171. Morality, Money & Medicine w/ Psychiatrist Dr. Ethan Short
Roger K. McFillin, Psy.D, ABPP (00:01.9)
Welcome to the Radically Genuine Podcast. I am Dr. Roger McFillin. We're certainly in an era right now where we're experiencing, we can only identify as a mental health crisis of unprecedented proportions. And there's a growing movement, psychiatrists, psychologists, mental health professionals speaking out against a system that we believe is failing both practitioners and patients.
Today's guest, Dr. Ethan Short, represents a new generation of psychiatrists who refuse to accept the status quo of quick diagnoses, rushed prescriptions, what we definitely see as an over-promised but under-delivered healthcare system. Like many of his colleagues, Dr. Short has witnessed firsthand how corporate interests and profit motives have transformed mental healthcare into what some critics call a pill mill system.
From the opioid crisis that devastated his community to the broader issues in psychiatric care, he represents a voice of reform from within the profession itself. What is striking is how established institutions often respond to these internal critics, labeling them as anti-psychiatry or anti-science for questioning current practices. Yet as Dr. Short and others argue, true science thrives on debate.
questioning and continuous refinement of our understanding. The attempt to silence or marginalize dissenting voices, especially those from qualified professionals within the field, mirrors historical patterns where established medical paradigms resistant to change have ultimately hindered progress and cost lives. Today we'll explore how the American mental health care system arrived at this crossroads.
why an increasing number of professionals are calling for fundamental reform and what alternative approaches might offer better outcomes for those struggling with mental health challenges and substance abuse. Dr. Ethan Short is a graduate of the University of Louisville School of Medicine, practicing psychiatrist who is double board certified in psychiatry and neurology. He started the Renegade Psych podcast as an opportunity to share his frustration with the American healthcare system, the commodification of
Roger K. McFillin, Psy.D, ABPP (02:20.896)
mental health and addiction medicine, and honest conversations about where we go as a culture, as a society, and how do we thrive to create a life worth living and how to overcome the challenges that many face with mental health and substance abuse. Dr. Ethan Short, welcome to the Radically Genuine Podcast.
Ethan Short (02:39.641)
Thank you so much for having me on Roger. I really appreciate what you've been doing with your podcast and specifically appreciate the nuance that you bring to these discussions. something maybe that we'll talk about in a little bit. I'm a big believer that our minds have this binary classification system and you see that societally that we have this feeling, inside of our brains or inside of ourselves that
We need to create order in our environment that I need to know the answer one way or another. but what I see in your podcast is that you embrace uncertainty and you try to find the appropriate middle ground in so many of these discussions. and I can't say enough about how important that is as a society, as a scientific community to help us actually advance our understanding.
of the conditions that we're treating and their, their, you know, the foundations of, or their basis. So I appreciate you and thank you so much for having me on. I'm super excited to talk to you and, and be on your podcast.
Roger K. McFillin, Psy.D, ABPP (03:52.62)
I appreciate the kind words. With what you just said, by any chance have you been watching the Robert Kennedy confirmation hearings?
Ethan Short (04:01.103)
So I watched a little bit. think they're, I don't know how many hours long they are. know the first day was three or four. And then the second day I was trying to watch when I could. so I've, I've seen bits and pieces, probably about an hour in total.
Roger K. McFillin, Psy.D, ABPP (04:15.874)
Yeah, it's fascinating when you speak to kind of these binary explanations or understandings, oversimplified reductionist way of kind of viewing healthcare and overcoming challenges of living. It really exemplified that were the questions of the hearings, right? Like a lot of yes or no, viewing science as something that's established almost like it's a religion that you'd have to blindly adhere to. if you
didn't if you question it, if you had in any way a discussion that reflected the nuance and the challenges of making medical recommendations, which include like risk benefit profiles. And if you got into that conversation, somehow you were then denying established science and you were a conspiracy theorist.
Ethan Short (05:02.725)
Yeah, absolutely. It does seem like we are living in a medical world in a, in a research world, uh, where it operates like religious dogma. mean, it reminds me of, um, you know, my upbringing when I was a young kid and I was going to a Baptist church and it dawned on me at the age of 10 or 11, when I was around the age I was supposed to get baptized. And I just had so much skepticism inherently about.
Religion. I said, well, why is, why is our religion the one that's right? And the other ones are wrong. That doesn't make sense. And as you go on, exactly. Right. no, I'm saying that there's a seat at the table for all religions, that there's all these common themes amongst them. but I think that inherit skepticism with religion kind of led me to.
Roger K. McFillin, Psy.D, ABPP (05:40.888)
So are you saying you hate God?
Ethan Short (05:59.813)
how I view the medical field as well and see a lot of similarities. I've had conversations with other psychiatrists, where we discussed this religious dogma and really being force fed information, with the threat of being discredited or, you know, essentially canceled if you don't agree with it.
Roger K. McFillin, Psy.D, ABPP (06:20.918)
Yeah. Yeah. Speaking of dogma and so forth, why would you be so brave to come on a podcast, you know, with myself who's an anti-psychiatry, anti-science conspiracy theorist?
Ethan Short (06:35.429)
Well, I think I recognize, right, right. I think I recognize, you know, and I think you do too, even though you're, throwing some sarcasm at me that, you know, there's this pendulum between, biologic psychiatry where, know, every human condition is pathologized and broken down into this simple, there's some biological issue that's wrong with you. And we need to give you something to affect your
Roger K. McFillin, Psy.D, ABPP (06:37.23)
You're not a psychiatrist yourself.
Ethan Short (07:04.707)
biology medication wise. And then on the flip side, there is the full on anti-psychiatry movement where everything can be rectified by diet and lifestyle changes and severe mental illness does not exist. And don't get me wrong. I absolutely diet and lifestyle change, especially physical activity are probably the two most paramount treatments in for any mental health clinician, whether you're.
helping somebody manage a condition like schizophrenia or manage their depression. but ultimately I have worked on dozens of different unique inpatient psychiatric units. And I have seen people who are struggling, not under the influence of any drugs have never taken a prescription medication. and so I fundamentally, you know, I do recognize that.
Biologic mental illness does exist, but the industry has taken that concept way too far to an extreme degree. And they utilize it to try to make money and sell more medications. But so I just find myself somewhere in the middle. Why am I willing to come on the podcast? because
You know, ultimately when I was exposed, during my training, trying to do therapy a half afternoon a week and not having a fucking clue what I was doing. it forced me to do my own investigation and I stumbled across, Stephen Hay's work and acceptance and commitment therapy and the foundational basis of that relational frame theory and a huge aspect of that. One of the, know,
six processes of act therapy, are living by your values. And so at the end of the day, I would have burned out of my field very quickly if, as we used to call it in residency, and you alluded to this earlier, if I just participated in this fast food drive through esque, mental healthcare system, you,
Ethan Short (09:21.957)
pull up to the window and you make an order and then you go and pay and you receive your food or your medication. And that's just not how, that is not the best way to approach our mental health. So in terms of why, why am I willing to do it? It's more so that I'm not willing to go in the other direction, I think.
Roger K. McFillin, Psy.D, ABPP (09:44.236)
Okay, so let's try to find some agreement today. Let's first talk about there are conditions that psychiatrists traditionally treat, and their degree of expertise is around these, I used the word severe biological mental illness, I might change the language, not that we differ in how we think about it necessarily, but I think language is powerful. Because if we, first of all, understood the origins of schizophrenia,
And we said that it was this clear identifiable biological etiology, which we may not know how to effectively resolve it, but we've clearly identified it, we test for it, we can evaluate it, we can measure it, then I'd stick to that language. Instead, we have to maybe potentially embrace the uncertainty and unknown of conditions that present itself under the category of schizophrenia. And that condition can be impairing, enduring, and chronic.
And I would argue that in the United States, the Western medicine's approach to schizophrenia, our outcomes are not any better, or in some cases worse, than less developed countries around the world. So there's ways that we think about it, and there's ways that we treat it, and we assume it is the pinnacle of scientific evidence, and that we have this great evidence to support that this is the way we do it, that it's a brain condition. As long as you're on your meds, you're stable.
If you're off your meds, you're unstable, right? And that is a lie. That's a lie that's sold to the American public. That's a lie that the politicians are going to repeat. And that's how the medical establishment is going to repeat it as well. I, on the other hand, will say, okay, there are places for psychiatric drugs. not going to call them medicines. There's places for psychiatric drugs as a tool, especially in emergency medicine, right? So if you have somebody who is detached from reality and
presents a clear danger to themselves or to somebody else. It is inhumane, in my opinion, to not provide them something that could at least stabilize that episode and create some stability to be able to work with that person and support that person, as well as keep the community safe or their family safe, right? I would also argue those conditions are quite rare. And so what we've done, though, is we've taken that model, we've called it medicine.
Roger K. McFillin, Psy.D, ABPP (12:04.898)
We've extrapolated to all aspects of living under an umbrella of mental illness. And we were saying that we have these medicines that are part of the standard care and the outcomes of that have been absolutely horrific. And in additionally, it stopped us from effective evaluation and understanding of what might actually be contributing to severe mental illness. Like if someone is in a manic episode or somebody is experiencing chronic
schizophrenia, we are horrible at understanding the etiology and making advancements in that area. Does that sound like an anti-psychiatry or extremist view?
