Who is Calling The Shots

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Hi, this is Dr. Daniels, and welcome to Healing with Dr. Daniels. This is the Sunday, December 15th, 2019 edition of Healing with Dr. Daniels. Today's topic is "When All Else Fails, Rename It." So today, I'm going to examine the application of sophisticated marketing tactics—not science—that increase the consumption of costly and gruesome interventions. As always, think happens, yes. We hear a lot about increasing health care costs and overutilization, and at the same time, prospects or, say, citizens are being subjected to some pretty intense high-end marketing tactics.

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What we're going to talk about today are tactics designed to increase the consumption of services, particularly one service we'll call palliative care, that doctors have refused to submit patients to. Patients have not been really receptive to it, and so these are the tactics that the industry has used to increase utilization of this particular service. Then I'm going to also talk about other medical services that began or were introduced in a similar vein as a cost-cutting measure and talk about the true economic impact of those services, not to mention the lack of health impact.

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Alrighty, well as always, we're gonna start by taking our turpentine. Alright. What do we got? We got a turpentine bottle. And as you know, I live alone, so my bottle is not labeled. You should label your bottle because you don't want people taking a swig of this, thinking it's something else that it's not. So next week, actually, I'm gonna have this bottle labeled, and you're gonna see just how explicitly your turpentine bottle should be labeled. For me, I take half a teaspoon, and that fills up right to the neck of this dropper. I enter this way so I don't drop it. And then we have, of course, white sugar. Yeah. Why I label this, I don't know, but the sugar label is worn off because I live in the tropics. We have high humidity, and so even my palatable granulated white sugar clumps. And here we are. As you can see, the sugar turns gray as the turpentine touches it, and not all the sugar is soaked. That's very important. From my facial expressions, it doesn't look like I'm taking the same thing every week, but I am. Sometimes it just goes down easier.

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Now we have magical Shilajit. Not as gooey today, but that's Shilajit. It looks just like black tar and tastes a lot like it, too. We happen to have a lot in the cap here, so we can just get today's dose right from the cap. So, there you go, and that is about as much as I would take. And this—you don't take it every day—like four times a week is quite enough, and these are trace minerals. That means these are minerals your body doesn't even use every day. So some of these minerals your body will use one molecule every other day or a molecule twice a week, some will use a molecule every day. And so it's a blend of about 80 different trace minerals. This is not like magnesium, which is something your body uses every day. Okay, and we just take this, put it in the remaining water, let it dissolve, and I will take that later—hopefully later in the show. A lot of people will take their Shilajit and they will fight with it, and they'll stir it and they'll mash it to get it to dissolve. No, just let it sit easy. Twenty minutes or so, and it's all ready to go. Just distract yourself with something else. For example, I'm doing a radio show.

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As always, today's show was prompted by an email. And this one is from Medscape, and Medscape, as you know or may know, is the premier internationally recognized source for medical information. So this is what your doctor refers to, and also, they're very proud that they thoroughly research the topics they write about, so they make sure that they are capturing the standard of care at that moment in time—up-to-date stuff. So this is from November 18th, and this is in Lisbon, Portugal, but they refer to the United States. So this is written by somebody in Portugal, but it's about a situation in the United States. Okay, so they say palliative care is often underused in cancer care. So we have a term: palliative care. Just for your information, just to make sure that we've got this right and we're on the same page, palliative care is relieving pain without dealing with the cause of the condition.

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So, it does not in any way address what the person's illness is. They clarify this: end-of-life care includes palliative care. So, if you have an illness that cannot be cured, palliative care makes you as comfortable as possible by managing your pain and other distressing symptoms. It also involves psychological, social, and spiritual support for you and your family or carers. Remember, this is medical, right? So standard of care is prescribed by the government and may or may not be consistent with your beliefs. Okay, so let's be clear. They are saying that they are managing your pain and distressing symptoms, and if the illness cannot be cured, so we're already conceding when you get palliative care, the doctor said, you know what, no cure here. So whatever the doctor is doing, he's already admitted this is not gonna cure you. We're just gonna do palliative; we're just gonna cover your symptoms, and we may or may not continue the care that we've already deemed is ineffective. Okay, let's be clear.

