Jeff Goldsmith on Pause to Go

Luck: [00:00:00] For the last two weeks, you all have been sending in great questions about menopause. And I really want to thank you for that. But one of the questions that I got many times went, something like this. 

Caller #1: Hi, Bree. I was wondering why it is so hard to find a doctor that knows anything about women's issues or chronic illnesses that affect women like auto-immune disease. Every time I seem to have a smart question with a lot of research behind it, I get shut down. Like, I don't know what I'm talking about.

Caller #2: Hi, Bri, love the podcast. My question is why is the health care system so bad for women? Please tell me.

Caller #3: Hey, Bree, I've got one for you. Why is it so hard for women to get comprehensive medical care in this country?

Caller #4: I'm calling in to ask why the medical industry [00:01:00] totally sucks for women. It seems nearly impossible to find a doctor that doesn't dismiss my symptoms, or dwell on BMI it's humiliating. And I often feel like a checklist rather than a person.

Luck: And after talking to lots of friends over many years, I know I'm not alone in this. I'm wondering if this will ever change or why this even happens. Let me know your thoughts.

Luck: Getting adequate health care has been a common theme throughout this whole season of pause to go. We've talked about it in episode one, with Dr. Theresa Diaz in episode three, with Dominique Yakuza, both gave their perspectives on why and how the medical industry. Shortchanges people who have, or who have had ovaries and I'm going to have to plug Heather Corena one more time.

They were the guests in episode six. In their book "What fresh hell is this?", They [00:02:00] wrote a whole medical history lesson that outlinesinfrightening, and yet still entertaining detail, the history of how medical providers have, shall we say, really screwed people with ovaries.

And in that episode, Heather also gave some great strategies for dealing with this. Like you can request not to get weighed at your doctor's office. And, you know, over in the pause to go discussion group on Facebook, I'll share some selections from a few really helpful books that might shed a little more light on this, but I really started thinking who do I know who can give us not only a look at why the medical industry came to be what it is now historically.

But who also forecast trends in the health system, because I don't know about you, but I need to be looking forward at this point. So I reached out to my friend, Jeff [00:03:00] Goldsmith to see if he might be able to shed a little light on the situation.

Jeff is the president of health futures incorporated. He tracks and forecast changes in the $4 trillion us health system. And few have been out of this long as Jeff Goldsmith 

 For over 40 years. Jeff has analyzed changes in healthcare technology, financing, policy and care organization. He's written for the Harvard business review and has been a source for articles on medical technology and health services. For the wall street journal, the New York times business week time magazine and the list goes on and on and on.

 I really appreciated his insights and his wealth of knowledge. And I think you will too. I'm also sharing a PDF of five tips for talking to your doctor about perimenopause and menopause based on this [00:04:00] conversation and other conversations throughout the pause to go season, I'll share it over in the Facebook group, and I'll also share it in the show notes.

And it's five tips about menopause, but really it could be used for any medical situation. And here's my conversation with Jeff Goldsmith.

Goldsmith: So we have to talk about women in medicine. 

Luck: We do. So as you know, I've been doing this podcast and the first season was all about menopause and perimenopause. And recently I asked listeners to send me any questions that they had, that I could try to get some, I'm not the expert. So I'd try to g et someone who might be able to speak to it or address it in some way.

And the question by and large that I've gotten, I mean, I've gotten it from multiple [00:05:00] people and it's probably the only question that isn't deeply personal. Like, um, I'm having these symptoms. Right. Um, but the question that I get from multiple listeners is why is healthcare for women so bad in this country?

So I wanted to ask you this because I feel like you have a different viewpoint on the medical system then certainly I have. And, and also because of. You're looking ahead at the future. So on one side, I'd really love to hear your thoughts on why it's so problematic. I'm going to say problematic for women in this country.

And then question number two. Is, is there hope and what can we do? 

Goldsmith: Um, well, I don't know. I mean, that's a, that there's a lot of running room there. Um, a little bit of personal background, um, believe it or not. Um, uh, I started working in the healthcare system almost 47 years ago. Uh, I was [00:06:00] fleeing, uh, working in the governor's office in Illinois and landed in the Dean's office of the Pritzker school of medicine at the university of Chicago on November 1st, 1975, um, as an assistant to a transformative new medical Dean that had come there from duke named Dan Tosteson.

