Announcer:
0:00
Welcome to MedEvidence! where we help you navigate the truth behind medical research with unbiased evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Dr. Michael Koren:
0:11
Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence! and I have a very special pleasure and privilege today to interview my guest here in the studio, Mr. Gene Kendall, who is a retired rear admiral, the commander, ex-commander, I guess, of three naval ships, and also holds the distinction of being one of the first five black students to be admitted to Duke University. And I also learned that he has high blood pressure and maybe some questions around high blood pressure and the management of that, particularly in African American patients. So it's my great pleasure to have you here as a guest on MedEvidence! And uh Gene, I'm really, really excited about our conversation. And I'd love for you to sort of introduce yourself to our listeners and viewers and tell us about your absolutely fascinating story about your career in the Navy and also your educational career.
Gene Kendall:
1:10
Well, thank you, Doctor. I am I'm Gene Kendall and a proud son of two parents who live their lives basically through their children, reared in a segregated system in high school and elementary school, and I was very, very proud to be the one of the first five undergraduates selected to integrate Duke University. I will point out that I'm the last of the surviving five, and I still hold very, very dearly the memories of of those classmates, and until the last one besides me passed, I paid attention to them. Duke was a pseudo-culmination. It was sort of a plateau. I had been, as I said, in a segregated high school, uh and sort of the big fish in a small pond.
Dr. Michael Koren:
2:11
What town was that high school in?
Gene Kendall:
2:13
Greensboro, North Carolina. James B. Dudley High School, historic, a very good school for what it was we had at the time. But we did not have the mathematics and the science, and of course that's what I picked to go uh uh conquer the world. And in Duke and my first exam in physics, I received a 28. Well and I and I was convinced that that was wrong.
Dr. Michael Koren:
2:43
28 out of a hundred.
Gene Kendall:
2:44
And it was amazing, but I knew I was in trouble. A couple of years later, I dropped out of Duke, and I was depressed. I was concerned that the efforts, because I'd been picked to do some things at other schools, my local high school renowned uh uh university A&T had offered me a scholarship and I had been accepted at Princeton and Columbia. And but going to Duke, it was closer to home. It was an opportunity that just put a lot of pressure that I could not resist, and off I went. I joined the Navy and I realized very quickly in the Navy that the Duke experience had been very, very useful for me. I had learned a lot of things, mainly in coping, but it would began to expose things health-wise, perhaps that I still didn't know about. And it was when I went into the Navy and the constant attention to examinations and physical tests, the stress conditions and so forth, that health things started to come out that still didn't make sense. As I said, we were a large family, and our visits to the doctors and the hospitals were in emergencies. We uh we did not just go for treatments and physicals and so forth, except the physical that happened at the beginning of the school year, and if you were going to go play sports. But the rest of the time, we didn't, you know, we didn't have the six-month, okay, let's go check go down to the doctor and and check up. We didn't we didn't have that.
Dr. Michael Koren:
4:40
Right.
Gene Kendall:
4:40
Parents didn't have that money, it's we didn't have the health insurance, et cetera.
Dr. Michael Koren:
4:44
So tell us a little bit just about how distinguished your career is. I know it's you're a modest person, and you may not want to do that necessarily, but I'm gonna egg you on a little bit. And I I was fascinated, a rear admiral, oh my God, and commanding three ships. You know, how'd you get to that point? And what was the experience like doing that? Being a leader and being responsible for these things.
Gene Kendall:
5:07
When I when I left Duke, I was enrolled in the Seaman Apprentice Nuclear Field, and I thought that that would be my opportunity to redeem myself, you know, to my family, to my city, my high school, and so forth. And that was a pretty heavy load for an 18-year-old. And I had I had sworn that I would not show my face again until I could face the folk that had believed in me. And there, and so that began the story. As about the retirement time from the sa uh the Navy, there was a term that had been coined at seaman admiral, and I had done that, or had gone from seaman apprentice to uh rear admiral. And and
Dr. Michael Koren:
5:57
Over what period of time? That that fascinates me.
Gene Kendall:
6:00
Thirty-five years.
Dr. Michael Koren:
6:00
Okay.
