by James Altucher: Ask
James: LOVE, SEX, BUSINESS, DATING, and GREED
I'm a doctor.
That's not quite enough. Some might take that to mean I'm a u201CDoctor
of Philosophyu201D. A PhD. In fact, I was rudely thrown out of graduate
school. I asked to at least use the office for the summer but they
said, u201CNo.u201D I needed to pack all my stuff and be out by afternoon.
While packing my desk I found a woman's earring underneath but that's
No, what I
really mean is I'm a u201CMEDICALu201D Doctor. In other words, you can come
to me with your ailment, I can either diagnose them or tell you
you need more serious help and recommend a specialist (for instance,
if your finger has been accidentally amputated by a lawnmower ,
then I am NOT the guy to sew it back on. You need to go to a hospital
where they have sewing machines for that sort of thing) and I can
recommend treatment for you: take 5 of these pills, for instance,
and call me in a week and avoid a diet that is high on carbs for
at least this week.
Wait a second?
I've read through all of this blog. James DID NOT ONCE ever mention
going to medical school.
Yeah? So? If
you came to me with a headache, for instance, I would ask you a
bunch of questions. Did you fall? Did someone hit you? Are you vomiting?
Then I would take an ophthalmoscope (that little miner's light where
the doctor says, u201Cnow open wideu201D and a bright light shines directly
into your eyesu201D) and I would look at the back of the eye (u201Cthe fundusu201D)
to see if I can detect any swelling in the brain or any brain tumors.
A simple check on the Internet will show many examples of pictures
of a swelled brain compared with an unswelled brain. I might do
an EEG also to see if there's anything abnormal. If I see anything
abnormal that requires immediate surgery or a neurologist then I
would send you off to a specialized hospital. Else, take two aspirin
and call me in the morning.
so hard, right? But to do that I need about 12 years of education
and go about $300,000 in debt and then pay massive malpractice insurance.
And not only that, what if your headache was the result of an ear
infection or an eye infection (easy to tell by various methods that
are easily found via Google)? I would have to prescribe you an antibiotic.
Now we're in
trouble! If you don't have insurance then it would cost you up to
$600 to take a four week regiment of most antibiotics. Not to mention
I have to charge you a few hundred dollars for my time even though
I only spent ten minutes with you and now I'm going to hop from
room to room to see all my other patients.
[And just as
a footnote: all I did was look at your eye and maybe do
that rap of the knuckles on your spine that doctors always do to
justify the $300 cost of your visit. And in order to do
that rap on the spine and maybe the little hammer on your knees
and let's check your pulse you have to completely humiliate
yourself by taking off all of your clothes, standing on
scale that has been specifically designed to prove to you you were
ALWAYS three pounds overweight so stop lying to yourself and then
you have to lie down on a this weird mechanical chair/couch that
the last 30 patients with infectious diseases also had to lie down
on and then your head is tilted so you are looking at me at this
upward weird angle the way you'll look at God after you die when
you have no idea where you are and all you want to do know is, u201Cis
this heaven. Or am I in hell?u201D
By this point
you are so utterly dehumanized and I come in with my white coat
and my oddly costume-like miner's light strapped to my forehead
combined with a magnifying glass so now it's truly like I'm god
because I can see right through to you in my sterile environment-
I can see everything- and then to finalize the demonization of the
doctor-patient visit I ask you the crucial question that you HAVE
TO ANSWER before I treat you further — u201Chave you had many sexual
partners of late?u201D — ok, enough footnote. I didn't even need to
footnote this but it's not crucial to the point. It just adds the
simple flavor. You're an idiot and doctors act like gods.]
