Podcast appearances and mentions of haider warraich

Discover the remarkable progress made in heart failure therapies with Jonathan and Haider Warraich, Director of the Heart Failure Program at VA Boston Healthcare System, Massachusetts, USA. They also discuss the intricacies of heart transplantation and end-of-life care. Use the following timestamps to navigate the episode:  (00:00)-Introduction (03:28)-Warraich's journey into cardiology (06:15)-Recent advances in heart failure therapies (11:15)-What is the median survival from diagnosis of heart failure? (14:45)-The current state of heart transplantation (20:20)-Warraich's experience in regulatory medicine (24:33)-Warraich's book: ‘Modern Death, How Medicine Changed the End of Life' (33:45)-Warraich's s book: ‘State of the Heart' (40:12)-Warraich's most recent book: ‘The Song of Our Scars: The Untold Story of Pain' (46:13)-Warraich's three wishes for healthcare

In this week's Parallax episode, Dr Ankur Kalra welcomes Dr Haider Warraich, a cardiologist at Brigham and Women's Hospital. Dr Warraich is not only a Senior Advisor for Chronic Disease to the FDA Commissioner but also a prolific author, having written three books, including "Song of Our Scars: The Untold Story of Pain." He is a regular contributor to publications like the New York Times and the Washington Post. During the conversation, we learn more about Dr Warraich's journey into medicine and his current role at the FDA, along with his passion for writing. Dr Kalra asks about how Dr Warraich manages his busy schedule and what it takes to write a book. Dr Warraich openly shares his personal experience grappling with chronic pain, a pivotal event that not only influenced his career trajectory but also inspired his book "Song of Our Scars." Moreover, he discusses his role as a Senior Advisor to Dr Robert M Califf, offering insights into his day-to-day responsibilities within the FDA. The conversation also touches upon the agency's perspective on emerging technologies like artificial intelligence (AI). How does writing complement Dr Warraich's work as a physician? How did he become a senior advisor to Dr Robert M Califf at the FDA? What is his message to our listeners?

Pain is more than a physical sensation; it has cultural, relational, and spiritual dimensions as well. Dr. Haider Warraich, a cardiologist and the author of The Song of Our Scars, talks with Amy Julia Becker about these dimensions, the opioid epidemic, and ways we can be a part of the story of healing, for ourselves and others.__Guest Bio:“Haider Warraich is a doctor at Brigham and Women's Hospital, Harvard Medical School, and the VA Boston Healthcare System. He is the author of Modern Death and State of the Heart, and regularly writes for the New York Times and Washington Post, among others. He lives in Wellesley, Massachusetts.”__Connect Online:Twitter: @haiderwarraich__On the Podcast:The Song of Our Scars: The Untold Story of Pain For full show notes, transcript, and more, go to: https://amyjuliabecker.com/haider-warraich/__This conversation is a great pair with previous conversations on the podcast that I've had with Dr. Matthew Loftus and Liuan Huska.}__Season 6 of the Love Is Stronger Than Fear podcast connects to themes in my latest book, To Be Made Well, which you can order here! Learn more about my writing and speaking at amyjuliabecker.com.*A transcript of this episode will be available within one business day on my website, and a video with closed captions will be available on my YouTube Channel.Connect with me: Instagram Facebook Twitter Website Thanks for listening!

Storytelling, pain, rage, and cultural competency are just some of the themes we will explore in this episode. Our guest, Dr. Haider Warraich, grew up and went to medical school in Pakistan before completing residency at Harvard Medical School and fellowship in cardiovascular medicine at Duke University Medical Center. Today, he is an assistant professor at Harvard Medical School and the associate director of the Heart Failure Program at the VA Boston Health Care System. A prolific writer, he contributes regularly to the New York Times, Washington Post, and others. He is the author of three books on medicine for the general audience, most recently 2022's The Song of Our Scars: The Untold Story of Pain, which examines the nature of pain not only as a physical, but also a historical and cultural experience. Over the course of our conversation, Dr. Warraich compares his medical experiences in Pakistan and in the US, discusses why he strives to incorporate palliative care into his cardiology work, and offers an impassioned critique of how modern medicine fails to address patients' suffering.In this episode, you will hear about:How Dr. Warraich went from thinking of his medical training as an “arranged marriage” to loving the career - 2:10How Dr. Warraich stays connected to his patients and his work despite the intense pressure and responsibility he experiences on a daily basis - 7:03What drew Dr. Warraich to cardiology and end-of-life care - 13:22Dr. Warraich's reflections on the gaps in the care of patients with heart disease and how he now strives to reform the practice of cardiology - 17:33A discussion of how the medical culture of Pakistan differs from the United States and how they can be shockingly similar - 22:06How Tom Brady, the football quarterback, inspires Dr. Warraich to stay connected to the emotional core of his practice - 28:49Why it's important to stay in a field if you care about it, especially if you hope to change and improve it - 35:37Dr. Warraich's reflections on the nature of pain and how he hopes to change our cultural conversation around it - 41:38How acute pain and chronic pain are very different processes and how we can address suffering as a subject and deeply personal experience - 45:17You can follow Dr. Warraich on Twitter @haiderwarraich.Dr. Haider Warraich is the author of several books, including The Song of Our Scars: The Untold Story of Pain, Modern Death: How Medicine Changed the End of Life, and State of the Heart: Exploring the History, Science, and Future of Cardiac Disease.In this episode, we discuss the article “At the Edge of the Inside” by David Brooks, for the New York Times, and the book Just Mercy by Bryan Stevenson.Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, and feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor's Art Podcast 2023

Pain is powerful — and when it becomes chronic, it can be all-consuming. It takes over our minds, saps our energy, and becomes the focus of our existence. And yet, pain is also invisible. We can try to describe it — stabbing, nagging, dull, achy; we can rate it on a number scale from one to 10, or point to a smiley or frowny face to define it, but it's not something we can ever fully communicate. Our pain is ours — to feel, to bear, to live with. Millions of Americans live with chronic pain, and yet it can be a profoundly lonely experience. The individual nature of pain, the mysterious way it often sneaks into our lives, without a definitive source, can make it hard to deal with — and even harder to treat. On this episode, we explore the nature of chronic pain — what causes it, how it affects us, and the ongoing fight to stop it. We talk with physician Haider Warraich, who wants to change the way medicine thinks about pain, people who've spent years trying to treat their pain, and a reporter who's tracking the newest developments in pain medicine.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Pain is powerful — and when it becomes chronic, it can be all-consuming. It takes over our minds, saps our energy, and becomes the focus of our existence. And yet, pain is also invisible. We can try to describe it — stabbing, nagging, dull, achy; we can rate it on a number scale from one to 10, or point to a smiley or frowny face to define it, but it's not something we can ever fully communicate. Our pain is ours — to feel, to bear, to live with. Millions of Americans live with chronic pain, and yet it can be a profoundly lonely experience. The individual nature of pain, the mysterious way it often sneaks into our lives, without a definitive source, can make it hard to deal with — and even harder to treat. On this episode, we explore the nature of chronic pain — what causes it, how it affects us, and the ongoing fight to stop it. We talk with physician Haider Warraich, who wants to change the way medicine thinks about pain, people who've spent years trying to treat their pain, and a reporter who's tracking the newest developments in pain medicine.

