Speaker 1: From CurtCo Media.
Bill Curtis: Previously in our Malibu Studio and this time visiting us
Bill Curtis: again by Zoom, we're honored to have Dr. Howard Jay
Bill Curtis: Fullman join us to catch up on medicine, practice and
Bill Curtis: politics prevention, and of course, a bit about our fight
Bill Curtis: against COVID- 19. So may we suggest that you pour
Bill Curtis: yourself a double, sit back and join us on Medicine,
Bill Curtis: We're Still Practicing, I'm Bill Curtis. First, our host, the
Bill Curtis: quadruple board- certified doctor of internal medicine, pulmonary disease, critical
Bill Curtis: care and neurocritical care, my very good friend, Dr. Steven
Bill Curtis: Taback. How are you, Steve?
Dr. Steven Taback: Hey bill. Good to see you.
Bill Curtis: We haven't had dinner together for a while.
Dr. Steven Taback: I don't even remember what that was like, to actually have dinner and enjoy an evening.
Bill Curtis: So, we have one of our favorite experts rejoining us
Bill Curtis: today, Dr. Howard Jay Fullman. He's board- certified in internal
Bill Curtis: medicine and gastroenterology. We'll learn more about that in a minute.
Bill Curtis: Howard served a multi- decade tenure at Kaiser Permanente as
Bill Curtis: partner, board member, president of the executive committee, chief of
Bill Curtis: staff and chair of the quality committee. He supervised 4,
Bill Curtis: 300 staff and over 500 doctors. Howard is now senior
Bill Curtis: operating advisor at the Atlantic Street Capital for their medically
Bill Curtis: focused investments. Dr. Howard Jay Fullman, welcome back.
Dr. Howard Jay Fullman: Hi, Bill. Nice to be here, Steven, nice to see
Dr. Howard Jay Fullman: you as well.
Dr. Steven Taback: Hey, Howard. Good to see you.
Bill Curtis: So last time we met in our studio in Malibu
Bill Curtis: was only back in February and it seems like a
Bill Curtis: whole lifetime ago.
Dr. Howard Jay Fullman: It's been quite a year and we're only halfway through
Dr. Howard Jay Fullman: it and we know there's a lot more to come.
Bill Curtis: Howard, I hope you'll forgive me, but I took my
Bill Curtis: nasty pill this morning. So I want to dive into
Bill Curtis: a difficult issue. But as of the time of this recording, according to
Bill Curtis: Johns Hopkins, Japan, although infected early has less than one
Bill Curtis: COVID death, per 100,000 population. While the US has 39
Bill Curtis: COVID deaths per 100,000 population. Japan has more elderly per
Bill Curtis: capita than any other country. They kept their borders open
Bill Curtis: during the Wuhan locked down. The stay home requests by
Bill Curtis: Japanese government have been voluntary as was any of the
Bill Curtis: closing of their non- essential businesses. And now for a
Bill Curtis: country with one city that houses more than 37 million
Bill Curtis: people, they have less than a thousand deaths countrywide. What
Bill Curtis: the hell is going on?
Dr. Howard Jay Fullman: I don't know that anyone knows exactly all of the differences,
Dr. Howard Jay Fullman: but I'll give you some of the reasons, I think
Dr. Howard Jay Fullman: that there may be differences. One is there's probably a
Dr. Howard Jay Fullman: genetic component to this disease that we don't quite understand.
Dr. Howard Jay Fullman: People are speculating. Why was it so much more (inaudible)
Dr. Howard Jay Fullman: Italy? Maybe it's because Italians get together a lot more
Dr. Howard Jay Fullman: than others. People even wonder whether there might've been some
Dr. Howard Jay Fullman: genetic predisposition to the cytokine storms, for example. Another are
Dr. Howard Jay Fullman: the comorbidities in patient populations, though age is one thing,
Dr. Howard Jay Fullman: you're right. Japanese population is actually older than the US
Dr. Howard Jay Fullman: population. But other comorbidities like obesity, which is turning out
Dr. Howard Jay Fullman: to be a very significant risk factor. There's unfortunately still
Dr. Howard Jay Fullman: a lot more obesity in United States than there is
Dr. Howard Jay Fullman: in Japan. So just because we've sorted out that the
Dr. Howard Jay Fullman: age factor may not explain it, but we have some
Dr. Howard Jay Fullman: more chronic illness in the United States that may be
Dr. Howard Jay Fullman: contributing to it as well. And then, the way we've
Dr. Howard Jay Fullman: handled the public health aspect of this. And again, I
Dr. Howard Jay Fullman: also want to be very careful about criticism of even
Dr. Howard Jay Fullman: the public health system, because I'm sure there's a lot
Dr. Howard Jay Fullman: of things we look back and could have done differently,
Dr. Howard Jay Fullman: but we also still have a lot of public health
Dr. Howard Jay Fullman: officers, some extremely courageous ones. And I'll say that I
Dr. Howard Jay Fullman: think unfortunately, some of our public does not really believe
Dr. Howard Jay Fullman: in this pandemic, the seriousness that they should, and that
Dr. Howard Jay Fullman: may be affecting the outcomes as well. There are certain
Dr. Howard Jay Fullman: communities as you know where substantial numbers of people were
Dr. Howard Jay Fullman: having just seemingly significant disregard. And so there might have
Dr. Howard Jay Fullman: been large numbers coming in that are just a bolus of people
Dr. Howard Jay Fullman: coming in all at once that saturated the healthcare system,
Dr. Howard Jay Fullman: made it hard to take care of so many people
Dr. Howard Jay Fullman: and possibly people coming in later than they should have
Dr. Howard Jay Fullman: because of perhaps denial about the significance of this illness
Dr. Howard Jay Fullman: when it is severe. And it's not because I'm a
Dr. Howard Jay Fullman: doctor that I don't want to fault the nurses and
Dr. Howard Jay Fullman: the doctors and the rest, is just I've seen what
Dr. Howard Jay Fullman: they're doing and I follow it very carefully and I'm
Dr. Howard Jay Fullman: very proud of them. But I think because of the
Dr. Howard Jay Fullman: differences in population and our public health system is not
Dr. Howard Jay Fullman: working well, is not designed the way it should be
Dr. Howard Jay Fullman: and is not functioning in the way that it has
Dr. Howard Jay Fullman: been planned to function in the past.
