Beyond the Prescription

Dear friends, The day I’ve been working toward for 3 years is finally here! It takes an *army* of supporters to launch a book. The video above is to say HUGE THANKS to everyone who has purchased books and supported this process. I wrote Beyond the Prescription to help you, your friends, and loved ones become empowered patients, armed with tools and actionable information to get what you need from our medical system. If you haven’t yet purchased your copy of Beyond the Prescription , today is the day! 🥳 🙏 📣 🎁 🎉 🥰 You can purchase and gift a copy here: With love and gratitude, Lucy P.S. If you purchased the book through my website, it will arrive within a week. And to anyone in DC, come celebrate with me at Politics & Prose (Conn Ave location) tomorrow night 8/12 at 7 pm ET. 🥳 🎉 Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

BEYOND THE PRESCRIPTION officially goes on sale next week. Get your advance copy here : Last week, I spotted a large box on my front stoop as I pulled in from work. It was either the dog food I‘d ordered from Amazon or fresh-printed copies of my debut book. When the return address read “Simon & Schuster, New York City,” I thought to myself: the dog is going to be hungry and THIS IS IT! I called out to my husband and asked him to film this moment. He shot it in one take, no prep. As you can hear, I have lots of instructions for him 😆 Let me know what you think! (Besides needing a box-cutter ✂️) Last, a huge THANK YOU to this readership. Without you, I wouldn’t have gotten the book deal, I wouldn’t be reaching people far and wide, and I wouldn’t have built a community of supportive, curious, thoughtful people who want to be more okay tomorrow than you are today. See you next week! 🙏 Lucy *BEYOND THE PRESCRIPTION* BOOK UPDATE: UPCOMING EVENTS 👉 * August 6 @ 6-7 pm PT | Zibby’s Bookshop | Santa Monica, CA | in conversation with Elise Loehnen | RSVP here ! * August 12 @ 7-8 pm | Politics & Prose | Washington, DC | in conversation with Franklin Foer * August 15 @ 1-2 pm | Mitchell’s Book Corner | Nantucket, MA | book signing My book, Beyond the Prescription , comes out on August 11. I wrote it with you in mind. The book is a roadmap for navigating your health in real life without perfectionism, pseudoscience, or shame. You can order your copy at Amazon , Bookshop.org , or Barnes & Noble . Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

My book, Beyond the Prescription , comes out on August 11! I wrote it with you in mind. Episode Summary Dr. Lucy McBride sits down with Dr. Amy Commander, breast oncologist at Mass General Brigham and author of Paving Your Path Through Breast Cancer and Beyond , to cut through the fear and misinformation around breast cancer. They cover who is actually at risk, what the screening guidelines mean in practice, what lifestyle factors move the needle, and how to make sense of the HRT and breast cancer conversation — including what the evidence actually says about hormone therapy for survivors. Risk: Genetics, Bad Luck, and Everything In Between * Only 5–10% of breast cancers in the U.S. are due to identifiable inherited gene mutations — BRCA1 and BRCA2 account for roughly half of those * Another 10–15% involve familial patterns without a single identifiable gene; the remaining majority are sporadic, meaning they occur without an inherited cause we can currently explain * Having breast cancer in your family doesn’t mean you have a genetic mutation — given that one in eight women will develop breast cancer in her lifetime, sometimes it just means you have women in your family * A strong pattern — grandmother, mother, and sister all with breast cancer — is a signal worth discussing with a doctor; a single relative is not necessarily a reason for genetic testing Screening: Mammograms, Dense Breasts, and MRI * Mammograms do not cause breast cancer — annual screening starting at 40 is recommended for average-risk women, with the end point determined by a shared conversation with a doctor * Dense breast tissue makes mammograms harder to read — finding a tumor in extremely dense tissue is like finding a snowman in a snowstorm; about 10% of women have extremely dense tissue and most should add an annual breast MRI staggered six months from their mammogram * Heterogeneously dense tissue is common — up to 40% of women under 50 — but not everyone with it needs an MRI; the decision depends on other risk factors and should incorporate a validated risk model like the Tyrer-Cuzick calculator * Breast MRI catches more, but also generates more false positives, particularly on the first scan; the downstream anxiety and biopsies are real costs that belong in the conversation Lifestyle and Prevention * Alcohol is the most consistent and modifiable lifestyle risk factor for breast cancer — even one drink per day carries a small but real increased risk, and the relationship is dose-dependent * Maintaining a healthy weight and engaging in regular physical activity reduce risk — partly by reducing circulating estrogen in post-menopausal women and by improving metabolic health overall * Soy is not a risk factor for breast cancer — this is a persistent myth; soy foods are a good source of plant-based protein and the evidence is clear that they are safe * Risk factors divide into fixed (age, sex, genetics) and modifiable (alcohol, weight, exercise, metabolic health); the goal is to lean into what can be changed without catastrophizing what cannot HRT and Breast Cancer: Separating Fear from Evidence * The fear around HRT and breast cancer stems largely from the 2002 Women’s Health Initiative study, which used synthetic progestins — not the bioidentical hormones most commonly prescribed today * In the WHI, women who took estrogen alone — those who had undergone hysterectomy — actually had a reduced risk of breast cancer, a finding that was not widely reported * The overall increased risk from combined hormone therapy is small, and causation has not been established; a family history of breast cancer is not an automatic disqualification from HRT * HRT is a tool in the toolkit, not a solution for everyone — the right answer depends on individual risk factors, symptom burden, and what a woman is willing to weigh Vaginal Estrogen and Breast Cancer Survivors * Vaginal estrogen is considered safe for virtually all women, including most breast cancer survivors, because systemic absorption is minimal * It is distinct from systemic HRT and should not be lumped in with it — women who have had breast cancer and are suffering from genitourinary symptoms should know this option exists * For women on systemic HRT who also use vaginal estrogen, the two can be used together; the patch is not a substitute for vaginal estrogen because the tissue itself needs local treatment * Oncologists are increasingly getting educated on menopause management — the divide between oncology and women’s health is closing, and patients benefit when their cancer doctor and primary care doctor are working from the same playbook Survivorship: Thriving Beyond a Diagnosis * Too many women feel defined by their diagnosis, or guilty that they somehow caused it — neither is warranted, and neither serves the goal of getting better * Breast cancer is not one disease; genomic tools like the Oncotype DX and ProSigna help determine whether chemotherapy is even necessary, sparing many women from treatment that won’t help them * The pillars of thriving after breast cancer mirror the pillars of health generally — sleep, movement, stress management, social connection, and a sense of purpose * Patients have more agency than they often believe: where genetics and diagnosis are fixed, how a woman shows up for her body, her relationships, and her care is not Upshot Breast cancer is common, but fear and misinformation make it harder to navigate than it needs to be. Most cases have nothing to do with inherited genes. Screening saves lives. HRT is not the villain it was made out to be. And a diagnosis, however frightening, is not the whole story — patients have more agency than they think, and thriving after breast cancer is a real and achievable goal. And, if you liked this episode, check out my conversations on Hormone Therapy, Hot Flashes and Sexual with Dr. Laura Streicher and Menopause and More with Dr. Sharon Malone! Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Dr. Lucy McBride sits down again with Dr. Greg Katz , cardiologist at NYU, to tackle the questions patients ask most about blood pressure: what the numbers actually mean, why a single reading in the doctor’s office can mislead, what drives hypertension in the first place, and how to think about treatment. Tune in for practical, plainspoken advice, grounded in the reality of everyday patient care. What Blood Pressure Actually Measures * Blood pressure is the force your blood vessels experience as the heart contracts and relaxes * Optimal depends on who you are — but is roughly 115 over 75 * Blood pressure is supposed to fluctuate — for example it goes up with exercise, stress, and other drivers of adrenaline; it goes down with deep breathing and rest White Coat Hypertension and the Case for Home Monitoring * Elevated readings in the doctor’s office don’t always reflect a diagnosis of hypertension * Getting more data points by assessing home blood pressure readings is almost always the right call before making a treatment decision * White coat hypertension is real, but so is the converse: people whose numbers are genuinely high regardless of setting, and who benefit from earlier intervention What Drives High Blood Pressure * High blood pressure is due to a combination of genetics, age, lifestyle, and underlying conditions * Controllable contributors include weight, alcohol, sleep apnea, sodium intake, and chronic stress; uncontrollable ones include family history, age, and sex * The blood pressure “serenity prayer” is a useful frame: accept what can’t be changed, lean hard into what can, and if blood pressure stays high after all of that, medication is not a defeat The Consequences of Untreated Hypertension * Stroke, heart attack, kidney failure, heart failure, and dementia are the major downstream consequences of untreated hypertension * Dr. Katz calls it the “boring killer” — doctors see it so constantly it stops feeling urgent, but the cumulative damage of even mildly elevated pressure over years is not trivial * The good news: blood pressure medications are cheap, well-tolerated, and effective; the hard part is implementing the right solution for each individual patient How Blood Pressure Is Treated Pharmacologically * ARBs like telmisartan or candesartan are often first-line, especially for patients with diabetes. * Calcium channel blockers like amlodipine are a strong alternative and require no lab monitoring * Beta blockers, once standard first-line treatment, have largely fallen out of favor for uncomplicated hypertension * Importantly, medication is never a life sentence; it can be adjusted as circumstances change Blood Pressure, Cholesterol, Blood Sugar aka the Cardiovascular Trifecta * Blood pressure, cholesterol, and blood sugar are independent risk factors for vascular disease * Metabolic syndrome (elevated blood pressure, large waist circumference, high triglycerides, low HDL) is a single condition that dysregulates all three simultaneously * Getting all three under control is the most reliable way to reduce cardiovascular risk for the vast majority of patients Upshot High blood pressure doesn’t make headlines, but it drives some of the most serious and preventable health outcomes there are. The science and the tools to treat it exist. What requires more attention is the human context — who this patient is, what their life looks like, and which solution will actually work for them. 📣 Don’t miss out! You’ve got a few more days to join me this summer for the official Beyond the Prescription Book Club ! It’s open exclusively to Substack readers and gives you early access to the book, pre-publication. 👀 We’ll get into the nitty gritty of health and wellness and what it all means for YOU. Just a few days left! Sign-ups are open in May only. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Dr. Lucy McBride sits down with Benoit Denizet-Lewis, longtime writer for the New York Times Magazine and bestselling author of You’ve Changed: The Promise and Price of Self-Transformation , for a wide-ranging conversation about how people actually transform. What Transformation Actually Means—and How It Happens * The self-help industry focuses on habit change and optimization; Denizet-Lewis was interested in something deeper: shifts in identity, perspective, and personality that make people feel genuinely different * Change happens in multiple ways: sometimes it’s intentional and goal-directed, sometimes it arrives uninvited through illness, aging, or a moment of unexpected awe * People are deeply conflicted about change: they want it for themselves and are simultaneously threatened by it in the people they love * The narrative of transformation is almost always tidier in retrospect than it was in the living of it Identifying What is Fixed vs. What Is Dynamic * Core personality traits can be tweaked with real effort, but wholesale personality transformation is rare * Genetics and childhood shape us in ways that are largely fixed, but how we relate to those things is not * Trauma can be repaired; relationships fractured by the past can, with sustained work, become the closest ones we have * The serenity prayer captures something clinically true: distinguishing between what is fixed and what is dynamic is the definition of wisdom Self-Compassion as the Engine of Change * The transformation Denizet-Lewis describes most personally wasn’t a dramatic identity shift: it was learning gentleness toward himself * Ram Dass’s approach to jealousy—welcoming it in, naming it, refusing to let it run the show—illustrates what it looks like to observe a feeling without being consumed by it * Honest self-observation is essential to change, but it has to be paired with compassion; without it, the mirror is too painful to look into * An apology that ends with a period is one of the clearest expressions of self-awareness and change Shame vs. Guilt—and Why the Difference Matters * Guilt says “I did something bad”; shame says “I am bad”—and the distinction has real consequences for whether change is possible * Research on young people who committed crimes found that guilt was a positive predictor of rehabilitation; shame, counterintuitively, increased the likelihood of reoffending * The shame of failing to change—of breaking a resolution, relapsing, or falling short of a goal—is under-appreciated and causes many people to stop trying altogether * Shining a light on shame, naming it, and normalizing it is often the first step toward dismantling it; living in it while organizing behaviors around it is one of the most reliable ways to stay stuck Change as a Social Act * We like to think of transformation as private and interior, but it happens in community—getting buy-in from others, having change witnessed and reflected back, is part of how it becomes real * Social media has complicated this: performing transformation publicly creates skepticism, making it harder for genuine change to be legible to others * Asking people close to you whether they’ve noticed a change—awkward as it is—can be one of the most grounding forms of accountability Technology, Distractions, and Reclaiming Space * The phone has become the first place most people go when anxiety surfaces — which means it’s both a cause of anxiety and the default coping mechanism for it * Denizet-Lewis and McBride argue that the best thinking—in writing, in medicine, in life—tends to happen in stillness Upshot Transformation is messier, slower, and more social than many before-and-after stories suggest. The question isn’t whether change is possible—it is—but whether we’re willing to do the unglamorous work of honest self-observation, shame reduction, and showing up differently over time. 📣 HELLO READERS! Please join me this summer for the official Beyond the Prescription Book Club ! It’s open exclusively to Substack readers and gives you early access to the book, pre-publication. 👀 We’ll get into the nitty gritty of health and wellness and what it all means for YOU. Sign-ups are open in May only. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Dr. Lucy McBride sits down with award-winning journalist Jennifer Wallace, author of the New York Times bestseller Mattering: The Secret to a Life of Deep Connection and Purpose , to explore why feeling valued—and adding value—may be one of the most powerful and overlooked determinants of health. They discuss the physiology of mattering and what you can do today to feel more grounded in their own worth. What Mattering Actually Means * Mattering is defined as feeling valued by family, friends, community, and society—and having the opportunity to add meaningful value back * After food and shelter, it is the motivation to matter that most drives human behavior * When people feel they matter, they contribute, engage, and show up pro-socially; when they don’t, they suffer and can act out in ways that harm themselves and their communities * Mattering isn’t simply a feel-good concept; it’s physiologically measurable and directly linked to behaviors, blood pressure, and chronic stress The Body Keeps Score on Mattering * Feeling worthless or useless registers in the body as chronic stress, i.e., cortisol stays elevated and the nervous system does not feel safe * In a study of suicidal men, the two words most commonly used to describe their suffering were “useless” and “worthless” * The social proof that we matter—once delivered through neighbors, religious communities, and stable workplaces—has been quietly outsourced to the market, leaving a gap that Uber Eats and Amazon cannot fill How Modern Life Is Eroding Our Sense of Mattering * Signals of mattering used to be embedded in daily life—neighbors relied on each other, communities were interdependent; that infrastructure is dissolving * The Dutch theologian Henri Nouwen’s three great lies—“I am what I have,” “I am what I do,” “I am what others think of me”—condition people to believe their worth is entirely conditional on external forces * Workplaces have broken the loyalty contract; social media algorithms reward outrage over connection; AI threatens to make human contribution feel obsolete * We’ve become less interdependent, and in losing that interdependence, we’ve lost one of the most reliable sources of feeling needed and valued Mattering to Yourself First * One of the hardest lessons: you cannot sustainably matter to others if you don’t matter to yourself * A simple daily practice: while brushing your teeth each morning, ask what one small need you can meet for yourself * The cultural message—especially for women and caregivers—that prioritizing your own needs is selfish is precisely backwards; burnout serves no one * Sturdy adults need sturdy adults: surrounding yourself with even one or two people who remind you of your importance is a legitimate health intervention Making Mattering Actionable * Researchers identify four core ingredients of mattering, organized by Jennifer as SAID: Significant, Appreciated, Invested in, Depended on * Feeling significant doesn’t come from life’s big moments; it comes from being remembered in the details, like a colleague checking in after a hard week * Appreciating the doer behind the deed—not just thanking someone for what they did, but naming who they are—feeds mattering more deeply than gratitude alone * A nightly practice: ask what one small need you filled today, one small way you added value, and one small way you felt valued—this works against the brain’s negativity bias and reinforces a sense of mattering over time Upshot The question isn't whether mattering affects your health — the research is unambiguous that it does. The question is whether you're tending to it with the same seriousness you bring to your labs. 