Food Over Medicine: The Conversation That Could Save Your Life

6. MANAGING YOUR DOCTOR

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GM: Pam, what do you see as the ideal role of doctors in people’s lives? Should people go for annual checkups? Should they do any tests to monitor their health?

PP: No. Newsweek had a cover story titled “One Word Can Save Your Life: No!”1 It’s about saying no to diagnostic tests. The article doesn’t make quite as strong a statement as either I or Dr. John McDougall would, but it’s right up there. It basically pointed out that the more tests you have, the more likely you are to discover something that’s insignificant but get treatment for anyway. Most major organizations, including the U.S. Preventive Services Task Force, have said that there’s no value to the annual exam.2 One interesting point that Dr. McDougall makes when he speaks about this issue, and it had a profound effect on me, is that he grew up where you go to the doctor every year for a physical. He said during that time he gained fifty pounds, he developed an intestinal obstruction, had to have surgery, and had a stroke. Obviously, the annual physical did him no good at all. The annual exam, the way we’ve structured it, is absolutely useless, so I don’t go. I don’t think you’ll find many people who are involved in this plant-foods movement spending much time in doctors’ offices. Probably the further away you get from doctors, the better off you’re going to be, in most cases.

GM: All right, let me play devil’s advocate here. I’ve always gone for annual checkups. For many years, my cholesterol was about 160 or so and then it started creeping up. I told you the story about how, a little bit more than a year ago, it went as high as 212. That’s when I spoke to Dr. McDougall. He told me to cut out the fructose; now I’m back down to my normal levels again. If I hadn’t gone for an annual checkup, I wouldn’t have known I was at 212. I would have thought, “Gee, I’m on a great diet. I’m fine.” I would have continued eating my few cookies in the evening and my sweetened soy yogurt and so forth. I had a significant problem brewing and I learned about it only from my annual checkup.

PP: First of all, you’re a little more enlightened than the average person, and have been for quite some time. Second, you didn’t have a doctor, obviously, who was trying to get you to do more than just come in, check in, get a blood test, and go home. Third, you were lucky enough to be able to discuss your problem with Dr. McDougall.

You’re not the one I’m concerned about, Glen. I’m concerned about the average healthy male who shows up and the doctor says, “Let’s do a prostate-specific antigen (PSA) test because you’re getting to that age where you ought to have one.” So you get a PSA test and it’s a little bit elevated. Soon they identify a few cancer cells and you’re rushed into having a prostatectomy. Now, in all likelihood, if you had done nothing, if you had never known about those funny cells, you would die with that cancer at the age of ninety-seven—die with it, but not of it.

I’m concerned about the woman who goes to the OB/GYN’s office for her annual checkup, and the doc tells her she needs a mammogram. As a result, they discover a carcinoma in situ and next thing you know, she’s labeled a cancer patient. She has surgery, she’s taking tamoxifen, and she’s had enough radiation to increase her risk of a heart disease significantly. Those are the more typical scenarios, which is why the whole situation is so inadvisable for people. What I tell people is, first of all, learn what the research shows in terms of results from common diagnostic tests. Once you do, you’re likely to do none of this diagnostic testing that doctors want to subject you to, and I’m not talking about a blood test to get your cholesterol tested. My gosh, you can go to a drugstore and get that done now; you don’t even need to go to see a doctor.

In my books and lectures, I advise people to do none of these diagnostic tests that you’re being pushed to do when you go in, whether it’s a Dexa scan, PSA, mammogram, colonoscopy, etc.; they’re not going to save your life. All they do is lead to more tests and more treatments that don’t work. A blood panel is fine only if you are a smart consumer about medicine. Here’s what I mean by that. In your case, you go to the drugstore, get a blood test, see that your cholesterol is up—notice that you didn’t ask your doctor what do to about it, you asked Dr. McDougall what to do. What do you think would have happened if the average person asked the doctor what to do about it?

GM: Probably a statin.

PP: Yeah. Because it runs in your family, Glen. That’s the type of advice that you would get. So to be a smart medical consumer, you decide what steps to take on your own behalf. You may want to look for any way to do so outside of the traditional medical establishment.

