What Is Person-Centered Healthcare? with Dr. James Marcum

PJ is joined by professor Dr. James Marcum. Together, they discuss the future and ethics of medicine, and what it looks like to tailor medicine more and more to each person.

Show Notes

In this episode of the Chasing Leviathan podcast, PJ and Dr. James Marcum of Baylor University discuss the philosophy of medicine and the need for patient dignity to guide the work of healthcare providers. 

For a deep dive into Dr. James Marcum's work, check out his book: 
Thomas Kuhn's Revolutions: A Historical and an Evolutionary Philosophy of Science?, which you can find here 👉 https://amzn.to/3rUVCqh 

To learn more about systems biology, check out the Institute for Systems Biology, which you can find here 👉 https://isbscience.org/

Check out our blog on www.candidgoatproductions.com 

Who thinks that they can subdue Leviathan? Strength resides in its neck; dismay goes before it. When it rises up, the mighty are terrified. Nothing on earth is its equal. It is without fear. It looks down on all who are haughty; it is king over all who are proud. 

These words inspired PJ Wehry to create Chasing Leviathan. Chasing Leviathan was born out of two ideals: that truth is worth pursuing but will never be subjugated, and the discipline of listening is one of the most important habits anyone can develop. Every episode is a dialogue, a journey into the depths of a meaningful question explored through the lens of personal experience or professional expertise.

What is Chasing Leviathan?

Who thinks that they can subdue Leviathan? Strength resides in its neck; dismay goes before it. It is without fear. It looks down on all who are haughty; it is king over all who are proud. These words inspired PJ Wehry to create Chasing Leviathan. Chasing Leviathan was born out of two ideals: that truth is worth pursuing but will never be subjugated, and the discipline of listening is one of the most important habits anyone can develop. Every episode is a dialogue, a journey into the depths of a meaningful question explored through the lens of personal experience or professional expertise.

[pj_wehry]: Hello and welcome to Chasing Leviathan. I'm your host, Pj Weary, and I'm here

[pj_wehry]: today with Doctor James Markham, Uh. Doctor Markham earned doctorates in

[pj_wehry]: philosophy from Boston College and in physiology from the University of Cincinnati

[pj_wehry]: Medical College. He also earned a Masters of Arts and theological studies from

[pj_wehry]: Gordon Conwell Theological Seminary. He was a post doctoral fellow at Harvard

[pj_wehry]: Medical School and Massachusetts Institute of Technology and a faculty member at

[pj_wehry]: Harvard Medical School for almost two decades before arriving at Baylor

[pj_wehry]: University. He has received grants from several funding agencies including the

[pj_wehry]: National Institutes of Health, the National Science Foundation and the American

[pj_wehry]: Heart Association. He delivers invited lectures frequently at both national and

[pj_wehry]: international conferences, and his current research interests include the

[pj_wehry]: philosophy and history of science and medicine. Doctor Markham,

[pj_wehry]: So glad to have you today. Thank you coming.

[james_marcum]: Well, thank you very much is a pleasure to be here and I'm really looking

[james_marcum]: forward to our conversation.

[pj_wehry]: Uh, today what we were talking about is, Uh, you've done a good amount of work on

[pj_wehry]: what is person centered health care and I'm really excited about this one because

[pj_wehry]: uh, I think allows us to get more into depths of what may be the problems of

[pj_wehry]: health care in the United States without

[pj_wehry]: Uh, getting too much into the weeds of political rhetoric and maybe offer some,

[pj_wehry]: uh, just really vital solutions that we need. But before we get into all that, Uh,

[pj_wehry]: talk to me, Doctor Markham, how did you get interested in philosophy of science

[pj_wehry]: and philosophy of medicine,

[james_marcum]: Well, um, when I was a post dock at um, M. I, T. and and and Harvard, Um,

[james_marcum]: I took a course from of philosopher's science by the name of Thomas Coon,

[james_marcum]: wrote a book called The structures of Scientific Revolution. You further the

[james_marcum]: term Paradigm

[pj_wehry]: Mhm,

[james_marcum]: shift. He's the originator of that term. I really enjoyed his class

[james_marcum]: and so I started to take more philosophy courses. I'd never had a philosophy

[james_marcum]: course before. When I was an undergraduate graduate, I signed up for a

[james_marcum]: philosophy course, went to the first lecture and this person launches off into

[james_marcum]: the some proof of the existence of God. I mean, it was so far over my head. I

[james_marcum]: got up out of the class. Walked down to the regist star and said, Look, I want

[james_marcum]: to drop this course and take another science course.

[pj_wehry]: Yeah, yeah,

[james_marcum]: So philosophy was my, really my thing, but I, as as I sort of matured it, as

[james_marcum]: as as a thinker.

[pj_wehry]: H,

[james_marcum]: Um,

[james_marcum]: it became apparent that there were important issues, particularly conceptual

[james_marcum]: issues that I think Often times we, uh, we sort of ignore and coon sort of

[james_marcum]: helped me with that, and I, I sort of got to know him Uh, rather well, and he

[james_marcum]: was said, If you really want to do this and be serious about, you have to go

[james_marcum]: get another doctorate and I thought

[james_marcum]: Yeah, I don't think so, but eventually that's that's the way it turned out.

[pj_wehry]: which to me is a real testament to your perseverance.

[pj_wehry]: That's really really amazing. Uh, how did you get interested to mention this? You

[pj_wehry]: asked me how I became interested in this topic. I also did um, fi, uh, most of my

[pj_wehry]: philosophical work with Godimer and he has the

[james_marcum]: Okay,

[pj_wehry]: enigma of health. Uh, so

[james_marcum]: Umhum,

[pj_wehry]: the person centered health care definitely resonate with me from a philosophical

[pj_wehry]: standpoint as well as well as personal. And course, you know from political

[pj_wehry]: standpoint Uh, it's a a big issue right now. I think just a national issue, right,

[james_marcum]: Oh, especially with covet, go going on. I mean it's just covet, is just

[james_marcum]: completely

[pj_wehry]: Yes,

[james_marcum]: changed the landscape.

[pj_wehry]: Yes, it'll be very interesting to see how things settle. But how did you get

[pj_wehry]: interested in person centered health care?

[james_marcum]: Well when I came um

[james_marcum]: to Baylor, it was

[james_marcum]: you know, a a philosophy job in in the philosophy department, and uh,

[james_marcum]: they had a course here. Uh, that was Philosophy of medicine and they had just

[james_marcum]: started up a medical humanities program

[james_marcum]: And so Uh, no one in the philosophy department really wanted to to teach that

[james_marcum]: course. So

[james_marcum]: along with Philosophy of science, I was invited to to teach that course

[james_marcum]: and I found I just I just really enjoyed that course. I enjoyed the Premt

[james_marcum]: students who were really interested in more than just sort of the technical or

[james_marcum]: the scientific dimension of medicine, but also the humanistic side.

[pj_wehry]: Hm,

[james_marcum]: so I taught that course and I still teach that that course today and I became

[james_marcum]: director of the medical humanities program for about dozen years,

[james_marcum]: And so that led me into writing one of my first tax on philosophy and

[james_marcum]: medicine, which was an introductory text, which I called sub subtitled Uh,

[james_marcum]: Humanizing

[pj_wehry]: Hm,

[james_marcum]: Medicine. There was a big push, and there still is a big push.

[james_marcum]: the sort of

[james_marcum]: sort of emphasize or to reintroduce that that dimension that that humanistic

[james_marcum]: dimension, And do you want I? I can sort of go into the a little the history

[pj_wehry]: four,

[james_marcum]: of of why this is the case. Uh, Basically it stems from a. Have you heard of

[james_marcum]: the Flexman report? Uh,

[pj_wehry]: No, sir,

[james_marcum]: A nineteen, ten,

[pj_wehry]: No,

[james_marcum]: Uh, this was Abraham Flexner, Um, who basically took a look at medical

[james_marcum]: education medical schools both in Canada and the United States, And it was

[james_marcum]: around a hundred and fifty schools that he looked at,

[james_marcum]: And

[james_marcum]: the the school I. It was just there were proprietorary schools, so that you

[james_marcum]: know anyone could open a medical school, You and I could open a medical school

[james_marcum]: if we just had paying students. I mean that's that's all you really needed.

