Dialyzing for Dollars with Tom Mueller

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Cases of COVID-19 continue to spike as new evidence shows that the fall booster has good reactivity to the Parola variant. A new survey of Gen Z attitudes about health care shows that the vast majority believe health care is a basic human right. A new poll finds that 70 percent of Americans have favorable impressions of their local health official. This is America dissected. And for the 200th time, I'm your host, Dr.

Abdul El-Sayed.

Imagine there was a universally deadly disease. Literally, you get it. You're almost guaranteed to die in a matter of months. But now, because of a new technology, you can be almost miraculously cured. However, that technology isn't available to everyone.

It's limited to a small handful of the vast number of people who need it. What do you think would happen? How do you think patients dying of the disease or their family members might react? How would advocates like you or I respond? OK, let's take a look at a few examples.

Now I want you to hold that thought. I promise we'll get back to it, though. Today we're talking about dialysis, basically the process of providing artificial kidneys for people whose kidneys don't work. Initially developed as a means to provide a short term bridge for people with acute kidney failure, it's become a lifeline for those with chronic failure. But with a catch, it means spending several hours a week hooked up to a machine.

Remember, the kidneys are your body's main filter beyond removing impurities from the blood, including excess nitrogen that our bodies generate. And can make you really, really sick. If it gets up to a high enough concentration, they also tightly regulate our blood volume. Orchestrating the tight dance between water and salt that keeps us hydrated, even when we fail sometimes to keep ourselves hydrated. Think about it, ever have a super salty meal?

Think pizza or burgers and fries. To balance all that salt your body demands, you drink water, but the real work it's done by the kidneys, which concentrate your urine, getting as much waste out using as little water as possible. Or think about those days when you do hydrate and your urine is that clear color.

Your doctors want it to be. That's your kidneys again, working to shed all that extra water from your body after your organs and muscles have had enough to drink. But if your kidneys are shot, that means you can't even pee because, well, there's nothing there to make it. You literally can't get rid of the extra water. Which means that people on dialysis know they need it when they start to feel bloated, or still, all those toxins the kidneys would usually get rid of.

Start to pile on, making them feel extra sick. Dialysis is literally a lifeline, which brings me back to those questions I started with at the top. Because after it was invented post World War Two and developed throughout the 1950s, dialysis became a test case for exactly that scenario. I laid out a life preserving treatment for a disease that had previously been universally deadly. So what happened?

Well, Congress acted, imagine that. Recognizing the need to vastly expand dialysis for Americans. In 1972, Congress expanded Medicare, which at that point wasn't even a decade old yet, to cover dialysis services for people with end stage renal disease. It's one of the only disease classes specifically covered by federal health insurance. Remember, Medicare is America's health insurance program developed specifically for seniors.

It was basically Medicare for more. Congress acted to assure that nobody who needed dialysis would die because they couldn't receive it. And that's a great thing. Full stop. But today's episode is about what happened next.

It's about how corporate greed moved in to exploit the system, it's about the rise of two monster corporations who ruthlessly crowded out the rest of the market. Turning dialysis patients into the human equivalent of hamburgers. Their analogy, not mine, and it's about how companies that get too big to fail are allowed to write their own set of policies. In a democracy that has long needed its own dialysis to purify itself of corporate campaign dollars, I learned about how dialysis became a sad microcosm of corporate greed in American health care. When I came across a new book by our guest today.

Tom Muller is an investigative, journalist and author of How to Make a Killing, which chronicles the rise of the two dialysis mega giants and how greed came to dominate dialysis and victimize patients and caregivers. Here's my conversation with Tom Muller. Can you introduce yourself with the tape?

They filter out toxic products of our metabolism, they remove fluid that normal kidneys pass through urination, they produce hormones that are important for red blood development and various other things. They are really kind of a Swiss Army knife of the human organism, largely unappreciated. They're unsung heroes.

You know, we talk about people's brains, their guts and their heart and so on, but they don't. We don't talk about their renal fortitude, but we do need our kidneys, so when your kidneys fail, you either get a transplant.

And that takes time. Or you go on to dialysis, which is a mechanical kidney that does some of the filtration that your natural kidneys used to do. You attach yourself to the machine, or you are attached to the machine by a staff in a dialysis clinic. Typically, the ideal way to do it is at home, but that's rarely used. It's a rarely used model in America.

