Two of American medicine's pioneers, and co-founders of Johns Hopkins Medical School, represented a fork in the road. William Osler, whose scientific humanism pushed back against a healthcare system teetering between commercialism and quackery, created a solution at Hopkins: clinical care, doctors as teachers, patients as teachers, an end to protocols and dogma. He believed in patient centric care: "If you want to know the diagnosis, ask the patient," he said. He believed that America was becoming a society of drugging rather than healing. He believed that nuance and uncertainty were inherent to healthcare, and that there could never be one right answer. His colleague, William Welch, was a pathologist, a eugenicist, a believer in German medicine, an AMA president. He did not believe in the importance of patient centered care, rather advocating laboratory medicine that trumped the patient. He believed in drugs and one-right-answer thinking and he rejected the value of clinical care in education. He wanted a medical education system run only by full time laboratory faculty, not practicing physicians as Osler had set up at Hopkins. Welch, in the end, won the day. Once Osler retired, Welch fired all clinical staff, and imprinted the AMA model upon all of healthcare. He is indeed the father of American healthcare, but of a healthcare system that embraced eugenics and the medical racial script, that marginalized patients, that created diseases out of numerical norms, and that worked with corporations and drug companies. If you want to know where our system came from, you only have to understand Welch's victory over Osler. And if you want to know how to fix the system, you only have to understand and revive Olser.

Alan and Andy discuss why they are dinosaurs, why primary care is becoming extinct and why its disappearance will instigate harm to the health care system, to patients, to our national debt, and to reason and sanity in health care. Talking about changes within the medical environment, they show not only why primary care is being left to die, but also the measures needed to revive it. It's not hard, but any reasonable measures we as a society institute will run into the wall of profits derived from keeping the system dysfunctional.

The AMA grew up in a libertarian America, but chose to change its nature during a top-down Progressive America, where experts and scientifically based rules were determined to be crucial to any viable reforms. Working with corporate foundations, Progressive reformers, and German-inspired Progressive academic doctors, the AMA shifted course and transformed into a top-down organization that sought to control all aspects of American medicine, including education. It changed its structure to rely on a very narrow board of "experts," it adapted a German ideology of care, it worked with corporations and drug companies to increase its base of money and power, and it started to survey medical schools and determine which ones were capable of surviving in a new Progressive age. All of this foreshadowed the Flexner Report, which would vault the AMA into total domination over the medical landscape, normalize German medical thinking, and create a formulaic dogmatic medical script that would be templated upon all medical schools and all licensing requirements.

In the 1980's dermatologists were somewhere in the basement of the doctor world in terms of reputation and reimbursement. It was always felt to be an easy job--not too much thinking, a limited scope of care, no after hours calls--but did not pay well So the American Dermatology Association hired a publicist and some lobbyists in Congress and created a generalized fear of skin cancer, stating there was an epidemic, that annual skin screens would save lives, and that aggressively removing both cancers and precancers is necessary. All the sudden it became difficult to even become a dermatologist and their incomes and reputations skyrocketed, with many earning $500,000 to $1,000,000 a year and still working less than virtually every doctor according to statistics. Yes, despite all this surveying and slicing, skin cancer deaths have not dropped at all. This has occurred simultaneously with the sunscreen craze, and now we are blocking our skin with substances that have not reduced skin cancer deaths but have likely increased sickness, including cancer, since sun hitting the skin is necessary for our immune system, and we are blocking that with all this toxic cream. We will dissect the truth of skin cancer and the role of dermatologists, and tell you how you can best protect yourself not from the sun but from snake oil salesmen who have abused your trust.

As the AMA gained power and scripted a plan to commandeer the medical system, it used its medical-racial script to leap on the progressive train, including an embrace of eugenics. Eugenics flowed from the medical racial script, and according to historians, was the secular religion of progressives. It was deemed to be sanctified science, taught at all major universities, and penetrating the hearts and minds of those who believed that science would solve the world's problems. Like German progressive medical science, eugenics relied on discrete numerical measurements to reach conclusions about race, intelligence, and even body habitus deemed to be scientifically unassailable. Thus were most of those who reformed health care in the German-progressive tradition also deeply steeped in eugenics. While we call eugenics pseudoscience today, that's very deceptive, because in its day it was solid science, and those who discredited eugenics were considered pseudoscientists. Hence we see that medical science had from the beginning specious origins, and it would only get more muddled and dogmatic as the AMA grew and spread its gospel across the nation.

We are always amazed watching TV. What used to be ads for car companies, beer, clothes, products are not proliferated by ads for drugs and companies seeking to sell you drugs. These companies, like Hims and Hers, are willing to provide you with drugs to help everything under the sun, whether your obesity, hair loss, anxiety, ED, or infections. No need to see a doctor now, just get on line, chat with an AI doc, and buy the recommissioned drugs sold by the company, and you are all set. Once again, drugs can be had on the cheap, real medical care evaporates in the wake of easy access, and more harm and cost flood the system. Hear as Alan and Andy discuss this disturbing new trend in healthcare.

Few people realize how important nutrition is, and it's not all about weight loss. You can lose weight and be less healthy because you are not eating food that will feed your gut bacteria, energize your muscles, and strengthen your brain. This is occurring in a lot of people on fad diets and taking GLP-1's. The newer nutrition triangle, which replaces one that was antithetical to health, places fats, fiber, and fruits/vegetables in their correct place as being the very lynchpins of health, with processed foods, sugars, and fake fats being the poisons we should minimize. We all have our treats, and that's fine, but the key is to focus most of the diet on the good stuff. The best diet is often the very opposite of what doctors tell you: it's high fat and high carb, and it's important to know how to chose the most quality fats and carbs and avoid the rest.

Born in Republican America, with its emphasis on democratic decentralization, the AMA was floundering in the late 1800's, with few doctors latching their sails to its agenda. Most orthodox doctors remained fully independent, many graduated from poorly regulated schools without any firm curriculum, and the medical landscape was dominated by non-orthodox providers. In this vein, the AMA shifted course in the late 1800's, increasing its funding stream, starting a journal, and gravitating towards a more top-down Progressive model of care. Part of its shift required certain compromises and a restructuring of its code of ethics, enabling stronger relationships with the growing pharmaceutical industry that led to more ads and increased revenue, and permitting the inclusion of homeopaths into its orbit if they adhered to certain orthodox precepts. Where the AMA did not bend is in its medical racial script, as it turned its back on the growing orthodox African American medical profession.