On this episode of Recode Decode, hosted by Kara Swisher, Kara talks with Dr. Jen Gunter, an OB/GYN and pain medicine physician, about how celebrity wellness brands have been overtaken by “medical conspiracy theories” and dangerous recommendations. After Dr. Gunter disputed a claim that bras cause cancer, made in an article written for Gwyneth Paltrow’s company, Goop, the writer accused her of “being in the pocket of big lingerie.” She also talks about the larger problems with finding reliable health information online and how regular people without medical degrees can be smarter consumers of what their doctors say.
You can listen to Recode Decode on Apple Podcasts, Spotify, Pocket Casts, Overcast or wherever you listen to podcasts. Below, we’ve shared a lightly edited transcript of Kara’s full conversation with Jen.
Kara Swisher: Today in the red chair is Dr. Jen Gunter, who’s an OB/GYN and pain medicine physician, but more importantly she’s been a pain in the ass for the wellness industry and I love her for that. She written a lot of excellent articles about the truth behind medical claims of companies like Gwyneth Paltrow’s company, Goop, which just got featured in the New York Times. Apparently, jade eggs aren’t supposed to go up there. Jen, welcome to Recode Decode.
Dr. Jen Gunter: Thanks so much for having me.
I didn’t think we’d be talking about this on Recode Decode, but I run the show, so I can talk about anything I want. And you know, I’ve been aware of what you’ve been doing for a long time, but not a lot of people were until this interview that Taffy Akner did in the New York Times. It was an article about Goop and you were featured in there quite prominently, about being a critic. And I thought, this is a really great opportunity to talk about medicine online, and a perfect case study for what happens when you have all these online outlets that are pushing stuff. It’s very different from before, because it’s more amplified. So talk a little bit about your background so we can get a sense of what you do.
Sure. So I am an OB/GYN and pain medicine physician, and I’ve been doing this for a long time. Been a doctor for almost 30 years, pretty close to it. And I became really interested in how people access information online when I went through my own medical issues. I had an extremely premature delivery, which involved the death of one of my children — I was pregnant with triplets — and two surviving sons who were in the Intensive Care Unit for months and months, who also had other health care problems.
And you’re a doctor, so you know stuff.
And I’m a doctor. Yeah, and it was really hard for me. And it was hard for me to find good information online, and so I started really thinking, “Gosh, if it’s that hard for me, how do other people manage?” And so once I got through all of that I decided to try to …
Can I just walk you through that part a little bit, a little more specific?
What did you do? You went online and you …?
I would go online and I’d look things up, and it would be so easy to fall down the rabbit hole with the clickbait, and this company saying they had this product, or this specialty pharmacy saying they could make this thing. And I would be asking my doctor questions they couldn’t answer because they’re not online looking at this stuff. And so I really found myself getting bad information about formula choices, or reflux, and all the health problems my children were having. And I ended up making health care decisions that, in retrospect, I wish I hadn’t.
Based on this information?
Based on this information.
Again, you were a doctor, too.
And I was a doctor. And then I started realizing that I had to just look at the medical literature and just talk to colleagues. And so, I had the advantage of being able to read an article and saying, “Well, this is bad quality.” Or to be able to call up a friend and say, “Hey, I need to speak to an expert on this.” And I just thought that the information that I would get back from these experts wasn’t actually crazy weird information that I shouldn’t have been able to find. And I kept thinking, “Why isn’t this simple information?”
Give me an example of something crazy, during that time?
I had a son with …
I want to walk you through — I think everybody does this. “I’m Dr. Blank,” you know what I mean?
Yeah. I had this … my son had terrible gastroesophageal reflux. And so after every feed, he would vomit out his nose. And the complicating thing was he was also on oxygen. So I would have to whip off the oxygen tubing, suck out his nose, change the oxygen tubing, and get all that done within two minutes, after every feed. So that was a really stressful time, and things got so bad I started asking my doctor about surgery for reflux. And it wasn’t the right thing to do. I was just very distressed, though. And what happens is when you’re really distressed, doctors keep sort of increasing what they offer you, and sometimes what you really need is just a hand-holding.
And so, I got an email from a … I was able to find a colleague who knew a world expert. And in distress, at three in the morning, I emailed. So I really appreciate how people are online and they’re desperate. And the answer I got was, “Well, if your son’s not having any complications why does he need surgery?” And that simple answer really … that’s what really got my whole wheels turning about, “Why did I have to email 20 people and go through all this …”
And also the online information.
Exactly, the online information. And I really feel a lot of the stuff that I read online kind of increased my anxiety about the problem.
Absolutely, it does.
As opposed to reassuring.
I can’t tell you how many … I just had an incident with someone I know who was thinking they were dying. It was insane, actually. And when you did look at the stuff online it was disturbing. It was all pointing … it was not easy to search correctly.
It’s very hard to search correctly and to learn appropriate internet hygiene. That’s one of the first things I do, is whenever people tell me they want to look stuff up online I’m like, “Well, you need to go to the National Library of Medicine and do their tutorial about how to research online,” because they have a great tutorial. But people don’t, they just Google and then they go above the fold, and then they look at the first two.
And it’s always cancer, it’s always cancer!
It’s cancer or a blood clot.
