I was wrong about "healthcare".

Dr. Robert Yoho

Dec 31, 2022

Welcome to 2023! This is a good one to start they year.

How many honest doctors are out there? Not many.

If honesty can cost you your licence, your living, your reputation, then honesty is simply too expensive for almost all doctors. This means that most doctors either have to maintain a useful, conscience preserving, ignorance, or develop the coping skills of living with the untruths and their consequences.

That’s why, when I find an honest doctor, I know that I’m in the presence of a rare creature.

Which brings me to Dr. Robert Yoho.

I first came across him via Substack, and have recently been reading his book titled Butchered by “Healthcare”. What I really like about it is the breadth of the work covering many different medical specialties, the self-reflective commentary on his awakenings and the details of the incentive structures that have ultimately led to the corruption and hollowing out of so much of medicine. It’s well worth reading. This, a recent comment from Robert:

American medicine is such a mess, but I never got around to questioning my assumptions about this topic [circumcision] despite my years studying medical corruption for Butchered my "Healthcare". We US docs are smug about our beliefs after our decades of indoctrination. I'm shocked anew every week or two when I realize another cherished idea was planted by industry.

Robert makes the pdf available for free here. But I recommend supporting his work by buying his work here and leaving a positive Amazon review if you like it.

If you download my book free, please at least review it and if you like it (it was three years of full-time work) please buy the ebook to support my Amazon Ads contractor. I don't make money on my writing.

I especially like Chapter 2 of the book, as it’s a bird’s eye view of many different compartments of the medical industrial complex.

You can also get his latest book, Cassandra’s Memo: Covid and the Global Psycopaths, here.

With thanks to Dr. Robert Yoho.

Butchered by “Healthcare”

Chapter 2

Wholly unprepared… we take the step into the afternoon of life; worse still, we take this step with the false assumption that our truths and ideals will serve as before. But we cannot live the afternoon of life according to the program of life’s morning—for what was great in the morning will be little at evening, and what in the morning was true will at evening have become a lie. - CARL JUNG

Doctors help patients, and they love us for it. We ﬁx bones, replace joints, cure killer infections, and control diabetes with insulin. We use painless scans for diagnosis. Liver, kidney, and heart transplants are now routine. Some patients get cured of lymphomas, leukemia, Hodgkin’s disease, and testicular cancer. Lives are prolonged for myeloma and amyloidosis. Vaccines have saved millions worldwide. [U: I don’t want to put word’s in Robert’s mouth, but I suspect he has moved on the vaccine issue since writing the book].

We have complex technologies such as the heart bypass machine and dialysis. We replace diseased heart valves with artiﬁcial ones that work. Cardiologists permanently correct irregular rhythms using techniques that would seem natural on Star Trek. Other specialists gift infertile couples with children. Despite this, many sources agree: for at least half of health-care, the potential beneﬁt does not outweigh the harm. For a lot of the rest, supporting evidence that it works is lacking. A review of over 5,000 articles recommends against many of today’s standard practices.

The list below introduces some of the topics in this book, the worst failures of healthcare, in rough order of wasted resources. The opioid disaster, now killing 50,000 people a year in the US, is not even in the top seven. I “knew” a lot because of my degrees and training, but I was wrong about many things.

1) Insurance.

What I thought: health insurance protects us against disasters, just like ﬁre insurance.

The truth: Most of the $3.65 trillion in US medical spending (2018) is run through insurance companies before payment, which produces an insanity of wastefulness. These corporations extract fully a ﬁfth twenty dollars of every hundred!—of whatever they touch for their administration and proﬁts, and they know that if total spending goes up, they get more money.

After the insurance layer has taken its share, only 75-80 percent remains for “providers” and suppliers. Every one of these has their own bloated overhead, which they must pay before patients get anything. Hospitals, for example, consume at least 25 percent more for internal expenses. This system creates outrageous total costs.

The smaller but more gloomy insurance story is the workers compensation system.

2) Hospitals.

What I thought: hospitals are bureaucratic, but physicians supervise them to make people better.

The truth: Although many people who work in hospitals are idealistic, most of these corporations are ruthless pirates that are looting the patients who trust them. These companies pay or bully physicians to cooperate with their agendas.

Hospital costs are about a third of US healthcare. They spend ten to ﬁfteen percent of their receipts just on coding, collections, and other methods to whip money out of the insurance companies.

3) Drugs and medical devices.

What I thought: Idealistic scientists wearing white coats develop new miracle drugs and devices all the time.