Ethan Short (12:46.559)
No, I don't think so. mean, I think if you look at something like Finland's open dialogue program, where they try to reach out to people who are under the influence of some sort of psychosis within 24 hours and involve their family or their community, you see rates of medication that, you know, are much lower than what we have in the United States, where, like you said, the ideology is, you know, I would say
to not be one of the, you know, extremists, I would say 90 to 95 % of the time, the answer is medication in America. And I know some people would probably say a hundred percent, but, there are some good conscientious folks out there, but in their open dialogue program, I believe their percentages of using anti-psychotic medication and not necessarily in perpetuity. We're somewhere around like 30%.
So I think that gives us a good, again, it's not exact. It's not, you know, specific, not any one, piece of medical research or data is, you know, proves things. have theories for a reason, but I think that gives us a little bit of a window into understanding maybe to what degree we are over medicating, even conditions that I think most psychologists, psychiatrists would agree.
have a biologic component or basis, not to say that it's all biologic. And also, you know, this, this breakdown of, it biologic? Is it environmental? Is it social? They all influence each other, you know,
Roger K. McFillin, Psy.D, ABPP (14:27.35)
Yeah, that's such an odd way to... I'm a human in a body in a material world, right? So every thought that I have has a chemical reaction in the body, right? I think it can even be measured with neuropeptides and stuff. There is a chemical reaction to a thought, to an emotional experience. So in that regard, everything is...
biological, I turn on the television affects my biology, I listen to something in my ear, affects my biology. I think when people are talking about that, they're sending a message or they're communicating a narrative, and it's a false one, that somehow it is like outside of our control that there's this genetic component to it, right? And that drives people to externalize treatment, to go to a doctor and in
Allopathic medical system, Western medicine for the most point, is like a diagnosis and prescribed system, right? So you're externalizing the treatment. It's coming outside of you, not from within you.
Ethan Short (15:34.917)
Yeah, absolutely. Um, you know, I think that one of the conceptualizations that I've heard that, um, seems most reasonable to me is the way that, uh, Nasir Ghami and, uh, I believe her name is Margaret Chisholm, um, conceptualize and treat patients. And they use this acronym called hide. I don't know if you've heard of it. It breaks it down very simply. It is, there are four perspectives or dimensions of, um, mental illness. is.
What you have is what you are. So these personality characteristics, temperaments, what you do. So ways that your behavior can positively or negatively impact your mental health and then what you experience. the way that things like early childhood trauma can biologically change your brain.
So, and you throw in the, you know, wanted to mention the, you know, field of epigenetics, the fact that all of those conversations, that you just mentioned turning on the TV, having really emotional experiences, they actually change our genetic code, the expression of it. So we've got this humongous genetic code and a lot of it is inactive and every day we're having things turned on and turned off and we don't understand it.
fully. And so we have to have a lot of respect and appreciation for all of the uncertainty that goes into these conditions that we're treating. And I just don't think as a field that we have enough respect for the unknown. I want to ask you a question, and there's not a right answer to it. There's no way for either of us to actually know the answer. But I think it's a good question to think about.
of everything of all of the knowledge base around mental health conditions. And again, these are things that we know and things that we don't know. What percent would you put out there as what it is that we know compared to the total?
Roger K. McFillin, Psy.D, ABPP (17:45.164)
Well, it's a fascinating question and I haven't always thought about it like that. So I'll try to add a percentage and answer to it. But one of the things that I think we do know, let's stay there. Like there's a common sense approach that probably when we think about what it takes to create a life worth living, that most of the mental health interventions that are most effective are free or somewhat free, right? So if you grow up in a safe environment,
and you have family or parents that love and protect you, right? So you're not abused. You don't have that exposure to early childhood trauma or continuing trauma. There's a degree of safety there. You have clean water, access to clean water and real food. There's a sense of community that's provided to you. You are able to sleep in a way that we were biologically designed to. I mean, and that's with the sun, for example. So you have this
circadian biology that allows that restorative sleep that is so necessary for you feeling well the next day. And so what does that mean? Maybe we have to protect ourselves from fluorescent lighting or blue lighting that impacts our circadian biology. There's enough movement and connecting and working with nature, right? So we have evolved to work in and with nature.
And modern society is pushing us faster and faster to be disconnected from nature, from the sun exposure to being outside, to exercise, to movement, to community. Right. And I think the more that we disconnect from that, the worse we're going to feel. There's social isolation. We're living through screens. We're exposed to toxic poisons in our environment. And so
We're getting physically and mentally unwell. You cannot separate the biology and the mental and the spiritual. They're all connected together. So there is some common sense approaches that I think we know, right? There certainly have stood the test of time, for example. And we also know that life is going to be difficult and there's polarities to life. You're going to go through very challenging and difficult times. That's probably part of the journey. And in that journey, we can grow, we can transform.
Roger K. McFillin, Psy.D, ABPP (20:04.14)
we can learn. And there are so many wise messages throughout the course of the written word and shared down from generation to generation. The more we get disconnected from our elders and the wisdom of those of people who are older, I think we get disconnected from this innate divine wisdom that's within all of us that we see emotional struggles as part of the process and not anything to actually fear we can lead into them.
We can face them, we can feel them. And traditionally speaking, the overwhelming majority of what we now label as mental health challenges were episodic. Now we're turning episodic struggles into almost chronic disabilities, right? And we've tried to overcomplicate this. We've complicated it in a way that we've medicalized much of the human experience, which in my opinion,
is only driving medical intervention and propping up an entire system where the outcomes are clearly demonstrating that we're all worse. So in some respect, I think there's like, you know, we had a good 75 % knowledge of how to live life well. But here's what we can't prevent, right? Someone comes and sees you or come and sees me, and they've been brutally, brutally raped, molested, abused, grew up in poverty, nutritionally deprived.
and they see themselves as broken and maybe there's this inherent biological process that led to an adaptation where they become disconnected from the now, the reality. Now we might call that psychosis, but that could be some protective biological mechanism. You can't go back in time and redo their life. We can't protect them from that abuse. And to say that there's some magic potion or pill that's going to correct all that is a...
again, it's selling something to the American people or it's selling something to the community that is not realistic. And you might be able to support that person and try to love that person and guide them. And certainly there are ways for us to be able to start a process of healing, but it's challenging, it's time consuming. And is there stuff out there that exists? Like right now, we're learning more about like plant medicines that could be potentially used in healing.
Roger K. McFillin, Psy.D, ABPP (22:26.348)
Right? And so what is the mechanism of action is that where people now see their entire existence from a new paradigm that leads to healing. Maybe there's something about these plant medicines that affect our brain, our consciousness in a way that we don't understand. And that's the uncertainty of all this because we're moving in a direction where we have to embrace the unknown and move away from old paradigms. So I know that's a long winded answer to a question, but I think it deserves that type of complexity.
Ethan Short (22:55.873)
Yeah. And I mean, just when you said that, you know, my mind, that automatic part of my brain that loves to just jump to an idea that I'm not trying to have, but, with how you presented that information, you know, there are, would say the most effective treatments medication wise or substance wise, you know, if you're talking about plant medicine are. They tend to be the things that are the cheapest in the most natural, right?
I'm a huge proponent of utilizing lithium and not necessarily at these mega doses. You know, I think that if it is introduced early enough at a low enough dose with the way that it works, that it can build in its impacts over time. use a lot of lavender extract, which has shown to be wildly effective. You look at a drug like clozapine in schizophrenia where
John Cain, you know, 50 years ago was tasked by the government to bring everybody off of clozapine. And he said, look, when I, when I do this in the inpatient, you know, state facility, state psych facility, everybody's getting worse. can't ethically bring all of these patients off of this drug yet. There are all of these loopholes that you have to jump through it for, as a prescriber to prescribe lithium, to prescribe clozapine.
which also just so happened to be two of the cheapest medicines that are available. so, you know, there is this intense, skepticism around any new drug or new medication. And like you said, the industry and, you know, the, the folks in our government that are supposed to be, they're regulating, the industry that are not doing their jobs. They're, they're in cahoots with industry.
I don't believe a word that they say they're selling Americans hope. That's what they're selling. Cause they know that there will be enough Americans that will fall into that trap of the hope of a medicine that will cure my condition. And the reality is most of our medications, especially in psychiatry, but I would extend this into most of healthcare. Most medications are modifying symptoms of a disease.
Ethan Short (25:16.367)
They're not modifying the underlying disease, like things like changing your diet, regular physical activity. And I would argue that, you know, lithium falls into that category too, but we've been taught again, I always use lithium as such an example because I was taught in my training, how dangerous it was, how scary of a medication it was, how I really shouldn't use it. And then when I got to talking to some of the attending psychiatrists that
I really respect it as critical thinkers who welcome debate. Even with, you know, us measly residents, you find out that it's got the best data of any psychiatric drug at reducing the risk of suicide. And this goes back to the ancient Greeks and it goes back to the Cherokee Indians in, in Georgia. This is something that before we knew what was in those water supplies.
Ancient Greek physicians would take their patients struggling with, manic like symptoms to highly lithiated waters. They'd have them bathe in it, drink from it. you know, you've got incredible results from the first time that, a psychiatrist used lithium on patients who had been institutionalized for years and they're able to get out and go get a job. And so, you know, I see something like that in the skepticism just grew and grew.
Especially when I'm told to prescribe a patient, especially an adolescent or a young adult, I'm told to prescribe them a drug that has a black box warning that it's going to increase or could increase their risk of suicidal thoughts. There's all these historical court cases, revolving or against, you know, the makers of these drugs for suicides, for homicides, for violence.
Again, it doesn't mean there's not any utility for the SSRIs, but to me it was insanity. And I was essentially forced into, you know, as a resident, when you don't have the final say about what somebody has prescribed into using those medications and things like that really kind of, think, set me on the path of, seeking out information that was not in my medical school textbooks.