[pj_wehry]: seems problematic

[pj_wehry]: yetm,

[james_marcum]: Yep, And so you had you know there were there. There was really no

[james_marcum]: standardization of of Uh, of medical education, Uh, and therefore practice. So

[james_marcum]: you had alopathy homeopathic hydrop, Oh, a whole different

[james_marcum]: approaches. So

[james_marcum]: in nineteen,

[james_marcum]: the the late nineteen hundreds, Uh nine, M, nineteen, o, eight or so,

[james_marcum]: Uh, the Carnegie Foundation wanted to take a look at medical education

[james_marcum]: And so Um.

[james_marcum]: Abraham Flexner was invited to Um, to do that that study, and interestingly,

[james_marcum]: his brother was Simon Flexer, Um, who was director of the Rockefeller

[james_marcum]: Institute and his brother. Simon was actually a graduate of Uh. John Topkins,

[pj_wehry]: okay,

[james_marcum]: So the model that was used to evaluate all these schools. What was John

[james_marcum]: Hopkins, which actually had the audacity to require a couple years of college

[james_marcum]: education before you could go to medical school? I mean, there are some places

[james_marcum]: you didn't even have to have a high school education?

[james_marcum]: I mean that's that's

[james_marcum]: you know. How

[james_marcum]: the the sort of lack of rigor

[pj_wehry]: yes, yeah,

[james_marcum]: Uh that existed there? So what Um. Flexner did is that he took a look at all

[james_marcum]: these schools and he, T. he sort of said You know this is. this is. you know

[james_marcum]: what these schools sort of need to live up to, And he came up with what was

[james_marcum]: called the two plus two and that is, there'd be two years

[james_marcum]: of Uh lectures in in terms of the basic science and clinical sciences, then

[james_marcum]: two years of rotation

[james_marcum]: and the A M. A jumped on board with this, and this pretty much

[james_marcum]: shove medicine towards the sciences,

[pj_wehry]: hm, hm,

[james_marcum]: so at one point medicine was even thought to be the youngest science. Uh.

[james_marcum]: Thompson wrote a book Um, entitled That And what's interesting is you went

[james_marcum]: from around a hundred and fifty Uh medical schools and you had a closure of

[james_marcum]: almost ninety schools. So you had about sixty five schools left over. Most of

[james_marcum]: them were associated with Uh, universities

[james_marcum]: or

[james_marcum]: with

[james_marcum]: hospitals that could act, or or medical schools could actually do research,

[james_marcum]: And that was his big push was research was going to sort of solve the

[james_marcum]: problems, Uh for medicine, And there was a big backlash

[pj_wehry]: Hm,

[james_marcum]: Uh to that, especially by the older clinicians, because they felt that their

[james_marcum]: experience of dealing with the patient like Osler, uh, Willie Mossler, a a

[james_marcum]: well known clinician,

[james_marcum]: Um that science was necessary, but it was just one part of the equation for

[james_marcum]: for being a good clinician, and so

[james_marcum]: the sciences. Pretty much to take over Um

[pj_wehry]: yeah,

[james_marcum]: in in terms of medicine, so we're reduced down to

[james_marcum]: you know, these diagnostic and from these diagnostic tests, Um. No

[james_marcum]: therapies are sort of uh

[james_marcum]: than enlisted. So

[james_marcum]: that's that's been the problem. It's

[james_marcum]: and that was the problem up toil about nineteen ninety, when the n. i h. Uh,

[james_marcum]: all of a sudden

[james_marcum]: wasn't funding as much basic medical research or clinical medical research

[james_marcum]: that had done in the

[pj_wehry]: Mhm,

[james_marcum]: past, and so now it was up

[james_marcum]: to Um, clinicians and biomatical sciists to come up with their own funding,

[james_marcum]: and a lot of that has come through,

[james_marcum]: you know, developing

[james_marcum]: diagnostic tests and and therapies, And and so there's this conflict of

[james_marcum]: interest that obviously,

[james_marcum]: Uh emerges. If if you're having the people who have to fund their research in

[james_marcum]: order to come up with the effect of therapy,

[james_marcum]: you, you have to be somewhat careful that

[james_marcum]: you know they're not biasing their their results.

[pj_wehry]: not doing it. Uh, yeah, yeah,

[pj_wehry]: because they they in charge of the criteria for evaluating it correct. I am I

[pj_wehry]: following you?

[james_marcum]: Well, I mean,

[james_marcum]: eventually you have to have uh, uh, f, d. a, uh approval. But as we've seen

[james_marcum]: with the c d C in the f d A. There's there's plenty of documentaries out

[james_marcum]: there. Uh, you know, in Netflixctional language,

[james_marcum]: which raise some disconcerting

[james_marcum]: um, thoughts about

[james_marcum]: about regulation.

[pj_wehry]: Yeah,

[james_marcum]: but for the most part it it. it sort of functions, but it opens up that

[james_marcum]: avenue.

[pj_wehry]: yeah, yeah, For sure.

[pj_wehry]: you mentioned something about how it almost seems like they were treating patience

[pj_wehry]: as the object of their study.

[pj_wehry]: Does that treating the patient as an object?

[pj_wehry]: If I'm over

[pj_wehry]: with the question, feel free to correct the question itself. but treating a

[pj_wehry]: patient is an object. Do they feel the need tolie the patient of responsibility?

[james_marcum]: Um.

[james_marcum]: Yes,

[james_marcum]: and

[pj_wehry]: Would you like

[james_marcum]: in some sense

[pj_wehry]: an example? Oh, sorry go.

[james_marcum]: what you want to provide an example?

[pj_wehry]: I didn't know if the question was clear, so I can provide an example, if or if you

[pj_wehry]: have something. Go ahead.

[james_marcum]: Well, Yes, I mean, patients have been objectified for for the most part

[james_marcum]: they've They've just sort of become Uh. a physical body made up of physical

[james_marcum]: components, And the

[james_marcum]: one of the earlier commentators on the Flexum report

[james_marcum]: was a Harvard physician,

[james_marcum]: Uh, by the name of Francis Pab,

[pj_wehry]: Hm,

[james_marcum]: D, and he wrote a a paper called The care of the patient, and in that paper he

[james_marcum]: talks about Mrs. Brown, who comes in with some just gastric distress,

[james_marcum]: and at the time all the attending physicians run all these diagnostic tests

[james_marcum]: and find nothing absolutely wrong with her

[james_marcum]: and just simply say, Mrs. Brown. We've done the diagnostic test. There's

[james_marcum]: nothing really organic wrong with you. Uh will give you a tonic and you can go

[james_marcum]: home and flexer. I mean, uh,

[james_marcum]: um,

[james_marcum]: Peabody says, Look,

[james_marcum]: you know really what they've done here is they've objectified this patient

[james_marcum]: and not

[james_marcum]: you know, empowered this patient. Uh, to really be part of the of the

[james_marcum]: diagnostic process

[james_marcum]: And so he says,

[james_marcum]: You know what a cognition really needs to do is to continue to ask questions

[pj_wehry]: hm,

[james_marcum]: 'cause really, the scientific method is about asking questions pursuing

[james_marcum]: until you get the Uh,

[james_marcum]: the the solution to the problem. And so he said, what was problematic here is

[james_marcum]: that they only got basically a a snapshot of the patient, rather than getting

[pj_wehry]: hm,

[james_marcum]: an expressionistic painting, which he says, You take the patient, you bed the

[james_marcum]: patient within that person's life,

[james_marcum]: and from that then you can make a diagnosis. and an excellent example. that is

[james_marcum]: by Richard Weinberg, who wrote a paper called Communion, and in there he has.

[james_marcum]: He has a mid twenty year old woman come in who has gastric distress and she's

[james_marcum]: been to every G I specialist in the town. And so she comes to Weinberg, and

[james_marcum]: basically what he finds by engaging her and the connection between them is

[james_marcum]: that she worked in a bakery. The family had a bakery and he liked Napoleons,

[james_marcum]: So he asked her about Napoleons

[james_marcum]: in in the city and and she's you know, she said these. These are their good

[james_marcum]: places, But that made a connection

[pj_wehry]: rightm,

[james_marcum]: on the first

[james_marcum]: Uh consultation

[james_marcum]: and

[james_marcum]: he could not find anything. The matter with her organically and said, you

[james_marcum]: know, come back in a month while she was back to next week, 'cause he had made

[james_marcum]: a connection in in that next consultation. Instead of talking about her

[james_marcum]: problem, they just talked about baking. And so he said, While seeing another

[james_marcum]: month she was back the next week

[james_marcum]: and interesting this time he noticed on the third consultation dark rings

[james_marcum]: under her eyes.

