The End of Medicine as We Know It.: Recent Episodes
Harald Schmidt, MD, PhD, PharmD
The End of medicine as we know it – and Why Your Health Has a Future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
Medical practice and research are stagnating whilst costs are increasing. Our current "solution" of calling a symptom in an organ a disease and chronically treating without curing it and without much benefit for patients, because we don't understand its molecular cause comes to an end. Its successor, systems medicine, will be the next big socio-economic revolution after the previous IT revolution. Using big data in medicine, generating your own digital twin will totally change what we call a disease, how we diagnose and cure it, and ideally prevent it. This podcast provides concrete tipps to live with the current situation and cuts through many myths, focusses on evidence, and gives an outlook into the future, which has already begun. Be part of it. Knowing = health. Twitter @hhhw_schmidt, E-mail harald.schmidt@mac.com, Web haraldschmidt.online, Groups on Signal and Threema.
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Know your genes
Sooner or later - depending on whether and how well and quickly biomedical research reforms - all genes and their importance in maintaining health and curing diseases will be elucidated. However, you, dear listener, will personally benefit from this only if you also know your genes.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Research for Patients
The insight into the far-reaching unsuccessfulness of our current biomedical research, at least as far as its relevance for you as a (potential) patient is concerned, must lead to a radical rethinking if we do not want to continue to waste a large part of the resources and lead bright minds on wrong tracks with false incentives (publications instead of medical progress). None of this is a criticism of my scientific colleagues, by the way. I am sure that the same brilliant minds who are now investing all their energy and strategy in producing Nature, Cell, and Science publications, and are thus among the biomedical elite, will be the ones who will make major patient-relevant discoveries with new incentives.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound, as a Kindle, and soon as an audiobook.
https://amzn.to/3NxHkUq
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Re-discover the whole patient.
The innovations required to eliminate the undesirable developments described in the first part of the book are tantamount to a revolution. It is no longer a question of optimizing a candle, but rather, like a light bulb, of something completely new.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
How healthy do you want to be?
Before we take off into the new medicine and move from Part 1 to Part 2, I would like to pause with you for a moment and reflect together on two aspects that the German physician and psychiatrist Klaus Dörner and the philosopher Byung-Chul Han have thrown into the spokes, as it were, like a little stick. Dörner writes: "One can do an infinite amount for one's health. But that doesn't have much, often nothing, to do with whether and to what extent one feels healthy - and it's the latter that counts." And Han observes, "Today there is a ... fear of pain everywhere. Any painful condition is avoided. ... Pain tolerance is declining rapidly." What both warn against is striving for a state of complete well-being, or rather suspiciously observing and optimizing oneself - whereby the slightest disturbance in well-being becomes an illness or at least a symptom that must be treated.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audiobook.
https://amzn.to/3NxHkUq
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Organ-based Medicine
The core problem of both medicine and all biomedical research, which would exist even if all research had become reproducible, statistically correct and exclusively patient-oriented, is the division of the human body according to organs. It is understandable that it is impossible for a single person to have all the medical knowledge at hand daily. So some way had to be found to divide the knowledge and fields of activity. The seemingly most logical or obvious way was to proceed organ by organ. So, for each organ, there is a specialist and a clinic. But these organ boundaries are beginning to fall. Nowadays, all tumour patients are discussed on a so-called tumour board. Completely independent of the organ in which the tumour occurs. Different immune diseases with symptoms in different organs can be treated with the same drugs and scientists agree that asthma should no longer be called asthma but is just an umbrella term for four or more completely different diseases with different causes.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audiobook.
https://amzn.to/3NxHkUq
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Research, Not For Patients.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
The end of Big Pharma.
The costs and risks for the pharmaceutical industry have become extremely high. At the same time, it seems to be running out of ideas.
False incentives.
No two countries are alike when it comes to organizing and delivering health care for their people. Health = Politics.
Male and low income = Double whammy.
The chances of a long life in health are strongly influenced by education and gender, not by the health care systems.
No prevention
Let's do a little research into the causes of the many chronic diseases and why they - in addition to all the other problems, risks and impairments associated with them - are threatening to shorten our life expectancy, as they are already doing in the USA and Great Britain. 80 percent of the cost of all chronic diseases is caused by a relatively manageable group of 15 symptoms and complaints.