Pain is powerful — and when it becomes chronic, it can be all-consuming. It takes over our minds, saps our energy, and becomes the focus of our existence. And yet, pain is also invisible. We can try to describe it — stabbing, nagging, dull, achy; we can rate it on a number scale from one to 10, or point to a smiley or frowny face to define it, but it's not something we can ever fully communicate. Our pain is ours — to feel, to bear, to live with.  Millions of Americans live with chronic pain, and yet it can be a profoundly lonely experience. The individual nature of pain, the mysterious way it often sneaks into our lives, without a definitive source, can make it hard to deal with — and even harder to treat. On this episode, we explore the nature of chronic pain — what causes it, how it affects us, and the ongoing fight to stop it. We talk with physician Haider Warraich, who wants to change the way medicine thinks about pain, people who've spent years trying to treat their pain, and a reporter who's tracking the newest developments in pain medicine. Also heard on this week's episode: As a med student in Pakistan, all Haider Warraich knew about pain was what he'd learned in textbooks. That changed when, while lifting weights at the gym, his back gave out, and he found himself thrust into a world of agony. Today, Warraich is a doctor who's calling on the medical world to change the way it approaches pain — we talk with him about his own experience, what he's learned about the nature of pain, and what doctors can and should do differently. His book is “The Song of Our Scars: The Untold Story of Pain.”  Millions of Americans live with chronic pain — and despite seeing doctor after doctor, never find an answer about what's causing their misery, or how to fix it. Reporter Alan Yu tells the story of one man whose journey to alleviate his pain took him through the gamut of medical options — and ended in an unexpected place. Drugs like oxycodone used to be a go-to solution for treating acute and longer-lasting pain — but that's changed in the wake of the ongoing opioid epidemic. We talk with Damian Garde, a biotech industry reporter for STAT News, about the challenges to developing non-addictive painkillers, and one candidate — a new drug from the biotech company Vertex — that could offer hope.

Pain is a deeply subjective thing. When it's with us it's all we can think about. So, what is life like then for someone for whom pain never leaves? Haider Warraich, Assistant Professor of Medicine at Harvard Medical School and author of 'The Song of Our Scars: The Untold Story of Pain' joins Jonathan to discuss.

In this episode of Talk Nerdy, Cara is joined by Dr. Haider Warraich, a cardiologist at Brigham and Women's Hospital, Harvard Medical School, and the VA Boston Healthcare System. They talk about his new book, "The Song of Our Scars: The Untold Story of Pain," including the multidimensionality of chronic pain and how the healthcare profession can better serve those who suffer from it.

Heart health is the top killer of women globally - and it's avoidable!! World renown cardiologist Dr. Haider Warraich is on with Jillian to discuss what tests our doctors should be running for proactive heart health and what age to start. Plus, he teaches us how we can manage our blood pressure; what cholesterol numbers mean for your LDL, HDL, total cholesterol, and triglycerides; what to do about hypertension; top strategies to remove plaque from the blood vessels; the risks and benefits of statins and other medications (like PCSK 9 inhibitors); supplements, aspirin, and vaccinations to lower cholesterol. Dr. Warraich also tackles questions on how to manage other factors for heart disease like genetics, environment, and lifestyle changes to help us transform our heart health.Guest Links:Dr. Warraich's books: The Song of Our Scars: The Untold Story of Pain State of the Heart: Exploring the History, Science and Future of Cardiac DiseaseTwitter: @haiderwarraichFor 25% off The Fitness App by Jillian Michaels, go to www.thefitnessapp.com/podcastdealFollow us on Instagram @JillianMichaels and @MartiniCindyJillian Michaels Community: https://www.facebook.com/groups/1880466198675549Email your questions to JillianPodcast@gmail.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode, Manny and Dylan speak with Dr. Haider Warraich about one of his recent publications on voting behavior and mortality rates in counties across the USA. His research found that overall, American mortality rate is going down (which is a good thing–we're living longer!) but that the rate of mortality rate decline is higher in Democratic counties than in Republican counties. Manny suggests that there are policy implications from this research. Dr. Warraich suggests that at least part of this can be explained by norms for health and medicine diverging in different parts of the country. We can clearly see this happening now in terms of the Democratic and Republican voters' response to COVID-19. Manny's article on this topic: https://scienceofsocialproblems.com/2022/06/19/who-should-we-vote-for-to-promote-health-and-well-being/ Dr. Warraich's webpage Dr. Warraich's paper in BMJ about politics and death The Song of Our Scars: The Untold Story of Pain Leading causes of death in the USA IPCC report on climate emissions Image by Milos Duskic from Pixabay

On today's podcast we welcome back Haider Warraich to talk about pain.  Now this may surprise our frequent listeners as we have had Haider on before to talk about heart failure as well as palliative inotropes, so why are we having him come on to talk about pain?  .   Well, Haider has an intimate relationship with pain, having experienced chronic pain himself and now having dove deep into the latest research on pain for his new book The Song of Our Scars: The Untold Story of Pain.   We discussed the nature of pain, what makes chronic pain different from acute pain, what's the difference between proprioception, pain, and suffering, and so much more.  So take a listen and if you are up for it, check out some of Haider's other books including Modern Death: How Medicine Changed the End of Life and State of the Heart: Exploring the History, Science, and Future of Cardiac Disease. 

Why is almost everything we know about pain wrong? How can we reframe our understanding of chronic pain? Is there a more effective way to treat pain outside of pills and procedures? Haider Warraich is a physician and researcher at the VA Boston Healthcare System and Brigham and Women's Hospital and Assistant Professor at Harvard Medical School. He has published more than 135 papers including in the NEJM and JAMA. He frequently writes for the New York Times and Washington Post, and is the author of the books Modern Death, State of the Heart and the just published The Song of Our Scars – The Untold Story of Pain (April 2022). Follow Haider: Twitter | LinkedIn Episode Website: https://mailchi.mp/designlabpod/haiderwarraich More episode sources & links Sign-up for Design Lab Podcast's Newsletter Newsletter Archive Follow @DesignLabPod on Twitter Instagram and LinkedIn Follow @BonKu on Twitter & Instagram Check out the Health Design Lab Production by Robert Pugliese Cover Design by Eden Lew Theme song by Emmanuel Houston

Pain is a "hallmark of consciousness among all beings," writes physician Haider Warraich in his new book "The Song of Our Scars." Pain, he explains, is also gendered, racial and above all so personal that it's the one thing truly our own. Like an estimated 1.5 billion people worldwide, Warraich himself lives with chronic pain, brought on by a devastating back injury. We'll talk to Warraich about the biology of pain and how we experience what he calls our most complicated sensation. Guests: Haider Warraich, author, "The Song of Our Scars: The Untold Story of Pain." He's also a physician at Brigham and Women's Hospital and the VA Boston Healthcare System and an assistant professor at Harvard Medical School.

Synthetic cell membranes have been fused with protein machinery from living cells to create an artificial membrane. Could this be a precursor to the creation of artificial life? The team discusses its potential and limitations.Babies with severe genetic conditions are being cured by new gene replacement therapies, allowing them to overcome fatal diseases. There are a number of different treatments which have seen success, and the team finds out how they work. The DNA of two people who were killed by the eruption of Mount Vesuvius in Pompeii has been sequenced. The team finds out how the DNA from 79 AD managed to survive the heat of the volcano, and what the findings tell us about the lives of these two people.Solar sails - a method of harnessing the sun's light for space travel - are usually quite clumsy, so a NASA-funded team is developing a new more agile type of solar sail. The team finds out how they're overcoming the problem.Haider Warraich, a physician at Brigham and Women's Hospital and Harvard Medical School, discusses his new book ‘The Song of Our Scars: The Untold Story of Pain', which addresses “modern medicine's failure to understand pain”.On the pod are Rowan Hooper, Penny Sarchet, Chelsea Whyte, Leah Crane, Alice Klein, Anna Demming and Alex Wilkins. To read about these stories and much more, subscribe at newscientist.com/podcasts.Events and discount codes:Free giveaway: newscientist.com/4weeksfree20% Discount: newscientist.com/pod20Blue Dot Festival: discoverthebluedot.com See acast.com/privacy for privacy and opt-out information.