📣 I’m starting an official Beyond the Prescription Book Club . We’ll get into the nitty gritty of health and wellness and what it all means for YOU. It’s open exclusively to Substack readers and gives you early access to the book. Sign-ups are open in May only. Learn how to join here! Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary Dr. Lucy McBride sits down with Dr. Vivek Murthy , the 19ths and 21st U.S. Surgeon General and the founder of the Together Project, to talk about why the “achieve, acquire, optimize” model of success leaves so many people empty, and what actually fills the gap. They explore the science of social connection, the hidden costs of optimization culture, social media’s complex role in our lives, and why relationships matter for human health. The Limits of “Achieve, Acquire, Optimize” * When Dr. Murthy asked young people across the country how they defined success, the answer was remarkably consistent: money, power, and fame. Yet many who had all three were deeply unhappy. * The real triad of fulfillment isn’t money, power, and fame; it’s relationships, purpose, and service * Over-optimization culture sells false certainty; the three-, five-, and seven-step programs over-promise and often obscure the fact that what we actually need is community, not a protocol. * We weren’t built to navigate life’s challenges alone. The myth of rugged individualism as a proxy for strength is a harmful story modern culture tells. The Four Dimensions of Health * Physical health is only one piece; mental, social, and spiritual health are equally important dimensions that medicine has been slow to embrace. (Read Dr. McBride’s two-part series, Mental Health is Health, here and here .) * Someone can have perfect vital signs and a clean lipid panel and still be profoundly unhealthy if they’re isolated, purposeless, or disconnected from meaning. * Dr. McBride wrote a prescription for human connection for an isolated patient during the pandemic—not a medication, but an instruction to reconnect with old friends. * Expanding the lens through which we look at health isn’t soft or quaint; it’s what the evidence demands. The Data on Social Connection * The WHO Commission on Social Connection , co-chaired by Dr. Murthy, synthesized decades of research in a June 2025 report showing that social disconnection nearly doubles the risk of depression. * Physical health consequences are equally striking: a roughly 30% increased risk of heart disease and stroke, and a 50% increased risk of dementia among older adults. * The overall mortality impact of social disconnection is on par with obesity and smoking, yet we treat it as a lifestyle preference, not a public health priority. * People often need explicit permission to prioritize relationships; both doctors here agree that medicine needs to “prescribe” it. Social Media and the Erosion of Real Connection * Social media was designed to maximize time on platform. Addictive features are not accidental but intentional. * Movements like Logoff are helping peers take deliberate breaks and reclaim their attention. * Practical starting points include tech-free dinner tables, devices charged in the kitchen overnight, and designated offline windows—none of which require waiting for a legislative fix or accountability from tech companies. The Together Project and What to Do Today * The Together Project focuses on three things: telling the story of connection and its science, supporting community builders who are often isolated in their own work, and expanding the research base. * Dr. Murthy’s framework for a good day asks not how many to-do items were completed, but whether he loved, served, and grew. * His single practical prescription: spend five minutes every day reaching out to someone you care about, just to check in. Upshot Human connection is as essential to health as any biomarker. The question isn’t whether relationships matters, it’s what we do every day to center them in our lives. My book, Beyond the Prescription , comes out on August 11! I wrote it with you in mind. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary Dr. Lucy McBride sits down with Dr. Greg Katz, cardiologist and educator at NYU, to make sense of the new 2026 cholesterol guidelines — and what they actually mean for real patients. Together, they cut through the noise on coronary artery calcium scores, Lp(a), statins, GLP-1s, and the lifestyle factors that matter most for heart health. The upshot: we treat people, not numbers. The New Cholesterol Guidelines — Goals and Limits * The 2026 guidelines were released in March, endorsed by eleven groups of medical experts, and they reflect a synthesis of existing cardiovascular evidence, not new data. * The goal of updated guidelines isn’t for doctors (or patients) to treat them as the Bible, but rather to help assess cardiovascular risk, estimate the benefit of various interventions, and help patients understand how medical evidence applies to them. * Guidelines are built on large populations; they can’t account for the individual patient sitting in front of you. For example, two people with identical LDL levels can have entirely different risk profiles, family histories, reasons their cholesterol is elevated, and therefore completely different treatment pathways. * Read more on what the new guidelines don’t tell you here . Coronary Artery Calcium Scores — What They Can and Can’t Tell You * A calcium score looks for calcified, hardened plaque in the coronary arteries — it tells you about the “plumbing,” not the whole story of a patient’s heart health. * A score of zero doesn’t mean you have no plaque; soft plaque is invisible on this test and can still cause blockages. * A non-zero score doesn’t mean a heart attack is imminent — age, sex, and the rest of your risk profile matter enormously. * When doctors overreact to elevated scores, it can set off a cascade of unnecessary tests and procedures and lead to patient anxiety. As always, context and appropriate communication matter when transmitting information to patients. Blood Pressure: The Underappreciated Risk Factor * Blood pressure is probably the most underappreciated driver of cardiovascular risk — contributing to heart disease, heart failure, kidney failure, and dementia. * If someone has an elevated calcium score and imperfect blood pressure, controlling the blood pressure often matters more than starting a statin. * Most heart disease prevention comes down to three things: blood pressure, cholesterol, and metabolic health (Read more on what your blood pressure is telling you here ). Statins — Who Needs Them, and What the Side Effects Actually Mean * Statins reduce cardiovascular risk by about 20-25% on average — but if your baseline risk is very low, 20% of near-zero is still near-zero! * Side effects are real but manageable: about 8-10% of people get muscle aches that are predictable and reversible when the medication is stopped. * Claims that statins cause diabetes are overblown — the blood sugar rise is not inevitable and often is small and predictable. * Non-statin options give patients who can’t tolerate statins real alternatives. Lp(a) — What It Is and What to Do With It * Lipoprotein(a) is a genetically driven particle that accelerates plaque formation, promotes inflammation, and makes blood more likely to clot. * It is not modifiable by lifestyle, and statins actually raise it slightly — the LDL remains the primary therapeutic target. * A very high Lp(a) combined with a strong family history of early heart disease is a red flag that should sharpen clinical decision-making across the board. * Drugs to directly lower Lp(a) are in late-stage trials and look promising, but aren’t yet on the market. Exercise, Diet, and the Case Against Prescriptive Protocols * The best exercise is the one you’ll actually do — movement matters more than which movement. * Strength training is especially important in midlife to preserve muscle mass, but the barriers are real; YouTube body weight workouts are a legitimate starting point. * Most people know what junk food is; the best dietary strategy is the one that fits your actual life — and only a real conversation reveals which approach will stick. Upshot The new cholesterol guidelines are a useful framework — not a personal prescription. Whether the question is statins, calcium scores, or Lp(a), the answer almost always depends on who you are, what your family history looks like, and what you’re willing to do. Numbers need context, and good medicine means treating the human behind the chart. Drop your comments here! Pre-order Beyond the Prescription — out August 11! Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Dr. Lucy McBride sits down with Dr. Zeke Emanuel — physician, bioethicist, and key architect of the Affordable Care Act — to discuss his new New York Times bestseller Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life . They explore the challenges of navigating our fragile medical system alongside a bustling wellness industry, what the data show about longevity, and why a living meaningful life is the best health strategy of all. The “Wellness Industrial Complex” * The wellness industry is flourishing in part because people lack access to primary care and they want to be well, but they don’t know who to trust with their health — their doctor? ChatGPT? the online guru? * Biohacking, optimizing, and obsessive self-tracking are marketing terms — whereas biology is built for moderation, not extremes * Both doctors cautioned against wellness influencers who may have conflicts of interest or whose advice is aspirational, extrapolated from animal studies, and not evidence-based Zeke Emanuel’s Six Rules to Live a Long & Healthy Life * Don’t be a schmuck, socialize, eat well, sleep, exercise, and stay cognitively engaged — all well-supported by evidence, none requiring expensive protocols * The goal isn’t perfection; it’s a sustainable routine you enjoy, because you’ll need to maintain it for decades * Missing a workout or a healthy meal once isn’t the problem — what matters is the overall pattern Social Connection Is Not Optional * Social isolation is one of the most dangerous and least-discussed health risks — chronic loneliness carries risks comparable to smoking 15 cigarettes a day * Among 50-year-olds followed over eight years, those without close friendships had a 25% higher mortality rate * Nearly 20% of Americans now have zero or one friend, up from about 5-6% in prior decades — and more than half of meals in the U.S. are eaten alone Meaning and Purpose as Medicine * Getting outside yourself — directing attention outward toward others — is both the antidote to modern narcissism and the foundation of genuine fulfillment * Meaning doesn’t have to be grand; a school bus driver who made it his purpose to help each child start the day well illustrates how ordinary roles can be deeply sustaining * People who have a sense of meaning tend to live longer — and unlike supplements or cold plunges, cultivating curiosity about others costs nothing and is accessible to everyone The Primary Care Crisis * The U.S. spends nearly 18% of GDP on healthcare, yet 95% goes to hospitalizations and procedures — only 5% to primary care * Research shows that adding primary care doctors to a community lowers mortality; adding specialists, counterintuitively, raises it * To fix the system, patient panels need to shrink, administrative burden needs to drop, and primary care physicians need to be paid comparably to specialists AI, Aging, and the Quality-of-Life Question * Dr. Emanuel has reviewed the full published literature on AI in medicine since January 2024 and is more bullish than many expect * AI holds particular promise for expanding access in rural and underserved areas where providers and facilities are scarce * His pre-pandemic essay arguing against aggressive medical intervention past 75 wasn’t policy — it was a provocation designed to get people thinking seriously about the life, and death, they actually want Upshot A long and healthy life doesn’t require biohacking or obsessive self-monitoring — it requires a sustainable routine built around things that actually work. The hard part isn’t the science. It’s building a culture that makes those things accessible to everyone. Pre-order Beyond the Prescription — out August 11! Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary Dr. Lucy McBride sits down with Dr. Lauren Streicher , Northwestern University professor and sexual medicine expert, to untangle two decades of fear-based messaging about hormone therapy in the wake of the Women’s Health Initiative . They revisit what the WHI actually showed (and didn’t show) and make the case for individualized, evidence-based menopause care across hot flashes, sleep, bone health, genitourinary symptoms, and sexual health. The WHI: A High-Quality Study That Was Badly Misread * The WHI was the first randomized controlled trial on menopausal women and hormone therapy — well-designed, but its early termination generated fear-based messaging clinicians are still undoing * The women who took estrogen only showed a reduced risk of breast cancer; the combined arm showed an increase of one case per thousand women, with breast cancer mortality still reduced Hot Flashes Are Not Harmless * The average duration of hot flashes is seven years — 10 years in Black women, lifelong for 10% * Each hot flash triggers a spike in heart rate, blood pressure, cortisol, and inflammation that accumulates real cardiovascular damage over time * Chronic sleep disruption from menopause compounds that cardiovascular risk significantly Local Vaginal Estrogen: Safe and Woefully Underused * Genitourinary syndrome of menopause — urgency, recurrent UTIs, pain with intercourse, pelvic floor dysfunction — is treatable at any age, including in women on aromatase inhibitors * The FDA recently removed the black box warning from vaginal estrogen; it was never warranted and existed only due to blanket class labeling tied to oral estrogens (listen to more discussion about the removal of the FDA black box warning here ) The 10-Year Window Is Not a Stop Sign * Women who start hormone therapy within 10 years of their last period tend to do better at a population level — it does not mean therapy must stop after 10 years * A woman still symptomatic at 62 is a very different conversation than a symptom-free woman who feels she missed the boat (read about options you may have after the 10 year window here ) Hormone Therapy and Breast Cancer: What the Science Actually Shows * For women with BRCA mutations, multiple studies — including a large 2025 prospective analysis — show no increased breast cancer risk on hormone therapy after oophorectomy. Breast cancer incidence was actually significantly lower in HRT users, with the protective effect concentrated in estrogen-only formulations. * For women with a prior breast cancer diagnosis, the evidence on HRT risk is limited and formulation-specific: older trials showed increased recurrence risk with combined estrogen-progestin (particularly in ER+ disease), but modern formulations are understudied, vaginal estrogen appears safe, and a 2025 expert consensus endorsed shared decision-making for women with severe symptoms. Existing data are too outdated and heterogeneous to apply universally. Perimenopause Requires a Different Playbook * During perimenopause, estrogen levels surge and crash erratically — standard menopause-dose hormone therapy often does nothing; a low-dose birth control pill is frequently the better tool * The decision to start, continue, or stop hormone therapy should be driven by symptoms and medical history — not arbitrary rules or influencers Upshot The fear that followed the WHI left generations of women under-treated and misinformed, and many are still paying the price. Hormone therapy is not right for everyone, but the decision should be driven by symptoms, history, and honest risk-benefit conversation, not by outdated warnings, arbitrary timelines, or wellness culture overcorrections. Women deserve accurate information about their own bodies, and that starts with clinicians who know the evidence and are willing to have a nuanced conversation. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary Dr. Lucy McBride uses a patient's obsession with getting a facelift to explore what aging well actually requires — and why the $60 billion anti-aging industry is designed to ensure you never feel like you're winning. She breaks down the four areas where aging actually shows up in your health and offers a more honest framework for deciding where to focus your time, energy, and money. - The anti-aging industry profits from a moving goalpost — you get older every day, and the message that aging is a failure of discipline ensures you never feel like enough - A patient's fixation on her neck and jowls turned out to be a proxy for loneliness, grief, and fear about her memory — concrete, "fixable" feelings standing in for things that felt unfixable - Aging well isn't about your telomeres or your biological age score — it's about identifying which parts of your health ecosystem are actually under strain - The four areas where aging shows up: your medical data, what you're putting in your body, your physical infrastructure (muscle, balance, strength), and your inner landscape (grief, loneliness, fear) - Muscle loss accelerates in midlife — especially in women not on hormone therapy — and affects metabolism, confidence, and literally how you carry yourself through a room - The questions worth asking before booking a consultation: What are you actually trying to fix? Is it your face, or your sense of agency? Is it fatigue, or loneliness? For weekly insights on taking charge of your health—beyond the prescription—subscribe to Are You Okay? at https://lucymcbride.substack.com/ Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Subscribe to Dr. McBride's Substack: lucymcbride.substack.com . Episode Summary Dr. Lucy McBride sits down with Dr. Bob Wachter , chair of the Department of Medicine at UCSF and bestselling author of A Giant Leap to discuss artificial intelligence in healthcare. They explore the current frustrations with electronic health records that don't communicate with each other, the unprecedented rapid adoption of AI scribes and tools among clinicians, and how AI can free doctors from documentation burden to focus on patient relationships. The conversation addresses the promise of democratizing healthcare access through AI, but also the critical need for oversight of tech companies whose profit motives may not align with patient welfare. The Electronic Health Record Problem Both patients and doctors are frustrated