1 00:00:01,320 --> 00:00:03,160 Speaker 1: Welcome to the Tutor Dixon Podcast. 2 00:00:03,200 --> 00:00:07,000 Speaker 2: I'm excited today we have a senior advisor for clinical 3 00:00:07,080 --> 00:00:10,440 Speaker 2: Sciences at the US Food and Drug Administration. We have 4 00:00:10,800 --> 00:00:14,160 Speaker 2: doctor Tracy Beth Hogue with us today. Doctor Hoague, thank 5 00:00:14,160 --> 00:00:15,280 Speaker 2: you so much for joining me. 6 00:00:16,280 --> 00:00:18,360 Speaker 3: So great to be here, Tutor, thanks for having me 7 00:00:18,400 --> 00:00:18,920 Speaker 3: on the show. 8 00:00:19,440 --> 00:00:22,040 Speaker 2: I feel like I cannot possibly have enough time with you, 9 00:00:22,040 --> 00:00:24,279 Speaker 2: because there's so much I want to talk about. But 10 00:00:24,400 --> 00:00:26,479 Speaker 2: I was looking at your Twitter feed and I was 11 00:00:26,560 --> 00:00:30,240 Speaker 2: watching some I guess it was a panel on SSRIs 12 00:00:30,320 --> 00:00:32,680 Speaker 2: and so for people who don't know what those are, 13 00:00:32,760 --> 00:00:34,640 Speaker 2: that's an antidepressant, Is that correct? 14 00:00:35,479 --> 00:00:36,080 Speaker 3: That's correct. 15 00:00:36,159 --> 00:00:41,280 Speaker 4: Yes, selective serotonin reuptake inhibitors and they're mainly uses antidepressants, 16 00:00:41,320 --> 00:00:42,000 Speaker 4: that's correct. 17 00:00:42,800 --> 00:00:47,400 Speaker 2: So that conversation was about using them during pregnancy. And 18 00:00:47,479 --> 00:00:50,320 Speaker 2: I found it fascinating because I think we as the 19 00:00:50,320 --> 00:00:54,120 Speaker 2: public are constantly searching for why are we having some 20 00:00:54,160 --> 00:00:55,840 Speaker 2: of these changes in our kids? 21 00:00:55,880 --> 00:00:57,800 Speaker 1: Why are we seeing higher rates of autism? 22 00:00:57,840 --> 00:01:01,000 Speaker 2: Why are we seeing different rates of brain development and 23 00:01:01,040 --> 00:01:04,120 Speaker 2: development in children? And one of the doctors who was 24 00:01:04,160 --> 00:01:06,400 Speaker 2: on there was saying, like, if you think that this 25 00:01:06,480 --> 00:01:10,039 Speaker 2: isn't affecting the baby's brain, but it is affecting the 26 00:01:10,080 --> 00:01:11,920 Speaker 2: mom's brain, then you're not really. 27 00:01:11,680 --> 00:01:14,000 Speaker 1: Looking at the research. And that was shocking to me. 28 00:01:14,880 --> 00:01:18,280 Speaker 4: Yeah, exactly, And that was doctor Adam Murato who said that. 29 00:01:18,360 --> 00:01:20,600 Speaker 4: And he is one of the world's leading experts in 30 00:01:20,640 --> 00:01:24,320 Speaker 4: this topic, and he's also an obstetrician and sees patients 31 00:01:24,840 --> 00:01:28,280 Speaker 4: daily who are on SSRIs and is very familiar with 32 00:01:28,319 --> 00:01:28,839 Speaker 4: this topic. 33 00:01:28,920 --> 00:01:30,760 Speaker 3: And it is. 34 00:01:30,840 --> 00:01:33,960 Speaker 4: Really important for women to understand that that if these 35 00:01:34,120 --> 00:01:38,199 Speaker 4: medications are affecting the way we think and the way 36 00:01:38,280 --> 00:01:42,160 Speaker 4: our brain works, then they would also because they crossed 37 00:01:42,200 --> 00:01:45,440 Speaker 4: the placenta to the baby, they are also affecting the baby. 38 00:01:45,480 --> 00:01:49,240 Speaker 4: And we know that serotonin plays a critical role in 39 00:01:49,280 --> 00:01:54,240 Speaker 4: fetal development, and so if we're altering the serotonin system, 40 00:01:54,640 --> 00:01:59,200 Speaker 4: then we would expect to find alterations in the development 41 00:01:59,280 --> 00:02:02,160 Speaker 4: of the baby. And in fact, we do see this 42 00:02:02,320 --> 00:02:07,280 Speaker 4: because we know one of the SSRIs has a well 43 00:02:07,320 --> 00:02:12,440 Speaker 4: known safety signal, this is paxel SSRI, that it's listed 44 00:02:12,600 --> 00:02:18,160 Speaker 4: on the FDA label that it causes heart malformations. Beyond that, 45 00:02:18,720 --> 00:02:22,560 Speaker 4: we know that it can cause persistent pulmonary hypertension, which 46 00:02:22,600 --> 00:02:26,560 Speaker 4: is another condition in the newborn. It increases risk of 47 00:02:26,639 --> 00:02:30,560 Speaker 4: postpartum hemorrhage in the mother, and so we know that 48 00:02:30,639 --> 00:02:34,520 Speaker 4: these SSRIs have impacts on both the mom and the baby. 49 00:02:35,200 --> 00:02:38,560 Speaker 4: And just to get back to your question about autism 50 00:02:38,720 --> 00:02:43,959 Speaker 4: and neurodevelopmental disorders, I agree this is a huge and important. 51 00:02:43,480 --> 00:02:44,359 Speaker 3: Topic right now. 52 00:02:44,440 --> 00:02:48,560 Speaker 4: Why are rates of autism increasing? Is it just a 53 00:02:48,560 --> 00:02:52,280 Speaker 4: different threshold for diagnosis alone, or is something else going on? 54 00:02:52,600 --> 00:02:55,720 Speaker 4: And you know, I think it's important to systematically look 55 00:02:55,760 --> 00:02:59,560 Speaker 4: at this, and I certainly the point of the panel 56 00:02:59,720 --> 00:03:02,560 Speaker 4: was not to say, look, SSRIs are causing autism, but 57 00:03:02,639 --> 00:03:05,520 Speaker 4: to say, let's take a step back. So we know 58 00:03:05,600 --> 00:03:08,960 Speaker 4: the SSRI that serotonin plays this crucial role in the 59 00:03:09,000 --> 00:03:12,160 Speaker 4: development of the brain, and we know that over five 60 00:03:12,200 --> 00:03:14,840 Speaker 4: percent of women in the United States when they're pregnant 61 00:03:14,880 --> 00:03:18,680 Speaker 4: are on these medications, and what impact is it having. 