Archive for the ‘Uncategorized’ category

Become compassionate caregivers

March 8th, 2018
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.

Earlier in the week, Dr. David Nicholson, former Chief Executive of the National Health Service in England, and Dr. Mark Britnell, Chairman and Partner of Global Health Practice for the accounting firm KPMG, referred to the opioid crisis in the United States as a blight on our country.

What did we learn? Although we have about 4.4 percent of the world’s population, we’re consuming 80 percent or more of the world’s opioid production.

Opioid addiction is the leading cause of accidental death in the United States. From 2001 until now, opioids have produced over a trillion dollars in losses to the American economy. But money isn’t everything, or is it?

The panel agreed that the manufacturing, marketing, and distribution of these opioid products was in part attributable to pharmaceutical and distribution companies misleading the physicians and patients regarding the addictive nature of these drugs.

When OxyContin was introduced, the marketing line was, “OxyCotin is safe and controlled pain relief all day and all night.” One of the speakers pointed out that the only word in that sentence that was true was the word and.

Of course, there was some casual culpability placed on pain control requirement guidelines, compounded by the emphasis placed on the reimbursable HCAHPS scores that impact health systems and physicians financially.

We do know that 80 percent of the individuals using heroin today started with prescription drugs. I spoke with a pharmacist last week who confirmed to me that they are selling far fewer opioid prescriptions but can’t keep hypodermic needles in stock.

One sad fact that has come out of this epidemic is that only one in 10 addicted individuals seek treatment, and this is primarily because of the shame inflicted upon the users by our society. Rather than seeing addiction as a sickness, the media, and we individually, continue to portray these addicts as sub-quality human beings.

Numerous steps can be taken to help control the national tragedy, many of which were delineated during the discussion. We can, of course, stop stigmatizing the individuals who have become addicted. We can provide transparency through primary care, and according to Congressman Ryan, we can change the arcane Medicaid reimbursement of thirty days and you’re back on the street. This was the typical cure for alcoholics, but drug users need more time to rid their system of these killers.

Dr. Cosgrove of the Cleveland Clinic would like to see a publicly visible daily clock showing exactly how many individuals have overdosed and died each day in the United States from opioid abuse. We’re fast approaching the number of people killed in total during the Vietnam war each year with opioid deaths.

With less than 3percent of emergency room physicians prescribing opioid meds, we know there are numerous other ways to control pain, and we must educate all physicians as to what these methods can be.

Of course, this would not be a Nick Jacobs article if I didn’t endorse the use of mindfulness training, acupuncture, massage, biofeedback, osteopathic and chiropractic manipulation and several more world treatments that are not drug-based.

Final warning, in some states, even marijuana has been laced with fentanyl and carfentanil, originally a weapon of mass destruction and now used for elephant sedation. It’s 5,000 times as potent as a unit of heroin and instantly fatal.

Bottom line? Clean out your medicine cabinets and become compassionate caregivers. This must end.



March 1st, 2018

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.


Knowing when to change

January 14th, 2018


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.


Advice for a longer life

December 6th, 2017




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.


Four ways to improve access to Integrative Medicine Practices

November 13th, 2017

Licensure, regulation, medical evidence, and funding are four sure ways to speed up the process needed to allow integrative medicine practices to be embraced. If we begin with the assumption that money has a lot to do with everything medical in the United States, then we must look at the winners and losers and the WIFM’s?  (What’s in it for me?)  If you’re a practicing surgeon, and acupuncture or chiropractic care results in the patient not needing a surgery, that can be a financial threat to you. Let’s be fair, that probably doesn’t happen that often, but sometimes it does, and when it does, that’s money lost to your practice.


If you’ve spent four years in undergraduate school, four years in medical school, four or five years in a residency, and your educational debts amount to hundreds of thousands of dollars, the last thing you need is a clinical study demonstrating through medical evidence that thousands of patients won’t need your services, and your skills will become exponentially less in the demand.


On the other hand, if, like ophthalmologists who surround their practices with optometrists, orthopods did the same with chiropractors and acupuncturists, could that not create a steady stream of referrals for their practices?


