Robert Yoho shares an emergency physician’s perspective on healthcare in this episode of the podcast. He is a retired emergency physician and cosmetic surgeon. Recently, he published 2 books, Butchered by Healthcare and Hormone Secrets. His self-proclaimed title is “healthcare whistleblower.” Based in California, Robert Yoho is a member of the baby Boomer generation. He brings a different viewpoint to the Perspectives on Healthcare Podcast with Rob Oliver.
Here are 3 things that stood out to me from Robert Yoho’s perspective:
· Almost 20% of our Gross Domestic Product is spent on healthcare
· Robert believes that any exchange of value “poisons the well”
· “Nothing is so strongly fortified that it cannot be taken with money” – Cicero
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Here’s the transcript of Robert Yoho: An Emergency Physician’s Perspective on Healthcare:
Rob Oliver: Welcome, and thank you for being with me. My guest today is Dr. Robert Yoho. He is a retired emergency medicine physician and also a board certified cosmetic surgeon. He did breast enhancement, liposuction facial procedures. He has recently published two books. One is called Butchered by Health Care, and the other is called Hormone Secrets. He calls himself a healthcare whistleblower. He is a member of the Baby Boomer Generation and joins us today from California. Dr. Yoho, thank you for being here.
Robert Yoho: Thank you, Rob. I want to make the Disclaimer that I’ve left before in Legion, and I’m no longer you can call me Robert from now on instead of doctor, so you don’t have to doctor me.
Rob Oliver: All right. No problem. Listen, I firmly believe that Robert is quite possibly the best name that a man can be given, but I may be slightly biased as it’s mine as well. So here we go. Tell me a little bit about yourself and your role in healthcare.
Robert Yoho: So I’ve been retired for about three years, and I’ve been writing about as I retired from healthcare the last few years, I started broadening my reading, and I soon entered a bunch of fields that I eventually thought of as corruption. And I thought after I read a few of these stories that I was opening a can of worms. But I eventually found out that I was opening a dumpster full of worms, and it just seemed to never stop. The basic problem. The basic problem is that we’ve raised money out of the sky on this industry through third party payers and the government sources, and that sort of attracted the entrepreneurs, which, if we want to be a little more honest, a lot of them are crooks, and we now have almost 20% of our GDP or gross domestic product devoted to health care. Other developed countries universally have 10% or less. In Singapore, which has excellent health care, has 5%. So we spend twice what these other countries do on health care, and we get a product that is about 50% effective the other 50%. And this is academically supportable is either injurious or ineffective. And so we spent all this money and we have a bad product. And the whole thing was a mystery to me because it’s not put down anywhere as a cohesive narrative. So what I did is I spent three years on this thing and I put it all together using entirely derivative sources. None of my material is original.
Rob Oliver: Got it. Okay. So what I’m kind of hearing you say is somehow in American medicine, the focus has shifted from the patient to the money, and that’s kind of how things are headed, as you see, it is that accurate?
Robert Yoho: That’s completely accurate. And it’s sad but true. The doctors are very well trained. These people are the most elite, large group in America. They’ve got high intellects and they still maintain their ideals. But if you understand financial influences and I want to cite Caldini here, his book, Influence Explains it all, and it’s become a Bible for sales, from industry to positions and any exchange of value poisons as well. And it’s hard to believe that these well trained, intellectual doctors can be bribed with a meal or bribed, even with a multi hundred thousand dollars a year added to their salary. But it said the true and their patients become secondary. Now I’m not saying that there aren’t miracles to be found, and you are a living example of the kind of miracles that modern medicine produces. But it’s very hard for anyone to divorce themselves when their salary is involved, they almost become a creature of the payer. It’s crazy. These guys, they have ideals. They try hard, but they can’t avoid the conflict of interest. And a Disclaimer that you have. A conflict is nothing like strong enough to prevent you acting in the interests of whoever is paying it.
Rob Oliver: Got it. It makes sense. In some ways. The idea would be that if we could make doctors a little bit more like NASCAR, where they have to wear patches from all of the quote, unquote sponsors, so that at least we know whose influence they’re operating under, it might be helpful.
Robert Yoho: Can you give me just interrupt for a second? That’s actually the strategy currently with medical publications. They have to disclaim the financial interests, but it basically doesn’t work at all. And other fields such as law and government work. If there are financial conflict of interest, they have to recuse themselves from the cases or they have to disforge their financial interests. The rules are entirely stricter in other fields of endeavor in America, and they’re statutory. But in medicine, we just have this fantasy that these highly trained, intelligent people can forget about these conflicts of interest. And the COI is a soft term. Bribery is what it is, although that’s a legal term, and I really shouldn’t apply that because it has legal limitations. But the conflict of interest idea and the Disclaimer idea is completely ineffective.
Rob Oliver: Got it. Can you give me what does quality health care mean to you?
