As an outsider who came into healthcare two decades after most of the leaders who were running things, I became immediately aware of one obvious reality, “The United States has embraced a Disease-Centric, Medical Industrial Complex model of care.”

It’s a system where, if we speak about the concepts of wellness and prevention, it’s as if that is a false god to which we should never pray.  We define health as the absence of disease, and through polygenomic tools, we can assist in preventing many diseases, but it’s difficult to embed these concepts in a pathology-based culture. 

Drs. Jeffrey Bland, Leroy Hood, Wayne Jonas, Len Wisneski, Mimi Guarneri, Tierrona Low Dog, Dean Ornish, Deepak Chopra, and many other wellness and prevention and functional medicine-oriented scientists and physicians have been a part of my life over the last thirty years, and the majority of them are oriented toward both the new and ancient ways of caring for people.

In this country, we have been relegated to modifying symptoms as a way of making people feel good, and our systems specialize in the virtual health train wrecks rather than early prevention of these catastrophes. Don’t get me wrong. I’d rather be here when dealing with extreme situations, but when it comes to preventing these health-related breakdowns, it’s safe to say our system is not the most robust when wellness and prevention is the goal.

On the personalized, precision, and personal health movement, science is moving faster than our medical school curricula and the results are sometimes mind-numbing.  A few weeks ago, I sat with a young physician who was getting his fellowship at a very prestigious medical institution, and when I began to show him the reports from my pharmacogenomics testing, his response was a cross between complete awe and total confusion.  

We have made great strides in personalized medicine, but we continue to get sucked back into our disease-based model because that’s where the reimbursements are. We now have the ability to quantify what was previously unquantifiable, and the knowledge already exists that might protect us from tens of thousands of medical errors, but it’s not main-stream yet because it’s not being reimbursed.

How do we objectify health?  How do we personalize it and arrive at a unified position of what health is?  Health is not extra-ordinary. Health is both normal and personal.  Health is a combination of  all things physical, psychological, cognitive, and behavioral.  It is essentially what is being identified as functional. Our genes interact with our environment, and we begin to realize our genomic potential when everything is in “the zone,” but it’s also safe to say that the wildcard in every disease is lifestyle.

 We can easily look at the 300 or so genes that determine our ability to metabolize medicines, and we will soon perfect that same science as it relates to our food. When that happens, we will be able to identify how we will physically react to everything that we put into our bodies. But that too is not being taught in medical schools, and it is just now beginning to be taught in some pharmacy schools.

If you were told that your children could live happier, healthier lives by having them provide one cheek swab to analyze those 300 metabolizing genes, would you consider it?  Let’s place a further caveat on this. If you knew that this swab would not be used to unlock any of their other genetic risk factors except for medicine and food sensitivities, would you then provide that swab?  Would you be interested if you saw a report that indicated that, because of your personal genetic profile, the medicine you have been prescribed could prove to be lethal to either them or to you? 

That information is available. Precision medicine is available right now, but so is the means to achieve wellness through prevention.

Yours truly,

A Disruptive Innovator

Sometimes my thoughts seem completely redundant, but that’s because I’ve had so many decades to have them.

Often, when I express these boring ideas, people are moved by their uniqueness. Usually, those people, however, are really young or have grown up not watching, reading, or caring about anything other than what they’re exposed to daily in their personal bubble. For example, family. When you mention family, reactions can be as varied as the eyes on a fly. (A fly has two compound eyes and each eye is made up of between 3,000 and 6,000 simple eyes.)

Oh, yeah, back to family. I’m pretty sure both my Italian and northern European ancestors have contributed significantly to my love of family. Recently, however, I paid about $40 to get “My Personal DNA History Book,” and, when it got to my over 1,100 DNA close relatives, it became a very revealing history indeed. If I had enough money, I’d pay for every closed-minded person in the United States to get their own version of this book. It’s not only telling, it’s humbling and a really flyeye-opener. It breaks down the geography of every relative identified through a DNA search, and let me tell ya folks, my relatives have not allowed any dust to collect under their shoes or coat tails.

