We all want to walk out of the doctor’s office with something that we believe is going to make us better. But it’s critically important to make sure that whatever you are opting in for – whether it’s a pill, a procedure, or some other product – you are making that decision with eyes wide open and asking the important questions. On today’s show: the “retailization” of healthcare, and how to be an informed consumer.
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We have that desire to walk out of the doctor’s office with a pill or a potion that we believe is going to make us better. And that’s often the first mistake.
On today’s show, we’re talking about the “retailization” of medicine. And I’m so glad to have Janet Jumper, nurse practitioner back in the Gutbliss studio with me.
Thank you for having me again. I’m so glad to be here.
Always great to have you. So this is something that Janet and I talk about offline a lot, which is this idea of medicine as a product. And to put it a little bit in perspective, I’ve been a gastroenterologist for around 30 years. Janet, you’ve been a nurse for about 30, a nurse practitioner for about 20. And we’ve worked in a bunch of different settings. We’ve worked in the hospital, we’ve worked in outpatient settings. I’ve worked in private practice. We’ve both participated in research. So we have a pretty, I think, well-informed view of the practice of medicine, but we also have our opinions, and that’s what we’re gonna share with you today. It’s something that I’ve noticed particularly in gastroenterology, this idea of gut health as a product that you buy. And it often begins with a test, and the reality is a lot of this testing that’s being done – my favorite way to put it when people ask me is to say, yeah, that’s actually not worth the paper it’s printed on. That may be a little bit of an extreme view, but a lot of the testing is really just a portal to a product. So the test shows, oh, everything’s wrong: your amino acids and all these various things are all off and here’s a product that can fix it. So let’s talk a little bit about the testing first.
Testing is a big thing. And I’ve experienced this too in my own gut health journey. You go down wormholes and try to find different fixes. And you and I have talked about this over time. And what I keep coming back to is that the fix is really the stuff we already know. So when you get these tests, whether it’s microbiome mapping or it’s certain types of digestive enzymes that you do or don’t have, you’re really looking for an answer to a problem that you really already know the answer to. So I don’t know what your thoughts are about that.
No, I feel the same way. And full disclosure here, I like gadgets. For example, in my podcast studio, it’s always like, oh, here’s a new mic and look at this new mixer. So I’m not anti-tech. I love tech, I love gadgets, but with certain things, like in my kitchen, I will often use a hand spiralizer over some big machine that’s gonna spiralize zucchini noodles, because I’m like, okay, this little $10 spiralizer is gonna do a good job. So that is a full disclosure. I really find that people sometimes are using the testing to validate something that they’re looking for. It is an answer and often they already know the answer, but they’re looking to say, oh, it’s this problem and I just need to take this product and then I’ll be fixed. And I find that that is rarely the case. It is rarely, if ever the case, that somebody is just missing this digestive enzyme, you know, for really no good reason, and they’re going to purchase the digestive enzyme and they’re going to be better. Right. That is, it is a sort of reductive way of thinking about it that is usually does not lead to the right solution.
And when we talk about processing, even in ultra processed foods, and then taking it back to the processing of some of these supplements that we’re talking about, I think what we we believe that someone somewhere has ideologically created these supplements and everyone has good intentions. I’m not casting any dispersions on that, but it’s still a processed product. To get butyrate, for instance, is a processed product. To get some sort of digestive pancreatic enzyme, that’s getting pulled from an animal usually or it’s created in a lab. So then what are we trading off for? Are we wanting to rely on our body’s natural processes to try to work something out or are we looking for a generated either lab or otherwise generated product?
