Thinking Outside a Conventional Mindset

Since 2017, board-certified internist Matthew Mintz, MD, FACP, has provided old-fashioned, personalized care with today’s advanced diagnostic procedures and treatments in Bethesda, Maryland. Dr. Mintz received his Bachelor of Arts from The University of Chicago, and earned his medical degree and residency in internal medicine and primary care at George Washington University School of Medicine. After completing a Chief Medical Residency at George Washington University, Dr. Mintz became a full-time GW faculty member for 20 years, where he saw patients and taught medical students/residents.

Episode Highlights

3:04 – How functional medicine changed a conservative mindset. “There were a number of steps in the way that really changed my conversative thinking quite drastically.

• The first was medical cannabis. When I opened my practice, I had zero patients, which most concierge doctors do not start a concierge practice from scratch. They usually have an insurance-based practice with thousands of patients, and they eventually realize the system just doesn't work anymore so they convert to concierge and a small percentage of those patients follow them. I was leaving downtown Washington, DC to open my practice closer to where I live in Rockville, Maryland and I really didn't have any patients. I was sitting there twilling my thumbs for a few months when a cannabis dispensary opened in my medical building. Again, I'm very narrow and conservative, but I wanted to go check this out. I spoke to the owners at the time and eventually started seeing these medical cannabis patients. These patients were getting better, so I decided I would incorporate it into my practice, but I had to learn about the evidence more. In medicine, if you're going to learn a new disease or skill, you take a course or you get certified, but no such thing existed for medical cannabis. I had to do my own research by going into the literature, reading all the studies, etc. Although there was evidence of cannabis working, these studies were not published in the journals that I was familiar with. As I dove into this research, it opened my eyes to the fact that the vast majority of evidence that doctors rely on that are published in these journals are funded by the biopharmaceutical industry. I think there is a role for medications, but it's the funding source. They have to spend the money on these studies, or their drugs will not be approved by the FDA. Even though cannabis is a huge growing industry, in both the recreational and medical space, they have zero incentive to spend money on research because they don't have to. It's legislated a completely different way. Another example is the supplement industry. Supplement is a multi-billion-dollar industry, but they're regulated more like a food than a medicine by the FDA, the Food and Drug Administration. It's not like there's not data on supplements - it's just not the robust data that I am accustomed to using. But if I'm just relying on this one set of data, what else might I be missing?

• The next big one was the pandemic. No one knew what was going on, but we had to come up with something because testing was barely available. This is certainly before the vaccines or treatments. Not to get political, but state, local, and federal government did very little to help doctors, and I was no longer at the university. I couldn't rely on higher ups. I would say that the most useful information I found was from doctors only groups on Facebook sharing what they heard, what they’re doing, and how they’re institutions were navigating the new space. Interestingly enough, they were looking at things like hydroxychloroquine, azithromycin, ivermectin and vitamins, specifically vitamin D. If you would have asked me five years ago if you should be taking any supplements, my answer would have been ‘if you want to take a multivitamin, it's probably not going to hurt, but there's no evidence that any of that stuff works.’ I meant that there was no large pharmaceutical or similarly funded trial that showed any evidence. That's not the same thing because it doesn't mean that there's not other evidence. Evidence-based medicine is not just looking at these large, primarily biopharmaceutical funded trials - it's looking at all of the evidence from smaller trials, animal data, clinical experience. It really opened my eyes to see there might be other things out there than just the traditional medical model that I was looking at.

• Another treatment, which I still do, is ketamine-based treatments for treatment resistant depression. There's a pharmaceutical version of that. There's also ketamine, which is a generic drug that’s been around for forever. There's no company that wants to do lots of research on this, but it can really benefit a lot of people. I also discovered that my psychiatry colleagues just want to give people more and more pills to take, and they're not interested in some of these other models. There's lots of different models for depression. The bio-amine model is just one of the models. I was really surprised that my psychiatry colleagues were not interested in that.”

