Paul Saladino· MD
almost every single condition I'm treating in my specialty is an inflammatory condition and the only tools I'm using are drugs and surgery and yet drugs and surgery can't do anything to change the physiology that's leading to inflammation in the first place and what I'm doing is not doing anything to affect the root causes so it's just I'm trying to paint the picture of like there is a swirl that you're caught up in that has Industries fingers all over it and all and you're working your ass off hours a week or more yeah and then there is literally no incentive nothing no training no time no education no incentive to look up and look around and be like Rome is burning Rome is burning this patient has come back four times for the same issue we're not getting to the root cause where there's nothing pushing you to do that you have to basically rip rip the Matrix cord to do that and that's scary and there's a lot tied up in you not doing that so it's just it's a wild world and until I got fully out of it I could I saw it clearly only when I could see it as an observer it was the same way when I was in cardiology the cardiologist would literally mime to me think here a box around the heart this is what you think about think here and granted I'm a PA at the time I'm not an MD right I went back to medical school and then I did my residency in Psychiatry at the University of Washington and it was the exact same thing in Psychiatry I would say to the attendings what is causing anxiety we don't know what about neuroinflammation and their eyes would just go blank and then you like even in residency and this was probably the beginning of the end for me you could do I could do like a little Pub men five minutes you know mitochondrial dysfunction right mitochondrial dysfunction and schizophrenia mitochondrial dysfunction depression a ton yeah neuroinflammation you know switching of the mitochondria or the switching of the phenotypes of the uh the micral cells in the brain the brain derived macrophases we have inflammation in the brain in depression we have inflammation in the brain in schizophrenia where's that coming from right they just no not a single attending in my residency could answer the question or or challenged me to even think about the question but I was just curious and I remember I gave a talk my the last year of my residency and I stood in front of a room it was a grand rounds at Harborview which is one of the main hospitals in Seattle and where we got some of the sickest patients because it's like downtown Seattle we would see florid psychosis massive drug withdrawals and people would come in with Incredible suicidality and and just really really intense neuroinflammation and I asked a room full full of attendings residents and and uh medical students what is inflammation and like really no one could answer me and I mean not that I'm so preeminently intelligent I was just thinking a little bit differently than them and and had done some research and tried to wrestle with this myself so is not surgery this is not this is surgery Cardiology Rheumatology it's every specialty in medicine specialy which is why I love what you're saying here yeah so let's let's talk