[james_marcum]: Now he had noticed that before

[pj_wehry]: yeah,

[james_marcum]: he's a G. I specialist,

[pj_wehry]: yeah,

[james_marcum]: he's not trained to see dark rings under the eyes and he says, Have you not

[james_marcum]: been sleeping? and she says no, I've been having nightmares and the nightmares

[james_marcum]: were a result of her being sexually accosted when she was a teenager And so

[james_marcum]: she could not tell this to her family. She she came from an Italian family.

[james_marcum]: Uh, and that would have just been too much for that for that family, and so

[james_marcum]: by by just engaging with her as a person

[pj_wehry]: hm.

[james_marcum]: at a personal level, he was able

[pj_wehry]: yeah,

[james_marcum]: to really she she was heal.

[pj_wehry]: yeah,

[james_marcum]: Mean that that is

[james_marcum]: an incredibly good example of getting what Peabody would have called that

[james_marcum]: impressionistic paining uh of

[james_marcum]: of the patient, and

[james_marcum]: I think for the most part health care workers would like to do that.

[pj_wehry]: hm.

[james_marcum]: Um, but

[james_marcum]: pretty much health care has become economized

[pj_wehry]: yeah.

[pj_wehry]: yeah.

[james_marcum]: and so not only was the scientification of of medicine,

[james_marcum]: but you know within the last couple of decades, Um. it's it's been the

[james_marcum]: econonization and so now you have

[james_marcum]: companies that that are interested in in making money. Nothing wrong with

[james_marcum]: making money, but

[james_marcum]: it it.

[pj_wehry]: you have to fulfil your purpose too.

[james_marcum]: Yeah, it. it can become problematic.

[pj_wehry]: Uh, with another word for ecoonzed be, uh, they start to focus. Maybe other way

[pj_wehry]: saying that they start focus on efficiency.

[james_marcum]: Yes,

[pj_wehry]: Yes,

[james_marcum]: and number of patients in

[pj_wehry]: yes,

[james_marcum]: how much time you have?

[pj_wehry]: yes, uh,

[james_marcum]: Uh, I've I've known health care workers who have ▁quit their job.

[james_marcum]: Uh, simply because you know they're expected to see, you know dozens of

[pj_wehry]: hm.

[james_marcum]: patients within a day and that that's I just can't see that benefiting anyone.

[pj_wehry]: yeah, yeah, I and I, I think this is coming from my own work in, but just uh,

[pj_wehry]: observing, real, like observing life. That, if you focus too much on efficiency,

[pj_wehry]: then uh, and you put that on human beings, human beings are not efficient. You

[pj_wehry]: know what? Like he? actually? um, Yeah, I believe it's peabty. Who? O. Was it? No

[pj_wehry]: was Richard Weinberg, Doctor

[james_marcum]: Yeah,

[pj_wehry]: Weinberg, Uh, I mean that's not efficient. like I

[james_marcum]: right,

[pj_wehry]: mean like that. a lot of health care would be really frustrated that she kept

[pj_wehry]: coming back, But that's how he

[james_marcum]: and

[pj_wehry]: solved the problem, which actually saves money in the long term, but sorry, go

[pj_wehry]: ahead,

[james_marcum]: yes, Yes, I mean he. he did this. you know, generally on his own time,

[pj_wehry]: yeah.

[james_marcum]: and on his own die

[pj_wehry]: Yeah,

[james_marcum]: for for the most part,

[pj_wehry]: hm,

[james_marcum]: and you know Un, unless we can have a ha. What? what was very interesting?

[james_marcum]: Uh about that situation between Weinberg and and his patient was that at first

[james_marcum]: he realized that he was a G. I specialist, not a psychiatrist, and so he tried

[james_marcum]: to say to the patient. Look, you know, I'm I'm not really trained in this,

[pj_wehry]: yeah,

[james_marcum]: but I, I' happy to refer you and she said No,

[pj_wehry]: hm,

[james_marcum]: she said I trust you.

[pj_wehry]: yeah,

[pj_wehry]: yeah, which is

[james_marcum]: And so

[james_marcum]: I think often times what we have to realize in health care that the patient

[james_marcum]: really does have a lot of empow, mean not just of themselves but of the other

[james_marcum]: person, the health care

[james_marcum]: professional.

[pj_wehry]: Yeah, and I think I. I really appreciate your answer because I think it ended up

[pj_wehry]: answering my question when I asked about responsibility. What I was referring to

[pj_wehry]: is that concept of empowerment, right, That idea that Uh, patients have to take

[pj_wehry]: control of their own, Uh, their own bodies. Uh, the example I was going to give

[pj_wehry]: Um, they just recently changed the high blood pressure mark for Uh, blood pressure

[pj_wehry]: medicine, And so my mom had been on the boundary for years and she went to the

[pj_wehry]: doctor and they tried to give her blood pressure medicine and she was like I'm

[pj_wehry]: sheoose, Like over by like five points or something, and she's like I'm not I. I

[pj_wehry]: know I've needed to exercise more and diet for like a decade like I'm just going

[pj_wehry]: to do that. Yeah, instead of dealing with all the side effects, paying for it all

[pj_wehry]: those things and it's one of those things where they were frustrated And um,

[pj_wehry]: if if that makes sense, you know they, they looked at her and like, No, No, you

[pj_wehry]: need take this medicine and she's like, But if I do this, it'll solve it. But they

[pj_wehry]: didn't want

[james_marcum]: Yeah,

[pj_wehry]: to leave it up to her right because they seen too many people who don't take

[pj_wehry]: responsibility.

[james_marcum]: well, I mean, unfortunately, a lot of the pharmaceutical industry send repent

[pj_wehry]: Hm.

[james_marcum]: who are pushing a particular drug and for a lot of physicians they sort of get

[james_marcum]: a kickba.

[pj_wehry]: yeah,

[james_marcum]: I mean, I, that's that is the best problematic.

[pj_wehry]: at best, yeah, it's uh. Yes, there are a lot of other words. I could fit there.

[pj_wehry]: No, exactly, um, and uh, but I also think do, uh, and I don't fully understand the

[pj_wehry]: industry, but is there also a problem with Um, legal ramifications if you let

[pj_wehry]: someone walk out of the office and you just say exercise more and they don't, Uh,

[pj_wehry]: I think there was a recent case where someone got uh, doctor got sued when he just

[pj_wehry]: said You need to diet more and they just wanted the pill.

[james_marcum]: Huh,

[james_marcum]: yeah, that's that's an interesting case. I, I'd have to take a look at at that

[james_marcum]: casecause. The industry standard

[pj_wehry]: Hm,

[james_marcum]: is pretty much pill for every ill.

[pj_wehry]: yes, yes,

[james_marcum]: and so yes, you could. There. Probably

[james_marcum]: lawyers who would be more than happy to take on

[pj_wehry]: yeah,

[james_marcum]: a case like that. The issue is that what's the evidence

[pj_wehry]: right,

[james_marcum]: to support

[james_marcum]: either therapy mean? if if the evidence recommends that by dieing

[james_marcum]: that that is just equally effective as as taking the pill,

[james_marcum]: then

[james_marcum]: you know

[james_marcum]: the the standard sort of has to be

[james_marcum]: reinvestigated in a way. but our our medical standards are pretty much set up

[james_marcum]: that we' reactionary.

[pj_wehry]: yes,

[james_marcum]: Once we have the problem, then we sort of react, and generally it is, since

[james_marcum]: it's Aopathy, it's usually through some pharmaceutical.

[pj_wehry]: Hm,

[james_marcum]: Uh that that's going to be recommended in order to to treat that disease. And

[james_marcum]: of course

[james_marcum]: pharmac pharmaceutical, The pharmaceutical industry has a really big interest

[james_marcum]: in in terms of promoting that, and certainly pills can be rather V.

