by Dr. Joseph Mercola
The U.S. health care system is riddled with
inefficiencies. With an annual budget of $3
trillion, it's the largest industry in the United
States, so there's financial motivation to
capitalize on expensive treatments, even if they
don't work well
Price gouging, overtreatment and fraud are yet other
problems plaguing the U.S. health care system,
contributing to its inefficiency
Many prevention strategies and simple, inexpensive
treatments are ignored and not used for the fact
they do not generate income for the doctors
Switching the incentive model is part of the answer.
Hospitals that pay their doctors a salary and
bonuses for patient health outcomes see significant
improvements and have lower health care outlays
Geisinger Health in Pennsylvania prescribed
prediabetic and diabetic patients fresh, whole food,
along with treatment and educational support. As a
result, they reduced the annual cost for Type 2
diabetics by 80%
Travis Christofferson - who has
a premedical undergraduate degree and a master's degree in materials
engineering and science - has written two excellent books about
The first one, "Tripping
Over the Truth - How the Metabolic Theory of Cancer Is Overturning
One of Medicine's Most Entrenched Paradigms," helped me
understand the profound influence of diet in cancer.
Here, we discuss his latest book, "Curable
- How an Unlikely Group of Radical Innovators Is Trying to Transform
Our Health Care System," which addresses questions such
"What has happened to
American health care?"
"What are the
foundational disruptions or corruptions in the system?"
His book, in some ways,
is based on the theory promoted in the book and subsequent film, "Moneyball."
It describes how you can use statistics to massively improve a
"I'd been invited to
speak at a small charity event in London. The speaker who went
right after me was Dr. Ndabezinhle Mazibuko. He was at this
startup clinic called Care Oncology in the U.K.
The idea behind this clinic was that there are drugs that have
gone off patent that have [other uses], but they're unrealized.
They're undervalued in the system.
One of these drugs is
metformin in the use for
There's this vast body of data to suggest it can improve cancer
outcomes, but there's no good mechanism to get this on the
prescription pads of doctors. It just doesn't happen. There's a
flaw in the system.
To address this flaw or this underappreciated argument, they
opened this clinic and then prescribed a combination of four
drugs that showed they had synergy, very few side effects and
the best chance to [improve] outcomes.
The cost of the drugs
is about $60 per month...
I agreed to open a clinic in the U.S. to help them start in the
U.S. I opened it up in my small town, Rapid City. We started
doing telemedicine as well to address the rest of the country. I
arranged the time to speak at our local cancer center, to
present what we were doing to the local oncologists.
My hope was that they would see the value in it and refer
patients to us, especially patients with dire cancers, like
glioblastoma, where there are
few good treatment options. This is such a low-risk intervention
that it had a good potential to help...
Immediately when I was done... one of the oncologists just lit
into me. He accused us of taking advantage of desperate
Then he brought up,
'Why would you
prescribe a medication for Type 2 diabetes for cancer?'
Another oncologist in
the room in the corner said,
'Well, I do
What struck me in
that moment is you can have these medical doctors in the same
room that have a profound disagreement on data that we have just
If this is the case,
what are the inefficiencies in the health care system?
That was the original
spark for the book."
Inefficiencies Within the System
Michael Lewis' book, "Moneyball,"
showed how, within a simple game of baseball, you can have massive
By taking away the human
biases and just applying statistics to find what is undervalued in
that market, you can massively boost the performance of a team (in
the book, it was the Oakland A's, which had a tiny budget).
"In health care, we
have a massive disparity in valuation - how we value
treatments," Christofferson says.
"As I said, metformin has got massive repositories of data to
suggest you can ward off not only cancer but a plethora of
chronic disease, but it's the price of a nickel a pill and very
rarely gets prescribed for these other indications...
['Curable'] is an
examination of these huge disparities in health care and why
it's gotten so out of control in the U.S."
The health care system is
the largest industry in the United States.
It has an annual revenue
of $3 trillion. So, there's a financial motivation to capitalize on
expensive treatments, even if they don't work well, and that's a
significant part of the problem. Price gouging is another related
Overtreatment and plain
fraud are yet others.
Christofferson suspects these issues may account for half of all
health care costs. One answer is to focus more on undervalued
treatments and low-cost prevention - both of which could help
prevent cost escalation.
In his book,
Christofferson recounts a number of stories demonstrating this.
Treatments Save Money
One such example is
Geisinger Health in
Type 2 diabetes, they introduced
the Fresh Food Farmacy.
In a nutshell,
patients with prediabetes or Type 2 diabetes are given a
prescription for fresh, whole foods.
