Sawbones: Dr. Asher

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Hello, everybody, and welcome to Sawbones, a marital tour of misguided medicine.

I'm your co-host, Justin McElroy.

And I'm Sidney McElroy.

Justin, I'm excited because I know you really like it when we do episodes that sort of relate to previous episodes.

Oh, yeah, a nice combo.

Yeah.

And that's where this one came from.

Yeah.

I love the connective tissue.

I think of them as like mythology episodes and like Monster of the Week episodes.

You know what I mean?

So there's like some that are like core to the mythology.

Like in X-Files, that's the split that X-Files used to have.

Monster of the Week, and then there'd be like some that relates to the core mythology.

Like you have to watch those to get the whole picture.

Yeah, like Buffy.

Yeah.

Buffy did that too.

Yeah, you got your like Beer Bad that is a bad example because that's a bad episode.

This is a bad episode.

You have a one-off that doesn't relate to anything.

Right.

We don't talk about a lot of that season.

Yeah.

But there's also the, there's also the, um, who are the men, the gentlemen?

Uh, that one's in that season, right?

Hush.

Hush is in that season.

So there is that one.

There is.

And Mark, and Mark Blucas is in that season.

And I saw Mark Blucas at Dragon Con recently, not saw in that I spoke to Mark Blucas, but I walked past his table.

And I, I struck, Travis mentioned this to me, and I think it's accurate.

Do you think when Mark Blucas walks past his table, there's still a moment where he's like, dang it, they misspelled my name.

No, no, that's right.

Mark Blucas.

Dang it.

Forgot again.

I can't imagine, no matter how excited you would be to talk to the celebrities at those cons, that you are ever going to do that.

That it would be easy for you to walk up and be like, hello.

No, I did it with, I've only done it twice.

I did it with Starbuck and I did it with David Tennant.

I mean, that was for me.

Katie Sackoff and David Tennant.

Yeah, for you.

I was like, I know.

But never for myself.

That's what I'm saying.

No.

Never.

No, you did do that for me, and I appreciated it.

It was nice.

I now have two little videos from people that I greatly admire telling me they're sorry I'm stuck at home with my kids.

Well, it's the least we could do.

Yeah.

So anyway, Sydney, I do love it when we have episodes that relate to previous episodes.

Yes.

We talked about factitious disorder or

as it has been named, Munchausen's, which we're not going to call it that anymore, right?

We're just going to call it factitious disorder.

And in it, I talked about Dr.

Richard Asher, who was the one who gave it that name.

And it was really interesting as I was reading about factitious disorder and specifically reading his paper describing it.

I really enjoyed his style of medical writing.

And it inspired me to go learn more about him.

Because here's the truth.

I don't know how many medical journals.

you, listener, read in your life.

I thought you were about to meet me for a second because you know for a fact the answer to that.

Well, I know the answer for you.

Now, I suspect that there are listeners who actually read many more than I do.

Oh, yeah.

Because there are probably other, you know, people in healthcare listening.

Sure.

And

I could read more.

I know.

I could read more.

But

who's that in response to?

The voice in your head?

Yeah.

Shut that down, Sidney.

That's an agreement you don't need to honor.

The voice in my head.

I don't know if any of you out there are like me, but you have this stack of aspirational medical journals sitting in your office.

I mean, take out medical journals and replace it with like Final Fantasy games.

I haven't played yet.

Or I'm like, I really need to go.

Like I've read an article from them or I scanned a few things.

I read the abstracts.

We all do it.

Come on, you know you do it.

And then I didn't read the rest, but I was like, but I'm saving it because I am going to read the whole article.

I just wanted to get the abstract in there real quick to get the.

Listen, Sid, that's me and Vagrant Story.

I've been saying for 25 years I'm going to play it, but at what point am I going to have an opportunity to sit down in front of my PlayStation and then play for, you know, however many hours?

I just don't have time for all these England journals.

All these square games.

Family practice.

I don't have time.

I could do Final Fantasy 9.

You know, it's all there to stick on the PlayStation.

I got another one to knock out for that.

So I want to tell you about Dr.

Asher.

Okay.

Okay.

Because

I think he's an interesting figure in medicine.

I hadn't heard much about him.

We talk a lot about doctors you've probably heard a ton about.

And I want to talk about him because I think some of the points he made about medical writing specifically are still valid and and probably we still could work on.

So he was born on April 3rd, 1912 in Brighton, England.