There's a long history, going back centuries, of treating some people's pain and ignoring others. Haider Warraich is a doctor at Brigham and Women's Hospital, Harvard Medical School and the VA Boston Healthcare System. He joins host Krys Boyd to discuss why there's more to understanding pain than what's measurable – and about how power dynamics have always played into its treatment. His book is “The Song of Our Scars: The Untold Story of Pain.”

Pain is central to every specialty, and we all played a part in the opioid crisis, says Dr Haider Warraich, author of The Song of Our Scars: The Untold Story of Pain. This podcast is intended for US healthcare professionals only. To read a full transcript of this episode or to comment please visit: https://www.medscape.com/features/public/machine Eric J. Topol, MD, Director, Scripps Translational Science Institute; Professor of Molecular Medicine, The Scripps Research Institute, La Jolla, California; Editor-in-Chief, Medscape Abraham Verghese, MD, Physician, author, and educator; Professor and Vice Chair, Theory & Practice of Medicine, Department of Medicine, Stanford University, Stanford, California Haider Warraich, MD, Assistant Professor, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital; Associate Director, Heart Failure Program, VA Boston Healthcare System, Boston, MA The Song of Our Scars: The Untold Story of Pain. https://www.basicbooks.com/titles/haider-warraich/the-song-of-our-scars/9781541675292/ You may also like: Medscape's Chief Cardiology Correspondent Dr John M. Mandrola's This Week In Cardiology https://www.medscape.com/twic Discussions on topics at the core of cardiology and the practice of medicine with Dr Robert A. Harrington and guests on The Bob Harrington Show https://www.medscape.com/author/bob-harrington For questions or feedback, please email: news@medscape.net

When a random weight-lifting accident left cardiologist Dr. Haider Warraich in chronic pain, he went from being a physician to being a patient in one moment. His experience of chronic pain gives him a hard won insight as he reexamines how we understand and treat pain. In this conversation, Kate and Haider discuss: the difference between pain and suffering why pain might be subjective, yet should be taken just as seriously (and perhaps invites doctors to not just treat blood work or an x-ray, but the patient in front of them) why we should erase the arbitrary demarkations between mind and body when it comes to understanding and treating chronic pain the value of accepting the reality of pain as a fundamental truth of being human (and why that doesn't mean “it's all in your head”) If you are someone (or loves someone) who suffers from chronic pain, this episode is for you. Haider talks with such gentleness about when your pain isn't believed and how doctors can do a better job at treating their patients in pain.  *** Find Kate on Instagram or Facebook or Twitter. Be sure to subscribe to our weekly email for bits of wisdom, prayers, free downloads, and more. No Cure for Being Human (And Other Truths I Need to Hear) is now available wherever books are sold. Order your copy, today. Introducing, GOOD ENOUGH: 40ish Devotionals for a Life of Imperfection. Available wherever books are sold. Learn more about your ad choices. Visit podcastchoices.com/adchoices

How do you define how painful something is? On the show this week we welcome back physician, writer, and clinical researcher Haider Warraich to talk about his new book The Song of Our Scars: The Untold Story of Pain. Warraich explores the idea that far from being something objective and easily defined, pain is complex, misunderstood, and culturally influenced. The book delves into the history of pain and explains how our understanding of it has been “shaped not just by science but by politics and power, by whose suffering mattered and whose didn't.” Support the show: https://www.patreon.com/inquiringminds See omnystudio.com/listener for privacy information.

When a random weight-lifting accident left cardiologist Dr. Haider Warraich in chronic pain, he went from being a physician to being a patient in one moment. His experience of chronic pain gives him a hard won insight as he reexamines how we understand and treat pain.In this conversation, Kate and Haider discuss: the difference between pain and suffering why pain might be subjective, yet should be taken just as seriously (and perhaps invites doctors to not just treat blood work or an x-ray, but the patient in front of them) why we should erase the arbitrary demarkations between mind and body when it comes to understanding and treating chronic pain the value of accepting the reality of pain as a fundamental truth of being human (and why that doesn't mean “it's all in your head”) If you are someone (or loves someone) who suffers from chronic pain, this episode is for you. Haider talks with such gentleness about when your pain isn't believed and how doctors can do a better job at treating their patients in pain. ***Find Kate on Instagram or Facebook or Twitter.Be sure to subscribe to our weekly email for bits of wisdom, prayers, free downloads, and more.No Cure for Being Human (And Other Truths I Need to Hear) is now available wherever books are sold. Order your copy, today.Introducing, GOOD ENOUGH: 40ish Devotionals for a Life of Imperfection. Available wherever books are sold. To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoicesSee omnystudio.com/listener for privacy information.

Pain is a "hallmark of consciousness among all beings," writes physician Haider Warraich in his new book "The Song of Our Scars." Pain, he explains, is also gendered, racial and above all so personal that it's the one thing truly our own. Like an estimated 1.5 billion people worldwide, Warraich himself lives with chronic pain, brought on by a devastating back injury. We'll talk to Warraich about the biology of pain and how we experience what he calls our most complicated sensation.

It's GeriPal's 200th episode.  Yup, we started the podcast in 2016 and over the years we have grown from basically podcasting for Alex's mom to now getting over 25,000 plays per month.    So to celebrate our 200th, and given that the last two years kinda sucked in a lot of ways, we are going to pivot to appreciative inquiry.  We have invited leaders in geriatrics and palliative care to quickly share: One thing that you are grateful for in Geriatrics and Palliative Care (other than GeriPal!) One thing you are hopeful for in 2022 The guests we had were an awesome group that included Rachelle Bernacki (@rbernack), Kim Curseen (@Curseen), William Dale (@WilliamDale_MD), Helen Fernandez (@hfernandez01), Lynn Flint (@lynnmomdoc), Anne Kelly, Allison Kestenbaum (@ARKestenbaum), Christopher Langston (@calangst), Nancy Lundebjerg (@nlundebjerg), Mary Lynn McPherson (@mlmcpherson), Sean Morrison, Christine Ritchie (@RitchieCS), Christian Sinclair (@ctsinclair), Wendy-Jo Toyama(@WJSvetanoff), James Tulsky (@jatulsky), and Haider Warraich (@haiderwarraich). We also invite you to join us in this discussion.  Go to either our Twitter account or youtube channel and share your answers to these two questions.   Eric

In your clinical experience, you may have cared for patients receiving palliative chemotherapy and wondered, hmmm, why is that called “palliative” chemotherapy? We've written about this issue previously here at GeriPal (“a term that should be laid to rest”) as has Pallimed (“an oxymoron”). Well, now we have “palliative” inotropes for people with heart failure.  And we have to ask, is this a fitting term?  And the answer is...complex...more so than you might think.  Recall that in one of our earliest podcasts, we talked with Nate Goldstein who memorably proclaimed “the best palliative care for heart failure is treatment for heart failure.”   To unpack the issue of palliative inotropes, we welcome back Haider Warraich, a cardiologist with a strong interest in palliative care.  We are joined again by Anne Rohlfing, palliative care fellow at UCSF who spent last year as a hospitalist on the heart failure service.  Please tune in to hear more about the role of palliative care in inotrope therapy, inotropes in hospice, Haider's study on palliative needs of patients with heart failure, and a bit about Left Ventricular Assist Devices (including a shout out to Dan Matlock's decision aids) and Haider's Journal of Palliative Medicine paper on top 10 tips for palliative care clinicians on caring for patients with LVADs. -@AlexSmithMD

Heart disease remains the most common cause of death in the United States, and yet it is largely preventable. CNN Chief Medical Correspondent Dr. Sanjay Gupta shares his own family history of heart disease and talks with cardiologist Dr. Clyde Yancy about what we can do to keep our hearts healthy, even if our genes make us more disposed to heart issues. And cardiologist Dr. Haider Warraich tells the story of one woman who fought against gender bias to change the way the medical community treats heart attacks.  To learn more about how CNN protects listener privacy, visit cnn.com/privacy

In today's episode of STAT's “First Opinion Podcast,” host Pat Skerrett speaks with Dr. Haider Warraich, a physician, writer, and clinical researcher.  They break down an argument Warraich made in a recent First Opinion, “Hospitals need to earn their tax-exempt status,” which details his first experience with the American healthcare system after training in Pakistan, and how he came to see its flaws.

