Has Medicine Lost Its Mind?

In this conversation, Brandy Schantz and Dr. Robert C. Smith discuss the ongoing crisis in mental health care, emphasizing the role of primary care physicians in addressing mental health issues. They explore the lack of training in medical education regarding mental health, the importance of empathy and communication in healthcare, and the need for a cultural shift within the medical community to prioritize mental health awareness and support. In this conversation, Dr. Robert Smith and Brandy Schantz discuss the critical need to integrate mental health into medical training and practice. They explore the historical separation of mind and body in medicine, the importance of preventative care, and the lifestyle factors that contribute to chronic diseases. The discussion emphasizes the need for systemic change in healthcare to address these issues effectively, advocating for public awareness and action to improve health outcomes.

Transcript

Brandy Schantz (00:01.262)
Hi, this is Living Chronic and I'm Brandy Schantz. Welcome. Today I'm here with Dr. Robert C. Smith. He is a professor of medicine and psychiatry emeritus at Michigan State University and an author. His new book should be coming out next month. It'll be published and it's called, Has Medicine Lost Its Mind? Welcome Dr. Smith, I'm so happy that you're here.

Bob Smith (00:30.323)
Brandy, thank you. Honored to be here.

Brandy Schantz (00:33.9)
So I'm particularly excited about this episode because you and I have very, very similar goals from different perspectives. You as a medical doctor who has worked in this field for many years and then myself as a patient with a chronic illness who has gotten to know far more about the healthcare industry than I ever wanted to know. But of course, having that experience has given me

really a drive to try to change it for the better so that you know future patients don't have to go through what I went through and of course one of the things you and I both talked about that I really love is I know that making things better for patients is very important to me and for many healthcare providers for you know various people around this country this world but people also want to know about the costs

in the economy and you and I both addressed that. So I really love that. I love putting that emphasis on it. So super excited and I really did love your book. Really loved it. So what inspired you to write the book and to just take on such a huge issue like this?

Bob Smith (01:45.941)
Yeah, Brandy, I've been working in this area for quite some time, probably since about 1978, and many other people have as well. I'm certainly not the first one to bring up these issues. And basically, we're all trying to get medicine to improve mental health care. Everybody knows it's in crisis, and especially since COVID. I doubt there's anyone that does not recognize the

Brandy Schantz (02:10.318)
Mm.

Bob Smith (02:14.357)
crisis mental health care represents. The problem is medicine is not doing anything to respond to it. Mental health care continues to get worse. People like Tom Insel, the former director of the National Institute of Mental Health, has labeled prominent medical care

Brandy Schantz (02:25.134)
Mm-hmm.

Bob Smith (02:42.261)
current, in other words, current mental health care, I'm sorry, as a human rights issue. This is an ethical issue. And so what's happened is we've all been talking to each other within medicine and nothing is happening. And so I've decided quite frankly to appeal to the public, to make sure the public knows what's going on and what they in fact

Brandy Schantz (02:51.437)
Yes.

Bob Smith (03:11.509)
can do about it. And many of your listeners and viewers are apt to be alarmed about what I'm going to say. Everybody knows there's a mental health crisis, but people don't know why it exists and how resistant medicine is to changing it. Simply put, primary care doctors like myself, and I'm as guilty as anyone.

Brandy Schantz (03:22.424)
Mm-hmm.

Bob Smith (03:40.949)
Primary care doctors are conducting 75 to 80 % of all mental health care in the U.S. But nobody trained us to do this. And the result of this is just devastating. Unnecessary suicidal deaths. Suicidal patients visit their doctor at least half the time in the month before they commit suicide. Doctors are not trained in suicide. They don't even recognize the problem.

Brandy Schantz (04:08.418)
right?

Bob Smith (04:11.492)
Opioid epidemic, 200,000 deaths have happened from doctor prescribed opioids in doctors who were not trained in opioids or in chronic pain for which opioids are given. And it just goes on and on. People, when mental health problems are unrecognized, and there's some 90, 95 million people in the US who have a major mental disorder.

Brandy Schantz (04:23.086)
Right.

Bob Smith (04:38.729)
When these are not recognized, the result is devastating. Unnecessary divorce, unnecessary job failure, unnecessary school failure, addictions, unnecessary incarceration, unnecessary homelessness. The list just goes on and on of the downside of unrecognized mental health problems. Now it's not the primary care doctor's fault. Don't blame them.

Brandy Schantz (04:48.674)
Mm-hmm.

Brandy Schantz (05:09.034)
Mm-hmm. No, you're right.

Bob Smith (05:09.653)
We've worked as hard as we can to do our best. We simply aren't trained. But this gets at the issue is talk to a primary care doctor. They'll tell you what I'm going to say right now. Bob, they tell me there's no psychiatrist at my town. What am I supposed to do? yeah, another one may say two or three psychiatrists here, but you know, it takes nine or 10 months to get anybody in to see them. And so.

Brandy Schantz (05:28.16)
Right, that's the problem.

Bob Smith (05:38.805)
Don't blame your doctor. The problem is the shortage of mental health professionals right now. Psychiatry sees no more than 12 % of all mental health problems in this country. Psychology sees another 12%. That's why the remaining 75 % are seen entirely in primary care settings by people like me who are untrained in mental health. Solution. Ask anybody. It's simple.