Yeah, absolutely. You know what’s interesting, I’m always like — and my brother, who’s also a doctor, is like — “Don’t go on the internet! Don’t Google it.” I do call him and ask him questions and then he’ll put me on to someone who knows stuff. But it’s really interesting, the proclivity of people to do that, including … to do that is probably really problematic, as a doctor.
I love when people research things online because I really think people want … people should be empowered, people should have information.
Right, which is the flip side of it, right?
Exactly. But the way the information appears to be now online, I feel like we’ve moved beyond the age of information into the age of misinformation. And so I’m always trying to focus on how to help people learn to find information online, trying to help them to learn how to be their own medical librarian.
Right, exactly. And so you were doing this, you had that personal thing happen too. I want to go through your history and then I do want to talk about those topics, because I think it’s critically important that people utilize the internet correctly, and yet not. But it seems like it’s spun out of control in a way that is just … especially quack theories and things that rise.
So you started reading Goop, right? Correct? So explain what happened here, how you got famous, internet famous.
I think back in 2015 … I’ve been blogging for I guess seven or eight years now.
Why did you start? Just because?
Yeah, I started because after my kids were probably 5 or 6, and they’d kind of come through everything, and I wrote a book on prematurity. And I thought, okay, well, I’ve contributed back to the prematurity community. And then I thought, why don’t I try to clean out my little corner of the internet? I really was like, knapsack on my back, I’m gonna fix this little problem!
With a knapsack, a digital knapsack?
What was in the digital knapsack? A little iPad?
Exactly, I think this was before iPads existed, this was a while back.
So you put on the backpack in your little corner.
I put on my little backpack, yeah, and then I …
What corner is that? The gynecology corner?
Yeah, the women’s health, reproductive health. And obviously, especially in the United States, really everywhere, there’s all this misinformation about women’s reproductive health that’s used politically, as well. So I started writing posts about just things that mattered to me and new studies.
On what, like a WordPress blog?
We just had Matt Mullenweg, the founder, on. He’s great.
It’s so … I’m very not tech-savvy and I can use it, so that’s probably as good an advertisement as any. So yeah, I just started blogging about things that interest me, like about vaccines, or about abortion, or different stories that mattered to me.
Which a lot of doctors are doing. There’s a lot of doctors online having blogs and answers and stuff like that.
And so I just kept doing it and it just kept growing and growing. And then in … And I have a large Twitter following and people send me crazy articles. And they’ll say, “What do you think about this?” And sometimes I’ll write about it, and sometimes it just kind of depends on what’s going on. So I started in 2015 blogging about Goop because I sort of view Goop as the couture of bad health information.
All right, so Goop is a site started by Gwyneth Paltrow. It was originally started as a newsletter where there was a lot of products, things she liked, like really expensive scarves and things like that. And I urge you to read this Taffy Akner piece in the New York Times because it really does explain what it is. And I know, I’ve met Gwyneth, and it’s … some of it’s just like rich stuff, like facial lotions and things, that’s where it started, which was things she used in the home. And she’s obviously … there’s a whole wellness category now that’s really taken off. And so she started to move into medical kind of things. It first started off with facial lotions, like, “If you put this on your face you’ll look like me.” I don’t think she ever said that, and nobody’ll look like her. But it started off in a different way, and then moved pretty quickly into medical advice, essentially. They weren’t pushing it that it was wellness, right?
They call it “conversations.”
Right, okay. All right, okay. So what’s the first thing that struck you? Anyway, it started off very differently than where it went, and then it got money doing more stuff. And there’s a lot of Silicon Valley people funding it and things like that. And some of it’s pretty interesting, it’s pretty funny to read, and some people hate-read it, and some people … different things.
I would say as a physician, it’s pretty frightening, the medical information, or the conversations. Which, I think if you’re selling the product, you’re pretty much endorsing it. But you know, the idea that people need supplements, or that they should be afraid. And they sell a lot of medical conspiracy theories, or the people that write for them promote a lot of medical conspiracy theories, which in turn are associated with lower vaccination rates and other kinds of problems. And so I think the problem is that many people see stuff, and just like I did when you’re desperate and you buy stuff, that’s exactly what happens. And I imagine that they’re only branching more and more into wellness because it’s selling and making money.
Right, there’s a lot of people branching into wellness. So did you see a particular thing that got you, that got you doing this? Why them versus … and I wanna talk about other sites and stuff like that.
I think it was … well, some of them … the first myth that I wrote about that they promoted was the idea that bras cause breast cancer.
And that’s a pretty offensive myth. And I think I had a friend who’s had breast cancer and she sent me the article. And I thought, “This is terrible, I gotta write about this!” And then the person who wrote the piece for Goop accused me of being in the pocket of big lingerie. I’m like, “What does that even mean?!” I wish someone would send me free bras, God. Like, what does that mean? What is wrong with you?
Is there a pocket of, or just a cup of?
I know, right? Like a cup.
So what did you say about it? This was saying that … what was the medical …
That somehow, bras obstruct lymphatic flow. And I’m like, well, they obviously have never seen a bra because nobody would wear a bra that tight. I was like, what are you talking about? So it was just ludicrous.
And then the one that I think really got people’s attention was the vaginal steaming one from a couple years ago, that was 2016.
Right, and explain, please explain.
