The Doctor Appointments & Lab Tests That Could Save Your Life | Dr. Mark Hyman

Coming up on this episode of the Doctor's Pharmacy, another drawback of conventional medicine is that it underemphasizes the role that diet and nutrition play in health. I mean, food is the number one driver of chronic disease. It's also the number one cure. And yet doctors learn nothing about food in medical school. I know this. My daughter's in medical school now. She ain't learned nothing about it. I certainly was in medical school 40 years ago. There was nothing on it then either. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hymen Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for summary of my favorite and tested products. Welcome back to another episode of the Doctor's Pharmacy and Health Bites, where we take juicy little bites into current health topics. I'm Dr. Mark Hyman, and today we're exploring a vital topic that affects us all. The pros and cons of conventional medicine, which I was thoroughly trained in and got really good at, but then realized wasn't all it was cracked up to be. But it's still good. They're just has some gaps. Now, definitely conventional medicine has some drawbacks, but it's really important to recognize that there are strengths and life-saving capabilities of conventional medical practices, and I personally have benefited from them. I've had back surgeries, I've had two heart surgeries for atrial fibrillation, I've definitely availed myself of the good parts of conventional medicine. Now, it's great in emergency care, early detection, diagnosis of chronic disease through all kinds of tools like mammograms, colonoscopies, blood work. And these diagnostic tools are really crucial for identifying conditions early and managing them effectively. But there are really limitations on the range of tests that are commonly ordered, and often the treatment focuses more on the symptom management with pharmaceutical drugs rather than addressing the root causes of illness. Now, despite this, the role of conventional medicine in saving lives through emergency situations and helping with palliative care and surgeries really can't be understated. I mean, I literally just had back surgery three weeks ago. Thank God I had spinal stenosis. I'm good. But, you know, if I lived 100 years ago, I wouldn't be so good, right? On the flip side, conventional medicine can fall really short when it comes to preventive care and getting to the root cause of disease and even further creating health. Okay. It tends to under emphasize the importance of things that really make a difference for creating health like diet, nutrition, lifestyle changes in both preventing and treating chronic disease. And that, my friends, is where functional medicine shines. So focusing on the root cause of illness, promoting long-term health is what functional medicine is about. And today we're going to discuss something really important, which are what are the essential doctor's appointments that you should not skip to ensure that your health is on track and catch any potential issues early. All right, so let's get into it. Something to know about conventional medicine is that it tends to focus on quick fixes and symptom management rather than addressing the root causes of illness, which can lead to a whole cycle of doctor's visits and medication dependency. But it's important to recognize the strengths also of conventional medicine. So there are a lot of pros. Conventional medicine has a time and a place where it's really useful and can save lives. It's really good in emergency care. I used to be an emergency room doctor. I get it. I've saved many, many, many lives in the emergency room using all the best tools and techniques and technology and science of conventional medicine. It's great at detecting and diagnosing chronic illnesses with things like mammograms, colonoscopies, blood work, other diagnostics. But there are really limitations to the breadth of tests ordered. We're just not doing a deep enough dive on people's biology. Part of that's convention, part of that's just lack of awareness, part of that's just the way the medical system works, which is to wait until you're sick and then test. And there are preventive screenings, but they're very limited. And then when you do get something, it just offers you drugs for managing symptoms, not curing the problem. or getting to the root cause. Now, this is not a long-term solution. It's really great for emergency situations and for surgery and palliative care, as I mentioned. Now, there's no doubt that conventional medicine saves lives and helps people live longer, but the real question is, does it help people live better too? So what are the cons of conventional medicine? Now, we know they can be great for diagnosing disease, for managing symptoms, for dealing with emergencies, but there are drawbacks. For example, it does not get to the root cause of what's driving the illness in the first place. for example, the things that I do as a functional medicine doctor, looking at the gut as the root cause of illness and gut dysbiosis, looking at inflammation, looking at insulin resistance and hormone imbalances and environmental toxins and lots more things that are really critical in determining what the root cause of disease is and what to do about it. So by the time the symptoms develop, it's often too late and chronic disease has already started