Now, if I had a relentless pain in my side, I didn’t know what it was, and it didn’t go away by Monday, I would clearly go see a doctor. That’s smart medical consumerism. But showing up in this perfectly healthy state that I am in to say, “Listen, I just want you to poke and prod and tell me that I’m okay after as much poking and prodding as you can get my insurance company to pay for,” well, that’s where the problem is.

GM: So you believe in going to doctors if you feel pain or if something unusual is going on?

PP: Of course. A woman in her thirties misses four menstrual periods in a row and she’s not pregnant—I think she ought to check it out.

GM: At that point, do you do whatever tests the doctor orders? How do you manage this relationship with the doctor?

PP: You should ask a lot of questions, but don’t consent to anything until you have a complete understanding of it. You go to the doctor and say, “Look, I’ve got this pain on my side and I can’t figure out what it is.” And she says, “Well, we need to do some imaging.” Okay, well, what kind of imaging? She might say a CT scan, but if you investigate CT scans, you may decide that that’s way too much radiation and that you’ll probably be better off with an MRI. What you really want to do is gather information. If you don’t know the answers to some of these questions, go home, do some research, and then decide what you’re going to do. I’m not saying you should dillydally for another nine months—you may be on a fairly tight schedule of needing to figure out what’s wrong—but you don’t just do what you’re told. Some doctors will test you to within an inch of your life. Again, the worst thing you can have if you walk into a doctor’s office or a hospital is great insurance because they’re going to use it.

GM: What if they find a tumor and say we need to operate immediately?

PP: The number of times that a condition is so life-threatening that we find out about it this afternoon and we need to have surgery tomorrow morning is such a tiny percentage that it isn’t even worth talking about. You say, “Great, I’d like to have any images and any other information that you can give me so that I’m really clear on what’s going on with me.” Take notes and then say, “Thank you so much, I’m really glad we’ve gotten to the bottom of this. Please tell me what you think I ought to do and I’m going to take real careful notes here. By the way, please understand when you’re telling me what you want me to do, I would like some outcomes and expectations in absolute rather than relative terms. I want you to tell me the straight story. I’m going to go check this out with some other people, get some other opinions from people who have different tools in their toolbox, and then I’m going to make up my mind about what to do.” And that’s when you get in touch with somebody like me or Dr. Ralph Moss or Dr. McDougall, get some other points of view, and then make your best decision about what you think is right for you to do. Don’t get herded into some type of procedure without looking into it first.

GM: Okay. What if a woman has a Pap test and they find precancerous cells on the cervix, dysplasia, and she’s told she needs a LEEP Cone biopsy? Isn’t that potentially a lifesaver?

PP: Well, yes, but there’s also a good chance that the treatment she was getting from the OB/GYN caused it in the first place; that’s what happened to me.

GM: Say that again? A chance that the treatment she was getting caused the dysplasia?

PP: Yes. First of all, birth control pills are carcinogens; they’re full of hormones. We know that supplemental hormones are carcinogenic; a lot of women get these conditions by taking birth control pills.3

That’s what happened to me when I got cervical dysplasia. What added to it was the terrible diet that I was eating at the time; this episode took place about five years before my conversion. I also got the human papillomavirus, which is a minor player in the whole thing. However, all of this could have been avoided if I had been eating the right diet and hadn’t been taking those dreadful pills. Even after you’re diagnosed with dysplasia, if you get off the pills, stop drinking so much alcohol and eating dairy products, and eat the right foods, that condition will right itself most of the time.

Since it’s not immediately life-threatening, it’s one of those conditions where it’s worth it to go home, practice dietary excellence, do the right things, go back to the doctor in four months and have another Pap smear, and see if it’s gone away before you do anything about it. Keep in mind that the LEEP Cone biopsy procedure requires a general anesthetic, something that’s best to avoid whenever possible. So, in my case, not only did this doctor who did the LEEP Cone biopsy give me the birth control pills, which were a major part of why I developed the condition in the first place, but I stayed on the birth control pills because he didn’t tell me to stop taking them. I went home and continued to eat cheese and drink alcohol and eat cookies for another several years. So my risk of recurrence was huge; I’m lucky it didn’t happen to me.