with fragmented EHRs—multiple patient portals that don’t communicate with each other create disparate care and wasted time Doctors spend huge amounts of time documenting in EHRs but get very little useful intelligence out of them AI as Documentation Solution, Not Relationship Replacement The act of caring for another human being is relationship-based, rooted in trust, rapport, and understanding the whole person AI can make the paperwork and documentation side more efficient, giving doctors more time to care for the person, not just their lab data The Rapid Adoption of AI Tools in Medicine The uptake curve of AI scribes and knowledge tools among clinicians has been astounding This rapid adoption reflects the superpowers of the tools and the desperation clinicians feel to better manage administrative burdens of care Patient Access to Information vs. Understanding Federal statute now requires patients to see doctors’ notes, lab results, and x-ray results through patient portals Patients see abnormal results but the portal gives them absolutely no assistance understanding what it means Portal access has created an average of three hours of after-hours work for physicians The Promise of Scalable Healthcare Access AI offers potential for patients to get fast, fact-based information The scalability and access to information that AI provides could democratize healthcare beyond just those who can afford to pay for a doctor This accessibility represents a significant opportunity to expand quality medical guidance to more people The Perils of Profit-Driven AI in Healthcare AI companies building healthcare tools didn’t take the Hippocratic Oath and will be trying to maximize revenue AI without physician oversight, training, and guidance is unlikely to prioritize patient welfare over economic advantage If stewarded by physicians who understand the human elements of care, AI holds promise to help elevate, not eliminate, the patient-doctor relationship (read Dr. McBride’s article about why AI won’t be able to replace doctors here ) Upshot The question isn't whether to adopt AI tools (doctors already do), but how to shape them so they serve patients and preserve the human elements of care. Doctors and patients alike must be part of the solution—ensuring AI becomes a tool for democratizing quality healthcare rather than creating new barriers driven by profit motives disconnected from the Hippocratic duty to put patients first. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary Dr. Lucy McBride sits down with registered dietitian Ashley Koff, best-selling author of "Your Best Shot," to discuss metabolic health, GLP-1 medications , and why the medical profession needs to shift from weight loss to weight health. They explore why BMI is just one data point, debunk the myth of the non-compliant patient, and examine how GLP-1s teach us about hunger and fullness. The conversation addresses why personalized healthcare that addresses trauma, family dynamics, and individual biology matters more than any single medication or diet approach when tackling America's metabolic health crisis. Shifting From Weight Loss to Weight Health Weight is a symptom, not a diagnosis, and the goal should be weight health—making the hormones and biological systems that regulate weight—rather than pursuing weight loss through willpower. The Myth of the Non-Compliant Patient Patients who struggle with weight aren't lazy or noncompliant—they've been dismissed and shamed by a medical system that lacks time to address the complex factors driving metabolic health. Understanding Metabolic Health Beyond BMI BMI is just one metric and doesn't indicate metabolic health—body composition, genetics, hormones, and social determinants all matter more than a number on the scale. GLP-1 Medications as Teachers About Health GLP-1s teach people to recognize actual hunger versus emotional eating, helping them establish sustainable eating patterns they can maintain even after tapering off the medication. The Non-Linear Journey of Metabolic Health Taking GLP-1s often means unpacking childhood trauma, navigating family disapproval, and gaining agency over your body—it's not just about losing weight. Ending Judgment Around Bodies and Medication Choices Society readily judges others' bodies and medication choices, but acceptance of what you can't control frees up mental energy for genuine empowerment. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

EPISODE SUMMARY: In this week's episode, Dr. Lucy McBride reads from her newsletter addressing how witnessing collective trauma affects our physical and mental health. Through patient stories, she introduces her "3 A's" framework (Awareness, Acceptance, Agency) for navigating anxiety during turbulent times and offers practical guidance for knowing when distress signals a need for help. KEY CONCEPTS: 1. EVERYONE HAS MENTAL HEALTH—NOT JUST "THE MENTALLY ILL" Mental health is not a diagnosis for a small percentage of people; it's a universal aspect of being human. Mental health has been treated as the "stepchild of physical health"—when in reality, it's ground zero of health. Physical symptoms (racing heart, jaw tension, abnormal bloodwork) often reflect underlying mental health struggles. Your genetic predispositions, personal history, and past traumas shape how you respond to crisis. 2. THE 3 A'S: A FRAMEWORK FOR MENTAL HEALTH Mental health is a lifelong process built on three steps: Awareness → Acceptance → Agency. Awareness: Understanding the facts of your story and recognizing your mental health patterns. Acceptance: Making peace with what you cannot control—genetic vulnerabilities, past trauma, current crises. Agency: Taking action over the thoughts, feelings, habits, and relationships you can change. 3. KNOW YOUR PATTERN: CATASTROPHIZING, INTELLECTUALIZING, OR NUMBING Catastrophizers imagine worst-case scenarios; they need reality checks. Intellectualizers can explain every policy failure but can't sleep; they need to feel their feelings. Numbifiers stop watching entirely because it's overwhelming; they need to stay connected. Self-awareness about your pattern is more important than having the most resources. 4. WHY WELLNESS AND TRADITIONAL MEDICINE BOTH FALL SHORT The wellness industry offers oversimplified solutions: meditation apps, "limit news consumption," "practice self-care." Traditional medicine screens for anxiety disorders and offers prescriptions without addressing complexity. Both approaches miss what's actually happening and are disempowering to patients. Medication can quiet anxious thoughts, but there's no pill for insight; therapy builds awareness but can't alone reverse anxiety spirals. 5. PRACTICAL STEPS FOR PROTECTING YOUR MENTAL HEALTH NOW Get honest about your baseline: Are you eating, sleeping, taking medications? Disruption signals something important. Notice your pattern: Identify whether you catastrophize, intellectualize, or go numb—then compensate accordingly. Set boundaries: Check news twice daily, call friends instead of doom-scrolling, turn off phones at 9pm, allow yourself to cry. Awareness of your limits is not weakness—it's wisdom. 6. WHEN TO ASK FOR HELP The signal: difficulty functioning—not sleeping, not eating, not taking medications, not showing up for work or family. This isn't about being "mentally ill"; it's recognizing when your mental health needs support right now. The real questions: How aware are you of your patterns? Where do you live on the continuum of anxiety and resilience? Call your doctor not because something is "wrong with you," but because mental health sometimes needs professional support. - For weekly insights on taking charge of your health—beyond the prescription—subscribe to Are You Okay? at https://lucymcbride.substack.com/ Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary Dr. Lucy McBride sits down with behavioral economist Emily Oster , PhD, to discuss the newly released USDA dietary guidelines . They explore what the guidelines actually say, debunk common misconceptions, and examine the problematic framing that suggests individual dietary choices alone can solve America’s health crisis. The conversation addresses the USDA’s appropriate emphasis on whole foods, but why access to quality healthcare and nutritional guidance matters more than specific recommendations when tackling America’s chronic disease epidemic. The Guidelines Are Mostly Unchanged * The new USDA guidelines are largely similar to previous versions, contrary to fears or hopes that they would radically shift dietary recommendations * Key advice remains consistent: prioritize protein, fiber, and healthy fats while limiting sugars, alcohol, and processed foods * One notable improvement is that the guidelines are shorter, tighter, and more digestible than previous iterations * The guidelines reflect evidence-based advice that most primary care doctors already give their patients daily The Real Problem: Most Americans Don’t Eat This Way * The biggest issue isn’t whether the guidelines emphasize protein enough or get saturated fat recommendations perfect—it’s that most American diets look nothing like what’s recommended * The average American diet contains a tremendous amount of ultra-processed, high-salt, high-sugar foods that aren’t satiating * Habit change around food is incredibly difficult, making implementation far more important than guideline details * Even previous sensible guidelines didn’t translate into widespread dietary improvements * The gap between recommendations and reality highlights why access to personalized nutrition guidance matters The Problematic Framing of Individual Responsibility * While the content of the guidelines is generally sound, the