We know that these diseases are not exclusively genetic, almost fated. All are influenced or possibly triggered in the first place by other influenceable or so-called lifestyle factors. So different people carry different, probably genetically or epigenetically (more on this later) defined risks, whose onset they can influence. It may be, of course, that you carry such favorable genes that you will live to be 100 years old even with the worst lifestyle. The problem is at the moment: unfortunately, we do not yet know the longevity-despite-unhealthy-lifestyle genes. It is undisputed that eight risks or forms of misbehavior are considered major triggers of chronic diseases.
Being late with lifestyle changes, namely only when a disease is diagnosed or only when symptoms have appeared - as it probably is for many (my blood pressure is high, I should ...; I urgently need to lose weight ...; my bronchitis is slowly becoming chronic, I need to stop smoking ...) - also means that at this point real prevention is no longer possible. However, the lifestyle changes are then usually still sensible. Better late than never.
So what about the offer, financing and use of prevention? At the important age of 18 to 35, when real prevention would really make sense, there is a big gap. All that remains are check-ups with the family doctor and the occasional visit to the dentist, and surprisingly, these are completely useless. Check-ups at the family doctor useless
Education, awareness and massive coaching to teach healthy and fresh eating, physical fitness, healthy sleep and stress avoidance. This wouldn't be cheap, but it would be orders of magnitude cheaper than driving the cart into the dirt and then treating symptoms in chronically ill patients at great expense until the end of their lives. High taxes on sugar and alcohol, as well as on tobacco, and education and clear labeling of harmful products and highly processed convenience foods would support this. Yet we spend only 1% of our healthcare budget for prevention.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Chronic disease?
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
Medically, there is no uniform definition for "chronically ill" or "chronic". Not even the duration is defined. Is a person chronically ill from as early as one year of suffering? Or as early as six months or as late as two years? Rather, the chronically ill are under lifelong medical control and treatment.
The social and family consequences are often dramatic for the chronically ill and their relatives. This is because, in addition to the doctor, they have very different points of contact with the health and care system, from nursing care to the social court. These are usually much more frequent and also more unpleasant and stressful than those of a "normal" sick person.
The rest of the population, however, notices little of this, because being chronically ill makes one lonely, and loneliness perpetuates or intensifies an illness. In addition, the risk of loneliness often has economic causes, or these increase the risk. Chronic diseases have a dramatic to existential impact on quality of life and enjoyment of life, which in itself should be unacceptable enough for our solidarity community - but unfortunately the effects go even further ...
Chronically ill shortens life
In relatively highly developed countries, mortality has fallen significantly since 1900 and life expectancy has increased. So we are healthier and live longer. In large part, this is a result of our ability to prevent infection or, if infection has occurred, to treat it effectively: better hygiene, the ability to get vaccinated, and antibiotics if an infection does occur.
If you take out the share of these three measures and therapies, there is not much left of medical innovation, actually nothing. Some causes of death have indeed decreased, while others - especially those caused by chronic diseases - have increased. Surprisingly, if one excludes the effect of being able to prevent or treat infections more effectively, there is no improvement in mortality or life expectancy since 1900.
Some causes of death, such as cardiovascular diseases, have decreased, while others, such as lung and tumor diseases, have increased; thus, on average and as a final result, there is no gain in life expectancy. But it comes unfortunately still worse, if one looks beyond the time 1999 into the 21. century, in which we are now ...
Not only has life expectancy stagnated since 2000, it is actually starting to decline in some industrialized countries. The U.S. and the U.K. are the inglorious "pioneers" in this regard, but it won't be long before this trend affects other European countries. Within Europe, Germany has the most expensive healthcare system, next to Switzerland. Despite this, Germany ranks 19th in terms of life expectancy in a Europe-wide comparison.