So vaginal steaming is the idea that if you squat over a pot of steaming allergens, because mugwort is a close relative of ragweed, that somehow you can cleanse your womb. I can’t stand that word, womb. And it doesn’t need cleansing. And that plays into so many patriarchal myths about women being dirty, that menstruation has toxins. And it’s so wrong on so many levels, never mind the fact that your vagina doesn’t want oxygen. It’s a hypoxic environment, so getting air up there is actually bad. So all kinds of misinformation, and then what happened from that is all these …
So you read this? Someone sent it.
I read it, yeah. Someone sent it to me at like 6:00 in the morning and my kids were still sleeping, so I sat down and I wrote something quickly, and then an hour later it was all over the internet.
Right, and you said … explain what you said.
I said, “Don’t!” I think I said, “Gwyneth Paltrow says steam your vagina, and I’m an OB/GYN, don’t.” And you know, my fellowship is in infectious diseases, so I know a little bit more about these things than other people. So yeah, that really took off. And I didn’t realize that there are all these spas then that started offering “v-steaming,” or vaginal steaming. And you can buy a home unit on Amazon, and at my little grocery store at the end of the street, they sell a sachet of herbs for it. So that’s kind of why I call her the couture, she mentions this trend and obviously not everybody can afford to go to the chichi Gwyneth Paltrow salon, but a lot of people might try it at home, or do other things, just like we all might copy Dior if we see something. So in that way she’s like that.
So were you surprised by the attention that got? Obviously the word vaginal steaming is gonna attract any kind of attention.
I was a little bit surprised because I’ve written other things about vaginas before on my blog obviously, because that’s kind of what I write about. But yeah, it took off. And then people just send me stuff, I don’t really … sometimes when I’m bored and it’s three in the morning and I can’t sleep or something, I might look at Goop or I troll Etsy. If you put “vagina” into Etsy all kind of interesting things come up.
But then it continued, it continued. Let’s continue with this and then I want to get other …
Yeah, it did continue. And so every, I don’t know couple of months, I’ve written a post about Goop. I write about them with the same frequency that I write about abortion or vaccines or other important topics. And I think my tagline’s a little bit … Come for the sex, stay for the science. And so every time I write a post about something on Goop I really include a lot of important scientific information. I sort of use it as a launching point. And then last year she was promoting this Jade Egg idea, which is of course ludicrous.
Explain the Jade Egg. This is an adult crowd.
I would like my children to listen to this, but go ahead.
Well my kids know … my 15 year old boys know all about this stuff. The idea was that you would put a porous rock, a Jade Egg, into your vagina to I guess try to help you do kegels, pelvic floor exercises for incontinence. But the problem is the way it was promoted by the Jade Egg-thusiasts was not bio-mechanically appropriate.
Right, explain why.
Her idea was to put the egg in and walk around all day with it in, which would lead to inappropriate muscle clenching, and that’s not how pelvic weights are meant to be used. And then of course when the energy runs …
Because people do kegels.
But you do them for repetitions, like any exercises.
Yes, usually it’s not with something in there. Sometimes there’s a machine, right?
But it’s not necessary. It just adds expenses, it doesn’t add efficacy. And then of course you would take the Jade Egg out and recharge it with the energy of the moon, as one does.
As one does. So you read this.
I read this and I …
I love your, “as one does.” She put it out with the moon shadow.
Right, yeah, as one does. And apparently also this was gonna improve your seed of femininity because your feminine knowledge comes from your vagina.
And I’m like, no, actually, my knowledge comes from my brain, thank you, this isn’t the Mists of Avalon. And women should know more about their bodies, not less. And so I wrote that post probably in about 15 minutes, and that just went nuts. And it was everywhere. And I was in People Magazine, and I had mothers of friends contact me on Facebook saying, “Oh, you really arrived, you’re in People.” And I’m like …
Well that’s all right, wherever you reach people.
Yeah, it’s true, it’s where you reach people. But I’m like, okay, great, sure. Anyway, so that was it. And so the Jade Egg thing went crazy. And then I tried one of her diets and it gave me gas.
Which one was it?
I don’t know, some three-day anti-bloat diet and it was horrible. And then I started really looking at a lot of bad information, like scaring people that they’re all full of parasites and you should drink raw goats milk to cure it, and diseases that don’t exist were talked about. So I would just blog about those on occasion, and then in July of last year, so a year ago, they wrote a post singling me out as being someone who couldn’t possibly know anything about the vagina.
Right. But you were also in the pocket of lingerie.
I’m in the pocket of big lingerie, yes. And so, they had a …
Oh my gosh. Who is big lingerie? Like Wacoal? Who is …
I don’t know.
Who would be big … Who is big … I’m still going to try to figure out who big … I don’t even think they meet with each other.
Yeah. I’m like, really? There isn’t a collusion of lingerie manufacturers trying to get women into bras. Really, I just … Whatever. Sometimes you just …
I just love that. I’m going to call you that from now on. I’m enjoying myself quite a bit here. A little too much. So, then they wrote a piece about you.
Right, and they said that I couldn’t possibly know what I know, and I’m like, “Okay. Sure.”
Well, they said that I was strangely confident.
And I wrote back, and I said, “No, as someone who’s done medical school and a five-year surgical residency and a fellowship, who’s got 20 years-plus of experience, I’m appropriately confident.”
And that line really stuck with a lot of women, because I had so much feedback from professional women who have so often been put down and …
Oh, man. All the time.
