President Trump indicated at his press conference on the pharmaceutical industry that a “tangled web of special interests” has conspired to keep drug prices high at the expense of American consumers.

Today I received an email reflecting the latest information about pharmacy costs for emergency rooms in the United States. The information was collected by IBM Watson’s Health Redbook which contains product information on more than 200,000 prescription and non-prescription drugs plus 8 of the 10 most frequently used emergency department drugs.

As a former hospital CEO, one of my most challenging aspects of budget season was predicting drug costs for the following year. Well, as most of us in the business know and Watson confirmed, within the past ten years, emergency department drugs have seen price increases of 50 percent or more.

Because I am neither a physician nor a pharmacist, many of these drugs mean little or nothing to me in terms of use or frequency of use, but as you will see, some of the more recognizable ones that are the most often used have had significant increases. Here’s just a few of them.

Ketoralac: 153 percent price increase (oral)

Morphine: 77 percent increase (injectable)

Albuterol: 69 percent increase

Hydromorphone: 81 percent increase (injectable)

Acetaminophen/Oxycodone: 90 percent increase

Lidocaine: 59 percent increase

Besides these drugs, another significant change has occurred that impacts thousands of patients annually. Depending on the manufacturer and quantity ordered, intravenous sodium chloride has increased in price by a whopping 162 to 328 percent.

What’s happening?

The pharmaceutical industry is a for-profit participant in what can only be described as the medical-industrial complex, and when you query them, they indicate that they have increased costs in producing their drugs, hence their higher costs to us, but their recent profits have been excellent.

I am also not an expert in the healthcare supply chain, but when it comes to things like IVs of saline solution increasing exponentially in cost, my head says, “Follow the money.” And following the money usually leads to lobbyists and politicians.

We know that drug companies have made billions of dollars by literally pushing opioids on our population. We consume 80 percent or more of the world’s production of these addictive pain meds. We also know that some of the most prominent supply chain companies were complicit in the illegal distribution of these drugs and were given only a financial slap on the wrist by our government for their involvement.

The current system of getting a new drug to market costs about a billion dollars, and the citizens of the United States are covering much of those research and development costs by paying more for drugs than any other country in the world. Is it a coincidence that the United States allows direct-to- consumer advertising for pharmaceuticals?

Follow the money.

In a private meeting, a top scientist from one of the pharmaceutical companies said to me, “You don’t understand the drug industry in the United States. We’re like the movie industry. We only want the blockbusters, a pill you have to take from age 5 until death that never makes you better.”

The big hammer the United States possess that could control these prices is the purchasing power of the federal government, something President Trump promised to enforce during his campaign. The U.S. government buys more drugs than any other entity in the world, but the President’s pharmacy speech touched on about 50 alternatives to that idea. He never came close to offering to bring that federal clout to the table.

In the EU, drug manufacturers are not permitted to set their own prices.

As securities analyst Ronny Gal, from Sanford C. Bernstein & Company said, “The President’s speech was very, very positive to pharma.” And he added, “We have not seen anything about that speech which should concern investors” in the pharmaceutical industry.

Follow the money.

Nadine Burke Harris, MD, a San Francisco based physician, made a presentation that captured both my attention and my concern, and I’d like to share some of the information from that presentation. Let’s be clear, these are her words, not mine, but if you take a deep dive into her work, it may be a little like the kid who saw his reflection in the water because many of us grew up in an era when several of the “conditions” mentioned in this description were considered normal.

In the mid-1990’s, a discovery was made that exposure to one thing contributed to the cause of seven of the ten most likely causes of death in the United States.  This discovery was known to impact Brain Function, the Immune System, the Hormonal System, and even DNA function. People who were exposed to it had a 20-year difference in life-expectancy with triple the amount of heart disease and lung cancer.  Now, that was a blockbuster discovery, but physicians are still not trained in even the most routine screening for this diagnosis let alone for its treatment.

What was this amazing discovery?  It was Childhood Trauma. The short list of things that fall into this category are abuse, neglect, and dealing with a parent who struggles with Drug and Alcohol Abuse or Mental Illness.

The discovery came from a paper written by Dr. Vince Felitti of Kaiser and Dr. Bob Onda from the Center for Disease Control. It was titled “Adverse Childhood Experience Study,” and over 17,500 adults who were exposed to these adverse experiences were interviewed for this study.  It became known as the ACE study.  This study included people who had been exposed to emotional or sexual abuse, physical or emotional neglect, parental mental illness, substance abuse or dependence, incarceration, separation, or divorce, or domestic violence.  That’s a list that many people can absolutely relate to on many levels.