62 00:03:18,880 --> 00:03:24,760 Speaker 4: And we have some observational studies that show adverse effects 63 00:03:24,800 --> 00:03:30,000 Speaker 4: on neurocognitive development and intellectual development. And so it's concerning 64 00:03:30,120 --> 00:03:32,240 Speaker 4: enough to take a step back and say, you know, 65 00:03:32,480 --> 00:03:34,640 Speaker 4: wait a minute, should we look more closely at this, 66 00:03:36,160 --> 00:03:40,000 Speaker 4: And also to inform women of child bearing age because 67 00:03:40,760 --> 00:03:43,960 Speaker 4: it may be you know, the development of the fetus 68 00:03:44,560 --> 00:03:48,680 Speaker 4: happens so early in pregnancy and SSRIs are medications that 69 00:03:48,720 --> 00:03:51,280 Speaker 4: are very hard to come off of, and so. 70 00:03:51,320 --> 00:03:52,040 Speaker 1: This is real. 71 00:03:52,160 --> 00:03:54,560 Speaker 2: He said you should think about it before because he 72 00:03:54,640 --> 00:03:57,080 Speaker 2: did say that in that panel, he said, if you're 73 00:03:57,120 --> 00:03:59,320 Speaker 2: thinking of getting pregnant, you need to think about take 74 00:03:59,360 --> 00:04:02,240 Speaker 2: getting off of SSRI before you get pregnant. 75 00:04:02,280 --> 00:04:02,800 Speaker 1: That's why. 76 00:04:03,680 --> 00:04:05,840 Speaker 4: Well, that's correct, and this is I mean, it's a 77 00:04:05,920 --> 00:04:11,320 Speaker 4: complex topic and discussion because obviously depression is an important problem, 78 00:04:11,360 --> 00:04:14,240 Speaker 4: but this is a conversation that should be had where 79 00:04:14,280 --> 00:04:17,560 Speaker 4: women are being fully informed about what we know about 80 00:04:17,560 --> 00:04:20,960 Speaker 4: the potential benefits but also the potential risks to their 81 00:04:21,000 --> 00:04:23,960 Speaker 4: developing baby. And so one of the reasons we wanted 82 00:04:24,000 --> 00:04:26,560 Speaker 4: to have this panel, and I was so excited that 83 00:04:26,640 --> 00:04:31,000 Speaker 4: doctor McCarey, you know, wanted to have this panel, is 84 00:04:31,040 --> 00:04:34,000 Speaker 4: to bring attention to this issue, which I don't think 85 00:04:34,080 --> 00:04:38,320 Speaker 4: has received enough attention. And so also that you know, 86 00:04:38,440 --> 00:04:41,360 Speaker 4: women who are of childbearing age, they don't wait until 87 00:04:41,400 --> 00:04:44,440 Speaker 4: they're pregnant to look into this. So it's something that 88 00:04:44,720 --> 00:04:47,760 Speaker 4: you know, our society really has a good understanding of. 89 00:04:47,880 --> 00:04:51,160 Speaker 4: So that women of childbearing ages just know to ask 90 00:04:51,200 --> 00:04:54,719 Speaker 4: their doctor and to have this conversation before they become pregnant. 91 00:04:55,000 --> 00:04:55,840 Speaker 1: Well, let me tell you why. 92 00:04:55,960 --> 00:04:58,400 Speaker 2: I felt like as I was watching that it was 93 00:04:58,480 --> 00:05:02,280 Speaker 2: so important right now because I think that that as 94 00:05:02,279 --> 00:05:04,560 Speaker 2: a community, as a country, we have come out of 95 00:05:04,600 --> 00:05:07,040 Speaker 2: this pandemic and we've started to go, gosh, do we 96 00:05:07,120 --> 00:05:09,760 Speaker 2: trust the CDC, do we trust the FDA? 97 00:05:09,920 --> 00:05:11,239 Speaker 1: Do we believe what they're saying? 98 00:05:11,480 --> 00:05:14,839 Speaker 2: And we've never had it seems like in my lifetime, 99 00:05:14,839 --> 00:05:17,160 Speaker 2: we've never had an FDA that's come out and said, hey, 100 00:05:17,200 --> 00:05:19,720 Speaker 2: even though these things are approved, maybe we need to 101 00:05:19,760 --> 00:05:21,760 Speaker 2: look deeper, maybe we need to talk to. 102 00:05:21,720 --> 00:05:22,560 Speaker 1: The public about it. 103 00:05:22,480 --> 00:05:24,880 Speaker 2: It was always like behind closed doors, like you know, 104 00:05:24,960 --> 00:05:25,839 Speaker 2: the Wizard of Oz. 105 00:05:25,880 --> 00:05:27,760 Speaker 1: It was something we weren't allowed to know about. 106 00:05:28,040 --> 00:05:31,640 Speaker 2: And to see doctor Jurato sit and talk about this 107 00:05:31,800 --> 00:05:32,720 Speaker 2: and to say. 108 00:05:32,480 --> 00:05:34,440 Speaker 1: You know what, I'm gonna be honest with you. 109 00:05:34,720 --> 00:05:38,400 Speaker 2: In rats, we've seen different behaviors and that, and even 110 00:05:38,480 --> 00:05:41,960 Speaker 2: on ultrasounds and human ultrasounds, we've seen different movements of 111 00:05:42,000 --> 00:05:43,599 Speaker 2: the baby and twelve studies. 112 00:05:43,640 --> 00:05:44,640 Speaker 1: I mean, I thought it was amazing. 113 00:05:44,680 --> 00:05:48,239 Speaker 2: He said, twelve studies show us that these SSRIs alter 114 00:05:48,360 --> 00:05:51,760 Speaker 2: the fetal brain. And he but here he was clear, 115 00:05:51,920 --> 00:05:54,520 Speaker 2: like we don't know that this is causing there's a cause, 116 00:05:54,560 --> 00:05:58,400 Speaker 2: and effect, but we do know that the that the 117 00:05:58,400 --> 00:06:00,599 Speaker 2: effect is autism, but we do know that there is 118 00:06:01,000 --> 00:06:03,600 Speaker 2: some effect, and that we've seen babies that have been 119 00:06:03,640 --> 00:06:06,719 Speaker 2: born jittery and babies that have been struggling to with 120 00:06:06,760 --> 00:06:09,799 Speaker 2: their pulmonary abilities and whatnot. 