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Don’t rely on your prescription. The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
Clear case: when you are prescribed a medicine and take it, you do so in the hope that it will work. Why else would you take it? But unfortunately, this hope is deceptive. Because every day, millions of people take medications that won't help them. For some medications, such as cholesterol-lowering drugs, only one in 50 patients will benefit. You might say to yourself: these are bad results and these drugs should never have been approved or put on the market in the first place. Unfortunately, we can't leave these patients untreated, otherwise we wouldn't even be protecting the one patient for whom the drug can help, often in a life-saving way. Where does this lack of precision come from. We are treating symptoms (cholesterol, blood pressure) with more patient-relevant goals (namely, preventing heart attack, stroke, or death) in mind. You don't know, however, which group you belong to; perhaps the very one in which the drug would have prevented a serious heart attack or stroke. We just don't know, and neither does your doctor. So it is not a mistake of your doctor to prescribe you this drug. There is currently no better alternative. It is probably not even a mistake on your doctor's part not to tell you about this lack of precision of your drug and the low probability that you will benefit from it. If he did that with all patients, it is likely that soon no patient would be taking his medication at all, even those whose lives could have been saved. So if the possible side effects are not too serious, you currently have to accept this risk. You might think that this sounds almost like a scandal. Have I, as the author, picked out a few extreme examples of drugs to dramatize and make my point? After all, don't many of the other drugs work for most patients? No, and there is a way to understand how much current medicine has to offer the individual patient. It's a simple statistical concept called "Number-Needed-to-Treat" or "NNT" in other words the number of patients that must be treated for one patient to have a benefit. The NNT can be calculated from any clinical trial involving a drug or other intervention such as surgery et cetera. You can research the NNT for each drug and ist associated use on the NNT team's website: https://www.thennt.com . By the way, besides the NNT, a second also not unimportant number can be calculated, namely the "Number Needed to Harm" (NNH), in other words the number of patients that has to be treated for one patient to experience a relevant, severe side effect for which the treatment is responsible. By compare these numbers one can establish a true benefit-harm ratio. And new drugs? It's not getting any better. In 2019, the German Institute for Quality and Efficiency in Health published an overview of all drugs evaluated between 2011 and 2017 that entered the German market after approval. Well over half provided no additional benefit compared to standard care. Perhaps even more troubling, a systematic review of new drugs for over 100 indications approved by the U.S. Food and Drug Administration (FDA) found that better efficacy over standard therapy was confirmed in less than ten to 20 percent of the cases.
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Too late.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
It's about medicine and health, but it's about much more than that. It's about the world's next great social and economic revolution, which we are now at the beginning of. And this revolution has even begun, is directly relevant to you. Big words, you may be thinking. What can be meant by them?
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Why this Podcast?
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.
Many questions, no answers.
The End of medicine as we know it – and why your health has a future. My name is Harald Schmidt, I am a medical doctor, pharmacist, and scientist. Every episode of this podcast is a sample of a chapter of my book published by Springer Nature bound and as Kindle and soon as an audio book.
https://amzn.to/3NxHkUq
Max has elevated blood pressure. His family doctor discovered this during a routine check-up. Max is prescribed a blood pressure medication, takes it relatively regularly and the values normalize. 130/80. Everything good? Not at all, because many questions remain unanswered. Why did his family doctor prescribe Max a drug in the first place? Well, elevated blood pressure correlates with the occurrence of heart attack or stroke. These and other possible complications from elevated blood pressure should be avoided. But his family doctor can't tell him with certainty whether he needs his blood pressure medication, nor whether he will benefit from it. On the other hand, the family doctor cannot advise Max to discontinue his blood pressure medication, because he has no alternatives, and not prescribing anything would mean the risk that Max happens to be one of the few patients who will have a heart attack or stroke and could have prevented it by taking a blood pressure medication. Thus, in accordance with the therapeutic guidelines, the general practitioner continues to prescribe Max the blood pressure medication on a regular basis, completely correct. Although Max finds these many tablets annoying, he also realizes that he is now truly chronically ill and a high-risk patient. He would so much like his high blood pressure to disappear, to be cured of it, but that does not seem possible. So, he hopes that he will at least be spared a heart attack or stroke. There seems to be no alternative. There’s nothing Max can do about it, or can he?
More about this chapter and how you can benefit from the new medicine already today all in my book "The End of Medicine as We Know It," written in an easy-to-understand style both for patients and hopefully not-yet-patients. Knowledge means health and quality of life.