Um, and so. I spent almost eight years in a medical school environment and then moved out into general consulting where I worked in the health system as a whole, pretty much across the system, not just hospitals, medical schools, but, um, large medical corporations, um, physicians, organizations, pharmaceutical companies, biotech firms.

I mean, I pretty much PR pretty much work across the whole system. So I mean, I've, I think I've got. Uh, a historical view based on that almost 47 years of watching this thing. Um, um, but also more than just one sector of it, it's also worth noting that my mom, um, worked in the medical care system.

When, when she was pregnant with me, she was a, um, lab assistant in and doctoral student at Stanford university and their biochemistry department was then called organic chemistry and believe it or not Bree, [00:07:00] she was working on the team that was working on synthesizing estrogen. 

Luck: Wow. 

Goldsmith: Yeah, her, her team ended up founding a company called Syntex that made the first birth control pill.

So, I mean, we, we actually go back a whole lot further than, uh, than, uh, than 47 years. Um, you know, to answer your question. I mean, when I entered the medical education system, uh, There were a handful of women, faculty members in our place, no chairs, no deans. Um, we had only one woman, senior faculty member in our place.

And I can't remember the graduating class or medical school, but I, it was well less than it was a handful of women and in our, our medical school, uh, at the time. Um, so. I mean, I don't think medicine is all that different from the other professions. I think if you look at the law schools, are you would've found roughly the same proportions, almost no senior faculty and you know, of course women's health was, um, you know, principally confined on the clinical side to OB-GYN.

Um, and on the research side to [00:08:00] endocrinology where you were looking at, the role of, of the endocrine system and that was it. And, and, um, So, you know, from, from that standpoint, I mean, if you roll forward to 2007, by that point, you were beginning to get a significant number of women, faculty in medical schools.

And, and about a quarter of the practitioners in the country, this was 15 years ago, were women. Um, today, roughly half of the medical students are. And so each graduating class is replacing a cohort of docs that were two thirds, three quarters men. Now I don't believe that that means you can't do good science related to the issues that affect women's health, if you were a man.

Um, but even within. That we're now approaching a little more than a third of the docs in the country. Being women, practicing docs, being women, they tend to pile up in a few [00:09:00] places. They pile up in obstetrics and gynecology and pediatrics. Those are the two big ones and, you know, haven't distributed themselves, uh, in a random way, uh, in, in the total, either the science or the, or the clinical enterprise.

You look at the number of women that are medical school deans. There's a handful of them. It's it's worth noting that one of them is here at the university of Virginia Molina Kibby, who was appointed a few months ago and absolutely brilliant appointment and an even rarer doc before being Dean. She was a chairman of surgery at the university of North Carolina.

You just flat out, don't see that. So even here in 2022, um, the women are 80% of the healthcare workers. You know, they're, you know, they're, they're Ascension to positions of power has been glacial. Um, so I think that's a piece of it. Um, I don't think it's the only piece that's relevant here. Um, I also think that like any other complex health problem women's health problems cut across these silos that are, [00:10:00] are, are rigid in, in medicine.

And I think, you know, I haven't listened to all of your podcasts. I've listened to a few of them, but the idea that there are elements in women's health that are endocrine related, there are elements that are mental health related. There are elements that are inherent in aging, which is different in men than in women.

Um, those problems cut across so many disciplines that someone that wants to take a holistic view of the problem, which is the way patients approach it. , you know, they've really got the entire structure of medicine stacked against them. And that's not the paternalism that I was talking about earlier, but the way in which science and medical care is organized, it's organized into silos.

Those silos are represented in clinical departments, but they're also in the discipline represented in communities of people that don't talk to the other communities. So if you're a practitioner out in the world, And you're trying to solve a complex problem that affects the well-being of a patient.