Ethan Short (27:40.363)
expanding my views on what medications have actual efficacy and safety versus which medications have a few studies done by companies who stand to profit from them and have zero interest in deciphering what the long-term outcomes of those drugs are. The last point that I'll make on this, and I've made this so many times before, my mom was a clinical pharmacist and
She was such a bright, such an intelligent and such a wise person. She told me from the time I was 10 years old, she said, don't ever take a drug that hasn't been out for 15 or 20 years. Because if you, we don't know the long-term effects of that drug or substance and it's not likely to be as effective as what maybe you're told.
Roger K. McFillin, Psy.D, ABPP (28:34.542)
Yeah, it's interesting when you talk about lithium is that you begin to wonder are the most effective medicines found naturally, you know, on this earth. And because of the role of the pharmaceutical companies in how powerful they are globally, especially post-World War II, that they really have created narratives around pharmaceuticals, chemicals made in a factory to support their bottom line.
and really have repressed the science around what is naturally found in there, not only just repressed it, but had an active campaign against anything found naturally. This reminds me of a chapter in Robert Whitaker's book, Anatomy of an Epidemic, when he was reflecting historically on the data for recovery for bipolar disorder. And previously, you have the book up there. Yeah.
It's a great book because of the research that was put into it, the data that's put into it. So like looking back at hospital records in the 1950s, for example, overwhelmingly bipolar patients recovered that there was only one episode and there was use of lithium, but not, it wasn't really a strong pharmacological approach to bipolar disorder, that this was not an enduring and chronic condition.
most people returned to previous baseline functioning. And so we don't understand what might drive a manic episode. But what we know is once we've entered into this pharmaceutical revolution, where we're combining all these different drugs to stabilize bipolar disorder, it's very clear that we took a episodic condition and we increased the number of people who identify bipolar. And we've increased the number of people who become disabled by bipolar.
So right now in psychiatry, it is a diagnosis that is haphazardly being applied to large groups of people that certainly would never have met that criteria by being incapacitated by the condition dating back to the 1950s or the 1960s when we had better outcomes. Instead, the addition of bipolar two disorder into the DSM and the brainwashing of physicians since that point,
Roger K. McFillin, Psy.D, ABPP (30:57.654)
is now we're drugging more and more people and harming more and more people with those drugs who now say just because I'm emotional or experience emotion dysregulation, I have this underlying medical condition, not one that they could test for, not one that you can see, you just because the doctor said so, right? And we have just deviated so far from science and safety in 40 years.
Ethan Short (31:21.571)
Yeah. And, know, I hate the term bipolar. I think that it is a absolutely just a marketing ploy. It is a way to roll out a new class of drugs for a condition that is much, much better conceptualized as manic depression. You didn't have to have a manic episode to be on the manic depressive spectrum. It indicated that you had a family history that there seemed to be.
some sort of, you know, genetic influence because you see so many, suicides run in families. And that obviously is something that you want to be able to impact in a positive way if you can, not just through medication, but like you mentioned through circadian rhythm, balance. And now one thing that I'm kind of, curious about is 1950s bipolar.
How much different is that fundamentally biologically, the influence on our genetic code compared to 2025 bipolar because of all of the just historical travesties that we've allowed to occur. You know, you have the, big tobacco, all they have to do is create doubt around a scientific issue. They're not trying to prove that, for example, in that vein that
cigarettes don't cause cancer. They want to create doubt about it. And eventually they couldn't stand by or they couldn't, they didn't have enough reasonable doubt. And it was very clear in the scientific community that cigarettes cause cancer. And then you have a few of those big executives jump over to big food and say, how can we create a similar system? Well, there's this sugar stuff. There's this added sugar. And at the beginning of, you know, adding sugar, it was more of a preservative thing so that.
the starving Americans in Southwest and South United States, because the vast majority of food production was in the Northeast, that food would stay. So it didn't spoil by the time it got out West. But that, we haven't needed that system for a long time, yet we still have all of this added sugar, all the processed food, you know, the massive expanse of information.
Ethan Short (33:44.835)
What does all of that do to our genetics? Does that make us more susceptible? I mean, you, you certainly see an over diagnosis of bipolar, but I also think, especially in the United States, and I've had the opportunity to talk to, you know, some psychiatrists who were, head of biological psychiatry, at the NIH for 20 years and you know, our
our bipolar outcomes are getting worse. So what is the role of the crap that we eat and the sedentary lifestyle and not following a normal circadian rhythm? You know, we just can't separate biology from environment and.
Roger K. McFillin, Psy.D, ABPP (34:31.35)
Yeah, I'd like to use the word emotion dysregulation, because I think when someone is on the emotion dysregulation spectrum, those are now being diagnosed or labeled as bipolar disorder. But in general speaking, the medical world and popular culture, the United States is going to see that as an underlying medical condition.
that they've inherited in some way and we don't understand why and they have to manage that with drugs for the rest of their life. So I would say we are seeing an increase in the amount of people that are emotionally dysregulated, enter into crises more frequently and struggle to kind of recover from challenges that they experience in their life. Is that tied to the chronic disease epidemic? Is there something going on with the mitochondria of our cells?
in metabolic illness that is leading for people much more difficult to feel okay to sleep well, which then influences emotion dysregulation. Yes, that's a valid hypothesis. And then we'd have to see, okay, do we start improving a person's health? Do they become more emotionally regulated? The answer is yes, we see that. And what happens is when you start implementing some of these like ketogenic diet interventions,
for people and they dramatically lose weight or stabilize blood sugar and improve their metabolic functioning is that there is a stability in mood and maybe even an increase in energy and a number of other things. And so what are the downstream consequences of that? Well, maybe they start being a little bit more social and connecting more with people. Maybe they're more open and then relationally speaking, they get better reinforcements, right? From another person, maybe they're outside a little bit more.
Maybe they start to sleep better and get more morning sun and these rays that they experience that are so necessary, this red light and all these things that are just necessary for circadian biology. There's just a downstream effect of like positive health outcomes. And it's like a domino effect. In our culture in the United States, we'd like to reduce everything to a simple answer. Ketogenic diet solves bipolar disorder.
Ethan Short (36:47.651)
Right.
Roger K. McFillin, Psy.D, ABPP (36:49.354)
Everyone is depressed because they're metabolically ill. It's a brain disorder. Yeah. And that's, you know, that's just as dangerous, I think, by trying to simplify that. And what you see is there's like influencers, podcasters, or people who've wrote the book. Now they are really financially invested in their model. Not that they're not bringing very important science to the table.
Ethan Short (36:53.047)
If you intermittently fast, everything will be better.
Roger K. McFillin, Psy.D, ABPP (37:16.482)
but the use of social media, the use of podcasting reels is now this false simplicity for people. Like there's a panacea. And I have to share, like you can be in great shape. You could be living in the woods, drinking the cleanest water and having loving relationships and you could suffer because life is suffering, right? There's gonna be loss. There's going to be pain. There's going to be doubt.
There's going to be struggle. if we fear, fear is going to exist. If we start to then internally judge those experiences as if there's something wrong with us, then there's this paradoxical effect, right? We start to intensify the experience. We turn the judgment in on ourselves. And now we're focused on us. And we have to get rid of everything that we're feeling because we're told it's some symptom of a disease when it's just part of being human.
ask people all the time. Like if I could give you a magic pill and you would be relieved of any sadness, anxiety, doubt, grief, loss, anger, would you take that? And still the majority of people would say, well, no. Well, why not? Because I wouldn't even be a human anymore. And those emotions are valuable. And if I attach and I love somebody and I lose them,
you know, that feeling of loss or that feeling of grief is also connected to the love that I experienced. So part of this is also cultural, where we've lost our language of suffering. We don't understand the value and all these emotions that are necessary. We learn in them. You know, there's something called justifiable and righteous anger, you know, that really does drive change. And so I have a real concern about how we're trying to alter
the human understanding, the nature and narrative of what it means to be a human being, especially with technological advances, the anti-human transhumanist movement, and then this use of technology to try to create this utopia where no one suffers and no one feels pain.
Ethan Short (39:31.491)
Yeah, I, I, a direct example to that. this is something I try to help my patients get to the understanding of, and to be quite honest that I often look in the mirror and remind myself of consciously, you know, I was, really sick at the beginning of the week. I've got two toddlers there in daycare. are, I can't believe how many freaking times they brought home norovirus. And in the last two years, it.
If you're not familiar with norovirus, called the stomach flu, it is associated with the most intense nausea, like debilitating to where you can't even move. laid on the bathroom floor for an hour the other day, vomiting, you know, diarrhea, and it runs its course pretty quick, but it's really, really uncomfortable and it will make you feel bad. And you may even say that you feel depressed when you have norovirus, but
Roger K. McFillin, Psy.D, ABPP (40:13.847)
Thank
Ethan Short (40:29.369)
The phenomenon that is not tied to that at all, or not, not typically tied to that is a couple of days later when you feel much better, there's not anything else in your world that is magnificent or wonderful or, or, know, beyond belief different than what you experienced a couple of days ago. But because you came from that perspective of feeling terrible, that normal day.
Feels incredible. The, the energy level that you feel like you have is much higher than it probably actually is. And that perspective shift is the only reason why you experience that. you mentioned the mind and, you know, how it loves to judge things as they happen and that, you know, I believe it's a very conscious and necessary process to.
it, not fake it till you make it, but to insert the conscious balance into, you know, these internal conversations that we have, because our minds are naturally programmed towards our survival and towards making judgments in a very binary, you know, coding way of a one or a zero. And if you think about, medication and the patient perspective to medication, I've got to counsel patients almost every single time that I started medication.