There are a lot of large numbers that involve heart failure, starting with the sheer number of patients diagnosed (6.5 million and counting), to the cost of their care (~$70 billion by 2030), to the amount of money invested by the NIH into research ($1 billion annually). But the smaller numbers deserve attention too - 50% of patients die within 5 years of their diagnosis, those older than 65 in the hospital die even sooner at ~2.1 years thereafter, the median survival on hospice since hospital discharge is 11 days, and

In this podcast we talk about all things heart failure - from the culture of cardiology, how to impart palliative care on trainees, and practical tips on helping predict prognosis and symptom management. For more reading be sure to check out Haider's article in JPM on Top 10 Tips for Palliative Care Clinicians Caring for Heart Failure Patients and his article with Diane Meier in NEJM on Serious Illness 2.0 - Meeting the Needs of Patients with Heart Failure.

This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.

This week we are looking at the concept of hridaya- or the true heart. Hridaya comes from the roots of 'give' and 'take' and as Shannon K (our resident anatomy instructor for 300 hour + anatomy and women's bio professor at IUPUI) shares is the actual anatomy of the heart displays just that. This is not a conclusion discussion, meaning we don't arrive at anything, but rather discuss the possibilities and intricacies that make the complex organ and metaphor that is the heart. Dive in this week to get curious about what the true heart is. Wanna reach out to Shannon? Send her an email at kuhns@iu.edu Worthwhile book to check out based on this topic: State of the Heart by Dr. Haider Warraich

Lincoln Larson of North Carolina State Univ on parks and safety. Haider Warraich, Harvard Univ, on heart disease. Elena Patel of Univ of Utah on family leave. Alexandra Horowitz of Columbia Univ on “Our Dogs, Ourselves: The Story of a Singular Bond.” Elizabeth Loftus of the Univ of California, Irvine on fake memories.

Lincoln Larson of North Carolina State Univ on parks and safety. Haider Warraich, Harvard Univ, on heart disease. Elena Patel of Univ of Utah on family leave. Alexandra Horowitz of Columbia Univ on “Our Dogs, Ourselves: The Story of a Singular Bond.” Elizabeth Loftus of the Univ of California, Irvine on fake memories.

For the first time in almost a century, Americans are dying at home more often than dying in hospitals. This seems to mark a cultural change that will affect both how and where clinical medicine is practiced. Dr. Haider Warraich’s letter to the editor of the NEJM presents the numbers, and he’s agreed to talk about their implications. […]

We talk to cardiologist, writer, and clinical researcher Haider Warraich about his new book State of the Heart: Exploring the History, Science, and Future of Cardiac Disease.

I said goodbye to my grandfather when I was 8 years old. He had his first heart attack, and my mom was convinced he didn't have long to live. Turns out he had many, many years ahead of him. Unfortunately, he was riddled with recurring heart problems, Parkinson's, and a whole host of medical challenges. He lived a long life, but not a healthy one. His rapid decline shook my family, turned my mother into a health fanatic, and she passed the bug onto me.  I wish I could say that pleasure and dreams of excellence motivate me, but it's pain and fear that drive most of the big moves in my life. “I don't want to end up in a rocking chair watching Wheel of Fortune,” gets me to my yoga mat much more often than “I want to glow with radiant energy.” I wish I chased carrots, but mostly, I run from the stick. What about you? My guest on this week's show is a medical doctor who has dedicated most of his work to trying to unravel the complex challenge that is the #1 killer in the world: heart disease.  Listen & Learn:  How medical advances treating heart disease are largely responsible for extended life expectancy  Why Lipitor is one of the most prescribed drugs in the world How your choices and health goals might shift if you planned to live past 100 in a healthy state Healthspan vs. lifespan: What matters most?  What the “heart-healthy” 1980s got right and what we got wrong Links & Resources:  Book on Amazon ABOUT OUR GUEST  Physician, writer, and clinical researcher Haider Warraich is the author of the new book, State of the Heart - Exploring the History, Science and Future of Cardiac Disease that we'll be talking about today. He writes for the New York Times but also contributes to the Guardian, the Atlantic, the LA Times and the Boston Globe. He completed internal medicine and cardiology training at Harvard Medical School and Duke University. Haider has appeared on CNN, Fox, CBS, PBS, and shows like Fresh Air, The Diane Rehm Show, The World, Marketplace and the BBC World Service. Nutritional Tip of the Week: Garlic and feeling bad Got Questions? Send me a voicemail here: Ask Lucas a Question Or write to us: podcast@yogabody.com  Like the Show? Leave us a Review on iTunes

Protesters Call on U.S. to “Liberate” Hong KongGuest: Eric Hyer, PhD, Professor of Political Science, BYUThere were more protests and clashes with police in Hong Kong over the weekend. These demonstrations have been going on since mid-June and they're continuing, even though Hong Kong's leader has withdrawn the extradition bill that sparked the protests in the first place. On Sunday, thousands protested outside the US Consulate in Hong Kong urging President Trump to “liberate” Hong Kong from Chinese control. Despite an Incredible History, The Future of Heart Disease Treatment Will Require Serious WorkGuest: Dr. Haider Warraich, MD, Cardiologist and Clinical Researcher, Harvard University, Author of “State of the Heart”Just a generation ago, having a heart attack was an automatic death sentence. Today open heart surgery, pacemakers, stents and artificial valves make it possible for people with weak or damaged hearts to live long lives. Statins to prevent heart disease from cholesterol build-up are the most-prescribed medication in the country.  And yet, heart disease remains the leading cause of death in the US. And that's true for both men and women. The hidden waterways beneath Greenland's iceGuest: Kristin Poinar, Assistant Professor of Geophysics at the State University of New York At BuffaloGreenland is the world's largest island –and it's an autonomous territory of Denmark, which I only learned recently when President Trump started talking about wanting to buy it. But there's some very serious news out of Greenland on the scientific front, related to how quickly the ice sheet that covers it is melting. Speedgate: New Sport Created by AIGuest: Whitney Jenkins, Creative Director, AKQA  What If All Our Digital Data Had Expiration Dates? The Case for More ForgettingGuest: Viktor Mayer-Schönberger, Professor of Internet Governance and Regulation, Oxford University, author of “Delete: The Virtue of Forgetting in the Digital Age”When was the last time you wished your memory was worse? I don't think that's even a thing. Mainly we're just trying to keep a handle on the stuff we do need to remember. But Viktor Mayer-Schonberger thinks we'd be better off if we forgot more. Specifically, he argues that our digital memory needs a purge. Bringing Indigenous People's Perspectives to National ParksGuest: Ed DesRosier, Founder of Sun Tours and Native Business Top 50 Entrepreneurs HonoreeGlacier National Park in Montana is one of the few places in the country where you can take a bus tour with the stories and perspectives of indigenous people for whom the park has always been “home.” Glacier National Park is the ancestral home of the Blackfeet Nation. Huge swaths of it were once part of the tribe's reservation, which shares a long border with the park. But the Blackfeet Nation has struggled to capitalize on the tourism dollars the park brings in. Ed DesRosiers was an early pioneer in that effort. He's an enrolled member of the Blackfeet Nation and fought a long court battle to become one of the few indigenous people in the country licensed to operate a tour business in a national park. 