Are you figuring out his astrological sign as I say that?

No, but I will.

What's the birthday?

April 3rd.

What is that?

You don't know?

I know.

Okay.

Hold on.

April 3rd.

Is that a Leo?

Aries.

Yours, right?

Mine.

Yeah, I know.

You asked me if I...

figured that out.

So this time when I looked up his birthday, I did figure that out.

And I thought, I wonder if I will feel like a kinship.

Oh, yeah.

I wonder if that's why I was so inspired by him.

Because your parents humped at similar times.

Maybe you guys would be spiritually kind of.

You made it gross.

He married Margaret.

He went on to have three children.

And his children all, I think this is like, this is an interesting side note.

So his children all kind of went into the entertainment industry.

That's great.

I love that.

And I, I, I wondered about that because I like I went to medical school with a lot of people who had doctor parents.

Like it was very common.

Oh, yeah.

Like it's that makes sense.

That makes sense.

That doesn't surprise me.

It is so common that our medical school, I believe, still has a legacy scholarship or like a legacy tuition rate.

Like you get reduced tuition for being a legacy there.

I am not, but many people were.

Yeah.

But

I would not encourage my children to go into medicine.

If they want to, that's fine.

And I will do everything I can to support them.

So I wonder if Dr.

Asher felt similarly.

Like, do something fun, kids.

Do anything but what I do.

The eldest Peter was part of a pop group, Peter and Gordon.

And he went on to become, yeah, that was their pop group, a music producer.

Oh, my gosh.

And then Jane and Claire became actresses.

And what's fat, so on TV and radio, Jane on TV, Jane Asher.

TV actress, and Claire on radio.

Are you looking up about Peter?

Go on, go on.

I'm going to talk about about Jane Asher because.

Yeah, please talk about Jane Asher.

Do you know what is notable about Jane Asher?

She's an actress.

Okay.

And also

dated Paul McCartney for quite a while.

Huh.

Back in 1963.

They dated for five years.

And McCartney actually lived at

Asher's family townhouse.

Okay.

So

fascinating.

So this doctor, Richard Asher, it just so happens that his daughter lived with Paul McCartney in their home.

And McCartney wrote all these songs about Jane Asher and I Love Her.

We can work it out.

You won't see me.

I'm looking through you.

All these songs that may have been composed right there

where Dr.

Asher lived.

Looks interesting.

Yeah, it looks like Peter and Gordon actually recorded several,

like their big hits were, were McCartney songs that were credited to lenon and mccartney so they recorded a lot of mccartney's tracks as well yeah fascinating i know well i mean it was interesting because as i was looking up stuff on richard asher i kept finding jane asher and then beatles stuff and so i don't know it all it all it's all connected but um i guess that when the beatles went to india to start their tm journey yeah did you did you know that's what they were doing over there i did not i thought you'd be into that you're into TM.

Yeah.

Yeah.

That's fascinating.

I had no idea.

Yeah.

And then

she went for a while and then came back.

And then I think maybe somebody, maybe there was some cheating.

Allegedly, McCartney was cheating on her.

Allegedly.

I don't know.

Who knows?

And anyway, and then they broke up.

Also, Jane Asher did a part on a Doctor Who radio drama in 1994.

Fascinating.

This is fascinating.

She was a companion.

She was a companion.

Amazing.

Hank Sidney.

I I haven't even told you about the doctor yet.

Doctor of what?

Yeah, which doctor was it?

Was it the seventh, eighth?

No.

Dr.

Asher, the doctor of the doctor of note.

Peter Asher managed Linda Ronstadt and James Taylor throughout the 1970s and 80s, Sydney.

I think this is cool.

I know this does not relate to his medical career.

We're going to get into that.

But like, this is all his legacy.

So I think that's kind of cool.

In 2007 and 8, Peter and Gordon were featured performers in the Epcot Flower Power Concert Series at Walt Disney World.

Excellent.

Sorry.

I could do this all day because the,

do you remember?

Sorry.

Snakes on a Plane, Bring It, the song Snakes on a Plane, Bring It by the band Cobra Starship.

One of the members of that was the grandchild of

Peter Asher.

Why?

Child of Peter Asher.

It's really interesting.

Anyway, sorry.

I'm going to stop going on.

This is fascinating.

And not to get like, I don't know.

Now I'm just sort of like theorizing, but I will say that.

