Patient Empowerment

(This section currently being edited. Sorry for the inconvenience.)

Summary

A core dilemma in healthcare is that everybody wants to be healthy, yet we're easily fooled by false claims and treatments that don't work. Even dangerous treatments spread and become popular. This leave patients vulnerable. Better health is not about more healthcare, it's about understanding the enterprise of healthcare: how new ideas develop, how they compete, and why treatments that don't work spread.

About

The Demand for Good Health

In order to understand healthcare and why we are so vulnerable it's important to start with what ultimately drives healthcare: our incredible desire for good health. Good health is on top of our list of things we desire the most, and bad health (and death) is on top of our list of things we fear the most. We demand good health.

The Massive Healthcare Market

In a market economy, wherever there is demand, a competitive market will arise to supply that demand responding to the laws of economics and market forces. With exceptionally high demand, the healthcare market is massive. If we include the 'wellness' component, healthcare is valued at about $7 trillion per year in the US.

About

The Healthcare Market

Let's explore the healthcare market paying particular attention to the features that make you, the buyer, vulnerable:

A Plethora of Products

In response to our high demand for health, the R&D component of healthcare is also massive. There are currently one million biomedical scientific papers published every year. Most of this is low quality evidence, like test-tube and rat experiments, relatively cheap and easy to produce, generating a plethora of products - things that claim to make you healthy. For example, there are currently 90,000 supplements and counting on the US market, each with a test-tube or rat experiment to back it.

A Very High Failure Rate

These products, however, have a very high failure rate. Eighty percent of studies can't be replicated. This is known as the replication crisis in science and is caused by a market that incentivizes positive results - product that work - not products that don't work. No one ever won a Nobel prize for proving a treatment doesn't work, so researcher p-hack their studies to statistical significance. But proving your product works in a test-tube or rat is only one step in the validation process. Less than 1% of these turn out to be safe and effective when tested in large human clinical trials called RCTs.

The Sellers Strategy

It's cheap and easy to generate products with weak evidence, like test-tube and rat studies, and the strong evidence, like RCTs, are not only prohibitively expensive, but most of the time prove your product is ineffective or unsafe. From a sellers perspective the strategy is obvious: avoid strong evidence.

Regulation

Due to this seller's reliance on weak evidence and our history of harm in healthcare, the healthcare market is not a 'free' market. It is regulated. For certain products, governments require large-scale human trials (RCTs) to prove safety and efficacy.

Deregulation & Regulatory Arbitrage

In response, industries like alternative medicine, regenerative medicine and the supplement industry try to either get their product deregulated, or find loopholes by moving to jurisdictions with lax oversight (Stem-cell tourism). They often cloak this in the language of "health freedom" or the "right to try," turning the public against the very regulations designed to protect them.

Hard To Evaluate Products

The first thing you will notice about this marketplace is that unlike other marketplaces, it's product are exceptionally difficult to evaluate. It's far easier to determine if your TV is working than your longevity supplement. To add to the problem the field is highly technical and even has its own language.

The Information Asymmetry Problem

The sellers know far more than the buyers. This is called the information asymmetry problem. The buyer can either try to learn on their own, which often leads to a dangerous overestimation of their skills (known as the Dunning-Kruger effect), or they can leave themselves in the hands of the sellers to determine what to buy (what's called seller-induced demand). This is equivalent to your butcher telling you how many steaks to buy. Either way the buyer is vulnerable.

Seller Incentives

Healthcare is primarily rewarded for treatments that work, not for treatments that don't work. No one wins a Nobel Prize for showing that a treatment does not work. Furthermore, the de facto financial model for nearly all of healthcare is fee-for-service, which directly incentivizes volume over outcomes. It rewards the quantity of appointments, tests, and procedures rather than the resolution of a clinical problem. This creates a universal clinical bias: the assumption that doing something is inherently better than doing nothing.