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But a simple name change can dramatically alter the usage of palliative care and give positive and productive results, says Dr. So-and-so in Switzerland. Palliative care should be called supportive treatment. It's not just about end-of-life, says the doctor, who discussed reasons for the change and then presented data for a 2009 study that showed dramatic effects at a major US Health Center. Now, you're probably thinking the same thing I was thinking: dramatic effects? Oh, patients were helped, people got better, lives were improved. But wait, he explained that both palliative and supportive care are integral to patient care, but palliation has an image problem. Really? It is often misperceived as the end of the line for patients and their care team—a time where they will part company as patients discontinue active treatment and enter hospice.

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Now, what he's saying here is that patients are feeling a loss of emotional connection to their healing team. In reality, in truth, palliative care, which primarily aims to provide relief from pain and other distressing symptoms, can be offered to all patients with cancer, regardless of their stage, and can greatly improve quality of life, he said. Supportive care, on the other hand, is typically thought of as involving treatment management and post-treatment issues. Traditionally speaking, supportive care relieves symptoms and complications of cancer as well as the cancer therapy, reduces and prevents treatment toxicities (poisonings), supports communication with patients about the disease and prior prognosis, and eases patients and their caregivers' emotional burdens. By contrast, a newly branded supportive care—one that incorporates the traditional notions about palliative care—breaks down that sequential timing and should proactively be offered to patients. Now, sequential timing of services means you do one service, stop it, and then you do another service. So he says, no, no, no, no, let's offer them concurrently. Then we can bill for one and the other at the same time. Yes.

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No, no, no, it should be there at the beginning when they start treatment. Start treatment and start palliative care right next to it at the same time. So now you have two billing streams going at the same time. Now we're waiting. We haven't got there yet, but we're waiting. You and me, we're waiting to find out about patient benefit. Like, wow, this is awesome. Where's the patient benefit? We're getting there. So, in 2009, palliative care referrals at the MD Anderson Cancer Center in Houston, Texas typically happened late in the course of a patient's illness. So we have a patient's illness beginning, middle, and end, so close to the end is where palliative care is introduced, and what they're now saying is let's introduce this billing stream at the beginning, and we can bill for both palliative care and active treatment—whatever the medical intervention is—at the same time. Okay, so more.

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So what they did then, theorizing that prevailing negative assumptions about palliative care posed an obstacle to early patient referral, was conduct a survey. This random sample of a hundred mid-level providers, whatever that is, 100 medical cancer specialists, and 140 patients. More participants preferred the name supportive care—80% to 57%—compared with palliative care—20% to 27%—and 19%. When the investigators combined data from the two groups of professionals, they found that the combined group stated a significantly increased likelihood to refer patients on active primary treatment and advanced cancer treatments to a service named supportive care instead of a service named palliative care. The medical cancer doctors and providers heavily preferred the name supportive care and stated they were more likely to refer patients on active treatment and advanced cancer treatments to a service named supportive care. As a follow-up to this study, the team changed the name of the unit and showed dramatic results. In a study of records of 4,700 consecutive patients with first palliative care consultation before and after the name change, they found a 41% greater number of palliative care consultations, mainly as a result of inpatient referrals. So doctors were sending people to supportive care in the outpatient setting. They found a shorter duration from hospital registration to palliative care consultation—median 9 months versus 13 months—and from advanced cancer diagnosis to palliative care consultations—5 months versus 6.9 months. In other words, the time the doctor saw the patient, it took him only five months to add on palliative care when it was renamed supportive care instead of the usual seven months it would have taken him to get around to giving the patient this add-on expense.

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What we're looking at here, in marketing terms, is an upsell or add-on purchase. For example, you go to the grocery store, and let's say you are buying a bunch of broccoli. If you buy a bunch of broccoli, you come to the checkout, and they say, "Hey, wouldn't you like this spice to put on your broccoli?" So what they're talking about, then, is this add-on purchase at the checkout, and this is the same thing. What they're adding on is about as beneficial as the spices you're going to add to your broccoli. Maybe, maybe not. It's not really gonna, you know, it's not broccoli.