now the patient has to spend $1200 (antibiotics + the first
doctor's visit for treatment plus the second doctor's visit where
I walk in andi say, u201Chow are we feeling today?u201D and I'm smiling
and you say, u201Cgood, doctor. Very good.u201D And I say, u201Cwell, we'll
see about thatu201D And you're stripped down again and wearing that
beautiful paper gown (so sexy) and I rap on your back, look at your
fundus, wrap on your knee, and maybe slip my hand into your vagina
(wearing rubber glove, of course) and then say, u2018yes, you are the
spitting image of health, tell the nurse up front to make an appointment
for about three months from now just to make sure.u201D) and why should
the patient spend anything? After all, although the certificate
on the wall says I'm an u201CM.Du201D it's all a lie. I, of course made
it up. I'm the guy who
screwed Yasser Arafat out of $2mm
pretended to be a psychic. Why should I be a doctor?
the entire industry is completely messed up and we all
know that but nobody just simply tells it like it is. We all want
to put Band-Aids on the situation instead of transforming the situation.
This is our gut reflex in almost all aspects of life.
We're unhappy in our marriage so we figure maybe some diamonds
and an expensive vacation can help. We're unhappy in our
jobs so we figure maybe if we take the boss out to lunch it might
help. These are all bandaids. It's time to just say the truth about
what will help.
require radical transformation. Don’t be afraid to do that
or say,”of that can’t be done.” At least consider
to end the FDA, traditional medical education and the insurance
companies. Just get rid of them.
with the worst and most corrupt semi-government institution known
to mankind: the Food and Drug Administration. The administration
that lets you smoke as many cigarettes as you need to get lung cancer,
drink a ton of alcohol to get liver cancer, but then won't let you
take any of the drugs or treatments for lung cancer or liver cancer.
I have to tell
you something: almost every cancer has been cured already. But let's
say I'm a scientist with a bad personality (I've been accused of
being a bad scientist with a congenial personality but never the
former). Let's also assume I've developed a drug that will cure
your liver cancer without chemo. Now what do I do?
the four steps I would CURRENTLY have to do:
It costs a billion dollars to get a drug through the Food And Drug
Administration. This is why I mention the bad personality
part. There's zero chance I'm going to raise this money. Instead,
because my personality is so bad I have no friends at the various
research magazines so I'll never get my findings published and consequently
I'm going to get fired before I get tenure and I'm going to end
up as a cashier at Walmart. What sort of tests do I need to do?
I have to round up potentially thousands of people to take my drug,
take placebos, check for safety, effectiveness, blah blah blah.
It takes ten years to do this so potentially valuable drugs stay
out of the hands of patients who will most assuredly die in this
At any one of these four steps, judges at the FDA can decide if
I passed or failed my trial. These judges are often people
who have worked at my competitors or who want to work at my competitors,
making it extra hard to get through the implicit corruption that
surrounds the FDA.
Now I have to convince the insurance companies to pay for my medicine
so patients don't have to pay the full cost. Because I just spent
a billion dollars on approving my medicine (over a TEN YEAR period
on average) the medicine is VERY expensive so I can make back the
cost. Insurance companies don't want to pay for my medicine. They
don't want to pay for any medicine really. So this is a hard process.
And I have to raise another $50 million to survive long enough to
hire people who will convince all the insurance companies to accept
Finally, I have to educate doctors that my drug will cure
liver cancer. Doctors could care less about me. They are going on
cruises funded by the big pharma companies (who just finished spending
billions on their drug trials) and the big insurance companies where
they are told what billion dollar drugs to recommend to their patients.
They aren't going to listen to me.
if I have the cure for liver cancer, nobody is going to ever find
out. It's like a five year old with the talent of Mozart who never
touches the piano. Nobody will ever know. I'll give up in the laboratory
before I even tell anyone. The best doctors do, in fact, educate
themselves and illegally prescribe u201Corphan drugsu201D: Drugs that might
have been approved for kidney cancer but NOT approved for liver
cancer and will recommend those drugs for liver cancer. But most
doctors will not do that because it's technically illegal..And certainly
no doctor will recommend a drug that has NOT been approved by both
the FDA and the insurance companies.