framing places disproportionate emphasis on personal dietary choices as the solution to health problems * The framing ignores systemic barriers including food deserts, economic constraints, lack of healthcare access, and limited time for meal preparation that are often the biggest barriers to healthy eating * The presentation creates a “blame the victim” mentality that suggests America’s chronic disease epidemic is primarily due to poor food choices when, in reality, obesity and metabolic diseases stem from a combination of genetic, environmental, biological, social-emotional, and behavioral factors * Effective nutrition change requires relationships with healthcare providers, not just information on a poster The Beef Tallow Controversy * The inclusion of beef tallow in the guidelines raised eyebrows and generated confusion among the public * Beef tallow is not a common cooking fat for most Americans and is less accessible and practical than butter, olive oil, or avocado oil * The emphasis on beef tallow appeared to reflect someone’s personal agenda rather than evidence-based nutritional guidance * For most people, traditional cooking fats like olive oil and avocado oil remain better, more practical choices * The controversy highlighted how specific recommendations can sometimes reflect ideological positions rather than public health priorities The Healthcare System Failures Behind Dietary Struggles * Nutrition is a foundational pillar of health, but meaningful dietary change requires supportive relationships with healthcare providers, not just guidelines * The current healthcare system often limits doctors to five-minute visits, making it impossible to address complex nutritional needs (Read my article on our broken primary care system here .) * Health is about relationships, not transactions—yet many Americans lack access to doctors who can spend adequate time with them * People’s relationships with food are deeply ingrained and often begin in childhood, making simple advice to “eat better” ineffective without strategic planning and support * Doctors frequently lecture patients about diet and exercise without addressing barriers like body shame, food access, financial constraints, or fear of change * Until every American has access to quality primary care that addresses nutrition, behavioral health, and whole-person wellness, dietary guidelines will have limited impact Upshot The new USDA dietary guidelines offer sensible, evidence-based nutritional advice that aligns with what most doctors already recommend. However, the real challenge isn’t refining what goes on the food pyramid—it’s ensuring Americans have access to the healthcare relationships and systemic support necessary to make meaningful dietary changes. Without addressing food access, economic barriers, and the broken healthcare system that limits meaningful doctor-patient interactions, even the most well-designed guidelines will remain just a poster on a wall. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary Dr. Lucy McBride discusses hormone replacement therapy (HRT) and menopause, breaking through the noise of conflicting medical information. She explains the science behind menopause, addresses common misconceptions about HRT risks, and examines the recent FDA announcement about removing black box warnings on estrogen products. Throughout the episode, she advocates for evidence-based, individualized decision-making that considers a woman’s complete health profile rather than fear-based restrictions. Key Concepts Understanding Menopause and Perimenopause * Menopause occurs when the ovaries stop producing consistent, robust amounts of estrogen and progesterone * Perimenopause is the 7-10 year lead-up to menopause, characterized by irregular periods, hot flashes, night sweats, mood instability, sleep interruption, and vaginal dryness * The average age of menopause in the United States is 51, but symptoms and experiences vary dramatically among women * Testosterone decline in women is age-related rather than menopause-related, beginning in a woman’s 20s and 30s (Listen to Dr. McBride’s conversation on testosterone for women with New York Times journalist Susan Dominus here .) * Every woman who lives long enough will experience menopause, affecting 50% of the population The WHI Study and Its Lasting Impact * The Women’s Health Initiative (WHI) study was the largest-ever randomized controlled trial studying menopause and hormone therapy. It was halted abruptly in 2002 and created widespread fear about HRT by linking it to increased breast cancer and cardiovascular disease risks * The study had significant design flaws: participants were older (average age 63), used synthetic hormones (Premarin and Provera), and the timing hypothesis wasn’t considered * McBride argues the study measured “harm of late initiation” rather than harm of HRT itself * The study led to black box warnings on estrogen products that persisted for over two decades * These warnings resulted in generations of women being denied information and treatment options for menopausal symptoms Health Implications of Estrogen Deficiency * Estrogen deficiency increases cardiovascular disease risk, with women losing their protective advantage over men after menopause * Bone density loss accelerates during perimenopause and menopause, increasing osteoporosis and fracture risk * Genitourinary syndrome of menopause causes vaginal dryness, painful intercourse, and increased urinary tract infection risk (Listen to Dr. McBride’s conversation on sexual health with Dr. Rachel Rubin here .) * Cognitive changes and dementia risk may be associated with long-term estrogen deficiency * Quality of life impacts include disrupted sleep, mood changes, and diminished sexual function that shouldn’t be dismissed as “just part of aging” The Science of HRT Benefits * Transdermal estrogen (patches, creams, gels) carries lower risks than oral estrogen by avoiding first-pass liver metabolism * Micronized progesterone is preferred over synthetic progestins for women with a uterus to protect the uterine lining * Early initiation of HRT (within 10 years of menopause onset) shows cardiovascular benefits rather than risks * HRT can reduce fracture risk, improve genitourinary health, and potentially offer cognitive protection * Local vaginal estrogen is topical (i.e, not the same as systemic hormone therapy) and is highly effective for genitourinary symptoms with minimal absorption into the bloodstream Breast Cancer Risk in Perspective * One in eight women will develop breast cancer over the course of their life; most breast cancers are sporadic (i.e., not hereditary or due to an inherited genetic mutation) * The absolute risk increase of breast cancer from HRT is approximately 1 additional case per 1,000 women per year; data from the WHI showed that women who took estrogen-only HRT had a reduced risk for breast cancer * Alcohol consumption (one drink per day) carries comparable or higher breast cancer risk than HRT * Obesity presents a significantly higher breast cancer risk than HRT * Having a family history of breast cancer doesn’t preclude HRT use * Dr. McBride emphasizes viewing women’s health holistically rather than solely through the lens of breast cancer risk Reframing Medical Decision-Making * The question to ask your doctors isn’t “Can I take HRT?”; it’s “What are the potential risks and benefits of taking hormone therapy given my unique health profile?” * Doctors should provide evidence-based information and guidance that honors patients’ unique health issues, tolerance for risk, and ability to understand tradeoffs inherent in any medical decision * Risk exists on a continuum; it’s not monolithic. Risk cannot be reduced to zero—it’s about weighing competing risks and benefits which will very person to person * Fear is real and valid, but shouldn’t be the sole driver of medical decisions * Women deserve comprehensive information about their bodies and treatment options, regardless of age or time since menopause onset * Read more of Dr. McBride’s article on vaginal hormone therapy and importance of empowering women to make informed decisions about their own health here . Upshot The conversation challenges decades of gatekeeping around hormone replacement therapy by emphasizing evidence-based, individualized care. Dr. McBride advocates for removing the stigma and fear surrounding HRT, encouraging women to ask better questions and doctors to provide evidence-based guidance that considers the whole person. Her central message: HRT isn’t right for every woman, but every woman deserves comprehensive information about her body and the right to make informed decisions. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