[james_marcum]: Pharmaceutical drugs can be rather effective,

[james_marcum]: but again, lifestyle can also be very effective. Um. I mean I, I personally

[james_marcum]: can modulate my

[james_marcum]: Um,

[james_marcum]: heart and and heart rate I. I. I do a lot of uh exercising simply because at

[james_marcum]: one point they wanted to put a pacemaker in because I was having some

[james_marcum]: problems. But and that's been almost thirty years ago. Uh, And and so by

[james_marcum]: exercising and and diet, I've I've been able to you know to stay pretty

[james_marcum]: healthy, At least live another thirty years.

[pj_wehry]: yeah,

[james_marcum]: So I.

[james_marcum]: I. I think there are a lot of issues

[james_marcum]: in our health care system. Uh, that that really need to be addressed all the

[james_marcum]: way from Uh, nutrition to sleeping, to Uh, to just

[james_marcum]: general,

[pj_wehry]: stress.

[james_marcum]: sort of. Yeah, stress and living.

[pj_wehry]: Yes, Yeah, and I think it leads us really well into kind of that main question.

[pj_wehry]: What is person centered health care?

[james_marcum]: I think the person centered health care sort of comes out of

[james_marcum]: Um.

[james_marcum]: There there was a a shift towards patient centered care

[pj_wehry]: Hm,

[james_marcum]: now,

[james_marcum]: Um, almost fifty years ago,

[pj_wehry]: Hm,

[james_marcum]: and

[james_marcum]: certainly

[james_marcum]: that was an important shift,

[james_marcum]: but

[james_marcum]: I think it left the health care providers

[james_marcum]: uh,

[james_marcum]: sort of in in an awkward position,

[james_marcum]: and a lot of that came from the autonomy of the patient. Um.

[james_marcum]: and so one had to respect that autonomy.

[james_marcum]: Uh. and and sort of empower the patient

[james_marcum]: and part of the problem there is that sometimes patients

[james_marcum]: y, you know they? They really don't know enough.

[pj_wehry]: yeah,

[james_marcum]: Uh, in order to make a a really well informed

[james_marcum]: Uh decision.

[james_marcum]: So

[james_marcum]: what what happened is that? Um. in order to humanize medicine,

[james_marcum]: it had to really focus upon the human person

[james_marcum]: and both the person as the patient,

[james_marcum]: as well as the health care professional.

[james_marcum]: And so

[james_marcum]: there, it's just not so much the autonomy of the person as it is the dignity

[james_marcum]: of the person,

[pj_wehry]: Hm.

[james_marcum]: and that's both of the patient

[james_marcum]: as well as the health care professional. So what you want is a health care

[james_marcum]: system that really respects.

[james_marcum]: Sure. autonomy's important.

[james_marcum]: Uh, beneficence is important. But the integrity

[james_marcum]: what that person is worth

[james_marcum]: is is really at at its ground. What what

[james_marcum]: makes us who we are?

[pj_wehry]: Hm.

[james_marcum]: Uh, as persons. It's it's who we are that that dignity defines us.

[james_marcum]: Um. does that sort of help?

[pj_wehry]: Yeah, Love that dignity defines us is

[pj_wehry]: an incredible line. Yes, um,

[pj_wehry]: thank you. The

[pj_wehry]: so. and I think this is kind of attached to it. I. I looked at some of your

[pj_wehry]: interviews

[pj_wehry]: that you talked about. The virtuous physician.

[pj_wehry]: Is that connected? and how is that connected? If it is?

[james_marcum]: Yes, Um,

[james_marcum]: virtue ethics you know, has its roots with within the Greek ancient Greek

[james_marcum]: philosophy. Uh, of course, with the Uh, with the four virtues in the like. So

[james_marcum]: I think what's important about virtues is that they really help us

[james_marcum]: to implement our values.

[james_marcum]: And so when I teach Uh, medical ethics, I actually begin with. What's the? The

[james_marcum]: term is axiology, which is a study of of of values, and what I try to help the

[james_marcum]: students is for them to connect with what values do you have?

[james_marcum]: And it's from what you value. Then

[james_marcum]: you'll equip yourself with the virtues that will allow you to realize those

[james_marcum]: values or to use those values.

[pj_wehry]: Hm?

[james_marcum]: Uh

[james_marcum]: in in terms of your own behavior,

[james_marcum]: Um, now,

[james_marcum]: unfortunately, a major value in our society is you know, Obviously money

[james_marcum]: and um,

[james_marcum]: power, prestige. All of these are, and in some sense they're they're

[james_marcum]: important.

[james_marcum]: But if they're the only values that really drive or if they're over

[james_marcum]: emphasized,

[james_marcum]: Um, it can result in harm,

[pj_wehry]: Yeah.

[james_marcum]: Uh

[james_marcum]: to to others.

[pj_wehry]: So how do you help someone developed their values, Uh assassin develop their

[pj_wehry]: values.

[james_marcum]: Well, that's that's the whole course is. we sort of go over what are core

[james_marcum]: values. Who is written there? There are a lot of people out there who have

[james_marcum]: have have have written on this. so there are a lot of little diagnostic tests

[james_marcum]: that that I have them take

[pj_wehry]: Hm.

[james_marcum]: to help them, Uh, identify their values and all these things are available

[james_marcum]: online. I mean you can go on and and get them and so,

[pj_wehry]: Do you mind naming a you?

[james_marcum]: um,

[pj_wehry]: I know. I put you on the spot there.

[james_marcum]: no, I. yeah, I. I. I don't have anybody off the top of my head.

[pj_wehry]: Okay. No, no wordors Nos, Yeah, but I mean everyone has access to Google. If

[pj_wehry]: you're

[james_marcum]: Yeah,

[pj_wehry]: listening to this then you obviously have access to Google. So yeah,

[james_marcum]: right,

[james_marcum]: so

[james_marcum]: is.

[james_marcum]: yeah.

[james_marcum]: I think what what you have to do is oftenimes. You have to sort of find that

[james_marcum]: diagnostic test which you think is is best for you

[pj_wehry]: hm,

[james_marcum]: that that you sort of track with

[pj_wehry]: yeah,

[james_marcum]: Um. And so I, I have a number of them out there that I have for the students

[james_marcum]: to uh to engage to determine their values.

[james_marcum]: Uh, and then from that we launch into the to the various virtues, and so I go

[james_marcum]: over the four Uh cardinal virtues themselves and then the three theological

[pj_wehry]: hm, hm,

[james_marcum]: virtues as well. And so I use those as as seven categories in which to take a

[james_marcum]: look at. You know, dozens and dozens of virtues, and I just have them reflect

[james_marcum]: on.

[james_marcum]: You know how these virtues can operate within their own personal life, or or

[james_marcum]: in daily life, as well as within the Uh, clinical Uh situation.

[pj_wehry]: yeah,

[james_marcum]: So,

[james_marcum]: and and we, we do take a look, then at mean the adverisements from hospitals

[james_marcum]: is just very interest. because they tell you what you value. you. Just go on.

[james_marcum]: I, You know you want to google something. Just go ont to some of these uh

[james_marcum]: clinics and they'll tell you what they value. You know. they value you health,

[james_marcum]: Uh wholeness.

[pj_wehry]: hm,

[james_marcum]: things, things of this sort. So it's it's what. What I try to have the

[james_marcum]: students do is I sort of promote this idea of a moral compass,

[pj_wehry]: hm,

[james_marcum]: and that by using these values and and the virtues, they can align that moral

[james_marcum]: compass, which will help them

[james_marcum]: in terms of negotiating. And so

[james_marcum]: you know we, we take a look at a lot of um,

[james_marcum]: sort of issues that are going on from food, a ethics to eugenics, And you know

[james_marcum]: I show these documentaries like What the health? Um.

[james_marcum]: And at the end I, I really try to get them to use that compass, Uh, in order

[james_marcum]: to take a look at a clinical ethical case case study.

[pj_wehry]: uh,

[pj_wehry]: absolutely fantastic. Um,

[pj_wehry]: and you mentioned something there. That's really interesting to me. I notice you

[pj_wehry]: got your Uh, Masters in theological studies from Gordon Conwell, Right, what?

[james_marcum]: So are you familiar with it?

[pj_wehry]: Yes? Yes, I am. Um,

[james_marcum]: It's a Presbyterian of,

[pj_wehry]: Oh,

[james_marcum]: sort of

[james_marcum]: kind of

[pj_wehry]: yeah,

[james_marcum]: kind. of. It's a lot of Presbyterians start there.