So Dr.

Asher's, one of his biggest thing is that things was that medical writing is boring and that we should do better.

And he was known for being kind of like evocative with the way he would phrase things and the titles of his articles and stuff like that.

And obviously he had a creative flair.

Yeah.

You know, he must have.

And then now his kids.

So he.

While all this amazing stuff with the Beatles and all this cool stuff is happening, he is an eminent British endocrinologist, a hematologist, and he was responsible for the mental observation ward at the Central Middlesex Hospital.

He was known, though, for being a very out-of-the-box thinker for his time.

The way that he approached medicine for that time period was different.

And he said that we re-his big thing was we need to be critical of our own thinking.

Like the idea that just because we have these established practices, we should just continue to embrace them forever.

He was very critical of that.

He thought that we should constantly be sort of like reassessing, reevaluating.

Okay.

He said that many clinical notions are accepted because they are comforting rather than because there is any evidence to support them,

which doesn't sound revolutionary now in an era where, well,

up until very recently,

we accept that you need evidence to support something.

But I mean,

we still have that happen constantly, right?

It wasn't, it was just in the last couple of years that phenylephrine, which is an ingredient in a lot of over-the-counter cold medicines.

If you look at, if you've got any sort of combo cold medicine at home, any of the Tylenol, Cold and sinus, Dayquil generic things, right?

If you look, a lot of them contain phenylephrine.

There's no evidence that it does anything.

Yeah.

It's still in there and it's been in there for a long time, but it's only been in the last few years that somebody finally like looked at all the data and said, I don't think that's helping.

I don't think that we should do that.

It's not doing anything.

Like we're not improving your symptoms with that.

What are we doing with this stuff?

What are we doing?

But outside of that, which are, those are good lessons in medicine for sure.

He also believed in writing in a way that people would enjoy.

Basically, the idea that like.

If you are reading something incredibly boring, it's going to be hard for your mind to engage with the material and take it in.

100%.

Which, you know, man, maybe this is why this spoke to me so much.

On this show, what we try to do a lot of the time are tell stories in order to illustrate like the history of something, the, the, you know, the concept behind something.

And I, and the reason that we do that, well, part of it is I just like telling stories.

But the other part is that I think that we learn things through stories really well.

I think it's a good way to contextualize information and absorb something.

A lot of the way that I taught myself medicine, I mean, I had professors, but a lot of the way that I would go home and put it in my brain to stay there was through creating stories out of of it.

Look at things like

Magic School Bus or Mr.

Wizard's World.

You know, you hook the kids with the science, but then you got Mrs.

Frizzle and Don Herbert for just the raw sexual magnetism.

You know what I mean?

To bring in the parents.

So you kind of have something for everybody.

I mean,

who has the raw sexual magnetism there exactly?

Are you talking about Mr.

Wizard?

And Miss Frizzle.

Yeah, it's a combo deal.

I don't know.

I mean, Miss Frizzle, I guess I get that.

Yeah.

I don't know.

I mean, I loved Mr.

Wizard, but I don't think I was necessarily seeing him with the same thing.

I didn't see him back in the day.

I mean, back when he was in his, like, when he was in, like, Mr.

Wizard's home, yeah, he was a, he was a, a handsome dude.

You know what I mean?

He had a lot.

Look, look, I mean, like, look here.

What am I going to show you pictures of Mr.

Wizard in his prime?

Look at that.

This is an obsession.

You know, that's that's.

I mean, he's a nice looking guy.

That is not my memory of him.

Honey, I love you so much, but it was just a joke.

And if if you make me sit here and defend it anymore, I'm literally going to freak out.

Now, I want to know.

Okay, after we're done recording, will you tell me more about how sexy Mr.

Wizard is?

Yeah, I'll explain jokes to you.

After the show, I will lovingly, lovingly explain how hilarious I am.

If I have a better understanding of that, that would probably improve our whole relationship.

Sorry, do you have any more notes, Dr.

McCarthy?

You're joking.

I love you.

So

one of the articles that Dr.

Asher wrote that really, again, this is going to sound silly, but you have to understand this was groundbreaking for the time.

He wrote an article titled, and this, again, evocative titles, Dangers of Going to Bed.

And this can sound really silly, like what

you're going to tell people not to go to bed.