to take root. Another drawback of conventional medicine is that it under emphasizes the role that diet and nutrition play in health. I mean, food is the number one driver of chronic disease. It's also the number one cure, and yet doctors learn nothing about food in medical school. I know this. My daughter's in medical school now. She ain't learned nothing about it. I certainly was in medical school 40 years ago. There was nothing on it then either. So conventional medicine is really good for screening and detecting conditions, things like cancer, type 2 diabetes, high blood pressure, heart disease, but that's already when you got it, right? Where it falls short is when it comes to tracking things very early on the transition from wellness to illness. when it comes to true prevention, when it comes to preventing chronic disease in the first place, and that is where functional medicine shines. And not just really about prevention, but also when you're chronically ill, how to reverse disease, not just manage it, but to reverse it. Now, we've talked about how to use the power of functional medicine to treat a whole bunch of different conditions in hundreds of other episodes. And of course, you can go to my website, drhyman.com, to check out those episodes and hundreds and hundreds of blogs and articles I've written. There's just a wealth of content. In fact, I completely redid my website to make all the content organized because I realized I had 20 years of content and they needed to organize it better so people could find what they wanted to look for. Now today we're talking about those doctor's appointments you shouldn't skip if your health is on track and what you can do to catch any potential issues early and maintain your health. The first doctor's visit you should make sure to put on your calendar is your annual checkup with your primary care doctor. Now you may think, oh it's not worth it, it's not necessary, but they're basically the hub for your healthcare. Their focus is on overall health maintenance, on early detection, on management of chronic conditions, and they play an important role in healthcare. They also can coordinate with specialists and can refer you to other healthcare providers when there's a problem. Now, your annual checkup provides generally a pretty good view of your overall health. It looks at your vital signs, like your blood pressure, your heart rate, and your respiratory rate, your weight, your height, and so forth. Clinical biomarkers, lab tests, which basically are not enough, but at least it's a start and maybe can catch issues early on. But during your annual exam, just like any other time with your doctor, your doctor will check your blood pressure, your heart rate, look for cataracts, look for questions about different symptoms that you have, look for a physical exam that checks your overall health. You know, by the time you find something like a clinical sign of a disease on an exam, it's always late, right? There's a book called Robinson Co-tran, it's the Pathologic Basis of Disease, something we all read in second year medical school who are doctors. And in that book, it says every pathological change, meaning anything you can see on an x-ray, anything you can see with your eyes as a doctor, on imaging or scans, anything that's a pathological change is always preceded, always preceded by a biochemical change. And so we're not looking in the right place for the problem. We're looking it down the road for pathology, and that's okay. We want to pick it up. because many people are not even diagnosed and don't know they have diabetes, they don't know they have heart disease, they don't know they have cognitive decline, but there's tests that can pick that up. And you're going to get some routine blood work. You're going to get a metabolic panel, look at your kidneys, your liver, your blood sugar, electrolytes, that's all important, but those are usually only abnormal when you're really, really sick. Blood count, you check for anemia, white cells, red cells, it can check for different cancers. It's all great, but it's just usually the tests that are out of range when you're in the hospital, I'm really sick. And of course, they'll check your cholesterol. basically your triglycerides, total LDL, HDL cholesterol, which is really not enough. It's just a very old and outdated cholesterol panel. And I've talked about that on many other podcasts and will link to show notes for Health Bites where I did very deep dives on cardiovascular testing. Now, there are a lot of problems with these routine tests. For example, if your LDL comes back high, your doctor is going to just, like a reflex, prescribe a statin. If your blood pressure is high, you're going to get a blood pressure pill. But that may not always be necessary. You know, sometimes it is, but not always. There's a lot that could be missed or misinterpreted by only looking at the biomarkers that we currently test on an annual physical. And the quote, the normal reference ranges, which we call normal, they're based on averages in a population, but it's a sick population. Right? 