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Beyond the name change, is there anything else clinicians can do to facilitate earlier palliative care referrals? But wait, let's see the benefit here. They also found a longer overall survival duration from palliative care consultation—6.2 months versus 4.7 months. Whoa, whoa, whoa, but wait. There are two things here—math, okay. First of all, you're making the referral two months earlier, so, of course, the survival from the time of referral is going to be two months longer. So you're just keeping an eye on the patient longer. The service you're providing is not extending their life by one minute. So the doctors are making the referral at the five-month point instead of the seven-month point, and patients are dying at the 6.2-month point instead of the 4.7-month point. Okay, so we've got about a two-month increased duration time of basically billing. Now, but let's just say I've misapprehended this. Let's just say survival really is improved by two full months. This is not two months of walking on the beach holding hands with the one you love. This is not two more months of water skiing. No, this is two more months of gruesome medical interventions, of surgery, painful drugs, ineffective therapies. This is not, you know, two more months of living. This is just two more months of lying in state, so to speak, where you just happen to be breathing and the billing machines are attached.

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To get back to their question, beyond the name changes, is there anything else clinicians can do to make it easier to have patients consume palliative care? Well, there are a lot of additional options which may require some reorganization. He cited a number of situations for advanced breast cancer, for example, integrating the primary care team if advanced breast cancer tumor boards exist, which is often not the case. It's helpful when cancer doctors see patients along with their primary care team early rather than when things are dire. So things are gonna get dire. No, don't worry about that. But they just want to add more services on earlier in the cycle so that now the billing can happen at a higher level, the consumption can happen at a higher level. And so what we have going on here is we have rebranding—a marketing term—we have add-ons and upsells. So what they've done is taken palliative care, rebranded it as supportive care, and created it as an upsell to be added as care is being consumed, even better as an add-on, boom, right at the beginning.

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How much does palliative care cost? Well, it's medical care cost. It's actually pretty darn cheap. It's only $100 a day. But get this, you add $100 a day for a year, and that is about $36,000 in order to live two more months in total agony and pain. You have to ask yourself, if you have $36,000 in cash, is that really what you want to do with it? That's like saying, "Put it on my credit card."

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So what happens then is as you consume these services, health insurance costs go up, you get put into a higher risk or insurance category, and so really, you're actually paying the increased costs out of pocket. It's not magical fairy dust. Now we have the Pew Charitable Trust—I think that's who this is. Yeah, Pew Trust. This is why some patients are not getting palliative care. So they're taking the position that maybe people should get palliative care, and the example they give is a cautionary tale. We have Jeannie Parker, or Jeannie—yeah, Jeannie Parker—who has a mother who will be 99 this year. Congratulations, Jeannie Parker's mom. We are happy for you. She still lives alone in the house in the Midwest where she raised her children. At 92—let's do the math—99 minus 92, that's seven years. Okay, at 92, she was diagnosed with a slow-moving breast cancer to go along with her vascular disease. Wait, pause right here. By definition, cancer is a fast-moving disease, so there's no such thing as slow-moving cancer. If it's slow-moving, and let me tell you, if it's not strong enough to kill a 92-year-old lady, it's a pretty weak condition. So she was basically diagnosed—she was labeled as having cancer when she was 92. This is an important concept to grasp.

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So despite those serious conditions, doctors did not think Martin's mother was near death. Of course, she's not near death. If you start at 92 and live till 99, you are not near death. You're doing pretty darn good. In other words, doctors appropriately figured out that this lady was actually pretty darn healthy, labels notwithstanding. So treatments intended to provide relief from the symptoms—a visiting palliative nurse likely would have detected and tended to the sores that periodically developed on her legs because of her vascular illness. At least three times over the last four years, Martin said they became open wounds that required intensive rounds of treatment at an outpatient hospital clinic. In other words, at no point did her condition require hospitalization. If someone had been visiting her, it would have not only prevented these wounds from developing but saved tens of thousands of dollars to treat them, said Martin, who lives in California and asked for her mother's name not to be mentioned to protect her privacy.