121 00:06:09,839 --> 00:06:12,280 Speaker 1: But he said, I think that we need to. 122 00:06:12,240 --> 00:06:16,479 Speaker 2: Be more upfront with informing the public, and to me, 123 00:06:16,800 --> 00:06:19,160 Speaker 2: just the panel was a huge step that we have 124 00:06:19,279 --> 00:06:19,839 Speaker 2: not seen. 125 00:06:21,080 --> 00:06:23,640 Speaker 4: Yes, well, thank you so much for saying that. And 126 00:06:24,240 --> 00:06:26,760 Speaker 4: I have to say that's one of the reasons I 127 00:06:26,839 --> 00:06:29,680 Speaker 4: absolutely love working at the FDA right now because I 128 00:06:29,720 --> 00:06:33,440 Speaker 4: feel like things are changing because doctor McCarey has really 129 00:06:33,480 --> 00:06:36,320 Speaker 4: made it one of his top priorities to be transparent 130 00:06:36,440 --> 00:06:39,640 Speaker 4: and also, you know, to challenge the current dogma and 131 00:06:39,680 --> 00:06:42,640 Speaker 4: to ask questions that maybe have not been asked in 132 00:06:42,760 --> 00:06:47,240 Speaker 4: the past, and to hear from different voices and so 133 00:06:47,440 --> 00:06:49,359 Speaker 4: you know, we don't always want to just take for 134 00:06:49,440 --> 00:06:51,760 Speaker 4: granted something that we've been told for many years in 135 00:06:51,800 --> 00:06:54,640 Speaker 4: a row. We want to hear from, you know, researchers 136 00:06:54,680 --> 00:06:56,839 Speaker 4: on the cutting edge and people who really know the 137 00:06:56,880 --> 00:06:59,640 Speaker 4: most current data like doctor Erroto and like many of 138 00:06:59,680 --> 00:07:02,080 Speaker 4: the other are experts in the panel and say you 139 00:07:02,120 --> 00:07:04,239 Speaker 4: know what, what have we been what have we learned 140 00:07:04,279 --> 00:07:07,600 Speaker 4: recently in the best studies that we have now And 141 00:07:07,760 --> 00:07:09,320 Speaker 4: and you're right, I'm glad that you brought up the 142 00:07:09,400 --> 00:07:13,600 Speaker 4: jitteriness too, because that is also in the newborn because 143 00:07:13,600 --> 00:07:16,720 Speaker 4: that is also a well established side effect of these 144 00:07:16,760 --> 00:07:21,000 Speaker 4: medications that I've heard and read around even up to 145 00:07:21,040 --> 00:07:23,360 Speaker 4: eighty percent of babies that are born with moms that 146 00:07:23,400 --> 00:07:27,200 Speaker 4: are on SSRIs have this basically have a withdrawal. 147 00:07:27,600 --> 00:07:29,240 Speaker 3: Syndrome when they're when they're born. 148 00:07:29,360 --> 00:07:33,520 Speaker 4: So we absolutely know these medications are affecting the babies. 149 00:07:33,640 --> 00:07:37,840 Speaker 4: And you know, grateful that this information is now getting 150 00:07:37,880 --> 00:07:38,679 Speaker 4: out to the public. 151 00:07:38,720 --> 00:07:40,880 Speaker 3: And I will tell you I have had. 152 00:07:40,760 --> 00:07:45,120 Speaker 4: So much positive feedback from friends and colleagues and family 153 00:07:45,120 --> 00:07:48,120 Speaker 4: members just calling me to say thank you. I had 154 00:07:48,240 --> 00:07:53,120 Speaker 4: no idea that and and this is actually, like I said, 155 00:07:53,200 --> 00:07:57,000 Speaker 4: well established on the label of one of the ssri 156 00:07:57,040 --> 00:08:00,080 Speaker 4: I products. So you know, we're we're constantly discussing, so 157 00:08:00,480 --> 00:08:02,840 Speaker 4: how do we change things. What can we do better 158 00:08:02,920 --> 00:08:05,840 Speaker 4: at the FDA to inform the public about what we 159 00:08:05,920 --> 00:08:08,880 Speaker 4: do and don't know about, you know, the risks of 160 00:08:08,920 --> 00:08:10,400 Speaker 4: these products during pregnancy. 161 00:08:10,880 --> 00:08:13,920 Speaker 2: Well, and it's a time when I mean my kids 162 00:08:13,920 --> 00:08:17,000 Speaker 2: are older now, my youngest two or twelve, but that 163 00:08:17,120 --> 00:08:20,239 Speaker 2: I mean, I clearly remember the time of being pregnant, 164 00:08:20,320 --> 00:08:22,720 Speaker 2: and it is a time where you are just consuming 165 00:08:22,760 --> 00:08:25,000 Speaker 2: as much information as you can because first of all, 166 00:08:25,000 --> 00:08:26,640 Speaker 2: you have no idea what you're about to embark on, 167 00:08:26,720 --> 00:08:29,160 Speaker 2: and you're like, what is this? You know, so you're 168 00:08:29,240 --> 00:08:31,560 Speaker 2: learning what your body is doing, and then you're learning 169 00:08:31,560 --> 00:08:33,280 Speaker 2: what the baby is going to be doing when. 170 00:08:33,120 --> 00:08:33,960 Speaker 1: You have the baby. 171 00:08:34,480 --> 00:08:38,760 Speaker 2: And I had never seen anything about outside of advil. 172 00:08:38,840 --> 00:08:41,000 Speaker 2: It was like, don't take advil while you're pregnant, take 173 00:08:41,000 --> 00:08:42,720 Speaker 2: tail and all. Now I think they're saying don't take 174 00:08:42,760 --> 00:08:46,200 Speaker 2: til at all. So I at the time that was 175 00:08:46,280 --> 00:08:48,520 Speaker 2: the only thing I had ever seen. And so I 176 00:08:48,600 --> 00:08:51,720 Speaker 2: was listening to this and I'm like, wow, that is 177 00:08:51,840 --> 00:08:56,360 Speaker 2: extremely powerful and such a great opportunity for because there 178 00:08:56,440 --> 00:09:00,360 Speaker 2: is such a massive consumption of consumption of information at 179 00:09:00,400 --> 00:09:01,479 Speaker 2: that time with parent. 180 00:09:01,240 --> 00:09:03,280 Speaker 1: Magazines and parent websites, and. 181 00:09:03,240 --> 00:09:05,120 Speaker 2: You have the you know, every week you get an 182 00:09:05,120 --> 00:09:07,080 Speaker 2: email this is what's happening in your body, and this 183 00:09:07,160 --> 00:09:10,160 Speaker 2: is what's happening in the baby's body. Wow, that's there 184 00:09:10,160 --> 00:09:12,920 Speaker 2: are so many resources to get this information to moms. 185 00:09:12,920 --> 00:09:15,440 Speaker 2: So I'm excited to see that it's starting to happen. 