GM: But wouldn’t a woman in that situation who delays the procedure feel that she’s taking a risk that it may spread if the diet doesn’t control it?

PP: That’s why you put a stop-loss on it. You don’t walk out the door and say, “I’m just going to go change my diet and I’m never coming back here again.” There are ways to figure out if it’s progressing, staying the same, or regressing. If it’s staying the same, you don’t do anything about it because it can’t kill you unless it progresses. Medicine does have a way of quantifying the situation. That’s why it’s so important to be knowledgeable. At The Wellness Forum, the information we provide about this type of topic is as important as how to eat the diet; if you don’t understand how to manage your relationship with your doctor, you could be just as victimized by the health care profession and end up in just as much trouble.

You have to gain enough knowledge and confidence to go in and tell the doctor, “I hear what you’re saying and I appreciate that because you have malpractice insurance and a medical license, you have to tell me certain things. Go ahead and note it in the file. I’ll even sign something saying that you told me this stuff. But I’ve learned enough about this now, having looked into it on my own, to know that there’s absolutely nothing to be lost by waiting three or four months to see if this condition clears up when I stop fertilizing it. I understand now that I’ve been fertilizing it with alcohol, cheese, sugar, and birth control pills. I’m going to try to protect myself now by eating a lot of whole foods, including lots that are rich in folate.”

GM: I think we need to acknowledge that one reason for overtesting is the legitimate fear on the part of doctors of medical liability.

PP: Certainly true, but on the other hand I accompanied a friend to the ER with a sinus infection, and the doc recommended an MRI—for a sinus infection. I don’t think he was worried about being sued. Consumers should be especially wary of doctors who do tests inside their own offices, because they have the strongest financial incentive to overtest, but the root of the problem is deeper than just greed.

GM: Let’s review different types of testing and get your opinion about the harmful effects, if any, of each type. I know that you’re an opponent of mammograms. Is there ever a use for mammograms, or are they always worthless?

PP: I would never agree to one myself. I think they’re worthless.

GM: I would imagine that this is fairly shocking to most women who have all been told that mammography can and does save lives.

PP: Remember, though, that these are marketing messages for mammography, not messages reporting the scientific findings.

Mammography is highly unreliable. It tends to miss aggressive tumors that grow between screenings, while detecting small, benign tumors, such as carcinoma in situ, that are usually not cancers at all and are often referred to as “pseudo-cancers.” As a reminder, the word “pseudo” means “false.” It’s a false cancer.

In spite of the fact that most of these pseudo-cancers will not develop into a cancer that will require treatment, women diagnosed with them are advised to have lumpectomies, to receive radiation treatments, and to take drugs like tamoxifen. This is overtreatment for a condition that is highly unlikely to be life-threatening. Particularly troubling is how these women are classified as “cancer survivors.” Almost all of them would be alive five years after diagnosis (the benchmark for survival for cancer patients) even with no treatment. This skews the survival statistics numbers, making it look like treatments for breast cancer are much more effective than they really are.

While mammography detects pseudo-cancers resulting in overtreatment, it does not reduce the risk of dying from real cases of breast cancer.

A research letter published in 2001 in Lancet reported the findings of a Cochrane Review that looked at the efficacy of mammograms for reducing breast cancer deaths. It is important to note that the Cochrane Collaboration is the most independent medical research organization in the world, and therefore its conclusions about various issues related to medicine are taken more seriously by many of us.

The article stated, “In 2000, we reported that there is no reliable evidence that screening for breast cancer reduces mortality. As we discuss here, a Cochrane Review has now confirmed and strengthened our previous findings.”4

Cochrane has further concluded that screening led to an increase in radical treatments due to overdiagnosis of 25 to 35 percent; that 49 percent of screened women would experience at least one false positive; and that the absolute reduction in risk of death was 0.1 percent.5

The Cochrane researchers also concluded that studies showing that mammograms reduce the risk of dying from breast cancer do not take into consideration the deaths related to breast cancer treatments, and that more women are harmed from overtreatment than are saved with mammography. The groups stated, “There is no reliable evidence from large randomized trials to support screening mammography at any age.”