You know, Hey, there are meds that are modifying symptoms and their meds that are modifying diseases. The problem with how you may perceive that as a patient is your mind is going to judge the impact of the medicine as soon as possible. And if you take a medicine like a stimulant or a Benzo or even an SSRI and you feel something change and you feel different.
then you will attach significance to that change. But if you take something that actually works more downstream, the example I use is you've got a polluted river and there's two ways to clean it up. You can pale out, you know, each liter of water, cubic liter of water at a time and put it through a purifier and then dump it all back in and you'll have a cleaner river pretty, you know, immediately if you have an efficient enough process. But over time it will become polluted again.
Ethan Short (42:52.909)
The alternative is to swim upstream, plug up the source of pollution. And as you go back downstream, the river is going to be in that next moment. It's going to be just as polluted as it was. You're not necessarily going to notice if you could be in that river for two months, two months later, all of sudden you can see to the bottom of the river. And it's the cleanest river that you've ever seen. But because there's not this.
massive perspective shift in a short amount of time, the mind can easily judge the disease modifying treatments as ineffective because I don't feel differently on them.
Roger K. McFillin, Psy.D, ABPP (43:34.22)
Yeah, well said and very strong metaphor. Let's shift gears a little bit because I'd like to talk about the substance abuse crisis in the United States. I know this is near and dear to your heart in the area that you grew up in was hit hard with the opioid epidemic. I think there's a lot in common between you and our current vice president and who speaks a lot about this and wrote the book.
Ethan Short (44:02.159)
Hillbillyology.
Roger K. McFillin, Psy.D, ABPP (44:03.924)
And it speaks to the culture and what people in that region have gone through and just kind of doing some background research on you. seems like it's something that has like motivated you to seek out this.
Ethan Short (44:24.546)
Is everything okay there?
Roger K. McFillin, Psy.D, ABPP (44:26.892)
Yep, we're fine. We'll cut that little part out.
Ethan Short (44:28.032)
Okay. Every, every now and then Roger, my sound will kick off for like five to eight seconds. So if that happens, just make a note and I'll start over.
Roger K. McFillin, Psy.D, ABPP (44:39.618)
Yeah, was just a quick stop. Yeah, so anyway, get back to that train of train of thought is that it seems like it's been a real motivated for you to go down a path of becoming a psychiatrist and working in addiction medicine. I want to first start with some maybe meta questions, you know, like, let's just zoom out a little bit. You know, how do you make sense of the substance abuse crisis that exists in the United States? Like, why do you think it's happening? Because we do have to understand the causes before we even begin to
try to brainstorm and implement solutions.
Ethan Short (45:10.666)
Yeah. I mean, I think like most issues that the, minds want to jump to it's this thing or it's that thing. So it absolutely is a multifactorial issue. I think societally that, especially in the United States, I mean, this is a pitfall that I think any human can fall into. And you talked a little bit about earlier. We, have this, knee jerk reaction to try to avoid things that are uncomfortable, to try to get away from, things that hurt.
And I think that plays a big role in reaching for substances. think there's a lot of different roads to substance use disorders. You know, you, you can have a traumatic past and seeking to get away from it. And then you can develop the physical dependence to something that you can't, you can't get over it without addressing both. You may have.
some sort of a biologic component to, the addiction or maybe there's, you know, you're, you're dealing with a depression, you know, one of those, depressions that runs in families that is, you know, leads somebody to be apathetic and anhedonic, not getting pleasure out of things that they normally enjoy that looks more like Parkinson's, than, know, more of a neurotic depression. I think there are so many different, you know,
factors here, but the thing that is most disturbing to me, this is not something that I was aware of until I went to medical school. My timeline is interesting for this because I graduated from high school in 2007 and you know, you go to a party and in that, you know, summer after my senior year of high school and people would be drinking alcohol. Some people would be smoking pot.
Didn't really go beyond that. It was one year later, I went to South Carolina for my undergraduate college experience. And one year later, I come back to my community in Louisville, Kentucky, and those same parties, all of a sudden there's OxyContin everywhere. And to me at the time, it is just the normal experience. I didn't realize it was any...
Ethan Short (47:35.984)
different than anybody else's experience, but fast forward, you know, six, seven years later, I'm in medical school and I'm learning about this. And then I become aware of all of the manipulation and aggressive immoral, dishonest marketing by Purdue Pharma of OxyContin, which was rolled out in my region of the country. I think very, very intentionally.
As JD Vance talks about, you know, rolled out in these communities that were, had high rates of unemployment, high rates of poverty because steel and textile factories were, you know, dried up in the seventies, eighties, nineties. that really pissed me off. I mean, in it, and it pissed me off because I've got a, my, my friend,
Has a, in his apartment, he has a printout of our graduating high school class and we can sit there and go through that graduating high school class. There's more than a dozen of, you know, less than a 300 people who are not with us anymore, who have died from an overdose or died from a suicide. And when all of this came full circle in medical school, and I kind of always knew I was going to go into psychiatry. mean, I.
It's something that's always kind of called to me, but coming full circle. It really, think drives my passion and it blows my mind that our government regulatory bodies allowed a company to state that their opiate was not addictive. mean, this shit's been known to be addictive since BC era. How are you going to say that it's not addictive? And I mean,
A really, really good friend of mine at a month into COVID, he had been, he'd had a long journey, had a struggle, with addiction. He was doing really well and had been sober for a couple of years. COVID hit lockdowns hit, and likely got a pill offline that was cut with fentanyl and his roommates found him dead in his, in his bed the next morning.
Ethan Short (50:00.778)
I just, I wish I could tell you that's the only story that I have, but I heard the other day of another, guy that I didn't go to high school with, but kind of ran around in the same group that, died by suicide last week. And you know, when you feel like there's this, I mean, essentially this evil, you know, company at the head that is just trying to get it, squeeze as much profit as possible.
out of my community and my friends and my family. That's absolutely unacceptable. And that really does like, motivates me to keep, keep going and keep doing this and keep speaking out on these issues. And I wish I could say it's just, addiction. It's just, opiates. mean, there are many psychiatrists going back to the early nineties who were warning about an impending Xanax pandemic or epidemic, sorry. And,
The same, same factors hold true, you know, 35 years later.
Roger K. McFillin, Psy.D, ABPP (51:04.654)
Yeah. Yeah. You mentioned that there's the, always the human desire to escape pain. So those who are more in pain or more hopeless, and there's then the availability of something that could at least give them temporary escape. You know, you see that we, human beings are vulnerable to the use of substances to escape the suffering of our, of each moment. And, but I wanted to speak more to about the culture that we live in. We live in a drug culture.
Do you believe the drug epidemic in our country is also at least partially related to how we view human suffering and struggle and how powerful pharmaceutical and drug culture exists in this country?
Ethan Short (51:48.78)
Well, I think there's a disconnect between our views of addiction and the realities of addiction. think there's an us and a them mentality and that the industry, really, jumps on that or, takes advantage of it. Like let's be radically genuine right now. I have one of these every day. I have a coffee every morning and it does that.
on a fundamental basis. Now, obviously this is not something that's going to lead to my death with one use, but on a fundamental basis is this me seeking to get away from low energy and using caffeine to do so. that fundamentally any different than the person who's seeking to get away from their trauma by using heroin? What about when I grabbed for this 500 times a day?
Because I start to think about something that I don't want to think about. these any fundamentally any different? So I think we have this us and them mentality. And I certainly do think that some people are more at risk based on genetic environment, social factors, but this is something that we are all struggling with in some degree. I mean, we all have our addictions. You can be addicted to work and you may miss out on.
time and experiences with your family that you can't get back. And obviously, you know, there are levels and degrees to this, but we've got to stop viewing this as a them problem or an other problem. This is an us problem. This is a societal problem. There's a reason we see one out of five world overdoses in a country that has four and a half percent of the world's population. we're trying to get away from ourselves and
I think it kind of also goes back to marketing outside of medicine. think marketing in medicine has gotten just absolutely out of control since direct to consumer advertising. But even before that, there's all of this marketing like, Hey, buy this thing and you'll feel better, right? achieve this and, you know, you'll, you're, then your life will be able to start, then you'll be happy. So I think fundamentally, we just have to find a way to.
Ethan Short (54:15.118)
Find this common ground as human beings that struggle and seek to get away from that struggle in ways that can be very counterproductive to very different degrees, depending on what we're doing to get away.
Roger K. McFillin, Psy.D, ABPP (54:30.742)
Yeah, totally agree. And I think that speaks to the range of normality in us, in how we approach our lives, that we have almost automatically accepted that, you know, there are socially acceptable ways of escaping. And then there are ways that we demonize. And, you know, we can create that us-versus-them mentality.
I'm a sports fan, Philadelphia Eagles fan actually. So, you know, really excited talking here today about the Superbowl. I'm watching the Eagles game on Sunday and it feels like half the commercials are alcohol related, right? And so like alcohol or gambling, So we've normalized that into our culture, right? To go out, to have a number of beers, watch a game or even bet on the game is somehow socially acceptable.
Ethan Short (55:12.362)
or gambling.
Roger K. McFillin, Psy.D, ABPP (55:27.564)
And then we question why we have more and more people who are turning to external means to change their and alter their experience. Even if it's drugs that obviously have much worse outcomes, you know, the potential consequences of heroin, for example, are pale in comparison to that of caffeine, but your point is, well taken. So now let's get into solutions. First of all, I wanted to learn more about addiction medicine.