186 00:09:16,679 --> 00:09:19,160 Speaker 3: Yeah. Absolutely, And I agree with you. 187 00:09:19,200 --> 00:09:21,840 Speaker 4: And I mean, I think women are very much when 188 00:09:21,880 --> 00:09:24,360 Speaker 4: when they become pregnant, they really want to do everything 189 00:09:24,400 --> 00:09:27,320 Speaker 4: they can to have a healthy baby. And I remember 190 00:09:27,360 --> 00:09:30,600 Speaker 4: too when when I think we both have four children, 191 00:09:30,960 --> 00:09:32,280 Speaker 4: and I if I. 192 00:09:32,280 --> 00:09:34,080 Speaker 3: Read correctly, yes, yes I do. 193 00:09:34,120 --> 00:09:37,440 Speaker 4: We can relate all the two of minor step children. 194 00:09:37,440 --> 00:09:40,160 Speaker 4: But but I will say I could definitely relate to that. 195 00:09:40,280 --> 00:09:42,760 Speaker 4: You know that all women really want to do the 196 00:09:42,800 --> 00:09:45,840 Speaker 4: best with their pregnancy so that they have healthy children. 197 00:09:46,000 --> 00:09:48,440 Speaker 4: And you know, I remember reading all sorts of things 198 00:09:48,440 --> 00:09:50,600 Speaker 4: like you don't want to be exposed to too much heat, 199 00:09:50,760 --> 00:09:52,840 Speaker 4: you know, you want to watch your mercury intake, you 200 00:09:52,840 --> 00:09:55,480 Speaker 4: don't want to clean the litter box. And now it's 201 00:09:55,559 --> 00:09:59,040 Speaker 4: like we have all of these medications, our society is 202 00:09:59,080 --> 00:10:05,839 Speaker 4: so highly metic CAD and vaccine recommendations, the different medications 203 00:10:05,840 --> 00:10:08,080 Speaker 4: that women may be on for different purposes when they 204 00:10:08,200 --> 00:10:11,280 Speaker 4: become pregnant, and it's like we have a different standard. 205 00:10:11,280 --> 00:10:14,720 Speaker 4: We're not asking those same questions as we were about 206 00:10:14,760 --> 00:10:17,640 Speaker 4: like changing the litter box, and like, you know, should 207 00:10:17,640 --> 00:10:19,600 Speaker 4: I be out in the heat for a prolonged period 208 00:10:19,679 --> 00:10:21,160 Speaker 4: of time, and you know, how much. 209 00:10:21,360 --> 00:10:22,360 Speaker 3: Coffee should I drink? 210 00:10:22,440 --> 00:10:24,439 Speaker 4: And it's like, why do we have a different standard 211 00:10:24,440 --> 00:10:27,520 Speaker 4: for pharmaceutical products, Like we really should be looking into 212 00:10:27,559 --> 00:10:28,640 Speaker 4: the safety. 213 00:10:29,720 --> 00:10:32,720 Speaker 3: Of these, you know, medications. 214 00:10:32,080 --> 00:10:35,240 Speaker 4: And vaccines that women take during pregnancy, and so I 215 00:10:35,280 --> 00:10:37,320 Speaker 4: hope that we can move the needle on that issue 216 00:10:37,320 --> 00:10:38,800 Speaker 4: so women are better informed. 217 00:10:39,040 --> 00:10:41,880 Speaker 2: So I think historically it has been that we have 218 00:10:42,120 --> 00:10:45,440 Speaker 2: anything medical, we have believed, Okay, this isn't a bubble, 219 00:10:45,440 --> 00:10:48,080 Speaker 2: that is not our expertise, and someone's telling us it's okay, 220 00:10:48,240 --> 00:10:50,200 Speaker 2: and therefore I won't research it anymore. 221 00:10:50,559 --> 00:10:52,720 Speaker 1: And generally that's not the stuff out there. 222 00:10:52,760 --> 00:10:54,880 Speaker 2: But you're right, it's like don't eat sushi and don't 223 00:10:54,880 --> 00:10:57,200 Speaker 2: eat this and take this supplement, and for some reason 224 00:10:57,400 --> 00:11:00,200 Speaker 2: we believe all of that. But now even more so, 225 00:11:00,640 --> 00:11:03,640 Speaker 2: you have a lot of influence on social media, and 226 00:11:03,720 --> 00:11:05,720 Speaker 2: some of that is good, in some of that is bad. 227 00:11:05,760 --> 00:11:08,400 Speaker 2: I mean, I remember being young and it was like, 228 00:11:08,600 --> 00:11:09,920 Speaker 2: do not ever eat an egg. 229 00:11:10,080 --> 00:11:10,959 Speaker 1: An egg is going to. 230 00:11:10,880 --> 00:11:14,200 Speaker 2: Give you high cholesterol to disaster, and then suddenly that 231 00:11:14,400 --> 00:11:18,079 Speaker 2: all change. And that's kind of so with that being said, 232 00:11:18,360 --> 00:11:20,960 Speaker 2: I feel like that's sort of been hormone therapy for 233 00:11:21,040 --> 00:11:23,240 Speaker 2: women too, if we go to menopausal women, so we 234 00:11:23,280 --> 00:11:25,960 Speaker 2: go from childbirth to menopausea and it's like my life 235 00:11:26,040 --> 00:11:29,439 Speaker 2: journey here if we do that. But you talk about 236 00:11:29,480 --> 00:11:32,200 Speaker 2: hormone therapy, and I think hormone therapy got a really 237 00:11:32,200 --> 00:11:35,240 Speaker 2: bad rap. But then I saw doctor McCarey saying, actually, 238 00:11:35,240 --> 00:11:37,360 Speaker 2: we're finding out that if you don't have it, you're 239 00:11:37,679 --> 00:11:38,679 Speaker 2: at a higher risk. 240 00:11:38,559 --> 00:11:39,360 Speaker 1: Of heart disease. 241 00:11:40,960 --> 00:11:41,240 Speaker 3: Right. 242 00:11:41,400 --> 00:11:44,400 Speaker 4: So this is such an interesting contrast because it's like, 243 00:11:44,480 --> 00:11:47,080 Speaker 4: on the one hand, you want people to be informed 244 00:11:47,120 --> 00:11:50,400 Speaker 4: about the harms and potential harms of you know, medications 245 00:11:50,480 --> 00:11:55,320 Speaker 4: and in this case, you know, hormone replacement, but you 246 00:11:55,360 --> 00:11:58,679 Speaker 4: also don't want to inappropriately scare people. And so that's 247 00:11:58,679 --> 00:12:03,760 Speaker 4: where the hormone replacement therapy conversation UH fell into that category. 