Food Fables Veganism

The transcript for the show is at the bottom of this post

There are many reasons people will adopt a vegan lifestyle. But some are fooled into thinking that this diet will allow you to be healthy, and many base this upon The China Study – see below.  In today’s podcast we will get rid of the myths of the vegan lifestyle. No matter what you think, the data is not there to say this is the healthiest way to live – in fact, as you will see- the data does not show it is anywhere near has healthy as the DASH Diet or the Mediterranean Diet.  Give a listen.

In The China Study T. Collin Campbell makes the assertion that cancer can be cured by a vegetarian diet – that if only people would get away from meats cancer could be gone.

To quote: “ Furthermore, a pattern was beginning to emerge: nutrients from animal-based foods increased tumor development while nutrients from plant-based foods decreased tumor development.  ” Campbell opines “There is enough evidence now that the U.S. government should be discussing the idea that the toxicity of our diet is the single biggest cause of cancer.

That phrase resonates with a lot of people, because we want there to be a single factor – something simple we can wrap our simplistic brains around.  Most pseudoscience relies on people wanting simple answers that don’t involve complex pathways. In fact, most pseudoscience and most charlatans rely on people being simple minded and not critical thought. In this case, Campbell, who is well trained, went global from rats to humans, from high doses of one milk protein to all animal proteins. We want scientists to think globally, but when we venture into fields not our own, we need to learn about those fields – in this case, Campbell is not a physician, but a physiologist who wants to relate rats to humans.

Campbell continues, “There is enough evidence now that local breast cancer alliances, and prostate and colon cancer institutions, should be discussing the possibility of providing information to Americans everywhere on how a whole foods, plant-based diet may be an incredibly effective anti-cancer medicine.

In the book Campbell relates how he tried to talk a woman out of getting a mastectomy to prevent breast cancer. The  woman has the gene for breast cancer, which is a high likelihood that she, like her mother, sister, and aunts, would develop breast cancer.  Campbell, who told her he was not a physician, was pressing his case that if she would change her diet, she would be protected against having cancer. well, lets quote him:

“I told her a little bit about the China Study and about the important role of nutrition. I told her that just because a person has the gene for a disease does not mean that they are destined to get the cancer: prominent studies reported that only a tiny minority of cancers can be solely blamed on genes. I was surprised at how little she knew about nutrition. She thought genetics was the only factor that determined risk. She didn’t realize that food was an important factor in breast cancer as well. We talked for twenty or thirty minutes, a brief time for such an important matter. By the end of the conversation I had the feeling that she was not satisfied with what I told her. Perhaps it was my conservative, scientific way of talking, or my reluctance to give her a recommendation. Maybe, I thought, she had already made up her mind to do the procedure.” He regretted that he was not more forceful, “When I think back to that conversation I had with Betty, I now feel that I could have made a stronger statement about the role nutrition plays in breast cancer. I still would not have been able to give her clinical advice, but the information I now know might have been of more use to her. So what would I tell her now?”

The book also makes the assertion that heart disease is secondary to eating a non-vegan diet. And just as the vegan cardiologist tells us that a vegan diet is better than a stent, lets look at the real data here about foods and heart disease. I asked to look at the evidence that Campbell looked at, the very data that he used to make his conclusions. I asked Jason Tetro, author of The Germ Code, to help with the statistical analysis of this paper.

Before I get into this, let me just point out that we calculate a risk factor for a particular disease as being a fraction of 100, or in many scales 100 is also represented as 1. At 1 there is no correlation. Less than 1 is an inverse correlation, meaning the opposite is true. Greater than one is a positive correlation and we usually wait until we have a relative risk of 2 or greater. 

 

When you see the following risk factors:

amount of fish consumed (r = -0.15)
frequency of fish consumption (r = -0.14)
amount of eggs consumed (r = -0.13)
frequency of egg consumption (r = -0.14)
animal protein intake (r = 0.01)
fish protein intake (r = -0.11)

And now the big one…meat.

amount of meat consumed (r = -0.28)*
frequency of meat consumption (r = -0.15)

 

In other words, NONE of these had any correlation with heart attacks. In fact, all of those seem to indicate that those non-vegan products reduce the risk of heart disease. 