And the machine filters your blood for a period of three, four or five hours, removing some of the toxins, some of the liquid that has built up over time. And then you detach from the machine and go for another couple of days. Ideally, most people are dialyzing every other day, so that's in essence what dialysis is.

And we don't really appreciate that. That. The work that the kidney does is about more than making urine, it's about all of the things that go into filtering blood. So that urine is what urine should be, and blood is what blood should be. And if you can't do that, there is a whole process that we've now discovered about how to do it. It's certainly decades old now. But I want to ask you, you know, as someone who is not a physician, not someone who, you know, learned about this in some formalized training.

When did you first hear about dialysis, and then why did you decide to write a book about it?

But the three of the whistleblowers that I interviewed, their settlements alone totaled almost a billion dollars. And and I thought, What on earth is this industry? They explained to me that that the industry is dominated by two multinational companies that control almost 80 percent of the patient population, and so on. But anyway, I got into dialysis, kind of backed into dialysis. Writing about whistleblowing, and I realized very soon that this story is much, much bigger than a chapter in a whistleblower book.

It deserves its own book. And at that point, I kind of took the plunge into into dialysis, into this world that really, most people don't even know about, unless they happen to have a relative on dialysis. It's just a sort of a facade and a mall that you drive by until you're unfortunate enough to have to need it.

What is your? What is your day to day like, and where does dialysis fit in? Or, more importantly, tell us about dialysis and how the rest of your day to day fits in?

They would have to get themselves psyched up to go in for treatment. They would have a really strong and miserable symptoms while treating. So they have cramps, nausea, vomiting and so on and be wiped out by the end of the treatment. Have to kind of arrest before they could even go home, they sleep the rest of the day.

They get up and start to feel, you know, decent the next day, but already start to psych themselves up for the following treatment. Obviously, this is the worst case scenario for for patients, but it's something I heard a lot when I was interviewing patients. So when dialysis is done short, sharp, fast, as one Australian nephrologist put it, bazooka dialysis, high speed, high throughput. Get them on, get them off. It can really create a crushing set of symptoms that make the dialysis patient's life very, very honest, very difficult.

And three hours is widely believed not to be a sufficient treatment for most patients.

And dizziness, confusion. They call it dialysis, fog, or brain fog. In the longer term, there's organ stunning and other heart and liver and and other organ damage, brain damage. That is because of sudden drops in blood pressure, quite often due to high ultrafiltration rate, high removal, rapid removal of the liquid from the bloodstream. That should be done gently and slowly, and over a period of a longer period of time. If it's ripped off, as some people have said, some clinic workers rip off that liquid.

In the medium term, you'll cause organ stunning and pretty serious side effects, including coronary arrest. You know, people die from this kind of treatment over the long term.

You drink too much water and your urine turns clear until you have that water taken off. You don't drink enough water and your urine turns ultra yellow until you drink more water. And you get really, really thirsty in the process, that's all your kidneys, your kidneys are doing all of that.

Now, if you don't have functional kidneys, what happens is that? Our process for correcting not just water flow, but all of the other waste that's sitting there in your blood can do that at a speed that is far quicker than your kidneys would know how to do it right. And so our kidneys are really smart about saying, all right, we know how fast we can adjust, but. But unfortunately, if you have an economic incentive to rip it off fast. Because you want to free up more seats in the dialysis unit, right. And operate at the maximal efficiency for your dollar flow, rather than the maximal safety for a potential patient. You can start to see what the implications can be, and if you adjust those things faster than your body can accommodate them, it can be really, really dangerous.

So, just to understand how big of a business is dialysis in America? Both in terms of the number of people who are getting dialysis care, and in terms of the money that can be made here.

And then you have a health event, you wake up in the ER, or you wake up in the hospital and someone is by your bedside saying, Sorry, kidneys failed. From now on, you have to attach yourself to a machine to survive until we can get a transplant, if you ever get one. And that's a real shocking physiological but also psychological shift for many people, this dependency on the machine.

And as part of the reason why? Dialysis, when it came out in the 60s and became a viable treatment, helped to kickstart bioethics. Because this is the first time that a vital organ was replaced by a machine, there was a huge demand for it, but very, very few actual dialysis units. So a lot of patients at the beginning were simply not able to be treated and died. So there was actual life and death panels being organized by hospitals to determine who would live and who would die anyway. Bioethics got kickstarted by this, and it's pretty easy to see why.