I've been having conversations recently with some policymakers on this area and like just discussing the role of government and you know, just, you political ideology and the way it influences the discussion points in America and what we can do with even taxpayer dollars to try to help change this. So my first question is around the incentive structures that exists in
in maintaining substance abuse, right? On one end of the spectrum, there are some left-wing policies where, you you're talking about free needle exchanges, open use, you're pretty much keeping, you know, addicts on the drug. And we've seen some of the detrimental effects of that, certainly in major cities, like, you can't even go to San Francisco anymore, you know, because there's just encampments where people are
freely allowed to use without any criminalization at all. On the other end of the spectrum, you know, there might be views that, you know, tough love is that you have to hit rock bottom in order to make change. If you're incentivized to continue to use these drugs are so powerful, they hijack the brain in a way that your entire
life becomes about getting that fix. Like that's all your brain will think about. And you're evolutionarily and biologically designed to do that, right? Because the only way you're going to feel okay is if you get that drug. So then there's a lot of people who are maybe ex-addicts and say, hey, you have to get sick and withdraw. Not withdraw. You know, just you'd have to suffer the effects of withdrawal.
Roger K. McFillin, Psy.D, ABPP (57:47.584)
in order to come to some conclusions in your life, that you have to make change, that the consequences of this drug, you far, you know, supersede any of the benefits that you're getting from it. It's ruining your life and even viewing it from a spiritual perspective. Find God, go through this pain and transform through it. So those are like maybe two endpoints, right, of like two dialectical extremes really in policy.
And then there's addiction medicine, right? Where we have drugs to help ease the withdrawal or the struggle. And so I want to get into that entire spectrum. I want to know where you fall, what you believe is the most compassionate yet effective treatment for people who are addicted. And where do we need as a culture to get people first off drugs and sober, and then to prevent it in the first place?
Ethan Short (58:40.748)
So I wanna lead with, I have a lot of inherent knowledge through experience on this issue, but I also have to throw caution to the wind or throw caution out there that I'm early in my career. I'm not gonna sit here and say that I am the expert on this. I do think that my ideas are good and could be helpful.
But I do just want to throw that out there. Like I don't want anybody to think that I'm promoting myself as, the expert on addiction, but there's a couple of, a few things that I want to mention on that, question. One is I got to give you a little bit of pushback. I am not a fan of the terms or the terminology or the labels, drug abuse, as well as addict. And so the drug abuse one is came from a patient actually.
And they said, you know, you talk about things like child abuse where somebody is bestowing physical violence or sexual violence on a child. talk about domestic abuse, but all of sudden it is that the person is abusing the drug. No, really the drug is abusing the person. Right. So again, I know that it is a semantics, but I think that that is something that does have some importance to decrease stigma.
And then the same thing with addict, Addict, schizophrenic, bipolar, you know, these do not describe the totality of who somebody is. And I think they can be very detrimental in treatment to say, Hey, you're an addict. No, no, no. You're a person who struggles with addiction that has a much more complicated and complex life history and factors that go into your addiction.
You know, but anyway, those are, those are maybe a little bit secondary. And again, it doesn't mean that even every person struggling with addiction, I've heard plenty of patients refer to themselves as an addict or a drug abuse. Did lose it?
Roger K. McFillin, Psy.D, ABPP (01:00:49.024)
Now I just wanted to chime in because I think you make some great points. And so it's worth highlighting. So the use of language I think is powerful. And so I would just be hypocritical if I dismissed the use of language when I talk about it so often. use of the word addict or the use of the word drug abuse, you made such important points because for myself in working with people who have become dependent on drugs,
You know, that is such a, it has such an impact on their sense of self that they really do begin to view themselves as broken or less than, and there is almost like there's some moral failing in it. And unfortunately that can maintain the cycle of drug dependence because now you're escaping that feeling of just feeling so inferior and having no meaning or purpose. And so I just wanted to,
I just let you know how much I appreciate that little piece of it. And I just learned a lot there. I'm sure a lot of people who listening right there learned a lot as well.
Ethan Short (01:01:55.328)
Yeah, absolutely. I mean, like you, like you said, if, if you feel like you're broken and you inevitably deal with the urge or the craving, which again is in my mind, it is the mind's response to something in your environment that is unsettling. And the mind is like, I remember the way to get away from this thing. so, you know, that, that terminology, I think goes a long way in terms of the,
kind of long-term treatment to say, this is not what you are. This is something that has afflicted you and is part of you, but is not your total experience and can be worked through. reference to, you know, mentioning kind of the two extremes with addiction treatment, what I would call the AA ideology and the MAT for everybody ideology, MAT being medication assisted treatment, the most, I guess,
common drug used for opiates now is Suboxone. Methadone may be one that more people are actually familiar with in the general public, but it's like so many of the, go ahead.
Roger K. McFillin, Psy.D, ABPP (01:03:05.25)
Yeah, those are important. I want us to be able to define those for the public what they what they do and how are they proven to be helpful or harmful.
Ethan Short (01:03:16.384)
Yeah. Yeah. Yeah. So I'll come back to that in just a second. but I was going to say like so many things we've talked about, we identified the extremes and I think that the answer or the best way forward is somewhere in the middle. think AA has so much to offer people. I've seen so many patients do so well. and I also think that
MAT using medications for some length of time. And for some people that may be in perpetuity, that, that, may have a role as well. I don't, I don't like, cause what I see most of the time is that treatment programs go in one extreme or the other extreme. And you know, when we're talking about medication assisted treatment, for opiate use disorder, methadone is a full opiate
agonist. so it gives somebody the opiate like effect and it binds a little bit more strongly to the opiate receptors. Therefore it can help if somebody is using another stronger opiate like fentanyl, which can kill, kill anybody with a very, very minute, microgram dose. You know, there may be benefit of that. I, I am not somebody who believes at all in methadone anymore because people can overdose on methadone.
there historically were, you know, four or 5,000 overdoses of methadone per year. Now suboxone to me is certainly different, but there is again, a lot of nuance there. Suboxone is what's called a partial agonist and what makes it so important in addiction treatment is whether I give somebody 12 milligrams or somebody tries to take a hundred milligrams, there's what's called a ceiling effect.
You cannot occupy any more of the opiate receptors beyond roughly three quarters of them with Suboxone, no matter how high on the dose you go. One of the, one of the things that drives me crazy is being in a addiction facility, which I can tell you about my experiences in those, in a little bit where providers are pushing Suboxone up to 24 and 30 milligrams when it doesn't offer any more protective effect yet.
Ethan Short (01:05:42.302)
It just causes more and more side effects like constipation and sedation. but with Suboxone, that can be such a useful tool for somebody who's early in the throes of a very serious addiction, to heroin, to methamphetamine, that both of those so often pain pills, cocaine cut with fentanyl. And that is the scariest thing about the drug market today.
is, know, you've got people who are seeking these substances out on the street, but then you also have college students who are trying to buy Adderall to study for their exams and they get something that's cut with fentanyl. anyway, little diversion there with something like Suboxone. It can be so important for somebody to be on early in their addiction treatment, especially so that if they do.
give into an urge or a craving and they use something that has fentanyl in it, Suboxone will block that fentanyl from killing them. Now here's where the nuance comes in and here's where my inherent skepticism comes in about Suboxone. From the business perspective, if I'm running an addiction facility and I only care about how much profit I'm making, well, I'm going to pair it with an outpatient facility that
prescribes the Suboxone after you've left the inpatient detox. And so often what I see is pushing administrative side, of these corporatized addiction facilities or these private equity funded addiction facilities, pushing for people to stay on Suboxone in perpetuity, no matter what, like there's some cookie cutter approach we can take to addiction that again, we've said is so multifactorial.
And in that way, you get somebody to come back to your business once a month forever. Now that may be in the patient's goals. And I would work with somebody and I, you know, I counsel people like, Hey, if you want to, if you want to come off of this, we can find a way off of it slowly, but surely in a way that protects you. But I have not made it at some of the addiction facilities that I've worked at.
Ethan Short (01:08:05.27)
because of those same philosophies, offering different paths, offering different ways, not saying, Hey, you've got to be on Suboxone. Like, Hey, this is something that could really protect you, especially in the short term. and I would recommend it right now, but we can work our way off of it when you feel comfortable in your ability to deal with the discomfort internally, the, the roots of the problem, when you feel comfortable,
You know, to deal with urges and cravings. So I think the answer again with medication assisted versus the AA model, it's somewhere in the middle, but we cannot have these cookie cutter treatment options where you, know, Suboxone for all detox for five or six days, no matter how long you've been taking a drug or what dosage. Nope. We're going to detox you in five or six days and you're going to have 30 days to.
to be better because that's our performance measure. And then we can report that we cured or we, you know, this percent of people got through treatment at our facility, but we're not going to tell you how many of them died in the next three months or six months, or how many ended up coming back to inpatient treatment, or how many freaking. Golly, I can't, I just haven't made it in that world because,
I was being scolded for taking people who were then put on eight different psychiatric meds coming off of heroin for saying, Hey, maybe we should take a couple of these off of your regimen. Anyway, a little long-winded.
Roger K. McFillin, Psy.D, ABPP (01:09:45.614)
So is that when we're talking about incentive structures that there's a financial incentive to keep people on drugs as long as possible, especially if the facilities are banking from that same approach.