Yeah, I knew that 42.5% of my relatives came from Italy, and at least 20% came from the British Isles, but that’s when it got crazy. For example, I have living 1% DNA relatives in France and Germany, Eastern Europe, Russia, Scandinavia, Iceland, Spain, Portugal, Greece, and a few other European places like the Balkans.

But here’s where it gets really fun. They have identified more than 50 Native Americans who have 1% of our DNA. I knew I had a great-great something or other relative who was kidnapped by the Seminole Indians and taken to Florida and after 10 years he became the chief, went home and decided he liked living with the Indians better.

It also traced Asian relatives who walked into North America via what is now Russia, and some relatives from the Islands showed up, too. But here’s where the closed-minded might have a problem. I have at least 45 DNA relatives from Western Africa, 55 Ashkenazi Jewish relatives, and that makes me really happy. The reason for my happiness is it proves, once again, that we’re all the same. We all bleed the same blood, and we’re all humans. My United States relatives live in California, Texas, Pennsylvania, Ohio, Florida, Michigan, Washington, Colorado, Georgia and Illinois, but that’s only 395 people. The other 4,165 of the 1% are all over the world.

Interestingly 54% of my relatives are more likely to have sky dived, 37% have learned a foreign language, 23% probably owned a dog, and 38% are less likely to have sweaty feet. But the most impressive statistic is 40% are more likely to be able to do side splits. By the way, I’ve owned dogs, but nothing else in that list applies to me. It would be great if all of my cousins had a giant reunion because at least 1/5th of us would not want to eat the cilantro because it tastes like soap.

Bottom line? All of you “pure bloods” out there need to send in your saliva, and put your prejudice in the same bag you use to get rid of the other garbage in the house because we are all one big dysfunctional family, and it’s time we started putting the fun back in dysfunctional. If you hate any group because of race or nationality, you’re missing the boat because there’s a good chance you are part whatever it is you hate. I’m afraid you’re going to be restricted to hating people because of religion only and that seems pretty ludicrous because it’s tough to define whose God is the better God.

Although I’ve prided myself on being a futurist, I’ve been sadly mistaken on too many levels to continue to embrace that moniker.

As a kid, the future that I saw for myself was simple. I’d go to college because my dad said we had to “no matter what,” and then I’d graduate, become a teacher, get married, have two kids and live a happy middle-class life until I died. Bwa-ha-ha-ha-ha-ha-ha-ha.

My strong belief was the Vietnam War would be the last war. We would solve problems of the world such as the population crisis and the pollution crisis, and we’d outgrow bigotry, prejudice, hypocrisy and stupidity because everyone was embracing education as the way out of the dark ages of existence.

Holy cow was I wrong. Instead of making things better, we Baby Boomers turned our dreams into journeys of materialistic greed and raised our children to believe that owning things and more things was the way, the truth and the light.

War? Well, war has become a way of life for mankind and the United States. According to one estimate, since 2001 in the U.S. we’ve spent $731,000,000 per day or about $30M an hour on wars. (That’s not to be confused with the war on New York City’s rats which will cost $32M.) Except for a very few years, we have been at war in this country for more than 240 years.

Oh, and how about bigotry and prejudice. As a kid I was protected from the “Eye-talian” haters because my dad had changed our last name from Iacoboni to Jacobs and because my mom was of English descent, but we, as a people, sure haven’t moved very far away from stupidly hating other humans.

If you had to explain this to a visitor from outer space, you’d say that we hate each other because we don’t all look alike, eat the same food, or come from the same country. Even though we all bleed just the same, it’s still a major problem. This continued hatred was a major miscalculation on my part.

So, as I prepare to move on to my next state of existence, I can rest assured that my kids and grandkids will experience pollution, bigotry, prejudice, war and stupidity from all over the world. Unless, of course, they figure this out.

Establishing colonies on Mars probably won’t help because you can’t breathe there, and even if we find and populate a Goldilocks planet that is close enough for us, we’ll still have our challenges because we will be there, and we are the problem, the entire problem.

OK, here’s another idea. Teach your kids, grandkids, relatives and neighbors to “Do unto others as they would have others do unto them.” Stop being d***s to each other because your tribe is different. We’re all on the same train, the same bus, the same ship. We just get off at different stops. Think about it. This is a short trip. Why do we enjoy picking on each other? We fight over toys, land, boys, girls, money, power and God knows what else, and to what end?