But it's a huge industry. There are two, as I said, major multinationals, Resinius and Davita. That, whose market cap combined is something like $40 billion. They make billions of dollars in profit every year. So it's a good business to be in from a financial point of view, it's not a great place to be in from a patient's point of view.

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Can you walk us through just the history of dialysis as a as a business? So it opens up in the in the 60s, and now we're in this in effect oligopolistic circumstance. And the other part of of dialysis, which a lot of folks don't appreciate, is that dialysis is really odd. Because it's entirely Medicare funded, unlike so many other pieces of health care. I mean, it really is unique insofar as it's the only piece of health care that, because of what it is, is funded by Medicare. So for most folks, Medicare only kicks in when you're 65..

But if you're on dialysis, Medicare will pay for your dialysis if you're 35, 45, 55 or 65.

And and that makes it really unique insofar as it creates this situation where you have this race for this business. Can you first talk about that Medicare policy decision? How did that come about?

But each time you attached it to the person, you would destroy a major blood vessel, and after a few treatments, you'd run out of access. Once in Seattle, the building Scribner, one of the one of the pioneers invented the Scribner shunt, a way to attach and detach a patient repeatedly from from the machine. And all of a sudden, dialysis became, you know, viable as a treatment.

Now, at the same time that the announcement was made, guess what? This former death sentence is now treatable? A line began to form outside their door. They got longer and longer and longer of people who the day before would have said, Well, you know, my number came up. I'm going, I'm doomed to die.

All of a sudden, there was a possibility, and this is where the the life and death panels came into play. So you had a number of different centers. But really, Harvard and Seattle were the two kind of standard bearers, and they had a totally different approach to the business of dialysis, Seattle said. Nonprofit all the way, fundraising in the local community, getting federal funds as well.

And we're going to treat people in a nonprofit model, the Harvard MDS said. No, we need to roll this up fast and we're going to get rich doing it. And they started National Medical Care, which was the first dialysis giant for profit, strictly for profit. In fact, they were back in the 60s. These were, you know, heady words.

They were the first among the first doctor entrepreneurs. They talked about how it wasn't a conflict of interest to make money while treating people is actually positive. It made you as an M.D. focus on costs and what's good for the patient. So I think that's since been debunked, but at the time, it sounded great.

And Reagan is coming in. And they were, they caught that wave, and ultimately they won the argument that the Boston model completely drowned out the nonprofit Seattle model. So it became a major flashpoint for the American conversation around health care. You have this new machine.

You can save lives that yesterday would have been impossible to save. But there's a very limited amount of treatment points and the costs were significant. So many people couldn't afford it, and people were dying because they couldn't afford it.

So Congress at a time now, remember we're talking in the late 60s, early 70s. This is a time when Republicans, Democrats, the AMA, American Medical Association, insurance companies and a bunch of others all had in mind. If we're pushing hard, a plan for comprehensive national health. It's hard to remember that, but back in the late 60s and early 70s, this is the great generation.

You know, the carry on from the new deal, this is, this is. This was part of the plan that that the U.S was going to join the rest of the civilized world. And in having comprehensive national health, and dialysis was considered in 1972 to be the first step towards comprehensive national health.

Everyone expected within a year we would have had a national health plan. So, in November of 1972, Richard Nixon signed into law an adjustment of the Social Security Act. That made, as you said, dialysis a Medicare for all condition. But again, with the expectation on everyone's part that this is just phase one, we're all going to have national health. And then Watergate Vietnam consumed Nixon.

We turn from, you know, stagflation and the OPEC oil embargo caused a reshifting of priorities from building great generation. You know, programs like health care to cost cutting, and Reagan came in, and Reaganomics and private does it better. Government's part of the problem.

There's a huge shift, and dialysis marks this as a era from from really great generation. Build a better society to cut costs, and private does it better. And we've never gone back.

Dialysis has remained this sort of legacy of Medicare for all. But there's never been another moment where there was bipartisan support. For, you know, whatever other developed country in the world has, and many lesser developed countries. National health care as a as a guaranteed right of all citizens. So it's hard to look back and think that Richard Nixon signed this.