Brandy Schantz (05:59.852)
Yes.

Bob Smith (06:07.433)
Must be obvious from what I'm saying right now. Train the doctors who provide the care. And yet medicine fails to do this. They have heard time and time and again of the need to do it, but they refuse to do it. And so this is why I am going public with this. Only an enraged and inflamed public is going to have any chance of changing this.

Brandy Schantz (06:10.018)
What?

Yes.

Bob Smith (06:36.411)
And I could go on and on, Brandy, but I'll stop at that.

Brandy Schantz (06:39.118)
You know, and of course anybody who really listens to my show knows this this is I I know this firsthand and it's very unfortunate and There's so much that surprised me I have been through a lot. I have been through a lot of trauma I can count on one hand despite seeing so many doctors over the last 12 years now since I was diagnosed with corneas disease and then of course the humeral reaction and all of the after effects

I've only had a handful of doctors ask me, Brandy, you've been through a lot of trauma. Are you seeing a psychiatrist or a psychologist?

That's it, just a few. And the truth is I needed somebody long ago. I needed mental health care. I needed vocational rehabilitation services. Heck, when I was going through the humeral reaction, I needed an exercise scientist for goodness sakes to explain to these doctors what overtraining syndrome was because every time I explained what I was experiencing as feeling like overtraining syndrome, they said, well, what's that? And I thought,

Well, we're just speaking two different languages. And it would have helped to have all of those professionals in a line to say, OK, doc, here's what's going on. This woman is experiencing this. We need to get her here. And it would have changed my outcomes so greatly.

Bob Smith (08:05.577)
Yeah. you've been through the mill, I can tell.

Brandy Schantz (08:07.06)
And I'm not alone, of course. Yeah, I mean, and of course I'm not alone. And I think that's one of the things that shocked me when everything happened. At first I didn't know what to do. just sort of, you know, after so much, I mean, it did take a while before I was completely knocked down. And I just stayed down for a little bit and thought, you know, I just don't know how to get up again. And then I said, you know, let's just see what I can do to help others. Maybe others have gone through this. And then that's when I started researching and learning and

I found out that I'm not alone. I am in a very large club, a very large club. None of us wanted to be in this club, but here we are. And it has so many various effects. For me, it's resulted in a loss of a career that I love. It's resulted in a lot of difficulties within my own relationships with my husband, in my everyday life. And this...

affects people in various ways. It can affect their families, their communities, their jobs, the broader economy, like I'm always talking about. We're not just disabled people. We're not an end game. We are a part of the economy. And we're just not including us in there with the way we should be. how do you think that medical schools can really help how we incorporate this into medicine and how we actually make those changes?

Bob Smith (09:30.697)
Yeah. Yeah. Well, you're right in pointing to the medical schools. Because the medical schools, in my opinion, and I hope you'll agree with me after I explain this, the medical schools are the centerpiece of how we must approach the mental health care problem. Everything else, the kind of things we do now today, and you'll hear about this all the time, but we're tinkering at the margins right now.

They'll do things, for example, like try to improve payment schedules for primary care physicians, even though they're untrained. That's not going to do anything. And that fact has proven to be the case. And we're tinkering at the margins. The problem is in the medical schools. Doctors go through four years of medical school, three, five, six years of residency. During that time, all they hear is,

Brandy Schantz (10:25.198)
Mm-hmm.

Bob Smith (10:28.767)
physical disease, physical disease, physical disease. The only mental health training they received during that seven or eight years is a five week rotation on inpatient psychiatry in the third year of medical school. Well, anything they learned there is washed out in the next three, four years. In addition, they're training on inpatient psychiatry.

Brandy Schantz (10:50.957)
Right.

Bob Smith (10:55.999)
This is where very severe psychiatric disorders are seen. Psychotic people, severe personality disorders, refractory drug problems. These are not the kinds of patients doctors see in practice. And so they receive, and that's the only supervised training they receive at all. Now, if you talk to a dean or a program director of a residency, they'll say, well, Bob, we do train people.

Brandy Schantz (11:10.542)
Mm-hmm.

Bob Smith (11:23.711)
We give lectures all the time. We give lectures on suicide and depression and chronic pain. We're always talking about it. But if you pin them down, there's no supervised training. It's all lecture material. And of course, you need to have some knowledge that the main thing you need is supervised training with actual patients with the problem. And medicine doesn't provide this except for that brief five week time in the third year of medical school.

Brandy Schantz (11:36.269)
Right.

Brandy Schantz (11:52.6)
Mm-hmm.

Bob Smith (11:53.627)
If I've looked at these data, and this comes from the AAMC, Associated American Medical Colleagues, they're the ones that run medical education. And from the ACGME, they're the ones that run residency training. If you put all their data together, they provide no more than 2 % of total training time across all of these.

years of medical education, four years medical school, three, five years of residency. Two percent is all that's provided and much of that is unsupervised training. And so now the next difficult issue. Mental health disorders are more common than heart disease and cancer combined. Mental health disorders are most common health condition in the U.S. and yet

Brandy Schantz (12:42.292)
Wow. Ugh.