Another study published online by the British Medical Journal6 was conducted in Denmark, a great country for studying mammography outcomes. For the past seventeen years, only about 20 percent of women in Denmark have been screened, leaving a large control group from which data can be gathered.

Two geographic areas were included in the study: Copenhagen, where screening was introduced in 1991; and Funen, where screening was introduced in 1997. Between 1997 and 2005, deaths from breast cancer dropped by 5 percent for women between the ages of thirty-five and fifty-five in both of these areas. For women between fifty-five and seventy-four, the decline was 1 percent in mortality rate.

In the nonscreened population in Denmark, the death rate from breast cancer declined by 6 percent for women between the ages of thirty-five and fifty-five, and 2 percent for women between fifty-five and seventy-four.

The researchers also observed that the diagnosis of carcinoma in situ doubled in the population of women who were screened and remained the same in the nonscreened population, reinforcing the idea that mammography results in overdiagnosis of pseudo-cancers.

Studies even show that mammography is contraindicated for women who carry the BRCA1 or BRCA2 gene mutation, which predisposes them to a higher risk of developing breast cancer. In one study, researchers concluded that mammography screening beginning at twenty-five to twenty-nine years of age results in a higher risk of breast cancer due to increased lifetime radiation exposure, and that mammography may have a net harmful effect for these patients.7

GM: What do you say to the person who reports that a friend or family member was diagnosed with breast cancer via mammography and it saved her life?

PP: Since the data is clear that more women are harmed than helped, this is highly unlikely. In other words, what has happened in most cases, where women truly have survived and thrived for a long time, is that they were diagnosed with pseudo-cancer and treated for it. The treatments for metastasized breast cancer are not much more effective today than they were decades ago.

Another thing I would add is that, according to Cochrane, if two thousand women are screened for ten years, one woman will benefit from early detection. You may happen to know the one in two thousand who actually benefitted, but it’s statistically unlikely.

One of the best resources for understanding this issue is Peter Gotzsche’s book Mammography Screening: Truth, Lies and Controversy. It’s a technical book, but I would love to see it become required reading for women since this is such an important issue.

GM: Let’s move on to CT scans.

PP: In certain situations they can be valuable, but because the dose of radiation is so high, and it’s a well-established fact that CT scans increase your risk of cancer,8 they really should be reserved for situations where it’s the only way to get the information you need. They’re way overused.

GM: And they’re highly overused with children, isn’t that right?

PP: Yes. Not only are they overused but they’re overused on the same people—individuals getting multiple scans. It’s not unusual to see CT scans that make the whole situation so much worse for them. CT scans should be the last resort, not the first line of action; unfortunately that’s not the way it goes.

GM: MRIs?

PP: Valuable and less dangerous. For example, in the case of breast cancer, it can sometimes be a valuable way to find out exactly what’s going on. The biggest risk may be that because the imaging is so good, you’re going to discover something else that you don’t want to know about. I was at a dinner party last night and listened to the story of a woman who is one of those people who goes to doctors all the time. She’s overmedicated and doesn’t want to hear what I have to say, so I just listened.

She apparently got an MRI for one reason, but they found something in her brain that they weren’t looking for. They sent her to specialists; she went through ninety days of testing and was scared half to death. The specialists put her on Coumadin because they weren’t sure it wasn’t a blood clot, but then found out that there was some type of tangled or turned vein in her brain. If you spend too much time allowing doctors to poke and prod you, you’re liable to find out things that you’re better off not knowing. The last doctor she saw about her condition said, “This isn’t even worth spending time on. Go live your life and forget about it.” Which was good advice, but that’s after ninety days, $10,000 worth of tests, and thinking she either had a brain tumor or was going to drop dead any minute. That’s a pretty frightening situation to be in for nothing at all.

GM: Ultrasounds?

PP: Not dangerous and very helpful sometimes. These are the least invasive of all of the forms of testing.