Gene Kendall:
6:08
Thirty-five years. And in that time I was enlisted and went nuclear power and I was selected to attend a program called uh the Navy Enlisted Scientific Education Program. And they sent me back to the University of Kansas, lots of stories associated with that, but we don't have time for that. And where I went, and remembering that I had essentially failed, flunked out of Duke, I left you know with bad grades, and I left Kansas as the president of the Physics Arms Society and the Secretary of the Engineering Fraternity, and went to the fleet determined to do what it was I had said in the old yearbook when I left uh high school. And I just basically tried to emulate the people that I saw who were successful. What did they do? I came across folks who had similar backgrounds or whom I thought had similar backgrounds, and I tried to do what they did.
Dr. Michael Koren:
7:15
That's fascinating. Just that the ability to recognize the traits that leaders develop is is is an incredible skill.
Gene Kendall:
7:24
As a young officer, once I had gotten my commission, uh the the the first African-American admiral, Sam Graveley, caught my eye. It was in Jet magazine and he was the CO of a at the time of a destroyer, a commander. And I said, Oh yeah, that guy I'd like to be like that guy. Then years later, I saw him, he was the CO of a cruiser, the USS Jewett. And then as a as Admiral, I ran across him when he was the commander of the Third Fleet in Pearl Harbor. I was a lieutenant, and that sort of cemented things for me. We had an incident that was embarrassing for me, and 30 years later, he played it back for me near his death that told me that he had been watching me for all of that time and paying attention to my career, and that was amazing.
Dr. Michael Koren:
8:29
Interesting.
Gene Kendall:
8:33
And it told me a story, that I needed to watch people and to be a mentor, whether they know it or not, whether they asked or not. And that was my became what I thought was my leadership style. And to take tough assignments without excuse, without complaint, and do the best you could with it, and always follow the example of not why didn't, but why not. Why this had to be that way, and what can we do to either make it better or adapt ourselves to make us better, so that if I can't bend the iron, then I need to mold myself to the iron such that the iron doesn't bend me. And that became the premise.
Dr. Michael Koren:
9:29
Yeah, that can do attitude is so important for leaders.
Gene Kendall:
9:33
I think so. You can't lead people if they don't believe that you believe in what you're saying or doing. And and the second thing is that you have got to infect them with your belief. And that belief is only that you are only as good as the tasks you think you want to do. And that's what leadership is. Now, unfortunately, it causes you to lose a lot of sleep sometimes. And I discovered that I had some traits that made for those sorts of things. I would wake up in the middle of the night for reasons unknown and scratch out notes about what it was I was trying to do And I don't know what all of that meant, except that sometimes it it meant that I I was tired during the day. Command opportunities came suddenly. There were strange commands, sometimes off the beaten track. Even the traditional commands USS Fletcher, traditional ship was still off the beaten track because we had we had special purpose uh taskings all the time. But always it was how you presented yourself to the troops and how you talked and expressed that which you believed to them and always put them first in everything, even when they didn't think they were ready for it, and say, I've got your back. Just go ahead and we'll make it happen. I discovered somewhere along that line that I had some issues. I tried to donate blood once, in a blood drive, and they discovered that I had a sickle cell trait. And that began a whole series of issues that ended up with them discovering that I had onset of diabetes. And then that was the beginning of high blood pressure. My blood pressure was starting to move up.
Dr. Michael Koren:
12:03
How old were you when that was diagnosed?
Gene Kendall:
12:04
I was in my late twenties. Yeah. Probably when the the the blood pressure issues and the diabetes issues, the sickle cell trait, I was probably about twenty-two. Now that has disappeared, and but I and I always wonder is it coming back or what?
Dr. Michael Koren:
12:23
But have you had other family members, brothers and sisters with full sickle cell symptoms?
Gene Kendall:
12:30
No.
Dr. Michael Koren:
12:31
Okay. That's fortunate.
Gene Kendall:
12:34
But I always am watching and very careful uh when something happens. And then the but the the principal thing has been the high blood pressure and the diabetes that has that followed me throughout my career. And in some cases, I think even as an admiral who contributed to my ultimately leaving the service. Not really, becasue thirty-five years is - that's about it. But there were there were assignments that I thought sort of went past me because I was under physician's care for some of those.
Dr. Michael Koren:
13:16
So I'm going to transition based on that really interesting descriptive, that really interesting narrative, that you're sort of a hard-driving person. You're interesting because you're have a very calm demeanor. But underneath that, clearly you're a hard-driving person that's driven by adrenaline and the intense passion to be excellent. It's so clear. And these are characteristics that I'm sure led to your succession in the military and ultimately becoming a rear admiral and commander of three ships. But it's also probably something that contributes to your high blood pressure. And we know that adrenaline is one of those factors, one of those hormones that actually influences blood pressure and can raise it. And we also know that blood pressure issues in African Americans tend to have more severe consequences than non-African Americans in the United States.