In this conversation, Dr. Lucy McBride sits down with New York Times journalist Susan Dominus to discuss her recent article “‘I’m on Fire’: Testosterone Is Giving Women Back Their Sex Drive—and Then Some” on testosterone supplementation in women. With testosterone use surging among midlife women, they explore the gap between recommendations from the medical establishment and the wellness industry, examining why women are turning to testosterone for sexual health, energy, and vitality—and what the limited evidence really tells us about risks and benefits. Key Concepts Women Actually Make Testosterone (And More Than Estrogen) * The common misconception is that testosterone is purely a male hormone * Most women don’t realize they naturally produce testosterone—and in higher quantities than estrogen * Women’s bodies produce testosterone from three sources: 25% from ovaries, 25% from adrenal glands, and 50% from peripheral tissues * Testosterone plays a role in libido, energy, metabolic health, and muscle tone throughout women’s lives, however the role of supplemental testosterone for issues other than low sexual desire remains unclear The Decline in Testosterone Levels Starts Earlier Than You Think * Testosterone levels in women begin declining around age 30, dropping to approximately 50% by age 60 * This is a gradual, age-related process, not a sudden menopausal crash * Menopause doesn’t cause testosterone to plummet; it coincides with the end of a depletion that’s been happening all along * Women in their mid-40s can feel the effects of low testosterone long before they’re perimenopausal * Understanding this timeline challenges the narrative that testosterone issues are specifically about menopause The Testosterone Surge: From UK Trend to US Phenomenon * Just a few years ago, testosterone therapy for women was primarily a UK conversation; the US medical establishment was dismissive * In the past six to eight months, testosterone use has exploded across the US * Women are discussing it on streaming feeds, social networks, and with their friends, indicating a cultural moment * The treatment has moved from relative obscurity to mainstream conversation at remarkable speed, and the wellness industry is seizing the moment The Evidence Gap: What We Know and What We Don’t * The medical establishment has been cautious about testosterone in women due to limited research and because supplemental testosterone is not currently approved by the FDA * Existing studies support the use of supplemental testosterone in women only for libido and sexual function (i.e., hypoactive sexual desire disorder) * Anecdotal evidence suggest that testosterone can help women with energy, muscle mass, metabolic health, cognitive “clarity,” and overall wellbeing; however more research is needed to understand where these are true effects versus placebo * The potential downsides are real (especially if given at high doses): voice changes, irritability, hair loss, hyper-arousal * Long-term effects remain unknown, particularly regarding cardiovascular health, metabolic changes, and other systemic impacts * Doctors face the challenge of counseling patients when definitive evidence is lacking, creating tension between patient demand and evidence-based medicine * This uncertainty leaves both physicians and patients navigating uncharted territory Navigating the Gray Zone Between Medicine and Wellness * Women find themselves caught between traditional medical systems that historically have not made space to discuss sexual health and wellness practitioners who proselytize products without adequate evidence * This dynamic mirrors other areas of women’s health where quality-of-life concerns have been historically undervalued compared to longevity metrics * The conversation reflects a broader cultural shift toward prioritizing women’s subjective experiences as legitimate healthcare goals * There’s a growing concern about polypharmacy: using multiple pharmaceutical interventions to address interconnected symptoms, then needing additional treatments for side effects * The question remains whether people are reaching for pharmaceutical solutions too quickly instead of evidence-based lifestyle interventions like exercise, sleep, and stress management * Both Dr. McBride and Ms. Dominus stress the importance of seeking care from practitioners who are well versed in medical evidence—for example those who are certified by the Menopause Society—and addressing testosterone levels in context, ruling out other causes for issues like fatigue and brain fog before jumping to testosterone as a quick fix, while acknowledging the lack of access to evidence-based care to address the nuances of patients’ health Upshot The conversation about supplemental testosterone represents a pivotal moment in women’s health—where patient demand for quality-of-life improvements collides with limited evidence. This moment underscores the need for nuanced, individualized discussions between patients and providers that honor women’s subjective experiences while acknowledging medical uncertainties, a challenge that extends far beyond testosterone to many aspects of midlife women’s healthcare. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary In this conversation, Dr. Lucy McBride sits down with psychiatrist Dr. Jessi Gold to discuss how to manage emotional wellbeing during times of political upheaval. With the country feeling unsettled by ongoing violence and crisis, they explore practical strategies for emotional regulation, the importance of naming feelings without judgment, and why small daily acts of self-care aren't indulgent—they're essential for functioning in a chaotic world. Key Concepts The Importance of Naming What's Really Happening * Pretending the external world doesn't affect you is both unrealistic and counterproductive * Avoiding the "grief Olympics"—comparing your struggles to others' and dismissing your own feelings * Everyone exists in the same messy world, and acknowledging its impact creates space for authentic connection * Naming feelings reduces the underlying current of stress that affects work performance and relationships * You don't have to fix the world's problems to acknowledge they're affecting you Feelings as Information, Not Pathology * Social media makes it easy to conflate normal human emotions with clinical diagnoses * All emotions serve a purpose and provide valuable information about your needs and circumstances * The continuum approach: you don't need to meet clinical criteria to deserve self-compassion and support * Feelings are temporary and meant to be experienced, not immediately eliminated or "fixed" Acceptance vs. Resignation: Reallocating Your Resources * True acceptance means redirecting energy from things you can't control to areas where you have agency * The serenity prayer framework: identifying what you can and cannot change provides clarity and reduces helplessness * Acceptance isn't giving up—it's strategic resource allocation of time, energy, and mental bandwidth * Small acts of self-efficacy can counter overwhelming feelings of powerlessness * Control-seeking behaviors often increase anxiety rather than providing the relief we're seeking Dialectical Thinking: Holding Two Truths Simultaneously * Both difficult realities and moments of joy can coexist without negating each other * Social media algorithms push people toward emotional extremes * You can care deeply about global suffering while still finding meaning in daily life * Examples like Viktor Frankl demonstrate that hope can survive even in the most dire circumstances * Dialectical thinking protects against all-or-nothing emotional spirals Practical Micro-Strategies for Daily Emotional Regulation * Small, discrete coping tools work better than major lifestyle overhauls for most people * Fidget tools, breathing exercises, and physical grounding techniques provide in-the-moment relief * Gratitude practices counter the brain's evolutionary bias toward remembering negative experiences * Body awareness (like noticing jaw clenching while scrolling) provides early warning signals for stress Digital Boundaries and Media Consumption * "Mindless scrolling" is actually highly stimulating and often traumatic content consumption * Watching repeated footage of traumatic events creates secondary trauma, especially for vulnerable populations * Moving phones out of bedrooms and avoiding immediate morning phone checking reduces anxiety activation * Setting specific times and limits for news consumption prevents information overwhelm * Parallel activities with friends (working quietly together) can provide connection without amplifying distress Upshot Dr. McBride and Dr. Gold emphasize that managing anxiety during chaotic times requires both self-compassion and practical action. Their message: you don't need to be clinically depressed or anxious to deserve support, and tiny daily interventions can make a significant difference in emotional resilience. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary In this episode, Dr. Lucy McBride sits down with Dr. Shira Doron, Chief Infection Control Officer and Hospital Epidemiologist at Tufts Medical Center, to cut through the confusion surrounding COVID vaccines and public health policy . With the CDC in upheaval and patients calling with urgent questions about protecting their families this winter, they tackle the messy reality of vaccine access, institutional breakdown, and what it all means for your health decisions. Dr. Doron explains why getting clear answers feels impossible right now—and offers practical guidance for navigating the chaos. Key Concepts The Regulatory Meltdown * FDA approved new COVID vaccines but only for high-risk groups, creating access barriers at major pharmacies * Entire ACIP advisory committee was gutted—all 17 members replaced at once—leaving no clear decision-making authority * CDC leadership departures and delayed meetings mean the usual vaccine rollout process has completely broken down * Retail pharmacies like CVS can't administer vaccines without ACIP recommendations, forcing patients to get prescriptions * The dust may settle by late September, but institutional trust has been severely damaged The Backstory Nobody's Talking About * A little known fact: the Biden-era ACIP was already planning to shift away from universal annual vaccines toward risk-based recommendations * Internal polling of that committee showed 76% support for targeting high-risk groups rather than everyone over six months old * Current policy direction mirrors what the previous committee intended, but the chaotic process has destroyed confidence * Medical and scientific