Bob Smith (12:49.647)
Medicine, get this, medicine is not providing its graduates with training to care for the most common health condition they'll see in practice. Has medicine lost its mind? That's where the title of my book comes from.

Brandy Schantz (12:50.316)
Mm.

Brandy Schantz (13:04.62)
Yes Well, you know what and and I also as much as I loved your book I also love a lot of what you've written for psychology today and I I admit that I got Just enthralled with everything you've written and I just spent a good evening reading your articles on psychology today and

You have a lot of practical application in there, which I really enjoy. think it's the army in me. And I know that you were a physician in the army for a couple of years, so maybe it's the army in you. They never leave you. but you do get these practical applications and I really loved your mnemonic nurse and you know, as somebody who has suffered so greatly from mental health over the years and not just me,

Bob Smith (13:42.623)
Yes.

Brandy Schantz (13:50.67)
You know, if I look back over the last 20 years, I've lost a lot of friends to suicide who also served in the army. I, you know, have suffered my own mental health struggles, especially after losing so much of my life and everything that I loved to my diseases. And all anybody can do is, well, just reach out, you know, it's kind of the thoughts and prayers and then.

Bob Smith (14:14.538)
No.

Brandy Schantz (14:17.398)
The other thing I noticed is every time somebody does commit suicide, every phone call I get from a friend, a colleague, somebody we, you know, start talking about it, it's always, why didn't he or she reach out? And I've always thought over the years, well, where were you? You know, when I've gone through everything, where were you when I was crying because I just didn't know how to get up in the morning? Where were you when I was saying, hey, I need some help with a career rehabilitation because I can't get to work?

Hey, you where were you when I was suffering at my greatest because there are signs and you came up with this mnemonic nurse because she can tell the signs and you know what guys, why is the onus always on the person suffering from depression, from survivor guilt, from, know, whatever it is, trauma, you know, anxiety, whatever they're suffering from, why is the onus on us to reach out? Friends, family, colleagues, community?

Bob Smith (15:11.369)
Yeah. Yeah. Yeah.

Brandy Schantz (15:14.368)
nurse. So tell me a little bit more about that because I just it really hit home for me.

Bob Smith (15:18.037)
Sure. No, and again.

These skills you're talking about are basic interpersonal skills. And I'll talk about them in a second. But again, back to doctors. Doctors actually receive some training in this, usually in the first year of medical school. But it is not reinforced after that. six or seven years later, it's long forgotten. But in essence, what one does is

Brandy Schantz (15:36.78)
Mm-hmm.

Bob Smith (15:50.389)
With any with any person this isn't just with a troubled person, especially with a troubled person But even try them with your spouses or your children or the person you're standing next to in line waiting to get into the movie Try them with anybody you'd be amazed at what this what this brings out but you start out with something like so how are you doing and people will tell you and You need to then draw them out with say things like

Brandy Schantz (15:56.034)
Mm-hmm.

Bob Smith (16:20.601)
that was upsetting to you. Or so, tell me more about that. And they will keep talking. And you're listening attentively, making eye contact like I am right now. And say, well, what else? And eventually, just in talking to someone like that, using these facilitative so-called open-ended techniques,

you will start hearing a coherent story. People tell their stories right away if you give them a chance. And part of what I'm doing is when you're talking to someone like this, is you don't start inserting your own ideas into it or your own experiences, but you keep actively facilitating what the person is saying. And so, well, tell me more. And then they go on for a minute or two and you just keep encouraging that

Brandy Schantz (16:53.154)
Mm-hmm.

Brandy Schantz (17:07.692)
Mm-hmm.

Bob Smith (17:16.239)
to keep talking. Eventually you will get to an area where it sounds like there probably is some emotion. Flunked your test at school.

New person at work disrespected you. And so it's something that suggests there's a feeling there. And so that's when you say, well, how did that make you feel? Well, scared, might flunk out of school. Upset, this person may be my boss later on that I'm hearing. And so you hear that emotion now, we'll just say you've heard they're upset. Tell me more about that. Upset, why?

Brandy Schantz (17:36.438)
Mm-hmm.

Bob Smith (18:00.361)
because I'm trying to get into law school and I can't afford to flunk this test. And so the law school, yeah, my dad's a lawyer. He's expecting it. And the story goes on and on. Now you've kind of understood why this young woman or young man is upset about maybe failing a test. Now is when you come in with an empathic statement. And this is the nurse, Brandy, that you're talking about.

Brandy Schantz (18:10.914)
Mm-hmm.

Bob Smith (18:28.661)
You've got an emotion, upset. You've heard enough of it to understand it. You now name it. Oh, I get it. That's upsetting. Understand it. Understand makes sense to me. You respect it. You've really been through a lot. I appreciate you're talking to me about this. That's the respect statement. Four is the support statement.

appreciate you're telling me this. Let's see if you and I can figure out something working together. So those are the four nurse statements done all in sequence. Now you don't usually use them all four at a time like that, but what you do is you keep using them. Once I've said to someone, I understand that was a pretty tough time. They will start telling me more about that issue. And you then develop that will say more than

Brandy Schantz (19:19.917)
Mm-hmm.