Incentives: Maximize Product Volume

With any industry, growth depends on increasing output. Healthcare is primarily rewarded for treatments that work, not for treatments that don't work. No one wins a Nobel Prize for showing that a treatment does not work. Furthermore, the de facto financial model for nearly all of healthcare is fee-for-service, which directly incentivizes volume over outcomes. It rewards the quantity of appointments, tests, and procedures rather than the resolution of a clinical problem. This creates a universal clinical bias: the assumption that doing something is inherently better than doing nothing.

Product Competition

Like any marketplace, however, there is competition of ideas. There are so many ideas, many of them are antithetical: To prevent cancer NEVER eat meat, to prevent cancer ONLY eat meat.

Market Segmentation

contains different segments of competing products or claims.

• Conventional medicine

• Nutrition and Organic food industry

• Exercise Industry

• Alternative medicine

• Functional medicine, Wellness, and Longevity

Create More Demand By Creating More Disease

The cornerstone of healthcare is diagnosis. If the consumer can be convinced they have a disease, they can be sold 'the cure'. This creates a secondary industry of 'diagnostics'. Healthcare can create more disease in several ways:

• More Testing: Examples include wearable biosensors (Oura ring, CGMs), and full-body MRI.

• Lower Diagnostic thresholds: Lowering the cut-offs for "pre-hypertension" or "pre-diabetes"; millions of healthy individuals are turned into "patients" overnight.

• New and Controversial Diseases: Examples include: "leaky gut or "chronic Lyme Disease"

• Turn Aging Into A Disease: Longevity turns everyone into a patient.

  
  

Aldous Huxley famously remarked in the 1950’s, "Medical science has made such tremendous progress that there is hardly a healthy human left." How prescient.

Leverage Experts and Specialists

Industry often uses "experts" to validate products. Unfortunately, these specialists are particularly prone to bias because they have invested their professional identity and financial success into a specific field or treatment. The person a patient might find most reliable—the expert who performs a specific procedure—is often the least objective due to this narrow focus. When your only tool is a hammer, every clinical problem starts to look like a nail. To make things even more confusing for patients, these experts and specialist are often sincere and truly believe they have your best interests. They have fooled themselves as well.

Weaponizing Institutional Mistrust

A growing sociopolitical shift toward mistrust in science and institutions has been weaponized as a marketing tool. Regulatory agencies like the FDA or professional medical societies are framed as "gatekeepers" or "corrupt actors" who are suppressing the truth. This mistrust leaves patients vulnerable to influencers and clinics that claim to have "secret" knowledge that conventional medicine refuses to acknowledge.

Rebranding

The wellness, alternative medicine, and longevity industries have successfully rebranded themselves as a "healthier" and "safer" alternative to "Big Pharma." Patients who are naturally skeptical of conventional medicine often lower their defenses for their products. Yet, these are simply different branches of the same aggressive profit-driven system they mistrust, with the same biases and conflicts interest. The only difference is strategy: avoid regulation and proof of safety and efficacy, embrace patient's appeal to nature fallacy, lean into the public mistrust of conventional medicine by pretending they offer an alternative. It's been very effective.

Marketing "New" as "Better"

Industry frequently uses the "Innovation Fallacy" to sell new products. By emphasizing high-tech delivery systems—such as robot-assisted surgery, AI-driven diagnostics, or proprietary genetic panels—the industry creates an aura of clinical superiority. Often, these "innovations" lack comparative efficacy data proving they are better than standard, less expensive care, but their aesthetic of progress makes them highly persuasive to patients.

About

Why We Get Fooled

The underlying issue leading to patient vulnerability is the nature of medical discovery. It's cheap and easy to find potential treatments, but costly and difficult to determine if they actually work. The vast majority of treatments look like they work initially, but end up not working. Every penicillin lies on a mountain of unseen failures.

Treatments Seem to Work on Paper

Of the million scientific papers published per year, 95% are positive. However, when we try to replicate these positive studies, less than 20% can be replicated. This is called the replication crisis in science. The reason for the high rate of false positives lies in the reward system. Scientists are rewarded for positive results, so they either hack the experiment to generate positive results (p-hacking), or they throw it out. We don't even see the negative studies. This is a reported bias called publication bias.