You've either got to become an expert in, in, in all of those things that [00:11:00] are outside your silo, or you've gotta have really great consultative relationships have the time to read and equally important gossip widely with colleagues that are working on that same, same thing. So I think it isn't just a question of the numbers or, you know, the sort of patriarchal 

history 

But also the way in which medicine itself is fragmented. And, you know, you look at diseases that disproportionately affect women. Um, lupus is a great one. Another one, uh, would be, um, um, chronic fatigue syndrome. These diseases took years before anyone really took them seriously. Um, and I don't think that was because just because women.

You know, uh, were with the victims, um, anddisproportionately, but because they cut across multiple disciplines, we're now discovering that they, they had viral origins and that, that those viruses affected people's immune systems in, in ways that fundamentally destabilize them like COVID is doing our medical care system, does a very bad job of crossing [00:12:00] those disciplinary boundaries, uh, and getting to solutions.

And it doesn't even worse job of communicating that information to the millions and millions of people that need help. So that's a really, long-winded circuitous, uh, explanation of why I think this is so hard and I, I don't know if, I mean, if it's blindingly obvious to, you know, or not, but it's certainly what it looks like to me.

Luck: Well, it makes sense. I love that you mentioned gossip as being something that we need. By gossip, I think it's just sitting around talking about stuff. It's really having Frank, uh, Frank discussions that are off the record that are not, they're not being tracked, you're not going to be sued for your coffee shop chat.

And, uh,  it's been interesting doing this podcast because I've been able to get some functional medicine doctors on naturopath on, uh, alternative healers [00:13:00] on coaches, but no one who is working in the. Western medical field, no MDs who are not practicing alternative approaches have been willing to come on.

And I, uh, I feel like it's too scary to say what you really need to say in this litigious culture 

Goldsmith: or, or maybe people are excessively respectful of the boundaries of their knowledge and don't want to be speculating about stuff. They don't feel like they really understand. Sure. I mean, I've, I've worked in and around both scientists and clinicians for, you know, my entire career and there is a reticence and I don't think it's a conspiracy at all.

I think it's just people respecting the boundaries of what they know and not wanting to speculate. 

Luck: I don't feel like it's a conspiracy. Uh, it's, it's just, yeah, that there's just a firm boundary there. 

Goldsmith: Just to back off and throw one additional angle at this, um, our [00:14:00] medical care system is absolutely enormous.

Um, it's bigger than. Um, it's two and a half times the size of Russia, economically 17 million people work in it. The vast majority of them are women also. I mean, I think the other element of this that is complicating is just the scale of the enterprise and, um, to, to add complexity to it, it's the most complex thing we do in our economy, um, by an order of magnitude.

And I'm not just talking about, you know, serving 330 million people, but also the nature of the problems that medicine is attempting to solve. They're bewilderingly complex. And, you know, you really have to be a complexity junkie, um, you know, uh, full disclosure. I'm one of them. You really have to be a complexity junkie to want to dive into all those little silos and root around and kind of understand that.

What's going on in them. I don't have a real job. I've been a free agent [00:15:00] for 40 plus years. My main focus is where is this gigantic economic activity and, and cultural and scientific activity going. And so, you know what I do instead of working as I read and gossip on the phone with my friends about what I read and what I learned.

So building that gossip network back to what we were talking about a minute ago, a lot of folks don't have time to do. And so their gossip network doesn't reach out beyond their discipline. It doesn't reach out beyond, you know, the, the small subset of people that are sort of doing what they're doing.

You really have to be into pain to want to reach out beyond those things. Um, and of course, the way you get promoted in medicine is becoming the world's expert on the neurophysiology of the left big toe. That's how you get promoted. It's how you get your grants funded. It's how you, achieve professional eminence.

So it's just, it's bewildering, highly fragmented, uh, in addition to being bewilderingly [00:16:00] complex. So I just wanted to add that dimension to it. I'm not excusing this system's failure to answer the fundamental questions that you've been asking, but I think there's, you know, there are some reasons why those questions haven't gotten there.

Luck: So it sounds like this complex system is also rewarding, further fragmentation by yeah. By rewarding specialization. 

Goldsmith: Well, here's a personal example. Um, I, I have, um, like a lot of older people. I have neuropathy in my extremities, my feet and hands and. Uh, there were about 10 years ago when it was diagnosed, I was told that it would progress rapidly and that I'd be in a wheelchair.