The truth: The pharmaceutical companies purposefully falsify the studies the FDA requires to patent medications, and the regulator turns a blind eye to it. Concealing negative studies that show little or no efﬁcacy, such as was done with the anti-depressants and the statin anti-cholesterol drugs, is just the start of their hoaxes. Because of practices like this, deciphering which medications work has become difﬁcult. Many drugs are ineffective, and a lot are damaging. Some of the worst are the statins, the newer diabetes drugs, the osteoporosis drugs, the inﬂuenza vaccine, and the whole psychiatric pharmacy. These are all bestsellers.

The huge implant device industry plays the same games as the pharmaceutical companies and has fewer rules that force them to conduct proper studies.

Here is what I thought about generic drugs: they are just about as good but cheaper than patent medicines, which are a rip-off.

The truth: I was right; patent medicines are a rip-off.

Generics are sometimes inactive or even contaminated, however. But they are now 90 percent of the American formulary because of patent drug price-gouging.

4) Journals and the academics of medicine.

What I thought: If I studied hard, read journals, went to meetings, and listened rather than talking to my friends, I would learn. Also, if I looked at Internet sources, I would quickly understand any medical ﬁeld.

The truth: Doctors’ information sources have been wrecked by corporations. We depend on journals, but their editors have been bought off. They print fraudulent studies containing purposefully confusing math developed by academics who are sponsored by corporations.

Patients’ information sources, on the other hand, are advertising, “advocacy” groups, blogs written by industry, and wall- to-wall internet link-farms. They are all marketing in disguise and create anxiety and spread false information.

5) Mental Health.

What I thought: psychiatrists have some strange ideas, but their drugs are effective and treat mental illness just like insulin helps diabetes.

The truth: This is our most expensive and least effective medical sector. Informed commentators now call psychiatry a pseudo-science, and a substantial, credible group - besides Scientology - openly questions their theories and drugs.

Psychiatry is nearly divorced from even the ﬂawed science advising the rest of medicine. The psychiatrists accept the most money from the pharmaceutical industry of any doctor group, which results in their ideas being the most contaminated. Their toxic medications might help a few sick people, but corporations promote them so heavily that one in six US citizens takes them. We mostly ignore the tragic consequences.

6) The heart industry.

What I thought: cardiologists and heart surgeons have effective treatments for coronary artery disease.

The truth: Invasive treatments for this are an immense but dismally ineffective industry. Sham surgery studies have now debunked stents, the tiny devices used to open coronary arteries. These might never work, depending on what you believe. The cardiologists understand the math yet continue placing them for the money.

Coronary artery bypass grafting surgery (CABG) is also useless or harmful. It immediately kills two to nine percent and gives long-term brain damage to a third. A few patients supposedly beneﬁt: the three percent with severe blockage of their one centimeter “left main” artery. For them, the studies show a ﬁve- year survival improvement of twenty (20) percent. But the operation is overwhelmingly performed for patients with other issues. These people suffer the complications with no chance of beneﬁt.

Medications and lifestyle changes work better for coronary heart disease than these hazardous, invasive procedures.

7) Low back pain.

What I thought: prolonged recovery might be the rule after back injuries, but the treatments, including surgery, help.

The truth: Unfortunately, our therapies are failures. Studies show every single one is an expensive, sometimes risky placebo. These include surgery, chiropractic, and the ultrasound and vibrators used by traditional physical therapists. Addictive opioid pain pills are prescribed long-term for chronic back pain, which is another disaster. Graduated exercise is the only treatment that helps these agonizing problems.

8) The opioid debacle.

What I thought: the cause of the opioid disaster is physician over-prescribing.

The truth: Purdue Pharma and some other corporations late to the party were primarily responsible. Purdue marketed one of these drugs, OxyContin, to nearly anyone with a painful condition, claiming it was safe and not addictive. This started a trend that resulted in hundreds of thousands of deaths.

Purdue declared bankruptcy in 2019, the first big pharmaceutical corporation ever dismantled by plaintiffs. Until this happened, the industry regarded legal problems merely as tolerable expenses, as their revenues were in the tens of billions.

9) Oncology or cancer treatment.

What I thought: we have a lot of cures and the science is advancing rapidly.

The truth: This is a heavily hyped sales pitch created by the industry. Cancer is the second leading cause of death after heart disease, but only a scant few treatments cure or even signiﬁcantly prolong life. Although pain relief counts, extending life is the critical measure of success, and if the patient dies sooner of something else, it is a failure. Most of our toxic, over-advertised, extortionately priced treatments offer less than two months of prolonged survival.

