Telemedicine IS Medicine

When I first solely started practicing Telemedicine in 2016, I couldn’t wrap my head around the push back in Medicine against Telemedicine. At that time, it was said that Telemedicine is equivalent to Medicine. Once I started working in the industry I realized what the main issue was. The start up Telehealth companies business model for Telemedicine was that of a prescription-pill mill.

One should complete a consult in 5 minutes, even for opioid use disorder, which included the time to eprescribe in another window on another platform with 2 point system authentication for a controlled substance, Buprenorphine. This is not Medicine. Ultimately, the COVID pandemic happened, and brick and mortar institutions were forced to pivot and adapt, including the adoption of Telemedicine, as it should be practiced, equivalent to Medicine.

I have been solely practicing Telemedicine for over 6 years, and I can hear flat affect via only an audio consultation. I can appreciate shortness of breath as well, secondary to the gasping for breath, and stopping mid-sentences to breath. I can hear distress. Ultimately, Telemedicine is Medicine, and one day 90-95% of Medicine will be conducted this way, due to the advances in wearables, and point of care devices, such as home-portable electrocardiograms (EKG).

The future of Medicine, in the form of the Jetsons, is here. There is no going back, and with the advent of generative augmented intelligence (AI), like Chat GPT, we are full fledged in the future.

Metabolically Healthy:The Bane of Obesity Medicine Health Equity

The first time I read what metabolically healthy meant, I believed it was a very spurious terminology. It meant the patient was obese without any parameters for metabolic syndrome, such as, hypertension, diabetes or dyslipidemia. Physiologically, this is not possible via a systemic inflammatory standpoint. This is again the issue with the 70 kg white military men metrics from World War 1 and World War 2. These numbers don’t truly represent what’s going on in the population today with genetically modified food, and high fructose sugar in food, not to mention the particulate environmental pollution that the current population is exposed to.

Ultimately, bench and clinical research have to be undertaken to determine present day inflammatory markers, such as, interleukins and inflammatory mediator markers that reveal what is going on in the body once one reaches a BMI of 27.0. This is already a heightened inflammatory state. Most clinicians don’t even assess prehypertension or recommend the DASH and MIND diet for dietary weight loss methods. The patients are just told to lose weight. There is no obesity medicine consult, dietitian or nutritionist consult. Most patients need support to be disciplined to consistently, and sustainably lose weight.

Luckily with the new drugs, such as, Semaglutide and Mounjora, most adults and adolescents will no longer need Bariatric Surgery to maintain weight loss. The only issue is you have to stay on these drugs indefinitely to keep the weight off, so far in the current literature.

Food-As-Medicine programs: A Feasible Pathway to Health Equity-Universal Healthcare

Hipprocrates once eloquently and profoundly said, “let food be thy medicine, and medicine be thy food”. The role of nutrition in healthcare, and the optimization of good-healthy gut microbiome is understated, and poorly taught in medicine. The part that gut barrier failure-leaky gut plays, in the gut microbiome etiology, and perpetuation-worsening of autoimmune and chronic diseases, should be at the forefront of the science and art of medicine.

The gut microbiome as the cure for several diseases, is well known. Diseases such as hypertension, diabetes and mental illness-depression/anxiety/ADHD are said to be heavily influenced by the gut microbiome. This is why medical cannabis works so well, as a plant that augments the gut microbiome, and boosts the endocannabinoid system (EBS). The EBS potentiates the gut-brain axis, and the hypothalamic-pituitary-adrenal (HPA) axis. Also, specifically, Indica which has more cannabidinoid than THC does not cause psychosis, heart ischemia or liver injury as THC, as well as, potentially exponentially boosting the good bacteria in the gut. Of note, one of the treatments for encephalopathy is Rifaximin, an antbiotic which inhibits bacterial protein synthesis in the gut, thereby preventing ammonia formation.

The cure for cancer lies in the gut microbiome, where the good bacteria prevents the overgrowth of yeast, which can be the genesis, and augmentor of many chronic diseases, such as, fibromyalgia and many autoimmune diseases. Adjunctively, the human autoimmune system is heaviliy regulated by the gut microbiome. The gut microbiome prevents cancer by sending signals/mediators to potentiate natural killer lymphocytes cells to improve immunosurveillance.

Summarily, the answer to Universal Healthcare and Health Equity is good nutrition, that can be consistently and effortlessly provided by food-as- medicine programs and nutrition security interventions, such as the one provided by Instacart Health. Thus, the best diet for mental illness-behavioral health, as well as obesity, is the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, with green tea with organic cinnamon, and juicing with 1 glass of organic carrot/beet/ginger juice daily with resultant weight loss of 3-5 lbs weekly without exercise. The recommended weight loss per week is half a pound.

The Real Reason Why Silicon Valley Bank (SVB) Collapsed

The economic markets follow basic concepts from the Wealth of Nations by Adam Smith. The United States economic market is it’s own living, breathing organism. It innately corrects itself. Adam Smith called it, “the invisible hand of the market”. Consequently, secondary to the influx of stimulus cash during the pandemic we had an abrupt blast of inflation. The marketplace however, needed to be slowly corrected to generate collateral circulatory support from the banking system. Thus, aggressively increasing interest rates over short periods of time would result in a great recession, great depression or banking collapse, similar to the Enron and WorldCom debacle that resulted in Dodd Frank and Sarbanes Oxley correction relative to regulation and oversight.