[pj_wehry]: yeah, yeah, I actually went to Trinity in Chicago, but I looked at

[james_marcum]: Oh, okay,

[pj_wehry]: Gordon Conwell so that's that's my background. Um, so I'm familiar.

[james_marcum]: yeah, David Wells used to teach there,

[pj_wehry]: Okay,

[james_marcum]: so at at Trinity before he came to Gordon Conwell.

[pj_wehry]: oh, okay, gotcha. Um. What role does spirituality and or life purpose, Uh, play

[pj_wehry]: into person centered health care?

[pj_wehry]: So you talked a little bit about in terms of physicians, right, You use the three

[pj_wehry]: Cardinal V or three theological virtues? Excuse me, Um. Is there any uh value that

[pj_wehry]: you see, I, in regards to patience?

[james_marcum]: Oh, sure. I mean

[james_marcum]: you know

[james_marcum]: spirituality is is a major factor

[pj_wehry]: Hm,

[james_marcum]: Uh, surrounding death and illness. I mean the movement in terms of western

[james_marcum]: Uh, health care was from the shaman or the or the the priest,

[james_marcum]: than to the Uh philosopher with uh, with hypocrates,

[pj_wehry]: Mhm,

[james_marcum]: Uh, and then to the scientist

[james_marcum]: Um. Within the eighteenth and nineteenth century, so medicine has its roots

[james_marcum]: with within the temple,

[james_marcum]: within the spiritual. And of course you know you, you take Jesus, who

[james_marcum]: was very active

[james_marcum]: in in in terms of of uh, healing miracles.

[james_marcum]: Um, so

[james_marcum]: yes, um,

[james_marcum]: I think spirituality is a a major element of of who we are, Um, as as people,

[james_marcum]: because as persons we're relational. What really defines the whoop of us are

[james_marcum]: the relations, the relationships that we have. Uh,

[james_marcum]: and

[james_marcum]: that is

[james_marcum]: that is governed by our our sort of moral nature. Um,

[james_marcum]: You know where we've often been compared to a rational animal. Well, yeah,

[james_marcum]: okay,

[james_marcum]: um, I'm not going to die that in you know, um,

[james_marcum]: also a social being, But what makes all that really possible is the fact that

[pj_wehry]: hm,

[james_marcum]: we're at roote a moral being.

[james_marcum]: We are conscious

[james_marcum]: of the morality of our behavior,

[james_marcum]: Um. And it's in that sense that we're made in the image of Go. Thought that we

[james_marcum]: are, are conscious of one another, and can place ourrself

[james_marcum]: um, compassionately hopefully as as

[pj_wehry]: yeah, yeah,

[james_marcum]: health care providers

[james_marcum]: in the Uh, in the patient's um, vulnerability, and and then benefit that

[james_marcum]: patient

[james_marcum]: Uh, rather than than harming that patient In that at root, Medicine at root is

[james_marcum]: sure, science is important.

[pj_wehry]: hm,

[james_marcum]: Technology is important.

[james_marcum]: but the morality of that situation

[james_marcum]: is absolutely absolutely critical. So you go back to the Wininberg.

[pj_wehry]: yeah,

[james_marcum]: He did not abandon her.

[pj_wehry]: yes,

[james_marcum]: he actually exhibited, I mean of all the virtues, he was incredibly courageous

[james_marcum]: and a step outside yourop professional

[james_marcum]: training.

[pj_wehry]: yeah, yeah,

[james_marcum]: And listen to this person, just talk,

[pj_wehry]: yeah,

[james_marcum]: Um, and, and to realize that that provided the access for this patient,

[james_marcum]: basically the heal.

[pj_wehry]: yeah,

[james_marcum]: I mean, she was healed at the end of this whole whole process,

[james_marcum]: and that by his taking on that

[james_marcum]: that patient with with such courage, I mean, he exhibited

[james_marcum]: a a moral nature that you know. it just just has to be respected, and I think

[james_marcum]: imulated in in in the health care system itself well in our society at large,

[james_marcum]: regardless

[pj_wehry]: yeah,

[james_marcum]: of of of the profession. I think

[james_marcum]: we are just moral creatures.

[pj_wehry]: yes, and I think you you talked about there is that whole connection between the

[pj_wehry]: virtuous physician, a

[pj_wehry]: person, person centered health care. And even as you Uh started that train of

[pj_wehry]: thought, I knew you' going to go back, or if you were, I was going to bring it up.

[pj_wehry]: Uh, to Richard Weinberg, cause, it's that connection right that we

[james_marcum]: right.

[pj_wehry]: are these moral beings in community, And that's that's why we have to be virtuous.

[pj_wehry]: That's why I, uh, we have to be person centered. Um.

[pj_wehry]: what? Uh? skill set would a person centered physician need?

[james_marcum]: I think there are. there are two major uh categories there. Uh, number one is

[james_marcum]: care,

[james_marcum]: and that goes back to Peabody's work. That, in order to care for the patient,

[james_marcum]: you have to care about the patient.

[pj_wehry]: Hm?

[james_marcum]: That's his famous. ▁quote.

[pj_wehry]: Yeah, yeah,

[james_marcum]: right. Two ideas of care. There one you're motivating says you've got to love

[james_marcum]: humanity.

[james_marcum]: You really have to be energized by engaging the patient. You've got to care

[james_marcum]: about that patient before you can actually take care of that patient in terms

[james_marcum]: of technical,

[pj_wehry]: H.

[james_marcum]: and the second I think is the compedence and again the confidence is going to

[james_marcum]: be

[pj_wehry]: that would be important. Yeah, sorry go.

[james_marcum]: y. You have. Yeah, you. you laugh about that.

[pj_wehry]: yeah, right,

[james_marcum]: you'd be surprised

[pj_wehry]: right, right, yeah,

[james_marcum]: that competent not only in terms of the technical procedures,

[pj_wehry]: yeah,

[james_marcum]: Uh, but also ethically.

[pj_wehry]: yeah,

[james_marcum]: I mean it's it's youve. You've really have to have both type of competence

[pj_wehry]: H.

[james_marcum]: in order to provide Uh, the quality health care that that the patient is going

[james_marcum]: to need. Now those are just two broad categories.

[pj_wehry]: yeah,

[james_marcum]: Um. that. I think that each Uh health care professional has to find

[james_marcum]: what skill set they need in order to implement both care and compedence, So if

[james_marcum]: they can provide that quality of care.

[pj_wehry]: yeah, absolutely. um. As we were talking, Uh, before the the episode, Um, one of

[pj_wehry]: the things that you mentioned is that attitudes have changed quite a bit Uh, over

[pj_wehry]: in our culture about medicine. Uh, what are some of the major themes that you have

[pj_wehry]: seen? One of the major things that you have seen change over the last

[pj_wehry]: over the course of your study?

[james_marcum]: Yeah, it's become a business.

[james_marcum]: Um,

[james_marcum]: I mean

[james_marcum]: for for the most part you you used to have

[james_marcum]: uh, and hospitals run by religious organizations where they would just you

[james_marcum]: know they would provide care for almost anyone. Uh, and now there's non

[james_marcum]: profit. I. I don't think there are any non profit

[james_marcum]: hospitals. I. I. I. I could be wrong about that, but the the pushes

[pj_wehry]: H, really,

[james_marcum]: been towards Um. You know profit.

[james_marcum]: And of course, once you begin that, there's the problem then of maximizing

[james_marcum]: profit for

[james_marcum]: Um, the sayquarters, And that's that's the kind of language that you know you

[james_marcum]: hear when when you read about health care policy,

[james_marcum]: Um, and it's implementation

[james_marcum]: in the United States. Um. So

[james_marcum]: I think if

[james_marcum]: if I've seen any major change, it's been Um

[james_marcum]: that drive towards um, Uh, the business model. The other is that we've over

[james_marcum]: medicalized, Uh, there's been a a lot of medicalization

[pj_wehry]: hm, hm, Hm,

[james_marcum]: of you know. there's the shaking leg syndrome. Um, I don't know. I. I shake my

[james_marcum]: leg quite a bit, but there's a. I think there's a pill now. Uh, for the

[james_marcum]: shaking leg syndrome, you know I. I really don't need a pill for my shaking

[james_marcum]: legs and romate. I kind of

[james_marcum]: doesn't really. Although it did bother one time a student that was sitting in

[james_marcum]: front of me during an exam. he said, Could you stop shaking your leg?