Bob Smith (19:23.541)
about your brother getting into law school and you not. I'm just making this up as I go. But and you hear more about that. So how does that make you feel? Angry. You nurse that again and you keep drawing that out and every 30 seconds or so you're throwing in another nurse statement just one or two at a time. Oh, I get it. 20, 30 seconds later. Let's work on that. 30 seconds later.

wow, that's really been hard for you, and so on and so forth. And with most people, this could be just an ordinary conversation you're having with your spouse or someone. These conversations don't go more than three, four, five minutes. But this way, this other person feels heard and understood. Those are the empathic statements, nurse. Name it, understand it, respect it, support it.

Brandy Schantz (20:04.941)
Mm-hmm.

Bob Smith (20:22.611)
We all are told, be empathic, everybody says to you. They don't tell you how. Nurse is how you can be empathic using these skills. Now, it is important in doing this, this is particularly in people with more difficult circumstances. People that have heard me talk like this say, well,

Brandy Schantz (20:27.978)
Right.

Brandy Schantz (20:42.36)
Mm-hmm.

Bob Smith (20:46.713)
Bob, I'm into this needy problem and she thinks she's going to flunk and never get into law school. What am I supposed to do about it? You don't have to do anything about it. It's not your obligation to do something. It's your obligation as a listener to be empathic and support them. And this could be a person who's just been given a diagnosis of a terminal illness. It's still you want to talk to these people in an empathic

Brandy Schantz (20:57.518)
All right.

Brandy Schantz (21:11.906)
Mm-hmm.

Bob Smith (21:16.367)
nursing way so that they know that you support them. And this is the critical thing. It's the support. It may be in some circumstances that you can actually offer some help. For example, in the young lady or man that's worried about flunking out of law school or not getting into law school. Here are some study habits. I use months X, Y, and Z. And here you might try this. On the other hand,

Brandy Schantz (21:32.568)
Mm-hmm.

Brandy Schantz (21:42.264)
Right.

Bob Smith (21:45.429)
You don't have to offer a solution. You simply have to be there and be present. And notice in all of this example I've given, I've not shared any of my own stuff. I haven't said, well, once I felt flunked a test too, and I just really did this, this, and this, that interrupts the flow. You're trying to draw out this flow of information that's

Brandy Schantz (22:00.078)
All right.

Bob Smith (22:14.919)
emanating from the person. And people will provide this almost immediately if you give them the opportunity. try it again, just we can stop with that. That's enough now. But in fact, there's a long section on this in has medicine lost its mind. But be empathic with people, draw them out, and then nurse the emotion that you hear.

Brandy Schantz (22:32.578)
Mm-hmm.

Bob Smith (22:42.461)
or even nurse the bad circumstance if you don't hear an emotion. So maybe that's enough for...

Brandy Schantz (22:44.494)
I really appreciate you discussing it because it is important and there's certain things that you don't really notice about life in general or understand even about things you think you understand like empathy until you're going through something yourself and I've always said one thing that I noticed and it really hit me after I started having issues is I would hear people often say well

At least you didn't lose a limb in Afghanistan. And it felt so dismissive. And then it continued to get worse after the reaction to humiroid here from doctors all the time. Well, you know, at least you're still walking. A lot of people with your condition have to use a walker every day. And I'm like, well, did you hear the 15 minute speech I gave you about all of the physical rehab I'm doing just so I could try to walk each and every day? And really, does that make it better? So I think it is important. just, and I don't think

Bob Smith (23:26.197)
Yeah.

Bob Smith (23:36.083)
Yeah.

Brandy Schantz (23:42.094)
People often have ill intent. They're not trying to dismiss you, but they are. And because we don't talk about that, be empathic, do not dismiss. Don't, you know, okay, great, good for you. You once dealt with getting shot and you crawled your way out and now you're fine. I love that for you, but it doesn't apply to me right now. So I really appreciate that.

Bob Smith (23:46.419)
No.

Bob Smith (24:01.205)
And as far as your doctors go mentioning this, I've seen some, medical schools now provide some training in this area, but it's usually, it's often the very first course at medical school. The problem is, and my experience is physicians and other people,

Brandy Schantz (24:22.348)
Mm-hmm.

Bob Smith (24:30.683)
learn these empathic skills and this so-called person-centered approach that I just kind of replayed with you. People learn this quite well. People are quite open to it and can practice it. In medical school, then they're getting this, the very first part of their very first year in medical school, all well and good. The problem is they never hear anything about it in the next seven or eight years. But what they do hear

Brandy Schantz (24:56.91)
Mm-hmm.

Bob Smith (25:02.081)
is and this reflects the so-called culture of medicine. What they do here is why are you talking to someone about all that touchy feely stuff? We don't deal with emotions. We're interested in real disease and people hear that just repeatedly throughout medical school and this is why oftentimes your doctors, doctors are not inhumane. It's simply been beat out of them.

Brandy Schantz (25:16.216)
Thanks.

Bob Smith (25:32.005)
over seven and eight years of training, they have been criticized for being empathic oftentimes. And just to give you an example of this.