Eric Hyer of BYU on Hong Kong protests. Author Dr. Haider Warraich on heart disease. Kristin Poinar from State University of New York on glacial lakes. Whitney Jenkins of AKQA on Speedgate. Author Viktor Mayer-Schönberger on digital memories. Ed DesRosier from Sun Tours on tribal National Parks.

In this first episode of the four-part series, Haider Warraich defines the clinical diagnosis of heart failure, including its causes, symptoms, and management, and palliative care, which he differentiates from hospice care.

In this second episode of the four-part series, Haider Warraich discusses integrating heart failure (HF) care with palliative care, answers questions submitted via social media, and offers tips on how to navigate the conversation about palliative care with patients with HF.

In this third episode of the four-part series, Haider Warraich explores a unique subset of patients with heart failure who benefit from the implantation of left ventricular assist devices in combination with palliative care.

In this fourth and final episode of the four-part series, Haider Warraich focuses on palliative care for patients with heart failure who have left ventricular assist devices, highlighting important conversations to have with patients and their families and caregivers.

Host: Maurice Pickard, MD Guest: Haider Warraich, MD Dr. Haider Warraich, author of The New York Times article “Dr. Google is a Liar,” speaks with Dr. Maurice Pickard on the growing pandemic of fake medical news and its startling repercussions for healthcare providers and their patients.

Host: Maurice Pickard, MD Guest: Haider Warraich, MD Dr. Haider Warraich, author of The New York Times article “Dr. Google is a Liar,” speaks with Dr. Maurice Pickard on the growing pandemic of fake medical news and its startling repercussions for healthcare providers and their patients.

For our first Narrative Medicine Rounds for Fall 2018, we welcome Dr. Haider Warraich, whose book Modern Death deepens and enriches the conversation about death and dying that’s been growing since Dr. Sherwin Nuland’s classic How We Die: Reflections on Life’s Final Chapter and Atul Guwande’s Being Mortal: Medicine and What Matters in the End. About the book, which was published last year by St. Martin’s Press, Siddhartha Mukherjee, who is the author of The Emperor of All Maladies and The Gene, and an assistant professor of medicine at Columbia University, writes: “Haider Warraich’s elegant and poignant book takes us on an unforgettable journey. A caring and thoughtful doctor, he also writes beautifully. He succeeds in humanizing a complex topic and gives us remarkable insights about the changing nature of ‘modern death.’” Dr. Warraich, who graduated from medical school in Pakistan in 2009, did his residency in internal medicine at one of Harvard Medical School's main teaching hospitals, Beth Israel Deaconess Medical Center. He is currently a fellow in cardiology at Duke University Medical Center. His medical and Op Ed pieces have appeared in many media outlets including the New York Times, The Atlantic, the Wall Street Journal, Slate, and the LA Times among others.