[pj_wehry]: Oh, man, yeah, I don't have. I don't have a syndrome, but I was. I was any kid, so

[pj_wehry]: I, I definitely got some looks during tests where I was thinking about something

[pj_wehry]: and I was bouncing the whole rove table. You, the whole

[pj_wehry]: I people just like, turned and like looked at me and I'm like, Oh, sorry.

[james_marcum]: It just you're in the ▁zone.

[pj_wehry]: yeah, yeah,

[james_marcum]: You know you're in the ▁zone. It's

[pj_wehry]: oh, it's like my apologies. no, um, but

[james_marcum]: so I. I,

[pj_wehry]: it's not, doesn't need a pill, right.

[james_marcum]: right, Yeah, it's just let's just let it go.

[pj_wehry]: Mm,

[james_marcum]: Uh, you know it's it's. it's qua right. Um, and you know that that is,

[james_marcum]: mean.

[james_marcum]: Sure, there's no perfect person when it when it comes to health,

[james_marcum]: But

[james_marcum]: mean At at what point do you intervene in in terms of medical procedures and

[james_marcum]: pharmaceolgical drugs? I mean, can you just live with it?

[pj_wehry]: yeah,

[james_marcum]: Um, Rather, rather than trying to intervene in order to

[james_marcum]: you know, Reach some what you consider to be

[james_marcum]: Uh perfect health.

[pj_wehry]: yeah,

[pj_wehry]: yeah,

[james_marcum]: So I?

[james_marcum]: what? What others?

[pj_wehry]: do you. Oh, it's sorry, go.

[james_marcum]: It's an interesting question. What? what do you see is? I mean. what? What

[james_marcum]: have you seen? Change?

[pj_wehry]: I. I, to be quite blunt, I'm thirty three and I was blessed with pretty good

[pj_wehry]: health. I mean the biggest thing that I think I've seen has been more from the

[pj_wehry]: diet side of things. we talked about that beforehand. How I, um,

[pj_wehry]: you know I you. We were just taught that it was you. There was a pill for that And

[pj_wehry]: but I was also aware, and I think, uh, I thank my mother for this that they. every

[pj_wehry]: time you take a pill there', they' are generally side effects. Not always

[james_marcum]: right?

[pj_wehry]: but you, there's always that risk. And so I was always wary of just jumping right

[pj_wehry]: to that. Um, also having experiences with Uh, different people who were close to

[pj_wehry]: me who took pills. They felt better. Uh, for me. it was I was struggling with

[pj_wehry]: depression. Um. And then after six months they had to change uh, their medicine,

[pj_wehry]: because it wasn't working anymore and they were constantly in the cycle of trying

[pj_wehry]: different medicines, and there always side effects and I didn't want that if I

[pj_wehry]: could avoid it, and then to discover that most of what I was suffering from was

[pj_wehry]: uh, diet, um,

[james_marcum]: Hm,

[pj_wehry]: really, like, I mean, that blew my mind, cause that wasn't the way I was taught

[pj_wehry]: about medicine in. I mean, I don't have any kind of medical background other than

[pj_wehry]: you know, just culturally right, and uh, the little that were taught Uh in high

[pj_wehry]: school, so um, but I'm thirty three. so I I havet I don't have a a breadth of

[pj_wehry]: experience. I don't have a background in it. Uh, so that's that's about all I

[pj_wehry]: have.

[james_marcum]: right. Yes, So it's

[james_marcum]: I. I think we're on a path where

[pj_wehry]: Hm,

[james_marcum]: Um. it's It's

[james_marcum]: medicine Is is, especially in terms of precision medicine.

[pj_wehry]: right,

[james_marcum]: It's it's going to be targeting

[james_marcum]: It's it's going to be targeting

[james_marcum]: what it considers to be

[james_marcum]: either the genes or whatever proteins that that might be responsible, so that

[james_marcum]: you can

[james_marcum]: sort of fix. fix the problem.

[pj_wehry]: Hm,

[james_marcum]: Whether or not that's that's going to happen is is really unclear

[pj_wehry]: yeah,

[james_marcum]: simply because it's

[james_marcum]: it's not known.

[james_marcum]: You know. There seems to be this gap between the genotype and phenotype

[pj_wehry]: Hm,

[james_marcum]: and Um, how we sort of fill that gap in, especially for patients. It's just

[james_marcum]: not clear. We don't know enough. Uh at this, so that's where medicine is is

[james_marcum]: sort of pushing. And that's the very technical Uh. end of medicine, so that at

[james_marcum]: some point you know it, it may be that you really don't even interact at all

[james_marcum]: with another person.

[pj_wehry]: Hm,

[james_marcum]: Might just be a machine,

[pj_wehry]: Mm,

[james_marcum]: Uh, especially with advances, Uh in deep learning in a I.

[pj_wehry]: yeah,

[james_marcum]: Um, so it's you know where where medicine is headed, I think is more in that

[james_marcum]: direction.

[pj_wehry]: what are the advantages and disadvantages of that?

[james_marcum]: I think the advantages uh, if it can happen, and this is a much larger

[james_marcum]: question, 'cause if you know that you're going to have Um, a certain disease

[james_marcum]: if you continue down a particular lifestyle,

[pj_wehry]: Hm.

[james_marcum]: and if you don't have the resources, say for changing your lifestyle, then

[james_marcum]: then what I mean? it's that's that's kind of depressing. Knowing that you

[james_marcum]: don't have the the resources uh, in order to change your lifestyle, say it's a

[james_marcum]: dietary where you know, instead of eating the uh, the dollar meal,

[pj_wehry]: yeah,

[james_marcum]: maybe you actually have to eat the salad

[pj_wehry]: yeah,

[james_marcum]: Uh, and you can't afford the salad.

[pj_wehry]: yeah,

[james_marcum]: Um.

[james_marcum]: So

[james_marcum]: I think that the advantage is that we can pinpoint what might become

[james_marcum]: problematic.

[james_marcum]: predict it, and thereby prevent it.

[james_marcum]: But are the resources going to be available to everyone? I mean, covet has

[james_marcum]: shown this that there

[james_marcum]: that the resources available to people not only here but globally are not the

[james_marcum]: same.

[pj_wehry]: right,

[james_marcum]: Um, I mean there's there's

[james_marcum]: just a an unfairness to way. Uh resources are distributed. So that's a major

[james_marcum]: concern that I have is just the price of all this technology

[james_marcum]: can can. Can people really afford it? Um or so, are we going to have just not

[james_marcum]: the very rich who can have

[james_marcum]: all the benefits of this precision medicine, but the poor too bad.

[pj_wehry]: yeah, yeah.

[james_marcum]: Um, you know, good luck with your dollar meal.

[pj_wehry]: I, and it's funny that you brought that up. Um, I wasn't sure I was going to go

[pj_wehry]: here, but uh, I have discovered that eating better often is more expensive

[james_marcum]: Yes,

[pj_wehry]: because it's actually subsidized for the like. Um. when you

[james_marcum]: oh yeah,

[pj_wehry]: look at, Uh, beef is subsidized like that. We pay through taxes

[james_marcum]: big time,

[pj_wehry]: and

[pj_wehry]: uh,

[james_marcum]: big time.

[pj_wehry]: but it. it's It's subsidized in in ways that are unhealthy right like there is

[james_marcum]: Yeah.

[pj_wehry]: healthy beef, but it's actually not very economical. right, um,

[james_marcum]: well, yeah, or all you have to do have. have you seen Earthlings the

[james_marcum]: documentary

[pj_wehry]: no, sir, no,

[james_marcum]: Yeah, it. It talks about the. uh. how we sort of abuse animals. Uh, and

[james_marcum]: there's uh.

[james_marcum]: There's also other documentaries out there that that will. They will show you

[james_marcum]: just the horrendous

[pj_wehry]: Hm, hm,

[james_marcum]: conditions that animal exist. Uh, in terms of factory farms. In fact, one of

[james_marcum]: the big fears is that you know one of the antibiotic resistant bugs

[pj_wehry]: yeah,

[james_marcum]: bacteria is going to come out of. you know the pig farms in in the Carolinas,

[pj_wehry]: yeah,

[james_marcum]: So

[james_marcum]: you know

[james_marcum]: that that raises a whole another issue in terms of our our health care system

[james_marcum]: itself.