Honestly, there are rational answers to these challenges, but there are also major influencers who would suffer financially if the status quo changed. The military-industrial complex, the medical-industrial complex, big pharma, insurance companies, the for-profit prisons, big oil and the industrial food producers. Every one of them has a stake in keeping things status quo.

Unless we can find these influencers a way to make money, they will continue to pay off the decision makers through every legal and sometimes illegal means possible to protect their interests.

My father’s best friend was an officer with a major railroad. When I asked him what his job was, he said, “Every day, I pay off politicians.” That’s “Peace, Justice, and the American Way

Some things never change

This was the title of a speech that one of my former Chief Scientific Officers used to give on a regular basis. I added the NOT because, for the past decade I’ve been working with scientists in a field that provides a technology that is proving to be invaluable. Unfortunately, it is still not being utilized by the vast majority of the physicians in the medical community because it is not being taught in the majority of the medical schools. This is primarily because it takes about 17 to 20 years for many discoveries and new technologies to become mainstream.

This technology involves genetic analytics and is called Pharmacogenomics, a long word with an easy explanation. By analyzing the 300 genes that metabolize medicines, science can now pinpoint how we, individually, will respond to specific drugs. This is truly precision medicine. With just two cotton swabs of saliva, the genetic equipment and the scientists can predict how you personally will respond to specific drugs. Imagine not having to take the drug to see if you will have the side-effect before you have that side-effect.

Not ironically, the physicians who are happy to use the pharmacogenomics test are psychiatrists. As a non-physician and non-scientists, these docs have explained to me that some psychotropic drugs actually exaggerate the symptoms for which they have been prescribed. So, if you get a prescription for schizophrenia, it may cause you to be more schizophrenic. If, though, you can tell how the patient will react to the drug before it’s given, why not?

Ironically, this test has touched both my life and the life of many of my friends. The examples are both moving and, in some cases, terrifying. In my own personal experience, I was admitted to the hospital 20 years ago on the verge of having a myocardial infarction. Two decades later, I received the results of my Pharmacogenomics test and read the following, “If you take x-statin, it could cause you to have a myocardial infarction.” X – was the drug that I was taking at the time.

My wife was experiencing severe gastric distress from a drug that she was on, and when she received her test results, one of the warning symptoms based upon her genetic make-up, was that she would have severe gastric distress. The good news was that there were five other drugs that could be used to treat her symptom that did not produce those outcomes.

My brother had experienced negative effects from pain medicines during previous medical encounters, and when he was admitted to the hospital with a collapsed disc, he cautioned his caregivers about these sensitivities. They simply replied, “We will be mindful of your sensitivities.” He was overdosed the following day, and his kidneys were permanently damaged.

One of my friends who, ironically, had worked at a hospital, called me to inform me that, at age 42, she had been diagnosed with breast cancer. She asked me to help her find the best physicians and the best hospital for her care. One of my suggestions was a pharmacogenomics test prior to chemo. She took the test, informed her physician that the drug he was prescribing would not work with her genetic makeup, and he said, “Don’t worry, it will be fine.” Eighteen months later, the cancer came back in exactly the same place.

This test is not negative toward pharmaceutical companies or physicians, it simply provides them with a “tool box” for decision making in regard to the individual genetic make-up of the patient. The best news is that these tests not only provide you and your physician with the information that you need regarding your personal ability to metabolize the prescription you’re being given, but it also contains a myriad of data substantiating the information you’re being provided.

Get the test. It just may save your life.