GM: There’s really no risk to doing an ultrasound, right?

PP: The main risk, and this is true of all forms of imaging, is finding something you may not want to know about.

GM: Would you say the same thing about ultrasounds for pregnant women?

PP: Today, having an ultrasound is a routine part of medical care for pregnant women. No one questions it, but the problem is that it often finds things that look suspicious, even when there is nothing wrong. One analysis of fifty-six studies showed that follow-up testing for abnormalities detected as a result of ultrasound would result in more miscarriages than confirmed diagnoses.9

GM: So ultrasounds aren’t inherently bad, but it sounds like they cause more problems than they prevent sometimes. What about other imaging procedures?

PP: There is a great book on this topic by Dr. Gilbert Welch called Overdiagnosed. I recommend that all of our members read it. It describes how imaging and testing tends to identify clinically insignificant abnormalities that would be better left alone, but this is seldom the response to finding them. Tiny abdominal aneurisms and small thyroid nodules are examples of conditions often found in completely asymptomatic people who are subjected to testing. All imaging, including ultrasounds, should be used with caution. In the book, Dr. Welch10 discusses the new epidemic of thyroid cancer. How did we suddenly get an epidemic of thyroid cancer? Is it something in the water? No, what’s happening is that people are getting X-rays and MRIs and they’re finding thyroid cancer. They’re not necessarily looking for it, but they end up with an image of it, anyway. A lot of people have little nodules on their thyroids, which they now call cancer. They are then advised to have to have surgery for it because the American Cancer Society has gone all out to make sure everybody now gets screened for the new epidemic of thyroid cancer!

GM: Well, I have a friend who it happened to. He had an ultrasound performed for neck pain, and they found a nodule on his thyroid, completely unrelated to the pain, of course. They did a biopsy and told him he has cancer. He faces the choice of an operation with serious risks or “watchful waiting.” I’m certain he’ll opt for the “watchful waiting.” I asked him if he would rather never have known. He didn’t hesitate for a moment. He would much rather never have known. The diagnosis has taken an enormous emotional toll on him and his family, to no good end.

Let’s move on to another test. Is there any point to an angiogram?

PP: The value of it really would be to scare somebody half to death. To put the image up there, if doctors did this right, and say, “See this? This is going to kill you. Now, medicine says I’m supposed to put a stent in that artery. I can do it, I know how to do it, I’m trained to do it; I’m just telling you it’s useless, even though your insurance company will pay for it. Or you can change your diet. If you don’t change your diet, this is going to kill you.” So it has some value in terms of scaring people a little bit, if doctors would be willing to engage in the right conversation with their patients. Unfortunately, that’s not what they’re doing.

GM: Okay, if somebody was having chest pain and was willing and eager to start a change of diet and lifestyle that you would endorse, would there be any point in his doing an angiogram? Or should he just get started eating a low-fat, plant-based diet?

PP: He should just start eating the low-fat, plant-based diet. Now, there are factors like how much chest pain, was there a myocardial infarction, have there been previous events? It’s hard to answer these questions in general because, in the real world, they’re always specific, which is why people really should consult with a medical doctor. But if your current doctor won’t discuss the importance of diet and won’t even entertain the idea that you ate your way into coronary artery disease and will probably be able to eat your way out of it, you may want to consider finding another doctor. There are docs who are more open-minded, even if they don’t completely understand the issues we’ve been discussing.

GM: Are there any times you feel a situation is so severe that, even though they’re going to eat their way out of it, it might help them now to have either a surgical intervention or a pharmaceutical intervention?

PP: Yes. If there is severe damage to the left ventricle, I’d think we’d all agree, then bypass surgery is probably valuable then. The other is relentless chest pain, which is not usually the way these patients present. They usually present with intermittent chest pain or pain from exertion. But if somebody has constant, relentless chest pain and it keeps him from sleeping, I think that person should be in the care of a good interventional cardiologist because surgery is needed. I would endorse it under that scenario.