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Now you have to understand the example they're giving to you and what they're telling you. They give you an example of one individual who might have not needed tens of thousands of dollars of care if they'd had palliative care. Now, to be precise about this, they are suggesting that everybody get palliative care to prevent this one outlier. In fact, let's just say that this young lady had received palliative care at the price of $36,000 a year. That's for seven years, $252,000. She was better off getting the occasional intensive wound care than getting the palliative care. So I doubt that $252,000 was spent, but let's just read on. Palliative care has been shown to increase patient satisfaction with the care they receive and to save on medical expenses by reducing the need for hospitalizations and trips to the emergency room.

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One study of homebound terminally ill patients—homebound, terminally ill, that means we're gonna die, we're all gonna die, newsflash—with a prognosis of approximately a year or less to live, plus one or more hospital or emergency department visits in the previous year, found that the average cost of care for those receiving palliative care services, $95 a day, was less than half the cost for those without palliative care, $212 a day. Now, the group that they have isolated here is not the same group that would be offered palliative care if you're gonna believe this theory. So the study of homebound people with a prognosis of a year left to live, who also had one or more hospital or emergency department visits in the previous year. So, in other words, this palliative care concept is generalized, as we saw in the previous article, to apply to all people, even those who had not had a prior emergency room visit or hospitalization in the prior year. And so what you have then is a study being done on one ultra-high-risk group that is then generalized to low-risk groups, ultimately creating no dollar cost savings at all and no increase in life quality or benefit to the recipients.

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Despite dramatic growth in the number of hospitals providing palliative care over the last decade, full palliative care services remain unavailable to many patients. But those who work in the field say they are encouraged by several developments over the last few years. The federal government has used recent demonstration projects to make palliative care more available to patients like Martin's mother, who has serious illnesses but is not in hospice care or hospitalized. Again, if we look at this particular case, this lady, from her diagnosis of breast cancer at the age of 92 to 97, would have consumed $252,000 in palliative care, which is far more than what she consumed in occasional increased outpatient visits to her house. So several states have enacted laws to require physicians, hospitals, and nursing facilities to provide patients with certain serious illnesses with information on palliative care and where to get it. Again, a person can have a serious illness but not have any emergency room visits or hospitalizations in the prior year, and they are now going to generalize the application of palliative care to even those people when it's only been shown to save money in people who have had a hospitalization or emergency room visit in the prior year. The point here is you research this thing and then apply the results to everything.

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Thus, the findings in this particular group are not generalizable to the rest of the group that doesn't have the same characteristics as the group studied. Several states have enacted laws to require physicians, hospitals, and nursing facilities to offer it. Some have also adopted consumer protections to assure the quality of the palliative care delivered. So now we have quality assurance to guarantee the quality of hospitals, and the death rate in hospitals is greater than the death rate in most war zones where bombs are being dropped. So we know that this consumer protection to assure quality is a very bad sign that things are pretty dangerous and going to get more dangerous. So California, of course, has gone the furthest. Governor Jerry Brown, a Democrat, signed a law in 2014 that will require all Medicaid—that's poor people—state program-managed care programs in this state to begin offering full palliative care benefits starting next year. Now, Medicaid, the program for poor people, has now morphed into the payment program for nursing home services in most states. And so what this then becomes is an add-on—extra $100 a day for nursing home care. Just saying. I'm encouraged by this forward movement, says so-and-so, president and CEO of hospice and palliative care. Right, so the person in charge of the cash machine at the palliative care center says, "I'm encouraged." And she should be, as doctors and nurse practitioners conduct about 175 palliative care visits a month in the San Diego area. But she said inadequate insurance coverage still prevents many patients from getting all the palliative care services they need. And so, in other words, as always, they want a raise, more money, more money, more money. But again, money's not the issue. Return on investment is the issue, and you have to ask whose investment, whose return.

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Since you're sitting in the same seat I'm sitting in, we're not owners of palliative care centers. What we want to know is, okay, you have a human being who's putting money into the system, and how much are they putting in, and how much palliative care are they getting out? And the palliative care they're getting out—is it adding value to their life equivalent to the amount of money it's taking from other areas of their life to pay for this palliative care? And I would bet you, if you go to these people who are receiving palliative care and say, "What do you think? Do you want palliative care this year, or would you like your grandkids to get $36,000 cash?" Most of them would probably say, "You know what? Give that kid the $36,000." This is the beginning, the nose of the camel under the tent. This is the beginning, and this is how things start in medicine. You get something like this, and you put it out there—palliative care—people say, "Man, no, I don't think so." All right, no, no, rename it, rename it. Supportive care. Oh, support! So you keep naming it until you find a name the public and that doctors will accept. Okay, so it looks like they found that with this palliative care, the rebranding—yay, success!