248 00:12:03,840 --> 00:12:08,640 Speaker 4: And and so actually doctor McCarey's book Blind Spots, which 249 00:12:08,640 --> 00:12:12,520 Speaker 4: if anyone hasn't read it is wonderful really I think 250 00:12:12,600 --> 00:12:16,280 Speaker 4: opened a lot of people's eyes to sort of the 251 00:12:17,120 --> 00:12:21,040 Speaker 4: dogma around hormone replacement therapy and how women have really 252 00:12:21,080 --> 00:12:26,680 Speaker 4: been misled about the risks about UH for for cancer, 253 00:12:27,080 --> 00:12:28,640 Speaker 4: for cardiovascular disease. 254 00:12:28,960 --> 00:12:30,400 Speaker 3: And he goes through the evidence there. 255 00:12:30,480 --> 00:12:33,520 Speaker 4: And then we also had this expert roundtable recently about 256 00:12:33,520 --> 00:12:38,720 Speaker 4: hormone replacement therapy where the experts really went through the 257 00:12:38,800 --> 00:12:42,400 Speaker 4: data and discussed that if you start hormone replacement therapy 258 00:12:42,440 --> 00:12:46,880 Speaker 4: within the first ten years of menopause, that really, you know, 259 00:12:46,960 --> 00:12:50,000 Speaker 4: what we're seeing in the studies is we're seeing benefits, 260 00:12:50,640 --> 00:12:55,160 Speaker 4: especially related to taking estrogen in terms of cardiovascular disease, 261 00:12:55,280 --> 00:12:59,600 Speaker 4: all cause mortality and and and and that the increase 262 00:12:59,640 --> 00:13:01,920 Speaker 4: in breast cancer that we saw it, you know, that 263 00:13:01,960 --> 00:13:04,880 Speaker 4: doesn't that doesn't pan out. If it didn't, it never 264 00:13:04,920 --> 00:13:10,800 Speaker 4: translated to increase in cancer mortality risk, and it we 265 00:13:10,880 --> 00:13:15,120 Speaker 4: don't see that when when women take estrogen alone or 266 00:13:15,160 --> 00:13:18,840 Speaker 4: if they started early in the first ten years after menopause. 267 00:13:19,200 --> 00:13:21,160 Speaker 4: And so I think you know, women had a lot 268 00:13:21,160 --> 00:13:25,480 Speaker 4: of questions answered about that. They were more reassured that 269 00:13:25,640 --> 00:13:29,000 Speaker 4: if you know you're experiencing symptoms of menopause, that you 270 00:13:29,040 --> 00:13:31,880 Speaker 4: know it may be a net benefit for youse an 271 00:13:31,880 --> 00:13:35,360 Speaker 4: individual to take the hormone replacement therapy. Some of the 272 00:13:35,440 --> 00:13:39,079 Speaker 4: data is showing benefits in terms of cardiovascular disease and 273 00:13:39,120 --> 00:13:43,080 Speaker 4: all and reducing all cause mortality and also bone health 274 00:13:43,200 --> 00:13:47,360 Speaker 4: and I was glad that we got into testosterone as well, 275 00:13:47,400 --> 00:13:49,160 Speaker 4: and I know it came up that we really need 276 00:13:49,160 --> 00:13:53,680 Speaker 4: some sort of a testosterone preparation for for for women too, 277 00:13:54,760 --> 00:13:57,040 Speaker 4: that that kind of was brought into the conversation with 278 00:13:57,120 --> 00:13:58,880 Speaker 4: hormone replacement therapy. 279 00:13:59,000 --> 00:14:02,120 Speaker 1: What do you mean back because women are are low and. 280 00:14:02,600 --> 00:14:05,880 Speaker 4: So yeah, so for women at the testosterone level also 281 00:14:06,559 --> 00:14:12,520 Speaker 4: decreases with age, and so that that wasn't covered in 282 00:14:12,600 --> 00:14:15,120 Speaker 4: depth during the panel, but I think that's something that 283 00:14:15,160 --> 00:14:18,480 Speaker 4: we there should be ongoing discussions about as well, and 284 00:14:18,559 --> 00:14:23,080 Speaker 4: also in terms of bone health and osteoporosis in women. 285 00:14:23,440 --> 00:14:26,200 Speaker 2: Let's take a quick commercial break. We'll continue next on 286 00:14:26,240 --> 00:14:32,920 Speaker 2: a Tutor Dixon podcast. So I will say, I don't 287 00:14:32,920 --> 00:14:35,920 Speaker 2: know if I have different types of doctor's appointments because 288 00:14:35,960 --> 00:14:38,840 Speaker 2: I am a breast cancer survivor, and so every time 289 00:14:38,920 --> 00:14:41,240 Speaker 2: I go to my appointment, they're like, oh, there's nothing 290 00:14:41,240 --> 00:14:45,200 Speaker 2: we can do for you. You have I have hormone 291 00:14:45,240 --> 00:14:48,640 Speaker 2: receptive cancer, so or we can't do anything for you. 292 00:14:49,240 --> 00:14:52,440 Speaker 2: But I wonder like, is it going to be common 293 00:14:52,480 --> 00:14:56,240 Speaker 2: for women to have their hormones tested? I mean, is 294 00:14:56,280 --> 00:14:59,360 Speaker 2: that something Maybe it's already been done and they just 295 00:14:59,480 --> 00:15:00,800 Speaker 2: don't do that for for me, I don't know. 296 00:15:00,920 --> 00:15:02,240 Speaker 1: I'm just curious about that. 297 00:15:03,400 --> 00:15:05,000 Speaker 3: I mean, that's that's a good question. 298 00:15:05,160 --> 00:15:07,480 Speaker 4: And you know, there are a lot of providers who 299 00:15:07,560 --> 00:15:12,200 Speaker 4: are now getting certified in hormone replacement therapy, and I 300 00:15:12,240 --> 00:15:15,920 Speaker 4: think that women should really, you know, try to seek 301 00:15:15,960 --> 00:15:20,920 Speaker 4: out physicians who have a specific certification in this specialty 302 00:15:21,120 --> 00:15:23,400 Speaker 4: so that they get the best advice and not always 303 00:15:23,440 --> 00:15:26,960 Speaker 4: settle for you know, there's nothing we can do because 304 00:15:27,000 --> 00:15:30,720 Speaker 4: I don't you know, I'm a practicing physician myself, and 305 00:15:30,760 --> 00:15:33,400 Speaker 4: I know I always try to avoid saying that. It's like, 306 00:15:33,720 --> 00:15:35,960 Speaker 4: you know, either I'm gonna try I would try to 307 00:15:36,000 --> 00:15:38,000 Speaker 4: find the information or I'm going to send you to 308 00:15:38,040 --> 00:15:40,080 Speaker 4: someone who I know can get you the information. 