For every YES checked off on that list, the participants got one point on the ACE score, and then the physicians compared them to health outcomes.  Of those interviewed, 67% of the population had at least one on the ACE score, 12.6% had four or more ACES.

Here’s the discovery. There was a direct response relationship between ACE (Adverse Childhood Experiences) and health outcomes.  The higher the score, the greater the risk and the worse the health outcomes.  Depression was 4.5 times more likely to be present, 3.5 higher risk for lung cancer, and a  3.5 times more likelihood of getting heart disease, but the most dramatic prediction was the incidence of suicidality, this suicide or attempted suicide statistic was 12 times higher.

There are real neurologic reasons why folks who were exposed to childhood diversity were more likely to engage in high-risk behavior, but even if they weren’t engaged in that behavior, they were still more likely to get heart disease or cancer.  You see, when you’re exposed to stress, the body’s stress response system that governs your flight or fight response mechanism ignites, and if that stress is coming at you every day, it evolves from being adaptive and life-saving to maladaptive and health damaging.

The most likely reason this “discovery” hasn’t become more highly promoted within the medical community may be because of something that is not directly evident. The information generated from these 17,500 people may have been marginalized because, as Dr. Harris points out, people may have just thought, “It’s those kids from those neighborhoods.”  The reality, however, is that the participants in the study were 70% Caucasian and 70% college educated. Maybe the study hasn’t been more widely embraced because it truly is “too close to home.”

This is an issue that touches many of us, and it’s easy to look away.  The very real courage must come from our ability to acknowledge this is a real problem and then in taking the steps necessary to deal with it through a multi-disciplinary treatment team that works to reduce impact of adversity through care coordination, counseling, attention to nutrition, holistic interventions, and, when needed, medicine.

When I was on that gurney in the ER at age 38 with a ruptured esophagus or was having stents placed at ages 49, 50, 58, and 67, or even at age 17 when the car full of my high school buddies was hydroplaning and spinning out of control on Route 51, I never thought I’d make it this far.

But as I look back over the past 70 years, I know for sure there have been accomplishments, successes, and joys that my parents would have been incredibly proud of and would have enjoyed sharing with me. I miss my family and friends very much.

Of course, I’ve made mistakes, plenty of them and would have done some things completely differently, but we can’t live a woulda, coulda, shoulda life either. We can’t change yesterday, and we don’t have tomorrow yet. All we have is, today, and we must make the most of it that we can.

But there is one thing that I really do know. The best part of my life started about fifteen years ago when a baby named Jude was born. After Jude came Nina, Lucy, Laura, Zoey, and Pete, and nothing, absolutely nothing has been more perfect than having had the opportunity to be their grandfather. The joy that I’ve experienced from having those kids in my life was magnitudes greater than I ever thought possible.

Do not get me wrong, I adore my kids and would give my life for them any day of the week, but when you have your own kids they come with a lot of responsibility. You’re not only responsible for feeding, clothing, housing. and educating them, it’s your job to make sure they grow up to be productive world citizens and that responsibility comes with a lot of angst and concerns.

Yeah, it all worked out great, but there were plenty of frightening days and nights during that journey. These grandkids, though, well, they clearly are not my responsibility, and what a relief that has been. It’s freedom, happiness, joy, and unlimited, unconditional love. There’s nothing like it.

However, my second shift of babies are growing up, my journey is once again changing, and I find myself searching for ways to continue to remain relevant. People ask me about my bucket list, but it’s pretty much empty because I’ve gotten to experience things that I never dreamed possible. No, I’m not wealthy, I’m not a TV star or a celebrity, and I’m not famous, but I’ve been very lucky with absolutely the most important thing life can offer, a wonderful family and the knowledge of having lived a purpose driven life.

It’s been almost 10 years since I’ve had to wear a suit and tie every day to work, since I’ve had to answer to a board of directors, since I’ve been on call 24/7 365 with the responsibility of hundreds of lives to protect and support. Truth be told, I don’t miss that part of my life very much. Sure, I miss the interactions with friends and co-workers, the banter at lunchtime, the challenges of building, growing, and maintaining something, but there’s a lot to be said for my life now.

I recently heard a student of Stephen Hawking talk about his passing from an astrophysics perspective. She said, ”When a large heavenly body dies, it explodes into many pieces and produces lots of stars.” That’s the legacy I hope to leave behind.”

So, where does it go from here? I’m not afraid of death, but I’m in no hurry to get there. That’s in the hands of a higher power, but when grandparent’s day rolls around, count on the fact that this poppa will be floating higher than a Snoopy balloon at the Thanksgiving Day parade because my legacy will live on six different ways through six amazing, wonderful, beautiful stars, my grandchildren, and that’s enough for me.