Ethan Short (01:10:05.44)
Well, in my understanding is that our government also profits off of Suboxone that they, the NIH had a large vested financial interest in Suboxone, but I admittedly don't know enough about that to speak at length on it. But yes, I mean, absolutely. And so I've worked in four different treatment facilities. One of them was outpatient and I was
pretty sure they were committing fraud. So I left there. another, the next one, they were trying to dictate how I, treated, a patient and telling me what to prescribe from somebody who didn't have any prescribing experience and didn't have credentials to be able to prescribe. and then the, the following two were, you know, I was trying to bring people down on their medication load.
I was very, you know, passionate about, I'll just give you one specific example. I had a 55 year old lady. come into the treatment facility one day and she's in a wheelchair and she's slurring her words and she just doesn't look good. Blood pressure is pretty low. And I'm like, what is going on there? she's just like, like, it's just said, that's just her. She just liked that. Is she normally in a wheelchair? Well, no.
So she had come in coming off of fentanyl. She had been given Seroquel, which is a anti-psychotic and used as a hypnotic or a sedative as well. She had been given a half dozen other drugs when she's not even 24 hours off of fentanyl. And so I immediately sent her to the hospital to make sure she didn't die. Three days later, she's back. She's walking around the facility. She is.
participating in all the groups she's doing so much better. but that story played out so many times and you know, I'm trying to start, treatments that are going to be, if they're going to have effect, it's going to be more in the longterm. And I'm trying to bring people off of these things that are blunting their emotions. and what I think is limiting, not blatantly terrible medication combinations that could kill them.
Ethan Short (01:12:28.214)
the lesser evils, you know, medicines that are ultimately not going to lead to long-term recovery.
Roger K. McFillin, Psy.D, ABPP (01:12:36.738)
Let me go back to Suboxone. I just want to get your medical opinion. And I know that each situation is individualized and I think you made it clear that, you know, you want to have the freedom as a doctor to be able to treat each person individually based on their circumstances. And I support the same thing. We have to have the best doctors out there who are ethical and act in the best interest of the patient's health and wellbeing. But if you were to say, all right, how do we safely and effectively use Suboxone for the best long-term health outcomes?
Are you suggesting that, you know, Suboxone as a temporary treatment, usually in the beginning, really serves its purpose and that you have concerns about the long-term use of Suboxone and the problems that could be associated with it?
Ethan Short (01:13:24.598)
Yeah. I mean, I think that my view on Suboxone is I'm never going to force somebody into a treatment because I just never think that is helpful. If somebody is not willing and wanting to participate in that treatment, then it's probably not going to be useful in the longterm. so it's something that I offer up and I essentially try to offer multiple different avenues. you know, in terms of longterm, dangers of Suboxone.
I don't think it's necessarily any more dangerous than the drug. And if I have a patient that says, doc, I can't get away without using this or having this suboxone. and they're working and they're living their life and they're engaging with what's important to them. have no problem maintaining them on the drug, longterm. I certainly think the ideal approach is to utilize it in the short term while they, you know,
improve their functioning in other areas and bolster their treatment with some of those more long-term, more effective treatments, diet, exercise, positive social engagement, mindset shift. but I offer pretty much every patient, Hey, we can come off of this. Now that is a problem coming off of Suboxone is a problem. And the longer you're on it, the harder it is to come off of it for the same reasons that it is.
more effective than methadone because it binds so tightly to the opiate receptor that fentanyl just swims around in it's trying to bind and it can't. But over time, just like a bandaid that's been on your skin for months, it's going to hurt when it comes off. And so I think we don't have enough respect for the influence of chemicals on our brains and bodies.
thinking that we can just bring anybody off of Suboxone in a week or two, as opposed to saying, Hey, you're on 12 milligrams. Let's drop you down to 10 milligrams and see where you're at. Let's then drop you down to eight milligrams and see where you're at. So I think ideally that would be the most effective way is you use it as a tool in the short term. You bolster the treatment in other areas, which not everybody is going to be willing to engage in those other areas of treatment.
Ethan Short (01:15:48.598)
Now I would not withhold Suboxone from somebody if they said, no, I'm not going to go to therapy. I'm not going to, change my social group. I'm not going to diet and exercise. I'm not going to tell that person. I'm not going to prescribe them a potentially life-saving drug. And hopefully over time, they will shift their mindset and be willing to engage in some of those, what I would say more effective long-term treatments. but we've got to give people options. We've got to try to understand the.
H what they have, what they are, what they do, what they experience, all those dimensions of their addiction illness. and then individualize that treatment. And a lot of people really do get a significant benefit, from AA, but the story that comes to mind on that is I was working in an addiction facility one time and, or sorry, in an inpatient, psych unit and as a
senior resident and a, one of the aides, uh, at the facility. Um, I, I recognize her and I said, how do I know? said, oh, I was in this, uh, addiction treatment facility where you were at and you know, how are you doing? Oh, you know, haven't used, uh, meth in two years and, uh, doing really well. the Suboxone came up and she said, well, you know, people aren't sober if they're on Suboxone. And I said, oh, you didn't.
Then I proceeded to watch her smoke 25 cigarettes in a day. And, you know, I didn't press the issue, but I'm sitting there thinking, so how are they, you know, still addicted, but you're not, I don't understand, you know,
Roger K. McFillin, Psy.D, ABPP (01:17:21.026)
Yeah.
Roger K. McFillin, Psy.D, ABPP (01:17:33.504)
Yeah, and you addressed this earlier, and I think the strength of AA isn't its community, right? And that's powerful. But if it becomes something that becomes that a person feels judged, and not loved and not supported, right, then it becomes has a cult like feel to it. And the thing about an AA program, tends to be its strength depends on the quality of the people in there, right? So if it becomes this new forced ideology,
that is put on somebody and then there's a moral failing that if you don't adhere to their rules, it loses its effectiveness, right? And so I think one of the things that you're saying and it's an important one is, listen, this is a complex issue. There are reasons why a person used in the first place. And if you throw them right back into the same environment without skills, without new ways of living, without a new approach, without
a real strong plan that includes community support and other interventions. The likelihood of their relapse increases rather significantly. Now, if we have a tool that's a medicine, even though it has consequences, and that helps mitigate some of those risks, we're talking about a risk benefit profile, one that we have to really analyze. has to be...
Ethan Short (01:18:54.304)
Are you in my head? Are you in my, in my mind? Cause it to me, it's all about the benefit to risk ratio for what I do. And it's not totally predictable, but that is how we've got to conceptualize what we do.
Roger K. McFillin, Psy.D, ABPP (01:19:10.124)
Yeah, and that's the way to communicate it. And here's the most important part, Dr. Short is, are you open and honest and transparent with your patient about that risk benefit profile? And you're respecting their individual right to choose under informed consent and medical freedom. And as opposed to what we're seeing right now is there is a medical authority
You have to follow what the authority tells you to do. And they misrepresent what the outcomes are, or they minimize the impact of the potential harms. And then a patient is harmed, right? And now you violated that trust. And now we are really eroding the trust in very important institutions that we need to depend on our physicians in our country, that they have our best interests in mind.
And that's what's been eroded. And there's a lot of reasons why that's been eroded. Some of it is, you know, coming out of COVID and the public health authorities. But other is this like long standing history that we are in a system where Americans are getting sicker, where Americans are getting more dependent on drugs. And we're getting the same medical advice. In fact, we're getting the same medical advice without even identification of the risks. And who
who's gonna just continue to do the same thing over and over again and expect different results without now challenging the authority. And so when I come out and I challenged what has become the medical authority, that's when I get branded and we're, you know, sarcastically talking about that at beginning of the show, anti-psychiatry, anti-science and so forth, when really pro-science, pro-informed consent, pro-medical freedom, I myself talk about drugs as drugs and they have drug effects.
Right? I'm not anti drug. It's a it's a tool. It has a drug effect. It might have a use under in one circumstances on one condition and can be incredibly harmful in another one. And if we don't talk about what those situations are, honestly and transparently, and we throw out there, take the medicine, this is your medicine, this is your cure. And it stops there. And we use words like life saving, life changing, we use words like anti depressed and anti psychotic, and we use the marketing terms without getting into the details of it.
Roger K. McFillin, Psy.D, ABPP (01:21:33.858)
This is where people get harmed.
Ethan Short (01:21:37.44)
Yeah, absolutely. I mean, it, you know, and to mention this about Suboxone, you know, the science says that people will live longer if they stay on it forever. Right. And, and I am very skeptical of that science. and don't think that we can just apply it to this, you know, the entire population of people struggling with addiction.
Rand Paul mentioned or talked about this, or something similar in the confirmation hearings yesterday. thought what he said was so poignant and well-spoken talking about the COVID vaccine, right? Which I have been hesitant to talk about with my podcast because I'm young in my career and you know, getting canceled or discredited. I want to be able to support my family and, but
We're on radically genuine. let's try to be a little bit radically genuine. So he, he shared the same view that I have, you know, when I go to the pediatrician in every freaking time, they're trying to give my kids COVID vaccinations and they, the look that I get as a physician, them knowing that I'm a physician is, we got one of these, we got one of these, misinformers here.
Well, do you know that there's good data on, and I said, do you know that almost nobody else around the world is vaccinating six months old for COVID? Did you know that children, especially under the age of, you know, five or six years old, they're not getting sick with COVID. You know why? Because a fundamental medical, you know, philosophy or, or the tenant is.
As that young person, you don't have as much of an immune reaction to things. You don't have the ability because your immune system is not as developed. And so what kills people with COVID is not the infection itself. It's an overreactive immune response to it that overwhelms their lungs around day five to day seven. And that is just not going to happen as often in kids, especially in healthy kids.
Ethan Short (01:23:59.906)
And so Rand Paul says, you I'm told that I should vaccinate my six month old for COVID. And I just fundamentally don't agree with that, but it doesn't mean that I'm anti COVID vaccine to anybody. Like, I think it's very reasonable to consider the fact that somebody who's over 65, who has diabetes, who is overweight, that has these risk factors that they may benefit from that vaccination that as that age individual.
Their immune system is on the way down. And so they may get a benefit from getting a little immune response ahead of getting the infection. but this, the, the vitriol around that conversation in 2020 that it was, it was insane. was intense and it tried to put everybody in the same basket for something that was absolutely brand new. That it's effective for all and it's safe for all. And go back to what my.
Pharmacist mom said, I just didn't know that. There's no way for us to know that this early.
Roger K. McFillin, Psy.D, ABPP (01:25:04.61)
And isn't your example, one of the reasons why the public trust in the medical authority has become eroded because we have lost the independent scientist practitioner model of physicians. That pediatrician who was making that recommendation has not evaluated the science on that. She's just blindly recommending it because it's part of the protocol of the place in which he or she works. And I've
done the work on this, had Amy Kelly on my podcast, where we talked in depth about the science of the Pfizer mRNA trials, right? And it's very, very clear that that is a harmful intervention. I don't think we have the data that even suggests that an older person would benefit from it. I'm not saying that we might not.
we may, we just don't have the data. There was no long, they stopped the trial. And so that's what happens when you don't study the results long-term is you're not gonna be able to make, come to any conclusions. So as a ethical scientist, I would say, you know, we don't have that. It's a personal choice for you. There are potential risks for taking this intervention. But when it comes to healthy people, young people,
It's absolutely a harmful intervention and we were all lied to. And so when we talk about the incentive structures, we automatically have to step back and say, why were we lied to? It was intentional. It's not that they didn't know, they knew. So when Joe Biden tells the American public that this is a vaccination that decreases hospitalizations and death, and that the unvaccinated are going to be a winter of death or whatever the exact words were.
You know, he's clearly lying to what end? Who's he serving? And this is what we unfortunately saw during the RFK hearings is that you senators who are certainly influenced by pharmaceutical money, right? It looks like and it sounds like they are attorneys that are representing those industries. And so that's where we have this
Ethan Short (01:27:10.753)
No.
Roger K. McFillin, Psy.D, ABPP (01:27:23.854)
Unfortunately, this is where we've had the financial conflicts of interest between our elected officials and industry. And we no longer trust the federal government's reporting of what is safe, what is effective, what is top line science. it just seems like on at least for a number of senators, especially
you know, Democrats who were trying to fight against the RFK nomination and confirmation that they haven't learned that we've already understand the playbook. Like you're gonna have to change it because the veil has been lifted. We know what you're doing to us. We've all awakened. You're gonna have to adapt. You're gonna have to adjust. We don't trust you. There's nothing that you're saying that we trust. have no more credibility. So you better start speaking about the nuance of
this, right? Like now is the time because we can recognize that that's a critical thinker. That's someone who cares and put time into this issue.
Ethan Short (01:28:25.214)
Yeah. It's funny that you mentioned that because I have sitting in front of me, something that I had written down a while ago to put on my podcast. And I never have yet. Um, but I was researching one day the congressional investment in the major pharmaceutical companies that made the most money during COVID and the biggest, you know, uh, one of those is Pfizer. Absolutely. But you had 39 members of Congress back in 2018 investing.
You know, at least a thousand dollars in Pfizer, you have a Jim Sensenbrenner investing somewhere between one and $5 million. And then you've got a situation where the government buys the vaccine from Pfizer using American taxpayer dollars, then cites to me that it's providing free vaccine, but you're using public funding for decades. You've got Pfizer making
$38 billion from the vaccine in 2022 and, you know, another 19 billion from PAXLVD. Um, and fundamentally this just drove me up a wall at the beginning. And I've been saying this to friends and family from the outset to colleagues. We learn in basic virology when there is a new respiratory virus that our immune systems haven't seen before, right?
Like let's say maybe it leaks from a lab. That was a conspiracy theory four years ago. And now it's the most likely conclusion, huh? Weird how that happens, but respiratory viruses, when any virus that our bodies, our immune system see for the first time can be very dangerous for us because we can have a massive reaction to this new and foreign substance. Whereas when you're talking about an evolution of a virus that's been around forever,
You might have little evolutions or, what's the word that they use in the media all the time? yes, mutate mutations, right. And I feel like they said it like, know they didn't, but they, said it like mutations. right. Respiratory viruses want to survive just like everything else. So what do they do throughout the course of history and
Roger K. McFillin, Psy.D, ABPP (01:30:25.208)
mutations.
Roger K. McFillin, Psy.D, ABPP (01:30:34.146)
That's an evil word. Scary, right?
Ethan Short (01:30:46.114)
All of these viruses that we've ever dealt with as a human population, they evolved to become more transmissible and less deadly. So over time, it's exactly what you saw with COVID. The numbers of people that tested positive went up and up, but the fatality rate dropped and dropped and dropped as we suffered with our second and our third bouts of COVID. that was never talked about.
All we heard was, you know, mutation, mutation without the appropriate scientific nuance that mutations in viruses are good for us.
Roger K. McFillin, Psy.D, ABPP (01:31:26.594)
Yeah. Well, you heard about it outside of the mainstream media. And so that's another group that's lost its credibility because it seems to be just a talking point for, you know, federal government. And, you I want to speak to what you were mentioning earlier about incentive structures and the federal government where essentially it's insider trading when you can get this inside information and the federal government is going to not only buy these vaccines, but also market it. You know, what is the incentive for the pharmaceutical industry?
who has protection against liability. you know, essentially it is the free market that allows the the safety of products to be investigated because if I'm creating a new product and a vaccine is just a product, we, you know, it's become a religion itself where people worship the word vaccine. The COVID mRNA technology is not a vaccine, it's a gene therapy. But
know, what is your incentive? Well, I want to study it long term before it goes to market. I want to make sure it's not only helps people, but they're safe because if there's going to be an adverse reaction or a potential fatality, then I am liable for that. am financially liable. So therefore I am incentivized to make sure that this product is safe. When the federal government removes that liability from the pharmaceutical companies,
Right? What is the recourse of people who are harmed and what is their incentive in any way to investigate this long term? Aaron Seary, who is a attorney for ICANN, informed consent action network, who's done so much great work on this, speaks about this. Listen, this is just a product, right? know, American people should have access to a product with all information, but they should also have the ability to be able to protect themselves in case they've been harmed by a product. That's how a free market works.
And so when the government is in bed with with industry and there, there's no longer a separation like the FDA is funded, what 50 % to 60 % of money coming into the FDA is funded by the pharmaceutical companies, that's a conflict of interest. So no longer they acting on behalf of the taxpayers, they're acting on behalf of the industry, right? And if they are the ones that are buying this product and marketing this product, and they can be sued,
Roger K. McFillin, Psy.D, ABPP (01:33:51.784)
companies can't be sued, but the federal government could be sued with, I think, a number of limitations. Well, that's when you erode the public trust because you are miscommunicating the potential harms. And when there are legitimate harms, you are now incentivized to dismiss those. Like right now, there are legitimate concerns about the vaccine schedule.
about specific vaccines, about vaccines in neurological conditions, vaccines with autism, and a number of health conditions. Because we have enough situations where we have, first of all, we have the rising numbers, but parents will say, my child changed the moment they got that vaccine, or my child died after that vaccine. So then if you just go into, well, it's the correlation versus causation argument, then all of a sudden you're saying, well, we don't have hard science on it. Well, how are you gonna have hard science if you don't investigate it?
Right? And then you get on the microphone and say the science disputes it, which are clear lies. So essentially like how we're going to close out this discussion today is you deserve the information. You deserve to know the risks. It's a right. It's a law. As healthcare practitioners, whether you're a psychologist or you're a psychiatrist or any medical professional, it is the law and it's an ethical standard for informed consent that you not only know this,
that you put the time into this, you understand the nuance that you can understand a risk benefit profile and then make a recommendation for a patient and respect their right to make a choice while also carefully understanding what the alternatives are because there are alternatives to every intervention. And if you don't do that, you're violating ethics, you're violating law. So the pediatrician who wants your toddlers to get a COVID vaccination is violating their
ethical standard and violating your right to informed consent. And we're not holding medical professionals and mental health professionals to that standard anymore. And part of it's modeled from the federal government, right? They hold a standard. They've dumbed down so much about the discourse. So it is really up to us as the individual practitioners, young
Roger K. McFillin, Psy.D, ABPP (01:36:09.486)
psychiatrist like yourself, I imagine you might be a millennial, millennials are driving this maha movement. They're, they're driving this discourse, thank God, right? And we need to have ethical and conscious clinicians like yourself, speaking out and having, having discussions on this with the nuance that it deserves, and staying away from the rhetoric that's pushed in social media.