And I didn't like that. And I actually began looking at the literature on, you know, what explains neuropathy? What is it, how does it work? All the rest of it. And I found a story that really troubled me. I was working at the time as. An advisor to a president of university that had a troubled medical school.

The Dean of that medical school was [00:17:00] an expert on neuropathy and he in his pre tenure, um, career had actually, he'd gotten the physiology of it down. And he'd actually found a really promising drug that could alleviate the problem that he identified that might conceivably have caused my kind of neuropathy.

It was good enough research to get him promoted. And he got tenure and the moment he did, he just dropped it. No one picked it up and he went on to become, you know, a medical school Dean. And then they had about the vice chancellor of a large health sciences center. So, you know, the reward structure in medicine doesn't promote continuity.

It's not like there was somebody who picked up his work and said, you know what, this drug didn't work, but maybe if we tweaked it, a couple of, of molecules we'd have a cure. There's no reward for that. So I think that's another piece of the culture that's, that's really troubling is that, even with a condition that afflicts [00:18:00] tens of millions of people, you don't get the continuity of effort needed to really press all the way out to a solution.

And, you know, you sort of need a societal crisis. Like the one we're having with COVID to force enough people to continue focusing until they found the remedies till they found the vaccines until they found the anti-virals. That is an extremely unusual circumstance in most medical problems that don't rise to the level of a societal crisis as COVID has.

Luck: Well, it does make me think is there anything that we can do? Um, as medical consumers what can we do?

Goldsmith: Well, look, I'm not advocating this as a solution, but you know, there are dozens of different cancers. One would argue hundreds or thousands of cancers. I, I have friends that argue that each individual person's cancer is a unique disease, but, um, there is a tremendous struggle for resources inside the cancer community, um, and women [00:19:00] organized, uh, breast cancer initiatives that were so powerful and pervasive that they ended up grabbing.

What many people felt was a disproportionate share of money devoted to solving the problem. And we got progress on breast cancer that maybe you didn't see for, you know, prostate cancer cancer of the liver or whatever it was because there was a coherent, organized political campaign by people that had the illness and their families and their loved ones, um, that ended up forcing Congress to appropriate money, to the relevant, uh, institutes and NIH to get the thing moved along.

So. I mean, it is certainly the case that focused political organizing can direct a flow of resources to solving problems. But again, if, if it's not a specific disease and I realized breast cancer, as you know, there's a bunch of different manifestations of breast cancer, some of which people don't think should be named cancer at all, [00:20:00] because they're not, you know, they're, they're extremely slow growing, but, um, You know, when you're talking about, you know, you talked about menopause and perimenopause, how do you focus?

How do you focus scientific energy on understanding this phenomenon, which is it affects half the population, uh, and, and in profound ways that affect their mental and emotional health as well as their physical health. And yet it's not, it isn't perceived as a crisis is not only not COVID, it's not breast cancer.

So, how do you generate a sense of urgency around unraveling? Some of those cross-cutting factors that we were talking about earlier to get the resources devoted, to get the scientists working, you know, to get answers, valid, scientific answers, that's a problem. And a political solution is not necessarily the best solution.

Luck: And I mean, menopause is not a disease. Right. It's not a disease at all.

It's life. Yeah.

Well yeah, it [00:21:00] is. And even hearing that there's a movement toward having more women. In higher level positions, slow going the way it may be gives me hope. I'm an optimist, right? , I am a relentless, I'm a realist. 

Goldsmith: I'm a realist, realism and optimism kind of join here. Um, you know, I think it's going to matter tremendously that we have women medical school Dean.

Um, and, and women directors of institutes of health, uh, and you know, women advocates in the Senate, uh, that are no nonsense, powerful, get it done, kind of people. Um, there's kind of a critical mass phenomenon here. So I don't think the optimism is, is not isn't grounded in what we can easily see going on that is going to produce tangible results that is going to take forever.

 And that's one of the problems with my discipline of, you know, looking into the future is, you know, you can see stuff that you're pretty darn sure is going to [00:22:00] happen. But the hard part is when, right. That's the hard part. That's where my colleagues in the Silicon valley and a lot of other places screw up is that they think stuff's going to happen the day after tomorrow when it almost never does.