The SVB upper echelon of management falsely believed that since they had invested years of money in the start up industry, that these companies would be loyal with their hard earned corporate profits. This is not organically appropriate fiscal principles, it is business not personal, always. The bottom line, is the bottom line, expansive marginal profit. Start up companies are extremely fickle secondary to the volatile nature of their marketplace. Hence, the resultant run on SVB coffers/liquidity.

Economics is basic to me, the economic marketplace is a human being with innate systems. The circulatory system between the Federal Reserve and the banking system stopped understanding each other, and it led to disaster. Ultimately, the old Spanish proverb from Don Quixote, “don’t put all your eggs in one basket”, rings true. For sure, one basket must be the local Credit Union.

Medical Cannabis: A Potential Therapeutic for Systemic Endometriosis/Adenomyosis

Endometriosis as a disease entity is so poorly understand, secondary to being a disease of women. Normally, a woman’s symptoms are not believed, and the symptoms are deemd to be psychiatric in origin, blatant psyche out bias. Addititonally, the systemicness of Endometriosis is often overlooked, and the woman is diagnosed with multiple other vague diseases, such as, fibromyalgia and irritable bowel syndrome (IBS). Luckily, a test was developed for IBS, but it is not extensively utilized.

Endometriosis in the population is about 20-30% of women, even in my population of Medical Cannabis patients. Stage 0 Endometriosis is very invisible, but the patient normally has severe pelvic pain with severe fatigue, intractable migraines, alternating constipation/diarrhea, worsening diffuse myalgia, starting from ovulation. Some women even have seizures secondary to the catamenial migraines, some women have nose bleeds every month with their menses, catamenial epistaxis.

I have included a table below to depict some of the possible systemic sequelae of systemic Endometriosis. In about 5 years Medical Cannabis, and the Endocannabinoid System (EBS) will be fleshed out in greater detail. There are over 600 compounds in Medical Cannabis, which include the Terpenes. Currently, Medical Cannabis remains a Schedule 1 drug, and therefore is poorly studied in America. The best and most comprehensinve studies of the many benefits of Medical Cannabis are out of Israel and Canada. Intensive studies are being undertaken in Colorado at the moment.

Table 1: Review of systems with corresponding endometriosis symptoms/sequelae.

PsychologicalPremenstrual syndrome
Premenstrual Dysphoric Disorder
Possible suicidal ideations  
Lower back pain
Diffuse Myalgia
RespiratoryChest pain
Pneumonitis with restrictive lung disease
CardiacPericarditis with angina/myocarditis
Dysrhythmia with coronary vasospasm
GastrointestinalInflammation of small intestine and large intestine with dysmotility/malabsorption
Bowel obstruction/strictures
Alternating diarrhea/constipation
Bacterial vaginosis
Bladder inflammation
Recurrent urinary tract infections
MusculoskeletalDiffuse myalgia/calf localization
HematologyHypercoagulable state
Vitamin D deficiency
Vitamin B12 deficiency
Vitamin B complex deficiency
Iron deficiency anemia

The Patient Is Not in the Medical Textbook

In medicine we try to fit all our patients in the academic textbook algorithm. This causes a loss of clinical judgment, and increases the potential for medical racism, medical gaslighting and healthcare biases.

Even in an office visit, Physicians have to get through their specialty algorithm in their heads. We should allow patients to speak without interrupting them for 2-3 minutes. Additionally, insert your algorithm around the patient’s input. Let them express their symptoms, and distress the way they are feeling them. Ultimately, we have to complete the medical Note, but not at the expense of quality person centered care.

Medicine is currently so commercialized, Physicians and patients have become commodities. We can never be rice, sugar, flour or chicken. Thus, the medical marketplace, which is it’s own living, breathing thing, rebels. The medical economic marketplace is a societal marketpalce, heavily influenced by biopsychosocial factors, the social determinants of health. The medical economic marketplace is not a capitalistic marketplace. So, the capitalistic hammer always misses the societal nail, that is the medical economic marketplace.

Hopefully, we can go back to the Hipprocratic way of dispensing medicine, and leave this capitalistic crucible of 21st medicine behind us in the distant past.

Universal Healthcare is Preventive Medicine: Basic Healthcare for All

I recently learned that there is now a specialty in Medicine called Preventive Medicine. Preventive Medicine is the Hipprocatic method by always espousing, nil non nocere, first do no harm.

Preventive Medicine focuses on clinical judgment, and whole person care secondary to fundamentally providing Medicine that should be culturally relevant, and appropriate at all times. Basically, following the NIH method of accounting for biological, and physiological variance in each patient’s genetics.

The future of health equity in America is to afford access to basic Preventive Medicine, thereby delivering Universal Healthcare. The current culture of educating the population of popping a pill to cure ailments has created the opioid epidemic, fast food coma/obesity and increased heart disease/heart attacks with strokes.