93% of Americans have metabolic dysfunction. So they say, oh, insulin's fine up to 15, but of course nobody checks insulin anyway. check on a checkup, but 1% of tests are insulin tests for a regular checkup. And yet the ideal insulin should be under five, not 15, but it says 15 because everybody in America's got high insulin because they're eating sugar and starch. So normal doesn't mean optimal. It's also important to get the right tests. So the right tests are important to get and they're different than typically what you'll get in your annual physical. For example, you want to get a lipo protein fractionation test which looks at the lipid particle size and the particle number. And there's different labs that do this. NMR is one technique, Cardio IQ is another technique, or ion mobility tests. They're basically different analytic techniques. But basically these are much more accurate in assessing your cardiovascular risk. They look at the number of cholesterol particles, how big they are, how small they are, whether they're dangerous or not dangerous. It's much more accurate at predicting cardiovascular risk. Same goes for your blood sugar. I mean, you should get a fasting blood sugar for sure, but that's a late stage phenomenon. By the time your sugar goes up, it's way too late. The horse is already out of the barn. You want to get a fasting insulin in addition to fasting glucose, because that'll tell you early if you're insulin resistant. You might not even want to get a insulin resistance score, which is a newer test with newer technology that's done by Quest that gives you a much better indication of your degree of insulin resistance. Now, your doctor might also want to check your thyroid-stimulating hormone. They do that sometimes on a screening test, but they don't do everything. They just do TSH, which is just one part of the story. They don't look at a full thyroid panel. They don't look at free T3, free T4, thyroid antibodies, which can often be abnormal when the other tests are normal, when TSH is normal, and you still may need treatment. They also often don't do really important tests like vitamin D, like C-reactive protein to measure inflammation, like PSA to screen for prostate cancer, which should be part of routine screenings, but are not. And they also don't look for really important tests that your doctor is not getting to, which are more predictive of your cardiovascular risk than just your lipid profile. For example, as I mentioned, fasting insulin, the lipoprotein fractionation, the high sensitivity CRP, but also other cardiac biomarkers that are almost never ordered, but are the most predictive of getting a heart attack, like lipoprotein little A or ApoB. We also look, also it's important to look at uric acid, an indicator of your level of insulin resistance and fructose intolerance, looking at your deep nutrient levels like vitamin D and magnesium levels, which are really depleted in our culture. Omega-3s, 90% are deficient in that. Iron panels, sex hormones, looking at B vitamins through homocysteine, a full thyroid panel. So you've got to look at all these tests, not just the ones that you get on your regular panel. And you can ask your doctor to do these tests for you. But if they give you a hard time or they say insurance won't cover it, There are other options. You can get comprehensive lab tests to measure all these biomarkers and more through a company that I co-founded called Function Health. And I created this company with my co-founders in order to actually provide people access to their own biological data. You should have access to your data. You should have to go through a firewall of a doctor, an insurance company, and figure out what to do. You can do this very easily. And I co-founded this to help you get access to your own biology and become the CEO of your own health. and it's just $4.99 a year, which may seem like a lot, but it's doing the equivalent of about $15,000 worth of tests over 110 biomarkers and are extremely effective in identifying where you're headed and what's going and you can track it over time and in a beautiful dashboard of insights from the world's top doctors. So if you want to skip the wait list, which is about 300,000 people now, go to functionhealth.com/mark. That's functionhealth.com, forward slash Mark to skip the wait list and learn more about everything Function has to offer. The next test is something that all men need to consider, and that's the most fun test you can possibly get as a man called a prostate exam. It's not fun, I promise you. If you've had one, you know what I'm talking about. Every three to five years, you should go get your prostate checked through a rectal exam starting around age 50 and maybe even earlier, because now we're seeing earlier cancers that in the 40s. And with function health, we've picked up, for example, prostate cancer in 40-year-old men that saved their lives because we got it early. Through PSA testing and gallery testing, which we'll talk about, which is a cancer screening test. Now, if you have a family history of prostate cancer or if you have a high risk, you know, high risk group like African Americans, you might start screening early around 40 to 45. Now, these exams can help detect prostate cancer and the most common type of cancer among men and it can detect it early. but you can also look at your PSA. Now, this is controversial and there's some controversy whether you should get it or shouldn't get it tested, whether there's, you know, false positives and there are. There are false positives, which means it might be elevated but it's not really because you have cancer. PSA stands for prostate specific antigen. It's a protein that's produced by cells in