Hemlock Society San Diego (619) 233-4418 In this episode, Faye Girsh talks about the Right To Die and why she continues to support the movement.     Faye was the President of the Hemlock Society USA from 1996-2002 and Senior Vice President of End-of-Life Choices (Hemlock's temporary name) from 2002-2004. She had served on Hemlock's national board and essentially succeeded its founder, Derek Humphry. While President of the Hemlock Society she started the Caring Friends program, in 1998, which provided free, personal information and bedside support to Hemlock members considering a hastened death. For the last 25 years, she has appeared in debates and speeches all over the U.S. and has been on national TV and radio, including Court TV, Good Morning America, and Nightline. She was a speaker at the World Federation Conference in Melbourne, Toronto, Tokyo, and Amsterdam and has spoken at law schools, medical schools, civic groups, universities, and to many other audiences in this country, Great Britain, Canada, New Zealand and Australia. Transcript Dr. Bob: Well, hello and welcome to another episode of A Life and Death Conversation. I'm Dr. Bob Uslander, the founder of Integrated MD Care and the host of this series of podcasts. I have a very special guest with me today. All of my guests are special in some way or another, but Faye Girsh is a phenomenal woman. She is truly a ... I don't know. Some people I've heard to describe her as a marvel and an inspiration, so I'm thrilled to introduce you to my dear friend and co-conspirator, Faye Girsh. Faye Girsh: Hello, Bob. If you're looking for a wonder woman, I'm not it, but I'm very happy to expound on our mutually interesting subject. Dr. Bob: Fantastic. And many people would argue that point and would call you a wonder woman, because you've had a fascinating life, and I know a very interesting career, and the things that you've devoted yourself to and committed yourself to are of great importance to many of the people who are listening, because this is a life and death conversation and to me, you have really lived a very inspiring life, and you never shy away from the conversation about death. And you're somebody who has really devoted herself to helping others have the best possible experience of life and as well the best possible experience of death. Faye Girsh: Thank you for all that. Dr. Bob: And thank you for all that you've done, because what I get to do in my career, some of what gives my life and my career a great meaning is a direct result of the work that you've done over the years. Faye Girsh: It's very encouraging now that there are so many people working on this very important issue for all of us. Dr. Bob: And the issue that you're referring to it's called by lots of different things. When you're talking to somebody about what it is that you do and what you've devoted so much of your life to, what are the words that you like to use to describe it? Faye Girsh: I guess choices at the end of life, if I have less than 30 seconds, that people should be able to die the way they want to, in a humane and peaceful way, with their friends and loved ones present, and consistent with their own values and beliefs. That's the 45-second version. Dr. Bob: Actually, I think it was probably closer to 20 seconds, and it's- Faye Girsh: 20 seconds, okay. Dr. Bob: ... very descriptive and appropriate, I think. Faye Girsh: It sounds very simple too, and it's definitely not simple. In fact, the progress towards it is absolutely glacial because many people don't believe that we should have a choice in how we die, which to me is amazing and also very unjust, unfair. Dr. Bob: Yeah. I agree. And you can spend a lot of time exploring how we got here, and I'm sure there's some value in that because it helps those of us who really do believe that people deserve to have that choice in how, where and when they die. It helps us to see where the challenges remain, by looking at the barriers and the things that have been blocking that- Faye Girsh: You know, I'm reading an interesting book now, Bob, called Modern Death. I don't know if you've seen it. By a Pakistani American doctor named Haider Warraich.  I don't know how you pronounce his name exactly. But he talks about how the way we die has changed so much in the last 50 years because of technology, insurance, hospital, everything. It explains a lot to me about how things have changed from when I was a kid, and the doctor would make house calls, and I assume that if we were dying, he would have given us a nice injection and sent us on our way, with the agreement of the family, but it's a long way from that now. It's a little bit back to what you do when you visit people at their homes, which is so unusual these days. Dr. Bob: That does sound like an interesting book, and I'd like to make sure that the listeners have the resources that our very experienced guests are recommending. So "Modern Death" is the name of that book? Faye Girsh: Yeah. Dr. Bob: I'm going to pick up a copy. I appreciate that. Faye Girsh: Subtitled "How Medicine Changed the End of Life". Very interesting. I haven't finished it yet. I don't think he is necessarily a proponent of medically assisted dying, but he certainly leads up to where it should happen. Because I do think that probably 40 years ago, your GP – there weren't specialties then – your GP would come to your house and if you and your family decided that your suffering was unbearable, something in his black bag would help you through to the other side, just to use all these euphemisms. But that's changed, and the laws have changed. The laws are changing for the better for sure, as far as giving you more choice at the end of life, but it becomes very legalistic and formalistic. And maybe that's good because now there are safeguards, but when men safeguard, they're another man's obstacles. It has become cumbersome and complicated sometimes for people to have a peaceful death. Dr. Bob: Well, it seems like it used to be a pact between the doctor and the patient and family. We didn't need all the legislation; people trusted that their physician was going to be there and help them make those difficult decisions knowing it was time. We also didn't have all the other options available. We didn't have all the intensive care units with all of the life-prolonging technology. We didn't have skilled nursing facilities, where people could be housed for months or years- Faye Girsh: Well, actually we didn't even live that long. We didn't live long enough to have a prolonged and agonizing death. We didn't die of these degenerative diseases that we have now. So, yeah. I mean, this book explains a lot of that, but this is something that we've sort of accustomed ourselves to over the years, ways to keep people alive. Faye: I live in a retirement community. I'm 84, and it's getting close myself, and it's very interesting for me to see people, my friends, get old, get disabled, wind up in the care center, or the memory unit at worst, and die quietly.   We really don't know how the end comes for most people unless they are very close friends. And then we get a little picture frame, and a white rose in the mail room and says we died. No telling how we died, or what we went through before we died. And then a little obituary says he died peacefully in his sleep, which is usually a lie. And then a little tombstone says, "Rest in peace," but before that, sometimes there is no peace, and sometimes these steps to getting dead are very difficult. Dr. Bob: Yeah, as I'm aware of through my own experience and career. That's an interesting ... it's really fascinating to think about that, living in these communities, many of which are very nice, right? They're beautiful. They're like luxury hotels or cruise ships. Faye Girsh: They are. Right. Dr. Bob: And then there are all these folks who come to the dining room, or you see them in the common areas, and at the activities, and then you just don't see them anymore. Faye Girsh: That does happen. Or you see them on walkers, and then in wheelchairs, and then you don't see them. Or if they're your neighbors, they move to the care center, which we have a very nice arrangement. And then the next thing, sometimes as you know, is their little picture and white rose are up there in the mail room. It's fine. It's a good way to experience death. We don't talk about it very much here, but I've appreciated knowing that, because in my life I wasn't among people who were dying, but now, that's what happens. And what I hope is that people can die the way they want to. And I know you spend time here too and you know the people who live here. They accomplished a lot. We say our motto in Hemlock Society is, "Good life, good death," which we actually stole from Christian Bernard, I think, who wrote a book. The heart transplant doctor wrote a book, I think, called Good Life Good Death. And many of us here have lived a very good life, but we often don't have a good death... I've only been here four years ... but who went out to [inaudible 00:10:00] parking lot and shot himself because he had early dementia. And other people who've struggled with dementia then wind up in the memory unit here for years. In fact, we're having a situation now with my very good friend, whose wife has been there I think now eight years. And they have treated her without consulting the family, but now the family has put their foot down, absolutely no treatment. So she gets nothing. No vitamins or anything. And she's never been healthier. And finally, the family's decision to withhold food and hydration. And of all the things that have happened, is the caregiver has protested and said she would sue the institution here for murder. So, that's a very interesting development. Dr. Bob: I wasn't aware that was happening. Faye Girsh: Well, if I were at lunch now, which I usually would be, I would be talking to this man whose wife it is and trying to enlist one of his children to speak at one of our Hemlock meetings on this subject, which is the refusal of treatment in dementia. A very complicated subject, because a demented person can't speak for herself or himself, but the loved ones can, the person who's been appointed as health care agent can. But often those wishes are violated. I will have another speaker at our January meeting, whose mother-in-law has been in the institution. Those who know Bonnie, was once a very active, beautiful, intelligent woman, and they had been coerced, shamed I guess is the word, into providing treatment for her twice, because she has to have her hip fixed because she fell. She has to have her ulcer treated. Even though she knows nothing it is has made an advance [inaudible 00:12:18]. She doesn't want treatment. So these things are very complicated, refusing treatment, medically futile treatment that's given so often. And hospice is not saying that they can fix everything, but really they can. They can fix a lot of the pain even, but alone the existential suffering that people have because they can't do what they are used to doing, they don't want to be doped up at the end to alleviate the pain. They want a peaceful way out, and yet they either don't know what's available to them, or they can't find a doctor who will help them use even our California law, The End of Life Option Act. So we have a long way to go. We are about to finish our 30th year as Hemlock Society of San Diego, and we're looking for new directions to go in. And for me, dementia is the direction because it seems so hopeless to be a long-time demented patient with no way out. Dr. Bob: That is just ludicrous, to think about that when there are so many people, there are so many people who, as you say, lived wonderful lives, they raised children, they had careers, they contributed, and if they were able to look at the scenario and to see what's happened to them and what's being done, and you ask them what they would want, we know that they would want to not be there. Faye Girsh: That right. Dr. Bob: They would be ready to ask somebody to mercifully end their lives. And I'm a physician, and I know that there are laws that prohibit that, and we can't just take it upon ourselves. And even if people have indicated that they would never want to be alive in those circumstances, our hands are tied. But it's just a crazy, crazy situation- Faye Girsh: Fortunately, we can look North and see what Canada is doing. And Canada is making much more progress than we are, which is not surprising of course. But the Canadian law that went into effect the same time the California law went into, that is June 2016, permits active euthanasia. That is a patient can ask for a lethal injection. It's so much better than what we have to struggle with, these expensive bad-tasting drugs that you have to be able to swallow, to use. That's not such a good solution.  And also, Canadians have made their laws much more liberal. That is, it doesn't just take a doctor to do it. A nurse practitioner can help you die that way. And in our law in California, you have to have a psychologist or psychiatrist to ascertain that you are mentally competent, and another doctor to determine that you are terminal, in addition to the first doctor. But in Canada, that's not the case. A lot of different people can ascertain that you're mentally competent. And again, it doesn't have to be a doctor to provide the lethal injection. And the criteria is not a terminal illness as ours is, which to me, it is not even relevant to the question of how much you're suffering, and how long you've been suffering, and how long you have got to suffer. A terminal illness means you're going to die within six months, which in some cases is a mercy, but some of these neurodegenerative diseases take years of suffering before death occurs. So, I think we have to look to Canada to change our laws. And we've had the Oregon-type model as our model law now in six jurisdictions, five states in the district of Columbia, but that law has existed now for 20 years. To me, it's inadequate, and it's time to move forward and to look at what other countries are doing.  And then, there's a whole collection of ... No, that's not true. There are some doctors and some organizations, and I'm thinking in particular of Doctor Philip Nitschke, who started in Australia and was the first doctor in the world to give somebody euthanasia at their request, under a law. And that was back in 1996. He's now living in Holland, but he doesn't believe that we should try to change the law at all. He believes that people should be able to do it yourself, get what's necessary, whether it's drugs or mechanical devices or whatever, and do it ourselves because he knows that doctors are resistant to doing this and the law is very slow to change. That's one point of view. I don't totally agree with it. I think it's very helpful to have somebody there, somebody with an organization like Final Exit Network, to be there with you, and certainly a doctor to be there with you if you can find a cooperative doctor like Doctor Bob Uslander to see you through this, because it's not just a one moment decision, you swallow something and you're dead. It's a decision that should be decided over months with consultation with your loved ones. But that is very difficult and complicated in our country. Dr. Bob: All of this is complicated for sure, so I appreciate you sharing your passion, and your viewpoints on this. If it's okay, I want to make one slight correction to one of the things that you indicated, about the process for the End of Life Option Act in California, in that it doesn't actually require a psychiatrist or a mental health specialist to weigh in- Faye Girsh: No. You're right. Dr. Bob: Only if the attending physician or the consulting physician feel that there is a mental health issue or a psychiatric issue that is impacting the person's ability to make a decision. Faye Girsh: You're right. It doesn't happen very often actually- Dr. Bob: No. Faye Girsh: That a mental health professional is required to make the decision about competency. I think in Oregon has happened very few times. We have- Dr. Bob: Yeah, because a physician is- Faye Girsh: Better data from Oregon than we have from many places else. We have 20 years of data that the government of Oregon has collected. No, you're absolutely right about that, Bob. Dr. Bob: Again, thank you for sharing. We definitely have strides to make. I think we both are feeling grateful that we have come to a place in California where people do have more choice and more options, but we do still need to continue pushing forward. There are still some issues and problems with the existing law. It doesn't address the needs of the people with cognitive impairment and dementia, and those are really challenging situations. Faye Girsh: And doctors are not being educated about what this law entails. I have a new primary care doctor