What would today be by many Republicans, be called a socialist, a law and a social sociable society? Those are good things to me, but hey, I'm not a doctor.

And to your point, right? This is seen as a logical extension of Medicare. We're going to first provide health care to people over the age of 65. This was also, you know, the same process. That's how Medicaid was created, so we're going to provide health care to the lowest income people.

And then we're going to piecemeal add different parts of health care. And this one seems to be an urgent one. Because we have this new, extremely expensive, but incredibly lifesaving piece of health care that is too limited to be offered to everyone. This seems like an obvious step to take, to save a whole lot of lives, to provide funding and to grow this program. And then history intervenes, and and frankly, here we are.

You know, I wrote a book called Medicare for All. And it is a really interesting question about what the impact of having one service funded by the government versus an entire health care system funded by by the government can mean. So we have this system now, where you have a 40 billion dollar industry dominated by two corporate players that are funded almost entirely by the federal government. How do we get from that moment when Nixon signs that law, to where we are today, where you just have these two corporate behemoths owning the industry?

And, and you know, the saturation point was never reached. But at a certain point, as often happens in industries, there's a process of consolidation. The big ones start eating the little ones, and that process, Pac-man process continued before, really, from the from the late 80s through the mid 2000 teens. Where, you know, small mom and pop shops were bought up by larger companies, those in turn, were bought up by regional giants.

And those, in turn, were bought up eventually by the Fresenius and the Devita. There are a couple other players but but those are really the two key ones. And I want to stress that consolidation, at least at the beginning, wasn't always bad. First of all, this was a new field of medicine.

You needed benchmarks, and you needed serious attention to detail. Many of the mom and pop shops in the early days were sort of, you know, I've heard these horror stories of of of rolling dialysis clinics on campers and various other things. That were really not simply people trying to take advantage of the incentives rather than providing good medicine. So in many cases, at first, the consolidation produced better outcomes, better dialysis, but at a certain point, consolidation has tended to produce a one size fits all model. A fast food model, and, in fact, you know, the leaders of the major companies often talk about the dialysis business as a fast food medicine business massive scale.

So you can have low unit costs and buy very cheaply. And you try to standardize the treatments and maximize the throughput. And you know, all of this sounds really good from an entrepreneurial point of view and produces what we've seen massively successful corporations from a health point of view. As you know better than I, if you aren't tailoring the treatments to individual physiologies, you can run into some big problems. Some people are not widgets. I interviewed some, some, I think, originally fairly right wing and maybe still right wing economists who started looking at the dialysis industry. Saying, Yeah. I think the fast food model is going to work here. Because, you know, bigger ones are going to do it better and they have better protocols and so on.

And they came out the far end, and I quote them in my book saying, This is an outrage they are taking. They're doing profits instead of patients. And it's not like burgers, where you produce a pretty good product and it's the same every time.

Tailoring treatment is critical to good dialysis, as is to good medical care in general.

They're 10 years older. The nature of the other diseases that probably caused the renal failure to begin with has progressed, has changed. They're on different medications that you have to engage with. Because a lot of medications are either cleared in the liver or cleared by the kidney. And so as those medication doses change, you need to be able to dialyze appropriately. So you're clearing out all of the metabolites that you need to get out that a kidney would usually clear.

And when you have a one size fits all medical model in this respect, you start to appreciate how broken that is. Now folks will listen to this and say, yeah, but isn't that the outcome of a government funded health care program? And it's a really fascinating thing, because this is one of the only pieces of health care that would even lend itself right to that kind of one size fits all thinking. Where a few corporations can hammer down their operations so efficiently and brutally to be able to offer this kind of service and then force everyone into it. I want to ask you, what are some of the ways that this kind of fast foodization of of this industry have shown up? In the lives of the patients who are brutalized by it?

You need the treatment and the patients on the one hand, you need the funding on the other. But in other countries, the funding goes straight through. There is no tollbooth and no one's taking a cut as it were. So the model is is, is is not necessarily the way it's purported to be.

I mean, every other country in the developed world doesn't have this massive for profit tollbooth between between the patients and the funding source. But to come back to your question, a standardized dialysis treatments. First of all. The whole business of being in center is something that from the beginning, from the debates in Congress in the 60s, it's clear that home dialysis, wherever possible, is vastly, vastly superior. A because you can tailor it to your own physical needs, b because you have control over your own schedule.