Patients are allowed
two free meals a day and recipes, along with intensive care and
As a result of this
program, Gelsinger Health was able to reduce its per-year
outlays and cost for Type 2 diabetics by a whopping 80%.
"It only cost them
$2,600 a year," Christofferson says.
"What interests me about that is they didn't leave out the human
component. They made sure that the patients' families [were]
engaged. They gave free food to the families so they can all
Pretty soon, when
people have this level of engagement and feel like they're part
of a system, they start asking questions.
'What else can I
do? Can I exercise? How do I stop smoking?'
Not only is it
changing their health status, but it's changing the way their
families view health and what they do about it. To me, there are
these wonderful examples of places, these pockets that are doing
extraordinarily good work.
The other one I focused on is
Intermountain Health Care
which, shockingly, if you... extrapolated their system to the
rest of the U.S., we would see a 40% reduction in health care
Overwhelming Power of Incentives
Another fundamental issue that really needs to be addressed is the
Most medical students
pursue medicine for the right reasons. But then they get brainwashed
into a single-minded focus on drugs and surgical intervention, and
aren't given the education and tools to address the actual roots of
What's more, once they're done with their schooling, they're a few
hundred thousand dollars in debt, which they need to pay off. And
then they go into a health care system where they're given just 10
to 15 minutes with each patient.
It's a system that is
designed to fail right out of the gate.
"As I wrote this
book, what I kept coming back to was the overwhelming power of
incentives," Christofferson says.
"Our system is so
flawed with regard to incentives. The biggest offender of that,
by far, is the fee-for-service system, where we demand our
doctors get paid for every test and procedure that they do.
This creates a terrible incentive for them so that they have to
think like businessmen... If there's a marginal procedure and
you have a financial incentive to do it, perhaps you're going to
do it. This leads to overtreatment.
There's a brilliant example of that in the book. This was
actually done by Atul Gawande. He wrote about this in The New
McAllen, Texas, had
two times the Medicare utilization compared to the national
averages - $15,000 per person.
And it wasn't specific to that demographic region, because if
you went to El Paso, up the border, it's the same demographics,
but it was half the cost there. He flew down there to ask why.
What had happened was
the doctors had just developed this entrepreneurial culture
where they almost competed with each other financially...
Really, their focus was money. Just putting a pen to paper and
writing that article had a sterilizing effect. Suddenly, the
regulators came in. They looked at all the fraud that was going
There was, I think,
$20 million fines levied. The overutilization started to drop...
When you look at the high-quality providers, like Mayo Clinic,
Cleveland Clinic, they put their physicians on a salary.
The marketplace will reward that behavior because now you can
see the data... [At] the Mayo Clinic... if they don't need
surgery, they won't get one.
The doctor has no
financial incentive to operate...
So, the incentive structure is entirely backwards. That's
the underlying theme of this book. We really have to take a look
at human incentives and what drives human beings; how they make
We can design systems
around that to do better."
The Success of
Intermountain Health, for example,
places their doctors on salary, and gives them bonuses based on
They also assess the
differences between treatments to see which works best.
they discovered that
inducing delivery in pregnant women led to more babies being
born with respiratory problems.
inducing labor were entered into the electronic medical record,
which led to a drop in early inductions from 30% to less than
This resulted in
babies born with fewer respiratory problems.
Patients are always
given antibiotics before surgery, but it's never been
established when the optimal time to administer the drugs is.
compared medical records, finding the optimal time was two hours
before surgery, which cut their surgical infection rate by over
The History of
Christofferson's book also addresses some of the history of
medicine, and the advent of controlled clinical trials.
practice of medicine was largely dependent on the doctor's
experience and personal ideas.
that a physician's judgment matters more than any external
measurement. This really guided medicine in the beginning, in
the 1700 or 1800s," Christofferson says.
"I was shocked to learn that the first well-conducted trial was
in the '40s...
That's how far
[medical science] lagged behind. And then all of a sudden, it
kind of exploded because they shifted the patent structure to
where over-the-counter drugs were separated from patented drugs.
into a for-profit venture...
They took over the
randomized control trials... That was the gold standard to
determine if a therapy was good, if it was going to be approved
by the regulatory bodies in the world.
Today... the pendulum has almost swung too far to where you have
to have this randomized control trial and Food and Drug
approval for a therapy to be good."
that Might Extend Life Span
In the interview, we also discuss a few side tangents, such as
cellular reprogramming therapies under investigation.
Ph.D., refers to the use of what's known as
Yamanaka transcription factors,
which can be used to reedit your genome to reset the
epigenetic clock and the
As explained by
Christofferson, who has looked into this research:
fascinated by it. I think it's not known as widely as it could
be. Longevity science is focused on caloric restriction. That's
the reliable way to extend mammalian lifespans... Epigenetic
rejuvenation is outside of that...