Yeah a butyrate supplement is definitely not the same thing as eating fiber and that fiber getting fermented by gut bacteria into a short-chain fatty acid of which butyric acid, butyrate is one of them. We don’t have any clinical evidence that taking a butyrate capsule and bypassing the fiber and the fermentation, etc. is having the same effect or quite frankly, any effect. But if we think back to, or if we think about the word supplement, it’s supposed to be something that is an adjunct to what you’re already doing. And I think what I’m seeing, because I definitely, I mean, neither of us are anti-supplement, that’s for sure. There are plenty of supplements I use in my practice. I recommend psyllium husk for people who are constipated or have diverticulosis all the time. Acacia fiber, if you can’t tolerate psyllium. Magnesium, fantastic for constipation and several other things. And in people who actually have pancreatic insufficiency, enzymes like Creon, which is usually a mixture of amylase and lipase are essential. But the problem is 99% of the people who I’m seeing who have been told they have pancreatic insufficiency based on an unvalidated inaccurate test actually don’t. And so they’re taking these enzymes thinking it’s going to cure this problem that they actually don’t have because that’s not the problem they have. The problem they have can be one of a variety of different things, but it’s not pancreatic insufficiency. So we’re medicalizing states that are not really diseases. And then we’re retailizing the process: you just have to buy this thing. So again, it’s not that pancreatic enzymes aren’t helpful. They are fantastically helpful if you actually have pancreatic insufficiency, but that’s an unusual and sort of rare disorder, right? Certainly if you’ve had a pancreatectomy, part of your pancreas surgically removed, if you have chronic pancreatitis and have had multiple episodes and there are a few other conditions that can lead to real pancreatic insufficiency, but we’re seeing a lot of over-diagnosing with the tests.
And when we get back to the retailization piece of it, and the marketing is so heavily amplified to us, so on social media, on the internet, popping up all the time, and the way that it’s visually brought to us or aesthetically brought to us really does make us feel like we can attain that goal with this product.
So when we come back, distinguishing between marketing and science, when we come back.
I’m talking about the retailization of medicine with my friend and colleague, Janet Jumper, nurse practitioner. And one of the things we were talking about before the break was this idea of distinguishing between marketing and science. And I just want to point out here, everybody is selling. This idea that, you know, naturopaths and functional medicine doctors and health coaches are selling, but conventional doctors are not. Totally untrue. My conventionally trained GI colleagues are selling colonoscopy. They’re selling upper endoscopy. That is a product that they are trying to convince people they need. Now, I think there’s some different checks and balances there, because for you to get your colonoscopy, the insurance company has to approve it, and they only approve certain indications. So, granted there’s some leeway with the indications, but there’s some customer indications that are going to get easy approval, like you have blood in the stool or a change in bowel habits or it’s your screening colonoscopy for colon cancer because you’re age 45 or older or because you are following up from a previous polyp. So a gastroenterologist can’t get insurance approval just, you know, hey, this person has a colon, I’d like to scope them. Not that people don’t try. So there are some checks and balances there. Whereas when we’re talking about things like the supplement industry, the OTC industry, we’re talking about a product you purchase, you don’t need anyone’s approval, there are no checks and balances in the same way.
Yeah. And I think that it gets back to the whole concept of everyone wants to have something that they walk out of the doctor’s office with or the naturopath’s office with or whoever, whomever, feeling good that they have a solution. And so there is an immediate desire, I think, on the part of anyone to sort of give an option that is medical or supplement motivated. And again, this gets back to the whole concept of if we want to really talk about our health, sitting down and having a prolonged discussion about nutritionadvice or non-supplement or non-medication driven conversations are difficult because people are, those are difficult to follow and they don’t generate revenue.
And to sort of follow through on that idea of everyone is selling, you are gonna walk out of the gastroenterologist’s office likely with a prescription for a proton pump inhibitor or recommendation. Now there, again, the difference is they are not selling you that product. They are basically writing a prescription, but they are selling the even larger ticket item product of a procedure that they are benefiting from. So I just want to make sure that nobody feels like I’m unfairly targeting functional medicine doctors.
Right. And not unfairly targeting anyone. I mean, this is really a product of the system. It’s a system breakdown issue. I don’t think that any of the people, theoretically, that we’re talking about are doing this with malintent. But we’ve gotten so far down this road of problem and fix that we don’t really understand how to back away from it. And then there’s people like you and I who are sort of banging on the door of back to basics and it sounds so radical because why would you do that? And it really does. I mean, that part of it to me is so fascinating.