Luck: Yeah. So given that, and I know that you're not, you are not offering medical advice in any way, but do you have any advice for women who are looking for medical care? In this time for women who are going through perimenopause and menopause in seeking help 

Goldsmith: for well, to not be satisfied with not getting answers is one thing is, you know, you need to, you need to be relentless.

Um, and you need to ask the people that are caring for you at present to move a little bit outside their comfort zone. Um, You know, to, to take advantage of their networks, um, to get you to people that can answer their problems who may or may not be women. Um, so I, [00:23:00] I, I mean, I think that's a generic piece of advice for anybody that is dealing with the medical care system is don't be intimidated by it.

Don't take, you know, we don't know for an answer, take it to the next level. Give me stuff to read. No, give me conferences whose podcasts I can download. Let me attend meetings virtually because they're all virtual these days that might help me be smarter about what's going on with me. That will help me answer some of these questions.

Perhaps myself. Don't hesitate to leave providers that don't want to do that. You know, if people don't have time to talk to you, you don't have time to be their patient. You know, and I realized, I having said that I've been on a tear about how much professional time we are wasting all of our clinicians time by all the typing that they have to do all the documenting that they have to do that, you [00:24:00] know, they spend half their time typing.

That's time away from answering our questions. So, you know, I'm kind of a terrifying patient, you know, I'm, I'm sitting in the emergency room, uh, with a problem and someone starts an IV and I'm like, why are you doing that? And not just because it's possible that they're going to waste money, that, you know, either I have to pay or that the system has to pay, because I kind of want to know what they're doing.

I think people are excessively deferential and I realized women are less deferential than men in some ways. Uh, particularly baby boom women. And I wrote about this, uh, in, in some of my early writings, baby, boom, women revolutionized, uh, the, the whole business of being a patient. You, you go back to our bodies ourselves, which I think was a seminal, uh, document in, in women's health.

Um, maybe the wrong metaphor, but, um, you know, there was a take, no prisoners. Get your needs met, define your [00:25:00] problems in your own way. Attitude. That was embodied in that. What now? What 50 year old, almost 50 year old document. It was brilliant. And a lot of it, what it was, what, what our bodies ourselves was trying to do is produced by a feminist women's health collective in Boston was to get people to not defer to the medical care system.

To to say to them, those folks, mostly men at the time work for you and they haven't met your needs. Don't let go of them. I mean, I just thought, I mean, I loved it and I, I mean, w it wasn't written for me, you know, but I have that very same attitude, you know, I can't tell you how many, you know, wealthy.

Powerful people get into the medical care system and kind of go, oh, okay, well know that it's not okay if your needs aren't getting met, you need to make noise and you need to, and you need to be a bit of a pain in the butt. [00:26:00] And I don't mean in an abusive way. That's something that's going on now, which is really scary.

People are losing it in, in, in their, their interactions with doctors and nurses. That's not what I'm talking about at all. I think in a sense. Thoughtful responsible way. You don't let them walk away. You don't abuse them, but you don't let them blow you off.

Luck: I think it's great advice. 

Goldsmith: I mean, there's no, I mean, you can be polite and not be different. 

Luck: Sure. Sure. 

Goldsmith: And I don't think there's any penalty for asking the person to take an extra two minutes to actually explain something to you and to give you the citations and to let you do the reading.

Um, and you know, it, I, you know, part of my little challenge in the eighties and nineties was trying to understand more of the science. And, you know, even if you can't read an article in nature or cell or science, you probably can read an article in scientific [00:27:00] American or in late lay publications, like the economist, which does spectacular medical reporting.

And doesn't talk about it. There are places to go. Where you don't have to understand what a glial cell is, or, you know, you know, how, um, how RNA works, um, to try and understand the underlying things that are happening to you. Um, so I think that there is a, an intelligent layperson could get a long way towards understanding the science by reading some of those intermediate publications that have as their purpose.

Trying to demystify and translate into English complex scientific concepts. Uh, scientific American is fabulous at this. And most of the people that write for it, aren't the scientists doing the work. They're science, curious journalists, people a little in a way like yourself that have gotten far enough along in an issue to be able to say, okay, well, geez, this is really important.