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So first, you introduce something, then see who adopts it, and as you can see with palliative care, a bit low adoption. You rename it—boom, increase in use. Yay, wonderful. Then you do a limited study showing that adding on this expense really saves money in other areas, and then you implement it in such a way that the net effect is just increased revenue for the industry. So one way to take a closer look at this is to say, "Hey, is there any other example of this?" And there are quite a few examples of this. So, palliative care, what's the take-home message? The take-home message of palliative care is, what are you palliating? In other words, if you're getting torturous chemotherapy intervention that is causing you to be in pain and just suffering terribly, then you want to stop the therapy that's causing the suffering. That makes sense, rather than pile palliative care on top of it. So if you need palliative care, you have to ask yourself, what are you palliating? And whatever you're palliating, if you can eliminate it, get rid of that. All right, the next step—take a look at the palliative care or supportive care and ask yourself, is it really helping, or is this just another government regulation interfering with your life, telling you how you should do this and how you should do that? You have to ask yourself, as a recipient of the care, is it really adding to your life? And then finally, is it worth not only the dollars and cents cost but the additional business? Is it worth the stress of even consuming it?

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I would say with palliative care, we can see that it does not offer any meaningful increase in survival. So you have to understand you're not going to live any longer—that's number one. Number two, you have to decide, in the person receiving it, what is their quality of life? Is this really the way they want to live? And I think that's really the better way to decide. Palliative care? Yes, I would say it's certainly not medically necessary. It does not appear to be beneficial based on their own research, so I would give it a definite no. You can say, "Oh my god, again, it's not like palliative care relieves the pain." But what could you do for pain in a person who's that far gone? An enema works wonders. People who are suffering from pain, either from the cancer or from the chemotherapy therapy for cancer, are amazingly improved and get relief just by a simple enema. So that actually makes a lot more sense.

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Now, what other examples of add-on therapy or add-on care? One is prenatal care with hospital delivery. This is just the biggest—talk about wool over your eyes—the thing. So back in the old days—and these are very old days, right, about at least 120 years ago—what would happen is a woman would become pregnant, no one cared how pregnant she was, and when her last period was, no one knew, no one inquired. And when she started getting contractions—well, first of all, during her pregnancy, she would call her girlfriends, aunts, whatever, and let people know she was pregnant, and she would get together a group of ladies who would help her out when or keep her company while she was in labor, and that was pretty much the size of it. Ladies would generally go into labor, and while they were in labor, either their mother or aunt or a girlfriend would sit with them. The baby would be born, and life went on. That was it. And if you sat with more than three or four friends during labor, you were labeled a midwife. This is the way it was done. Then, medicine intervened in the early 1900s with hospital delivery, and the death rate from childbirth skyrocketed. As you recall, doctors were not washing their hands, and so the death in childbirth was 33%—the maternal death rate. So now what we have is, I would say, as early as 1970 or so, it was about $1,000 for a healthy live vaginal birth in the hospital. Now it is $16,000 for a vaginal live birth in the hospital. This is with all the added technology in the prenatal period and the delivery period. Obviously, no savings there over your relative coming and sitting with you. But even worse, there appears to be no benefit in health to the baby, and a six-fold increase in maternal death rate since 1970. Facepalm.

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So we have here prenatal care as an excellent example of a service that was introduced as something that would save money, something that would promote health, and what we've now found, you know, 50 years into the experience, is it doesn't do either. And this initial expense for a young family is devastating, absolutely devastating. And then, oh, take on the infertility expenses just to get pregnant because now women are getting their education first and having babies at a later point in life when their fertility has declined. So, prenatal care—excellent example. We're now spending $16,000 per event for something that used to be pretty much $50 or free, or, you know, you just make a pot of stew, and you and your girlfriend enjoy a pot of stew after the baby's born. So, prenatal care—ouch.