the prostate and it circulates in the blood either bound to other proteins or free PSA, which is unbound and is active. Now, measuring your PSA is crucial. for screening for prostate tumors and monitoring pre-existing prostate cancer. So tracking your cancer progression and whether you're in remission or not. And they vary from person to person depending on age. Depending on your age and the size of your prostate, you should be really low. It should be less than 2 nanograms per milliliter. Now the reference range goes up to four, but individuals with levels below four can still have prostate cancer. So what's important to look at the progression of rise. So let's say you go one year and your prostate PSA test is 0.5, but the next year it's 2. Well, that's worrisome. It's often the change that's worrisome. Now, other people may have prostate abnormalities with a PSA level between 4 and 10 nanograms per milliliter, but they might not have cancer at all. If they're above 4 or if you are increasing by one or two points from your last year's check, your doctor might want to send you for further testing and checkups. Now, when they're on the rise, these PSA levels, especially if there's a lump during a prostate exam, your doctor might want to get a prostate ultrasound or an MRI and maybe even a biopsy to look at the tissue to see if there's any cancer. There's also another way to help determine what's going on, which is another test called the free and total PSA. Most doctors just check the PSA. You want to check free and total. And that can help determine whether a prostate biopsy is needed or if the elevated level is due to a benign condition, like just an enlarged prostate with getting older. The percent free PSA is calculated by dividing the free PSA by the total PSA and multiplying by 100. It's just how you get obviously the percent free, which helps determine the risk of prostate cancer. And studies have shown that a lower percent free, less than 25%, is linked to a higher risk of prostate cancer. So for example, if your total PSA is 10 and your free PSA is 1, this is going to be concerning because it's not a good ratio. However, if your total PSA is 3 and your free PSA is 1, not so concerning. It might just be because you have something called BPH or benign prostatic hypertrophy or enlargement or hyperplasia. Now remember, the PSA test alone can't diagnose cancer. You gotta look at the false positives. Now only about 25% of biopsies that are done after an elevated PSA will actually show that someone has prostate cancer, which means 75% don't, right? So getting a high PSA, getting a prostate ultrasound, getting a biopsy, it can cause anxiety and it can lead to extra procedures like I just said, like biopsies, which may not be necessary, but better than having prostate cancer. There are other ways to test too. We'll talk about that. Another limitation is that many tumors found via PSA grow real slowly and are unlikely to be life threatening, leading to over diagnosis and over treatment. Most people say in medicine that you don't die from prostate cancer most of the time you die with it. One of the largest randomized controlled trials ever on prostate cancer screening showed a higher likelihood of prostate cancer diagnosis with screening but no reduction in death rates. So in other words, you screen people, you find more cancer, but it didn't really impact the rate of death because most people don't die from it, or maybe it was a slow growing tumor and it just does never end up being a problem. Now, this is a tricky area. Researchers are working on better methods for detecting prostate cancer and fast growing cancers like free and total PSA ratios, which is good. There's also the GALLERI test, another test which we'll talk about that looks at liquid Bob's he's maybe even more sensitive. Another test you shouldn't skip, and this is another fun one, which is why people skip it, is called a colonoscopy, which is where they stick a giant tube up your butt and look at your colon. Now, colorectal cancer is important to diagnose. It's the third most common cancer today. It's the number one cause of cancer in people, men under 50, and second leading cause of cancer in women. under 50 as well. So it's very concerning. It's often called a silent killer because it can show up without any symptoms until it's progressed to the late stages. And it's the number one cause of cancer death, as I said, among men under 50 and number two leading cause of cancer death among young women. Now it's increasing also by 1 to 2%, which is a lot every year in adults younger than 55. So something's going on. I've talked about this in a previous podcast about cancer, but key here is that you want to get screened. and I have many friends who are young who've gotten colon cancer and died from it. So I can tell you this is a real thing. Now, colonoscopies can help catch the disease before symptoms appear, which is good. And they'll show up as polyps because cancer doesn't just start all of a sudden. It starts as a little bump and then it grows to a polyp and that polyp becomes abnormal and that abnormal polyp becomes cancer and then it invades. So it takes a while so you can track it with colonoscopies. And when you do this, you're going to improve outcomes and survival. For example, the five-year survival rate for stage one colon cancer, which is localized, is 91%. And for stage four, where it's