How about people who assert that vegans will live longer.  Well, that just doesn’t appear to be the case. Here is a graph of carbohydrates consumed and mortality from The Lancet in August of 2018.

What you see is a curve that shows the sweet spot is 50-55% carbohydrates for longevity.

That isn’t a vegan diet – that is more like the Mediterranean Diet.

What is worse is when someone doesn’t listen to their physician’s advice because they think they are eating a “vegan” diet.

Steve Jobs, a lifelong vegetarian, delayed surgery because he thought “alternative” therapies might work.

Show Transcript:

Dr Simpson: I know as a surgeon how people fear surgery, and I know from my field of culinary medicine, people will seek nutritional answers to avoid surgery even if surgery is the only way they can be cured.

Dr Simpson: There is so much bad information out there, so let me tell you the story of a man who had been diagnosed with cancer, the kind that we can cure with an operation. He was wealthy, famous and a genius. He could get the best care from the finest physicians in the world and did. He was so famous that doctors made house calls when he was first diagnosed with cancer, a type that can be cured through surgery. He delayed treatment. Instead, he adopted a strict Vegan diet because he was told vegetables would cure our stop his cancer. Being a Vegan wasn’t new for him. He had been a vegan before. He had been on a lot of odd diets. A few months after he was diagnosed, there was this best selling book called the China study by T. Colin Campbell. The China study is often cited by new begins as “science behind why they became Vegan.”

Dr Simpson: The book convinced President Clinton to become a Vegan. I don’t know if he read these lines from the book. Furthermore, a pattern was beginning to emerge; nutrients from animal based foods, increase tumor development, wild nutrients from plant based foods decreased to or development unquote, but the book and that quote are pure nonsense. Not only is this best selling book misleading, not only is the science shotty, but when you drill down to the statistics of the original studies, they don’t support the conclusion that plants stop or prevent cancer, but it isn’t the first time people made the claim that vegetables can prevent, stop or cure cancer, and I don’t know where this famous man ignoring the advice of world famous physicians decided to go with this information,

New Speaker: but he did the his life saving surgery and his cancer continued to grow and after a painful few years, steve jobs died.

New Speaker: My name is Dr Terry Simpson and this is my podcast, culinary medicine food cons and food conversations where we have conversations about food as medicine and discuss food cons, exposing myths, cons than mom.

Dr Simpson: It would be great if there was a single food or food group, something we could wrap our brains around that prevented cancer or heart disease. Would it be great if we could cure or prevent cancer with just dietary? Yeah, so how did Campbell a Ph.D. in physiology, not an MD, come to the conclusion that animal proteins cause cancer and being a Vegan would stop it? I’ll quote from his book, there is enough evidence now that the US government should be discussing the idea that the toxicity of our diet is the single biggest cause of cancer, but let’s get into his book.

Jason Tetro: Oh yes. The China study, that lovely book. Oh my goodness. It’s come back, has it.

Dr Simpson: It does seem to be making a comeback. They’ve had. They’ve put out a couple of movies, “Forks over Knives” and other stuff which are not really documentaries but really are more movies, but it came to mind because I continued to find patients that come in and say, well, I’m going to adopt a Vegan lifestyle, which is okay. I’m always happy to meet them where they are, but when I asked them why they say, this is the book.

Jason Tetro: yes, yes, I’ve heard that many times with a number of different books. I’ve actually met some of the authors of some of these books and it’s very interesting to see how passionate and how committed they are to selling those books. I mean, to helping people be healthy. Uh, you know, the China study was, it was a very interesting book and, and quite honestly you might think that it does have quite a lot of data because people seem to be so devoted to following what it’s suggesting. But as a scientist, when you start looking at the information that came out from that particular book, it kind of just scratching your head and you know, in times pulling out your hair at the same time.

Dr Simpson: That Is Jason Tetro, microbiologists author. You may have read his columns in the Huffington Post or read his books, The Germ Code and The Germ Files. If you haven’t, you should. So let’s go into some of the data for this. For Dr Campbell, who is a committed vegan and thinks everybody should be because in his belief, animal proteins cause cancer based on: A, some of the work you did in China and B, some of the work he did with mice fed bad peanut butter.