Robert Yoho: So the doctors need to become aware of their problems and their conflicts. And so on. The first thing they need to understand is this golden rule, which means that those are the gold make the rules. And as I said, anytime any value is accepted, even tiny, tiny gifts, it has tremendous influence. And you probably are well aware that if you can to seduce a girl, you take her out for dinner. And this has genetic exchange of food has a genetic lock, and it’s tremendously persuasive. And at the end of the dinner, you might get something much more valuable than the dinner. So medical industry basically requires these patents to make their outsized profits, and they are allowed to ruin their own studies to demonstrate either that the competitor is no good or that their drugs or whatever it is, are superior. And Gold Acres book Bad Pharma is ten years old. Plus, but it shows just how they do it with statistical frauds and all kinds of things. They destroy the evidence for 50% of the studies that show it doesn’t work. For example, the human Papilloma virus vaccine. They hid 50% of the studies. Japan abandoned the vaccine. We are still using it. And so these Pharma companies have accumulated more federal settlements for criminal activity than any industry in history. It’s documented on a Wikipedia page of shame that you can easily access by going big Pharma settlements. Wikipedia and the doctors have to understand certain things about these studies. First, that they’re easy to misinterpret, and second, that they’re adulterated with misinformation. And third, they play these statistical games with large numbers and small differences and claim that statistical significance prove something. And it’s just not the case. Doctors and patients must understand what’s going on. And just like their relationship with lawyers or financial advisors. If you’re hearing something you don’t quite understand, you have to assume that the person telling you the story is trying to sell you something and is essentially BSing it. So those are the things that we need to do. And that’s what quality health care would mean is if we can get our awareness higher about what’s going on. I think that we could push for higher quality health care both individually and at the more global levels.
Rob Oliver: Sure. And it’s interesting. I had a gentleman named Gunther Mueller on who is an optimal health strategist, and his take on it was follow the money.
Robert Yoho: That’s exactly right. Cicero said it best. He said nothing is so strongly fortified that it cannot be taken with money.
Rob Oliver: Got it.
Robert Yoho: And he was talking on military. He was talking about all kinds of things.
Rob Oliver: Sure. Can you give me an example of what would be quality health care?
Robert Yoho: Okay. So we have a number of models in our country, right. And we’ve got three very dysfunctional systems that are administrated by the federal government, Medicare, the Indian Health Service, and the Veterans Administration, and anyone that’s worked in the last two knows that they’re total messed. A lot of the patients don’t care what’s going on. Neither do the doctors. That’s an overstatement. But the question is that is on everybody’s mind. Is there a quick fix with the universal Medicare? And I think because of the industry influences and you may be aware that health care lobbying in Congress is much higher than the sum of oil and natural gas banking. Plus the military, it’s just an unbelievable thing. They’re by far the most powerful force in our federal government. They are actually bigger than our federal government. They’re almost $4 trillion, and our tax revenues are only about three and a half trillion dollars. They’re just ubiquitous, and they’re tremendously powerful. But there are some models in our private sector that are much better quality. And we have one down here called Kaiser Permanente in Southern California. Now, I’m not saying it’s perfect, but they do get their doctor group, their hospital group and the insurance company into one entity. So they saved the money that all these things just burn with the current system when they compete for the money with each other. So they’re all, in theory, pulling for the same yoke. Their doctors are on salary, so they don’t even have the conflict of interest that they’re trying to push more patients through the system or do surgeries that are superfluous or anything like that. And I’m not saying they’re perfect. Their problem may be that there may be some internal pressure for them to do less. And of course, if you get everything in health care, we couldn’t afford it as a nation. So there’s got to be some cap on the crazy thing. But I think the Kaiser system is certainly a reasonable model to examine what the heck to do. And it’s just so hard for anyone to get a handle on this thing. And you can’t eliminate these people with the enormous amount of money they’re throwing Bobbing money at the decision makers.
Rob Oliver: Yeah. What do you wish that people understood about your role in health care? And I’ll let you take that in any direction that you choose.