309 00:15:40,200 --> 00:15:41,960 Speaker 3: So there is at least so we at least have. 310 00:15:41,960 --> 00:15:44,880 Speaker 4: Things we can try and look into to help you, 311 00:15:44,880 --> 00:15:47,000 Speaker 4: you know, to help people with their symptoms. 312 00:15:47,880 --> 00:15:52,280 Speaker 2: I mean that is interesting because I feel like maybe 313 00:15:52,320 --> 00:15:54,920 Speaker 2: I have fallen back into I told myself I would 314 00:15:54,920 --> 00:15:57,520 Speaker 2: never fall into the trap of taking the first bit 315 00:15:57,560 --> 00:15:59,160 Speaker 2: of information from a doctor if. 316 00:15:59,000 --> 00:16:01,640 Speaker 1: It didn't sound like it was the best possible. 317 00:16:01,680 --> 00:16:04,640 Speaker 2: Because when I did have cancer, I went to multiple 318 00:16:04,640 --> 00:16:08,080 Speaker 2: different places ultimately ended up at Johns Hopkins with actually 319 00:16:08,360 --> 00:16:11,120 Speaker 2: a friend of doctor McCarey, so it was and I had. 320 00:16:11,000 --> 00:16:12,960 Speaker 1: A great experience there. 321 00:16:13,160 --> 00:16:14,880 Speaker 2: I mean as great as you can have when you 322 00:16:14,880 --> 00:16:18,200 Speaker 2: have cancer, but you know, you want to have good healthcare, and. 323 00:16:18,040 --> 00:16:19,400 Speaker 1: I had great doctors. 324 00:16:19,880 --> 00:16:23,600 Speaker 2: But now you make such a great point because I'm thinking, gosh, 325 00:16:23,600 --> 00:16:26,760 Speaker 2: you know, I did go into just my general practitioner 326 00:16:26,800 --> 00:16:30,200 Speaker 2: and they were literally like, hey, there's nothing you can do. 327 00:16:30,360 --> 00:16:30,960 Speaker 1: You can go on. 328 00:16:30,920 --> 00:16:34,480 Speaker 2: An SRSRI, and I was like, that's that's not for me. 329 00:16:34,680 --> 00:16:36,440 Speaker 2: I'm not going to do that. So there's nothing I 330 00:16:36,480 --> 00:16:39,160 Speaker 2: could do. But I didn't look any further, and now 331 00:16:39,160 --> 00:16:40,440 Speaker 2: I'm like shaming myself. 332 00:16:41,000 --> 00:16:44,120 Speaker 4: Well, you shouldn't shame yourself or feel guilty. But that's 333 00:16:44,120 --> 00:16:46,360 Speaker 4: so interesting because obviously that didn't get to the root 334 00:16:46,440 --> 00:16:48,680 Speaker 4: cause of the problem, which is also one of the 335 00:16:48,680 --> 00:16:52,160 Speaker 4: things we're really interested at the FDA is root causes 336 00:16:52,240 --> 00:16:56,000 Speaker 4: of health problems, and prescribing an SSRI for a problem 337 00:16:56,040 --> 00:17:00,320 Speaker 4: that's related to you know, hormones and that could be 338 00:17:00,400 --> 00:17:04,040 Speaker 4: addressed with hormone replacement therapy. It's really a shame that 339 00:17:04,080 --> 00:17:06,720 Speaker 4: we default to something that sort of masks the symptoms 340 00:17:06,800 --> 00:17:08,920 Speaker 4: rather than trying to solve the problem. 341 00:17:08,960 --> 00:17:12,359 Speaker 1: Do you think that that happens too often? And how 342 00:17:12,400 --> 00:17:13,399 Speaker 1: can that be changed? 343 00:17:13,400 --> 00:17:16,280 Speaker 2: Because I'm looking at again on your twitter feed, I 344 00:17:16,280 --> 00:17:19,199 Speaker 2: think I saw that one in five people is on 345 00:17:19,280 --> 00:17:23,440 Speaker 2: an SSRI in the country, and it seems like, gosh, 346 00:17:23,520 --> 00:17:27,160 Speaker 2: it's like such a massive push to get you on something, 347 00:17:27,240 --> 00:17:29,520 Speaker 2: and this is like, oh, this has nothing to do 348 00:17:29,640 --> 00:17:30,480 Speaker 2: with this is. 349 00:17:30,480 --> 00:17:32,520 Speaker 1: The effects of like hot flashes. 350 00:17:32,560 --> 00:17:34,840 Speaker 2: This will change that put that will put you on 351 00:17:34,880 --> 00:17:37,040 Speaker 2: an SSRI, And I'm like, I don't want to be 352 00:17:37,080 --> 00:17:40,440 Speaker 2: on a massive antidepressant for something that I'm like, I'll 353 00:17:40,480 --> 00:17:42,719 Speaker 2: just take a layer of clothing off, you know, Like 354 00:17:42,800 --> 00:17:47,280 Speaker 2: this is it seems crazy to think that it's immediately 355 00:17:47,280 --> 00:17:49,800 Speaker 2: pushed and in the past I would have just been like, oh, great, 356 00:17:49,800 --> 00:17:52,040 Speaker 2: a medication that will fix this, Yes, I want that. 357 00:17:52,080 --> 00:17:54,240 Speaker 2: And I think too often we think that there is 358 00:17:54,280 --> 00:17:58,040 Speaker 2: a quick fix and people are just going on a 359 00:17:58,080 --> 00:17:59,280 Speaker 2: massive amount of medication. 360 00:17:59,400 --> 00:18:01,040 Speaker 1: Are we over dedicated as a country? 361 00:18:02,119 --> 00:18:04,760 Speaker 4: Yeah, I mean absolutely. I mean I do think that 362 00:18:04,960 --> 00:18:08,280 Speaker 4: there are so many examples of medications, SSRIs being one 363 00:18:08,280 --> 00:18:10,040 Speaker 4: of them where it really. 364 00:18:09,840 --> 00:18:11,879 Speaker 3: Isn't the fix to the problem. 365 00:18:12,000 --> 00:18:14,720 Speaker 4: And I think, you know it, it may help with 366 00:18:14,840 --> 00:18:17,720 Speaker 4: symptoms but the issue is that, you know, we have 367 00:18:17,880 --> 00:18:22,520 Speaker 4: been told the medical profession and the public alike that 368 00:18:22,680 --> 00:18:26,360 Speaker 4: there's some sort of a serotonin deficiency or some sort. 369 00:18:26,200 --> 00:18:27,679 Speaker 3: Of imbalance in the brain. 370 00:18:28,200 --> 00:18:31,280 Speaker 4: That means the SSRIs are what's going to solve the problem. 