Jason Tetro: Yeah. Well, first off, um, before we even get into the data with the humans, you have to realize something. When we’re talking about mice, they act very, very differently than us. If you believe Douglas Adams, they’re incredibly smarter than us, but at the end of the day, if you’re taking any kind of information that you’re getting from a mouse, we like to call this fundamental research fundamental data. We don’t call this even preclinical data. Preclinical means that you’re using an animal that is even more closely related to humans. Primates. So when you start looking at the results that are coming up from mice, you kind of have to realize, okay, well this may be something, but it’s not something that you can put in a book and claim to be fact until you’ve actually done those future studies. And of course, in this particular book he decided that he was going to do that in the China study.

Dr Simpson: Yeah. So his first conclusion was the fed the mice bad peanut butter, which had an Alpha toxin. They develop tumors and when he gave them high levels of milk protein, they. These mice had worst tumors than the other mice. And from that came the conclusion that well, clearly proteins from non plant sources are evil.

Jason Tetro: Yeah. And I mean, the fact of the matter is, is that when you’re ingesting a protein by itself, your body is going to digest it in a certain way. There is a process and how that happens, and that’s sort of one individual components. But the problem that you face is that you don’t just simply eat proteins. I mean, when was the last time you were just eating, you know, Al Leucine by itself, it’s tasteless. Yeah. And I always overcook it. Yeah. Well the. Yeah. The thing is, is that you, you’re at the other end of the Maillard reaction. So you know, it’s, it’s just going to burn. So when you start looking at all the other components, then what you start to realize is that there are other factors that are involved and if you don’t start looking at all the other pieces of the puzzle that make up the food that you’ve just ingested, you’re really doing yourself a disservice.

Jason Tetro: So when you start looking at how plants are, then you’re really looking at the idea of fiber and the fiber is nondigestible, which means that you’re going to have to be incorporating higher levels of bile and that’s going to lead to what they’d like to call them. More efficient breakdown of the food so that it become more absorbable and potentially have less impact on the immune system through inflammation. That’s great. That’s absolutely true. When you start looking at something like dairy, you’re incorporating other components and again, you’re going to have the bile, maybe not as much and depending on the microbial composition that’s in your gut, you may end up actually creating a whole bunch of beneficial molecules that are going to help your immune system. Or if your microbial composition is such that they’re just going to chew up all of that lovely dairy stuff and then pump out all these toxic byproducts and this happens, we like to call that dysbiosis, then certainly you’re going to potentially have inflammation and sparking the immune system so that you could literally end up with a higher risk for cancer and other diseases. So at the end of the day, the protein really doesn’t fit into the equation, but if you happen to be committed to selling your books, I mean helping people. You might actually find yourself going into one spot such as protein and then making these rather outlandish conclusions. We like to call them overstatements.

Dr Simpson: The only problem with people who are selling their book, even if they think their premise is right, is that they have sold an unproven hypothesis, but now let’s look at the actual data from the study and how it was collected. So I wanted to also go to what he did in China. His theory was I’m going to go out to these rural villages where they eat traditional food

Jason Tetro: and then we’re going to collect all of their blood samples and see how they react. So one thing that bothered me was it’s not like he collected sample a villager a and B and c and d and made that sort of typical scatter gram. We’re used to pooled it all together. And what I find interesting is that, um, you know, when you start reading the, how he did this, you know, you’ve got 6,000 people, 367 different variables, 8,000 comparisons to see whether or not our diets are responsible for us becoming sick. And you know, that is all fine and dandy. But here’s where it gets a little lot. First off, you’re pooling everything as opposed to doing individual. So in that case, you’re losing the variation, which is good if you’re trying to create a statement by the same respect, you’re also losing the individual variability.

Jason Tetro: And I think that is where things become really problematic because when you forget about the individual, then you’re forgetting about the whole complexity that comes with being an individual and that needs to always be taken into consideration. Otherwise you start making statements that you know, may sound like they make sense, but in reality dumped. But even in this study that that pooling of, of all the people to create those associations and try and find what we call risk factors, it didn’t really pan out the way that he would have liked. And, and this is what bugs me the most about this particular type of study, let’s just put it this way. You’ve done risk analysis before, right? Yeah. And you know that we calculate that risk factor of a particular disease based on some action that we take. When we do this, we usually create what we call a fraction of 100.