C Because, as in any chronic condition, a sense of control, a sense of empowerment, of agency, prevents this sort of feeling of just being at the mercy of your condition. And all of these things produce better outcomes and produce outcomes. And if you look at places like Australia and New Zealand, where home dialysis is is is widely practiced. The results are vastly better. In fact, the results are vastly better everywhere else in the developed world than they are in America. So what's wrong with this picture?

But also once you're in the facility, if you're being rushed on and rushed off the machine. If they're cranking up the ultrafiltration rate, so they're ripping this liquid off of you. We've talked about some of the really onerous symptoms that are produced, but also some of the physical harms that are produced as a part of this model. I actually, I was at the annual dialysis conference in Orlando in 2018, and Alan Collins, a very, very senior researcher. We are creating a disease state with this high pressure dialysis. We are actually creating medical harms with the medical treatment we are providing, if we provide it in this manner.

So it's pretty well understood there are 30 years more or less of of peer reviewed data on why this is a bad way to produce dialysis. But from a financial point of view, it makes a lot of sense. And we're in a society in which a medical corporation can be judged almost exclusively on its financial performance. And and that's a nonsense to people who come from other countries.

And it should be nonsense to us, frankly. I mean, you know, people are not burgers, as we discussed, but at this current moment, people can say, Hey, you know, we are extremely successful. Hospital system. Well, how are your patients doing? Secondary question, right?

Look at our, you know, talk to our Wall Street analysts, they're overjoyed, look at our stock price, we're golden. So, you know, I think we have to kind of fundamentally rethink the priorities here between office and patients.

You know, this current system, as it's configured, victimizes patients, but also victimizes caregivers. From the dialysis text, with sort of the low people on the totem pole, to registered nurses, straight on up to nephrologists who feel that their autonomy as MDS is severely limited. By working for a big company, they are forced to take part in the. As one put it, I contribute to the ill health of the people I'm supposed to be caring for. They realize that the model itself, this fast Bazooka dialysis model, is actually detrimental to the patient's health.

They're rushing people on, rushing people off not having time to clean the units. And so they realize that they're not curing or helping their patients, they're harming them and there's nowhere for them to go.

Complications for people who are being dialyzed too fast or not being dialyzed enough.

And maximizing their chokehold on this service in this country. And you brought up the specter of other countries where dialysis is done differently, also publicly funded, but done differently. How much worse do American dialysis patients do relative to counterparts abroad?

I mean, it's vastly, vastly inferior treatment for vastly higher outlays. I mean, the amount of money that is spent on U.S dialysis is something on the order of seven percent of all Medicare goes into dialysis, and that's just the Medicare piece. So we're talking about a lot of money for, ultimately, outcomes that don't measure up to the rest of the industrialized world. There's something wrong with this picture.

First, what would it look like to fix the dialysis system? And then, second, what does that tell us about what we need to do to fix the American health care system more broadly?

So another senior economist, Ryan McDevitt, said to me, you know? I think one of the things we need to do is start start talking about breaking up these big companies. They are too big, they are functionally monopolistic in many regional markets. Because you have to remember, you can't shop around as a dialysis patient. You need a facility either in your home, ideally, but that's difficult to arrange because of the current model or near your home.

And so, in many cases, the presenting a certificate that has a kind of a stranglehold on the local market. So, really, there's only one game in town for you. And these economists have said that step one is making smaller companies that are, and there's, and more real competition. Because in their view. And from what I've been able to research in my in the process of six years of reporting and researching, there isn't a lot of competition between the companies. There are, there's phenomena that kind of suggest that they're working together in certain ways. For instance, I chronicle the process of involuntary discharge from dialysis.

And if you just take one moment to pause and think involuntary discharge from lifesaving dialysis care, you know that gets your attention, right? I got my attention and I thought it was a one off thing at first. The more people I interviewed, the more I dug into it, the more I talked with regulators and former regulators. It's, it's a major problem.

It's also a major problem in other areas of health care, you know, in in hospital, in in elder care, and in certain hospitals. People are put to the curb when their insurance runs out or when they cause trouble. But in any case, people who are involuntarily discharged, in my experience from my reporting, discharge from facilities are quite often blackballed. And in neighboring facilities, even those run by other companies, which says to me that they are saying, OK, this is a person who's probably not financially. Very interesting. And maybe there. They are perceived as a troublemaker, whether they're not, whether they are a troublemaker or not, is a very, very different question.