Right? Like, that you don’t know what you’re talking about. And I just, you know, I was like, “I’m appropriately confident.” And after that I just decided, you know, I’m not backing down. I don’t care who you are. You can be some big celebrity or whatever, that doesn’t make you right.
Right, right, right. And so, have you talked to her?
No. Okay. All right, okay. Well, she might reach out. Who knows.
Well, it would have to be an apology first.
Right. So, did she write this piece, or did they?
It was the editors, right?
The editors wrote it. I’m sure they fretted over their ionic water cooler about what to say. And it was really, I think, a very poorly written piece, and I was like, “Well, if that’s what your editorial board came up with against me and my single-woman blog, I really don’t know what else to say.”
And, you know, they had some male doctor mansplain to me about how I shouldn’t swear, and I’m like, “Okay, well, thanks, Dad.”
Right, right. Right. You swear in your blog, don’t you?
It’s fine here to swear. We’re good, we’re big swearers.
Oh, okay. Well, the whole thing, the post where I wrote back, responded to Goop initially, had swear words in it, because her tag line is, “If you’re going to F with me, you better bring your A game.”
I’m like, okay, well, so I responded with my A game and some swearing.
And I said, “It really doesn’t take my A game. Maybe my C game.”
Right, to swear. Yeah, swearing’s pretty easy. It’s low-hanging fruit, as they say. So, you … And then what happened? So, then they’re getting a fact-checker, right? They had an issue with Condé Nast, according to this article.
Yes. So, then they kind of continued on their merry way. They had sort of … When they lashed out at me they said that was going to be …
Boy, they should have stuck to pashmina scarves, I feel like.
I know. Stick with what you know.
Right. Pashmina scarves. They’re excellent on … I have to say, nice products on that stuff.
I mean, I don’t write about fashion, I don’t write about makeup. I write about what I know about.
So, they were going to have, I guess, a regular piece where they told people what they thought, but they just didn’t. They just ended with me. And then, yeah, I went to their wellness conference in New York in January.
Okay. All right.
And I can swear here?
Yeah, that was a shit show.
Right. Okay, all right. Explain.
Well, it was a fucking carnival, because we started with a medium who did cold readings.
And we’re in a room full of women who could spend $600 plus, right? To go to this. And her leading question, you know, the questions the mediums do to try to …
Yeah, yeah, yeah. “Do you know someone who died?” Yeah, one of those. Yeah.
Yeah. “Have you thought about buying a purse?”
Oh, my god.
“Do you like shoes?”
We’re in a room full of … I’m like … That’s insight from the beyond? You know? “Do you have a blog?” “Was your father a poor communicator?”
And so then I’m looking around going, “Does everybody know this is a cult? Am I the only one?”
Mediums do that.
They’re very funny.
But that was present, she’s, well, she’s not just a medium …
Have you ever been to Lily Dale? Lily Dale’s one that’s up in … They just wrote about it in New York Times.
They have all these leading questions. “Does someone here have someone who died of a heart condition?” I’m like, “Everyone.” Like, at least 79. I’m fascinated by it.
It was really interesting, and then it just got worse from there.
You know, there were people who said that …
I don’t mind the mediums. Let people do them. My mother love a good psychic, whatever.
Well, great. Don’t present it as health care.
No, of course not. Yes, yes. A hundred percent.
Entertainment, if that’s what you … If you want to spend your money on that, that’s your choice. But to say people could get information about their health?
And, you know, Gwyneth Paltrow also promotes this guy called the Medical Medium who was born with an ability to commune with a spirit called Spirit, like Cher, like, goes by one name, Spirit. And Spirit gives information for a price, I guess.
And yeah, and I read his book, and did you know that apricots are best for you after five?
Yeah. It doesn’t know if it’s picked that time, or where you live, or hemisphere, it didn’t say.
Right. So, five, apricots.
Yeah, five, apricots.
I like an apricot any time. I do. I enjoy apricots quite a bit. My neighbor has a tree and I eat them quite a bit.
Yeah, but I eat them in the morning, I’m sorry to tell you.
It’s five somewhere.
It’s always five somewhere.
It’s like an old drinking thing. It’s true. So, you go to the conference, and then the medical … Let’s focus on the medical things. Again, I don’t care about the pashmina scarves.
Well, yeah, but it was all like that. So, you know, we heard people tell us that death isn’t real.
Like, literally not real, and that when you die your dead brain can bring you back with love.
You could cure your cancer with your brain. And, you know, I’m with another physician, and people are scared enough of getting treatment for cancer.
And that’s why people go and get these IV vitamin therapies instead of chemo. And we do know there’s a recent study that show that people who engage in these complementary medicine approaches with cancer are more likely to die, because they’re more likely to not get the therapy they need.
And so people don’t need to hear that they could try the alkaline diet, or they could try love, whatever that specifically means, then that probably is …
And that’s born out of hope, right? People want, especially when it’s fatal. I mean, we’re all fatal, right?
But if you tell someone that you can cure yourself with love, then if you haven’t cured yourself, what does that mean about you? Then that assigns fault.
It’s like The Secret. I can’t stand that.
Even as a parent of a child who died, that’s really offensive to me that, you know, so what?
If you had tried harder, right?
Yeah. So, you know, it was like that all day.
Really lack of any useful information.