Robert Yoho: Thanks, Rob. My role is to try to spread the truth and nobody makes any money on this. And it just seems like at 67, I need to do something meaningful. Doctors often understand parts of my story. But just like the old Indian fable, they may have their hand on the elephant’s toenail or their hand is on the elephant’s trunk, and they understand that part of it. For example, internists frequently know about the studies that show that the angioplasty, which is opening of the little arteries in the heart with a wire and a balloon, is ineffective. And the basic story in two sentences about angioplasty is it saves one in 40 people. That’s all the number needed to treat in one in 40. But it kills about 2.5% of those guys, which is one in 40 also, and that’s in the best case, which is a severe heart attack known as an St elevation heart attack. In other cases, it’s completely ineffective. But in the best case, it’s a wash. As far as I can tell from looking at the statistics oncology is even worse. Well, over half of the oncologist income is made by retailing cancer, chemotherapy, drugs. Now, Rob, if you and I were both doctors and I sold you a product and told you to take 25% of the products sale value for yourself, that would be called capital. It’s a federal crime, and we could easily both go to jail. But there is an exception for the Pharma companies, and they’re somehow allowed to do this. It’s this a profound conflict of interests. Some might call it a bribe or a kickback, but those are legal terms, and I don’t want to go that far. And so the third example is we have 18% of the entire country on site drugs and 50% to 70% of the entire population on prescription drugs of some kind. So if people understood all that, I think they would be horrified enough to start looking at this thing in more detail. Now, my book is written down to a basic level, but it has 500 references that you can get as clicks in a book. So here it is, my Moment of Fame on Rob’s podcast. It’s called Butcher by Healthcare. You can get it on any platform. It’s available on Amazon. I am obscure. I’m not selling thousands of books. I’ve sold less than 1000 books in a year, so I’m trying to raise awareness a little bit.
Rob Oliver: Sure, in some ways, I imagine that you kind of feel like a David against Goliath to use the metaphor.
Robert Yoho: I’m not a David. I’m a freaking ant. Anyway, go ahead.
Rob Oliver: Tell me what excites you about the future of health care.
Robert Yoho: Okay, so I’ve had criticism that I was too negative, and I don’t want to imply that there are not miracles. There are miracles everywhere to be found in health care. And I don’t want anyone to interpret my message as being too hard on the doctors. Our name is still on medicine door, and we must still rise to the occasion. One of the favorable things that has happened with coded is Trump did an executive order that said that anyone could get a virtual consultation. And now prior to this, the medical boards were censoring doctors if they didn’t do a quote, good faith exam in person on at least the first visit and possibly once a year. So there are many advantages to exam. I mean, a physician whose experience can look at a person just like a veterinarian without even saying anything. And you can often discover exactly what’s going on. You can leap to, and it’s harder on a Skype or video conferencing on the phone. But I think that it’s a very positive thing, because what this does is it opens up areas of the country that may not have the best health care to supervision by the top medical centers in the country, and you cannot imagine how much more competitive the physician slots are for Stanford or Harvard. They accept, like one out of 100 or one out of 500 of the very best positions that apply. And this is a very elite pool. So when you visit with these people, even virtually, and you can do it for a few hundred dollars, you get someone who is a very nice intellectual qualities, but they also even have personality skills. They’re smooth. So that’s a very positive thing. And I would encourage anyone with a complicated problem to look elsewhere. Read online. Who’s the best? The third thing that’s really good is we now have these patient blogs and they can cut through the boat and help you figure out what you have. And if you have and the patients are very amenable to spending their time and patiently explaining the problems of a specialized nature to anybody on the blog, they’re really very useful and some of the doctors hate them because they claim that they are losing power or whatever. But information is always helpful. If you have a complicated problem, you need to consult with many people, but most people don’t have complicated problems. They just need to stay away from doctors.
Rob Oliver: Got it.
Robert Yoho: Avoid the psych meds.
Rob Oliver: Right. Last question for you. And that is what is one thing medical professionals can start doing today to improve the quality of health care?
Robert Yoho: This is a very hard thing for medical professionals because the practice of medicine is just unbelievably consuming. And the biggest single problem and people are going to think this is crazy, but is the billing that has been imposed on them by the electronic medical records? Now this seems like a great idea. This is very well intentioned. Obviously, we’re doing more and more on computers, but it now takes up 25% to more realistically 50% of the time of practicing physicians. Now these guys have to go home at night and click on their computers for a couple of hours or 3 hours or they don’t get paid. The answer to your question is there’s no clear path to improvement in health care it may take because of the powers that are involved. Any evolutionary step imposed by the legislature is going to result in compromises that are imposed by the people that pay the legislators. It may take a vast financial disaster to really change things and to make it more reasonable. I think we’re long past simple capitalistic solutions and old country doctor solutions for this thing because it’s so expensive. I have a number of things that would help, but they’re basically impossible politically, for example, getting rid of the prescription drugs and making them all over the counter. Now this sounds crazy as a position. But when you really examine the issue, it would get rid of drug patents or certainly make it would make it possible for these things to be better evaluated by the consumer rather than the doctor. I mean, if you get sick or feel crappy on an SSRI antidepressant, you’re not going to take it and the doctor is not there to urge you to take it.
Rob Oliver: Sure.
Robert Yoho: We must all struggle to act ethically to try to keep our patients interest in the front of the line. But it’s just so hard with all these conflicts and bribes.
Rob Oliver: Excellent. Listen, I’ve heard someone put forward the concept that when things really started to head in the wrong direction was when Pharmaceuticals became covered by insurance, because in some ways then patients are not as aware of the cost or aware of anything. But listen, Robert Yoho, thank you so much for being here today. I really appreciate you sharing your perspective on healthcare.
Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.