that I talked to the other day at Scripps, and she didn't know anything about it. There's never been even, not only a policy described by Scripps but no education about the law at all. She didn't know what to tell me. She's going to find out and tell me later. But this is not acceptable. This is a law now, and even though everything is voluntary, so it's completely voluntary on the part of the doctor, the patient, the hospice, the pharmacist. That doesn't mean that people shouldn't be educated about it, and that's what we try to do in Hemlock. I just gave a speech to bunch of elder law attorneys, and before that to an Episcopal convention. And the more people we can talk to the better, but that's a drop in the bucket compared to the people who don't know what their rights are. And some hospitals have gone all out. Kaiser's very helpful in that respect, but my hospital, Scripps Clinic, they don't seem to know anything. It requires a massive educational effort, and it requires a little more cooperation and enthusiasm on the part of doctors and institutions, and definitely on the part of hospices. I think it's a disgrace that no hospice that we know of in this county will actually provide a doctor to do this for you. Many of them will refer to you, which is fine, but I think hospices should be able to assure a patient who comes for hospice care that if their suffering becomes too great, or they've had enough, that somebody will help them achieve a gentle death, which is what happens in Canada now, especially in Quebec, which has been the leader in this. The formally very Catholic province now, very progressive. And in Belgium and Holland. Their hospices will also provide peaceful death, voluntary euthanasia, but not ours. Dr. Bob: Not ours. Faye Girsh: And ours maintain that they can do everything in make dying fine for you and many of them can. I have no question about that. But for many people, there needs to be another option. Dr. Bob: And I always think about that when we hear from the palliative care and hospice folks, who are all very well-meaning, and compassionate, and they make it very clear that if the suffering becomes too great, then we can medicate people into unconsciousness. It's called palliative sedation, where you get medication so that you're no longer aware of your surroundings, no longer feeling pain, no longer feeling like you're struggling to breathe. And once you get medicated to that level, you will no longer be able to eat or drink, you won't have any nutrition, and eventually, you'll die of dehydration. And I understand that that is possible, and we for years have been doing that for or to patients. And my response to it is, if somebody has another option if somebody has the option of actually taking something on their own that will prevent that from being necessary, that they have the control, they get some of their power back, why wouldn't we want to make that available to them? Faye Girsh: I have debated that with so many hospice directors and doctors and nurses. I can't understand why the answer is not as simple as you make it. I mean, palliative sedation is very nice. I remember debating one hospice director, I guess she was, and she said, "No. Doctors should never help their patients die, never." But later she said, "When I see a patient in intractable suffering ..." well, she said pain, initially, but she was talking about suffering, " ... then, of course, I will administer something that will relieve them, and they won't wake up." Isn't that what I just said? No. Because the doctor has control over the decision, not the patient. Dr. Bob: Exactly. And I believe that's- Faye Girsh: And that's wrong. Dr. Bob: That's where the big divide is. The medical profession has so much ego, and we are unwilling to give control away. So instead of giving the patient and the family the ability to be empowered to have the option to act on their own, to make this determination, we need to do it for them or to them. We don't believe that people have the intelligence or the ability to make this determination of what's in their best interest. Faye Girsh: I'm not a great critic of the medical profession because I was married to one and I have given birth to one, and I like doctors very much in general. I've always liked the doctors I've had. It's some kind of paradox. I guess it's like politicians, you like the one you have, but then generally they're no good. I don't know what they need, education or something, and they need to be assured that they're protected from the law, because even though this law that we have, The End of Life Option Act, is clear that if a doctor does this, he or she is fully protected under the law. Somehow doctors don't believe it, and – again another generalization about what doctors think or do – they don't like to be bothered. There's a lot of paperwork ... you know this ... involved, there is not just, "Let's see. I write the prescription. Goodbye." You really should attend to your patients; you should find out what's going on with them. So they should be involved, and they don't want to be involved because that's not their job. I just saw a cartoon recently that said, "I'm a doctor, and I believe in preserving life at any cost." And the cartoons said, "Make sure you don't get that doctor." I mean, it's very nice. I do like people who are pro-life but up to a point. Up to the point where the patient says, "Okay. Death is not the worst option here. Staying alive under these conditions is worse, and I want to die gently and peacefully. And I don't want it to be a big secret, and I don't want to jeopardize anyone by helping me. Let's do it." And there's certainly more places in the world that are enlightened about this than we are. Dr. Bob: And I believe we're moving in the right direction as we both stated before. We have a lot of work to do, but we don't want to discount the fact that we are certainly in a better position than we were a couple years ago here in California. I try not to be critical of physicians. Many of my very good friends are physicians. I have spent a lot of time with some amazing physicians, and I think in general, doctors really do care a lot about people. They go into the profession because they're caring, and they want to help, and they want to do good. And it's not that they, in general, don't want to be bothered. They don't have the time; they're not allowed to have the kind of time that it takes to do this well. Many physicians are still very uncomfortable with the whole notion of death. When you go to medical school, and in your training, you would assume that there is no such thing as death because it's really never talked about. The textbooks don't mention anything about death. It's all about what we can do, how we can utilize the technology available to us, how we can do the right screening and prescribe people the- Faye Girsh: To prevent this from happening. Dr. Bob: So the training isn't there. A lot of people, I think, have to go through their own personal experience, they have to go through their own personal journey. Maybe have their own epiphany about what their role here is, and how they can best serve their patients. Faye Girsh: Bob, present company excluded, I don't think doctors need to be the agents of a peaceful death. In fact, when I was head of the National Hemlock Society, I started this program called Caring Friends where we educated our peers, older people like us ... I mean, I'm talking about the members of the Hemlock Society now, not you ... to work with people in their homes and tell them what means they could use to achieve a peaceful death, short of getting the drugs necessary. And there are many means. And of course one of them is not eating and drinking, but that's not the one we advocate. I'm talking now about the national organization called "Final Exit Network," which I was one of the founders, and that emanated from the Caring Friends program that I started at Hemlock. And we knew that doctors were not going to help, that we're not going to be able to get these drugs, which is the gold standard, but there are other ways. Now I'm using my Final Exit Network hat here–the guys at Final Exit Network teach people how to die peacefully, not using drugs, but using other means, which essentially lowers the oxygen in the brain, which causes a peaceful death but doesn't require drugs.   And there's an organization, a very loose organization, called Nutech, which has been working on this now for years, maybe 15 years, also started by Derek Humphry who started the Hemlock Society, New Techniques in Self-Deliverance. And I just went to a Nutech meeting in Toronto, where people from all over the world were there. It was a $5,000 reward for people who could come up with the best inventions so that people could do it themselves and die peacefully. So we're a long way from making an ideal situation, but there are situations that people can use, but that's not enough. I always gave the prototype of an 85-year-old woman. I'm about to be that. But an older person who's alone, who's sick, who may be partially blind, who is not mechanically inclined, a limit to what they can do to do this for themselves. So we do think that people should be there with them, and that's what they do in Final Exit Network. The Exit guide is present when people use these methods, and coaches them in how to use them. And we think we're covered under the First Amendment, but there's some litigation going on, which has challenged that assumption. Dr. Bob: Not surprising. Faye Girsh: No. But there are books, and videotapes, and YouTubes telling you how to end your life peacefully. And that certainly has its drawbacks because we don't believe that ... I mean, I am a psychologist by training, and I've worked with a lot of suicidal people, who with therapy have come to realize that suicide is not the answer to their problems. And it isn't. And there's a fine line between assisted dying and suicide, but generally, people who want help in dying would much prefer to live, but because of their disease or condition find that dying is preferable to living that way, whereas suicidal people don't want to live. They want to die. That's the difference. So if you make these methods available, then suicidal people have access to them, and that's arguable too. I mean, maybe it's better that they die peacefully than jump off bridges, as one of my very good friends did, or shoot themselves, as another very good friend did, and they could choose to die peacefully. That's a whole another discussion. Dr. Bob: Yeah. That's a whole another discussion. And I'm just thinking about, as I'm hearing you speak and discussing these topics that are certainly not part of the mainstream conversation that people are having, I'm just imagining that there are going to be people listening to this, who are squirming and feeling uncomfortable about these topics. And you know what? And that's okay. Faye Girsh: No doubt. Dr. Bob: These are things that we all really should explore and try to determine our own comfort level with them, and hopefully become more comfortable engaging in the entire spectrum of conversations about life and death. Faye Girsh: The Hemlock Society of San Diego, which has existed now for 30 years, is at a juncture of where to go next. We can continue having meetings and having speakers and everything else, but we do have to tackle these very naughty issues. And we are tackling them. Maybe we're the only organization in town if anywhere, that is doing it, but it does make people squirm. But we have a lot of people come to our meetings. They're all free. They're all open to the public, and they all deal with different issues about dying. To one meeting we had three veterinarians who talked about how they can help animals dying. It's so nice. Everybody was so jealous they wanted to grow two extra legs and a tail and be one of these animals that die in the arms of their loved one, peacefully and gently. A little shot in the paw and that's it. And then I've been a defender of Jack Kevorkian all these years. I thought, when he showed how his patient Tom Youk died, to 60 million viewers, that was a good thing, that we don't see people actually die and we don't even die on ICUs, or even in hospices. We don't see them junked out with drugs for days on end. We never see how people die except fictional, machine guns and that kind of thing. To see somebody get a lethal injection, keel over and he's dead, and how simple that was, and how desperately he longed for that relief from his ALS. This was the last patient that Doctor Kevorkian helped. And for that, Doctor Kevorkian spent eight years in prison doing a 10- to 25-year sentence that he got. For a doctor to come out and say this is what's important for doctors to do ... and the thing about Jack Kevorkian was there was nobody in the world practically, unless you were in the middle of a jungle somewhere, who hadn't heard of him, who didn't have an opinion about him, and who hadn't heard from his own patients why they wanted to die. And that kind of education thought, at that point, when Jack Kevorkian was I think in his seventh or eighth year of doing this, 75% of Americans believed that people should have assisted dying from a doctor. That's gone down considerably, because people don't hear about this, they don't engage in the dialogue, their doctors don't talk about it certainly, and it's up to us, the Hemlock Society of San Diego, and a few other organizations, to discuss this openly, so people know what the issues are. Dr. Bob: On that note, I think we're going to kind of wrap it up, but I do want to make sure that anybody who is interested in getting more information about anything that we've spoken about, that you've shared, has direction on how to get that information. I want to thank you for being a pioneer and for dedicating so much of your time and energy and money to this effort. There are many, many people who are indebted to you and have gratitude for the work that you and your tribe, your peers have done. Faye Girsh: Thank you very much, Bob. Dr. Bob: You're welcome. Faye Girsh: I'm getting to the point where a peaceful death is becoming more of an immediate issue, so I'm working extra hard, but I'm very glad you're around. Very comforting to me and many other people. Dr. Bob: And seeing you and being around you, you have vital energy, and I don't think it's going to be dissipating anytime soon. How do people learn more about the work that you're doing? Faye Girsh: Well, we have a website that's very informative, HemlockSocietySanDiego.org. And that will give you our phone number, which is 619-233-4418. We have, of course, an email address, which is ... I'm not even sure what it is. Dr. Bob: I'm sure they can get it off of the website, right? Faye Girsh: The website has all this information. And people are welcome to get on our email list to get a notification of our monthly meetings. And they're welcome to come, no charge. Although we will be having special meetings, I think now, for Hemlock members that we don't particularly want to share with the public, but that's another issue. Because we want people to be empowered the best way they can about ways to have a peaceful death. And not only for them, but we're having more young people come because their parents are dealing with this issue, or not dealing with it. Dr. Bob: And I've been to meetings, I've spoken at the meetings, and there's a wealth of information, and really some pretty incredible people there. I find that the level of intelligence and acceptance among the people who are really paying attention to these issues is very high. Faye Girsh: Yeah. And you've gotten to know some of them. Dr. Bob: I sure have. Faye Girsh: The ones that have had a peaceful death with your assistance. Maybe that's not the right word, but I don't know- Dr. Bob: That's fine. Faye Girsh: ... one has to be a very good- Dr. Bob: With my guidance. Faye Girsh: Guidance is a good word. Dr. Bob: And I've shared with our listeners some of the experiences that I've had and how powerful they've been. And the more people that I'm able to support and be with, the more strongly I feel about helping to spread the message and allow more people to understand how they can get this control, how can they be empowered when their life is coming to an end, and they're just like many of the people we've discussed. They're just not okay allowing this natural decline to decimate them further when they have a more peaceful, gentle option available. Faye Girsh: Thank you for doing this, Bob. And thank you for doing the podcast. I appreciate having an opportunity to talk about this. Dr. Bob: Yeah. Well, you're so articulate and passionate, and I look forward to our next conversation together. Faye Girsh: Absolutely. Dr. Bob: This is Doctor Bob Uslander, A Life and Death Conversation, until next time.