Brandy Schantz (25:32.269)
Right.

Brandy Schantz (25:39.394)
Yes.

Bob Smith (25:45.909)
49 % of students entering medical school are interested to a high degree in psychiatry. People are pretty humane. They come in pretty humane, interested in the bigger things in life and what makes people work. By the time they graduate from medical school, it's down to 4%. We have beat out

Brandy Schantz (26:02.7)
Yeah. Yeah.

Brandy Schantz (26:13.408)
Right.

Bob Smith (26:15.657)
that interest in psychiatry in them through four years of medical school. And after that, except for the very few, three or four percent who go into psychiatry residency, after that, it's even worse. You hear nothing about mental health. And so there is a powerful anti-psychiatry, anti-emotional, anti-psychological bent in all of medicine.

Brandy Schantz (26:32.855)
Right.

Bob Smith (26:44.271)
in favor of what they want you to know is physical disease. Doctors will get in training, a student or a resident in training will be severely chastised if they make a wrong diagnosis, say of a heart attack or if they miss the diagnosis. Miss a diagnosis of depression, they could care less. And so this is this pervasive

Brandy Schantz (26:49.559)
Right.

Brandy Schantz (27:02.168)
Mm-hmm.

Brandy Schantz (27:07.821)
Right.

Bob Smith (27:12.287)
thing within in medical training and you're right back to the medical schools. It is through the medical schools and this focus on physical disease for seven or eight years that in effect, you probably shouldn't use this term, but I will, doctors become brainwashed against mental health, against the psychosocial and emotional aspects of medicine and in favor of an isolated focus on physical disease.

They're brainwashed. They can't help it.

Brandy Schantz (27:44.216)
Well, you what's interesting about that too, is there is a mind body connection and your mental health does affect your physical health. And the more I read about it, the more I understand it, the more I think, aren't we, you know, just like I talk about how we need to be talking about nutrition and exercise in every single, you know, primary care team setting. That's why mental health is so important as well. If you're mentally feeling well,

Bob Smith (27:53.243)
of course.

Brandy Schantz (28:12.034)
Well, you know what you can do? You can get up and do that exercise that might get you to the next level in your disease. But if you're feeling bad, it does manifest itself in physical pain.

Bob Smith (28:25.043)
That's right. and the mind-body connection, I mean, it's of interest. I'll comment on this. I think you know it already, but the mind-body split happened four centuries or so ago. And this is why medicine is so brainwashed and focused on physical diseases only. Hasn't always been this way.

from the fifth century BC, this is way back the time of Hippocrates for a millennium after, more than a millennium after that, doctors always saw the mind and body together. But come the 16th century, this is the start of the scientific revolution. All the sciences were starting to get some traction and want to improve. This is same in physics, Newtonian physics, mathematics and so on.

Brandy Schantz (29:06.52)
Mm-hmm.

Bob Smith (29:23.709)
And in medicine, they were starting to insist that they become more scientific. Well, how did medicine become scientific? Dissection of the human body. That was the basic science at the time. But the church, up until that time, had prohibited the section of the human body. so doctors dissected goats, pigs, and so on.

Brandy Schantz (29:31.566)
Mm-hmm.

Brandy Schantz (29:48.526)
Hmm.

Bob Smith (29:52.485)
and inferred erroneously, of course, that that's what human beings look like. Well, in 1537, Pope Clement approved that medicine could dissect human bodies for educational purposes. But there was one proviso that the head must be removed from the body before the dissection began, decapitated, and turned over to church authorities who would handle the services.

Brandy Schantz (30:17.804)
Mm-hmm.

Bob Smith (30:23.123)
The church viewed the head as the source of the mind, the soul, and the spirit. And that was their province alone. They said, medicine, you can have it from the neck down. We keep the mind, the spirit, and the soul. Descartes, Locke, Hobbes came along in the next century and philosophically provided the basis for continuing this separation.

Brandy Schantz (30:52.748)
Mm-hmm.

Bob Smith (30:52.827)
of the mind from the body. And medicine after that went on and just gradually progressed over the centuries, focused entirely on physical diseases. This is why they do this. This brainwashing hasn't occurred just in this century. This brainwashing of physicians has been going on for four centuries. It is no wonder they have trouble getting out of it. It must be empty.

Brandy Schantz (31:13.324)
Right.

Brandy Schantz (31:18.466)
Mm-hmm.

Bob Smith (31:22.485)
Catholic with them as well. And let's congratulate them also. Come 1900, this mind-body split, the isolated focus on physical diseases started to pay off. From 1900 to the end of the century, life survival doubled from 40 to 80, almost 80 years of age. That is a tremendous

Brandy Schantz (31:25.174)
Great.

Brandy Schantz (31:48.704)
Mm-hmm. Yes.

Bob Smith (31:52.603)
accomplishment and make no bones about that. The problem is that medicine has not evolved to now incorporate mental illnesses and chronic diseases. Much of medicine's success was on eradicating acute problems from diphtheria, tetanus, polio, all the acute diseases.