And then, like, you could get a vitamin B12 shot from some dude who, you know, was a doctor, but nobody, there was no health history. You didn’t give any health history. I mean, I wasn’t going to line up and get a shot. I’ve seen “The Stepford Wives.”
That was a good movie.
It was a great movie. The book was great. I love Ira Levin.
Yeah, everything. He wrote a lot of great books, actually, right?
So, you were at this conference. Did they know who you were?
No. I used my real name, I’m all about honesty. Although, at the time my online persona was a red wig, because it was my … I do a lot of cosplay with my kids, and I have a son who’s a Brony, and so that, I was in my Sunset Shimmer wig.
So, most people only knew me as someone with long, bright-red hair.
So, I walked in, I registered under my name, and I stood six feet away from her, and, you know? And, yeah, I was unrecognized.
So what is the goal here? You want to just get people good information, right?
Especially because online is where people are now getting a lot of this wellness information. So, your goal is what in this? Because calling attention to someone who’s well known is a good way to do it, but there’s lots of this stuff that goes on all over.
Yeah. I mean, my goal is to get people to learn how to sort out good information, to learn that studies matter — I get that it’s so hard to find good information — so to have a good curated source. So, if people know me as a trusted source where they can get information, they can go to my blog and they can say, “Well, what does Jen say about the HPV vaccine?” And then, “Oh, she’s got some links here.” And then, “I’m going to use it as a launching point for discussion with my health care provider.” So, that’s really what I’m just trying to offer people, is a way to get good information.
Right. Now, Goop has now added a fact-checker, right? Correct?
So they say.
So they say. They didn’t offer you the job?
It’s all right, they couldn’t afford me.
They couldn’t afford you. But the concept is that they had some issues with Condé Nast because of fact-checking.
Is that this, a lot of this stuff is not something Condé Nast wanted to be.
Well, yeah. I mean, I think Condé Nast is definitely in there, you know, and to their credit, you know …
There’s enough avocado on your face there, but I don’t mind that kind of stuff, right? Okay.
Yeah, but that’s not …
You know, that’s not … I mean, some of the claims and medical claims in Goop are really quite outrageous.
And, you know, like I said, they pony up with anti-vaccine conspiracy theorists. You know, people who write for them believe that the mercury in your fillings are causing whatever. I mean, name your conspiracy theory.
So, you know, you really have …
That’s a big thing online. I wrote about that today.
It’s, yeah. I try not to read too many conspiracy theories, because you start thinking about them, going, “How do … How? How?”
But, you know, it does happen.
So, what do you hope to do? What do you hope to do? And then I want to get into the wellness industry in general online.
I just hope people … I want people to learn how to look up good information. I want people to know that they can question their doctors. I want, you know, to say, “Hey, why do I need to do this? What’s the good information?” I mean, the thing that makes me most proud is I’ll get an email from a patient and say, “You know, my doctor told me I couldn’t get an IUD because I’d never been pregnant before, and I printed off your blog post, and I took it in. I showed it to my doctor, and then my doctor said, ‘Oh yeah, you’re right.’”
So, you know, I’m hoping to empower women.
It’s your body and your choice, and if you want to do raw goat’s milk for parasites you don’t have, obviously that is your choice. But it would be correct for you to know that you don’t have those parasites, and that you could get really ill from, you know.
And then you make the decision with the right information.
Right, right. Right. And so, when you’re … When are you going to end this with Goop? Are you just going to keep fact-checking them?
Well, you know, I just write about things that I think that women want to know about.
You know, so I think that if they’re going to keep promoting vaginal misinformation, you know, I’ll probably keep calling them out on it. But I write about a lot of other things, too. So yeah. I mean, I think that they should know that there’s other people out there looking, as well.
Looking very … You’ve caused a lot of attention towards it, which is great, which it think is great. It’s important. You know, again, it’s one thing to do silly things. It’s another thing to do medical things.
So, talk about the wellness industry in general and getting this information, because, look, I had a stroke a couple years ago, five years ago. And the first thing you do is tappity tap tap, and one of the things I do like to do is have good information at my fingertips. And when I had a baby, same thing. I had very low white blood cells, and I went and took test after test and nobody could figure it out for me. Like, it was … And at one point one of the doctors said you had neutropenia, right?
Which is low white blood cells, and I said, “You know, I’m good with the words, and I think that’s a description, not a diagnosis.” And they’re like, “Well, that’s my diagnosis.” I go, “That’s not a diagnosis.” And so, it was interesting pushing back at doctors, which I think people should do, because I think people lack full information, and someone who has good information, like me, had a lot of it around my stroke, but I still felt not able to push back … You know what I mean? Like, how hard it is to push back. And there’s a new relationship between the enormous amounts of information we can get and is at our fingertips and our phones, and experts at the same time, and that they should welcome some of that and push back on some of it.
So, I want to talk about that, because people are self-diagnosing, they’re using the internet, there’s WebMD, there’s all kinds of things. What is good to do and what is not good to do? And what should doctors be thinking about in this new era?
Well, I think, first of all, what’s good to do is to start with properly curated sources. Until recently, data has told us that .gov sites are the most reliable. I’m not sure if the funding for medical librarians at the National Library of Medicine is going to continue with the current administration, but .gov sites, the National Library of Medicine, medical professional societies often have really great information. Patient portals and other things. That’s the place to start, not WebMD or Wikipedia or places like that at all.