Jason Tetro: It’s kind of like a percentage and the closer that you get to 100, the more likely it is that that particular activity is going to be a risk factor for that disease. Now I should also mention that if the amount is negative, in other words, there’s no correlation, then you can’t really make a statement. So in terms of the cancer, there’s not really a heck of a lot of of correlative data just kind of out there, but if you actually look at something else that he was looking at, and this is hard because you’ve heard too much red meat leads to heart attacks, right? That’s what some people say. Yes. Yeah, exactly. Well, at the end of the day when you start doing these correlation studies and you start causing these percentages or these risk factor amounts to be calculated, you find something very strange. Now this is actually coming from his own data.

Jason Tetro: Let’s just talk about fish. If you happen to be eating a lot of fish, well then the number that comes up with respect to heart attack is minus 15. Let’s try that with eggs because I mean surely we’re going to get better than minus 15, right? Well we do. It’s minus 13. So just for our listeners, what this is saying is not only is it not a positive correlation might be beneficial to eat fish and maybe eat eggs and surprisingly that’s what a lot of people suggest and yet for some reason this particular study said otherwise, don’t know why. So when we go to the animal protein intake, which is of course his big thing, right? Well the fact of the matter is is that the correlation is minus 28. So animals are good for you. Yeah. Animal Protein is actually pretty good for you when it comes to your heart attack.

Jason Tetro: And I had another question about one other thing he did, and this is kind of in your wheelhouse. He seems to ignore schistosomiasis and liver cancer as a cause of lubricants are and seems to think it’s animal protein. Well, yeah, I mean that’s again, when someone is very committed to selling those books or helping people out, they’re going to say what’s in the book. Right? And so something as unfortunate as a shift, stowe, which you know, is happens to be endemic in many areas is a priority. And in healthcare it doesn’t seem to really play a role in this particular design. One other thing that you really need to think about, and I don’t know about you, but you know, when you start talking about things like chronic diseases like cancer or heart attacks or stroke and things like that, there does seem to be one particular enemy that maybe we don’t talk about so much and was completely ignored in this particular book.

Jason Tetro: Have you ever actually measured blood glucose on people? I do that. Yeah. Yeah. And, and, and I mean we do that for something called diabetes, right? A lot of my patients seem to have that. Yeah. Well, it turns out that if you start looking at rather than that diabetes, you look at blood glucose as a potential risk factor for a heart attack. That risk. Remember meat was minus 28, the risk of blood glucose is plus 30. So let’s just put it this way, in a village when you’re taking blood glucose and pooling it together, you’re going to have somebody there who may have a blood glucose of 80 normal doing fine and you probably have some people there that might have it at 300 and not realizing what’s going on inside of them because unless they’re paying a lot, they probably don’t know they have blood glucose problems.

Jason Tetro: Exactly. So there was a separate study in 2013 that actually started looking at, well how can we associate this? And what’s really interesting is that that 30 percent kind of woke a number of people up who went back to the study, went back to the China study to start looking at whether or not maybe it had nothing to do with meat protein and maybe just maybe he might’ve had something to do with that blood glucose. So when we talk about blood glucose, a lot of us end up talking about sugars and of course a really good form of sugar comes in the form of bread, wheat, right? Yeah. Northern Canada has a lot of that. Yeah. And so when they started looking at that, all of a sudden when it came to heart attacks, surprise, surprise, that number was 50 positive 50. Now of course they don’t have wheat everywhere.

Jason Tetro: They may have corn, so maybe if you’re having more corn that’ll help. But that was 30 or sorghum, which is a huge thing in China was also 30 and mill. It was about 37. At the end of the day when you start thinking about it, you’ve got a minus 28 from meat and in terms of blood glucose, as a result of eating too many grains that are non rice, you’ve got anywhere from a 30 to 50 percent increase in your chances of having a heart attack. And you start going, well, why is he going after meat? Instead of going after a more balanced blood glucose level? We ran through those statistics fairly fast. An analysis of Campbell’s data shows his conclusions are not backed up by his data.