What happened then was that mental illnesses started to surface and chronic diseases replaced acute diseases. Well, it's obvious how excluding the mind results in excluding mental illnesses. We've already talked about that. What is not recognized is that chronic disease care

Brandy Schantz (32:26.998)
Mm-hmm.

Bob Smith (32:50.195)
by modern medicine is also insufficient. Because medicine excludes the psychological, the social, and the mental, it ignores the very lifestyle factors that cause most chronic diseases. Too much drinking, too much smoking, too much eating, not exercising, stress, and on and on it goes.

Brandy Schantz (32:54.678)
Mm-hmm.

Brandy Schantz (33:13.186)
Yep.

Bob Smith (33:19.861)
All of these things cause chronic diseases. Not all. 80 % of all heart disease, strokes, and diabetes are caused by and are entirely preventable by addressing these very lifestyle issues. This is called prevention. Well, even after a person develops these problems, they've now got heart disease, stroke, diabetes.

Brandy Schantz (33:49.398)
Right.

Bob Smith (33:49.429)
it's still critical to treat these lifestyle issues. You should quit smoking. You've got to lose weight. Quit drinking so much. All of these are lifestyle issues, but doctors aren't trained in psychosocial lifestyle issues. And so what medicine has done is allow problems to happen and then treat them. For example, in 1970, the prevalence

Brandy Schantz (34:03.297)
Right.

Bob Smith (34:18.377)
That means how much there was in the population of obesity was 15%. It's now nearly 50%. That is a colossal failure in prevention. Think what would happen if we had prevented all these problems. But medicine doesn't do that because medicine is anchored in this mind-body split and focuses just on physical disease.

Brandy Schantz (34:26.488)
Mm-hmm. Yep.

Absolutely.

Brandy Schantz (34:47.944)
And the prevention really does help not just the patient, but it saves money. And we're always talking about how do we reduce, how do we reduce healthcare costs? Well, here you go. That would reduce our cost. Imagine if you didn't have to take that pill every single day for your high blood pressure or for your...

Bob Smith (34:48.194)
And sure.

Bob Smith (34:53.404)
it saves fantastic amounts of money, yes.

Brandy Schantz (35:11.054)
diabetes, lowering your A1C, all these different things. One of the things that I'm always shocked about, I always love to make fun of me because here I am now. I'm always reading medical journal articles and getting into medicine and I do not have a science background. I always joke, I'm not even science adjacent. But I may have taken more science in college, I just don't remember. I remember my exercise science class as well because that's something I loved. And of course I just kept up.

you know, with, you know, running and stuff my whole life. And it always amazes me how many people go to their primary care doctor and they say, I have low back pain. And then their doctor and you know, fair, do an x-ray. That's, you know, that sounds like some good medical stuff to me. But then they end up with pain pills. And then when I said, well, why don't you try a yoga class? They always say the same to me. No, no, I have a bad back. The doctor said, I can't, I just take the pain pills. And I think, but do you have a bad back?

or do you have a weak core? I'm always harping on people about that. And doctors will do that every time. I had a friend go to the ER, she was in so much pain. She had recently fractured her back because of over prescription of prednisone. And she called me, said, Brady, I just don't even know how to describe it. They put me on more prednisone. I thought, you just broke your back from over prescription, your back on prednisone? And they gave her some pain pills.

Bob Smith (36:29.151)
No

Brandy Schantz (36:34.062)
She said, but I think I need to go to the ER. What do you think? It feels like my hips are turning inward. And I said, no, I know that feeling. You have a weak back. That makes sense. You need to talk to your physical therapist. And she said, well, let me go to the ER in case. And the ER gave her more drugs and there was a whole thing. And she left and she saw her physical therapist the next week. And she says, okay, my crazy friend, Brandy, said to ask about weakness in my back. And he did an assessment and he said, yep, crazy friend, Brandy's correct. So think about all of that.

that she went through, the prednisone, the pain pills, the ER visit, and it's taken care of by physical therapy and doing some marches.

Bob Smith (37:10.261)
Yeah, no, it's it the cost is this is extraordinary if you think remember we said 80 % heart disease broke diabetes can be prevented 40 % of cancer can be prevented too by covering these lifestyle factors, but let's just stay focused on heart disease diabetes and stroke. Okay, if you could prevent 80 % of those

What do you think? And these constitute the probably 80, 90 % of hospital populations today. They constitute 80 or 90 % of all drugs being produced today. You say the recent obesity drugs you keep hearing about that are what are they $1,000 a week? All of these things. What if you prevented 80 %

Brandy Schantz (37:58.188)
Mm-hmm. Yep. Yes.

Bob Smith (38:09.563)
of all of that. We've got a health care budget that's probably a little over $5 trillion by now. What if you prevented 80 % of all that stuff? What would that do to health care savings? Do the math. You're talking into the trillions of dollars. This is more than the defense budget. This is double what the defense budget is.

Brandy Schantz (38:27.896)
Yes.

Brandy Schantz (38:33.783)
Yep.

Bob Smith (38:36.521)
You could pay for healthcare for everyone out of these savings. You could pay the defense budget. You could pay tax breaks if that's what you're interested in. But the savings are just inordinate that can come from starting to include the psychological, social, mental, and emotional aspects of medicine, the very ones medicine now explicitly and repeatedly

Brandy Schantz (38:36.983)
Absolutely.