371 00:18:31,320 --> 00:18:35,040 Speaker 4: But one of the expert panelists and now it's actually 372 00:18:35,200 --> 00:18:38,480 Speaker 4: she knows very much about this, has published a lot 373 00:18:38,480 --> 00:18:42,080 Speaker 4: about this, doctor Moncrief, But and it's really been exposed 374 00:18:42,119 --> 00:18:44,440 Speaker 4: over time that that's not the case, that there's not 375 00:18:44,680 --> 00:18:48,080 Speaker 4: actually a serotonin chemical and balance in the brain. And 376 00:18:48,119 --> 00:18:51,119 Speaker 4: really what the medications SSRIs are doing is sort of 377 00:18:51,480 --> 00:18:54,000 Speaker 4: you know, dulling you know, the way you feel and 378 00:18:54,119 --> 00:18:57,159 Speaker 4: masking the symptoms but not getting to the root caused 379 00:18:57,200 --> 00:18:59,800 Speaker 4: the problem, which as you pointed out, it may be 380 00:18:59,880 --> 00:19:02,800 Speaker 4: the you're going through menopause and hormones are changing and 381 00:19:02,840 --> 00:19:06,120 Speaker 4: maybe you know any number of things, like there are 382 00:19:06,320 --> 00:19:10,080 Speaker 4: many different causes of depression and really getting you know, 383 00:19:10,119 --> 00:19:13,159 Speaker 4: going back full circle, it's it's really important to have 384 00:19:13,280 --> 00:19:16,159 Speaker 4: that conversation and and and get to the cause, the 385 00:19:16,200 --> 00:19:20,120 Speaker 4: cause of the depression and try and treat that rather 386 00:19:20,200 --> 00:19:23,440 Speaker 4: than rather than masking it with the medication. But but yes, 387 00:19:23,600 --> 00:19:27,600 Speaker 4: I absolutely think that we as a society are over medicated. 388 00:19:27,600 --> 00:19:30,880 Speaker 4: And as someone I used to practice medicine in Denmark 389 00:19:30,880 --> 00:19:34,880 Speaker 4: and I'm a dual citizen Danish American, and it's it's 390 00:19:34,920 --> 00:19:37,840 Speaker 4: a very different approach to medicine there, which has given 391 00:19:37,880 --> 00:19:41,840 Speaker 4: me an interesting perspective because they do not default to 392 00:19:41,920 --> 00:19:44,919 Speaker 4: medications to solve problems like we do in the United States. 393 00:19:44,920 --> 00:19:46,880 Speaker 3: And I don't know if that's you know. 394 00:19:47,480 --> 00:19:49,840 Speaker 4: The result of sort of the pressure of the pharmaceutical 395 00:19:49,840 --> 00:19:54,040 Speaker 4: industry direct you direct to consumer advertising. But there's something 396 00:19:54,200 --> 00:19:57,679 Speaker 4: very different in our society that we we tend to 397 00:19:57,800 --> 00:20:02,359 Speaker 4: look to medical solution in surgeries, drugs, you know, first, 398 00:20:02,480 --> 00:20:04,760 Speaker 4: rather than you know, finding out how can I solve 399 00:20:04,800 --> 00:20:07,720 Speaker 4: this through what I do, the way I live and 400 00:20:08,440 --> 00:20:10,000 Speaker 4: alternative sorts of treatments. 401 00:20:10,440 --> 00:20:12,879 Speaker 2: You know, I've I have had many people in my 402 00:20:12,960 --> 00:20:15,520 Speaker 2: life and I don't know if this is something that 403 00:20:15,640 --> 00:20:19,879 Speaker 2: is like Michigan based or what, but in the medical 404 00:20:19,920 --> 00:20:22,680 Speaker 2: system here, for you to go to a therapist, the 405 00:20:22,680 --> 00:20:28,320 Speaker 2: therapist almost so a psychologist they almost always say well 406 00:20:28,440 --> 00:20:31,879 Speaker 2: you need to be prescribed something, and then you have 407 00:20:31,960 --> 00:20:34,840 Speaker 2: to go to the psychiatrists. And so you have it's 408 00:20:34,880 --> 00:20:37,439 Speaker 2: like a schedule. You go to the psychiatrist once a 409 00:20:37,440 --> 00:20:39,560 Speaker 2: month you have, but then you have to have the 410 00:20:39,600 --> 00:20:44,280 Speaker 2: two appointments with the psychologist for the psychiatrists to prescribe. 411 00:20:44,359 --> 00:20:46,679 Speaker 2: It's like this, that's how the system works. So you 412 00:20:46,880 --> 00:20:50,320 Speaker 2: have to pay for three appointments every month because you 413 00:20:50,400 --> 00:20:52,360 Speaker 2: have to see both of these people. 414 00:20:52,480 --> 00:20:54,240 Speaker 1: And then you have the prescription. 415 00:20:54,400 --> 00:20:58,040 Speaker 2: And it almost seems like there's it's like when you heard, oh, 416 00:20:58,119 --> 00:21:03,040 Speaker 2: dentists have a a number a quota they have to 417 00:21:03,040 --> 00:21:05,119 Speaker 2: get for cavities, Like do you have a quota of 418 00:21:05,240 --> 00:21:07,639 Speaker 2: patients you have to have that are on a medication. 419 00:21:08,040 --> 00:21:09,200 Speaker 1: But I really do think. 420 00:21:09,000 --> 00:21:12,080 Speaker 2: There's such a push for medication, And I think what 421 00:21:12,119 --> 00:21:14,520 Speaker 2: you said is interesting because I think probably most of 422 00:21:14,520 --> 00:21:17,440 Speaker 2: the people that are listening who have had a loved 423 00:21:17,440 --> 00:21:20,720 Speaker 2: one who has gone on one of these medications, has 424 00:21:20,720 --> 00:21:25,080 Speaker 2: seen that where they may see that there is less depression, 425 00:21:25,320 --> 00:21:27,800 Speaker 2: there is less feeling overall, and that can be really 426 00:21:27,840 --> 00:21:30,600 Speaker 2: hard for the person around that, the people around them. 427 00:21:30,960 --> 00:21:31,640 Speaker 3: Yeah. 428 00:21:31,680 --> 00:21:37,600 Speaker 4: Absolutely, and so I do think that it's also just 429 00:21:38,880 --> 00:21:41,640 Speaker 4: you know, in the United States, it's there's a very 430 00:21:41,680 --> 00:21:44,280 Speaker 4: limited amount of time that doctors have with patients, Like 431 00:21:44,320 --> 00:21:47,720 Speaker 4: the visits are also very quick, and prescribing a medication 432 00:21:48,440 --> 00:21:53,200 Speaker 4: is really sometimes the easiest thing to