Yeah. Why would you change your diet when there’s a pill for every ill? And you know, one of the sort of medical scandals last year that really appalled me, and it appalled me because personally, my mother has advanced Alzheimer’s, and I realized that in 2025, for the level of Alzheimer’s she has, there is no cure or medication. And that’s not just my opinion as a lowly gastroenterologist, that’s the opinion of the neurologist in the Alzheimer’s Clinic at Georgetown, which I respect and believe. But the medical scandal was that last year, the director at NIH, the National Institutes of Health of the Institute for Aging, who had been the director of that institute for well over a decade, and had spun off companies with medications to treat dementia, like Alzheimer’s, and I believe also Parkinson’s, it turned out that he had falsified a lot of that research. And that research had been used to create pharmaceutical products that, you know, ostensibly had been prescribed to many, many people, and also just the hope, the false hope that it probably gave people. So we are seeing, you know, I don’t know what to call it, fraud, deceptiveness, bad medicine, bad practices, greed, at every level of medicine. We’re not just talking about a gastroenterologist doing a colonoscopy that maybe you needed, maybe you didn’t. We’re talking about entire pharmaceutical industries being built on research that has been intentionally falsified to make it look like a drug works versus not. And when there are literally billions of dollars at stake, these are really difficult decisions, I think, that people make because there’s just so much money at stake.
Yeah, and so much crossover between medicine and money now that there didn’t used to be. And I don’t think that the average consumer really understands how all the motivations, real or imagined, play into the decision making that any health care provider is making on a daily basis. So whether it’s a storefront selling you a marketed supplement product or your hospital or doctor’s office that you go to who also has a retail product that they’re trying to give to you, it crosses all the lines. And so it’s really about how we figure out how to wade through that, that I think is the most important thing.
And I think it’s so important to, on the one hand, not become paranoid and think like, okay, well, everybody’s selling me stuff and none of this is good and everybody’s a shyster, but also to have a healthy dose of skepticism. And I always suggest that people ask the question – whether it is a supplement that’s being recommended, whether it is an ultrasound of your gallbladder, whether it’s brain surgery, to ask this really important question: is this absolutely necessary? Is this vitamin D supplement? Is this brain surgery? Is this ultrasound of my gallbladder, whatever it is, is it absolutely necessary? And to ask follow-up questions like, what would happen if I did not proceed with that? This is the sort of counseling I give people around antibiotics all the time, because again, I’m just a lowly butt doctor. You might be at your ENT for a sinus infection. Chances are that sinus infection could be viral or self-limited, but if the ENT wants to prescribe antibiotics or the dentist wants to prescribe antibiotics or whatever it is, I tell my patients, make sure and ask, is this absolutely necessary? Second question, what would happen if I didn’t take this? What would the natural course of this illness be? And it’s shocking how much of the time it’s like, oh yeah, no, you don’t really have to take it, I’m giving it to you just in case. Or the natural illness is, oh, this will resolve on its own. You may be sick for a day or two longer, but you’ll be fine. And so really to ask those questions, not to, we’re not trying to engender distrust of anybody in the healthcare field, but as Janet said, there is a lot of profit being made and it influences what people recommend to you.
And certainly not to go to the extreme. I mean, based on this podcast, if you have a medical diagnosis like cancer that is sad and unfortunate, we’re not telling you to go out and rub some dirt on yourself and do a dance in the woods in hopes that cures it. You know, I mean, we’re not. Please do not do that. We’re not talking about that. There’s a happy medium, but it is about navigating the tricky waters of exactly what you said. Is this necessary? What’s going to happen if I don’t take this and also sort of understanding the why behind the supplement or medication given. If the why is a significant diagnosis, then that’s important.
When we come back, the medicalization of everything. Okay, we’re back talking about the fact that healthcare has become a bit of a retail transaction. You have this problem, you buy this product or this test, this cures the problem, which unfortunately it often doesn’t. Sometimes it does. There are some things that are simple. You know, you have low vitamin D, take this vitamin D supplement, vitamin D comes back to normal, good things can happen. But so often we’re being oversold and we’re being overdiagnosed. And I think part of what’s going on is this idea of the medicalization of everything.