When you think about humans, about all life for that matter, we
are essentially immortal in the fact that we take our aged germ
line cells and we recombine them through the process of
fertilization to create a new life.
That life is
biological age zero when it comes into being.
How does that happen?
The way that happens
is it takes 23 chromosomes from the mom, 23 from the dad.
There's a process in the egg that wipes off the processing of
the software. The software in the genome is the
tags on our DNA that are wiped clean and new ones are put on.
This kicks off the process of embryogenesis.
In the process, it resets the aging clock. Now we're starting to
learn that you can do this, you can take a cell... and put it in
a Petri dish, add these factors - there are four factors
involved in this process - and you will reset the epigenome back
to age zero...
Potentially, now it's
a therapy. You can inject this back into them."
of Lifestyle and Social Connection
Christofferson also points out science showing that inherited
genetics account for a rather small portion of our health and
longevity potential - about 20%.
The remaining 80% is
predicated on environmental variables, factors such as toxic
exposures, certainly, but also love and interpersonal relationships.
"All of these things
we experience day to day have an impact... Our epigenome changes
the way genes are expressed. This has a massive impact on our
We know this because of identical twin studies... When you track
them over time, their destinies are very different. They very
rarely die of the same diseases.
This nurture aspect,
this 80%, that's the part we have control over...
I looked at that in the book.
misconceptions do we have under these kinds of medical
What are our
misconceptions as individuals about our own health?...
What are the most
important factors to stay healthy and live a long life?
We always think of
diet, exercise and genetics... [but] the biggest factor is your
social life and how engaged you are in the world - the number of
close friends you have, social integration.
How many people
have you talked to throughout the day?
Did you say hi to
Did you talk or
chat with people at the gym?
That's got a massive
influence on your immune system.
When you're lonely, you have this sort of corrosive inflammatory
response. But when you're not lonely, your immune system has a
more targeted response.
Inflammation, as we
know, is the root cause of so many cardiovascular disease,
cancer and so many chronic diseases.
That's kind of why these blue zones get so much attention.
That's the constant variable... People are connected and they're
surrounded by each other all the time.
[The blue zones] is
where you have... 10 times the number of centenarians than you
do in North America."
programming, which is dependent on environmental factors, far
outweigh the influence of your genetics, and it does this in a very
It's usually through
transcription factors that either methylate the DNA (put small
one-carbon molecules on the DNA), which essentially silences that
specific genome, or they acetylate it, which activates those genes.
Depending on the combination of shutting off and turning on of
genes, you get the expression of the genome.
So, it's not what you've
inherited, but your expression of the genome that's so important,
and this is really how these lifestyle factors influence your genes.
"The good news about
the epigenome is it's able to be manipulated," Christofferson
"We can change it,
from lifestyle factors all the way to these Yamanaka factors
that kind of reset it back to a younger age."
In short, the fact that epigenetic factors control so much of your
health and longevity potential is powerful motivation to make
simple, inexpensive lifestyle changes.
Basics include sleeping
well, choosing the right foods, choosing when not to eat
(time-restriction eating), exercising, getting plenty of sunshine,
and addressing loneliness and stress.
These are simple basics that pretty much everyone could apply to
radically improve their health and avoid the medical care system,
which is fraught with hazards.
While medical mistakes
are a leading cause of death in the U.S., the greatest hazard is the
fact that so many doctors fail to understand what the foundational
cause of disease is.
By failing to address the root of disease, they are causing
premature death and needless pain and suffering in a majority of the
As noted by
"The numbers are
scary. I think it's 200,000 die every year from
I learned that 7,000
people die from sloppy physician handwriting. If you're in the
hospital for four weeks, you have about a coin-flip chance of
C. diff, which is a horrible,
horrible intestinal infection.
Anytime you can stay out of that system, [you avoid] not just
the financial but the very real health risks. We didn't even
touch on the overtreatment and cancer that is so rampant...
We've had such a focus on early detection for cancer. We've
gotten much better at it.
However, that hasn't
changed the death rates at all. But it's led to an incredible
amount of overtreatment, unnecessary treatment, because most of
these tumors are not dangerous at that point.
If you are diagnosed with prostate cancer from a
prostate-specific antigen (PSA)
test, you're 47 times more likely to receive damaging treatment
- chemotherapy, surgery or radiation - than you are to have your
My editor said something to me while I was writing the book that
I thought was beautiful.
You can be your
own culture of one when it comes to health. Just do these
very simple things... and just being with other people.
That, in and of
itself, is health care."