But what he was trying to critique was that at that time, in medicine, a lot of the medical advice that a doctor would give would would

entail you laying in bed like rest was i mean we know that if you go back a little further from than asher's time the rest cure especially for female patients yeah was was a common thing just go lay in bed for a long time and you'll feel better um sexist but also it had the advantage being one of the few things that we are pretty sure works like we have seen a lot of these if you just wait they will improve sure and but part but the waiting it wasn't just wait wait while laying in bed that was key Lay in bed.

Right.

Stay in bed.

Stay in bed.

And if you, it's, it's interesting.

Nowadays, we don't, I think that most of us, if you've had a hospital stay or if somebody you know has,

most people don't stay in the hospital for super long periods of time unless, I mean, unless you're sick enough that it's necessary.

Hospital stays have gotten shorter and shorter.

Now, a lot of that has to do with our completely ridiculous way we pay for healthcare.

Remember, health insurance is a giant scam that's been perpetuated on the American public.

Literally the original sin of this system.

And that's why it's all bad.

And if you dig down to the roots, they're sick.

We need an NHS.

I'm jealous of you.

Enema is what we need.

Yeah.

No, we need an NHS.

Oh,

what?

That was great.

An enema.

Yeah.

Like the Joker says in the hit film Batman, this town needs an enema.

Like, the medical system needs an NHS.

You were saying it needs an NHS, and I said, we need an enema.

After the show, we were going to have to set aside so much time for me to explain.

Explain jokes to me.

So he, no, well, just like, not explain the jokes, but just like how good they are.

You know what I mean?

Like the quality of them.

So

he, so at the time, if you were sick, you would be told to go home and lay in bed, or if you were sick enough, you would stay in the hospital.

And we kept people in the hospital a lot longer, like for their entire recovery period.

And I'm not saying that.

that was completely false.

I think we do probably discharge people too quickly now in the hospital because of the financial pressures.

I think that's probably a fair statement to make.

But at the time, it was like, we're just going to have you lay in this bed for days and days and days until you get better.

And there was an overkill to that too.

And that concept of the patient as the bed, I was thinking about this.

We refer to patients in the hospital by bed.

Bed one needs ice.

Bed five.

is headed to CT.

Yeah.

Bed 24 is coding.

Get over there.

I mean, like, that's how we talk about patients.

That's not just me.

I mean, that's very common wording in a hospital setting.

We think of you as the bed.

We put you in the bed.

And then we give, and a lot of times we'll give you medicines to keep you from getting clots because you're laying in bed for so long.

So like we do tend to turn to the bed a lot.

Now, sometimes that's necessary.

But he wonders if maybe we aren't creating.

more problems with our dependence on bed rest than we are actually solving.

Okay.

I think that sounds insane.

I'm going to get into like why why this, I know it sounds silly, but this is solid medical advice.

But first we have to go to Billing Department.

Let's go.

The medicines, the medicines that escalate my cow before the mouth.

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Hi, I'm Justin McElroy, and my cats like my wife a lot better than me.

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I mean, just Sidney and I were talking a couple of days ago that we feel like since we've started giving our cats smalls, their coats are shinier and softer.

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And so with Smalls has been great for our family.

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Okay, cool.

All right, Ted.

So he goes through system by system to describe if we just leave somebody in a bed for a long time, what happens.

And some of this stuff is really obvious, right?

Like you get skin breakdown, you get bed sores.

You can develop things like blood clots.

You can get constipation.

You can get depression.

You can get something called atelectasis.

It's when, like, the bottom pockets of your lungs kind of collapse because you're not using them, because you're not taking deep breaths because you're just laying in bed all day.

Habit's bad for your sleep hygiene.

It's bad for sleep hygiene.

It's bad for your muscle, muscle weakness, your bone strength.

It's bad for lots of things.

So, if somebody doesn't need to be in bed, it is good to get them up and moving.

And that was his point.

It sounds all very dramatic, but all he's trying to say is, why don't we get patients up and moving more?

Why don't we, I mean, this is the like before physical therapy would be part of every hospitalization the way that it tends to be now.

Why don't we get people out of bed?

And this was a revolutionary idea.

A lot of doctors were like, whoa, whoa, whoa, this would change everything.

They're already in bed.

This is the ideal scenario.

And but the way that he described it, I think this was the art to it.

So here's a paragraph from it.

We look at patient lying long in bed.

What a pathetic picture he makes.

His blood clotting in his veins, the lime draining from his bones, the scyvala stacking up in his colon, hardened balls of stool, the flesh rotting from his seat, the urine leaking from his distended bladder, and the spirit evaporating from his soul.