community feels betrayed by political interference in normal advisory processes * Reform was needed, but "slash and burn" approach leaves the country vulnerable to future health crises Making Sense of Who Should Get Vaccinated * Dr. Doron suggests talking with your doctor but in general she recommends waiting for the new formulation rather than rushing to get the current vaccine during this summer's wave * Dr. Doron notes that “high risk” for COVID is broadly defined—and includes sedentary lifestyle, history of smoking, anxiety, ADHD—such that most Americans will qualify for a shot. Plus, self-attestation of risk is likely to continue (rather than requiring medical documentation at pharmacies), and she predicts it will not be difficult to get a shot if you want one (though cannot be sure, and insurance coverage is up in the air) * Professional medical societies are creating their own guidelines to fill the regulatory void * Individual risk assessment with your doctor beats one-size-fits-all recommendations What Vaccines Actually Do (And Don't Do) * Modest protection against any infection for 2-3 months, more like "wearing a raincoat in a rainstorm" than a force field * Strong, durable protection against severe disease (due to cellular immunity i.e., T cells) is the real benefit for high-risk individuals * Limited impact on transmission, so getting vaccinated to protect others isn't particularly effective * Timing matters: Dr. Doron suggests waiting 6 months to get vaccinated after a COVID infection, 3 months after previous vaccine for most people * Novavax may offer better side effect profile and longer-lasting protection than mRNA options Beyond Vaccines: Testing and Treatment * Paxlovid remains effective for high risk patients when started within 5 days for people at risk of severe disease but is not a standard recommendation for healthy, vaccinated people; we live in a data-free zone on the degree of benefit (if any) for lower risk individuals * Test for COVID or flu only when results would change your management—mainly for those who might benefit from antivirals * Home rapid tests can help gauge contagiousness as you recover * Basic rule: stay home until fever-free for 24 hours without medication * Early testing and treatment of high-risk household members beats trying to prevent transmission through vaccination Trust, Messaging, and Moving Forward * Current chaos represents backlash against heavy-handed pandemic messaging that ignored individual risk differences * Public health authorities lost credibility by overpromising vaccine effectiveness and dismissing legitimate concerns * Acknowledging uncertainty and meeting people where they are builds trust better than blanket mandates * Need institutional reform, not destruction of essential public health infrastructure Upshot Dr. McBride and Dr. Doron emphasize that navigating this regulatory chaos requires working closely with your healthcare provider for individualized risk assessment rather than relying on one-size-fits-all guidance. They stress that while patients must advocate for themselves in the current fragmented system, the real solution lies in rebuilding trustworthy public health institutions that prioritize transparent communication and evidence-based recommendations over political interference. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe

Episode Summary In this episode, Dr. Lucy McBride tackles the crisis facing American healthcare and provides practical strategies for navigating a broken system. She explores a fundamental disconnect between what patients need and what the current system delivers: while patients require comprehensive, relationship-based healthcare that addresses their whole story, the system provides fragmented, rushed medical care that focuses solely on immediate symptoms. Key Concepts The Systemic Breakdown of Primary Care * Root causes : Pressures from insurance companies and large hospital systems force doctors to see high patient volumes in brief increments, creating unsustainable working conditions and suboptimal care * Consequences : Primary care has evolved from comprehensive problem-solving into rapid referrals and prescription writing, leaving doctors feeling burned out and unable to provide the care they trained to give * Scale of crisis : Millions of Americans currently lack access to a primary care provider, with shortages expected to worsen significantly in coming years * Financial reality : Only 5% of U.S. healthcare spending goes toward primary care, while the vast majority addresses damage control rather than prevention * Professional exodus : Primary care physicians are leaving medicine due to burnout, time constraints, and inability to practice the comprehensive care they were trained to provide Medical Care vs. Healthcare: Understanding the Critical Distinction * Medical care defined : Problem-specific, episodic, transactional treatment focused on immediate symptoms (what urgent care and emergency rooms provide) * Healthcare defined : Patient-centered, relationship-based care involving shared decision-making, understanding of individual health risks and goals, and comprehensive whole-person treatment * The integration challenge : True healthcare requires connecting physical symptoms with biographical data, social determinants of health, and emotional well-being * Relationship foundation : Healthcare depends on trust, rapport, and a provider's understanding of the patient's complete story and context * Access inequality : While medical care is available through urgent care and ERs, comprehensive healthcare is increasingly accessible only to those who can afford it Primary Care Options in the Current System * Insurance-based care : Traditional approach using provider networks, though often limited by short appointment times and restricted access * Federally Qualified Health Centers (FQHCs) : Community-based centers providing comprehensive care regardless of ability to pay, often with shorter wait times ( findahealthcenter.hrsa.gov ) * Direct Primary Care (DPC) : Membership-based model allowing doctors smaller patient panels and longer appointment times to provide more comprehensive care, though not universally accessible due to cost * Nurse practitioners and physician assistants : Can provide excellent primary care when well-trained and aware of their knowledge limitations * Telehealth services : Options like One Medical and MD Live meet specific needs but have limitations in providing comprehensive relationship-based care How to Evaluate & Select a Primary Care Provider * Access assessment : Inquire about wait times for routine appointments, same-day sick visits, and between-visit communication methods * Care philosophy evaluation : Understand appointment lengths, approach to preventive and whole-person care, mental health integration, and specialist coordination methods * Logistical considerations : Verify insurance acceptance, understand membership details for DPC practices, and clarify after-hours coverage and prescription refill processes * Red flags to avoid : Providers who lack time for building relationships, demonstrate defensive behavior when questioned, or fail to provide adequate access when needed * Fit assessment : Recognize that doctor-patient relationships require mutual trust and respect; switching providers when the relationship isn't working is acceptable and necessary Self-Advocacy Strategies & Appointment Preparation * Priority setting : Prepare the most urgent issues for each appointment , understanding that comprehensive care may require multiple visits * Rapport building techniques : Acknowledge providers' time constraints, share personal details to establish connection, and express understanding of systemic pressures while maintaining care standards * Documentation responsibility : Keep personal medical records since electronic health records are fragmented across different healthcare systems and make sure they are updated with medications, dosages, allergies, family history, vaccination records, and specialist information * Follow-up planning : Schedule subsequent appointments proactively rather than waiting for problems to arise, ensuring continuity of care The Future of Healthcare Technology and Innovation * Electronic health record limitations : Current systems serve primarily as billing tools rather than patient-centered care coordination platforms, with each healthcare system maintaining separate, incompatible records * Technology's potential : AI and digital innovation (if done well) could create centralized, real-time health records shared across all providers, improving care coordination and reducing redundancy * Innovation priorities : Successful healthcare technology must elevate —not eliminate—the patient-doctor relationship. Tech entrepreneurs who understand this principle are most likely to achieve meaningful reform * Patient empowerment through data : Individuals must maintain their own comprehensive health records until systems improve, including all provider visits, medication changes, and test results * Systemic reform needs : Long-term solutions require centering primary care in the healthcare system, ensuring universal access to medical homes, and prioritizing prevention over damage control The Upshot Dr. McBride encourages everyone to advocate fiercely for comprehensive relationship-based care rather than settling for episodic medical transactions. She emphasizes that while individual self-advocacy is essential for navigating current realities, true reform requires investing in primary care and ensuring universal access to medical homes that address the whole person. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe