Patient Empowerment

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Summary

A core dilemma in healthcare is that everybody wants to be healthy, yet we're easily fooled by false claims. Persuaded into treatments that don't work. Persuaded out of treatments that do work. This leaves patients vulnerable. Consequently, better health is not about more healthcare, it's about understanding the enterprise of healthcare; how treatments are developed, how they compete, and how they spread.

About

A Bird's-eye View of Healthcare

Healthcare is highly complicated. To understand healthcare better, we need to take a bird's-eye view: define it, its players, and its main driving forces.

What is Healthcare?

Healthcare spans any product, procedure, or practitioner that claims to improve health. From scans, surgery, and doctors, to organic food, meditation, and personal trainers. As health overlaps with almost everything in our live - literally, how we eat, sleep, breathe, and think - almost any thing or any one can be 'healthcare'.

The Healthcare Market

Since we live in a market economy, healthcare is bought and sold. The healthcare market is massive, valued in the tens of trillions. Like any market it responds to classic market forces - supply and demand.

The Players

The market is made of buyers and sellers. The buyers are you, the patient, and the sellers are three interdependent entities:

• Researchers: Those who discover health claims.

• Industry: Those who commodify and volumize health claims.

• Practitioners: Those who dispense health claims.

About

The Driving Force of Healthcare

The buyers and sellers of healthcare are driven by an insatiable demand for good health.

Buyer Demand

The buyers of healthcare (you) are seeking good health. Good health is arguably the most desired human state, and bad health, disease and death, the most feared. In surveys, billionaires would offer half their fortune for ten extra years of life. It's hard to find another commodity with that much demand.

Buyer Action Bias

We also have a bias for action. When faced with a problem, we would rather do something than nothing. Doing something gives us a sense of control, even if it's not the best option. It's particularly true for health. When we feel ill, for example, it's hard to do nothing, even though the majority of complaints resolve on their own and the cure is often worse than the disease. We reach for an antibiotic with a cold, even though it usually causes more harm than good.

Seller Action Bias

Healthcare sellers are likewise driven by action. Buyers not only demand it, but action can be monetized. Inaction - "Let's wait and see if you get better" - is hard to monetize. Researchers are rewarded by finding actionable items, and industry and practitioners are rewarded by 'commodifying' them and selling them by volume. More tests, more disease, more procedure, more visits. Whether they are a pharmaceutical company, a neurosurgeon, or an energy healer.

About

Disease and Wellness Models

In every market, sellers induce demand by convincing the buyer that they have a problem, and then claim to known the solution. In healthcare, the goal of the seller is to convert people into patients. As Aldous Huxley pointed out 70 years ago, "Medical science has made such tremendous progress that soon none of us will be well." There are two models sellers can use:

The Disease-Fear Model

This is the classic model of healthcare. Sellers generate fear by either creating new disease or expanding diagnosis of diseases that already exist.

Creating New Disease:

• Exposures: mold, mercury, pesticides, GMO's, sunscreens, microplastics.

• Biomarkers: Insulin resistance, weak grip strength, bad gut flora

• Unmeasurable phenomena: chi imbalance, chronic Lyme, candida hypersensitivity.

• Social Issues: Male pattern baldness, social phobia, ADHD.

• Other Treatments: vaccines and autism, statins and dementia.

  
  

Expanding Diagnosis:

• Lowering Diagnostic Thresholds: pre-hypertension, pre-diabetes, mildly elevated mercury levels, mild ADHD.

• Screening Drives: Free testing, Testing healthier and younger populations.

• Expanding Test Usage: Full-body MRI, continuous glucose monitors.

With 'longevity', we turn even aging and death, the ultimate fear, into a disease. We all becomes patients at birth.

The Wellness-Aspiration Model

With 'wellness', the absence of disease is no longer good enough. We must aspire to a state of complete physical, mental, and social well-being. You could be bigger, faster, stronger, and happier. Instead of driven by fear, patients are driven by the pursuit for unattainable perfection. An infinite consumer loop.