Right, and we’ve talked about that and the pathologization of otherwise normal processes in life, one topic that we’ve talked about a little bit is the menopause topic. And I don’t want to get into a controversial topic with you because certainly I think there’s room on both sides for all different types of therapies and discussions but I think in general women in the 48 to 60 age range are made to feel like it’s abnormal for everyone. This is terrible for everyone. Everyone’s going through this and we all need something to make us not crazy or not unhappy. And so just, you know, it’s worthy of a really long discussion, but it’s definitely turned into a pathology.
Yes. “Estrogen deprivation syndrome”. And this deserves a whole episode of its own and nuance because certainly people experience menopause in different ways. And it’s like labor. Well, my labor was 18 hours of pain where I felt I was going to die. So, you know, you think about something like natural childbirth, I was like, oh, no, I need some help here. So people experience things in different ways. Right, exactly. But like everything else, there is often a platform, a foundation of things that you can do that can help alleviate a lot of those symptoms and my concern is that we’re just bypassing that and going straight to “here’s the cure”.
I agree because I mean I would like to put a plug in again for just nutrition therapy, eating good nutritive foods, removing things that are not helpful to you and also following really the Gutbliss Method which we’ve been talking about which is pretty simple and pretty basic and it it helps.
Foundational approach to gut health. But speaking of that, there are so many people out there who are providing fantastic information on menopause, and I am so grateful to them. I think it’s wonderful. They’re doing a much better job than the medical community has done. So kudos to folks like Mary Claire Havers and others who are out there providing people with a lot of good information. I appreciate that. But again, we have to be aware of the idea that we’re telling people that things that are a normal part of aging, like our bones are going to thin as we get older. There’s a difference between mild osteopenia, bone thinning, and severe osteoporosis that may require an intervention. But what we see is that everybody is being told, even with the slightest bit of thinning, oh, you need to be on this drug, this bisphosphonate. Yeah, we don’t need the Dexa scan and the drug right away. And the drug, by the way, has some pretty serious side effects, including potentially some forms of GI cancer. So that’s a great example, I think, of pathologizing something that is a normal part of aging. And guess what? Weight-bearing exercise, getting a lot of calcium through things like small boned fish like salmon and sardines, green leafy vegetables, those things are more effective than a lot of the medications people are being sold. When we think about the menopausal symptoms like vasomotor symptoms, hot flashes, Dr. Neil Barnard and the folks at the Physicians Committee for Responsible Medicine published a paper showing that changes like eating primarily plant-based, and that may mean just plant-based at dinner, are more helpful than a lot of the medications. I know that avoiding alcohol, particularly at night, because it’s a vasodilator, so it’s gonna give you, you know, hot flashes. Anything that causes vasodilation, dilation of the blood vessels, is gonna make that worse. So for example, limiting or eliminating alcohol, having a lighter dinner, these are things that are incredibly helpful. And so my criticism is not that women are being offered hormone replacement therapy, there are many, many women who benefit greatly from that. It’s that they’re not being offered information like have a more plant-based dinner, cut back on alcohol, and these things are gonna help you in all kinds of other ways too.
Right, I agree. And I think too, because that is a little bit harder, I think it is a lot easier to consider doing the medical interventions because it’s put out there, we’re talking about it more. And again, it’s not a bad idea. It’s just something that maybe considering other options along with it.
And it’s also a lot of the marketing is sort of disempowering because it’s saying to people, there’s nothing you can do. This is happening and it’s terrible and take this pill. And this is always a playbook, you know: “there’s nothing you can do”. You just have to, there’s no cure, there’s no, you know, diet, there’s no lifestyle thing. And that’s just inaccurate so much of the time. I mean, yes, sometimes that’s true. You know, you have stage four brain cancer. This is a good idea to think about what your neurosurgeon is recommending! But you have a headache? This may be the time to do some sleuthing. Am I dehydrated? Am I having caffeine withdrawal? Is this a side effect of a medication that I’m already taking?