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Next, what else is on par with this palliative care rebranded, roll-it-out-to-everyone strategy? Hypertensive treatment. Hypertensive treatment was presented to me in medical school as a fait accompli: hypertension causes heart disease, heart attack, stroke, kidney failure—got to treat it, boom, that's it. At no point were we actually confronted with or presented with the data supporting that assumption. It was just like, don't worry about it, don't look, nothing here, move along, accept this information as is. It wasn't till I graduated from medical school and had been out of medical school for four years that I discovered the data showing that treating hypertension does not save any lives—zero. People who are taking blood pressure medications do not live any longer than had they not taken the blood pressure medicine. This was a total shock for me. Like, what? You kidding me? I was a primary care doctor; treating high blood pressure is literally bread and butter. If you took the treatment of hypertension away from family practice and internal medicine doctors, most of them would literally have an empty office, or I should say not enough volume in the office to pay the bills.

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But here's the truth about hypertensive treatment: it takes 100 years of taking medicines every single day—100 years—to prevent one heart attack. One. And this is not even a deadly heart attack, right? One heart attack. In other words, it prevents heart attacks people would have survived. So we're not even talking about saving lives here. So, what are we spending? What are we saving? Well, it costs $53,300 in hospital costs for one heart attack. Now, I know in a prior show I mentioned $300,000 as a cost, and that estimate was lost from work, blah blah blah, whatever—a lot of other associated costs, which may or may not take place. But just the hospital cost—$53,384 is the hospital cost. So to spend $102,000 to prevent one $53,000 event? You're not saving money—money's not being saved here. Also, if it takes more than a lifetime of use to get the result, oh, there's the red flag, right? I'm only one person. Even if I do live to be 100 years of age, most people who are diagnosed with hypertension are diagnosed around the age of 40 years, or 30 years, let's say 30 years. So, at 30 years, a person starts their blood pressure medicines, and it takes 100 years of use—age 130—before they can expect to see benefit. That is not a realistic investment of time or money. In other words, even if it's free, this is not worthwhile.

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So hypertension treatment was introduced as a money saver, and we see here it absolutely is not. It was also introduced as life-saving, which research has shown it's not. And so again, with palliative care, we have the same type of marketing going on—a major marketing campaign. And people say, well, I think I have to have my blood pressure checked. I have to bring my blood pressure down. I have to treat my blood pressure. And you ask them why, and they will tell you, I have to save my life. And the truth of the matter is, there is no scientific or statistical evidence indicating this. At best, it takes 100 years of therapy to get rid of, to avoid one heart attack, and that one heart attack avoided is not even a deadly one. So there you have it—hypertension therapy. But it doesn't stop there.

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We've got the granddaddy of them all—cholesterol management. Now this runs about $4,500 a year minimum. I took the lowest number for this, and it takes 16,667 years of use to prevent one event. One cardiac event. Again, we're just talking a cardiac event—this is a heart attack, not necessarily a deadly one. This is $75 million invested to prevent one $53,384 event. Yep. Yep, yep, yep. So we can just add palliative care, supportive care to this list, and this is really the backbone of what we now call modern medicine. We have numerous interventions that are very expensive, that are widely accepted, and for which available scientific evidence does not support the use. Yeah, amazing. Absolutely amazing. Now, this cholesterol figure, this information was gotten from the package insert. Okay, so just open your cholesterol drug, read the package insert, and in the package insert, they have to include the studies, the scientific studies they did to show that the drug was effective, the basis on which the FDA approved it. So that's where this information—the cholesterol information—has gotten from, package insert.

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The hypertensive treatment information is in the Journal of the American Medical Association. It's a very—it's an accepted number that takes 99 years to 100 years to 105 years of use to prevent even one event. And prenatal care—this is from the medical literature, and all you can find on prenatal care effectiveness is, geez, it's not as effective as we thought. Gee, we thought people would get more benefit. Oh well, let's keep doing it. And it's $16,000 a pop, and that's uncomplicated. It's like, no C-section, that's if everything goes right. It's pretty hard to justify prenatal care, not only on a cost basis—$16,000—but the intervention in the life of the pregnant lady. I personally have been pregnant, and I can tell you, as a pregnant lady, getting up and traveling to that prenatal visit is a serious imposition. That time can be better spent eating, or resting, or picking out baby names.