[pj_wehry]: Yes, and I, I've actually just um,

[pj_wehry]: uh, for me, I did watch Food Inc. and so

[james_marcum]: Okay,

[pj_wehry]: yeah, like very. So everything you're saying is very familiar. I haven't watched

[pj_wehry]: earthings, but uh, when you talk about like just seeing

[pj_wehry]: um, cows like up to their knees in their own manure and it it's there's no way

[pj_wehry]: that that can be good for for the cow or for us right, And anywayise,

[james_marcum]: right, right, Yeah, cook your meat

[pj_wehry]: Yeah, yeah, very much. so, Um

[pj_wehry]: A. and we're we're taught. Like if it's a factory that it, it's better than like a

[pj_wehry]: farm, for instance. And then when they do actual tests on the like, uh, they were

[pj_wehry]: killing chickens in the open air in in tent, uh, at a farm, and they did tests on

[pj_wehry]: that versus chickens in a in a factory,

[james_marcum]: right.

[pj_wehry]: and the factory was way worse for bacteria,

[james_marcum]: Yeah, and they were going after him in the attack.

[pj_wehry]: right, right and

[james_marcum]: They were trying to prevent him from,

[pj_wehry]: yes, and that was the crazy thing and that and that was after they wash it with

[pj_wehry]: like bleach, which is

[james_marcum]: right.

[pj_wehry]: uh, you know, Uh, that's anyway, the it. Yes, the like all of this, I mean this is

[pj_wehry]: part of uh, the why I wanted to have you on. but

[james_marcum]: Yeah, it's yeah. The, the, the whole thing I mean with with the chickens, They

[james_marcum]: they have the Feecal soup.

[pj_wehry]: oh

[james_marcum]: Uh, they. They didn't mention that in Food Inc. But when these chickens are

[james_marcum]: washed well, you know their feecs are all over the place.

[pj_wehry]: yeah,

[james_marcum]: And so if they go through this water, it's just called the Feecal soup and

[james_marcum]: that's washing them.

[pj_wehry]: oh,

[pj_wehry]: it's yeah. it. yeah, definitely don't watch it. Uh, you know, I have had friends

[pj_wehry]: like I watched it. and then I didn't care when Nate burgers anyway. Now it was

[pj_wehry]: like like like immediately after I was like I, you know, props to your bravery.

[pj_wehry]: That's

[james_marcum]: Yeah,

[pj_wehry]: um.

[james_marcum]: and it,

[pj_wehry]: yes,

[james_marcum]: you know it, it raises a much larger

[pj_wehry]: yeah,

[james_marcum]: issue of how sustainable this is on

[pj_wehry]: right,

[james_marcum]: a global scale.

[pj_wehry]: yeah,

[james_marcum]: Mean you know we're burning. We're burning down the rain force. An incredible

[james_marcum]: rate.

[pj_wehry]: yeah,

[james_marcum]: Um, you know at at one point is this not going to be sustainable? Um, that

[james_marcum]: that could really be problematic to global health?

[pj_wehry]: yes,

[james_marcum]: Uh, just you know,

[james_marcum]: never mind our personal health.

[pj_wehry]: yeah,

[james_marcum]: But but what about

[james_marcum]: Um, the earth itself? You know, getting into this whole Gea hypothesis

[pj_wehry]: yeah,

[james_marcum]: in in the life

[pj_wehry]: yeah, yeah, the uh, you. I mean. Uh, like the heat bubble that uh sat. Uh, was it

[pj_wehry]: over the northwest United States, which was like, Um, I think it was Uh, Alaska in

[pj_wehry]: the last couple of months just had. Uh. It's a record high for a winter. It was

[pj_wehry]: twenty degrees warmer than the previous record. not the average the previous

[pj_wehry]: record and I was like Okay, I understand like I don'. I'm in central Florida, so I

[pj_wehry]: meet people who are are skeptical about climate change and I'm like

[james_marcum]: Just a few,

[pj_wehry]: something's happening something.

[pj_wehry]: but um. but again you know we talk about the stress side of it. It's not fair. Um

[pj_wehry]: to require people to learn so much about this so quickly. A. and especially when

[pj_wehry]: there's so much misinformation. I, I think there's a. There's a lot that needs to

[pj_wehry]: be done in terms of Uh, how we handle,

[pj_wehry]: Uh, the way information is spread, uh,

[james_marcum]: Right how that's regulated.

[pj_wehry]: uh, I'll be. Yeah, and it's not even for me. I, That's part of the reason why I

[pj_wehry]: wanted to do this podcast was so I could have people on. and whether they agree or

[pj_wehry]: disagree with you. at least they get to listen to you in more than a thirty second

[pj_wehry]: sound bite. Because I think that a lot of the problem are way more complex than

[pj_wehry]: can be represented in five minutes. Uh,

[james_marcum]: Oh yes,

[pj_wehry]: honestly, like way way more than an hour right, but at least like an hour's got to

[pj_wehry]: be better than five minutes. Um,

[pj_wehry]: I, I, I digress, but the um.

[pj_wehry]: The there was uh, one question. I really, um, kind of

[pj_wehry]: wanted to, uh, as it was, start to wrap up here, Um end with, And that was for you

[pj_wehry]: and I think some of this is. uh. You know, In your interview talked about Thomas

[pj_wehry]: Coon, Um,

[pj_wehry]: and

[pj_wehry]: uh, you talked about the exemplar and the disciplinary matrix. Uh, you know,

[pj_wehry]: that's part of where I got the idea for the skill set question. What is an ideal

[pj_wehry]: physician look like?

[james_marcum]: caring and competent,

[pj_wehry]: Okay, Yeah,

[james_marcum]: just just. I mean, genuinely cares.

[pj_wehry]: Mm,

[james_marcum]: just not about the Pa, but also about himself or herself.

[pj_wehry]: hm,

[james_marcum]: I think we are taught in this society. We are sort of driven

[james_marcum]: by this society.

[james_marcum]: Um. Have you read the book Magic Mountain by Thomas Mon?

[pj_wehry]: No, it's on myself. I should. I know it's be really good.

[james_marcum]: It's It's an investment, but it's

[james_marcum]: we. We have to be careful not to play games,

[james_marcum]: to really live authentic lives. not to sort of live the banal life, but to

[james_marcum]: live a life. That's that's genuly. caring,

[james_marcum]: just not about

[james_marcum]: others. but you know really about ourselves. We have to have

[james_marcum]: that genuine self love, Because if we don't have that then it's going to be

[james_marcum]: pretty hard to love someone else. if we really can't sort of care for

[james_marcum]: ourselves and the health care system.

[james_marcum]: I mean there's a thing called the hidden curriculum where generally uh,

[james_marcum]: after you've graduated from med school you, you sort of are in the um,

[james_marcum]: uh rotations and you are just grilled Uh, and if you want to see an example

[james_marcum]: that uh, there's a movie called um,

[james_marcum]: um,

[james_marcum]: What is wit

[pj_wehry]: Hm. Hm,

[james_marcum]: by uh,

[james_marcum]: um,

[james_marcum]: Margaret E Etsent, And in there there's an example of that that grilling that

[james_marcum]: goes on uh

[james_marcum]: at at the bedside when when Um interns are being being taught, and when I was

[james_marcum]: at at Boston, it was awes. it. It was often when when you're sort of in a room

[james_marcum]: in your you're you're having a meeting. It's often considered the smartest

[james_marcum]: person in the room.

[james_marcum]: You You want to be the smart. That's what you're pushed to be. You are to

[james_marcum]: perform

[james_marcum]: as the smartest person. Uh, in that room and a

[james_marcum]: it's It's incredibly stressful. Uh, That sort of the way our education system

[james_marcum]: is set up that we that we want the best and brightest, rather than having an

[james_marcum]: education system that produces the best and brightest that everyone can be.

[james_marcum]: Uh, so we have this

[james_marcum]: Uh, sort of competitive system that eliminates people rather than

[james_marcum]: uh, empowering and incorporating them. Uh, I mean we, we have a lot of

[james_marcum]: we. We need to do a lot in terms of our educational system in order to really

[james_marcum]: equip people to Um.

[james_marcum]: to make this a better world. Uh, for ourselves rather than

[james_marcum]: you know, Not not equipping them so that they have to

[james_marcum]: you know, engage in activities that that really harm others.