Gene Kendall:
14:09
Oh, really?
Dr. Michael Koren:
14:10
Yeah. In fact, um, one of my first publications was comparing the effect of blood pressure in African Americans versus others, and we found that African Americans were twice as likely to develop enlargement of their heart when they had high blood pressure compared to Caucasians.
Gene Kendall:
14:29
Wow.
Dr. Michael Koren:
14:29
Yeah. And with that, we learned that the enlargement of the heart can lead to heart attacks. It could be a precursor to a stroke syndrome, it can lead to congestive heart failure, all these really serious complications of hypertension. So with this information, and again, this was a paper that I published 30 plus years ago, a long time ago, but we've learned that we can actually intervene and make a difference. This is not an inevitable progress from hypertension to heart enlargement to heart failure to death. Through aggressive management, we can make a huge difference. It's actually one of those places where multiple research studies, clinical trials, have shown that we can really change the outcome for people. And so it's kind of interesting to just ask during your treatment of hypertension, did the healthcare system, do the physicians acknowledge that there may be some differences for black patients compared to white patients?
Gene Kendall:
15:32
No. In fact, I suspected as much, but mostly after I was retired, and then clearly in the civilian system, y you must remember that most of the time we my care was physicians that unless there was a specific thing that happened that put you in a hospital, our care was relatively generic. You- the military, the doctors -excellent corpsmen and soforth- who's treatment was almost generic. Now I I make the assumption that because we had and on and on my sailors on the various ships, and knowing what some of the medications they had, they had various uh medications that were different, but not necessarily any, you know, both had high blood pressure, and the Caucasian might have something, and the African American might have something different. I made no real distinction about that as when I was coming up, and that that even happened for me, and there were some experiments. I I remember a situation. I was not in com- yes, I was in command. And I had been, I think it was diazide or something. I had been prescribed.
Dr. Michael Koren:
17:04
That's a diuretic, combination of two diuretics, actually. Yeah.
Gene Kendall:
17:07
And I I always coughed. I was really coughing, and my my wife woke me up once and said, you know, you're coughing, you're, you know, you're wheezing. I want you to go to your doctor and and tell him that whatever, because you it sounds like you're stopping your breathing. And I went back and I talked to the doctor, and he said, Oh man, I was hoping that wouldn't happen to you. And I was I went ballistic. I said, What do you mean? You're experimenting on it? And he says, Yeah, that's one of the side effects that uh we were hoping wouldn't wouldn't apply to you. And so they changed that medicine.
Dr. Michael Koren:
17:48
Was it diazide or dio van?
Gene Kendall:
17:51
It was a dia something. But-
Dr. Michael Koren:
17:54
it might have been dio van, because that's the drug that blocks something called the renin angiotensin system. And that is more likely to be associated with a cough than diazide, which is a diuretic.
Gene Kendall:
18:07
I don't think it was uh the dia. I don't think it was that
Dr. Michael Koren:
18:12
But the point you're making.
Gene Kendall:
18:14
I was coughing and my breathing was stopping
Dr. Michael Koren:
18:18
And that may or may not have been related to the medicine because people uh can have sleep apnea, for example, and stopping.
Gene Kendall:
18:25
I did have. I did. But but that's that stopped after that medicine that was was was changed.
Dr. Michael Koren:
18:33
Yeah, so that's a great, it's a great example. So what you brought up I find fascinating because in your career as a commander of a ship and in your experience with the healthcare system, there are some tensions between bringing people together and finding the unity in the common cause, and also looking at individual differences and making sure that you address individual differences based on race or age or whatever the case may be, whatever the distinguishing features are. And hypertension is a great example of that because we know that all people benefit from getting their blood pressure down when it's too high. There's no question about that. It doesn't matter if you're black or white or Asian. We also know that there are certain medications that blacks respond better to, and there's certain medications that white people respond better to. And there are also side effect profiles of different medications. And sometimes it's very time-consuming for a doctor to explain all this, and often in the healthcare system will say, well, try this and see how it goes. So it's not necessarily an experiment, but it's certainly the practice of medicine. Again, we call medicine an art, not a science, because of these issues. So uh for an African-American, for example, diuretics like diazide would typically be extremely effective drugs. Where diovan, which is also called valsartan, is a drug that blocks the renin angiotensin system. And that sometimes doesn't work quite as well in black patients. Tends to work a little bit better in white patients compared to black patients. So these are examples of differences, but at the end of the day, your doctors did a good job because they got your blood pressure down. And you mentioned to me before that it's been under control.