17:39 – Functional medicine is the study of health and healing.  “Lot of twists and turns along the way, but somehow, I stumbled into this practice of medicine called functional medicine. I've been hearing about that, and I took a pretty deep dive about five years ago, and I decided that is what I wanted to do for the rest of my career. I closed my practice to new concierge patients and started doing functional medicine on these patients. The current medical model is really an illness and disease model. You have symptoms, you do a test, you see the specialist, they do a procedure, or they give you drugs. This is sort of the model that I had been practicing for at this point for 23 years. This model serves us very, very well for acute things - if you have cancer, don't be like Steve Jobs, who was like the wealthiest person in the world at the time, who had all these resources but didn't want conventional medicine. He wanted a more natural approach to his pancreatic cancer and died. When I was a student and a resident, half the people at the hospital that I trained in were all dying of AIDS, yet now we take a pill once a day and we don't have AIDS anymore. Modern medicine is great, but this model doesn't work well for the vast majority of things that people have, which is chronic disease. One in five Americans has a chronic disease and 30% of those Americans have three or more chronic diseases. We're all on so many of these pills now for all these chronic diseases and, for the first time in our history for decades, life expectancy in the United States is starting to go down. Not true of other Western countries, by the way, but we're actually going down. We're getting sicker, unhealthier and more prone to chronic diseases. This pill for every ill mentality doesn't work for the vast majority of things. When I looked into functional medicine, it was the missing piece. This is the solution to all these complicated sick patients that I've been trying to help but can't. Part of the pathway that got me there is long COVID. So again, one of the twists was the initial pandemic, but then we're starting to see these long COVID patients, and they look a lot like chronic fatigue patients, which I had seen before and knew that conventional medicine couldn't help. Functional medicine takes the opposite approach. Conventional medicine is the application and discovery of illness and disease while functional medicine is the study of health and healing. How does the body stay healthy? How does the body heal?  Because if there are errors in that, that's what makes us sick. If you understand the mechanisms by which the body heals and you can fix those mechanisms, that can make a lot of things go away.”

 23:37 – Just calling it medicine. “One of the aspects I do in functional medicine is longevity for someone who is otherwise healthy. What can we do if you want to  bio hack or tweak your own system so that you live longer and healthier? We don't want to live to 100 but be in a nursing home at 80 and spend the last 20 years of our life decrepit. We want to live to 100 and be healthy and vibrant. Using a functional medicine approach, we’re strengthening those systems that the body uses to heal to allow people to live healthy and longer. Conversely, you take a patient with long COVID, whose systems have been out of whack for some time and use those same principles to make them healthy again. Long COVID patients and longevity patients have a lot of overlap in keeping the body healthy. It's a huge piece in medicine that's missing and it's going to take a while for conventional medicine to catch up because they want that data and randomized trials, but the funding, tools, and technologies aren’t quite there yet. My belief is 10 or 15 years from now, we're not going to be calling it functional medicine - we'll just be calling it medicine.”

25:21 – Looking outside the conventional system. “I'm an internal medicine physician that does primary care. Usually, we are the referrer, especially in this insurance-based model. Even before I was doing functional medicine, I didn't refer out a lot because I tried to do as much as I could in house and really only referred to specialists. Now, of course, I still do because there's still a value to modern medicine. It's not like we’re just throwing it away. When I first started doing this, I had patients in my practice that had these complex chronic conditions that I wanted to try functional medicine on first to see if it worked. Once I started getting some good results, I knew this is definitely the way to go. More recently, I started opening these up to other patients on my website who maybe had their own doctor or were in the conventional system and it just wasn't working. Most people aren't being referred to me by my colleagues - most people are finding me because they're looking for something outside of that conventional system.”

28:10 – Does it exist? “One of the problems with the conventional mindset is that if I can't diagnose it, test it or have a treatment for it, it must not exist. Doctors don't like to say that they don't know. If all the tests come back normal, the doctor would basically gaslight the patient and say it’s in their head, but people have these real diseases. It's very, very frustrating. I have not looked at the CDC's website in the last 30 days, so you can check me on this, but last I checked, it mentions that the treatment recommendations for long COVID are essentially support groups, which is crazy.”

29:49 - Rethinking as an MD. “I can't tell you there was a logical progression. I will tell you what definitely convinced me that chiropractic worked. Basically, I had thrown out my back. I had a back problem before and used physical therapy, which it solved it, but it eventually came back worse. I could deal with pain, but I literally couldn't stand up and see my patients. I decided to try this chiropractic thing because I was out of options. I called Dr. Jay, and he sent me to his Rockville office with one of his best chiropractors. Within minutes, I was 60% better. Again, five years ago, I would’ve told you there's no evidence on any supplements. Now my closet is full of all these things, and I continue to explore and use all sorts of things, like light therapy, electrical medicine - all sorts of things that are so far away from what I was trained on. Unlike prescriptions and surgery, there's almost no harm. I mean, if you take enough of a supplement, like vitamin C, it can be dangerous. Yet, you have some of these things that date back decades that were disposed by the medical community but are amazing technologies that I'm starting to look into. There's just so much out there that can help people along with physical manipulation and chiropractic care. Of course, you also have to eat healthy, exercise, sleep, reduce stress, and get rid of all these toxins, plastics, and bad things like that.”

39:59 - AI is changing healthcare. “That can be another podcast, but I'll give you two examples. One is taking all this data and interpreting it. It's very easy for me to look at a couple tests and say you have this or that, but if I'm looking at thousands and thousands of data points, AI could help us by sorting through it. The second thing is patient information or patient education. It's a little bit different than just searching up Dr. Google. There's just so much out there. I certainly could use this, and patients can too, to help synthesize the information and educate my patients because it's all over the place. That's just two very quick examples, but we could go on and on. I see AI being a really important role in how we stay healthy.”

Episode Resources

Matthew’s Website