Dr. Steven Taback: First of all, I agree with you on just about
Dr. Steven Taback: every single point. I do believe the health care delivery,
Dr. Steven Taback: when it comes down to doctors, nurses, ancillary staff who
Dr. Steven Taback: are caring for the patients in this country are courageous,
Dr. Steven Taback: hardworking, dedicated. One of the things that is not different
Dr. Steven Taback: is the treatment of these patients, really are standardized because
Dr. Steven Taback: we're so global in our information dissemination. Remdesivir now is
Dr. Steven Taback: standard and Decadron now is standard. And everybody is looking
Dr. Steven Taback: at the literature very clearly on what to do and
Dr. Steven Taback: what not to do. Hydroxychloroquine quickly dropped out. So there is certainly a public
Dr. Steven Taback: health deficiencies, but I think in terms of health care
Dr. Steven Taback: delivery, the standard of care has been the standard of
Dr. Steven Taback: care. Minimizing intubations, proning patients. This is all stuff that's
Dr. Steven Taback: being done in a standardized way. And everybody is sort of
Dr. Steven Taback: catching up with the literature very quickly. When I look
Dr. Steven Taback: at the two cultures, and I don't have the real
Dr. Steven Taback: stats on this, but two things I would look at
Dr. Steven Taback: if you're with the question of comparing Japanese society and
Dr. Steven Taback: the United States would be, again, the populace compliance. Is
Dr. Steven Taback: the general public compliant with the stay at home orders,
Dr. Steven Taback: the distancing orders? And although it may be suggested if a
Dr. Steven Taback: 100% of the people are following the suggestion, versus the
Dr. Steven Taback: United States where I'm not even sure what the compliance rate
Dr. Steven Taback: is, but you can sort of do your own sampling,
Dr. Steven Taback: but I don't think that we are in the state
Dr. Steven Taback: that we're in at this very second, so much because
Dr. Steven Taback: of the public health entities as it is that we
Dr. Steven Taback: are not as mature as we should be in this
Dr. Steven Taback: country relative to taking care of each other's wellbeing.
Bill Curtis: The reality is that was a nasty question because the expression, there
Bill Curtis: are lies, damn lies and statistics. We didn't take into
Bill Curtis: account in that question, the number of people who are
Bill Curtis: coming down with the virus and how transmissible it is
Bill Curtis: in the way our society is structured. One thing you
Bill Curtis: have to know about Japan is personal discipline and public
Bill Curtis: respect is at a high level in Japan. Steve, in
Bill Curtis: many of these shows I've thanked you for being on
Bill Curtis: the front lines. You and your brethren are just doing
Bill Curtis: an amazing job at dealing with this pandemic. We, on
Bill Curtis: the other hand, our country is not doing an amazing
Bill Curtis: job. And the part of the lies, damn lies and
Bill Curtis: statistics that I was referring to, is that frankly, a
Bill Curtis: lot more people are catching the virus as a per
Bill Curtis: capita statistic than in Japan. And the reason for that
Bill Curtis: is because we're sloppy. And I'm just wondering for those
Bill Curtis: of you in the medical profession, does that piss you off?
Dr. Steven Taback: Okay. I can speak to that and two things. One,
Dr. Steven Taback: yes, it makes me angry, but it also makes me incredibly
Dr. Steven Taback: sad because you like to think of United States as
Dr. Steven Taback: really the leader of the world. And we've led the
Dr. Steven Taback: world in so many positive ways, but this notion of
Dr. Steven Taback: respect for your fellow citizen, a sense of discipline, a
Dr. Steven Taback: sense of a greater level of sophistication that we should
Dr. Steven Taback: be afforded because we are a free society, it should
Dr. Steven Taback: make us more advanced in our thinking. It should make
Dr. Steven Taback: us more sophisticated in our response to stress.
Dr. Howard Jay Fullman: Yeah. I think we're very proud of our country in
Dr. Howard Jay Fullman: terms of the sense of self expression and the almost
Dr. Howard Jay Fullman: duty to speak up. We don't always do that so
Dr. Howard Jay Fullman: well, but certainly compared to countries around the world. But
Dr. Howard Jay Fullman: I think we've lost a little bit of the concept
Dr. Howard Jay Fullman: of the value of expertise and the concept of pulling
Dr. Howard Jay Fullman: together as a group when it's important to. And sometimes
Dr. Howard Jay Fullman: is hard for people to change that mindset because we're
Dr. Howard Jay Fullman: so often in that autonomy mindset and wanting to know
Dr. Howard Jay Fullman: everyone's opinion. But at a time like this, there are
Dr. Howard Jay Fullman: certain opinions that are actually more valuable. So I'm hoping
Dr. Howard Jay Fullman: that since we have months and months of this pandemic
Dr. Howard Jay Fullman: ahead of us, that we can get a little bit
Dr. Howard Jay Fullman: away from the demonizing and the divisiveness and the politics
Dr. Howard Jay Fullman: and stay with the facts and the science and get
Dr. Howard Jay Fullman: us collectively to do the right thing because we are not
Dr. Howard Jay Fullman: through it and we have a long way to go.
Dr. Steven Taback: What do you think the solution is? Because obviously philosophically, we are all
Dr. Steven Taback: on the same page here in this room as we're
Dr. Steven Taback: talking about this. There is some truth to the fact
Dr. Steven Taback: that if you are slowly eroding your resources financially, eventually
Dr. Steven Taback: not having a business almost equates to loss of life
Dr. Steven Taback: and limb and a family has to decide, " Listen, we
Dr. Steven Taback: have no choice. I have to take a risk. I
Dr. Steven Taback: have to go to work. I have to do something.
Dr. Steven Taback: Otherwise, it's either my family is going to die of COVID or
Dr. Steven Taback: my family's going to die of starvation. I'm going to
Dr. Steven Taback: take my chances." What is the equation that allows us
Dr. Steven Taback: to strike that balance amongst those families that they say
Dr. Steven Taback: the average family has about three months worth of cash
Dr. Steven Taback: stored up before they're in dire straits?
Dr. Howard Jay Fullman: Very valid point, because we've been until now speaking kind
Dr. Howard Jay Fullman: of unit dimensionally as though the whole goal is simply
Dr. Howard Jay Fullman: prevent as many people as possible from getting COVID period.