In healthcare, this manifests as the 'Disease, Cause, Test, and Treat' model. "You have a disease", "We know the cause", "We can test for it", and "We have the treatment".

Product Ecosystems and Downstream Revenue

This creates a 'product ecosystem', a group of interconnected goods and services that generate downstream revenue. For example, a hospital offers 'free screenings' to find blocked arteries, only to generate downstream revenue for cardiology and surgery. A health influencer promotes 'insulin resistance as the cause of disease' to profit from the clicks, and then generates product endorsements from glucose monitors to diagnose it, and protein bars and supplements to treat it. Free 'public services' and 'informational content' induce demand acting as entry points into product ecosystems.

More Diseases, Causes, and Tests

More Treatments

Sellers can generate treatments (with low-quality research) by creating new treatments, repurposing older treatments, or relabeling something into a treatment. The shear volume of this is unprecedented. The supplement market in the US, for example, has grown to 90,000 supplements.

The other trend is to convert an existing commodity into a 'treatment'. To 'medicalize' it. This not only legitimizes it, but increases the perceived value, driving demand, and allowing the seller to charge a premium. Recent examples include:

• Food: organic food, non-GMO food, 'functional' food, kale, acai berries.

• Recreational drugs: THC, psychedelics, ketamine.

• Recreational activities: sauna, cold water immersion, meditation.

• Performance enhancing drugs: testosterone, human growth hormone, peptides.

These disease and treatment claims can be so numerous and so confusing that one seller's treatment is another seller's disease. "Meat consumption prevents cancer"."No, meat consumption causes cancer".

About

Low-Quality Research

'Disease, cause, and treat' starts with the researcher. Researcher are rewarded by finding something - a new disease, a cause of disease, or a treatment of disease. Something. Not nothing. No one ever won a Nobel Prize for showing something does nothing. It should come as no surprise that 95% of biomedical research yields positive results.

A Plethora of Low-Quality Research

Researchers must also generate a lot of research. Publish or perish. The only way on a limited budget to accomplish this is to pump out low-quality research: single case studies, test-tube and rat experiments, or analysis of existing data sets. With an estimated one million papers published every year, and growing, healthcare is now flooded with a plethora of low-quality - mostly positive - research. With it, sellers can essentially make any claim they want.

A Very High Product Failure Rate

When we try to replicate this low quality research, less than 80% can be replicated. This is known as the replication crisis. It is a direct result of researchers trying to make their studies look positive. But it gets worse; even when the the low quality research is replicated, less than 1% of treatments will work when subjected to the high-quality research, like the RCT (randomized placebo-controlled trial).

This last point is worth repeating. When our ideas are tested with better tests, most do not work. Every penicillin lies on a mountain of bloodletting and leeches.

About

Avoiding Testing and Regulation

Of all technologies, what makes healthcare unique is that, by far, the most challenging and rate-limiting step is testing, not invention. Real testing requires high-quality research. This not only exceptionally expensive, but will likely show your product does not work or is unsafe. From a seller's perspective, the strategy is clear: avoid high-quality research.

Regulation

Untested healthcare has a well-documented history of harm to patients. For this reason, and for your protection, healthcare is regulated. It is not a 'free' market. Regulatory bodies include: scientific oversight from professional associations like the AMA or the ACC, government agencies like the FDA and state medical boards, and payers like medicare. They help to ensure quality in healthcare. From discovery to dispensing.

• Researchers claims: Should be reviewed by peers to achieve sceintific consensus.

• Diagnostic tests: Should be externally validated for accuracy and usefulness.

• Treatments: Should be subjected to high-quality research (RCT's)

• Practitioners: Monitored for evidence-based practices and dispensing accurate information.

Regulatory Arbitrage, Disclaimers, & Deregulation

Markets respond to regulation by either finding ways around regulation ('regulatory arbitrage)' or by lobbying for deregulation. Below are some examples:

• With a disclaimer, diagnostic labs can sell unvalidated and inaccurate tests.