Dr Simpson: In fact, the opposite conclusions have better data that meat, fish and dairy are a healthy diet. We will have more information about this in the blog. Your doctor’s orders.com. It wasn’t only Jason who came to these conclusions, but many other people who have looked at the data from this study. The study wasn’t only about cancer but also about heart attacks. So the conclusions are looking at the data is fish seems to be pretty good for your heart. Meet seems to be pretty good for your heart and meat and fish are in cancer. Doesn’t seem to be that sort of an issue unless you happen to have schistosomiasis, which he acknowledged. Yes. Refined grains aren’t really good for you. Uh, I, I didn’t read those conclusions

Jason Tetro: book and you see the problem is that sometimes scientists, including myself at times, well, we unfortunately fall into something that we know is bias. I’m sure you’ve heard about that once. I heard that once, once, once. Yeah. Well bias is a huge problem when it comes to science because what happens is that when we’re performing experiments in a lab or, or even something as vast as a 6,000 person clinical trial, we formulate a hypothesis. We have a theory that we want to prove or disprove. I think that’s the problem is that in many cases when we start doing these studies, we’re actually trying to prove something as opposed to find out whether or not it actually is true or not. When we do these types of tests, it’s really great when you’re doing say a clinical trial for a drug because essentially you’re talking about does the drug work or does the drug not work, which is great for clinical trial, but when you’re doing risk factor or associations like this was done in the China study in it and number of others. I mean we’ve seen some really interesting clinical trials come up with some very odd conclusions. You forget about the fact that human nature is a dynamic variable in and of itself, so if you go into rural China and you look at where those people are and you look at how those 367 variables could be altered, you start to realize, well, there’s a couple of things that maybe they should have looked at. You know, the idea of the environment.

Dr Simpson: I can’t buy that. This was a terribly well done study.

Jason Tetro: That’s normal. Unfortunately,

Dr Simpson: I can buy that this thing was publicized exceedingly better than in almost any poor study I’ve seen in a long time. Yes, absolutely, and the problem that I have as a physician, a surgeon, there are body bags that people have to account for when they come to these conclusions that they come to. Let me give you an example. Colin Campbell in his book said he was talking to a woman who had the BRCA 1 gene, which is the gene that increases significantly. She was going to undergo a double mastectomy because she wanted to decrease her risk of breast cancer, which her mother had died from. Her aunt had died from her sister, had died from and he said he was trying to talk her out of it by saying if you just eat plant, you probably will never get breast cancer. Yeah, I mean that’s practicing medicine without a license.

Jason Tetro: Wow. In a way that sort of almost a criminal act.

Dr Simpson: He was upset. She didn’t listen. I’m glad for her sake that she didn’t. But considering this is sort of that, you know, and I had a, an acquaintance of mine, which was the reason for this podcast, besides this patient who is a dentist, so some scientific training and he decided to become a Vegan based on reading this book.

Jason Tetro: You know what, unfortunately, it’s unless you’ve had an opportunity to read through numerous clinical trials, learn how they’re developed, learn how information is gathered and then how that information is all put together. You run the risk of being convinced of a particular statement as a result of bias rather than from the data itself. And this is something that we see all the time. I mean, are you still drinking alcohol?

Dr Simpson: Me periodically. Yeah.

Jason Tetro: Well, the thing is is that you shouldn’t be touching a drop of it or you’re going to die based on a more recent, a clinical study in the Lancet.

Dr Simpson: In fact, we just had that podcast that was one of our, I think, our fifth podcast.

Jason Tetro: No. So, yeah, exactly. Um, the other thing is, uh, are you eating lots of dairy? Because apparently if you eat dairy, you can jump out of an airplane without a parachute.

Dr Simpson: Well, because I have lactose intolerance, I probably could.