Dr. Howard Jay Fullman: Right? And if we do that, that will lead to
Dr. Howard Jay Fullman: the maximal savings of life and prosperity and everything. And
Dr. Howard Jay Fullman: it's actually not entirely true. So yes, we should be
Dr. Howard Jay Fullman: doing prudent things, evidence- based things but the lesson by a
Dr. Howard Jay Fullman: lot the chances of people getting COVID, but we also
Dr. Howard Jay Fullman: have to realize that some of the ways that we're
Dr. Howard Jay Fullman: tackling the problem are causing not just economic problems, but
Dr. Howard Jay Fullman: your own health problems. So, if someone goes from solid
Dr. Howard Jay Fullman: financially to impoverished, that has health consequences. In addition, as
Dr. Howard Jay Fullman: we know, yes, this is a very, very serious virus,
Dr. Howard Jay Fullman: but many people have no symptoms. And we have some
Dr. Howard Jay Fullman: sense about who's at the greatest risk of developing severe
Dr. Howard Jay Fullman: symptoms or death. And so as part of the public
Dr. Howard Jay Fullman: health response, and as part of the economic approach, we
Dr. Howard Jay Fullman: need to be taking into account how do we save
Dr. Howard Jay Fullman: people when actions are being taken that hurt them financially?
Dr. Howard Jay Fullman: How do we put some structure around them, whether it's
Dr. Howard Jay Fullman: at the school level or what have you? How do
Dr. Howard Jay Fullman: we make sure that the other medical care that's also
Dr. Howard Jay Fullman: lifesaving and important is not forgotten? That's why this is
Dr. Howard Jay Fullman: so complicated. So the solutions have to be much more
Dr. Howard Jay Fullman: robust. They have to build on the things we've been
Dr. Howard Jay Fullman: talking about, but it's also going to mean that we
Dr. Howard Jay Fullman: have to stratify people and we have to protect the
Dr. Howard Jay Fullman: most vulnerable in a more profound way than those that are
Dr. Howard Jay Fullman: less vulnerable. And we have to be thoughtful about how
Dr. Howard Jay Fullman: we try to keep things going in the society as
Dr. Howard Jay Fullman: we get through the pandemic until we have true game-
Dr. Howard Jay Fullman: changers and those game changers in my mind, the medications
Dr. Howard Jay Fullman: that we have so far have been to a degree
Dr. Howard Jay Fullman: game changers, there will be more. Getting testing done to
Dr. Howard Jay Fullman: a large enough extent that we can actually figure out
Dr. Howard Jay Fullman: who should be isolated and quarantined and who should not
Dr. Howard Jay Fullman: be and making sure that testing is available very substantially,
Dr. Howard Jay Fullman: especially for institutions. And then the ultimate game changer, the
Dr. Howard Jay Fullman: hope that we ultimately get a vaccine.
Bill Curtis: Would you guys suggest that perhaps we let younger, less
Bill Curtis: vulnerable people go back to work and go back to
Bill Curtis: the restaurants and go back to school and recommend the
Bill Curtis: folks that are more at risk, they stay home?
Dr. Howard Jay Fullman: I would say, this is where leadership really comes in,
Dr. Howard Jay Fullman: because I actually do agree with some version of what
Dr. Howard Jay Fullman: you stated, put the maximum focus on those at greatest
Dr. Howard Jay Fullman: risk. On the other extreme for the young and healthy
Dr. Howard Jay Fullman: so to speak, I don't think we should say to them, "
Dr. Howard Jay Fullman: You just go out and just work, do whatever you
Dr. Howard Jay Fullman: want." That's just absolutely unwise and we should still recommend
Dr. Howard Jay Fullman: to them strongly and again, this is where leadership comes
Dr. Howard Jay Fullman: in, that they take very appropriate (inaudible) and actions.
Dr. Howard Jay Fullman: And especially if they have contact with people at higher
Dr. Howard Jay Fullman: risk, they in particular need to be more isolated from
Dr. Howard Jay Fullman: those folks, et cetera. But I'm not convinced that we
Dr. Howard Jay Fullman: should do it in a binary manner. The elderly should
Dr. Howard Jay Fullman: be isolated and the young and healthy should just be
Dr. Howard Jay Fullman: able to do whatever they want without any modifications whatsoever.
Dr. Howard Jay Fullman: I think there's something between the extremes that we should
Dr. Howard Jay Fullman: be doing, but it's going to take some serious leadership
Dr. Howard Jay Fullman: to get that to happen just as Steven says. We're
Dr. Howard Jay Fullman: having a devil of a time getting the current recommendations,
Dr. Howard Jay Fullman: going and to have the population adhere to them. And as time
Dr. Howard Jay Fullman: goes on, people get fatigued and it gets a little
Dr. Howard Jay Fullman: harder to abide by these things. Not easier. I'd like
Dr. Howard Jay Fullman: to see the politics go away. The polarization go way.
Dr. Howard Jay Fullman: This is a time for us to come together. We
Dr. Howard Jay Fullman: need solidarity in the American resolve and common purpose to
Dr. Howard Jay Fullman: get through the next several months.
Bill Curtis: We're going to talk about politics in medicine in just a minute. We'll
Bill Curtis: be right back after this break.
Speaker 5: Welcome to Life Done Better. Listen to the weekly episodes
Speaker 5: where supermodel and health coach, Jill de Jong talks to
Speaker 5: some of the world's most inspiring women in health and
Speaker 5: wellness. It's the place for all the unicorns who strive
Speaker 5: to create a life on their own terms. Join us
Speaker 5: to explore, discover, and create a Life Done Better, together.
Speaker 5: Listen and subscribe from CurtCo Media, media for your mind.
Bill Curtis: We're back with doctors, Howard Jay Fullman and Steven Taback.
Bill Curtis: I don't want to go back to the beginning of
Bill Curtis: COVID, which seems like eons ago, because arguably there are
Bill Curtis: those who say that if the administration had handled the
Bill Curtis: beginning of COVID differently, then we might be in a
Bill Curtis: different situation. But if right now we had a new
Bill Curtis: administration and they had to take on what is happening
Bill Curtis: with this pandemic where Florida, Texas, California, I think Arizona
Bill Curtis: is just breaking out. Do you believe that a different
Bill Curtis: administration could have an effect on the disease?