Here's what's going on. There's [00:28:00] a lot of that information out there. 

Luck: Yeah, I think that's great. And I think what I'm going to do after this podcast is, is drop, uh, five ways to be polite without being differential, to get the medical care that you need. Based on this conversation, I'm going to share it in the show notes and create a PDF from that.

So. Um, cause I just think it's helpful just to remember when you go into the doctor's office, these are the things before you go into the doctor's office to be thinking about how to get the care that you need. And to be curious about the information that you're receiving from your doctor and to demand curiosity of your medical provider as well.

Goldsmith: I hope you'll underscore the polite part because I, I think that one of the casualties of COVID has been, uh, a, um, uh, a real, uh, rising hostility to people that are just flat out over-matched and exhausted. And I think we have to acknowledge the fact that they're, they're really struggling right now.

So I think, you know, the idea [00:29:00] of acknowledging that struggle is an important part of the, you know, the foundation of this conversation. 

Luck: We're all human.

And if someone is attacking us, no matter what we go into defensive mode, even if we don't attack attack, we go into defensive mode. We're all trying to work together here. I know for certain that.

My medical care providers who are excellent are only have my best interest in mind when they're giving me the medical advice that they offer, even if it's limited. And it is so 

Goldsmith: well, you know, it's interesting. Um, I had a lot of medical care issues in a very intense two and a half year period of time. Um, and believe it or not.

Um, I mean, I, I've got a lot of choices in a lot of, you know, my gossip network's really useful for times like that. Um, I ended up seeking out not only younger people, but women, clinicians to take care of me. Um, I had five major surgeries in [00:30:00] 29 months. Uh,  four of which were performed by women.

Um, and in my experience for the most part, they're better listeners. Maybe that's from a lifetime of enduring mansplaining. They don't want to be like that, but they really, um, they really want to understand maybe a little better than their male colleagues where you're coming from. 

Luck: Yeah. One of my recent guests said that she's seeking out women from medical care for that reason, 

Goldsmith: well, you know, it's, it's, um, the women that I, that I met in the process of doing this paid a pretty steep price during their professional upbringing, just for being women. And I think it was sort of a challenge, um, to not push back and to become arrogant and defensive. Um, And then maybe remember what it felt like to not be listened to.

Um, and I, I, um, you know, I have a lot of respect for people that have gotten that far and their own self-awareness. Um, I I'm, I'm tremendously optimistic about where our medical care system [00:31:00] is headed. And, and I may be one of the only people in my generation that feels that. I mean the five surgeries that I mentioned to you in 29 months, only three of the people that touch me were over the age of 40.

And it was stirring. That's a funny word to use. It was stirring to see the teamwork. And, um, that's obviously pre COVID just pre COVID, you know, the, the teamwork and comradery and positive energy and spirit that those young people brought to dealing with me. Um, I really, I felt safe in their hands and I felt like some of the fear that I was, you know, trying to deal with, they understood it and they helped me cope with it.

Luck: One last question, and I don't know how much you can speak to it is insurance. Um, and I mean, how, because I know that for a lot of, for many of us, the kind of care that we want is not covered by insurance or is not adequately covered [00:32:00] by insurance. And do you have any thoughts on the.

Economic engine of the insurance industry as it pertains to women? 

Goldsmith: Um, honestly, no. I mean, I'm not, I'm, I'm a, um, I write about our health care financing system. I've lived with it and worked with it for almost 50 years. Um, we've still got the better part of 10% of the population that have no health coverage.

And we've got a significant number of people that nominally are insured, but who have policies with five to $7,000 deductibles who don't have the five to $7,000. And we've kind of looked the other way and pretended that it was okay, but what that huge front end financial burden really is, is a 12 foot barbed wire fence between them and the care that they need, which is flat out, not.

And where the data on the human cost of people delaying [00:33:00] care, they need has not been tallied. So I'm, this is an area of real concern. Um, you know, forget about the question of whether things like what used to be called alternative, which are now called complimentary medicine. Things are covered or not. Um, it puts the patient in a completely untenable position.