Mm-hmm.

Bob Smith (39:06.097)
excludes when they are advised to do otherwise. And so it's a, yeah, and what my interest in this is, I think I mentioned earlier, I decided to go public with this and this is what I'm doing right now. I am trying to inform the public of how bad things are. And it is only an inflamed, angry, angry public.

Brandy Schantz (39:10.292)
And of course, I mean, it's just so far beyond just an individual in healthcare.

Brandy Schantz (39:23.822)
Mm-hmm.

Bob Smith (39:36.565)
for how badly their needs are being met. It's only an inflamed public that's going to do anything about this. And there's a precedent for this. This works, what we're talking about. Ralph Nader wrote, unsafe at any speed. This was in reference to the automobile industry, who had discovered seat belts, they knew they worked.

Brandy Schantz (39:36.854)
Yes.

Brandy Schantz (39:44.471)
Absolutely.

Brandy Schantz (39:54.862)
Yes

Brandy Schantz (40:00.931)
Mm.

Bob Smith (40:04.553)
didn't want to use them because they were afraid it would cost too much and they were afraid people wouldn't use them and wouldn't buy their cars. They also had the gear shifts misaligned so that when people put the car in forward it often went backwards and so it was just some gross problems but the industry refused to do anything about it cost too much. Nader's book came out and it enraged the public

Brandy Schantz (40:06.158)
Yeah.

Right.

Bob Smith (40:32.885)
and they effected change. Rachel Carson did the same thing with Silent Spring, another derelict industry, the chemical industry. They were polluting everything they stepped on. There was DDT in our water that we drank. They knew it, but they didn't want to do anything about it. Cost too much. Okay, Rachel Carson's book comes along, Silent Spring, and forces...

Brandy Schantz (40:35.948)
Yes.

Brandy Schantz (40:53.737)
Mm-hmm.

Bob Smith (40:59.893)
Through the politicians, the public became enraged about this, understandably and justifiably. Enraged and insisted politicians do something about it. This is why you have the Environmental Protection Agency, EPA, today. And that's why you drink clean water and have safety in so many other respects. Has medicine lost its mind, seeks to do the same thing with the medical industrial complex?

Brandy Schantz (41:14.627)
Mm-hmm.

Brandy Schantz (41:28.556)
Mm-hmm.

Bob Smith (41:30.393)
public has to become upset and angry and force its politicians to do something about this. Otherwise, this will not change. The costs will continue to go up and the care will continue to deteriorate because medicine is no longer addressing the needs of the public.

Brandy Schantz (41:34.401)
Absolutely.

Brandy Schantz (41:38.922)
and your book outlines the roadmap for it.

Brandy Schantz (41:52.3)
Now, absolutely, your book really does a great job of putting forward that roadmap. know, I say I love the book, I mean it because this is very important. Every person in the United States of America right now living with a chronic illness knows how bad our system is and how badly it needs to be improved. As a matter of fact, so do leaders. I work and try to help companies to understand how to better keep.

workers well, how to deal with chronic illness, because that costs money. It costs productivity. It's not just individuals and families and societies. It's economies of scale. And it's a big deal. It's a big deal.

Bob Smith (42:28.147)
That's right. And it's the health of the people, the well-being. If you could prevent heart attacks, strokes, cancers, people when they retired would not look forward as they do today to living with the ravages of diabetes, heart failure, strokes, lung cancer, emphysema. They would retire

Brandy Schantz (42:50.69)
Mm-hmm.

Bob Smith (42:58.173)
and live a happy retirement. Don Berwick and colleagues have emphasized this. It's a 10 years of a happy retirement and a healthy retirement, not one where you are bogged down seeing doctors all the time with some sort of a preventable but chronic, no chronic disease.

Brandy Schantz (43:11.767)
Yes.

Brandy Schantz (43:21.376)
And a lot of this, and again, I encourage people to read the book. This is important. A lot of this comes down to, especially people my age, because you know what happens when you're in your 40s and the people in your 50s and you go back and you see old friends from high school or college, you start seeing how your choices in life have made a big difference in how you live your life today. I have friends in their 40s who have already had hip replacements.

Bob Smith (43:43.935)
That's right.

Brandy Schantz (43:49.706)
I have friends in their early fifties who can barely walk. You know, we all, you know, just focus, we love to focus on Jennifer Lopez, cause here she is in her fifties and she looks better than I did at 22 somehow. But that's not what we need. That's not the message that we necessarily need to get out. The message we need to get out is, Hey, I was a lifelong runner and I've had health issues, but thanks to my life of health and exercise, I walk today instead of using a walker. And that's what it's about.

Bob Smith (44:16.693)
That's right.

Brandy Schantz (44:18.624)
It's about what you put in today. I always tell young people because I hear them say all the time Well, I know once I hit 40 everything's gonna go downhill and I say no no, no, no, that's not true at all If you continue with bad habits that starts to gradually add up and then by the time you hit 40 now your body is saying well You've given me so much sugar now. We're pre-diabetic or diabetic or you've given me so much bad food We're now going to have some high blood pressure some high cholesterol. It's the addition

Bob Smith (44:27.902)
you

Bob Smith (44:38.41)
Yeah.