Listen NowEarlier this year St. Martin's Press published Dr. Haider Warraich's Modern Death, How Medicine Changed the End of Life. As the dust jacket notes, "the mechanics and understanding" of dying, "the whys, wheres, whens and hows are almost nothing like what they were mere decades ago."  Today, eight in ten Americans die at an advanced age, or under Medicare, die in a medical setting after suffering for some while from a chronic, eventually fatal disease or diseases.  If lucky, how Americans die will have been determined, or at least informed, by an advanced directive or like document.        During this 27 minute conversation Dr. Warraich discusses what characterizes "modern death,"  how the 1970s Karen Ann Quinlan case redefined death or dying, the role family caregivers play and the unintended consequences for them in providing a family member care, the limitations of advanced directives and living wills, euthanasia, physician assisted suicide and terminal or palliative sedation and whether "how medicine changed the end of life" has made "modern death" comparatively better. Dr. Haider Javed Warraich is currently fellow in cardiology at Duke University Medical Center.  He was graduate from medical school in Pakistan in 2009 and did his residency in internal medicine at the Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School   He is a regular opinion page contributor to The New York Times, The Atlantic, The Guardian, The Wall Street Journal, the LA Times and has contributed to several academic publications such as The New England Journal of Medicine, the Journal of the American Medical Association, Lancet and Circulation.  During the interview mention is made of a November 28, 2016 Fresh Air (NPR) interview titled, "The Debate Across the Nation Over Death With Dignity Laws," that featured Dr. Warraich along with Dr. Ira Byock.  The interview is at: https://dianerehm.org/shows/2016-11-28/aid-in-dying.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

We talk to physician, writer, and clinical researcher Haider Warraich about his most recent book "Modern Death: How Medicine Changed the End of Life."

Host: Brian P. McDonough, MD, FAAFP "Doctors 'Google' their patients. In fact, the vast majority of physicians I know have done so... But it surprises me that more physicians don't pause and think about what it means for the patient-doctor relationship." This an excerpt by physician and author Dr. Haider Warraich from his New York Times article titled "When Doctors ‘Google' Their Patients." Join host Dr. Brian McDonough for an interesting discussion on the ethical ramifications of this trending practice among clinicians.