, how can we, you know, organize for power as opposed to something like, Oh, if we just had this certain thing, that would be enough.

You know what I mean? So I think, so I think on the one hand, it's like really always having our lens and our orientation towards. How we can be transforming our society to be less harmful. I think another, I do think another piece of it to think about and to understand is that, you know, I'm someone who really comes with a strong orientation towards transformative justice and prison abolition.

And I think that that the transformative justice spaces are ones where I've really learned some really amazing things about how we think about conflict and harm. And so I think that starting with also a lens of like, so just, we as a society in general, right. Are actually not very good at dealing with like.

Conflict and harm, whether that's like, you know, interpersonal conflict, or, you know, whether it's like sort of harm between two individuals, or whether it's like more like obviously things like systemic types of harm to groups of people. And I think the reason that's important, right, is because When we're talking about like medicine in general, right.

If you're working for a hospital, right. There's going to be like the people who like own or run the hospital, right. That are like, they're big money interest, but there's also people who have a lot of privilege within that hospital system. Right. Like I would say like, you know, doctors are centered much more than patients.

And I think that it's just, it's important to understand that though, when we're, what we're talking about is like a system where in general. Nobody is actually usually that good at dealing with harm. And then there's people who have a group of power and when they do harm, there is no accountability. And so that, and that's really, you know, what I, what I think you're talking about in some of your stories and like what I see in birth all the time is that like, there, there is no structured type of accountability for healthcare providers.

And I think, and, and, and I will say like, as a healthcare provider, I also really actually do have a lot of compassion that like, Healthcare can be really hard, right? Like, especially, like, you know, in certain situations, like, there's so many, like, there's, there's no way to just, like, have a formula and practice it enough times that then you, like, always get it right, right?

You're in a dynamic situation where you're trying to do the best you can, but if there is no system of accountability for when you do harm, then why would you ever, like Stop doing harm and I'm going to share, okay, I think this was Neil Shaw, the same person I said before, but I'm actually not sure if it was him.

I heard, I remember I was hearing someone, a doctor who is very oriented towards trying to, you know, change birth for the better who said like, he's like, yeah, you know what, like, It was great to be me. And he was like, if I do a C section and the kid comes out looking like, not so great, I'm like, Oh, it's a good thing I did a C section.

And then he's like, if the kid came out looking great, I'm like, Oh, it's a good thing I did a C section, you know? And, and he was like, so, you know, that that's a great life. And I think that's such a good example of like. There's no actual accountability of like, so if you did an unnecessary surgery, like what, what are you going to have to do differently to retrain?

So that like, next time you don't do that, he's like, that doesn't, that, that, that doesn't exist. Right. It was like sort of his point. So I think that in the, you know, in the context of the medical system, whether it's ketamine or birth or, you know, again, knee surgery or, you know, whatever, like things that, you know, it's what, what are ways that we could set up some types of system for actual accountability.

And I, and I, and I want to name two that like, The only thing we have right now, really, like, you know, there's very limited things. It's sort of like If you can sue somebody, right? And like, if you, if something bad happens to you at the hospital, like, you're not like, oh, wow, it's so great that now I could sue somebody, right?

You know what I mean? You're like, and, and also, again, as you may know, there's also like many, many, many types of harm that you, you can't sue for, right? I think it's important to understand that if you are a healthcare provider now, if you, if you were listening to this and you were like, wow, I want a system of accountability for when I do harm, like you actually can't access that.

And, and like, healthcare providers are trained. You should never, ever, ever apologize to them. Do not ever, ever go to a patient and be like, I'm sorry, I screwed up because then you might be able to get sued. We don't have good systems of accountability for harm generally, right, is a big, is a big part of the problem.

You know, I certainly, and I think that then when we We try to superimpose sort of like maybe some small structures onto that, but, but like they, they are, it's very hard to make anything that actually has the power to actually do something. Right. So like, yeah, I love the idea of like, could have like a patient advisory board or, you know, something like that be something that could be helpful, but it's like, well, If it's not actually like there's not actual accountability, like if it wouldn't, it couldn't actually do something about harm, then like, no, it doesn't matter.

And I think back to your point about the conference, another thing that, that I really, really wish was true about our, like, that we could change about our medical system that, you know, again, many, many, many people have written about this, that, you know, in general, healthcare providers are not required to disclose their financial, Ties to things, you know, things like pharmaceutical company, and again, many people have written about like, there's been major medical journals where there's been like people who left in protest over the fact that it's like a conflict of interest.

Like if you're reviewing a bunch of like, you know, scientific studies about a drug and you're getting a bunch of money from that drug company, like that is a conflict of interest. And so, so conflict interest has been like a huge, again, lots of people talked about it. It's a huge issue generally. And, and again, that sounds like exactly what you're talking about with that psychedelic conference with when it's just like, you know, if you go into.

