No-Bullshit Medicine

The necktie that taught me three principles I've followed for nearly 40 years.

Toward the end of my medical training at Columbia, in northern Manhattan, an unearthly pale 58-year-old Dominican woman walked into my office with a baffling, life-threatening problem: aplastic anemia. Her bone marrow had stopped making blood cells. Without transfusions she would die.

Her husband sat beside her at every visit. He held her hand, answered questions, and translated when needed. The love between them was palpable. We spoke mostly in Spanish. After I exhausted the other causes of aplastic anemia, I asked him to bring in every pill she had ever taken.

He brought a paper bag full of pill bottles. One label stopped me cold: cyclophosphamide (Cytoxan)—a chemotherapy drug that destroys bone marrow.

I asked why she took it.

"Su médico dijo que debía tomarla todos los días o el cáncer volvería," the husband explained. Their gynecologist had told her to take it every day or her cancer would come back.

She had been taking this medication every day for 30 years.

I phoned the gynecologist. He confirmed he had prescribed the toxic medication to "prevent cancer recurrence." But here's the thing: He had removed a benign ovarian cyst. There had never been cancer. There was no reason for her to take Cytoxan. The medicine that was supposed to protect her was killing her.

I sat down with the couple. In plain Spanish I explained the medication was unnecessary—there had never been cancer to prevent. Maybe, if she stopped taking the Cytoxan pills, her bone marrow would recover.

She had taken the medicine for so long, she was terrified to stop. They were convinced that stopping would let "the cancer" return. At some point, perhaps I used strong language to emphasize that there was no cancer, had never been cancer, and there was no reason to take the medication. Finally, they agreed and she stopped the toxic medication.

We treated infections, managed transfusions, and hoped her marrow would recover. It never did. Months later, organ failure overtook her.

At our final appointment, her husband pressed a patterned tie into my hand.

"Para que recuerdes," he said. So you remember.

I still have it. It reminds me why truth matters.

That tie taught me three principles I've followed for nearly 40 years:

1. Tell it like it is. - Whether it's an unnecessary prescription or a covered-up outbreak, because truth saves lives

2. Admit what we don't know. - Uncertainty isn't weakness; pretending to know when we don’t is deadly.

3. Call out dangerous nonsense immediately. - Waiting to tell the truth kills people.

My patient’s tragic story — and too many like it — are what led me to spend the past ten years writing The Formula for Better Health: How to Save Millions of Lives – Including Your Own.

The illnesses, cancers, and pandemics that kill most people today simply do not have to happen. In the next twenty-four hours, preventable infections, heart attacks, and strokes will kill thousands of Americans and tens of thousands worldwide. In the next hour, 15,000 babies will be born around the world; at least 5,000 will develop preventable, permanent physical or neurological disability. We have the tools to prevent these tragedies—if we use the formula.

The formula can be more powerful than hype, political interference, and killer industries. Facts are stubborn things. They remain true even if they are twisted, suppressed, or ignored. Next week, I’ll share more details about the formula.

Two hundred years ago, no one could have predicted that typhoid, tetanus, and trachoma would become rare. Progress was not the result of miracle cures or individual choices alone but through systematic action. You, your children, and your children's children can be safer and healthier. The heart attacks and strokes responsible for one of every three deaths today can become as rare as those forgotten killers.

These principles matter more than ever. When science and public health are under attack. When social media algorithms favor sensational falsehoods over plain truths. When your doctor might be influenced more by pharmaceutical marketing than rigorous evidence—you need to know how to spot the bullshit.

The widower who gave me that tie couldn't see the danger hiding in the medicine cabinet. My patient couldn't believe her trusted doctor would prescribe something harmful. And she couldn't create her own path to health because she didn't have the tools to question what she was told.

Today, we face similar challenges on a massive scale. Miracle cures flood social media. Supplements promise what medicine can't deliver. Politicians push treatments based on ideology, not evidence. And too often, the medical system itself prioritizes profit over patients. The tie reminds me of a simple truth: In medicine and public health, bullshit isn't just wrong. It's deadly. And we all deserve better.

In this Substack, I'll share:

• How to spot dangerous health misinformation before it harms your family;

• Which health controversies are manufactured for profit vs. real scientific debates;

• What's really happening in health policy, programs, and agencies — and what you can do about it; and

• The difference between interventions that work and expensive placebos.

Public health has a superpower: We can see the invisible. Please join me. I'm going to do my best to show you how.

Next week: The Formula vs. The Bullshit.

I hope to see you then.

Tom

Dr. Tom Frieden is author of "The Formula for Better Health: How to Save Millions of Lives – Including Your Own."

The book draws on Frieden's four decades leading life-saving programs in the U.S. and globally. Frieden led New York City's control of multidrug-resistant tuberculosis, supported India's efforts that prevented more than 3 million tuberculosis deaths, and led efforts that reduced smoking in NYC.

As Director of the CDC (2009-2017), he led the agency's response that ended the Ebola epidemic. Dr. Frieden is President and CEO of Resolve to Save Lives, partnering locally and globally to find and scale solutions to the world's deadliest health threats.

Named one of TIME's 100 Most Influential People, he has published more than 300 scientific articles on improving health. His experience is, for the first time, translated into practical approaches for community and personal health in "The Formula for Better Health".