Gene Kendall:
20:21
Yes, most of the time.
Dr. Michael Koren:
20:24
Well, you still have those probably visions of something with the command of your ship that would still wake you up at night, I imagine, being a hard-driving guy.
Gene Kendall:
20:34
Well, yeah, my my wife says, yeah, I still have some of those tendencies. But we it's fascinating. You know, there you're always in suspect, and I had great doctors aboard the ship too, but the doctors that generally go to the ship, they are they're doctors who are not assigned there because of a specific specialty. You may have, you know, one of the best doctors I had was a foot doctor. And I happen to have uh toenails that were messed up and he wanted to do things. No, I'm not gonna I'm not gonna be walking around the ship with a boot uh and and having all of the sailors making their own jokes about and memes and so forth. Sailors are- sailors are pretty good about that sort of thing. With the commanding officer.
Dr. Michael Koren:
21:23
Captain boot, right?
Gene Kendall:
21:24
Yeah. That's we weren't gonna do that while uh while we're at sea. And then they were very great. Uh uh and but they all they're not always the guys that have the specific problems, and then we get near the say the aircraft carrier, which may have several doctors, or we're in port near the naval hospital, and you can get them to a specialist and so forth. But generally you don't return to that port again for a while, and so the process starts over again once the health issues, and then that's uh and that was a problem that we we uh it was only after really I had retired that health issues became my problem as opposed to the Navy's problem because you know I was always taken care of, you know, even and then as an admiral or captain and an admiral, it was even worse. I mean you were you know you were scheduled. It was part of your schedule, and you went in and things happened, and you know, and you had to I gotta leave to go to a meeting and so forth, and you came back and it was back on your schedule to do whatever. And now as a civilian, it's my job to pay attention to when I'm supposed to do certain things or whatever.
Dr. Michael Koren:
22:49
And so Yeah, that military discipline is probably somewhat useful in terms of taking your medications when you're supposed to take them, I would imagine.
Gene Kendall:
22:58
I think so. I hope so. I still mess up every now and then. And and but it's uh I I like to think that I believe in the process and it has helped me. But it's that was always a challenge and still is, because you deal with so many different people. As a commanding officer of a ship, you're responsible for everybody and all things, some of which you don't know because HIPAA applies aboard ship as well. And only if there is a decline in something is it ever brought to the commanding officer's attention because no sailors are gonna walk up and say, I, you know, I think I have my blood pressure's up and whatever. It's only when there is
Dr. Michael Koren:
23:51
performance change.
Gene Kendall:
23:52
Yes, yeah. Or something happens and and then suddenly you're thrust into into it and you find out that for X number of months you've been having this, such and such, and you did you didn't go to the to the clinic and present yourself because you didn't want to be seen as a whiner or whatever. There's there's a lot of that still in uh in the military because of the things. You know, we're supposed to be macho, we're supposed to gut it up, you're supposed to, you know, the old high school thing with my old high school coach that, you know, if you got hurt, rub some dirt on it and go, you know, give me ten push-ups and get and get back in the action. It's the same thing in in the in the military, particularly when the action gets hot or perceived to be getting hot. You you tend to forget about yourself and you and and you look toward the mission. And that's no different for commanders or in some cases is even worse for the younger guys because they don't have anything to fall back on to start with because they never developed the habit of that.
Dr. Michael Koren:
25:07
Right.
Gene Kendall:
25:07
And so there's there's no good check for if I hit this level that I need to check myself because they've never been there before. It was always just push, push, push, push, and then somebody will pull you out of the game and set you on a bench.
Dr. Michael Koren:
25:25
So I I have a tough question for you. I'm really curious to see your reaction to it. And if it makes you feel uncomfortable, that's fine too. But you know, there's a lot of resistance among some of the African-American community about getting involved in clinical trials. And I want to ask you if I approach you, obviously an incredibly sophisticated, accomplished person, if uh you would be interested in getting involved in a trial for a high blood pressure treatment that would be injectable and that would help control your blood pressure over an extended period of time instead of something you would have to take every day. It'd be something that would work in your body for months. How would you respond to that?
