Dr. Peter Attia

Because we think you're depressed. You're depressed.

Because we think you're depressed. You're depressed.

Not FDA approved drug. Approved for pain is what you meant. Yeah. Thank you. Thank you for that correction. FDA approved for something else. You're absolutely right. Okay. Well, this brings us to opioids, which I saved for last because of, well, there's actually more drugs I want to talk about, but in terms of the off the shelf, typical stuff that people think about.

Not FDA approved drug. Approved for pain is what you meant. Yeah. Thank you. Thank you for that correction. FDA approved for something else. You're absolutely right. Okay. Well, this brings us to opioids, which I saved for last because of, well, there's actually more drugs I want to talk about, but in terms of the off the shelf, typical stuff that people think about.

So a lot of hay has been made over this. There's no question that opioids have been overused and abused. And there's no question that illicit use of these things has had a devastating impact on our society. But it would be difficult to say that the field of medicine would be better off having never had an opioid. We just talked about surgery, for example.

So a lot of hay has been made over this. There's no question that opioids have been overused and abused. And there's no question that illicit use of these things has had a devastating impact on our society. But it would be difficult to say that the field of medicine would be better off having never had an opioid. We just talked about surgery, for example.

Very challenging to deliver medical care in a hospital without opioids. So the question becomes, what is the most responsible case for oral opioids, which by definition are meant to be used outside of a hospital, not inside a hospital? And as a pain specialist, I would imagine few people are better equipped to navigate the nuance of that question.

Very challenging to deliver medical care in a hospital without opioids. So the question becomes, what is the most responsible case for oral opioids, which by definition are meant to be used outside of a hospital, not inside a hospital? And as a pain specialist, I would imagine few people are better equipped to navigate the nuance of that question.

By the way, the perfect analogy to this is the mortgage crisis in 2006 to 2008. If you took a zeroth order view, it would be really easy to blame one of the entities, but it is actually a perfect storm.

By the way, the perfect analogy to this is the mortgage crisis in 2006 to 2008. If you took a zeroth order view, it would be really easy to blame one of the entities, but it is actually a perfect storm.

Just one thing, you are not taking care of somebody in the acute phase of expected pain typically, is that correct? In other words, that guy that just had a knee replacement, he's being managed by his surgeon, correct?

Just one thing, you are not taking care of somebody in the acute phase of expected pain typically, is that correct? In other words, that guy that just had a knee replacement, he's being managed by his surgeon, correct?

When is the big gun of your team's expertise being brought in for a post-surgical routine case versus not?

When is the big gun of your team's expertise being brought in for a post-surgical routine case versus not?

You know, when we brought pain in for every case when I was in residency, anytime we did a thoracotomy, It was a non-negotiable. Pain was consulted before the case, just for people listening, a thoracotomy. We didn't do these often because a lot of times by the time I was in residency, we did minimally invasive surgery in the chest.

You know, when we brought pain in for every case when I was in residency, anytime we did a thoracotomy, It was a non-negotiable. Pain was consulted before the case, just for people listening, a thoracotomy. We didn't do these often because a lot of times by the time I was in residency, we did minimally invasive surgery in the chest.

But sometimes you had to actually make a huge incision under the ribs. And that's a very painful, you just know this from experience, that that's such a painful experience. You cut this huge incision in the intercostal muscles, you put rib spreaders in, you crank these things open so you can do this big operation.

But sometimes you had to actually make a huge incision under the ribs. And that's a very painful, you just know this from experience, that that's such a painful experience. You cut this huge incision in the intercostal muscles, you put rib spreaders in, you crank these things open so you can do this big operation.

We just know those patients are going to need an epidural catheter and we want that in before surgery, not after. And it makes all the difference in the world. So pain was a part of that response. I don't remember us routinely bringing pain in regularly. otherwise, but things have changed, I'm sure, in 20 years.

We just know those patients are going to need an epidural catheter and we want that in before surgery, not after. And it makes all the difference in the world. So pain was a part of that response. I don't remember us routinely bringing pain in regularly. otherwise, but things have changed, I'm sure, in 20 years.