Two-thirds of cancer doctors’ income comes from retailing drugs, or rather getting “rebates” for selling them. This is legal for corporations, but it would be criminal fee-splitting if done between physicians. Whatever the legalities, manipulating patient care with ﬁnancial incentives has overwhelming potential for abuse. This must be banned.

10) The amphetamine tragedy.

What I thought: amphetamine abuse is mainly an issue for poor people in ghettos.

The truth: As with opioids, the pharmaceutical companies’ products are virtually identical to and produce the same disastrous effects as street drugs. Addicts use high doses, which make health destruction inevitable for this small group. Patients use lower doses, but prescriptions are so universal that this disaster is far more signiﬁcant.

Corporations manipulate captive, well-paid psychiatrists to expand the indications for these drugs, despite the brain damage and behavior deterioration they cause. Nine percent of our children (a ﬁgure cited by the Centers for Disease Control) supposedly have “attention deﬁcit hyperactivity disorder” (ADHD). Psychiatrists recommend medicating them. Many of our other kids get these medications from their friends.

The recent claim is that adults, including older people, also have an epidemic of ADHD, so they get prescriptions also. Some children now buy the drugs from their neighborhood senior citizen.

11) Mammograms.

What I thought: mammograms save women from breast cancer.

The truth: Mammograms used to check women without lumps or other indications are a waste of time, money, and emotional energy. Millions of these tests are performed each year, hundreds of thousands of them are positive or unclear, and untold women get repeated mammograms and ultrasound examinations to chase the ﬁndings. After this, biopsies and surgeries are done to evaluate and cut out the areas of concern.

This process is expensive, and each procedure is a little risky.

But the math does not work—patients do not live longer after accounting for the hazards of the invasive procedures that ensue after a mammographic ﬁnding. We would be better off if the system only evaluated women with lumps, they ﬁnd themselves.

12) Colon cancer.

What I thought: colonoscopy saves us from colon cancer.

The truth: Colonoscopy for random patients looking for colon cancer has no beneﬁt.

This tumor is the second most frequent cancer killer after lung cancer. US gastroenterologists look inside the colon to identify small cancers and pre-cancers before they spread. Since surgeons can often cure these in their early stages by cutting out a section of the colon, this screening program seems reasonable. But examining patients without symptoms or known disease does not increase the average time they live.

13) Prostate cancer.

What I thought: urologists save men from dying of prostate cancer by checking a blood test on everyone over a certain age.

The truth: This does not work. The standard routine is to check the prostate-speciﬁc antigen (PSA) in the blood, and when it is high, to do painful biopsies. If cancer is seen, a removal operation called “radical prostatectomy” is often recommended.

This commonly results in impotence and incontinence and saves no lives overall. Other therapies for the early stages of this cancer are also ineffective and damaging.

Even though about 75 percent of older men get prostate cancer before they die, it is only fatal in two percent. The tumor is usually inactive, and an aggressive approach does more harm than good.

14) Endoscopic knee surgery for arthritic knee and hip pain.

What I thought: if my knees hurt, an endoscopic operation will help.

The truth: Sham surgery studies compared patients who had this procedure versus those who only had incisions and anesthesia. There was no difference - the operation was a failure. The orthopedists know this, but they still perform this somewhat risky surgery. The costs in the US are $4 billion a year.

Whether you are a doctor or patient, THE PAINFUL REALITY introduced here is running you over. The next two chapters explain how it all started and developed.

A bit about Robert’s story, in his own words.

Why did I write about healthcare corruption?

Every surgeon carries within himself a small cemetery, where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation for his failures. - RENE LERICHE, PHILOSOPHY OF SURGERY

In the summer of 2013, when I was 61, I had two women in their 30s die in my surgical center. I sent them to the emergency room, but nothing worked. It was my place, so I was responsible. It was the worst period of my life. I felt guilty and was sleepless, and my wife thought we would have to give up our practice.

I did not learn why it happened until the autopsy reports came back fully six months later. One woman had an embolus of fat blocking her lungs. This occurs unpredictably, and there is no way to prevent it.

The second had a high local anesthetic blood level. We inject this drug into fat to decrease pain, and after liposuction, we sometimes transplant the fat back into breasts and buttocks. This may have raised her levels and caused her death, but there was no way to be sure.