Gene Kendall:
26:08
I I would respond to anything that one furthers my life or has potential to further my life and further the profession, yes, I'm interested in that. I'm not interested in dying to prove that point. So if it is extremely risky, no, I'm not interested in that. But if there are if there are mutual benefits, I don't I don't see any reason why not.
Dr. Michael Koren:
26:42
So you're receptive to the process
Gene Kendall:
26:42
Yes, absolutely. Well, some of my diabetic treatment involve injections. So no, I'm not uh and and that was new to me when that was introduced to me. I didn't we never did that before.
Dr. Michael Koren:
26:53
Right. And remember, in a clinical trial, often there is a placebo involved. So we don't know necessarily exactly what you're on, but you're in this very nurturing process of having a staff member that's looking out for you, having a doctor like myself looking out for you, measuring your blood pressure over time and over different circumstances and using different techniques for measuring it, checking your blood test, sharing that information with you, making sure that the experience is safe based on all these parameters that we collect, and also a commitment of your time and you telling us how you feel. Are you sleeping better, are you sleeping worse? So that we can understand the full ramifications of the products that we're testing and using. And I was just curious, does that make you uneasy? Does that do you trust the system? Tell me a little bit more about how you would respond to.
Gene Kendall:
27:46
The only thing that that it would would bother me is how would that work with respect to my doctors that I'm already involved with, my primary care present cardiologist and whatever. I I I don't, you know, I, you know, I don't want to be locked out of their offices and you know, and have so that's those are the only issues that I would have of, you know, what
Dr. Michael Koren:
28:14
and those are great questions, and we can assure you that none of this replaces your usual care. This is all in addition, and we're more than happy to share information with your usual caregivers and communicate with them. We we do that all the time in clinical trials, but it's a it's a good point that you're bringing up, and and certainly a concern a lot of people that are not familiar with what we do may have some questions around that. And they're very legitimate questions, of course.
Gene Kendall:
28:38
No, I don't have any I have no reservations, no concerns.
Dr. Michael Koren:
28:42
Okay. Well, then I find that interesting to know. As you probably know, there is some baggage with the African American community with regard to past misdeeds. I think that's been cleaned up pretty nicely over the years, but there there's still that concern.
Gene Kendall:
28:59
There's there still is considerable concern, particularly when when we talk there have been some enough advances that when something has done well and then there is a a backlash of some sort that talks about and nobody d has done anything to initiate an explanation, for instance, the old experimenting days when mass groups of folk were given drugs and and you know, I think.
Dr. Michael Koren:
29:34
They weren't even told they were in in research back in the old days, yeah.
Gene Kendall:
29:38
And uh and then we those associations are made about with respect to other misdeeds. It is very hard to convince uh a group who have been excluded from information for a long time that the information that you're finally getting is good.
Dr. Michael Koren:
30:04
Right.
Gene Kendall:
30:04
And you have generations of blacks who had that. You know, in the old Jim Crow days that the things happened. They there was blacks didn't go to to physicians, not because they didn't trust them. They didn't have the money. Families, you know, you just didn't you didn't go. And so when something happened then the naturally that one person became the example for everything. And if it happened enough times, it didn't take long before communication made it real. And then it became history. And and part of the the problems that we have is we have got to make sure that we clean up what was and is the truth and there's a lot of there's a lot of misdeeds and mis and untruth that
Dr. Michael Koren:
31:14
Absolutely.
Gene Kendall:
31:14
Has to be explained. And it goes full circle. You know conspiracy theories and the ability to communicate quickly exacerbates all of that. And that's where we are. Those are the things that we're involved with and and I will confess freely that I hear the medical the medical community is absolutely involved in it because those are the sort the the controversy we have now about vaccines specifically that's one of the things that for years will have to be combatted. And right now there a lot of blacks don't know.
Dr. Michael Koren:
32:03
Right.
Gene Kendall:
32:03
Okay. But particularly in the areas where they're not as well served population wise rural hospitals where they can't get to clean advice and so they have to rely on what somebody else said who may or may not know what they're talking about. And more often than not they don't know and it gets worse and worse. And then finally you're confronted with someone who does know and you don't want to you don't believe it. Okay. And how do I know that's true? Because I've seen it. You know my my parents you know my grandfather's death certificate simply said old age. Grandpa Kendall did not die of old age. He uh he he fell he broke his hip and there were complications. His old age made it harder for him but that was not what killed him and so
Dr. Michael Koren:
33:02
how old was he when he died?
