I had an encounter a few years back that concisely encapsulates how many physicians think about medical practice.

My cardiology office was on the ninth floor of an office building located on a large mall campus. It was late in the day, so I locked up the office and took the elevator. The elevator stopped at the eighth floor and a middle-aged man got on. He introduced himself, a gastroenterologist, with an office on that floor. He then asked, “Aren’t you the cardiologist on the ninth floor?” I answered “Yes,” but said that I was in the process of receding from practice due to demands on my time to speak, appear in media interviews, etc. because of the books I wrote.

“Oh, you’re that guy. You know, you wouldn’t have to write so many books if you did more procedures!”

That took me by surprise, so I snapped back, “No, I write books because of people like you.”

Thankfully, the elevator reached the bottom floor and the door opened. Had the elevator descent taken much longer, I fear the conversation would have come to blows.

I share this story because it reflects the dominant mindset of the majority of my colleagues in high-paying procedural specialties. Performing procedures is less about serving the needs of people and is far more about reaping generous procedural fees. This attitude is most firmly grounded in surgical specialists, gastroenterologists, and cardiologists, whose days are dominated by efforts to line up more procedures. For many, it becomes an obsession: trying to line up as many procedures per day as possible. Many therefore bend the rules on how and why procedures should be done. Ask any technician or nurse working in an operating room or procedure laboratory, “How often do you witness doctors doing procedures that are unnecessary or questionably necessary?” You will be shocked at how often the response is “All the time.” It is not rare. I’ve seen many gastroenterologists line up a dozen or more upper endoscopies and colonoscopies per day, cardiologists performing ten to twenty heart catheterizations, stent implantations, and related procedures every day, two to four bypass surgeries by cardiothoracic surgeons per day.

It also means that interest in such issues as getting at the root causes of a condition, issues such as nutrition and microbiome issues relevant to numerous conditions, hold no interest for these physicians. I even asked a well-trained gastroenterologist with both a M.D. and a PhD how he managed SIBO (small intestinal bacterial overgrowth), just to test his knowledge. He answered, “I don’t. I don’t have time for that. If a patient insists, I’ll write them a script for Xifaxan, then send them back to the primary care doc.” In other words, he could barely bother managing something as crucial to health as SIBO—because it does not involve a procedure nor reap procedural fees. And, of course, the primary care physician has no idea how to manage SIBO–“That’s the job of the gastroenterologist!” The end result is therefore neglect due to procedural practitioners pursuing profit ambitions, primary care physicians’ ignorance and indifference to anything that does not involve a pharmaceutical or referral to a specialist. I tested the knowledge of another M.D., PhD, a general surgeon (who mostly perform abdominal procedures) with a doctorate in physiology, special focus gastric (stomach) acid physiology. I asked, “How are you managing hypochlorhydria (low stomach acid from H. pylori or autoimmune gastritis)?” (Hypochlorhydria is a common and difficult to manage condition that virtually ensures severe and persistent SIBO, since the loss of stomach acid means that a barrier to swallowing oral microbes and the ascent of fecal microbes has been lost.) His response: “I just prescribe a PPI (proton pump inhibitor to reduce stomach acid)!” I said, “No, not HYPERchlorhydria. HYPOchlorhydria.” He drew a blank and walked away.

It is shameful that modern healthcare has become, for many, an effort to churn people through as many procedures as possible for procedural fees. I tell you all this because:

  • You should ALWAYS question the need for a procedure or obtain another opinion outside of emergency situations. Don’t be afraid to make a nuisance of yourself with questions on not just the why, but also the physician’s track record with the procedure and whether there are alternatives.
  • If the procedural specialist and the primary care physician choose to be ignorant or indifferent to issues such as nutrition and management of the microbiome, both huge issues in health, then it falls to YOU to take the reins. Neither doctor will venture beyond cholesterol management to address cardiovascular risk, meaning numerous risk factors remain unaddressed. Neither will explore the question of SIBO and endotoxemia that plague half the U.S. population, yet you have access to tools that are wonderful safe and effective to manage. Neither doctor will like have any interest in anything but the most passing interest in factors such as vitamin D or restoration of collagen and hyaluronic acid that impact bone health, joint health, and body shape. Only you have interests in those things.
  • Don’t be fooled by TV, radio, and online ads boasting of the expertise of this or that healthcare system. You will find that the most reputable systems are also the ones that are also notorious for “churning” patients through high-revenue procedures. Yes, should you require a procedure, you want a physician and hospital with plenty of experience. But know that the rules and indications are often flaunted in high-volume institutions, virtually an everyday phenomenon.

This can get awfully dark and cynical, I know. But on the bright side, once you accept that doctors for the most part cannot be trusted and that healthcare systems are silently complicit, then begin to open your eyes to all the information and strategies that empower you in health, you begin to recognize that you have unprecedented and enormous control over your future health. Consider, for instance, that:

  • Much risk for colon cancer begins in the mouth with infestation of the microbe, Fusobacterium nucleatum, that, in turn, enters the bloodstream and colonizes the colon where, good evidence suggests, it is a major driver of colon cancer. The gastroenterologist may have patted you on the back when he failed to find cancer during the colonoscopy, but he/she likely made no mention of this fact uncovered by, for instance, assessment of the oral microbiome. Yes: colon cancer risk begins for many in the mouth.
  • The endotoxemia that results from SIBO is a major driver of risk for cognitive impairment and dementia. While most doctors have no knowledge of this connection, you have enormous influence of this situation. Start with the benign, inexpensive, yet hugely powerful SIBO Yogurt, i.e., a method that achieves very high microbial counts of species that colonize the small intestine (where SIBO occurs) and produce bacteriocins, natural antibiotics effective in killing invading fecal microbes. Because you can accomplish this in the comfort of your own kitchen that will involve no hospital procedures or pharmaceuticals, your doctor will show no interest.
  • Restoration of factors lost from modern lifestyles because of misguided and damaging advice to “cut cholesterol and saturated fat,” nearly everyone has abandoned consumption of organ meats such as tongue, heart, stomach, and skin rich in collagen and hyaluronic acid. Lifestyles deficient in these factors leads to premature skin aging, premature deterioration of joint cartilage and thereby arthritis, acceleration of arterial diseases such as hypertension and coronary/carotid/aortic atherosclerosis. We therefore add back some organ meats (whatever you are willing to include, given how squeamish modern people have become to organ meats) and/or supplement your diet with collagen peptides and hyaluronic acid.
  • The majority of people with type 2 diabetes have the potential to completely reverse or at least minimize their diabetes reducing, for instance, a crippling HbA1c level of 11.7% that virtually ensures kidney failure, blindness, heart disease, and leg amputations that can be easily and inexpensively reduced to 5 or 6% or lower without use of medications or procedures. But you cannot rely on doctors, the American Diabetes Association, and certainly not the procedural specialists to inform you of this well-established fact.

The healthcare system has also perversely managed to make obesity a disease to be managed with pharmaceuticals and procedures, failing to recognize the profound impairments in health that result long-term from such practices. It is therefore up to you to take the reins of health and protect yourself from the profiteering and indifference of modern healthcare. I invite you to join our frequent live Zoom video conversations on such topics in my DrDavisInfiniteHealth.com Inner Circle.