Dr. Steven Taback: Ask Texas, ask Florida, ask Arizona. They all were kind
Dr. Steven Taback: of adhering to the party line of our Republican president
Dr. Steven Taback: that said, " This is a hoax. This is not as
Dr. Steven Taback: significant as everyone else's making it and you don't need
Dr. Steven Taback: to be wearing a mask." And everybody in solidarity to
Dr. Steven Taback: the president, adhered to his recommendations and showed that we're
Dr. Steven Taback: going to open churches, we're going to open schools, we're
Dr. Steven Taback: going to open restaurants. We're not going to social distance.
Dr. Steven Taback: And they're paying a huge price and quickly they shut
Dr. Steven Taback: their societies down. And they realized that maybe this wasn't
Dr. Steven Taback: the right choice. So yeah, I think even now, if
Dr. Steven Taback: we had everybody on the same page and this wasn't
Dr. Steven Taback: politicized and we say this is dangerous. Yeah, it would save hundreds of
Dr. Steven Taback: thousands of lives over the next year.
Dr. Howard Jay Fullman: Well, first of all, in the obvious, this is a really
Dr. Howard Jay Fullman: bad virus. So I want to make the point that
Dr. Howard Jay Fullman: I don't care who's running the country, this is a
Dr. Howard Jay Fullman: very difficult problem. You look around the world and yes,
Dr. Howard Jay Fullman: you can find some countries that are doing relatively better,
Dr. Howard Jay Fullman: but by and large, most countries are having a devil
Dr. Howard Jay Fullman: of a time. Now going to your question, Bill, do
Dr. Howard Jay Fullman: I think... Let's not make a Democrat, Republican, just another
Dr. Howard Jay Fullman: administration comes in. Do I think that that would make
Dr. Howard Jay Fullman: a difference? Absolutely. I do. I think having the leader
Dr. Howard Jay Fullman: of our government make it clear that this is serious.
Dr. Howard Jay Fullman: Now we all have to pull together and stop blaming
Dr. Howard Jay Fullman: people. What we should be doing is pulling together, coming up
Dr. Howard Jay Fullman: with a (inaudible) and plan and try to advocate for
Dr. Howard Jay Fullman: that plan. And that plan should include in my mind,
Dr. Howard Jay Fullman: masks, physical and social distancing, protecting the weakest members and
Dr. Howard Jay Fullman: the most vulnerable members of the society, improving testing capacity
Dr. Howard Jay Fullman: massively so it could be available on demand. Making sure
Dr. Howard Jay Fullman: we have an adequate amount of PPE at all times
Dr. Howard Jay Fullman: in all states, all hospitals and all institutions. And then
Dr. Howard Jay Fullman: making sure every bit of support is being given to
Dr. Howard Jay Fullman: the scientific community to make sure that as quickly as
Dr. Howard Jay Fullman: possible, a credible vaccine can be developed and commercialized, the
Dr. Howard Jay Fullman: more medications can be done. Those are the basic elements.
Bill Curtis: So all of that being said, you guys actually have
Bill Curtis: learned a remarkable amount about this disease in a very
Bill Curtis: short period of time. If you look at the Johns
Bill Curtis: Hopkins breakdown, the very early states who contracted massive amounts
Bill Curtis: of this virus, New York and New Jersey, for example,
Bill Curtis: the death rate was off the charts. Can you tell
Bill Curtis: us a little about specifics of what has changed in
Bill Curtis: the last four months that is radically reduced the rate
Bill Curtis: of deaths from this virus?
Dr. Steven Taback: Well, let's start off with the notion of stay at
Dr. Steven Taback: home, of social distancing, of flattening the curve, because the
Dr. Steven Taback: whole reasoning behind that isn't stay at home forever until
Dr. Steven Taback: the virus decides it's going to go away. The whole
Dr. Steven Taback: point of that is to limit the number of people
Dr. Steven Taback: who get the illness so you don't overwhelm your healthcare
Dr. Steven Taback: system. But more importantly, in the longterm, you want as
Dr. Steven Taback: many people as possible to avoid the illness so that
Dr. Steven Taback: technology can catch up with the disease. If we can
Dr. Steven Taback: wait long enough, there will be new technology that actually
Dr. Steven Taback: will be lifesaving and will mitigate the severity of this
Dr. Steven Taback: illness. And I think that's exactly what you're seeing.
Bill Curtis: Even in four months?
Dr. Steven Taback: Yes. You have to remember when this first came out,
Dr. Steven Taback: we heard that hydroxychloroquine, this malaria medication was thought to
Dr. Steven Taback: be effective than it has been used in other countries.
Dr. Steven Taback: And that was our initial treatment. And then we realized
Dr. Steven Taback: that most people who were intubated and on a ventilator
Dr. Steven Taback: seem not to do well. So then there's this philosophy
Dr. Steven Taback: that maybe we shouldn't intubate so soon. Historically in medicine,
Dr. Steven Taback: if someone's really struggling to breathe, you want to ease
Dr. Steven Taback: the metabolic stress. You put them on a ventilator and
Dr. Steven Taback: you rest them so that you're breathing for them. We
Dr. Steven Taback: found this to be somewhat counterproductive. And so we delay
Dr. Steven Taback: mechanical ventilation. We are proning people, people are put in
Dr. Steven Taback: a face down position because it improves oxygenation and at
Dr. Steven Taback: the end of the day, will lower the amount of
Dr. Steven Taback: oxygen that you have to give these patients, which will
Dr. Steven Taback: reduce a lot of the scarring of the lungs that
Dr. Steven Taback: are caused by the free radicals of oxygen. All of these
Dr. Steven Taback: things have ramped up fairly quickly over past four months,
Dr. Steven Taback: not quick enough, unfortunately. But yeah, this is the beauty
Dr. Steven Taback: of technology. This is the whole point of flattening the
Dr. Steven Taback: curve to let technology get ahead of this. A vaccine
Dr. Steven Taback: is coming.