Bob Smith (44:43.733)
Yeah, no, Brandy, you're a case in point of somebody with baseline good health who is following good lifestyle issues. You had this unfortunate problem hit you, but you survived it because you were in good health before it hit.

Brandy Schantz (45:03.894)
Yeah, absolutely. And I can't, you for the younger people out there, I just can't say it enough. Treat your body well today. Your 45, 55, 65, 75 year old self will appreciate it. And it's the difference in being my friend Lucy, who's like, I think she's about to turn 80 and she's still running marathons and you know, all sorts of great stuff, you know, or another friend of mine who is in her early 50s and you know, has a hard time moving.

Bob Smith (45:16.085)
I threw it.

Bob Smith (45:20.169)
Yeah.

You

Bob Smith (45:27.507)
Yeah.

Bob Smith (45:31.081)
Yo.

Brandy Schantz (45:31.126)
So, you know, it's really your choice in many ways. We can't prevent everything, but we can certainly make better choices. So what can we do today? What can policymakers, healthcare leaders, what can we do today to close this gap?

Bob Smith (45:37.673)
Yeah.

Bob Smith (45:41.02)
Yeah, yeah. Here's what needs to happen. You, the public, are going to become upset, irritated, and blamed. You're going to insist your politicians do something. What are they going to do? Okay. Here it is specifically, and this is detailed, and has medicine lost its mind. They will set up a presidential commission, a congressional commission.

National Academy of Medicine, some sort of a federal commission independent of medicine, which will investigate medicine to see how effectively it is meeting the needs of the population that it's supposed to support and which provides taxpayer support for it. And you will find, given what I'm telling you today,

Brandy Schantz (46:13.154)
Mm-hmm.

Bob Smith (46:33.427)
that medicine will be severely deficient in doing this. Second thing they will find is that medicine is severely deficient because it is not being scientific.

Every science from about 1900 on has adopted what's called a systems perspective of their science, which means in brief, considering all parts of a problem and how they interact and how they go together. Only medicine.

Brandy Schantz (47:00.344)
Mm-hmm.

Bob Smith (47:13.659)
Among the sciences, only medicine has not adopted a systems approach. Medicine, instead of looking at the multiple psychological, social, environmental, and physical parts, stays focused just on the physical parts of the subject of their science, who is, after all, the patient. The patient is largely excluded by modern medicine. And so this

Brandy Schantz (47:37.261)
Mm-hmm.

Bob Smith (47:43.273)
congressional committee or whichever federal committee it is will find medicine severely wanting not only scientifically but in meeting the needs of the population it serves and that will immediately trigger changes of the sort we are talking about that must happen. Now on my website

I have a letter that people can send to the president, the surgeon general, National Academy of Medicine, your congressperson, and your senators. It's robertcsmithmd.com. Don't forget the MD. There too many Smiths around. They won't find me if you don't have the MD. it's...

Brandy Schantz (48:35.736)
That is the truth, but I will also have that website in the notes so that everybody can access it.

Bob Smith (48:41.493)
robertcsmithmd.com. Very first page, you'll see something that says, now. Just follow your nose through that. There is a letter there, and I would encourage you to put your own paragraph in there, also about how this is so important to you and the problems you have had. Then take that letter, then the email addresses.

are all there for you to need. You simply follow your nose, plug those addresses into your email, paste this in, and off you go. And it is in this way that we can do something actively to get to our political representatives and get something done, which is, again, a federal commission of some sort to investigate medicine.

Brandy Schantz (49:35.8)
As far as I'm concerned, this is a national emergency. I've said that many times. And we have to do something and we owe it especially to our younger people. We're dealing with so many issues. There's an epidemic of loneliness. There's so many issues with communications, those feelings of being disconnected. We're so connected today, but we're so disconnected. And mental health is just affected so greatly as well as physical health. And we owe it to our young people. We got to do something.

Bob Smith (49:50.549)
That's right.

Brandy Schantz (50:04.628)
It is a state of emergency. I, you know, I really thank you for what you're doing because this is, this is to me, this is the most important issue we have right now. We have to fix our healthcare system and we've got to do something about mental health.

Bob Smith (50:05.109)
That's right.

Bob Smith (50:16.969)
Yeah. Well, thank you for what you're doing. This is consciousness raising. You're raising these issues to the public. And it can't happen without folks doing the work you're doing.

Brandy Schantz (50:33.4)
Gotta scream, we have to scream. Squeaky wheel, that gets the grease. So thank you again, I really appreciate it. Dr. Robert Smith, your new book's coming out, Has Medicine Lost Its Mind? It's a great book. I also encourage if anybody loves to sit up at night and read psychology today, your website has some great links to your articles. I really enjoyed them. Thank you so much for coming on Living Chronic.

I really appreciate it and I hope to have you back again because we got a series coming about your mental health and social media.

Bob Smith (51:08.533)
I'd love to, Brandy. Thank you for having me.

Brandy Schantz (51:11.404)
You'd be perfect for that as well. Thank you so much.