There are few drugs or surgeries that I would say have absolutely no value. It’s the misapplication of them that causes me to say the things that I do. I don’t think we should eliminate bypass surgery. I’m saying instead of performing five hundred thousand of them annually, we should perform about fifteen thousand.

GM: What about colonoscopies? During my first checkup after I turned fifty, my rather humble and very decent doctor said to me, “You know, Glen, honestly, there isn’t a lot that doctors can do for people, but the colonoscopy is one thing we do that’s really helpful for the general public. I recommend having one at fifty.” And I said, “Well, are there any downside risks?” He said, “Occasionally, we perforate the colon.” I said, “Hey, it’s been very nice visiting with you, doc.”

PP: They’ve now found out that the colonoscopy is not any more valuable than a sigmoidoscopy. A couple of researchers at Columbia University looked at three different studies and determined that a colonoscopy does not offer any advantages over a sigmoidoscopy.11 However, it does offer significantly more risk, and the pleasure of a tube up your rectum, if that’s something you’ve always pined for.

GM: Exactly what is a sigmoidoscopy?

PP: Sigmoidoscopy involves the use of a flexible endoscope. It provides a view of the large intestine from the rectum to the sigmoid, the most distal part of the colon. It does not allow examination of the entire bowel, but the portion that is examined is where colorectal cancer is most likely to occur.

GM: So should people do a sigmoidoscopy?

PP: I wouldn’t have one. By eating a high-fiber, low-fat diet, people will reduce their risk of colon cancer as much as they possibly can.

GM: What’s the value of a PSA test, in your opinion?

PP: Zero. Worthless. And that’s not just my opinion, that’s also the opinion of Dr. Richard Ablin, who discovered the PSA protein. To his credit, he’s said that he didn’t realize that his discovery would lead to “the overdiagnosis, the overtreatment, and the billions of dollars that are basically wasted on a test that can’t do what it’s purported to do.”12

Furthermore, the U.S. Preventive Services Task Force has now said that PSA tests are useless and men should not have them. The task force’s conclusions were based on five clinical trials that showed PSA testing does not save lives and that having the test leads to more tests and treatments that cause impotence, incontinence, and other side effects.13

The lead researcher, Dr. Virginia Moyer, stated, “Unfortunately, the evidence now shows that this test does not save lives. This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does.”

GM: And the Dexa scan for osteoporosis is worthless?

PP: Completely.

GM: How about genetic testing to find out if you have the genes for breast cancer or something?

PP: Harmful, terrible. It labels people as patients. It turns them into victims.

GM: The case for genetic testing is that it simply makes people aware of their risk profile.

PP: Yeah, and then you have to live with that information.

I had a member who recovered from an autoimmune disease who’s doing quite well, actually. She has been practicing dietary excellence. Her sister died of ovarian cancer, so her family and her doctor pressured her to undergo genetic testing. They found that she had the gene mutation that predisposed her to have ovarian cancer, so the doctor removed her ovaries. While taking them out, they found out that she had some diverticular pouches, so they recommended a colonoscopy.

She asked me for my opinion. I said, “I want you to think about what’s happened in the last thirty days. You were happy, living your life with two ovaries; now you’ve had two ovaries removed and the doctor wants to do a colonoscopy. When are you going to stop this? How much more are you going to let them do to you? You have two well-formed bowel movements every day; you have no bowel problems. Those diverticular pouches are probably left from the days when you were a cheese eater.”

If these interventions just stopped with notifying someone she is carrying the gene mutation and she could put it in the back of her head and forget about it, that would be great. But nobody puts it in the back of her head and forgets about it. We think we have to do something about it. Human beings are designed and engineered to solve problems; generally speaking, that’s a pretty good idea. If I have a flat tire, I need to get a new tire; we’ve got to solve that problem. But when you get into a lot of these tests with their dubious results about genetic predispositions, all you’re doing is putting terrible stress on people who are not medically knowledgeable. You may be solving a problem you don’t have.

GM: What about Pap tests?