Several books have had a major impact on me: books such as “The Naked Ape” by Desmond Morris, “The Prophet” by Kahlil Gibrand, “I’m Okay. You’re Okay” by Thomas Harris and Gail Sheehy’s “Passages.” Her book explored the natural personality changes common to each stage of life, and she takes the reader through the passages of each decade of life, what to anticipate, and how to use each of these passages as an opportunity for growth.    Much of “Passages” content has remained embedded in my mind because of the way she described our twenties and all the things we tend to do wrong during that important beginning adult decade of our lives. I was in my early thirties when it came out, and, to my delight, she explained that those second decade mistakes we made can be cleared up and corrected during the next ten years of life. It worked.
By embracing that life lesson as we move through our personal passages, there are things that we can undo, things we might not repeat, and things we can fix to help us grow toward a higher consciousness and level of achievement, however we define that for ourselves. And it sometimes takes mistakes to get there, but that’s okay.
Not unlike that hackneyed Thomas Edison quote, “I have not failed. I’ve just found 10,000 ways that won’t work.” And “Many of life’s failures are people who did not realize how close they were to success when they gave up.” We can try, fail, try, fail, try, fail and finally get it right if we just stick to it.  Persistence is frequently the only commitment that’s needed to move things forward in positive ways. The other thing, though, is knowing when to quit and move on when a lesson is learned and not to be repeated.
Personally, as a musician or artist, it was never good enough for me to have a Plan B. In fact, when teaching leadership classes, my recommendation to the participants is to have as many plans as it takes to get it done, even if it means having a Plan Z.
Much of life requires risk-taking, and if you’re completely risk-adverse, you will be stuck in place because of your own fears and insecurities. You don’t have to fight the ocean to ride the waves.  Even in the most horrendous situations, there are amazing life lessons that allow us to grow and make unbelievable progress during that next opportunity or challenge.
If at first you don’t succeed . . .  Remember, it’s how we learned to walk, and it applies to most other challenges that we face. I remember asking a genomics scientist what happens if we block the communication pathway between genes and proteins, which are the workers and foot soldiers of the human body, and he responded casually yet assertively, “They do the same thing we do as people. They find a different way and get it done.”
Watching very young children who are presented with a problem creatively work their way through obstacles is always fun because they aren’t encumbered with our give it up attitude. They just keep trying until they figure it out. That spirit of creativity, stick-to-it-iveness, and optimism is the child portion of our brain described in the book “I’m Okay. You’re Okay” that we need to continue to embrace throughout life.
We can’t let our amygdala talk us down or convince us to quit, or that we’re not good enough, not bright enough, not creative enough.  We just need to make the mistake, fix it, learn from it and move on.  Growth comes from challenge.
Winners never quit, and quitters never . . . you get the idea. You can make life work for you by being persistent, determined and tenacious.  Wait. Those are all synonyms.

Sent from my iPhone

Because I’ve recently been eagerly searching for my next chapter, it’s taken me down some very interesting, sometimes brilliantly lit, passages. Frequently, getting older feels challenging and emotionally wasteful to me, and because of that, I’ve begun to realize that there’s plenty of time, but sometimes not enough life.

Leonardo Da Vinci said, “Time stays long enough for those who use it.” But Albert Einstein had his own viewpoint when he said, “Time is an illusion.”

When I revisit all the negative experiences of my lifetime –the Korean War, Vietnam, the assassinations of John Kennedy, Martin Luther King, and Bobby Kennedy, the Chicago riots, Kent State, Nixon, Iraq, 9-11, Iraq and Afghanistan, Hurricanes Katrina, Maria, Sandy and Michael, mass shootings in schools, movie theaters, concerts and night clubs, and the Boston marathon bombing – a quote from J.R.R. Tolkein’s “The Fellowship of the Ring” comes to mind:

“I wish it need not have happened in my time,” said Frodo.

“So do I,” said Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.”

Instead of watching life passing by, my goal has been to enthusiastically work to create a legacy that helps others. I’m not striving for immortality through these actions, it just seems so much more productive than the alternatives.

As we begin to notice the sands in our own personal hour glasses rushing through like darting fireflies on a warm summer evening, we realize that the panic or unrest that we sometimes experience is not so much fear of death, but fear of not having the time left on this planet to get done whatever we think we were put here to do.

One of my favorite quotes about time and life is from Sarah Dessen.“There comes a time when the world gets quiet and the only thing left is your own heart. So you’d better learn the sound of it. Otherwise you’ll never understand what it’s saying.” Just listen.

If we embrace science’s theory that man and all of life simply evolved through billions of years of chemical interactions, there has to be some safety net, some handle to grasp onto tightly or we might free fall through infinite intellectual space.