I understand people will say out there, well, Dr. McPhil, aren't you pushing that rhetoric? Well, to some extent, I am on the harms. So when so many people are unaware of what the harms are related to SSRIs or polypharm drugging, or misrepresenting psychiatric diagnosis, yes, I go hard on social media to educate the public in a way that allows that information and to hit the algorithm and have people get access to it. That is an intentional and purposeful
decision on my part. And I think it's saved lives. Actually, I know it's saved lives because I've gotten overwhelming amount of emails who said, thank you, I've been able to do research, or we didn't make this decision because we know better now. Right. But once you have these long form discussions, like we're having today, that's our opportunity to talk through this, right. So this platform exists for me. So if people just look at an X post, that's limited in characters,
You know that you can go somewhere else to the radically genuine podcast or go to my sub stack and you can understand a little bit more of the nuance and the detail. Unfortunately, and I'm going to say at least 95%, probably more are just following guidelines, following what they were told, following what they were taught, not even potentially knowing the level of influence, pharmaceutical money.
that has gone on into those recommendations. And they believe they I mean, they ultimately believe they're practicing good science. And unfortunately, that the market's gonna have to drive this. And the market's driving it from recognizing the harm and then creating new alternatives in mental health and in substance abuse. And I'm so grateful for today's conversation.
Ethan Short (01:38:34.844)
Yeah. I mean, that's what Renegade Psych is all about. I mean, it is so that, you know, I can continue to grow and learn as a clinician, but to get the message out there, I probably need to do a little bit more work on my understanding of the algorithm, but I want people to have an outlet for nuanced discussions for, Hey, you know, this one, we don't really know the answer to that. this is the likelihood, you know, the, the, what I would say the probability that
this theory is correct versus that theory. We don't know for certain. and for any, you know, deemed expert out there, if somebody has not reviewed the full body of literature and research on something, I don't care what your opinion is. If you haven't reviewed both sides, but in doing this podcast, it has forced me into interactions with people on both sides of the aisle.
people on both sides of academic debate on certain, you know, issues, the role of SSRIs or the basis of something like schizophrenia. The people who are saying these things are not, they never were a conspiracy theorist. They, they are, I mean, you're talking about Michael Nels, who's an MD, who's a PhD, who worked on mRNA technology.
And he is telling us that this can create these vicious cycles of inflammation and decreased resilience to stress. you talk about Harvey rich at Yale school of public health, who was essentially canceled for saying that hydroxychloroquine maybe had a role. This is a guy who's got a 40 year career in public health, who has always, carried a lot of respect in the academic community that.
All of a all of that got flipped on. It's these are not lunatics saying this. am, I am not somebody that I, know, in going through medical school and residency and taking tests after test and ABCD and E, these are the options and find the right answer. You realize that there are some extremely intelligent minds out there. There are people who can.
Ethan Short (01:40:55.826)
conceptualize at the molecular level, what's happening, and you can just see in their minds, they can even visualize the way that neurotransmitters interact with each other and downstream changes. That's not me. But I think what I do offer, what I am good at is listening to people, understanding their backgrounds and their motivations, and then coming to my own reasonable conclusions based on what actual experts say.
And the actual experts very, very rarely will have these hard line stances that they're absolutely correct. My, my favorite attending a psychiatrist in my training, he would go on this rant about how, know, this thing is influenced, by the sodium transport channels and ourselves and the potential for mania. And he'd get to the end of this long, very reasonable and detailed explanation.
And he'd say, but maybe that's completely wrong. And I'm totally off base on that. Like leave the, leave that room open for that uncertainty. you know, I think, if, if it was people without any scientific background making these arguments, then I probably, and again, just the standing back and watching at the beginning with, you know, being dictated as to how to live my life, the propaganda that came out that
Roger K. McFillin, Psy.D, ABPP (01:41:59.146)
Yeah.
Ethan Short (01:42:24.376)
was not reflective of basic common sense science and, and, you know, medical training. it's, it's, I don't know what the answers are. don't know. you know, the full effectiveness or safety of something like the COVID vaccine. I certainly am. And I hate that I even have to say this, but I am absolutely pro vaccine. So many vaccines have been so critical.
for our development as a society and eliminating, you know, really, really dangerous and debilitating diseases. But we can't just say that because there's effective vaccines out there that every new vaccine is effective. That is so silly and you're
Roger K. McFillin, Psy.D, ABPP (01:43:10.102)
or combining them in ways that haven't been combined before on a very vulnerable developing baby with the immune system that you spoke about earlier.
Ethan Short (01:43:22.236)
Yeah. So, I mean, it's, it's just, I recognize that I am being force fed something and not, not something, but a lot of things. and it doesn't mean that I know the truth because I recognize that some aspects of what I'm being told are the truth are probably not very accurate. but it does mean that I know that I am being lied to and I can't just inherently trust.
my government, the response of, you know, to these, major, societal issues. I don't know where I'm going with that. I was going to mention something about our training and how that plays into, you know, doctor's roles and all this, but, maybe.
Roger K. McFillin, Psy.D, ABPP (01:44:07.352)
We're going to end up continuing this conversation on the Renegade Psych podcast, right? So, now I want to alert all my viewers right now and those who are listening to this, that this is a new podcast. And if you're as impressed with Dr. Short as I am and really enjoyed the refreshing conversation that we had today, that he's going have a lot more of these.
Ethan Short (01:44:14.258)
Yep, absolutely.
Roger K. McFillin, Psy.D, ABPP (01:44:34.366)
And I'm going to be on shortly. I don't know when that will be released, but, you know, we'll, we'll get into even more nuance and more depth on some of these, these subjects. And I really do encourage everybody to check out his work. have a pretty good feeling that, he's going to advance the conversation, because this is exactly what we need in psychiatry and addiction medicine. need somebody who is an independent thinker and a critical thinker, but cares about people.
and motivates people to make legitimate changes and then has the ability to...
to really reflect on the limitations of the information that's provided to us and have humility in communicating this to our patients. When you do that out of love and you do that out of compassion, you talk about things from a completely different perspective. And this is what you heard from Dr. Short today. It's like, hey, we have these tools, we have these options. There's no perfection. Life is hard. It's challenging. There's risks and there's...
benefits. And, you know, it was even interesting when you asked that question about what we do know and don't know. And I just kind of went to some common sense basic things, right, that tend to get, I guess, overshadowed by the new technology that we try to advance. you know, just I know that having somebody in a space where they're reflecting and they feel cared for, and you're looking out for that person.
and you're predicting consequences and you're improving their ability to solve problems and you're validating what they've gone through and you see them as a person who is capable of recovery and capable of transformation and you start setting up these opportunities for them to do that. Then you can look at medical interventions differently. Then you can say, this is what it does, this is what it doesn't do. And I think maybe what I'd like to do is in the next conversation that we have on the Renegade,
Roger K. McFillin, Psy.D, ABPP (01:46:45.676)
Psych Podcast is, you know, also talk about, you know, what are the damages of long term drug use, whether those are prescription drugs, or those are street drugs or whatever alcohol, you know, they do affect the brain. And you know, even SSRIs, they affect the brain, some people can't get off these drugs. And we're not very good at tapering people off successfully, without them having to deal with the horrible consequences of that, which unfortunately then drives more
ineffective behaviors and some problematic use, right? So there's so many, there's more nuances to this. so because we've taken, I've had you on so long, it's like probably a good place to stop. Where else can people find you? And the Renegade, if you can tell us a little bit more about the Renegade Psych podcast.
Ethan Short (01:47:34.352)
Yeah. So, social media wise, you can just, you know, at renegade psych, Instagram, Facebook, Twitter slash X, over the summer, I started releasing video interviews and started adding graphics. If we reference things like a specific paper or a news article then, so I did that over the summer. that's on YouTube. Same thing. Just type in renegade psych there.
like subscribe to all those things that I hate telling you to do, but are probably important in terms of the overall mission of kind of spreading the messages, far and wide as possible. and interact with us, however, you know, email me renegade psych at gmail.com. you know, my team, AKA me will respond to it. leave a comment, you know, if you have somebody that you think would be a good guess, let me know. And I'll see if I can find a way to work them, into my schedule.
Roger, I got to say it like I am so appreciative for you having me on and especially on, you know, such short notice because as a young provider, you know, I'm, I tend to be a pretty stubborn and that goes way back before I ever did any sort of medical school or any of that. and stubborn, I'm able to move off of my stance. If you show me the evidence and the research, but to be quite honest, you know, going through the training process and.
you know, being laughed at for asking certain questions that I thought were very logical, like why use an SSRI if it increases suicidality? You can get to a point losing jobs for doing things that seem so in line with what is medically reasonable and good for the patient. It can really be demoralizing and defeating over time operating within that system and
One of my favorite parts about doing my podcast is that I get to talk to other people that make me feel like my views are so much more reasonable than, than they have in the past. so, you know, that is so, so important. It, I find myself after these conversations, just feeling a lot better through the rest of my day and feeling support from others in the community. So.
Ethan Short (01:49:55.718)
I seriously do appreciate and I appreciate everything that, that you're doing and trying to promote a very similar message.
Roger K. McFillin, Psy.D, ABPP (01:50:03.064)
Well, I appreciate you stepping out of the medical group think and having the reasonable discussion today. And I think what we, we learned it is certainly not fair to label me as anti-psychiatry when I support, psychiatrists like Ethan Short. In fact, I'll, I'll repeat what I've said in the past. think psychiatry as a profession can evolve in advance, for specialties and working with people with mental health issues. There's a whole range.
of science that's growing from circadian biology to nutritional psychiatry, to safe tapering practices, to knowing how to use drugs in a way that can actually support recovery and not create long term health issues. There's so much there. It is a complicated and nuanced profession. We require the best to be a part of it. And unfortunately, there's too many who don't understand the nuance and are not practicing in that way and are not evolving their
profession. Dr. Shortwill, I want to thank you today for a radically genuine conversation.
Ethan Short (01:51:08.306)
Thank you.
That's a perfect play.
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