Last week it was my privilege once again to attend the Lake Nona Impact Forum. One of the most important sessions was a panel discussion by some of the top thought-leaders in the medical community on the opioid addiction crisis. Speaking on this panel moderated by Dr. Sanjay Gupta were people such as Dr. Toby Cosgrove, former CEO of the Cleveland Clinic; Tim Ryan, Ohio Congressman; and Dr. Tom Mayer, Medical Director of the NFL Players Association.

Over the past two months, I’ve become an ardent follower of National Geographic Fellow and New York Times bestselling author, Dan Buettner. He is the founder of the Blue Zones and Blue Zones, LLC. Dan has spent the last 15 years or so studying the five places in the world where people simply forget to die. They live into their late 90s and early 100s and include places like Sardinia, Italy; Loma Linda, California; Okinawa, Japan; Nicoya, Costa Rica; and Ikaria, Greece.

In his original book, Dan found that only 10 to 20 percent of longevity is dictated by genes. In those areas where people lived longer it was not because of diets, treadmills or supplements. “Long life was not something they pursued. It was something that ensued.”

These long-lived people had a great sense of purpose to their lives, were nudged into movement about every 20 minutes by their geography, were completely energized by being in what he described as “Like-tribes” that help keep people on the right track, and were facilitated by living in the right community. They lived in interconnected, mutually supportive clusters of behavior allowing them to do the right thing long enough not to get disease.

He then changed his focus slightly to attempt to determine where the happiest places were in the world. What he found might throw some of you for a loop, but for many of us, it’s that not so common, common sense that our grandparents, parents and friends have shared with us throughout our lives.

Mike Norton from Harvard asked this question on three continents: Do you think life is short and hard or long and easy? The people who selected long and easy were always happier, and they were also more civic-minded and generous. In fact, they were 40 percent happier, 30 percent more likely to vote, and 60 percent more likely to donate money. So when you have your next fundraising event, invite only generous, civic-minded, happy people.

Dan Buettner worked with Google, Gallup and the University of Pennsylvania and discovered that the 50 billion Google searches they analyzed were more predictive of happiness than either age or income. They found, for example, that people who own dogs are happier than people who own cats. People who like action movies or comedies are happier than those looking for romance movies.

From his world studies, he found that gender equality is important. In fact, it makes the men happier when women are treated equally. (Read that again, guys.) Education for both men and women is an important key to happiness, not Ph.D education, but at least a high school education because educated girls become educated mothers and produce better everything.

They found that healthcare–not America’s sick care, but genuine health care which includes prevention and wellness–is a great predictor of happiness, and countries where there is complete healthcare equality is where the happiest people live.

Happy people place their values on family, some type of belief system, face to face conversations, walking to the church, market and friends’ homes, laughter, and seven hours of sleep a day. They also take all their vacation days, try new things and have some type of intimate relations at least twice a week.

So, own a dog, socialize, stay married if you can, pick a job you love over money, give something back, and most importantly, pick where you live because that is the single most important happiness indicator. If you live in an unhappy place and move to a happy one, you will be exponentially happier within a year.

He also recommends meditation, financial security over consumption, big windows for lots of light, a front porch, and having a best friend at work. Armando Fuentes said, “Eat without gluttony, drink without drunkenness, love without jealousy, argue but don’t go to bed mad, and occasionally, with great discretion, misbehave.”

Check off your happiness boxes, and make some changes.

There are certain times in our lives when we know that something is over, and we’ve just had it. We don’t always know exactly why it’s over, but we’re absolutely sure that, for whatever reason, “It’s over.”

For example, do you remember the very last time as a young two or three year old you dedicated in your pants as a child? Maybe it was because of the awful smell, the embarrassment, the discomfort of carrying that extra load around, or just the fact that you wanted to be more like your parents or older siblings. It doesn’t really matter. Something just clicked, and you said, “That’s it. I’m done.”

It’s like the scene in “A Christmas Story” when Ralphie has had it with the bully, Scut Farkus, and he decided that it was over and, regardless of the potential outcome, he’d had enough.

Some of us have lost our jobs over moments like this. Lots of people lose significant others. Some folks stopped smoking or drinking or, if they’re really lucky, stopped taking drugs. It’s a sort of cold turkey, abrupt cessation, a sudden withdrawal that can happen once we’ve reached a breaking point, a specific limit, a so-called red line that we won’t cross.

The Amish have an explicit terminology for the social rejection version of this phenomena. It’s called shunning. It’s a formal decision by the congregation to formally cease interaction and to ostracize an individual. When we decide to stop doing something, it’s a little like Mr. Wonderful, Kevin O’Leary, on “Shark Tank” when he says, “You are dead to me.”