PP: While I don’t oppose the Pap test as much as the others, its importance has been overstated, and the test too often results in overtreatment. According to Dr. Welch in Overdiagnosed, a fifteen-year-old girl who has annual Pap tests has a 75 percent chance of eventually having a colposcopy14 (the procedure to biopsy abnormal cells). There is no watchful waiting or dietary change recommended in response to an abnormal Pap, and the treatments range from simple freezing with local anesthesia in the doctor’s office to hysterectomy. The American College of Obstetrics and Gynecology now recommends that screenings start much later and be performed less frequently.15

GM: I wonder if the tide is turning. Nine medical societies, taking part in an initiative of a group called Choosing Wisely, have come up with a list of forty-five dubious medical services, most involving testing.1617

PP: That’s a long overdue first step.

GM: Let’s turn to mental health. Can diet be related to the condition of depression?

PP: It can be. First, there are a lot of people being diagnosed with depression who are eating a terrible diet; they’re dehydrated, sedentary, out of shape, tired, have no energy, have low sex drives, sleep poorly, and suffer other related symptoms. These are also common symptoms of depression. I think some doctors are quick to label patients as depressed when there are other things going on. Sometimes an optimal diet, drinking adequate water every day, and exercise will cause the person to feel better, to have more energy, feel more clearheaded, sleep better, have an improved sex drive, and other noticeable improvements.

Then we have people who are depressed for visible reasons, such as the loss of a loved one or a job. We are labeling everyday stress and disappointment as depression and medicating people for it, when what they really need is just time to process their emotions.

Even for those who are truly clinically depressed, diet is important; they will feel better and think better, which will help them to get more out of therapy and to resolve their problems. Of course, nobody is saying that diet is the whole remedy; a truly depressed person won’t overcome his issues with broccoli.

For the clinically depressed, therapy can be helpful if it is the right type of therapy. I recommend Cognitive Behavioral Therapy (CBT), which has been shown to be very effective for treating conditions like depression, anxiety, ADHD, and other mental and emotional disorders. It works quickly—usually fourteen sessions or so—there’s a very low recidivism rate, and drugs are rarely used. The therapists who practice CBT are to the mind and emotions what Dr. Caldwell Esselstyn and Dr. McDougall are to the cardiovascular system and the endocrine system.

If you seek help for depression, I think the first thing you should say to your doctor is that you’re not interested in a pharmaceutical solution to your problem. You’re interested in talking and working your way through it. Psychotropic drugs are being dispensed like candy in this country and their side effects, including addiction, can be highly destructive. You want to avoid them at all costs.

GM: What do you think underlies the overprescription of antidepressants?

PP: There’s a real arrogance today to the practice of psychiatry. Right now, we know that taking antidepressant and antianxiety drugs not only increases your risk of suicide but they ultimately make people more depressed.18 That’s why people have to take multiple drugs, which have to be constantly switched out to be effective. Forty percent of the time, there’s absolutely no response to the drugs at all,19 other than the depression getting worse. However, it doesn’t stop psychiatrists from prescribing them. The trend in the psychiatric profession is to do less and less talk therapy, so the profession is now attracting people who don’t like people. They have no interest in relating to people; they don’t want to talk to them, and they don’t have to talk to them; they just prescribe drugs.

Doctors are very smart people, but I think many times we’re admitting the wrong people to medical school. We’re bringing people into the profession who are very bright and technically very proficient, but they don’t have the right idea about what medical practice should be about: preventing, stopping, and reversing disease. So they go to work every day and get used to the idea that everybody gets worse, everybody has to have more drugs, everybody has to have more procedures. Most of them are still making a lot of money and don’t really have much interest in changing anything. I suspect that many of them like remaining ignorant. When confronted with evidence, they’ll get upset about being confronted, but many will just continue to do what they’re doing.

GM: You know, you’re remarkably antidrug and antisupplement for a woman named “Popper.”

PP: Maybe I overcompensate.

GM: Out of curiosity, when was the last time you went to a medical doctor, Pam?

PP: That was in 1994, about nineteen years ago. A cat bit me, and I got an infection. I went to a doctor, told him I needed an antibiotic and which one I wanted, and got out of there in ten minutes.

I want to make it clear that I have nothing against doctors. I’ll go back promptly the next time I need one.