I just finished up the excellent new book First Do No Harm by Paracelsus, which is available for pre-order now and will be released on Tuesday, May 3rd. It is a great analysis of the rot that has set in across the American medical establishment. The full extent of individual physicians’ incompetence and the pervasiveness of deadly medical errors was unsettling to say the least. Although the last chapter of the book offers practical advice for readers (and policy-makers), I decided I had to meet this mysterious physician-author to discuss just how one would go about finding a decent doctor in a sea of quacks and mediocrities.
As it so happens, we were both planning to attend a conference of dissident doctors, researchers, and bio-hackers held at a rustic lodge at Deep Creek Lake in the remote woods of Maryland. We enjoyed a hearty dinner and then settled in for drinks and conversation, which is where events took a sinister turn. I noticed that one doctor had opened a new bottle to make a second round of drinks, but the first bottle was only half empty. I took the proffered drink anyway, intending to throw it away, but in the course of a lively conversation as to why good quality porcine thyroid extracts had seemingly disappeared from the market, I forgot what I had noticed and took a sip. The room began to shift. The walls appeared as liquid. I excused myself and went to a bedroom to lie down. I crawled on the bed and begin to feel feverish. The doctor who had given me the drink entered the room, but I was too delirious to react. He loomed over me, then gripped his cheek and begin to pull off his face. It was a mask. I shrieked in terror. There standing over me was the grinning visage of Dr. Anthony Fauci, director of the NIAID. “I’ve gotcha now” he proclaimed in a harsh Brooklyn accent, “I’m going to feed you to the sand flies…after I cut out your voice box.” The last thing I saw before blacking out entirely was the movement of the bedroom door opening again.
When I woke up, Paracelsus was standing by the bed whistling. As it turns out, the Bulgarian doctor known as Landshark had noted when I was followed out of the dining room and suspected that I was being pickpocketed. Dr. Fauci’s crucial error was in disguising himself as a gypsy. I also learned that I was given an injection of Ketanserin to reverse the toxic dose of LSD I had been poisoned with. I was handed a glass of salted orange juice, and after a soak in a tub filled with hot water, horse aspirin, and epsom salts, I felt relatively normal.
I went out for a walk to clear my head and found Paracelsus sitting by a campfire near the lake, stirring various concoctions in laboratory beakers set over open flames. I was offered a cup of tea, and while my earlier experience made me wary, the life of a rogue researcher is one of relentlessly self-experimentation. The following is my recollections of the interview.
Braddock: I think what people will find most interesting and disturbing about First Do No Harm are the revelations about medical education, and how the quality of individual physicians is in great decline. Until someone like Thiel, Andreessen, Musk, or Dorsey plows billions of dollars into creating a real healthcare system, what is the average person to do?
Paracelsus: It wouldn’t take billions…we could create an alternative system with just hundreds of millions of dollars – I mean, look at me, I’m out here doing mass spectrometry on Bunsen burners trying to figure out exactly which derivative of LSD you were poisoned with. Now to your question – it starts with selecting your primary care doctor. That is the point of contact for most people with the healthcare system. It’s also where many people are sent down a terrible path of pills, side effects, and then more pills to treat the side effects of the first pills. I have a set of criteria I use to find the remaining few doctors who still think for themselves and treat patients like individual human beings. Not surprisingly, many autists have already figured out some of these tricks.
Braddock: I start with how they look, physiognomy is a real science you know. There are doctors that instantly resonate or repulse — Paul Marik for instance, has the bearing of the older gentleman-doctor types who have enormous hearts and stiff upper-lips.
Paracelsus: Absolutely! Would you take seriously the advice of a doctor whose gut hangs halfway to the floor? Your doctor doesn’t have to be a bodybuilder or athlete (though it would be preferable if they were) but they need to be healthy. It’s an abomination that so many doctors cannot button up their white coat because of their gut or man boobs (also, white coats are vectors of disease and feeble attempts at commanding respect, I’m skeptical of any doctor who wears one). That’s why I think a good first question is: what does the doctor do for exercise and nutrition? If their answer is, “Well I walk all day seeing patients and I eat a couple energy bars during my break,” then it’s pretty clear you need to run away.
Braddock: So you recommend interviewing doctors — I agree. And I find that receptivity to even being asked questions is enough to disqualify a few. Some become very defensive.
Paracelsus: John Steinbeck wrote about this in East of Eden, “The medical profession is unconsciously irritated by lay knowledge.” Some doctors believe they have a monopoly on anatomy and physiology (hence the obnoxious memes “Don’t confuse your Google search with my medical degree”). While that may have been true pre-internet, it is not true anymore. So yes, you need to interview the doctor – in person, by email, or over the telephone. If they or their practice don't allow for questions and/or an office visit to meet the staff before you become a patient, that is a deal breaker. Also recognize that if it’s a big practice, you may have your regular doctor for check-ups, but for any urgent or sick visit you may end up seeing someone else. So, it’s important to ask about the habits of the other doctors in the practice as well.