spread and metastasized, it's only 14%. So that's not good. Now, colonoscopies can detect precancerous polyps before they become cancer, making them both a screening tool and prevention. So you get the polyp taken off, and that's good because that would have maybe turned to cancer. In 2022, a randomized controlled trial published in the New England Journal showed that Colonoscopies can reduce the risk of colorectal cancer by 31% and the risk of dying by 50%. So seems like it's a good thing, right? Don't want to die from something you don't have to die from. In fact, nobody should die from colon cancer because it's totally treatable early and preventable and it's really important to look at. Now something interesting to note about this study though is that participants either received an invitation for the colonoscopy or which is the invited group or they didn't get an invitation, which was the usual care group. Now, of those who were invited, 42% actually went to get their appointment, which doesn't seem like a lot, but it is a lot in medicine. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group, as compared with 622 cases in the usual care group. That's a big difference, right? More than twice the number of people in the group that didn't get invited and didn't get the colonoscopies got cancer. More importantly, there was an 18% lower risk of colorectal cancer at 10 years in the invited group, meaning even 10 years out they still were better off because they had probably precancerous polyps removed. Now could the risk reduction have been higher if more people in the invited group had followed through with their appointment? Probably. This means that getting your colonoscopy really can help you detect and prevent colorectal cancer, but it's critical you have to schedule and follow through with your appointment. And yet, according to the CDC, one in five adults between the ages of 50 and 75 have never been screened for colon cancer. So that's not good. So what should you do? Well, what are the recommendations? The American Cancer Society now recommends screening for colorectal cancer at age 45 instead of the previous recommendation, which was 50. Nothing's abnormal. It's recommended to get another one every 10 years, which is not so bad. If you have a family history of colorectal cancer or polyps, you should be getting colonoscopies at age 40 or 10 years before the age at which the affected relative was diagnosed. So if your relative was diagnosed at 45, you want to start at 35. Now, depending on individual risk factors and so forth, more frequent screenings may be recommended maybe every 3 to 5 years. If you have a polyp, you might want to do it sooner. Or if you have ulcerative colitis or Crohn's, you might want to do it every 1 or 2 years. It's important to know that there are some really innovative tests that are on the market now that help you detect cancer at an earlier stage than you would even get on a colonoscopy called the Galleri test. This is available through Function Health that I mentioned, I'm a co-founder of. It's a blood test. I recommend getting it every year to screen for over 50 cancers. It's got a very low false positive rate. The false positive rate for PSAs is like 75%. This is less than half a percent. So very, very effective in diagnosing it. if you have it, it's about 75% of the time it picks it up, but it won't give you a lot of false positives, meaning it says positive, but you don't have cancer. And there's another test that's specific for colon cancer called the free nOME test as well. So they're available now and I encourage people to use those. Now the fourth doctor's visit you shouldn't skip, ladies, and this one's for you, is your annual gynecological exam. These visits are really important because they help you screen and detect early potential cancers that can kill women and are often silent, like cervical cancer, ovarian cancer, uterine cancer, they can detect other health issues, trouble with cycles, and reproductive health, and managing all the things you want to manage when you're a woman. So for preventive care, you can use things like Pap tests, which detect cervical cancer, and also will help you detect something called HPV or human papillomavirus, which is a viral infection that can actually cause cancer, and it can damage the cells. And early detection of abnormal cells can prevent cervical cancer from developing. Pelvic exams also are helpful because they detect abnormalities in reproductive organs like the uterus, the ovaries, fallopian tubes. Often doctors who are GYNs will do just vaginal ultrasound as a retune part of screening to look at your uterus and your ovaries, fallopian tubes. Breast exams also important to detect lumps or changes that might indicate breast cancer and you should learn how to give a self-breast exam because you're the one who's going to pick it up early and they may also find other breast conditions. Also the screening test, the gallery also helps screen for all these so it's really helpful. Now these are all somewhat obvious if you've seen a gynecologist before. before, but mammograms are something every woman should consider once they hit perimenopause. Now, mammograms help with early cancer detection and treatment outcomes, and if you have abnormal lumps in your breast, during exam, your gynecologist or your primary care doctor can write a prescription to get a referral to a radiologist