Obviously, it could be much more fun to go through this fleeting journey with no guiding principles, no moral compass and no ethical boundaries because every day would be a random holiday of self-gratification without retribution and many days it feels as if we’re living in an era where positive values are being denigrated, ignored and vilified, but the emptiness of that type of narcissistic journey is well documented.

We now know definitively that we are connected at a molecular level with everything and everyone in the universe.

If we think positively, we can feel peace as in this quote by Rabindranath Tagore, “The butterfly counts not months but moments, and has time enough.”

Possibly, just embracing goodness is the very best answer and a wonderful brass ring to grasp.

Think about the ethical implications of The Golden Rule. It exists in some form in every religion of the world. Maybe just doing the right thing will be enough.

If we acknowledge our complex web of connectivity, why not spend each day being good to others, and thus being good to ourselves?

It shouldn’t be about guilt. It should be about making clear, positive choices between things like giving vs. greed; or loving vs. hating; kindness vs. meanness; positive actions vs. negativity. Those positive choices are good choices.

What if we’re born, we live, and we die and that’s it?

My personal recommendation is to embrace the goodness.

The hospital environment in the United States is quickly changing nationally and exponentially more rapidly in Pennsylvania. According to Moody analysts from a Modern Healthcare article by Alex Kacik, hospitals are successfully lowering their operational expenses but not as quickly as their revenue is dropping. The implications of that statement are onerous. There are only so many ways to cut until you reach rock bottom as an organization and the point of no return. Shrinking to greatness is typically not considered a viable option to survival.

The statistics from 2017 are very telling as expense growth was cut by 5.7% but revenue has only grown by 4.6% and that was in spite of the numerous mergers and acquisitions that have taken place. In fact, with 13 M&A transactions, Pennsylvania was the most active merger and acquisition state nationally followed by Georgia and Texas at nine and eight each. In the year 2000, there were approximately 122 independent community hospitals in Pennsylvania and now there are just 36 with several of these hospitals hanging by a proverbial economic thread.

Without getting too deeply into the financial woods, Medicie and Medicaid payments as a percentage of gross hospital revenue increased slightly, but higher paying commercial insurances have gone down by 33.9%. In a financial structure where less than 3% of net patient revenue came from capitated and risk-based contracting in 2017 and 41% from DRG’s (Diagnostic Related Groups), 28% from fee schedules and 17% from the actual charge master or list price, based on a traditional operating model, there is no clear pathway for small and rural hospitals to remain viable.

Add to these economic challenges, the 2868 total number of retail clinics in the United States supported by Minute Clinic, Walgreens, The Little Clinic, Walmart, Target and dozens of other smaller corporations as well as an exponential growth in free-standing surgi-centers and independent physician-based clinics, and hospitals must take additional aggressive steps to change their business model.

In the Modern Healthcare article, Lyndean Bric, President of Advis Group, a healthcare consulting firm, states that hospitals must find ways to grow volumes, be creative, and do things differently than they have by looking to monetize assets and seek out non traditional revenue.

What if your hospital could afford to have its own Innovation Officer, and creativity could be added to your C-suite agenda at every meeting? With experience in the latest “Omics” research, expertise and connectivity in Integrative Medicine, and other cash income producing innovations, we can change the way a community utilizes their local hospital facilities while generating significant financial gains to their bottom line.

Although some of the areas that we may recommend may seem a little like “driving in front of your headlights” to the traditionally trained C-suite executive, each of them comes with a proven track record of success from multiple settings. Ultimately, the hospitals that work with us have experienced new levels of community acceptance and involvement that helps to reposition them as true partners with their patient base on a level that drives increased volumes and patient revenue.

Be it cash paying integrative treatments, pharmacogenomics testing, human longevity, federal and state grant opportunities, new technologies for treating depression, opioid testing labs, the creation of a 501©3 Foundation, mobile imaging, polypharmacy, or just creative supply chain payment methodologies, we hav experience, knowledge, and connectivity in all of these areas and because of that can bring the right people to the table to make “creative things” happen in an economically viable way for you and your organization.