Dr. Howard Jay Fullman: I would add, we're getting a better understanding of the
Dr. Howard Jay Fullman: pathophysiology of the virus as we've had more time to
Dr. Howard Jay Fullman: understand it. So for example, one of the phenomena that's
Dr. Howard Jay Fullman: contributing to some of the severe morbidity is this concept of
Dr. Howard Jay Fullman: cytokine storms and such, certain people for whatever reason, have
Dr. Howard Jay Fullman: an overreaction of their immune system. And that means that their
Dr. Howard Jay Fullman: lungs will fill up with various inflammatory cells and fluids,
Dr. Howard Jay Fullman: and that contributes to the morbidity of the disease. And
Dr. Howard Jay Fullman: so we're trying to figure out how to tackle that particular
Dr. Howard Jay Fullman: element. I think it's amazing how much has been learned
Dr. Howard Jay Fullman: in such a short amount of time, just starting with
Dr. Howard Jay Fullman: being able to get the RNA sequencing of the virus
Dr. Howard Jay Fullman: itself in such a short order. And then lastly, we
Dr. Howard Jay Fullman: are fortunate having this pandemic occur now, as opposed to
Dr. Howard Jay Fullman: let's say 20, 30 years ago. For one thing, our social
Dr. Howard Jay Fullman: adaptation to it, think about it, if we didn't have
Dr. Howard Jay Fullman: all this ability to communicate with each other, the isolationism
Dr. Howard Jay Fullman: that is already happening to a degree would be much more
Dr. Howard Jay Fullman: profound if we didn't have these other ways of connecting
Dr. Howard Jay Fullman: as we are for example today. But also, we are
Dr. Howard Jay Fullman: benefiting from the great work done by so many scientists
Dr. Howard Jay Fullman: during the AIDS epidemic and subsequently where there's so much
Dr. Howard Jay Fullman: more knowledge about viruses and antiviral therapy. And there are
Dr. Howard Jay Fullman: so many medications that are on the shelf that have
Dr. Howard Jay Fullman: been tried for a variety of serious viruses in the last
Dr. Howard Jay Fullman: 25 years, that experimenting with those drugs and not having
Dr. Howard Jay Fullman: to just create brand new drugs anew has also, I
Dr. Howard Jay Fullman: think, accelerated the rate of treatment and the ability to treat this
Dr. Howard Jay Fullman: illness as well.
Bill Curtis: Well, we're going to take another quick break. And when
Bill Curtis: we come back, we're actually going to talk about something other than COVID.
Speaker 6: If you're like us, you're looking for a way to
Speaker 6: make stay at home a little more special. Well, we're
Speaker 6: going to let you in on our secret. Join Robb
Speaker 6: Vices to get luxury cocktail kits, toys, tools, tech, and
Speaker 6: other incredible items delivered straight to your home on a
Speaker 6: monthly basis. The value is incredible. Your first box is
Speaker 6: going to be a $ 400 tequila curation, and you can
Speaker 6: sign up for as little as 99 bucks a month.
Speaker 6: Use the code PODCAST and you'll save an extra 50
Speaker 6: bucks at signup. So head to robbvices. com to bring
Speaker 6: exciting experiences safely to your door. Remember use the code
Speaker 6: PODCAST and go to R- O- B- B- V- I- C- E- S. com.
Bill Curtis: Okay. We're back with Dr. Howard Jay Fullman and Dr.
Bill Curtis: Steven Taback. And I promised you we'd talk about something
Bill Curtis: other than COVID. I'd like to talk to you for
Bill Curtis: a minute, Howard, about your gastroenterology. First of all, define
Bill Curtis: it for us.
Dr. Howard Jay Fullman: Gastroenterology is the study of the intestinal system.
Bill Curtis: So tell me, has your specialty been affected by COVID?
Bill Curtis: I told you we wouldn't be talking about COVID.
Dr. Howard Jay Fullman: Yes, it has been. This virus causes symptoms and problems
Dr. Howard Jay Fullman: in many, many different systems. Again, I think as we
Dr. Howard Jay Fullman: were (inaudible) to before, primarily this is causing trouble
Dr. Howard Jay Fullman: in the pulmonary system, but patients do have gastrointestinal symptoms
Dr. Howard Jay Fullman: often as a part of this, about 30% to 40%
Dr. Howard Jay Fullman: of patients have nausea, vomiting, diarrhea. And very common symptom
Dr. Howard Jay Fullman: has been loss of taste and loss of smell.
Bill Curtis: Yeah, that's weird. What causes that?
Dr. Howard Jay Fullman: It's important to know that know viruses are not actually independent
Dr. Howard Jay Fullman: living things. Viruses are only able to exist by attaching
Dr. Howard Jay Fullman: themselves to cells and then taking over the cell infrastructure
Dr. Howard Jay Fullman: and then using the infrastructure to multiply and do other
Dr. Howard Jay Fullman: sorts of things that harm the individual. And each of
Dr. Howard Jay Fullman: these viruses has a different propensity to attach to different
Dr. Howard Jay Fullman: parts of the body based upon the chemical makeup of
Dr. Howard Jay Fullman: the virus or the receptors that the virus has that
Dr. Howard Jay Fullman: can attach to the receptors of the cell. It seems
Dr. Howard Jay Fullman: as though there's some particular connection between this virus and
Dr. Howard Jay Fullman: the nerve that controls smell and the taste buds. So
Dr. Howard Jay Fullman: the olfactory nerve and the taste buds and the fact
Dr. Howard Jay Fullman: that might even be the way it enters the body. And
Dr. Howard Jay Fullman: when it connects to those parts of the anatomy, it
Dr. Howard Jay Fullman: damages them. And there's a loss of taste and loss of smell.
Bill Curtis: Interesting. So I wanted to ask you about gut immunity
Bill Curtis: pertaining to our youth. In theory, exposing our kids to
Bill Curtis: more dirt and bacteria helps them build their gut and immune
Bill Curtis: system. Is this safe, or should we keep them more sanitary?
Dr. Howard Jay Fullman: There is dirt and there's other kinds of dirt. Some
Dr. Howard Jay Fullman: people think that we have been a little bit austere
Dr. Howard Jay Fullman: in trying to avoid contact with germs and that in
Dr. Howard Jay Fullman: fact our immunologic system requires a regular contact with various
Dr. Howard Jay Fullman: kinds of germs so that we're constantly making antibodies and
Dr. Howard Jay Fullman: our lymphocytes have exposure to different foreign elements so that
Dr. Howard Jay Fullman: they have greater capabilities. So obviously we don't want to
Dr. Howard Jay Fullman: expose our children or our adults to dangerous germs. And
Dr. Howard Jay Fullman: there are many of them and some of them can
Dr. Howard Jay Fullman: be in dirt and some of them are in the
Dr. Howard Jay Fullman: environment, in the air. And some of them are things
Dr. Howard Jay Fullman: we have physical contact with. I should say parenthetically people
Dr. Howard Jay Fullman: are very worried about COVID and there's so much work
Dr. Howard Jay Fullman: going on sanitizing surfaces, and that does have some value,
Dr. Howard Jay Fullman: but by and large, this virus is contracted through a
Dr. Howard Jay Fullman: respiratory contact. So actually that's why the masks are so
Dr. Howard Jay Fullman: important, then the distancing is so important.