One of those conferences and you don't have the money there. They're like, well, we have to give it to the people. We have to give those voice to the people who have the money. Right. And, but on another level, and this is what I want people to be thinking about. Right. It's like, when you walk into a healthcare provider's office, like you, you don't necessarily have access to that information about like, you know, like what's their relationship to those venture capitalists?

You know, what, what's, you know, are they, you know, on the payroll as a consultant. for, you know, one drug versus another. And then when you're trying to access like information on what the best option for you is, they're going to be colored by the money that they're getting from those companies. So that's a, you know, like a huge issue in, in, in healthcare generally.

And I think really, really, really, you know, it's important for people to, to understand. 

[00:50:38] Molly: It sounds like it's, that's really helpful. I think the, it sounds like the two main things that you're kind of pulling out our accountability and disclosure, I couldn't agree more. I, you know, I have an MBA, I worked in international development, I saw the way that structural, that lack of accountability can stop best of intention, the people with the best of intentions from doing good work, because it gets in the way of learning.

You can't, if you're never. accountable for the things that you do wrong, just structurally the organization doesn't learn. And it's not a, it's not an indictment of any, any individual participant even. It's just that organizationally, you're not going to learn if you don't build those systems of accountability into your organization.

[00:51:38] Betsy: Yeah, I, I, I was like, Oh, I thought of this other thing and I want to, I do another thing that I want to mention on that, though, the, this kind of like elitist medical system that we have, right, where there's all these barriers to people like becoming a provider, you know, is, is also a way of essentially like, Shielding or preventing accountability, shielding people from accountability or preventing it from, you know, happening and because I think that, I mean, on the one hand, just if providers are more sort of in a community, right, that is actually going to provide some level of accountability, this way that the medical system, like I said, tried to like eliminate all these different types of providers and then be like, okay, there's this like one path for you to be able to access Being, you know, whether it's being a psychiatrist who then can like provide ketamine or it's being a doctor who can attend birth as opposed to, you know, we don't have, we don't have midwives anymore.

It's something that really changes there then is like, who can become a provider. Right. And so then that really means that there's fewer providers. There's fewer options for providers. And there's, your, your provider is much more likely to be much more removed from the community. And if you have ever heard someone say that, like, Oh, you know, there's, There's all these counties in this rural area where there's like, there's no provider.

There's no obstetrical providers, right? You've probably heard people say that. And like, some people even say it's like, you know, a healthcare desert. And so, so like, I, I just want to make it really, really, really clear that like, that was intentionally created, right? Like that was an intentionally created.

So there were providers there. They eradicated them. They made them, they made it illegal for them to practice. And they basically said, you know, now you can only access care. from these specific types of doctors and you cannot access care from these community based providers. And then they're like, oh, look, there's a shortage.

But you know what I mean? Like that's, you know, I mean, it's literally like, like damming up a river and then being like, oh, there's no water downstream. Like when we're talking about like, Places where there's not health care or like when they're talking about like racism in the medical institution and black folks or other folks of color who have a much harder time accessing concordant care, accessing, you know, a care provider that shares their racial or cultural background that that is because of intentional choices that were made to eradicate certain types of providers.

But I think it really also plays into that accountability. It's like these very specific type of professionals, right. Who go through a very specific schooling path, who have a very specific credential, who are like allowed to be doing this, you know, legally, even though, you know, certainly like there are certain types of psychedelics that have been part of, you know, people's communities and people's, you know, lives and experiences for, you know, many, many thousands of years, much longer than European folks have been on this continent.

And so I just, I just think it's important to understand that, like, when I see things about like, Oh, like now, like. Some state is passing a law for psychologists to be able to, you know, do this or, you know, whatever, like, just understanding that it's like, that is, like, sort of doling out this thing to this, like, specific elite group of people.

It's not actually, like, creating access for, you know, Everyone who, you know, I think would deserve that. And again, that comes up a ton with midwifery when we're talking about licensing and stuff like that, because of like, you know, who gets to access these certain pathways that are then sanctioned by the state and you know, who doesn't, and just like wanting people, like every time you see like someone who for whatever reason is having trouble accessing health care in our society understanding that like it comes from like intentional choices to eradicate certain health care providers so that other health care providers could make a profit. 

[00:55:09] Molly: I think that's such an interesting and such an important point that like first of all commute health care providers in community there's a sort of natural accountability because people know of their their record and their, you know, manner and their people, it's just known because they're in the community.

And also that the elitism that you talk about, you know, like, you're, it's very, I never thought of that, but sort of traditional wisdom that exists around birth and the traditional wisdom that exists around psychedelics is, you know, they have that in common, and that people have been using psychedelics for, you thousands of years.