[pj_wehry]: Hm, Hm,

[james_marcum]: Um in in one way or another, So

[james_marcum]: yeah,

[pj_wehry]: That

[james_marcum]: does that

[pj_wehry]: folk go. Yeah, that's that's that's great. Uh, and that that focus on being the

[pj_wehry]: best and brightest instead of being the best that you can be, stops you from

[pj_wehry]: engaging with others right, like I, when you talk about

[james_marcum]: Yes. Well, it becomes a competition.

[pj_wehry]: right, A any E, even with the patient right, like

[james_marcum]: Yes,

[pj_wehry]: you're not going to take advice from a patient If it's very important that you're

[pj_wehry]: the smartest person in the room,

[james_marcum]: especially when they come in something from like Webm. D.

[pj_wehry]: Okay, I will say

[pj_wehry]: I. I. I get annoyed with people looking up things on Web, M. D, and I'm not even a

[pj_wehry]: doctor. So's it's cancer. Every time I have a headache, I think it's cancer. Oh,

[pj_wehry]: um,

[pj_wehry]: uh, I, I love my wife and she's really good about it. But there was one time she

[pj_wehry]: had uh, she had my uh, a migraine and uh, she looked it up on Web. M. D, and I was

[pj_wehry]: like, Don't don't look it up.

[pj_wehry]: I think I might like. I might have cancer and'm why, don't you just like take some

[pj_wehry]: tyle all, drink some water and we'll see how long it lasts and you know it got

[james_marcum]: Yeah, yeah,

[pj_wehry]: might the next day. but

[james_marcum]: it's called Wait and see.

[pj_wehry]: yes, yes,

[pj_wehry]: oh man, um, last question for you, Do you feel that the field of medicine needs a

[pj_wehry]: paradigm shift in that kind of in kind of coon sense,

[pj_wehry]: Or do you feel like this is something that would stick within the current paradigm

[pj_wehry]: when you talk about person centered health care?

[james_marcum]: Yeah, uh is. is it a counum paradigm shift and that

[james_marcum]: the two approaches are sort of incommensurable with one another, and that they

[james_marcum]: really don't have anything

[james_marcum]: to do with one another? I. I, I think what what really needs to be done

[pj_wehry]: H,

[james_marcum]: is that we need to build on the biomatical field that we have, And and sort of

[james_marcum]: move that along in terms of. there's a a movement towards systems

[pj_wehry]: hm,

[james_marcum]: medicine. Is is part of the precision medicine, Uh movement, and that what we

[james_marcum]: need to incorporate in that is this

[james_marcum]: humanity? This, this idea that we are training

[james_marcum]: physicians. not only to be you know, caring, but, but, but also competent in

[james_marcum]: terms of Uh, their their skill sets. Um,

[pj_wehry]: hm,

[james_marcum]: and

[james_marcum]: so, I think, for

[james_marcum]: for the future, I,

[james_marcum]: I really hope that we continue

[james_marcum]: with the technological end of it, but really also making that available

[james_marcum]: not just to the rich and and and to a few, but making that accessible, Uh to

[james_marcum]: pretty much everyone but that. Re, that's really a a larger sociological

[james_marcum]: question, and I,

[james_marcum]: I, I just don't know. I mean, you know, take, take a look at. you know. I grew

[james_marcum]: up in a small midwestern town

[pj_wehry]: yeah,

[james_marcum]: that used to have industry there and it is all gone.

[pj_wehry]: right,

[james_marcum]: Mean it is, and you know there's another documentary on

[james_marcum]: how this one midwestern town how uh, foreign investors came in and opened up a

[james_marcum]: um, um,

[james_marcum]: uh, a factory. But they were paying a minimum wage and there was no Um.

[james_marcum]: You know no ability to unionize and if you ever want to really understand the

[james_marcum]: importance of the unions, um,

[james_marcum]: uh, adversary in the house, by um, uh, what's his name? Um,

[james_marcum]: Irving Irving Stone, Um,

[james_marcum]: it's it's about Eugene debt, Uh, one of the first ones to actually uh,

[james_marcum]: unionize the um, Uh, the Railro workers. I mean, the conditions that these

[james_marcum]: people worked under were incredible, and I think as as a society we've we, we

[james_marcum]: just find ourselves being polarized more and more and more. And it, it it

[james_marcum]: seems that classism has has really become our, our major ism

[pj_wehry]: hm,

[james_marcum]: uh at at this stage of the game. And

[james_marcum]: it it, it just it, doesn't it? You know. it cares only about wealth.

[pj_wehry]: yeah, yeah,

[james_marcum]: Yeah, that's that's That's what. it's what. what it's based upon, But

[james_marcum]: certainly one of the the chief values. Uh that it's that it's based upon, And

[james_marcum]: so

[james_marcum]: I, it's the problem is so large, so much larger than just medicine.

[pj_wehry]: hm,

[james_marcum]: What would be the ideal physician to get at that? I, I think we've got make

[james_marcum]: some major changes,

[pj_wehry]: yeah,

[james_marcum]: Uh, in terms of

[james_marcum]: our social structure itself, and that's that's why I like your podcast. I

[james_marcum]: liked listening to it. You. You really take on

[james_marcum]: Um.

[james_marcum]: a number of facets. That sort of are important in terms of where we are today,

[james_marcum]: and sort of what we need to be thinking about

[pj_wehry]: hm.

[james_marcum]: in order to really chart. Uh, a better future,

[pj_wehry]: Thank you. I really appreciate that. Um. I, I mean, that's been my goal, So it's

[pj_wehry]: It's very uh, gratifying, but more importantly helps me make sure you know I. I

[pj_wehry]: don't get a lot of feedback right now like I don't. it's not. I'm not a huge

[pj_wehry]: podcast by any means, and so to hear that is very gratifying Thank you. Um.

[pj_wehry]: forgive me for looking to the side. I was listening, Um, but I was looking up your

[pj_wehry]: books be cause you' talking about systems biology. I know that's one of your

[pj_wehry]: books. If someone wanted to learn more about this, What is the best way? Uh, what

[pj_wehry]: book would you recommend of yours for them?

[james_marcum]: Um, Um,

[james_marcum]: In, in terms of of systems biology, I just go on in Google. I mean there

[pj_wehry]: Yeah,

[james_marcum]: are a lot of good authors

[pj_wehry]: yeah,

[james_marcum]: Um out there. Uh, If and in, in terms of Uh, systems medicine, there's there's

[james_marcum]: an institute of of systems biology, Le Roy Hood, Uh, who is one of the Um,

[james_marcum]: major people involved in the uh, uh, human Genome project.

[pj_wehry]: hm.

[james_marcum]: Uh, he has a an institute out Uh in Seattle, Washington,

[pj_wehry]: hm.

[james_marcum]: and he has this whole systems uh medicine thing, So I'd go on and google his

[james_marcum]: thing. he's got, Um,

[james_marcum]: Um,

[james_marcum]: He, Hes, just got a very nice website that that would introduce you to all

[james_marcum]: this stuff. And he's got a newsletter that he can send you. I, I subscribe to.

[pj_wehry]: okay,

[james_marcum]: It's kind of cool.

[pj_wehry]: Yeah, we'll make sure to link to that. uh, uh, in the

[pj_wehry]: description, Um,

[pj_wehry]: Doctor Marham, It's been such a pleasure having you on. Um, I just

[james_marcum]: Well, thank you

[pj_wehry]: wanted to say thank you. Yeah, Um, and I'd like to thank the uh. Let. thank our

[pj_wehry]: listeners for joining us. Um, if you enjoy the depth of conversation or learn

[pj_wehry]: something, please lecurer and subscribe so someone else can, too. Uh, so someone

[pj_wehry]: else can hear Doctor Markham, and uh. I, I think the first important step is

[pj_wehry]: assessing the problem right, and uh, I

[james_marcum]: nine

[pj_wehry]: want to thank you for for providing that force today.

[james_marcum]: right, but it's been my pleasure. I, just

[james_marcum]: this is, this is just a lot of fun.

[pj_wehry]: Yeah,

[james_marcum]: You're really. You're really

[james_marcum]: a great person to communicate with just just to have a talk. Your questions

[pj_wehry]: thank you, sir. Appreciate that.

[james_marcum]: were great.