Bill Curtis: Howard, that being said, if as you said a minute
Bill Curtis: ago, if regular exposure to germs is important, wouldn't this
Bill Curtis: stay at home, lack of exposure to other germs because
Bill Curtis: we fear COVID, wouldn't that end up having ramifications down
Bill Curtis: the road where we could all die of the common cold?
Dr. Howard Jay Fullman: Yeah, I guess it's possible. I don't think any public
Dr. Howard Jay Fullman: health official or epidemiologist would recommend that longterm we have
Dr. Howard Jay Fullman: everybody isolated from each other. But right now we have
Dr. Howard Jay Fullman: such an incredibly contagious virus that it's more likely that
Dr. Howard Jay Fullman: someone could acquire something bad than being exposed to something beneficial.
Dr. Steven Taback: And we're not isolating in an aseptic environment. There's germs
Dr. Steven Taback: at your home. There's germs at the post office. There's
Dr. Steven Taback: germs in the grocery store that you're still coming in
Dr. Steven Taback: contact with and you've already had tremendous exposure throughout your
Dr. Steven Taback: life. So, let's say this is a one year deal or even
Dr. Steven Taback: a two year deal. That alone is not going to
Dr. Steven Taback: have significant ramifications. And certainly when you weigh what you
Dr. Steven Taback: were saying, Howard is would you weigh out the risk
Dr. Steven Taback: benefit, the risk of actually exposing yourself to COVID far
Dr. Steven Taback: outweighs any kind of risk that you would endure by
Dr. Steven Taback: the common cold two years from now.
Dr. Howard Jay Fullman: But Bill, I do want to add on if I
Dr. Howard Jay Fullman: may, even while we're now isolating to a degree and
Dr. Howard Jay Fullman: wearing masks, there's still things we can be doing in
Dr. Howard Jay Fullman: addition to exposure to germs that can help our immune system.
Bill Curtis: And what are some of those?
Dr. Howard Jay Fullman: Well, healthy eating. Even by the way, people who have
Dr. Howard Jay Fullman: diabetes, obesity, right now, adhering to the diet that the
Dr. Howard Jay Fullman: physicians have recommended could be very beneficial to them. Losing
Dr. Howard Jay Fullman: a few pounds for someone who's a bit overweight, could
Dr. Howard Jay Fullman: be very beneficial. Having a balanced diet with proper distribution
Dr. Howard Jay Fullman: between proteins, carbohydrates, and fats. Exercising can help the immune
Dr. Howard Jay Fullman: system. And then certain minerals and vitamins can be beneficial.
Dr. Howard Jay Fullman: Zinc probably is beneficial. Vitamin D is probably beneficial. So
Dr. Howard Jay Fullman: even taking a multiple vitamin.
Bill Curtis: Vitamin D like getting out into the sun?
Dr. Howard Jay Fullman: That as well, a little bit of sun can be beneficial.
Dr. Steven Taback: What are your feelings about the probiotic craze? Because you
Dr. Steven Taback: see the commercials that are touting this for optimal immunity,
Dr. Steven Taback: that gut health is basically the controlling factor for your
Dr. Steven Taback: immunity and probiotics are basically the answer.
Dr. Howard Jay Fullman: So, first of all, we're just discovering the importance of
Dr. Howard Jay Fullman: this microbiome. Billions of bacteria, starting in your small intestine
Dr. Howard Jay Fullman: to a very small extent, mostly in your colon and
Dr. Howard Jay Fullman: these bacteria it turns out play important roles in our
Dr. Howard Jay Fullman: physiology. They affect everything from digestion itself to cardiovascular health,
Dr. Howard Jay Fullman: to liver health, and even to cognitive health. And there
Dr. Howard Jay Fullman: are more and more studies that show that there are
Dr. Howard Jay Fullman: relationships between the bacteria in your intestine and a variety of
Dr. Howard Jay Fullman: either healthy or unhealthy conditions in the body.
Bill Curtis: Can you give us a sample of the kind of
Bill Curtis: study that would result in cognitive health being affected by
Bill Curtis: your gut?
Dr. Howard Jay Fullman: There are studies now that suggest that there is a
Dr. Howard Jay Fullman: relationship between the bacteria in your GI tract and the
Dr. Howard Jay Fullman: likelihood developing dementia. The best evidence is the relationship between the
Dr. Howard Jay Fullman: bacteria in your GI tract and a whole host of autoimmune
Dr. Howard Jay Fullman: diseases in your body, including rheumatoid arthritis and systemic lupus.
Dr. Howard Jay Fullman: I will tell you that, of course, the effects of
Dr. Howard Jay Fullman: the bacteria in the GI tract are profound. And the ability to digest
Dr. Howard Jay Fullman: various kinds of foods is dependent on the kind of
Dr. Howard Jay Fullman: bacteria you have. So for example, lactose intolerance, which is
Dr. Howard Jay Fullman: high, very pervasive around the world is dependent to some
Dr. Howard Jay Fullman: degree on genetics and what part of the world you
Dr. Howard Jay Fullman: come from, but it's also dependent on which bacteria you
Dr. Howard Jay Fullman: have in the GI tract, and it could be improved or worsened based upon those
Dr. Howard Jay Fullman: particular bacteria.
Bill Curtis: Can you map the bacteria in the gut? We're doing
Bill Curtis: genetic mapping. Do we know what kind of bacteria we
Bill Curtis: need to have in our gut in order to be healthy?
Dr. Howard Jay Fullman: Yes and no. So we're getting a sense about it
Dr. Howard Jay Fullman: again, when you have billions of bacteria, not so easy
Dr. Howard Jay Fullman: to map that, but we have names of certain bacteria
Dr. Howard Jay Fullman: that we feel are healthy and some that are dangerous.