To occupy my mind, I started reading medicine twenty to thirty hours a week. My original training was as a generalist, but for decades I had studied only cosmetic surgery.

I began with the Prozac-class antidepressants, which I had prescribed since their invention. It stunned me to learn that they hardly worked and were often damaging. I read further and found that other psychiatric medications produce irreversible brain and health problems. Doctors have been trained to pass them out like jelly beans.

I learned that many drugs are given for wholly theoretical, even speculative beneﬁts. Many are damaging. I consulted people for cosmetic surgery who were taking ten (10) of these at once. I began to see how medical corporations had done this to us.

I read about back pain. Most of it goes away on its own, but doctors had been thoughtlessly prescribing opioid painkillers and turning many patients into struggling addicts. Low back surgeries are the most expensive and some of the least effective procedures in all medical care, bar none. No one admits this even to themselves—not the surgeons, the hospital administrators, nor the surgical centers’ owners. The enormous proﬁts short-circuit everybody’s judgment.

I also realized that over the past three decades, younger and younger people had been getting heart disease, obesity, and diabetes. I wondered if healthcare, particularly medication use, might be the cause. I thought about Peter Van Etten’s line, “In this insanity of healthcare, the patient always loses.” I saw that we were breaking them on a medical torture-wheel.

The amount of wealth thrown into American healthcare is astounding. Since the corporations took over, hospitals, drug companies, and senior doctors on their payola are scrapping for it like giant carp eating bread. We pay them handsomely for anything they can slap a billing code on, and they dictate every move according to proﬁtability. Patient wellbeing is now secondary. Healthcare quality—and our general health—has deteriorated.

I have afﬂuent peers, and many are not shy about it. A gastroenterologist boasted in the doctors’ lunchroom that he puts diamonds on the ﬁngers of his infant daughters. In 2004, a cardiologist wearing a $3000 suit told me he “couldn’t pay his personal expenses” if he made less than $600,000 a year.

Nouveau riche posturing like this is usually accompanied by stories about expensive, supposedly lifesaving treatments. I always vaguely smelled a rat, but I was busy and never gave it much thought.

As I continued to study, I realized that newer science proved that many of the therapies these people were selling were worthless. I wondered what proﬁt their fancy cars or high incomes could be for them if they did not put patients ﬁrst.

After a great deal of personal and professional reﬂection, I decided to write about the whole medical-industrial calamity. I understand I am a whistleblower, what it means, and what I face. In late 2019, I retired and left the melee. I can now say what I need to from outside the tent and without conﬂicts of interest.

My story is not the narrative of Wikipedia, WebMD, or other online sources. These are constantly being rewritten by marketers. Wiki is the most reliable, but like the others, it is under guerrilla attack by corporate ghostwriters. Most physicians disagree with me as well. When I shared my conclusions with them, most became resentful, cited their training, and told me I was dead wrong. The few who know the story are afraid to speak up.

Industry shills and people born yesterday say my tale is dated and claim everything has changed. They are right—it is not a new story. Since information remains concealed until drugs are off-patent, some of my references are ten to twenty years old. But they are only half-right: they are wrong about the change—the situation has become progressively worse.

Even though this history has been an open secret for decades, only an elite few understand the whole dysfunctional puzzle. You have the chance to join them, but the more you learn, the more it will break your heart.

Physicians, to practice effectively and ethically, must under- stand what they face. Familiarity with these controversies is indispensable, even if you reject some conclusions. Your work will improve after you realize that doing less may produce better results.

Likewise, patients must learn about these issues to have the best chance of beneﬁting from healthcare. I share practical, little- known ways to deal with doctors and hospitals. You will also learn about health, sickness, and the limits of medicine. The more you know, the more conﬁdent you will be accepting—or in some cases, refusing care.

Despite my best efforts, I may be partly wrong. For example, statisticians are more optimistic than I am about the triﬂing improvements shown in large studies. You may also think you “know” about an area where I am mistaken, and that this destroys my credibility. For some cautious readers, what follows may even sound like a hostile, one-sided polemic.

So proceed with caution. If some disagreement kidnaps you and you quit reading, you will lose your chance to understand the ecosystem. Before feuding with me about a tree in this forest, scan at least the ﬁrst dozen anecdotes. Money has poisoned our well, and this pattern establishes legitimacy even before you look at references. You need not swallow everything I serve up to believe that we are managing patients poorly.

The ﬁrst step to deal with the situation, either as a doctor or a patient, is to learn the truth. This is also necessary for reform. By the end, you will understand the mess that has developed after we permitted industrialized medicine to snowball for thirty years.