Another good question to ask the staff or office manager is what does the practice do after business hours – do they refer all patient issues at night to the ER? Or do they have a way to reach a doctor or nurse to answer your questions if you feel sick outside of the 9-5 (which is when everyone gets sick). Another question on office policies – can you do follow-ups by phone or through telemedicine? Titrating your asthma medications doesn’t require an in-person follow-up visit, but predatory billing practices do.
Braddock: Good point. My father had a neck surgery some time ago, he was in good shape when discharged but by that night was running a fever of 102. We couldn’t reach his primary care doctor or his surgeon, and the hospital refused to say whether or not this was significant enough to bring him back to the hospital. One thing I have told people is that a good screening question is to ask their doctor to explain the actual function of cholesterol - not just what the ideal test numbers should be but what cholesterol actually does. It’s depressing to me how rare it is that I’ve been able to find a doctor who could give me a satisfactory answer. What other questions would you ask?
Paracelsus: Hopefully all your readers know about cholesterol’s function, but if not, time to start reading (Deep Nutrition, The Case Against Statins, Ray Peat, etc.). I think the best way to test a doctor on all the major points is to ask: What guidelines do you use most often in your practice? Can you describe to me how those have changed over the past decades? What is your opinion on those changes? The truth is that these so-called medical societies change their guidelines every five years or so, and studying that evolution is very telling.
For example, the guideline for what is considered high cholesterol has been revised downward over the years. Ask the doctor why was that done, and did it help? Today we have more people diagnosed with ‘high cholesterol’ and taking statins, but the incidence of heart disease continues to skyrocket. The honest answer is that the American Heart Association receives millions of dollars in donations from big pharma, and so of course their guidelines and so-called ‘cardiovascular risk calculator’ are going to be programmed to put everyone on a statin. Ask the doctor if they use that calculator because it’s total horse shit. If you put normal numbers in there, but you are 65 years old or older, it’s going to tell you to start taking a statin, but not to take a baby aspirin!
Braddock: The same goes for the American Academy of Pediatrics’ (AAP) policy on male circumcision. In the 1970s and 1980s the AAP said that “there was no medical indication for routine circumcision.” Then in 1999 they came out with a lukewarm statement saying circumcision was not necessary for the well-being of the child. But in 2007 and again in 2012, the AAP advocated for circumcision by saying “the health benefits of newborn male circumcision outweigh the risks.” I have ethical issues with circumcision because it is a permanent bodily modification done to a baby that is obviously too young to give informed consent, and while complications are rare, they can be quite severe. Are the benefits of circumcision substantial or is this another case of guidelines not following good medical science?
Paracelsus: The purported health benefit of circumcision is a decreased incidence of urinary tract infections (UTIs), but what is left unsaid is that the vast majority of little boys don’t get UTIs. If any of your readers are looking for a pediatrician, definitely ask the doctor’s opinion on the medical necessity of circumcision. An objective doctor will say it’s not medically necessary; a great doctor will say it’s an immoral barbaric practice of genital mutilation.
Beyond cholesterol and penis health, another good example are the guidelines for what a normal average blood sugar should be in a diabetic patient. The older guidelines set a rather aggressively low target, which of course prompted many doctors to prescribe new pharmaceutical concoctions to diabetics. But it turns out many of those patients had episodes of dangerously low blood sugar, and some died! So now the new diabetes guidelines revised the target blood sugar upward. Anyways, I could go on forever about medical societies chasing their tails like animals in a zoo while big pharma laughs.
Braddock: Speaking of big pharma, I imagine you’d want to ask about taking donations from big pharma.
Paracelsus: Yes, and medical device companies too. You have to phrase this carefully, as there are supposed voluntary regulations limiting the donations doctors can receive. So, ask if the doctor has ever gone to a free “educational dinner” at the local steakhouse, or if they speak at conferences, who paid for their hotel and travel to give some silly talk entitled, “Innovative Uses of Remdesivir.” (Innovative is a code word for highly experimental.)
Braddock: At this point I imagine most doctors are going to be some combination of offended and annoyed at being questioned. That is, if they’re paying attention and not fixated on the electronic medical record.
Paracelsus: If you stare too long into the blue light of the electronic medical record your spirit will suffocate and gangrene of your soul will set in….Besides that, the mark of a great doctor is someone who isn’t afraid to admit what they don’t know. As I write in the book, doctors today have been coddled from the instant they were accepted into medical school. As long as they follow instructions, they will graduate medical school. Then as long as they follow hospital administrators’ commands, they will graduate from residency into independent practice. By that time, they are board-certified robots.
Braddock: I have to admit, I do enjoy playing a bit dumb and asking loaded questions about SARS-CoV-2, ivermectin, and the COVID-19 vaccines.
Paracelsus: Oh absolutely. I think your readers who have taken the time to read and become independent scientists could have a lot of fun with this line of questioning. On that note, perhaps the most incisive and piercing question anyone can ask a doctor is: Is “let’s wait and see” ever an option?
Braddock: Well said. Paracelsus - thank you for your time. I really did enjoy the book, and the tea too, actually.
Paracelsus: It was a potion to relieve your writer’s block. I’ve been waiting for your book about COVID-19 to be released, and I’m getting impatient. And be careful on the way out, I saw some tiny little man being chased into the woods by a pack of snarling beagles.