And I get that in my book as well. But and we're not going to treat them. But that's almost in my view, acting in concert, you know, your collusion siding, yeah.

Yeah, I mean, it's a cartel kind of style. I can't prove it, but all the evidence that I was able to gather suggests that. So, there are concerns here that I think have to be looked at. In terms of just the scale of these of these corporations and whether patients wouldn't receive much better care, much more tailored care from smaller organizations.

Who fundamentally need this, this care to survive. And it is a wake up call to all of us who care about a health care system that is more just more equitable, more sustainable. That does not force people to bear the insult to the injury of their illness that is bankruptcy. And we really appreciate you joining us today to share more about your findings. Our guest today is Tom Muller. he's an investigative journalist.

His latest book is How to Make a Killing. I hope that you all check it out, Tom, thank you so much for taking the time.

Remember, the fall booster was built around maximizing reactivity to XBB, the omicron subvariant that had been dominant through most of the spring? Since, however, two new variants have emerged the first is Aris, another omicron subvariant that is currently accounting for most cases. But the other one is Parola, or BA..2.86, which is, if you'll remember, a vast leap forward from Omicron rather than just another Omicron subvariant. Parola is as far from the original Omicron as the original Omicron is from the original SARS-CoV-2..

While Parola has been discovered in several countries, there have only been a few dozen reported cases. And early laboratory evidence suggests that, despite its mutations, it just doesn't seem very effective at invading cells. And that's really good news. More importantly, a recent study preprint showed that the fall booster has strong reactivity against Parola. That suggests to us that we'll probably be getting the final go ahead for the new boosters any day.

Now we'll keep our eyes and ears out for you. Have I ever told you how much I love young people? They just get it, say what you will about Gen Z, but they've grown up in an era where they watch the basic slogans about the American Dream, etc.

Fundamentally, fail them. Most of them weren't even born when 9-11 launched us into two decades of foolhardy wars. There were children when their parents lost homes and saw life savings wiped out during the Great Recession. They were in high school or college when the pandemic derailed their early adulthood. And the vast majority don't believe they'll ever be able to afford a house.

Which is why it's not surprising that they understand that it's absolute trash. That we're the only high income country in the world that doesn't guarantee health care as a human right. In fact, a recent survey of Zoomers aged 18 to 24 found that the vast majority believe that health care was a human right and that the government had a responsibility to provide it. Ninety three percent of Gen. Z Democrats and get this. 76 percent of Gen. Z Republicans. Three quarters believe that health care is a human right. A whopping 68 percent of Gen. Z Republicans. Republicans believe that government had a responsibility to provide health care. When people ask me about the potential for Medicare for all in this country, I've always said it hinges on the next generation.

One that watched as America struggled to provide a basic response to the pandemic. And now I've got the data to prove it. A new poll from the Beaumont Foundation, one of our sponsors, found that 70 percent of Americans have favorable impressions of their local health official. As a local health official, I can tell you that I'm really glad to hear it, thank you.

But also, I think that it should serve as a call to action for all of us in public health. Since the pandemic, I think that the public health community has felt a pervasive sense that we're under attack. But a lot of that has more to do with the ways we get our information than it does with how the vast majority of Americans feel about public health. The very online, right? Well, they occupy a disproportionate share of our mind space, making us believe that they speak for everyone.

They clearly don't, and that means that, rather than retreat, we need to press on. This is the time to be present and engaged in folks day to day lives, fighting on the issues they care about. Whether it's the way that pollution is choking their kids, or distracted drivers are wreaking havoc, or pharmaceutical companies are charging us way too much for insulin, or vaping manufacturers are exploiting our kids. It's time to go on the offensive.

We need to earn that trust that folks already have in us every single day. That's it for today. On your way out, don't forget to rate and review. It really does go a long way. Also, if you love the show and want to rep us, I hope you'll drop by the crooked store for some American dissected merch.

If you haven't gotten one of those sick pod bro tanks, I highly recommend it.

Our theme song is by Takeo Sazawa and Alex Uguiera. our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul El-Sayed, your host. thanks for listening.

This show is for general information and entertainment purposes only. It's not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.