You know, anybody obviously can go in and edit …
I mean, I haven’t read everything on there, and so, obviously, you know …
Because they’re very aggressive in that space.
Yeah. A few things that I’ve read on there have been fine, but it’s hard to know. I think it’s important for us to teach people some really … And you brought up a really good point about that’s a symptom, not a diagnosis, but sometimes they are the same thing, and the best example’s headache. Headache’s a symptom, and it’s also a diagnosis. I think that doctors need to learn better how to communicate that to patients in ways they can hear it. I think that’s not taught enough.
No, they were just giving me a big word that I actually could define.
Right, but, you know, the thing is, if you sit down and take the time and explain it to somebody, then I think they … You know, once people have more information, they do so much better.
I think what was interesting is I just wanted, “I don’t know.”
“We don’t know.”
Yeah, and I …
“And you’re not going to know more by looking it up, either, by the way.” That’s what I would have preferred.
And that’s exactly right. So, sometimes it’s better to just say, “You know, I don’t have an explanation, but what I do know is this isn’t cancer. This isn’t going to end your life. This isn’t going to do this.” And then, a good thing for you to say, and then, “Hey, this is what the National Hematology Society has to say about it, and here is their patient handout on this.”
And so I think that the conversation needs to continue in ways until a person is satisfied and feels comfortable.
And that’s something that is missing a lot in medicine.
Right. And do doctors … Are doctors … You’re annoyed by the internet. Do you, when people bring stuff in, because there is little self-diagnosis going on almost continually now …
Oh, everybody’s an e-patient.
Everybody looks everything up, and to assume that they’re not, if someone says they haven’t, then, you know, I’m like, “Sure, whatever.” But I’m sure they have.
And I think that’s great. I’m really all pro-research, and so I think that you can’t tell people not to do something. I think what you should do is be directing them how to do it appropriately. And I would say that I have yet to have somebody be unhappy with me telling them where they can get better information.
People are unhappy when you say, “Don’t look it up.” But they’re very happy to get good direction, and so that’s what I would encourage all physicians to do. Whenever I lecture on this subject I always say, “You know, you should look up your most common diagnoses to see what your patients are finding, and then figure out how to answer that proactively.”
Right. Very fair point. That’s a great point. And also, getting information of your health online more easily. I think the medical industry has not been good at that. I mean, I just was trying to go on the Sutter [Health site]. I just can’t, and I’m real good at it.
You know, I was trying to find out some blood work, which wasn’t explained very well. I finally figured it out by piecing it together, but I felt like an archeologist.
It’s a bone over here, and, oh wait, looks like a nose. You know what I mean?
And it shouldn’t be like that. There should be a better user interface, for, I think, lack of a better word.
Right. Right, right.
You know, we need to be more like dogs and less like cats.
Right. Oh, explain that.
Well, you know, dogs always look at you like, “How can I help you more?”
And, you know, cats, one minute you’re petting them and they love it, and the next minute they’re biting you, and you’re like, “Wait, what happened?”
Like, your remote control is broken.
“I thought you loved me. I thought you loved me.”
It was a cholesterol thing, and I just want to know is this high or low. There’s all these new medical things that are coming out. Forward and others that try to technologize your health care. It’s just bells and whistles, really. It was just an easier way to hear it, which I think people are criticizing. I was like, but it actually was an easier way to interface with it and to talk to your doctors and stuff like that, which I thought was interesting.
I think that’s been really understudied, is how best to communicate with people. The thing is, different people need different types of communication. You can’t just say, “We communicate with patients this way,” because there’s so many, as many different type of people. People learn differently. I think that we have to try to invest more time and effort in learning that.
Also, the medical profession was really behind the eight ball, I think, social media-wise, because eight or nine years ago, it was considered unprofessional for a doctor to be on Twitter. Even now, some professional societies say you should have two separate accounts. My answer to that is patients want real people. They want to know that their doctor looking after them is …
Why two separate accounts?
Well, because it’s unprofessional to talk about your personal life.
Oh, okay. All right.
Which I just don’t think that’s true. When a patient comes to see you in the office, there’s a big power differential and people are afraid. Once they know that you’re a real person, they disclose more about themselves so much easier.
Yes, which can help in your diagnoses.
Especially if you’re talking about sexual health. It’s really personal for you to disclose something. I think if you know that your doctor’s a real person, it makes a difference.
Absolutely. What about getting, not just access to your health care, but the communications are going to be all online going forward. A lot of it’s going to be in apps. It’s going to be in all kinds of ways besides in-person things. Eventually, there will be no in-person things, and they’ll be a robot there giving you your diagnosis at some point. I’ve seen some stuff at MIT that’s pretty fascinating.
Yeah, I know. Also, as somebody that’s really gone through a lot medically, I don’t know, man. The personal touch is also really …
Yeah. It is. It is.
When you get something really sucky, having somebody sit down and just put their hand on you and really sit with you is …
Yeah. Care is really important.
One of the issues around the robots I was talking about at MIT was they can’t … There’s about 10 things that everybody has that is really easy to diagnose, certain different things that they could use that they don’t need to repeat … lather, rinse, repeat, essentially. They can’t get the eyes right.