Robert Yoho, May 2020 Yoho.Robert@gmail.com Pasadena, CA

What happened to my colleagues and me?

In the midst of winter, I found there was, within me, an invincible summer. - ALBERT CAMUS

Back to my personal story. The family of the patient who died of the lidocaine overdose sued us, and after several agonizing years, our insurance company settled. The family of the woman with the fat embolus never sued because they had no chance of winning. It was an unpreventable risk of the procedure. Because I had two deaths, the California medical board looked at it. Like the vast majority of cases, they negotiated it to a probation. I still had my license, but they required me to have ten percent of my patient records reviewed. I attended a few days of testing.

Dr. Gøtzsche had touched the “third rail of healthcare,” vaccines. He pointed out that the corporations had hidden half of the Human Papilloma Virus studies, just like they did with the antidepressants. As a result, the Cochrane collaboration had an excuse to remove him from their board. It was a minority vote, considering the abstentions. This was a disaster for Cochrane’s reputation, and many observers thought the industry’s money was behind it.

He explained the situation in a book, a blog article, and an explanatory document. Without his guidance, the Cochrane has lost much credibility and good karma. Maryanne Demasi, PhD, in the BMJ, said they were “a sinking ship.”

Abraham Katz became very discouraged after Cochrane kicked Dr. Gøtzsche out. He wrote:

The media have been saying that Gøtzsche had signiﬁcant conﬂicts of interest, his calculations regarding the HPV vaccine were wrong, and that he was a lunatic who is controversial just for the sake of it.
They ignored that a third of the HPV panel at Cochrane resigned in protest after his ouster.
The Japanese Ministry of Health withdrew their recommendation for the vaccine as well. The percent receiving it went from 80% to 1%. This country has an excellent system to report harm from drugs. They found that the HPV vaccine had three times the adverse events of any vaccine that they had ever used. If a highly educated country like Japan can conclude that this treatment was unsafe, then I would expect the Cochrane report to ﬁnd, in their customary fashion, that not enough high-quality studies have been done to determine the truth. This is what they offer most of the time.
I am now doubtful that we can trust the Cochrane Collaboration. My skepticism started in 2016, when they claimed, contrary to the data, that tPA was effective in reducing stroke symptoms. One of their committees, loaded with industry influences, supported this expensive clot-dissolving treatment. This contradicted their opinion a few years earlier when they said it did not work.
Cochrane was one of the last respected refuges of quality science. When there wasn’t enough evidence to make a statement, they were always willing to say that the answer was unclear instead of guessing.
These events are a debacle. I am concerned that medicine is moving in the wrong direction, which is tragic.

Nortin Hadler has spent the best part of three decades trying to get his ideas across to physicians and legislators. I doubt it has been easy. He has a beautiful body of work in his books, blogs, and YouTube presentations.

Wendy Dolin, who won the $3 million judgment after her husband’s (generic) Paxil-related suicide, lost her appeal. The issue was whether the original patent holder’s concealment of complications and deaths during the approval process made them responsible for other deaths caused later by generics. If her lawyers had won, the original manufacturer might have been on the hook for hundreds of millions of dollars.

Wendy has not let the appeals court defeat her; she was not suing to make money but to get the word out. She has continued to work on her awareness group about drug-related suicides.

Her annual event in the fall of 2019 was a success.

I speak to Martha Rosenberg frequently, and we support each other.

My biggest personal gut-punch was when I found out how industry propaganda had overrun the Internet, including social media. The disease-mongering discouraged me the most. I saw an obviously ghostwritten article “How Pharma Sales Reps Help Me Be a More Up-to-Date Doctor.” The ubiquity of these messages affected me more than the other swindles.

I continued my cosmetic surgery practice on a small scale through the fall of 2019. I liked the patient interactions and was the master of a few specialized surgeries such as liposuction, fat transplantation, and breast augmentation through the navel. I ﬁnally retired when I was sixty-six.

I continue to learn. I read about other government-supported industries: defense, energy, and arguably the worst, banking.

Just like healthcare, they are corrupted by outside funding, special status, and tax advantages.

I also contemplate the ﬁercely competitive corporate sectors that have been such a boon to us all - hotels, airlines, computers, and rental cars. Corporations, even whole industries, have personalities. Some are wonderful, and some are criminals.

I wonder about the rest of science. Is it as shaky, biased, and degraded by money as medicine?

Lies are Unbekoming

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