• With a disclaimer, the supplement industry (deregulated in 1994) can sell any of its 90,000 products without high-quality research.

• With a disclaimer, health influencers and persons with no training or license, can monetize inaccurate medical advice and upsell unvalidated tests and supplements.

• Alternative medicine practitioners have achieved legal and regulatory immunity to prescribe treatments without high-quality evidence. (Conventional doctors are currently fighting for similar immunity).

• Stem-cell doctors go off-shore to sell their products (Stem-cell tourism).

  
  

About

Why You Are Vulnerable

With the buyers, the sellers, the researchers, all driven by action - doing something over doing nothing - you (the buyers) are vulnerable. Let's explore how this manifests:

The Information Asymmetry Problem

Healthcare is exceptionally hard to evaluate. It's much easier to figure out if your TV's working than your longevity supplement. Healthcare requires special knowledge, and the seller knows far more than the buyer. This is the information asymmetry problem. The buyer can either attempt to learn healthcare for themselves, very problematic in a world full of misinformation, or they can rely on the seller to tell them what to buy. This is like asking your butcher how many steaks you need. The seller determines demand. Either way, the buyer is vulnerable.

Leveraging Institutional Mistrust

A growing sociopolitical shift towards mistrust in science and institutions has been weaponized as a marketing tool. Regulatory agencies 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.

The False Dichotomy

The wellness, alternative medicine, and longevity industries have successfully rebranded themselves as a 'healthier and safer' alternative to 'Big Pharma and surgery'. 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. From the buyers perspective, from the frying pan into the fire. 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.

The Wealthy

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The Healthy

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About

The Spread of Healthcare

Direct-To-Consumer Marketing

For the seller of healthcare, the best marketing is you, the buyer. Your stories - or anecdotes - of getting better spread treatments fro

Anecdotes

For the seller of healthcare, the best marketing is you, the buyer. Your stories - or anecdotes - of getting better spread treatments from person to person. This is not new. It's been going on for millenia. From bloodletting to peptides.

For patients, anecdotes are incredibly powerful. For medical science, anecdotes are incredibly misleading. Of all the issues in healthcare that make patients vulnerable, this is probably the number one factor.

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 muddied by: poor documentation, multiple treatments, and hard-to-measure outcomes, like pain. More often than not, the real reason for improvement is placebo effects, natural recovery, and effort justification. After spending $30,000 and enduring the pain and the travel to an off-shore stem-cell clinic, we are far more likely to look for and spread a positive result than the embarrassment of a negative one.

Media. Social Media, and Misinformation

Although its very clear to parents that their children are prone to influence from social media, it's hard for them to see the effect in them. The only difference is that for adult, health and wellness, is the topic.

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.

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.

Teaching Scientific Literacy

Patients seeks certainty. Science, and in particular, medical science is not about certainty.

Medical science is:

• A competitive process

• Never absolute certainty: only degrees of certainly based on the strenght of the evidence.

  Peer review

• Consensus:

• Never absolute certainty: only degrees of certainly based on the strenght of the evidence.

Individuals can stray, commit fraud, be consumed by ideology or conflcit of interest. The goal is to trust the process of science, not any one individual.

Recognize and Evaluate Medical Claims

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.

Addressing Action Bias

Action bias is major problem in healthcare. Addressing action bias, and its sources, are a major goal of my practice.

• Removing financial conflicts of interest eliminated. My only source of income is your annual fee. There is no upsell of supplements, testing, or procedure.

• Nor do I generate income from outside sources such as social media, or and company involved with healthcare.

• My aim is to help you evaluate bias in others, particularly specialists, experts, and the media. To read more, click here.

Remain a Generalist

Addressing bias includes remaining a true generalist. If your primary care doctor is practicing 'functional' medicine or 'longevity' medicine, for example, they are no longer generalists. They are specialists. The true power of primary care, is that we have no 'skin in the game'. As it is said, "If all you have is a hammer, everything looks like a nail". The true generalist doesn't own a hammer, and can easily discard it if it causes more harm than good.

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.