This is in a medical journal.

It's kind of wild if you think, well, you said though that he wanted to make it spicy, right?

I did.

I know.

It's kind of wild if you think about, this has never occurred to me until you said that about patients being beds and stuff.

The idea that like everyone who needs to be in a hospital also should be laying down seems to be in service of like, it's easier to keep tabs on where people are if you know where they're stopped like where they're set but like you don't really need to be in a bed like it seems it's it's weird to think now that I think about it it is and it's like some of it is very functional right like sometimes depending on what you have if you're recuperating I you should rest to some degree right like you it's good for you some of it is um practical from a public health standpoint do you have something contagious we'd rather you stay in this room please don't go wander around everyone if you have something that could be spread from patient to patient um some of it you're right is very much convenience.

Stay in this room in this bed because I'm going to come talk to you and I'm going to order tests on you and I'm going to give you medicines and whatever.

And if you're just like in this room in this bed, there's safety issues too.

We treat everybody.

We don't know what you're up to.

We don't know if you're a,

you know,

like you're spreading, you know,

illness.

Right.

So like there's a lot of pragmatic reasons for this, but we do stress too much, like stay in bed.

I do think that's, that continues to be, I mean, less valid today than it was back at this time, but like it's still a valid criticism.

Now, he does say, after this very disturbing picture, he says, I've painted a gloomy and unfair picture.

It's not as bad as all that, but he, but he does say, like, he shares a bunch of case histories then and says, we need to get people up and moving.

We need to do physical therapy, occupational therapy.

We need to get people to move more during their recovery so that once they leave the hospital, they're not so weak and experiencing all of these other complications from being in bed so long.

Valid medical

standard that needed to change.

He says at the end, teach us to live that we may dread unnecessary time in bed.

Get people up and we may save our patients from an early grave.

This is again in the article.

I bet you love that old rhyme in there.

I love that.

I love putting poems in articles.

I love that.

He gave a lecture in 1948 where he

named the seven sins of medicine.

And again, I think that this is very evocative title, obviously capturing your attention.

He says there's lots of sins in medicine, lots of them.

There's way more than seven.

But he felt like the seven were the worst.

And these are often, I was not personally taught these in medical school, but I know that these are still like referenced in a lot of different medical educations as some of the things.

And I've seen like updated versions of this article in a lot of journals more recently.

Like, here's what I think are the current seven sins, or here are the seven sins in this specific type of practice.

But he talks about obscurity.

Like we use jargon too much.

We gatekeep information from patients.

If patients can't understand what we're talking about, then they can't,

they're not going to be able to take our advice.

And so obscurity is a problem.

And he levels that at medical journals too.

Medical journals are hard to read and understand.

They are inaccessible for people outside of medicine.

Broadly speaking.

I don't mean every single one.

He talks about cruelty and he kind of breaks that into the mental and the physical.

He says there's the cruelty of the way the system, like we don't always answer our patients' questions or give them enough time or

help them, you know, work through like psychologically what they're and emotionally, what they're experiencing.

But then also like

the physical cruelty of

some of the tests that we order or the fact that we wake people up at 4 a.m.

in the hospital to ask them a bunch of questions or not being as careful as we should with like he references putting a sticky dressing on a hairy arm you know something like that um I think about that a lot it's funny I think about that when I read that I thought specifically that at one point in the practice that I now have I switched from ordering gauze pads to ordering non-adherent pads and the reason is that I undress so many wounds from other facilities and hospitals and stuff that where they put gauze over an open wound and when i'm saying gauze you're imagining those, imagine those little squares of like woven material.

You know what I'm talking about?

Yeah.

The threads get stuck in there as it dries.

And that's very uncomfortable.

It's very painful in some cases.

Non-adherent pads don't stick.

They're like one solid piece.

So I switched to that.

Yeah.

But I still find gauze in a lot of wounds.

And so I don't know.

I was thinking like, we don't, we don't always, we're using the thing that's practical and we're not putting ourselves in the patient's shoes enough.

That's still true.

He talks about bad manners.

This is mainly aimed at students.

He says, I mean, and this is true to this day.

Do not be rude to the nurses.

Do not be rude to your colleagues.

Certainly don't be nude.

Don't be rude.

Yeah, don't be nude.

Don't be nude pretty much in any context.