Jason Tetro: Yeah, so I mean that’s the problem with these clinical trials is they come up with a particular bias and then when they go through the testing, what they do is they look at the variables in such a way that it helps them to achieve the bias that they’re looking for

New Speaker: Food as Medicine,

New Speaker: it is too often used by quacks. What we eat does affect us. It does, but in the culinary medicine movement, many don’t like the phrase food is medicine. I think we in the field of culinary medicine to take back that phrase, food as medicine simply because we can show where reasonable eating decreases risk of diseases. The Mediterranean Diet has clear reductions of risk in heart disease, cancer, dementia. The Dash Diet has clear reductions in hypertension and stroke. The problem is when mountebanks, charlatans, maybe even well meaning think that food can cure something or completely prevent some disease. There is something about food as medicine that appeals to every human because it provides sometimes simplistic and easy answers to complex medical issues, but even more it empowers us. It gives us a key to our health and we kind of want to encourage that. So here’s what happens when the Vegan activist hears this podcast. They’re going to say that Steve Jobs wasn’t always a perfect vegan because Jobs, death

New Speaker: doesn’t fit into their narrative that plants protect you from cancer. They will say that Jobs did need perfectly, although if you read the biography about them, you will see that he did, but let me tell you about a patient of mine. He was 36 years old and I had diagnosed the metastatic colon cancer that would ultimately kill him. And as I was sitting in his hospital room telling him the results of the operation, I performed; telling him of the horrific findings of the cancer. He couldn’t understand. He couldn’t believe he had cancer. Denial is pretty common in medicine and denial is more common when you’re young and think you’re immortal. Ignore the blood on the toilet and you may miss the chance to cure the colon cancer. Think that you have something special about you that you won’t get cancer and it’s easier to justify not going to the doctor.

New Speaker: It is human nature to want to understand and control our bodies. We think that if we do everything perfectly well, we won’t die. But we do. We all do. We just don’t want to die too young. lLike my patient did. As a physician I don’t want you to miss the chance to cure a disease, to let symptoms go on too long or to be taken in by a myth like this young man. A myth perpetuated by those who play doctor because of food. In culinary medicine, we talk about food as medicine, but the difference is we know medicine. A food myth killed this young man. A myth allowed him to ignore the signs that would have sent most people to their doctor. He didn’t think he needed to call when his body was telling him, screaming at him that something bad was happening.

Dr Simpson: Because he believed someone who wasn’t a doctor. When I had that difficult conversation with them, the one where I had to tell him that the colon cancer was spread throughout his abdomen and his liver throughout his body that I couldn’t cut it out, and when the cancer doctor, the oncologist told him he couldn’t cure it, but that this cancer would kill him within months, if not weeks. My patient came forward with that myth. He said, “Doc, I have been a Vegan since I was 14 years old. In fact, he was raised as a Seventh Day Adventist, so he had never eaten meat in his

New Speaker: life. But he had read Campbell’s book any believed it and now he’s gone.

New Speaker: To be clear, there is nothing wrong with being a Vegan, but there is something wrong if you think it is a perfect diet. It isn’t. My patient who died, ignored the clear warning signs of cancer, partially because he was under the false belief that he could never get cancer because he ate vegetables and never in his life ate meat. Then there was Steve Jobs who had every advantage but chose not to listen to the best physicians on the planet. It’s sad when a genius made that mistake because hucksters out there gave him bad advice.

New Speaker: Special thanks to Jason Tetro for lending his comments to today’s show. And of course thanks to you for listening to this episode of Culinary Medicine with me, Dr Terry Simpson. While I am a doctor, I am not your doctor and you should always seek the advice of a trusted, licensed, medical provider with experience in your particular condition or concerned before taking any action. But if I am your doctor, what are you cooking tonight? Culinary medicine is a part of the Your Doctors Orders network and is produced and distributed by our friends at simpler media. Evo Terra, my Sensei for beer and podcast. My executive producer is the talented and beautiful @producergirl from Producergirl Productions. You can follow me on twitter where I am @drterrysimpson. I’ll be back next week where we’ll have another conversation about food as medicine or unveil another food con. Until next time, don’t drink the water. Drink the wine.

Dr Simpson: Hey, producergirl. You were born in Hong Kong. You lived there for a lot of years. Tell me about Chinese food.

Producergirl : Why don’t we just forget this part?

New Speaker: I like this part. I don’t even know what Evo is going to put in.

New Speaker: Sorry. Evo.

New Speaker: I think we’re done.

Producergirl: I like editing.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate, graduate, and medical degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. Until he found he liked people more than petri dishes. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2018 and 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.