Am I tense right now? Am I tense? Some people have food intolerances that can manifest that way. So there’s so many things to look at.
And again, the criticism is you go to the headache clinic and they basically give you the prescription and that’s it. And so you don’t really fix the underlying problem. You just now medicalize it. You’re taking a medication, that medication itself has multiple side effects. You’re probably going to end up on another medication to treat side effects of the medication you’re taking for the original symptom. So we are always advocating for an approach that is built on a foundation of diet and lifestyle changes. And as Janet mentioned, the Gutbliss Method, a foundational approach to gut health that involves some basic simple steps we’re going to be telling you about coming up soon. Janet, what final words do you have for people who are out there struggling with something and they feel like they’ve done the things and they’re not getting any better?
Yeah, so I think the first thing really to do is self-assessment and that you can do that in a very kind way. I’m not trying to be harsh or judgy, but to really drill down with yourself and say, have I done everything that I can do prior to medical intervention to manage this? And I think that most of the time we can all find an answer that is, no, I probably haven’t. So then you have to, you’re at a crossroad. Can I make some lifestyle and diet changes or do I need to go on the medication? And that’s really where you then have to make the decision and commit. And maybe it’s the med this time, but if you’re doing that, then I think you’re depriving yourself of a real chance of trying to achieve optimal health that can be achieved, in my opinion, that can be achieved. And I also do believe that pretty much anybody can do it.
And I also want to add that I spend a lot of time trying to get people’s guts back into shape because of the medications they’ve been taking, whether that’s antibiotics, acid blockers, steroids, biologics, laxatives, antidepressants, so many different medications as well as supplements. A lot of these things are really creating a toxic load on the liver and the kidneys, in the gut. And so people will come in with literally a shopping bag full of all these different things. And I’m like, let’s just do a medication break. Let’s go drug-free, no supplement, no nothing other than what is absolutely required for you to be alive for 90 days and see. And I cannot tell you how often people are better, significantly better just with that. With stopping the very thing they have been sold, claiming this is going to heal them.
Yes, and I have recent personal experience with this because I was on the protein kick for a while within the last couple of years and had a super clean protein powder that I was using. I felt so great about this. It was going in my morning coffee. Everything was wonderful. And all of a sudden, I was having this bloating that I wasn’t used to having, and I wasn’t feeling good when I woke up in the morning. And I thought, I’m not doing anything bad, I mean, I’m perfect. Everything that I’m doing is fantastic. And then I really analyzed myself. I said, I’m actually taking an ultra processed food, this protein powder, let me cut it out. And when I did, lo and behold, all the bloating went away, the difficulty at night and the mornings went away. And so just again, and I’m not knocking protein powder. I’m not.
Well, I’m knocking protein powder!
Yeah, I know. I know. Well, Robynne is going to knock protein powder.
I can tell you for sure that I see so many people who are having GI distress and it’s a result of the protein powder, the collagen powder and the bars. And we have very little evidence that this stuff is actually doing something, right? So I say to people, if you want protein, go eat an egg. Or kale. Put hemp seed in your green smoothie. Sure, plant protein or animal protein, but actual food protein, for sure. Just something to think about.
So I want to leave you with three takeaways about this idea around the retailization and the medicalization of health care:
1. Everyone is selling. Make sure that what you are buying, whether it’s a pill, a procedure, or some other product, make sure you are buying it with eyes wide open.
2. Self-assessment is key. It’s important to ask yourself, have I done everything I can do to solve this problem before opting in for whatever is being sold to you?
3. Many GI problems, many medical problems, but especially GI problems, are actually caused by medication, not cured by them. So you want to have a reasonably high threshold before committing to taking something. And that goes for prescription drugs over the counter and supplements. And don’t be afraid to ask that important question to whoever is prescribing things: What would happen if I didn’t take this?
So that’s it for this episode of the Gutbliss podcast on the retailization of medicine and how to be an informed consumer.