Gene Kendall:
33:04
he was 74 and so
Dr. Michael Koren:
33:10
Which is not that old these days.
Gene Kendall:
33:11
No but but the thing is you know we we just you're just finding out that you know he I don't think grandpa Kendall I don't think he'd ever been to a doctor until he fell. He was a farmer Trying to raise his kids and you know even my dad you know my dad died at 79 of multiple things. Cancer was finally the thing that that ultimately took him out but dad I'd never seen dad miss a day of work in coming up. And there were times when we knew that he was so sick he, you know I I think the only argument that I ever heard my mom and dad get into was him insisting he was going to go down to the mill and work and she said you're not the only person can make that place work and that and we were we were hot they were in the room on the other side and scared to death what was going on.
Dr. Michael Koren:
34:08
Right.
Gene Kendall:
34:08
But that was he you know I never I had never seen him miss a day at work.
Dr. Michael Koren:
34:13
Interesting. Well there there as you know there have been some tremendous breakthroughs in medical science. One of them for example is there are now gene editing products that help people with sickle cell you know fortunately you have sickle cell trait but neither you nor your family has actually had sickle cell disease because you need two genes from both parents for that to occur. But for those unfortunate people that are in this situation there is a treatment that has been developed based on recent clinical trials. And some of that technology that has been applied to gene editing for sickle cell is now being used for other diseases. So as I mentioned for example we're looking at and talking about using these techniques for treating blood pressure for treating high cholesterol issues for treating high triglyceride issues. And it's fascinating and one of my goals is to make sure that African Americans understand that this is a safe environment for the m to get involved doesn't mean that there are no risks when we say safe environment there's always risks in life but that we're doing everything possible to reduce those risks and also to create an environment where everybody, all of our patients will benefit from the interaction, will learn from the interaction, will glean insights that hopefully will make them able to pursue a healthier life. And so yeah I so appreciate you talking to me about this and and your honesty about the concerns in the African American community. I think it's really important.
Gene Kendall:
35:49
There's a there's a trust factor that and I don't I would probably say for the African American community it's probably more vociferous than any of the other minorities, even the Native Americans because they developed the distrust much earlier and so they are very very insular with respect to it. Or even a Hispanic community they um it's it's not but for some reason I you know and I'm not you know I'm not a historian how but it's a deeper rooted feeling and probably because it's closer to the surface with respect to defined specific segregation and Jim Crow era practices. Other minority groups were just simply not in evidence enough that the things that probably happened had a chance to to be exploited because of the the confluence of display caused by mass communication at a time when things were overflowing in the civil rights area and so forth. And so it they just were the numbers. But that is a that's a deep schism that still exists and uh particularly the the less well educated the less well attuned the patient a minority patient is to the system the harder it is to to get to the whatever. But it's but I thank you for and yes I am interested
Dr. Michael Koren:
37:45
Well, Gene. Thank you so much for being a guest on MedEvidence and I just absolutely enjoyed our fascinating discussion and maybe we get you back someday and we'll talk more about your hypertension and your interface with it. We'd love to have you back. And I think our audience is getting more and more interested in the personal journey of patients in the healthcare system.
Gene Kendall:
38:12
Well thank you it's it's interesting to to try to explain something that you don't know much about and that's me. I'm I'm not a doctor and generally as a a Navy commanding officer and leader and so forth generally when we see the problems that are not our own personal problems it's at the acute stage and it is at the emergency stage and we're ill equipped to handle that. We we're now in the fix it stage and generally we don't know what caused it. You're just trying to you know the it's like a fence the fence fell over and the most important thing is to get the fence back up before all of the animals leave. But we don't know why it fell and and if you don't fix what caused it right you know it it you're subject to get it again.
Dr. Michael Koren:
39:09
In medicine we say it's better to prevent disease rather than dealing with the long-term manifestations after it presents itself.
Gene Kendall:
39:18
That's no different in in mil in in the military as well.
Dr. Michael Koren:
39:22
You share that with the military for sure
Gene Kendall:
39:24
Absolutely we want to prevent a conflict rather than having to fight it. B It is a whole lot easier to to uh to pay for the things of of not having to fight in the first place than the count the bullets that that that that were expended and and and and dig the holes to to plant absolutely bodies in.
Dr. Michael Koren:
39:46
Well, Gene, thanks again for being part of MedEvidence!
Gene Kendall:
39:48
Thank you.
Announcer:
39:49
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