Dr. Howard Jay Fullman: So, going to how we use that today and when
Dr. Howard Jay Fullman: do one use probiotics? So for example, antibiotic related diarrhea,
Dr. Howard Jay Fullman: Steven I'm sure has seen more than his fair share
Dr. Howard Jay Fullman: of patients (inaudible) had to give antibiotics too for a
Dr. Howard Jay Fullman: variety of pulmonary conditions. And some of them will get
Dr. Howard Jay Fullman: digestive symptoms from the antibiotic because the antibiotic (inaudible)
Dr. Howard Jay Fullman: killing the bad bacteria, causing the pneumonia or whatever other
Dr. Howard Jay Fullman: illnesses being treated, it can kill the good stuff and
Dr. Howard Jay Fullman: that can lead to some symptoms. And so, there are
Dr. Howard Jay Fullman: some studies that suggest that antibiotic related bacteria can possibly
Dr. Howard Jay Fullman: be improved by the use of probiotic concomitantly. Is it
Dr. Howard Jay Fullman: wise for everybody to take a probiotic every day, like
Dr. Howard Jay Fullman: multiple vitamin? I don't think we've gotten there yet. I'm
Dr. Howard Jay Fullman: not sure we would know what probiotic would be the
Dr. Howard Jay Fullman: right one to use and in what conditions, but I think
Dr. Howard Jay Fullman: you'll be seeing more and more people advocating for probiotics
Dr. Howard Jay Fullman: in particular clinical situations and perhaps more pervasively based upon
Dr. Howard Jay Fullman: what data is generated in the future.
Dr. Steven Taback: What do you think about all these commercials then, where (inaudible)
Dr. Steven Taback: probiotic wars? Is this responsible marketing or is this
Dr. Steven Taback: just taking advantage of the craze where there's insufficient evidence
Dr. Steven Taback: to support it?
Dr. Howard Jay Fullman: Well, again, until we have to delve into either the
Dr. Howard Jay Fullman: problem with TV commercials is they're not very nuanced and
Dr. Howard Jay Fullman: they don't really take into account the specifics of various
Dr. Howard Jay Fullman: scientific studies that you're talking about, Steven. So if we
Dr. Howard Jay Fullman: were to line up the studies on the use of probiotics
Dr. Howard Jay Fullman: for antibiotic related diarrhea or C diff in particular, I
Dr. Howard Jay Fullman: think there's probably an equal number of studies pro and con.
Dr. Steven Taback: So with that in mind, I don't want to put
Dr. Steven Taback: your back to the wall on this, but one of
Dr. Steven Taback: the things we'd like to do on Medicine, We're Still
Dr. Steven Taback: Practicing is sort of debunking various medical myths and theories,
Dr. Steven Taback: and certainly frank charlatanism of people pushing therapies that are
Dr. Steven Taback: not beneficial. With all these unknowns and you as highly
Dr. Steven Taback: respected, very well educated gastroenterologist dedicated your life to this
Dr. Steven Taback: field, would you think now, because there are so many
Dr. Steven Taback: unknowns that the recommendation would be not to take a
Dr. Steven Taback: probiotic just as a matter of routine course?
Dr. Howard Jay Fullman: I agree with that. I would not recommend that. But I do
Dr. Howard Jay Fullman: recommend people being open- minded, especially if they have some
Dr. Howard Jay Fullman: chronic GI condition or other health condition where it's been (inaudible)
Dr. Howard Jay Fullman: that probiotics might be beneficial. That's the kind of
Dr. Howard Jay Fullman: thing they should talk to the doctor about. But as
Dr. Howard Jay Fullman: a matter of course, that everybody should be in a probiotic everyday, I don't
Dr. Howard Jay Fullman: think the data exists for that.
Dr. Steven Taback: Okay.
Bill Curtis: So I want to go back to the brain- gut connection that you mentioned earlier. Over
Bill Curtis: the years, the strides we've made in that world are
Bill Curtis: fascinating, especially in regard to mental illness and depression. Now,
Bill Curtis: in this heightened time of pandemic where quarantine and isolation,
Bill Curtis: fear and uncertainty, and surely anxiety are running amuck, what
Bill Curtis: is your specific recommendation on how we should be managing
Bill Curtis: our gut to optimize ourselves for mental health?
Dr. Howard Jay Fullman: There's a lot that's been written about the brain gut
Dr. Howard Jay Fullman: connection, and it goes really in two ways. So it
Dr. Howard Jay Fullman: seems as though certain aspects of the function of the GI
Dr. Howard Jay Fullman: tract affect mood, depression, anxiety may have something to do
Dr. Howard Jay Fullman: with the GI function. And it works both ways in the sense
Dr. Howard Jay Fullman: that when someone is depressed or anxious, they often will
Dr. Howard Jay Fullman: get GI symptoms. That may be a reflection of an
Dr. Howard Jay Fullman: underlying GI disorder or not. And the way one's GI
Dr. Howard Jay Fullman: function is going can affect their mood. So I just
Dr. Howard Jay Fullman: want to generalize this even beyond the GI tract for
Dr. Howard Jay Fullman: a second. And let's talk about how do we control
Dr. Howard Jay Fullman: mood from the point of view of a non psychiatrist
Dr. Howard Jay Fullman: at a time like this? First of all, one thing
Dr. Howard Jay Fullman: that helps both depression and GI function is regular exercise.
Dr. Howard Jay Fullman: So, we're coming back to exercise again, but there's an
Dr. Howard Jay Fullman: enormous amount that's written about walking as being a very
Dr. Howard Jay Fullman: effective antidepressant. So one thing I recommend for folks now
Dr. Howard Jay Fullman: is walking outside in a socially distanced or physically distanced
Dr. Howard Jay Fullman: way on a daily basis can really help your mood
Dr. Howard Jay Fullman: an awful lot. Light, seeing light on a regular basis
Dr. Howard Jay Fullman: is a very important part of controlling one's mood. Secondly, we are
Dr. Howard Jay Fullman: what we eat and with all due respect to the
Dr. Howard Jay Fullman: pulmonary specialists and the cardiologists, and even the neurologists, the gastroenterologist
Dr. Howard Jay Fullman: think the GI tract is the most important part of
Dr. Howard Jay Fullman: the body. So here are things that can help a lot.