One of my personal challenges has been knowing when to pull the plug. I’m sure that my tolerance for people lasts way beyond what both my brain and my gut tell me is correct. As a young teacher, I spent 10 years working with teenagers. The difference between a teenager and an adult is that sometimes teenagers actually change.

Because I witnessed these miraculous changes with kids over and over again, I embraced it as something that essentially was normal. But when I became an administrator and gave the same benefit of the doubt to adults, I was simply dealing out of a fool’s deck because it’s a rare thing when a leopard changes its spots. Time after time, I’d give the adults chance after chance after chance, and it was a fool’s journey.

So, what do you think makes us change? Those professionals who study change say that even when it’s a life and death situation, people respond negatively to change 90 percent of the time. They’d rather die than change.

Well, for one thing, people have to know why change is necessary. They need an awareness of the depth of the problem and a desire to change. Then they need to be offered solutions, and they need to be coached as to how to make the change. They also have to be assured they will be able to change and will receive the resources necessary to make that change. And while the change is occurring, it’s up to their sponsors to ensure it will actually happen by measuring, correcting mistakes, and rewarding success.

Just to keep this real, I’ve followed all of those steps above and was still chewed on by those darn leopards who had no desire to change. It’s human nature that at least 10 percent of people will fight change in the workplace to the bitter end.

So, in those cases, it’s important to understand that some people just get used to carrying an extra heavy load in their pants, and no one can alter that. On the other hand, sometimes they find that red line and decide they will not cross it, and they do it on their own.

With all of this in mind, let’s work together this year to make the world a better place, and to unify for the common good. It’s really worth it.

Back in 1997, I was given a death sentence. OK, it wasn’t one that was exactly spelled out by a judge, but it was provided to me by my ancestors in the form of genetics. You see, I failed a stress test at age 49 and ended up in a cath lab. I’ve been there four more times over the next two decades, but it was primarily because my first set of stents were not medically coated and Mother Nature doesn’t like that.

After this medical crisis slapped me directly in the face, I went to the most progressive physician I knew and asked her what was going on in heart care that was not common knowledge at the time. She told me about a researcher, Dr. Dean Ornish, in San Francisco. I called him, and he invited me to come to a retreat for heart patients in Sausalito, California. Over a five-day period, I learned about yoga, meditation, stress management and group support.

Clearly, my biggest personal challenge was managing stress, and unfortunately, I didn’t get good at that until I left day-to-day healthcare administration in 2009. But the real eye-opener that occurred during this retreat was something called PET Scans. Dr. Ornish introduced us to several heart patients who had been given their own death sentences 20 years earlier, and during their introductions, he showed us their before and after PET Scans. It was at those sessions where I saw that the human body is capable of healing itself. All you have to do is give it a chance and some tender loving care.

Their blockages literally opened up, and in some cases disappeared. Since that retreat back in the nineties, I’ve experienced a similar reversal of a blockage that is lovingly referred to in the healthcare world as a “widow maker.” So, diet, exercise, stress management and group support were the key. It wasn’t cheeseburgers, and one more pack of cigarettes a day that would do the trick.

Turn the clock ahead to October 25, 2017, in San Diego, California, where physician Dr. Daniel Amen presented information from his new book, Memory Rescue, about the human brain. Guess what? Once again, it was demonstrated that epigenetics can supersede genetics. He showed slide after slide of SPECT scans of individual’s brains that had reversed damage caused from head injuries, poor circulation and horrendous American diets. Yes, it was another life-changing event for me as well

Dr. Amen has written about 20 books that address brain health, but I’d highly recommend that you buy this one. He talks about the essentials of brain health that include blood flow, continuous learning, managing inflammation, epigenetics, head trauma, toxins, mental health, infection, diabetes and sleep. I’m sure that’s an overwhelming list for many of you, but let me boil it down in this way. Diet, exercise, stress management, and group support.

If you care enough about yourself, here’s a list: limit fat and fatty foods, walk several minutes a day, stimulate your brain by reading and learning, seek out people who provide you with love and support, and cut back on alcohol, caffeine, and head-butting. Finally, if you work to drop your belly fat and try to stay away from sugars and lots of alcohol, your brain will actually heal itself. Brain damage can be reversed.

Of course, sadly, if things are too far gone as with advanced Alzheimer’s, nothing will do much good, but generally, he has seen the reversal of serious brain function loss when his patients begin to eat healthy fruits and vegetables, drop unnecessary weight, stop eating junk and fried foods, stop zoning on television and actually read, perspire to eliminate toxins by exercising regularly and sleep. Oh, and take fish oil because none of this can hurt you.