do rather than saying, okay, 433 00:21:53,280 --> 00:21:56,159 Speaker 4: so let's go through this, what's going on, Let's go 434 00:21:56,240 --> 00:21:58,919 Speaker 4: through all the medications you're taking. Let's go through like 435 00:21:59,000 --> 00:22:01,880 Speaker 4: your overall health and how things are going at home, 436 00:22:01,960 --> 00:22:04,359 Speaker 4: what do you enjoy doing? You know, these sort of 437 00:22:04,680 --> 00:22:07,600 Speaker 4: background questions that can give insight into you know, what, 438 00:22:07,600 --> 00:22:10,240 Speaker 4: what might be the cause of the depression, Like you know, 439 00:22:10,320 --> 00:22:13,720 Speaker 4: it may even be another medication that they're on, and 440 00:22:13,800 --> 00:22:18,640 Speaker 4: so you know, it's I think, you know, if there's 441 00:22:18,680 --> 00:22:20,440 Speaker 4: one I would I would really love to see a 442 00:22:20,520 --> 00:22:23,479 Speaker 4: shift in our society to focusing you know, you know, 443 00:22:23,680 --> 00:22:28,000 Speaker 4: more on the root causes of the problems and less 444 00:22:28,080 --> 00:22:30,520 Speaker 4: on seeing medications as a quick fix. 445 00:22:30,600 --> 00:22:32,080 Speaker 3: And and and. 446 00:22:32,200 --> 00:22:35,920 Speaker 4: I think that this current FDA, you know that that's 447 00:22:35,920 --> 00:22:39,200 Speaker 4: something that we're prioritizing, which I which is really cool 448 00:22:39,200 --> 00:22:43,200 Speaker 4: because it's different than in the past, but also really 449 00:22:43,240 --> 00:22:47,160 Speaker 4: focusing on, you know, how to get effective cures quickly 450 00:22:47,320 --> 00:22:51,800 Speaker 4: to patients with serious diseases, especially where there's unmet needs. 451 00:22:51,840 --> 00:22:53,960 Speaker 4: So it's like, you know, there has to be a 452 00:22:54,000 --> 00:22:57,320 Speaker 4: balance of the two things. But over medicating and not 453 00:22:57,400 --> 00:23:01,320 Speaker 4: getting to the root cause of problems of common problems 454 00:23:01,400 --> 00:23:04,200 Speaker 4: is certainly not the answer that we're looking for. 455 00:23:04,720 --> 00:23:08,080 Speaker 2: This has been honestly, I've so enjoyed talking to you, 456 00:23:08,119 --> 00:23:10,400 Speaker 2: and I think this is the beauty of what we 457 00:23:10,480 --> 00:23:14,800 Speaker 2: see with the Maha movement and with this administration in general, 458 00:23:14,840 --> 00:23:17,400 Speaker 2: I think there's a lot more freedom to have these discussions. 459 00:23:17,440 --> 00:23:19,880 Speaker 2: I know a lot of people we've had some experts 460 00:23:19,880 --> 00:23:22,280 Speaker 2: on who have even said they want to do some 461 00:23:22,320 --> 00:23:26,000 Speaker 2: studies on how these medications are affecting teens and if 462 00:23:26,040 --> 00:23:29,800 Speaker 2: they have been involved in any of these mass shootings 463 00:23:29,840 --> 00:23:33,600 Speaker 2: where teens suddenly, for some reason, something trips in their 464 00:23:33,600 --> 00:23:35,480 Speaker 2: brain and they decide that they're going to go in 465 00:23:35,520 --> 00:23:38,600 Speaker 2: and shoot up a school, And is there a way 466 00:23:38,680 --> 00:23:40,879 Speaker 2: to research that? And I think that so many of 467 00:23:40,960 --> 00:23:45,600 Speaker 2: us feel like we've been screaming into a vacuum for 468 00:23:45,640 --> 00:23:48,560 Speaker 2: so long that there's nobody just a black hole, and 469 00:23:48,640 --> 00:23:51,359 Speaker 2: it is a breath of fresh air to have you 470 00:23:51,440 --> 00:23:53,919 Speaker 2: all in there and focused on this. Thank you for 471 00:23:53,960 --> 00:23:56,120 Speaker 2: coming on and talking to us, Thank you for being 472 00:23:56,160 --> 00:23:59,119 Speaker 2: willing to share this with the public here. And I 473 00:23:59,160 --> 00:24:02,320 Speaker 2: think these are the omens where we continue to engage 474 00:24:02,320 --> 00:24:05,639 Speaker 2: with the public and educate and say I like you 475 00:24:05,760 --> 00:24:08,760 Speaker 2: reminded me you don't always have to take that first 476 00:24:08,800 --> 00:24:11,720 Speaker 2: bit of advice from a medical professional. You can you 477 00:24:11,800 --> 00:24:14,120 Speaker 2: are in the United States of America. You can go 478 00:24:14,160 --> 00:24:16,560 Speaker 2: ask someone else, that's right. 479 00:24:17,160 --> 00:24:19,120 Speaker 3: Thank you so much for having me on. 480 00:24:19,280 --> 00:24:23,520 Speaker 4: I really enjoyed this discussion as well, so thank you 481 00:24:23,600 --> 00:24:26,080 Speaker 4: for asking these very excellent questions. 482 00:24:26,600 --> 00:24:29,679 Speaker 2: Well, you know, it's interesting when you're going through some 483 00:24:29,800 --> 00:24:31,560 Speaker 2: of these things on your own, you know, and you're like, 484 00:24:31,640 --> 00:24:34,960 Speaker 2: if I'm doing it, most people other people are dealing 485 00:24:34,960 --> 00:24:37,880 Speaker 2: with this and they need to hear so Doctor Tracy 486 00:24:37,920 --> 00:24:40,160 Speaker 2: Beth Hogue, thank you so much for being here. 487 00:24:40,600 --> 00:24:42,640 Speaker 1: Thank you Tutor absolutely, and. 488 00:24:42,600 --> 00:24:45,480 Speaker 2: Thank you all for joining us on the Tutor Dixon podcast. 489 00:24:45,520 --> 00:24:46,680 Speaker 1: For this episode and others. 490 00:24:46,720 --> 00:24:49,159 Speaker 2: You can go to the iHeartRadio app, Apple Podcasts, or 491 00:24:49,200 --> 00:24:52,200 Speaker 2: wherever you get your podcasts, or watch it on Rumble 492 00:24:52,320 --> 00:24:53,719 Speaker 2: or YouTube at Tutor Dixon. 493 00:24:54,119 --> 00:24:56,000 Speaker 1: Thank you so much and have a blessed day.