Dr. Howard Jay Fullman: And again, everyone's got different physiology and some of us
Dr. Howard Jay Fullman: have intestinal disorders and some not but these are some
Dr. Howard Jay Fullman: generally wise ways to live. First of all, avoid really
Dr. Howard Jay Fullman: large meals. That's generally not healthy. Now the GI tract we
Dr. Howard Jay Fullman: are constructed and we've evolved that we actually can eat
Dr. Howard Jay Fullman: infrequently and still survive. We are capable of being that
Dr. Howard Jay Fullman: way. So the hunter side of us, part of our
Dr. Howard Jay Fullman: evolution meant that we needed to possibly go days without
Dr. Howard Jay Fullman: eating and then we get a big meal and that
Dr. Howard Jay Fullman: would suffice. So the GI tract can function that way,
Dr. Howard Jay Fullman: but it's not at its best function that way. Foods that
Dr. Howard Jay Fullman: help us and foods that don't, the easiest food to
Dr. Howard Jay Fullman: digest by and large are proteins and fats can be
Dr. Howard Jay Fullman: okay to digest, but they lead to a slowness of the
Dr. Howard Jay Fullman: GI tract. Now they slow down the stomach and the
Dr. Howard Jay Fullman: emptying of the stomach and create a sense of bloating
Dr. Howard Jay Fullman: and actually can sometimes make people mentally a little bit
Dr. Howard Jay Fullman: reduced. I'm advocating for a balanced diet, which has a
Dr. Howard Jay Fullman: good amount of protein, a modest amount of fat, a
Dr. Howard Jay Fullman: moderate amount of carbohydrate, minimizing sugar, and doing so in
Dr. Howard Jay Fullman: modest amounts several times a day.
Bill Curtis: As we wrap this up, I wonder if you guys
Bill Curtis: would each talk a little about how do you feel
Bill Curtis: this pandemic has changed medicine in your specialties for our lifetimes?
Dr. Steven Taback: Well, certainly because of the frontline effect, physicians we pride
Dr. Steven Taback: ourselves on being current when it comes to literature and
Dr. Steven Taback: making sure that we're staying up with the times, because
Dr. Steven Taback: there's so much research that goes on day in and
Dr. Steven Taback: day out. But I have never seen such a cooperative
Dr. Steven Taback: effort of sharing of information in real time as it's
Dr. Steven Taback: coming hot off the press in such an enthusiastic way.
Dr. Steven Taback: And I have a feeling we're going to be behaving
Dr. Steven Taback: this way for years to come. I think it's going
Dr. Steven Taback: to become part of our new habit if you will,
Dr. Steven Taback: to constantly be checking the latest literature in a more
Dr. Steven Taback: voracious fashion than we have in the past, because that's
Dr. Steven Taback: certainly what's going on at this point.
Bill Curtis: Is that nationwide, Steve or worldwide?
Dr. Steven Taback: It's worldwide. It's nationwide predominantly because we tend to... Especially
Dr. Steven Taback: in this country we speak one language. Any English speaking
Dr. Steven Taback: literature we're going to see, I can't read the Danish
Dr. Steven Taback: literature. I can't read the Italian literature, but as soon
Dr. Steven Taback: as it gets translated, it is worldwide. But I think
Dr. Steven Taback: there also will be a vulnerability on the human side
Dr. Steven Taback: and not just medically, but certainly on a medical side
Dr. Steven Taback: because we feel responsible for our patients although medical science
Dr. Steven Taback: has limitations and we're always aware of those limitations, we've
Dr. Steven Taback: never felt them to this extent, the helplessness that we
Dr. Steven Taback: have felt with a virus that we truly started off
Dr. Steven Taback: with zero treatments for, watching people deteriorate, get to support
Dr. Steven Taback: the body until they recover. I think we will always
Dr. Steven Taback: be a little bit on guard and feeling our vulnerability
Dr. Steven Taback: more than we ever have before. And I've always felt
Dr. Steven Taback: this vulnerability. And I think if you're a confident, conscientious physician,
Dr. Steven Taback: I think you realize that whatever you've learned in medical
Dr. Steven Taback: school and the years of training, it's still deficient. There's
Dr. Steven Taback: still not enough known to save everybody, to diagnose everybody,
Dr. Steven Taback: that the vulnerability that I feel now, I think I'm
Dr. Steven Taback: going to carry with me throughout the rest of my career.
Dr. Howard Jay Fullman: That's definitely a sense of humility. I think that all of the doctors
Dr. Howard Jay Fullman: and other medical professionals feel that. I think we've always
Dr. Howard Jay Fullman: been a very collaborative profession. We are now at our
Dr. Howard Jay Fullman: greatest degree of collaboration in many, many years, and I
Dr. Howard Jay Fullman: think that'll continue. Respect for science and what the scientific
Dr. Howard Jay Fullman: method can lead to and honoring the people who work
Dr. Howard Jay Fullman: within the scientific method and the expertise that gets developed,
Dr. Howard Jay Fullman: I think is an important part of medicine that I think is
Dr. Howard Jay Fullman: being enhanced right now as a result of this as
Dr. Howard Jay Fullman: well. And the respect for the patient, because obviously we
Dr. Howard Jay Fullman: have many, many courageous patients who are suffering so, and
Dr. Howard Jay Fullman: families that are going through so much and doing it
Dr. Howard Jay Fullman: with so much class and grace at a very difficult time.
Bill Curtis: Well, Dr. Howard Jay Fullman, I want to thank you
Bill Curtis: for joining us again tonight. You've left us at the
Bill Curtis: end with a bit of a sunrise in the horizon
Bill Curtis: that lets us think that there are aspects of this
Bill Curtis: situation that are actually going to make us a better
Bill Curtis: people and medicine, a better practice. I hope you'll come back
Bill Curtis: and join us again. And Dr. Steven Taback, I love
Bill Curtis: you, man. Thanks for coming.
Dr. Steven Taback: I love you too, Howard. Great talking to you.
Bill Curtis: Bye- bye. Thanks to our guest, Dr. Howard Fullman. This
Bill Curtis: episode was hosted by Dr. Steven Taback and me, Bill
Bill Curtis: Curtis. We're Still Practicing is produced and edited by AJ
Bill Curtis: Moseley and sound sweetened by Michael Kennedy. Music was created
Bill Curtis: and performed by Celleste and Eric Dick. Don't forget to
Bill Curtis: subscribe and leave us a comment, we value your opinion.
Bill Curtis: And take care of everybody.
Speaker 1: From CurtCo Media, Media for your mind.