In one case, especially with elderly people, it’s a nice thing because it’s an interface, and in other cases, they never can get the eyes right. People are always off-put by the eyes.
I can imagine. Yeah.
Right, you can’t get human eyes. It’s really funny. People are bothered by it. Everything else works really well.
It was interesting for me. In certain cases in medicine, radiology might be replaced with an AI or something like that, because it’s better diagnosis, computers can do it. In another cases, you’re right, care doesn’t matter.
I want to finish talking about where things are going, especially in the wellness industry. Right now, in Silicon Valley, there’s all kinds of things about diets, fasting and things like that. There’s stuff around these pills that people are selling, these wine … There’s all kinds of pills. There’s neurotropics. I’ve had that guy on, where you take different pills for your mind to bring … There’s a huge interest in this.
Recently, I had Michael Pollan on talking about psychedelics, which I think actually is interesting to replace opiates and various pain medications. I’d just like to get your thoughts on any and all of these topics.
I guess I would say that it’s very hard to advise anybody when people don’t invest in high-quality studies. I think that many people put stuff out in the hopes that it’s just going to sell, and then the studies come later. A lot of times, the basic science is actually really poor. For example … I’m blanking on the name of the blood company with the micro …
Oh, yeah. Yeah.
Anyway, every doctor I knew, and everybody I knew in lab medicine, said there’s no way this is going to work.
Theranos. Yeah. There’s no way this is going to work. This is impossible.
Yeah, my brother said that a hundred times.
Yeah, it’s impossible, but it was cool.
Well, it’s a nice thought. Wouldn’t it be great if?
Yeah, wouldn’t it be great if? I wish I could raise a billion dollars off a thought. I don’t know. Maybe that’s why I’m not in Silicon Valley, I guess. I think all these people that claim they can do these things, I would say there’s no way I would ever recommend your product without a quality study showing me that it made a measurable difference. If you have all of this money, instead of putting it in the hands of celebrities, why don’t you invest in some quality research if you actually want to make a difference?
Right. There’s a lot of people going into the health care … There’s Color Genomics. There’s 23andMe. They’re all different. They’re all different in their ways. There’s the heart one, it’s the EKG machine. There’s a lot of investment going by technologists, all of which to me points to the fact that they don’t want to die, which apparently you don’t have to do.
Right. I think that if you go to these wellness conferences, a lot of this is an investment in how to stay young forever. I think, “Well, I want to enjoy life.” I think that it’s interesting because we kind of know the real basics that aren’t being done. Most people don’t eat healthy diets. Most people don’t get enough exercise. Some, whatever, like 17 percent of people, smoke. There’s still a lot of things that we could do. The problem with a lot of these supplements and things like that is people do that instead of exercising or they do that instead of eating right. If you have an extra 40, 50, $60 a month, invest it in a quality diet. Don’t invest it in supplements.
In supplements. What about the focus on genetics, like 23andMe and all the others? There’s Color Genomics. There’s all kinds of … they’re diagnostic. Cardi is another one.
I don’t know about all of them. I know about, for example, instead of spending your money on 23andMe, spend your money, go to a geneticist and find out if you actually need to be tested. The problem is a lot of these results, we don’t know what to do with.
Right, right. Well, they’re preventive, too. They were initially quite full of information that you then would bring to … Some of them are affiliated with doctors now. These reports go to the doctor, and so the doctor gets more information.
Yeah, I would just say that it wouldn’t be something that I’ve done. It wouldn’t be something that I would do. I’ve heard people have swabbed their dogs’ mouth, sent them to 23andMe, and got a human result back.
Yeah. I think I read that. Maybe I’m incorrect. I’m pretty sure I read something like that.
How do you think Silicon Valley should approach health, because they’re really starting to make major investments in it. Obviously, Theranos aside.
Right. I guess what I would say is that investing in health sounds like you’re investing in making money off of health. Investing in health to me means helping people get better. Helping people get better requires quality research. I would say that if they’re really interested in helping people as opposed to selling product, that they would invest in quality research.
On whatever they’re doing?
Because they’re also selling a lot of wellness programs to companies. There’s all kinds of napping, meditation. I don’t mind the mediation ones.
Nothing wrong with meditation.
Wellness has become a bit corrupted, I think, in the sense that people have confused it with things that can make you live longer or necessarily be healthier. Doing things because they make you happier, fine. There’s not really good data on massages helping chronic pain, but if you have chronic pain, you go get a massage and it makes you feel better, that’s okay. Right? You’re being honest about it. “It makes me feel better. I like it.” The problem with a lot of the company wellness things I think is the whole idea is to improve productivity. I don’t know. I’m not sure the data’s very robust on it. I’m not an expert, though.
There was a story out today that they don’t work, which is interesting, that it doesn’t move the needle in the way … I think companies want to do it because they want a healthier employee population.
I think if the rush instead of tech and investing is we make gains in health care over the long term, not over the short term. If anything sounds too good to be true, it almost always is.
Yes. That’s always the case. I want to finish up talking about how people should … Your next book is coming out to explain it.
Yes. It’s called “The Vagina Bible.”
It’s going to be dedicated to Gwyneth Paltrow now.
No, it won’t be. Actually, it’s going to be dedicated to every woman who’s been told something nasty by some dude about her vagina.
Okay. All right.