You'll get kicked out.

Don't be rude to your professors and attendings and residents.

Don't be rude.

He talked about over specialization.

And he jokes about.

I think that, so I think when he's talking about it, what he's saying is,

whatever you're,

he's not saying we shouldn't have subspecialties.

He's saying that don't be so locked in whatever your specialty is that you refer out for anything that deviates slightly from it.

Like there's too much of that.

And the joke he makes is that

an ophthalmologist, so an eye doctor, sending a patient to a hand specialist to confirm that they do indeed have an extra digit on their right hand.

Right.

Okay.

Right.

Like that's the joke he's making.

I think there's a lesson there.

I try really hard as a family doctor to do everything I possibly can until it's like, okay, now I, this is outside what is in your best.

As long as it's something that I know I can manage competently and you can get the best care from me, I'm going to do my best to do it.

Once that's not true, I'm going to send you to somebody else.

But that's a lot of stuff that I can do.

Right.

And then he talks about love of the rare.

Love of the rare is the

old adage when you think hoof beats.

Think horses, not zebras.

Yes.

Right.

And we we like that.

Um the final one, actually, that was only six.

The final one is common stupidity.

And I think this is the best.

I mean, yeah.

Because what he says is that this is

this is the opposite of common sense.

And he talks about, I mean, what he's really talking about is algorithmic treatment.

What he's saying is don't.

don't put every patient into the same box.

Like, oh, they have this.

I'll treat it like this.

Individualize your care for the patient.

And that is maybe the most valuable lesson because so much of medicine today is algorithmically guided

because of insurance companies and the way things get paid for and the way that they make us do certain tests to get other tests approved.

And like, I have a, there's a whole subset of patients.

I treat hepatitis C.

I am forced by the West Virginia Medicaid to send any patients who already have liver damage to a gastroenterologist gastroenterologist before I can treat their hepatitis C.

I'm forced to.

It's not because they need that.

It's not because, I'm not saying that there isn't value in them seeing a liver specialist, but that's not really necessary for me to treat their hepatitis C.

That's the insurance companies making me do that.

That's common stupidity.

I could cure those patients, but I'm not allowed to.

And algorithms can drive that kind of thinking.

I think that, I think that I think he would be really upset if he saw how much of our medical practice today is driven by that common stupidity.

Like as if every diabetic patient needs the exact same course of treatment and the exact same attention from their doctor.

And you know what I mean?

Yeah.

We have to individualize our care, use the evidence, and then do what works for the patient.

That's like at the core of a lot of the medicine I practice.

That was only six.

The last was sloth.

I just can't count.

What?

I just can't count, apparently.

Is that one of them?

The last one was sloth.

And sloth is sloth.

You know what sloth is.

Sloth.

You know, sloth from Goonies.

Well, no, he's not a physician.

Don't be lazy.

He doesn't want to be a physician.

He lives in a pirate ship.

He's just saying don't be lazy.

Okay.

You know.

But I think that this was all really

revolutionary thinking at the time.

It's still not something that we fully embraced or that we have combated, especially in the American healthcare system now.

You know, I don't know if some of these deadly sins of medicine are better addressed in like the UK or in any other country, in any other of the,

you know, many, many countries that have some sort of universal healthcare system, a single-payer system, perhaps it eliminates some of these issues.

Maybe you are allowed to provide better care to your patient.

And

I don't know, maybe there aren't so many barriers.

But

he wrote some other articles based on the things he observed because he was, like I said, in charge of that unit.

He was able to write about.

and describe what we called myxedema madness.

So in severe cases of hypothyroidism, when you don't have enough thyroid hormone,

a patient can begin to have some psychiatric symptoms as well.

And those two things were being treated completely separately.

People did not understand that by treating the thyroid, by replacing the thyroid hormone, it would help alleviate the psychiatric symptoms.

And he was the first one to sort of pull that together, which again, the importance of understanding that for some psychiatric illness, there's some other, like it's a secondary symptom to some other medical cause is really critical.

And it's why today, if I have a patient come in with symptoms of mania, I'm going to check their thyroid or depression.

I'm going to check their thyroid a lot of times, just in case, because if that, that could be treatable.

Although, just to make the point, depression and mania are treatable as well, just like primarily.

These are all things that are treatable, but we need to treat them in the appropriate way, right?

Not use common stupidity.

He did talk about how hypnosis is pretty cool.