Treatments Seem to Work in Friends

We are bathed in stories of someone who tried something and felt better. Occasionally these anecdotes are impressive and even lead to a medical discovery. However, the vast majority of anecdotes are unimpressive. When properly interrogated, the results are invariably muddied by: poor documentation, multiple treatments at the same time (purple hat therapy), and hard-to-measure outcomes, like pain. And more often than not, the real reason for improvement is placebo effects, natural recovery, and sunk costs fallacy. And, there's a reporting bias. After spending $30,000 in an off-shore stem-cell clinic, a person is far more likely to spread a positive result than the embarrassment of a negative one.

Social Spread of Ineffective Treatments

The bias to report false positive papers and false positive anecdotes creates an asymmetric amplification of ineffective treatments. This is further accelerated by social media, which spreads fake news faster and further than true news. Even dangerous treatments can become immensely popular. For the vulnerable patient this 'social proof' is highly compelling. In behavioral economics and network theory this is called an 'informational cascade'. It's the cause of 'herd' behavior, and the spread of irrational ideas. The history of medicine is replete with thousands of examples, including: Z-pac for cold virus, blood-letting, and monkey testicle transplants.

Most Treatments Do Not Work

The most accurate test of a treatment is the randomized placebo-controlled trial. It is a large trial in humans, that includes a control group taking placebos, and looks at real outcomes like death or heart attacks. It is specifically designed to address how we get fooled in medical discovery. When these trials are performed, they show most of our promising treatments do not work - our discovery rate is actually dismal. For example, less than 1% of the pharmaceutical industry's promising drugs end up safe and working. This discovery rate is critical for the average patient to understand.

Ultimately, what this means is that the trendy treatment that's all over social media, that your friends are doing, and that works in a test tube, probably does not work. It's circled the planet three times before anyone has even contemplated testing it with an accurate test. This leaves patients very vulnerable.

About

Engineering a Practice to Empower Patients

My practice was specifically engineered to empower patients. Using the above issues as blueprint.These special features of my practince include:

Allotting Time for Education

It's been estimated that just 20% of a doctor's visit is dedicated to patient education. In my practice, this is turned around. I prioritize most of our time together to be spent on education. The goal is to provide you with understandable and accurate information and level the information playing field. You will have the same information as the expert. Accurate information is the cornerstone of patient empowerment.

Learning to Evaluate Medical Claims For Yourself

Medical Science has been the single greatest step towards patient empowerment. Going from eminence based medicine to evidence based medicine. I would argue that the most important invention in the field of healthcare was The Randomized controlled trial. Not because it is a definitive test of a treatment, but it is the foundation of knowledge and calibrates the other kinds of evidence.

The importance of sharing evidence - submitting your ideas to your peers, consensus, replication. Science vs pseudoscience - Prove yourself wrong. To read more, click here.

Shared Decision-Making

Some decisions in healthcare are black and white. These are the minority. For everything else patients need to get more involved in the decision-making process. Incorporates your values, preferences, and circumstances. It is an open and collaborative process where you're encouraged to question everything. We work as a team and I treat my patients as equals. To read more, click here.

Remain a Generalist

Specialists are incredbility improtnat for the practice of medicine. However, with all the their biases, it is crucial to have an expert on your team that is a generalist. Someone expert in evaluating medical claims, that does not have their skin in any one particular medical claim. If your primary care doctor is doing 'functional, 'longevity', or 'integrative' medicine, they are no longer generalists. They are specialists. The concierge model gives me the time to help my patients evaluate claims but my most important commitment is to always remain a true generalist.

Addressing Bias

Bias is the major source of misinformation in healthcare, and addressing it is paramount. Within my practice, I have eliminated all sources of conflict of interest, financial and non-financial. No selling supplements. Outside my practice, my aim is to help you evaluate bias in others, particularly specialists, experts, and the media. To read more, click here.

Teaching Media Literacy

The 'social proof' from social media and friends can be quite compelling. A basic understanding of how the media works, what's called 'media literacy', is crucial to be able to understand how bad ideas spread. A vital tool for modern living.