Really. It’s called “The Vagina Bible.” It’s everything you need to know about the vulva and the vagina so you can wade through the stuff on the internet, so you can speak with your doctor, so you can tell your boyfriends, your girlfriends, your family what they should or shouldn’t know. It’s all the information that I think everybody should have.
Are you going to have a big online element?
Yeah, as it gets updated. Absolutely. Obviously, some of it’s up to the publisher. It’s Kensington Publishing. They make decisions. I’m just trying to produce good content.
Right. Absolutely. So, when you’re thinking about health online and how you do … when you’re thinking about health, I think it’s really laudable that you’ve done this. I think what does happen is this quackery just gets amplified. Quackery has been around since the beginning of time. They used to have those tinctures and tonics. This will do that. Even Kellogg started as …
You know about the goat testicles, right?
No, no. Tell me. You must.
I must. There was a guy called John, I think it’s Binkley or Brinkley. I can’t remember. This was in about the 1920s. He failed out of medical school, so he went to Kansas and started implanting goat testicles into men for loss of vigor and other things that are quasi-medical things.
Where did he implant them?
In their scrotum and lower abdomen. He did it for some women, too. Obviously, a lot of people got sepsis and really ill, but he made a lot of money off of it. He bought a radio station, so he was controlling the local media. He paid off the governor. There was this whole craze. There’s an animated movie, I think, that just came out about it. I saw something about that online. The book about is called “Charlatan,” which is a really great read. He was doing the exact same thing in the 1920s and ’30s.
There’s always been these really crazy ideas around for a long time. I think it just goes to show that a lot of the symptoms that people turn to wellness for like bloat, fatigue and ennui, I personally think that a lot of those are part of the human experience.
Nobody wants to be uncomfortable these days.
Yeah. We need maybe friendship. We need medicine to tell us it’s not cancer, it’s not heart disease and it’s not something serious. Then when we’re left with other things, diet, exercise, and better sleep are part of the answer. It’s just, these crazy schemes have been around for a long time.
Yeah, so what do you recommend people do? I recommend … I have this thing I talk about all the time called WeCroak. You ever heard of it?
It’s 99 cents. It’s apparently in Bhutan, they think about death a lot. It gives you five amazing quotes every day on death. They pop up on your screen. They’re great. They’re really great. I’m telling you. It does make me feel better. When you think about death and it doesn’t scare you, it’s really … It’s called WeCroak. This one today is, “Drink your tea slowly and reverently as if was the axis on which Earth revolves. Slow in the evening without rushing toward the future.” I feel good about that.
They’re really astonishing quotes. They’re really interesting, because it’s a peace of mind thing more than anything else. You’re right. It just makes me feel better. There was a Marcus Aurelius. “Think of yourself as dead. You have lived your life. Now take what’s left, and live it properly.” Sounds good to me. What do you recommend?
My personal wellness is shoes.
Okay. Online. All right. Go ahead, shoes. Let me see your shoes.
I’m wearing Fluevog today. They’re a Canadian shoe manufacturer. I wear all of their shoes. What do I do online for wellness? I have an app. I use Lose It to keep my weight in check. I’m a calorie counter. I lost 60 pounds about eight years ago. I keep it off that way. That’s my biggest app. My big wellness thing is I now do one of those meal delivery things where they deliver it to you and you cook it yourself, because I hate the grocery store. I hate the grocery store more than anything else in the world. Anything that keeps me out of the grocery store, that helps me get good food. I’ve been doing it for about a month now.
Actually, you can make some really good stuff.
The food is fantastic.
Plato does a nice one. There’s a whole … Sunbasket.
We’re doing Sunbasket. The kids love it.
Yeah, it’s fun.
I’m not paid by anybody. This is not any kind of …
Yeah, it’s a good way for diet.
My kids are loving it. We’re trying new food. I spend less time in the grocery store, and that is my big personal wellness.
That is your big personal wellness? All right. Jen, this has been really fascinating. I really do think it’s really important for lots of doctors to be online. There’s a lot of quacky doctors too that have used and abused it in a lot of ways. What you’re doing is not easy. There’s not easy answers. I think a lot of people think they can Google something and come up with answers, and it’s not the case.
Yeah. Thank you. I think that science is sexy in a lot of ways, but it’s also not the fast answer. So it’s really hard when everybody online is looking for the cool flash, and you’re like standing in the corner going, “No, hey. We’re over here. Come. Come. We just have the regular brownies. Not any souped up fancy ones with M&Ms or any weight-loss brownies. We just have like the regular ones. But they’re good.”
It’s a multi-part answer that’s going to take years.
I think the other thing that we could all focus on is more scientific literacy. Teaching more people about what it means. We still have people that don’t believe in climate change. This isn’t just unique to medicine about wanting to believe or not understanding about science.
A lot of those issues — climate change, anti-vaccines — all rocket around the internet. It’s funny that a lot of these things, that’s where they thrive and live, where people get too much of their information.
Yeah. I know. It’s really hard because people share stories and they don’t even realize that to share something to make fun of it actually helps propagate the information. I think we could all learn better internet hygiene about how to prevent the spread of myths, too.
Do not steam your internet.
Don’t steam your vagina or your computer.
Okay, don’t do it. Thank you doctor. What a great diagnosis. I really appreciate it. I was just going to go home and do that. Anyway, it was great talking to you. Thanks for coming on the show.