Of having to make value based choices with no data with no real recourse about whether it's worth me writing a check to do acts that isn't covered by my insurance or that is, you know, the front end of which isn't covered by insurance. Now we had this obsession in the seventies and eighties with the idea that if care was free, it would be freely used.

And there'd be a lot of waste. And people were trying to figure out a way to allocate risk to patients in a way that routine things that maybe weren't as serious were the patient's responsibility. Um, but the really serious stuff was completely [00:34:00] covered and they never got even close to doing that correctly.

Um, that issue of how you allocate the risk appropriately just got punted. Um, and, and. Um, you know, I'm an avid consumer of complementary medicine. I, sampled every one of the possible things you can do, you know? Um, and I'm a believer, um, particularly in, um, acupuncture. You want to have some fun ask, ask a neurologist what it does and how it works.

They still can't tell you, in 2022, you know, when, when Richard Nixon went to China in 1973, or whenever it was one of the things they did was showed him a patient undergoing open capsule brain surgery, where the only anesthesia was, um, a few little needles in the person's ear. It was like, what what's going on here?

Well, you think, you know, I mean, suing 50 years, people would be curious enough about stuff like that, to be able to answer [00:35:00] the question, they still don't know what it does. You know, there's this system, the meridians. Okay. Well, what are those? Can you take a picture of him? You know, do you know how they were?

I mean, no one knows, so. That bothers me, 

Luck: you know, I'm also, I am a believer in acupuncture too. I had, I don't know if you know this. I had chronic Lyme for several years and tried just about every modality, just about every modality of treating. And was really debilitated. I mean, couldn't hold a pencil. And, um, and finally, as a last resort, before being put on an IV antibiotic for, uh, you know, six weeks or something, I went to an acupuncturist and this is after 14 months of, of really debilitating illness.

And within two weeks, I was 80% better [00:36:00] within a month. I was 95% better. It was a mate and I was not a believer. Yeah. 

Goldsmith: Yeah. Well, it's, it's compelling enough. I mean, I have a spectacular acupuncturist here in town and my daughter found her and my daughter was worked in China. Before going on to Hopkins and getting a master's in public health.

And she was really, she was intrigued enough by, by, um, traditional Chinese medicine to want to go and study it in China. Um, but when she told me about this person, she said, you need to go to her and tell her to treat you as if you were Chinese. And what that means is you put the needles in a quarter of an inch and then attach electrodes to them.

So, I mean, it's even within even the acupuncture, there are gradations of, of intensity. 

Luck: Sure. Well, thank you so much for sharing your expertise and your vision for the future. And for some, I think for some great strategies for getting the care that we [00:37:00] need, as much as we can. 

Goldsmith: Well, you know, again, I mean, I guess, um, as a futurist, it's kind of arrogant to be optimistic when you're 73 years old because no, one's going to be, I'm not going to be around to be held accountable if I'm wrong.

But I think our medical care system is slowly moving in the right direction on a lot of the issues that you've been exploring. And I just wish the progress were more, more rapid. 

Luck: Well, we just need to keep gossiping. Just keep the gossip. 

Goldsmith: There you go. 

Luck: Here are my key takeaways from this conversation with Jeff Goldsmith. Number one until very recently, women have not been in key positions as medical practitioners, researchers, scientists, funders, and an academic leadership. So the male bias or limited viewpoint was a factor in missing so much about women's 

health 

Luck: But that's beginning to shift. Now that women are [00:38:00] stepping into key leadership positions. And right now women comprise roughly half of all medical students. Number two. Another thing to consider is that our medical system is heavily siloed.

So doctors and researchers aren't really equipped or rewarded for taking on complex problems that cross disciplines and many of women's health issues like menopause and perimenopause are complex and affect multiple bodily systems. Number three. Focused political organizing can direct a flow of resources to solving problems

 number four. And lastly, and I think this has been a takeaway for at least eight of the last 12 episodes. You don't have to defer to your doctor's opinion. Ask them questions. And if your doctor doesn't have time to talk to you, then you don't have time to be their patient. I'm posting a link to a PDF on five tips for talking [00:39:00] to your medical provider about perimenopause and menopause in the pause to go Facebook group.

And in the show notes for this episode.