And there's all kinds of practices built up around that. It's not, they haven't been using it willy nilly. And we, you know, we talk a lot in the psychedelic community about honoring that, but there aren't a lot of mechanisms for, by which we actually learn from that, from those different traditions. And I, I would, I would, I, I listened to a podcast recently where, I'll link to the, the person in the show notes, I can't remember their name right now, but they were saying in almost every tradition, globally, there's a history of psychedelic use. And so if you want to do this work, tap into your own tradition, tap into your background, your ancestry with psychedelics, figure out where your lineage comes from and your cultural, you know, cultural background in psychedelics and start there. And I thought that was such a great, such a great suggestion that we just need to find it and dig it out and learn from the wisdom that's been around for so long. 

[00:56:56] Betsy: Yeah, that's I definitely appreciate appreciate you saying that and I think another piece that I just want to add is that like, I think I think part of the I want to make like an explicit connection that I feel like I maybe didn't say but is like important that part of the thing is that like when we're talking about accountability, right, like accountability in a way doesn't matter if there aren't like sort of options around who provides care if that makes sense.

So even just like a like a really like Sort of ad hoc example, right? Of like somebody, somebody may be like, this is a terrible hospital. I would never want to give birth there. Every person I know given birth, I've had a terrible experience. It's the only place covered by my insurance. Right. Like, you know, that's like a, that's a common thing.

So like, so I think that's why it's so important that we're thinking about like who gets to be a provider, how people, who gets to decide who is a provider. Is it the state or is it the community? Right. Because. Yeah. Like there are also I think cases where like people are like, yeah, I fully well know that like, this is not the care that I want, but there's no, there's no other thing that, or, you know, again, either I can't access it because of like financial barriers or like in some geographic reasons, there's, there's nowhere else, or, you know, whatever.

And so I just think that like, if we, if, if we were trying to create a system of accountability, like it doesn't matter unless there's actually like enough, like options out there for people, which of course currently there are not. So. 

[00:58:15] Molly: Yeah, I think I heard some, I heard a talk once about why healthcare should not be a commercial venture.

And it was speaking from a very microeconomic perspective. It said, in order for a market to work, you need to be able to switch and you need to know the value of the product that you're getting. And if you don't know the value, if there's too much informational asymmetry, then you The market won't work.

And if based on that information, you're not able to change providers or change products or whatever it is, then the market won't work. And in healthcare, you can't tell the quality of the surgeon before you go into surgery and you can't switch if you want to. So it's not a market. It's already not a market and to treat it like it is, it's just not an effective way to run a healthcare.

This is, this has given me like truly a lot to think about, Betsy. I really appreciate you taking the time to talk about patient centered care because I think it is like, I care about psychedelics. I care about mental health. I care about disability because these are things that affect me personally. But when it comes to which stakeholders we center, that's relevant in almost every realm.

And, and I, I love it. I find it really, really fascinating. You know, like it's not just important. It's also really intellectually interesting. How do we fix this problem all over? And I know you have you have such a global like you have specific knowledge of that and also this like global perspective that I really appreciate.

So thank you for bringing that to us today. 

[00:59:48] Betsy: Well, I, I think again, thank you so much for having me. And, you know, as I've said, like, I have really enjoyed your podcast and I don't know a ton really about psychedelics or mental health. And so partly I've enjoyed it cause I'm like, Oh, this is interesting. And it's like cool to hear about, but like, but then as I have said, like specifically, it's just like another way to expand in terms of my understanding of the healthcare and how like the problems and the struggles that like people face.

You know, in birth and how they're, they are facing those things in other areas of healthcare and, you know, how those struggles are related. And then, you know, how we can strategize for you to get people, to get people something better in, in whatever ways we can. So yeah, grateful for your work. I definitely, whenever anyone is like saying they're thinking about ketamine, I'm always like, you should really listen to Molly's podcast.

It's so good. So I'm always, always talking it up to folks. Thank you. Glad for everyone who is out there like trying to help. People navigate our healthcare system and get their, get their needs met in this system that, as we said, is not designed to do that. 

[01:00:41] Molly: Well, thank you so much, Betsy. I really appreciate it, and hopefully we can talk again soon. 

Thanks for listening. If you enjoyed this episode, please send it to a friend and take a moment to give us five stars on your favorite podcast app. You can help us keep this podcast going by subscribing via Patreon or Substack. Check out our website for those links.

Our website is ketamineinsights.com. You can email us directly at ketamineinsights@gmail.com. Ketamine Insights is hosted and produced by me, Molly Dunn. Our music is by Solid State Symphony. Talk to you soon. In the meantime, remember to advocate for yourself and never ration your joy.