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So that is the story on sophisticated marketing tactics—not science—that increase your consumption of costly, gruesome, dangerous interventions. So I hope that this information is helpful to you and can help you maybe reallocate your resources and improve your quality of life, and have those walks on the beach and water skiing, or whatever it is you feel like doing, or just cradling a grandchild. Alright, that brings us to time to drink our Shilajit. So this is the Shilajit, as you can see, it has dissolved. Let me give it a stir for you so you can see. There we go. Believe it or not, it's easier for me to take the turpentine than the Shilajit. The Shilajit takes a few more swallows of flavored water, but here goes.

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Mmm. Okay, that was not bad. Alright, that brings us to questions, questions. Screen. Uh-huh, I think it's here. Yeah, here it is. I'll tell you, all I need is a few more buttons to click, and I'll be just fine. Alright, Carl says, "What do you recommend for non-toxic hand soap, dish soap, and laundry detergent?" So, these are my beautiful hands. Another beautiful hand. And I am 62 years old. So, what do I do with my hands? I do not bother with soap for my hands because this destroys my skin.

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So what do I do? I mix together some salt, sugar, almond oil, and a few drops of lavender oil. And I keep it next to the sink. When I want to wash my hands, I just take a little bit and rinse it off. It leaves my hands satiny soft and clean. Now, if you want, you can add a few drops of lemon oil—a little more disinfectant. But just the action of the salt and sugar exfoliates your hands and washes all the germs off. That's the hand soap. Dish soap? I recommend Dr. Bronner's. You can just dilute that and use it as dish soap. And for laundry detergent, I simply use borax. The other thing that I do is I make sure my clothes don't get that dirty, so I only wear my clothes once and then I wash them, and that means that the borax, which is less harsh, is more likely to get them clean. Then for a fabric softener, I use white vinegar. And it works great, and I don't have any static in the dryer—major victory.

(48:13 - 49:48)

Okay, and we have Tanya who's got several questions here. "Can another brand of Vicks VapoRub be a good alternative?" I would say that because Vicks has its own ingredients and the substitute might not have the same ingredients, also, there's a method of compounding and formulation. And I've personally only done testing with Vicks, so that's really all I can recommend. If you want to use something else, you can, but as far as what I can recommend, what I've used, what's worked, that would be Vicks. And there are a lot of imitations to Vicks, and they vary greatly. So I would not go for a substitute on that one. Also, the price is pretty pitchy. "Would you consider creating a medical dictionary or app where people could type in the words—for example, granulomas of the lung—and your interpretation, based on your education and experience, would translate the words?" You know, that's a great idea, and I've been thinking of making an app and what kind of app, and yeah, I finally have a software team. Yeah. And hopefully, they can come up with an app. It would have to be a paid app, but yes, and they would hear from the doctor or read from the lab results and find accurate, sincere translation. And that is a problem too, by the way, is that your doctor doesn't even know what he's telling you because a lot of doctors just learn doctor-ease and never translate it to English as they were going through medical school. But as I was going through medical school, I literally translated every single thing they were telling me into English. I was like, "Oh, no way!" So you've got to—yeah, that would be a big help.

(49:48 - 50:20)

"What is a semi-calcified granuloma?" That's simply your immune system handling an infectious situation by calcifying it. And Tanya says, "In many of your podcasts, you informed us—the audience—that nothing stays private at the doctor's office." That is true. Last week, my father received for the first time a letter, a charity request from St. Jude's Hospital. I find it very unusual because we do not donate to research, especially medical research. So it made me think that a third party read the correspondence the doctor wrote to the lung specialist regarding the five-millimeter semi-calcified granuloma Dad had in his lung.

(50:20 - 51:29)

It's even better than that. The radiologist read the X-ray, and that data—it's at that point that the data is disseminated. So once we have in the chart, "X-ray done, granuloma found," boom, it goes out to marketing. Literally, these people—like these foundations—purchase mailing lists of people who have granulomas, of people who have whatever. And because medical records are now electronic, records can be scanned, boom, electronically in seconds, and these lists generated. So the cost of generating these mailing lists is way reduced, and it's totally paid for, by the way, by you, the patient. That's part of your medical business because you're paying for the cost of generating and maintaining your medical records, and that is the marketing cost. And that is what makes this marketing possible—the electronic medical records.