for a mammogram. Now, for the average woman without significant risk factors, the American Cancer Society Screening Guidelines recommends this. basically starting annual mammograms around perimenopause, age 40 to 45. For high-risk women, this would be women with the cancer genes, the BRCA1 and 2, or who've had a history of breast cancer or have a strong family history, you might want to start earlier at age 30. What else is your gynecologist going to do? Well, they can help detect reproductive conditions, different things that you might have, like fibroids you might not know, or endometriosis or ovarian cysts. they can help with your regular cycles, they can help address causes of infertility and do diagnostic tests to figure it out, or maybe want to have a baby, they'll refer you to a specialist in IVF. They can help you with PMS or premenstrual dysphoric disorder, which is more severe PMS that makes you really depressed, or PCOS, which is basically causing acne, hair growth on your face and irregular cycles and also infertility. Now, when hormone balances are detected, they're managed often with traditional treatments like hormonal birth control pills, IUDs, whether without hormones, different medications, but not always the best way to handle things. So what should happen? Your doctor should actually order a comprehensive lab test to get to the root cause. For example, PCOS is called polycystic ovarian syndrome, is caused by insulin resistance most of the time. So they should be measuring your metabolic health, not just your hormones, but your metabolic health, looking at fasting insulin, glucose, hemoglobin A1C, lipid particles. They should also look at other forms of hormones that might be relevant like testosterone or DHEA sulfate or androstenedione and look at estrogen and progesterone. So really look a comprehensive look at everything. They might also want to do other tests to look at the onset of menopause and fertility to S with, for example, something called the AMH test. This is anti-mullerian hormone and that is a test that can measure the quality and the quantity of your eggs. so that's going to be really helpful. So you want to get really a much deeper set of labs. Most doctors don't do a deep enough set of labs. And again, that's why I co-founded Function Health, so you can get that at a very affordable cost on a regular basis with twice a year testing. That includes a full hormone panel, inflammation checks with CRP, thyroid testing and antibodies, vitamin D, magnesium, and a lot more. But they usually don't test all this stuff. And we do this all at Function Health. It's easy to do. It's five minutes sign up, 15-minute blood draw, draw your in and out, and then you get your labs in a beautiful dashboard with great insights about what to do about them from the world's top doctors and all the scientific evidence. So, you know, you can ask your doctor for them or you can go to function, whatever you want to do. Regardless, scheduling your annual gon visit is really important for screening for breast and cervical cancer. So don't miss out on that. There's just no reason that women should be dying from these diseases at the rates they're doing it. Bottom line, go get checkups. They're important. It's not the whole story. You still need to look at your health optimization, creating health, which is what functional medicine is about. But conventional medicine has a role. These screening tests are important. We might do deeper dives. That's why I created functional health with my co-founders that offers you the opportunity to do that. And then you will not be sorry you did all these things because you will prevent needless suffering and needless death. I hope you have a clear understanding of the strengths and limitations of conventional medicine. Now, while it's excellent for emergency care and for diagnosing illnesses, it often falls short in addressing the root cause of health and emphasizing preventive care. So we've seen how conventional medicine can be life saving with its diagnostic tools and its treatments, but we've also highlighted the importance of looking beyond those quick fixes to achieve long-term health and well-being. Now it's really critical to recognize that while conventional medicine plays a vital role, integrating an approach that includes diet, nutrition, and lifestyle changes, and using a functional medicine model of creating health can really enhance our health and significantly improve our health outcomes. Functional medicine, with its focus on the root cause of illness, offers a really comprehensive way to prevent and manage chronic diseases effectively. Remember, your health is in your hands, and taking a proactive informed approach is the key to living a healthier, happier life. So keep tuning in for more insights into how you can take control of your health in ways that empower and rejuvenate you. Thanks again for joining, and see you next Friday for another juicy episode of Health Bites. thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman, and we'll see you next time on the doctor's Pharmacy. For more information on today's episode, please check out my new video and audio podcast, health hacks. It airs every Tuesday and includes a more detailed breakdown of these Friday Health Bites episodes. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com/markspicks. 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