So I don't know about that one, Dr.

Asher.

He had a whole series on why we need to investigate hypnosis more.

This is settled.

And I thought you would appreciate it.

He wrote a whole series of articles on using your senses in practicing medicine.

And in the first one, he misquoted Sherlock Holmes.

Oh, no.

And he immediately got a letter to the journal from somebody saying, you know, actually.

You misquoted Holmes, to which he put out this huge public apology because he was part of like a Sherlock Holmes historical society and was like a scholar on a home.

If you're going to mess up with somebody, don't do it with Sherlock Holmes fans, man.

That's the last group you should try to mess up with.

And he, uh, and and relentless.

Oh, absolutely.

And then he finally wrote an entire article called Why Are Medical Journals So Dull?

And in it, he is so like complete, he is so thorough.

He starts off with like the first section of this article is wrappers and covers.

Like the first thing he talks about is how drab the wrappers are.

And nowadays they come in like plastic, like clear plastic.

They look like cool cars.

You know?

There's never pictures of cool cars.

They're cool, like sports guys or anybody, like nothing cool like that.

No planes, nothing neat.

He talks about how many would come rolled up and that they would be hard to read because they were rolled up and you'd have to to keep unrolling them as you're reading

so he's like i mean he's completely trashing like the wrappers and covers the titles are terrible uh they don't have color so much of the journal is just words they're just no pictures the one that any jm

covers that you used to get sometimes they had what was that the journal that had the wild images on every single cover it was like an illustration that was wilder than the one before it like that was trying to communicate something so abstract it was just like illustrating an article that was in the magazine but like it would be.

You're talking, no, any JM is just a list of articles.

Yeah, that's not, that's not, maybe it's the family journal that the American Academy of Family Practice Journal, that one, the AFP journal is,

that has a picture.

Yeah, and sometimes those are drawings.

Those are commonly drawings, not just picture pictures, but yeah.

But yeah, he talks about there need to be more pictures.

There need to be color pictures, and then like the actual articles that they don't,

that the content of them doesn't have a point.

And I think it's interesting because

the way that a journal article is supposed to be structured, you're often just sort of, like there are

big chunks of it where you're just saying what the data was.

Yeah.

We found this.

This was the number.

This was the statistical analysis.

They aren't, there isn't a point per se.

It's just like listing the, now there is a thing at the bottom where you have the discussion piece.

Right.

And the discussion, you can get to a point.

Like you can say, okay, here was all the data.

This is what we drew from it.

And I mean, I think what he's trying to get to is like,

think about how you're going to use that to impact your audience.

Which I, I mean, I don't, I can't say I was ever taught to do creative writing within a medical journal.

If it's not practically useful, at some point, you, you lose some of the purpose, I guess.

Anyway, he was, he was a really interesting character.

He eventually

retired and stopped, stopped working as much.

And I think he had some like health complications, but he spent a lot of time.

I know.

You don't agree this with everybody, honey.

What I was going to say is he spent a lot of time playing wind instruments in the piano at that point in his life.

Yeah.

Very musical, which obviously we've talked about was passed along to his children.

And his

book, Richard Asher, Talking Sense, it was actually published after he passed away.

It was a lot of his papers and stuff like that.

And I think that there are a lot of lessons there about the way we talk about medicine, the way we talk to to our patients, the way we think about taking care of people that we could really continue to,

you know, to learn and benefit from today.

But I just like him.

He was eccentric and he was

a little irreverent.

to medicine, which I think is always a good thing.

Don't get so steeped in the tradition and austerity of the ivory towers that you forget that you're just taking care of people.

It's the most human thing you can do.

It's the,

I think, an instinct we all share, and it's what connects you to your patients.

And don't ever, don't ever lose that.

Thank you so much for listening to our podcast.

It's called Sawbones.

It's a marital tour of Misguided Medicine.

We are your co-hosts, Justin and Sidney McElroy.

I want to say thanks to the taxpayers for the use of their song of medicines as the intro and outro of our program.

They have some new merch on their Bandcamp page.

If you search for it, you'll find it.

And you can buy some shirts or some vinyl records, whatever you want to do.

You can get it there.

Thanks to the Max Fun Network is having us as a part of their extended podcasting family.

And thanks to you for listening.

That's going to do it for us for this week.

Until next time, my name is Justin McElroy.

I'm Sydney McRoy.

And as always, don't drill a hole in your head.

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