For America to continue being the wealthiest Nation in the world, and to surpass China in GDP, health must become the first, and only wealth for every multinational enterprise (MNE). Ultimately, its all hands on deck, and we are all clinicians; Nurse Practitioners, Pharmacists, Physician Associates, Medical Doctors and Doctors of Osteopathy.

Financial Literacy is Health Equity

I recently read an article that said the black population is audited by the IRS more than the general population. I found that statement to be interesting, since I really think the issue is financial literacy in the black community. I filed my first 1040 at 19 years old. Lucky for me my guardian at the time, my Aunt, is an Accountant. Actually, 50% of my Aunt’s are Accountants. One is a Chartered Accountant from Jamaica, who is now a Tax Accountant in Canada. Another one is still an Accountant in Jamaica, and then there is me.

Apparently, I had genes for Accounting that I did not know about. I have always been good with money. I used to assist the 1st black female Entrepreneur I ever met, my Grandmother, by selling kalaloo with her in Three Miles-Waterhouse, Jamaica. We also raised rabbits, goats and chicken for consumption. I have been going to the bank since I was 6 or 7 years old. I had my own account, and went to the bank by myself. I would tell Grandma how much I would need, and return the bank book to her when I retuned from the bank.

In the black community, most people have no idea what a Form 1040 is, or a Schedule A, I was always dumbfounded. This is America, how does one not know the basics about the tax system or tax laws. I believe this is why we pay more taxes, and have run ins with the IRS. Full disclosure, I have a Masters in Accounting in Taxation-Government from Kaplan University Online, now Purdue Global University.

Many moons ago, I thought the answer to affecting change in health equity was health law. After attempting a Masters of Jurisprudence at Loyola University, and my law professor told me I would have to become a health law judge to achieve what I wanted to do, I started praying really hard. Luckily for me, Adonai’s answer was Accounting. Yes, that’s right, it’s Accounting knowledge. It turned out that the answer was, you had to be able to write the budget, that is, the appropriations, encumberances and expenditures. A high school student can write health policy, but health policy can’t be implemented without a budget, and a budgte justification.

Ultimately, I encourage everyone one to read Deduct Everything by Eva Rosenberg, and How to Pay Zero Taxes by Jeff Schnepper. Fundamentally, with decent Preventive Medicine care and these 2 books, a heart attack and a stroke can easily be averted, honestly.

Clinical Judgment in Medicine: The Road to Health Equity

We have lost our way in medicine by solely relying on laboratory results and diagnostic tests that were fleshed out using 70 kg white men from the military, from World War 1 and World War 2. The CDC finally sent out an alert about the inaccuracy of the pulse oximeter findings in the black population. They concluded that clinical judgment must be used instead.

The core of clinical judgment is based on what the patient says/symptoms, as well as, the use of their biological and physiological variance (NIH lingo), to come up with a treatment plan that is specific/precise to the patient.

This is what is lacking in the care of the black population. Fancy words such as implicit bias are used to describe florid medical racism. The black population normally becomes symptomatic when their labs drift below the 50th percentile, but we are told our labs are normal, not for us. Sometimes, by the time the lab results drifts down to 25th percentile, we have already experienced a catastrophic event, a heart attack or stroke.

To advance medicine in the 21st century, the patient’s genetic polymrphisms and epigenetic polymorphisms must dictate their care. I envision a promised land of quality healthcare driven by precision medicine.

Surgery Critical Care Science Saved My life

When I was a chid in Jamaica, my black bag, a Jamaican plastic bag called scandal bag, had Chloraseptic, Vicks, Dettol, Mercurochrome and of course, user friendly ice from the Freezer. I was the one everyone called for cut and scrapes. I was a healer before I was a Doctor.

I thought I became a Doctor to practice Tikkun Olam, healing the world, starting with Jerusalem, your family and immediate community. As someone with a chronic disease and chronic pain syndrome, I realized that my knowledge of wound healing and repair was to be used to first do no harm to myself, since as a black woman in America I was constantly being exposed to medical racism and medical gaslighting. Yes, it is true your educational level is irrelevant. As a matter of fact, it is thrown back in your face. “Stop being a Doctor and be a patient”, I was told. Whenever I allow the healthcare system to take over my care outside of the great Dr Millicent Comrie, I end up with several emergency room visits, where my symptoms are vague, and one emergency Surgery performed by Dr Millicent Comrie.

Black and indigenous women you MUST seek a culturally relevant or appropriate Physician. Fancy words for someone who listens to your symptoms, and believe they are real. The medical racism and medical gaslighting shows up in the deadly fetal-maternal mortality rate in black women, and our cancer sruvival rate, which is abysmal secondary to being diagnosed 6 months to 18 months later than the general population.

Black women, you are not paranoid or delusional. Please make sure you ask the healthcare insurance company for a Physician that has a large population of black and indigenous women, and they are statisfied with their care. For now, this is the solution to the level of medical racism, and medical gaslighting that is occuring currently in medicine.