(51:29 - 53:12)

Have I been to Cuba? No, I've not been to Cuba. "What do you think of the medical system?" I have no opinion. "And what do you think of their cures?" I have no opinion. So again, the problem with cancer cures is that 80% of cancer diagnoses are bogus. The person is actually healthy and does not have cancer. So if you're talking about a cancer cure, the best cure is not to get the test showing you have cancer. "The book about parasites librarian permitted you to read for a day." Oh no, I didn't get it for a day. Did I get it for a day? I'm not even sure because I had to even beg her, pressure her to let me carry the book from the library desk to the table in the library where I sat down to read it. I think she might have let me check it out for a day. Okay, but that book was at the Harvard Library. No, it was at the Upstate Medical Center library in Syracuse, New York. No, I don't—I don't remember the title.

(53:12 - 54:17)

"Can castor oil be used internally and externally at the same time?" Actually, yes, it can. "Would you consider going to Russia and maybe developing a beta structure system of natural healing?" I would consider that. However, I'd like to say the reason I would consider it is because Russia actually has a pretty well-developed beta structure already. And so the addition to it would be, or buttressing it, or making it strong would actually be pretty simple. In Russia, this is—see, I read about this—1990-something, less than nine—in the late '90s. I read about this, that in Russia, because Russia is such a huge country, and the road and infrastructures to reach all these remote areas is very poor, just because it's just so huge, and the population compared to the landmass is very small, so it's very spread out—at least that's what I was told. So what the government did—and this is prior to 1990s—was actually mail a manual to every single citizen saying, "For this medical condition, you treat it this way at home." And the government decided it just didn't have the money to create this whole hospital, ambulance, blah blah blah, and so it just sent everyone a book on how to heal themselves at home. And the manual was—I'd like to get a copy of it—anyone out there could contact a grandparent or a great-grandparent, or maybe old documents or something, and find it. But yeah, so I think the Russian government is actually pretty open to that, so it would not be a problem.

(54:17 - 56:43)

Miranda says, "Miranda, you probably need an appointment." So Miranda says, "I just want to say I've just started watching, and I love all the healing information you provide. I've been battling stomach issues for some time. I've just been informed that my numbers for anemia are low enough that I need an iron infusion." So let's just stop—iron infusion? You can do your own iron infusion—just beet juice, prunes, blackstrap molasses. These things are ultra high in iron. So let me recommend beet juice. That means you take beets, put them into a juicer, and drink it. If you don't like the taste, then just dilute it, and actually, it goes on a lot easier, but there's your iron infusion right there. The question, of course, is why are you losing blood? How are you losing blood, and how to stop the blood loss? "I also battle reflux." No, you're not battling reflux. You've caused reflux, so you have to figure out what it is about your diet that's causing your reflux. "I've had it left, Nissan hiatal hernia repair." Oh, too bad, and I still suffer. Of course, it's not effective. So yeah, an appointment will be best to straighten out the rest. You've got quite the laundry list here. "What do you recommend for turpentine and tablets for parasite and bacterial and fungal infections?" You can use Vitality Capsules and turpentine. You can go to vitalitycapsules.com and get your free report there, which is the Candida Cleanup Report. So read that.

(56:43 - 58:35)

Shonda says, "First of all," Eddie's—what was that he said? Eddie says—somebody scrambled—I asked if you're Candida overgrowth. "How often can I take turpentine?" You can take it up to every day if you reduce the dose to half a teaspoon. "My husband's 52 years old, has sleep apnea, snores very loud. Sometimes it sounds like he's struggling to breathe for a few seconds, then he lets out a very loud snore. He also has high blood pressure. Not sure if the two are related." Yes, they are. "What can be done to help him with this?" I say let's work on the snoring first. Increase his water intake and his bowel movements, and you'll see his snoring is going to improve greatly. Okay, that is all the questions that we have time for. As always, there are appointments available—not many, but some—and you can look into that at vitalitycapsules.com/appointment. I will see you again next week. And as always, think happens.