Let’s face it, there is a role for all three of those professions, and there are skill levels in every profession and duties relegated to each that both overlap and potentially conflict. So, wouldn’t it be better to have the three practice as a team of professionals working together to help you?


“There’s not enough medical evidence”  has been the hue and cry of the uninformed for years. Ironically, once traditional medical evidence is thoroughly interrogated, it’s not unusual to find numerous flaws in even the most accepted medical practices. We’ve seen slanted reporting in even the furthermost prestigious journals where various drugs, procedures, and devices have been proven to be ineffective years later.


There are over 19,000 papers that have been written and submitted to medical journals in which acupuncture has been endorsed and proven to be effective, but there never seems to be enough medical evidence for the naysayers.


Credentialing is a very challenging area as well.  Not unlike the highly skilled surgeon with her medical degrees from the Sorbonne in Paris that is not permitted to practice medicine in the United States, there are sometimes economic and political reasons to limit the number of practitioners allowed in the United States. In my experience, by creating a hospital-based credentials committee that specializes in integrative medicine, the nay-sayers ability to discredit highly trained practitioners with different skills will become more limited.


Regulation may be the most difficult challenge in this discussion because, as we have come to know very well, political power can come from political contributions, and when it comes to regulations, those with the gold have more clout than those without. That is not to say that our politicians can be encouraged to be more flexible because they can.  All it takes is for hundreds of constituents to stand in front of a Congressional office to encourage change to occur.


So, what are we really dealing with here?  In 1910, the AMA put out a request for proposal to determine what should be taught in the medical schools of Canada and the United States and no physician would accept that assignment.  Consequently, a Ph.D., Abraham Flexner, did, and his approach was to eliminate everything that wasn’t already proven science.  From there we have evolved to a “heal to the pill” mentality where words like root cause and placebo have been dropped from the vernacular.


Finally, funding is the key. It has been proven time and again that integrative medicine practices can reduce health care costs exponentially. With that in mind, every bill that comes out of Washington ignores that fact, and funding for many of these well-documented practices is not present. There were over 5000 codes in the Affordable Care Act that were intended to fund such practices as acupuncture, but when the FAQ initially was released, it said, in essence, “Don’t worry about paying these codes.”


If you go almost anywhere in Europe and Asia and you will see integrative practitioners thriving because their value is acknowledged and embraced. Of course, we’re not professing that a massage therapist performs open heart surgery, but we do know that Integrative medicine can help to reduce costs across the board.


There are many good things that can come from Integrative medicine. You just need to be open-minded.


Opioid addiction terrorizes U.S.

September 18th, 2017

Can you imagine a tragedy equivalent to the number of deaths on 9-11 occurring in this country every three weeks? How would we, as a society, endure the loss of nearly 3000 lives every 21 days due to terrorist attacks? Would we dedicate trillion dollars to addressing this issue?

Now try to imagine that there was no end to these attacks, that they would simply go on and on and on forever. Okay, let’s add a level of complicity to these deaths that did not exist in the 9-11 attacks.  Let’s suppose that trusted members of our communities were literally coerced into participating as somewhat guiltless bystanders by large companies that benefited financially by their complicity.

How about another level of complication? Let’s say that friends and relatives who either through what they perceived to be compassion or through stupidity also contributed significantly to these deaths by participating either knowingly or unknowingly in this involvement.

Now we’re honing in on why this situation exists.  Physicians, nurse practitioners, and physician assistants pressed by heavy marketing techniques employed by Pharmaceutical companies and relatives leaving their unused bottles of meds unchecked or knowingly giving these drugs to other relatives have contributed to a massive opioid problem in our country.

Approximately, 140 Americans are dying every day in their homes and on the streets due to this new type of drug terrorism, and this terrorism is opioid addiction.  Each year, we see the equivalent of nearly 20 times 9-11 in the number of Americans dying of drug overdoses.  This does not include the number of drug dealers, police, and bystanders killed by gang activities related to drug sales.

In many cases, the drug addiction emanates from what we have come to describe as chronic pain.  More than 100 million Americans categorize themselves as suffering from chronic pain, that’s approximately 1/3 of the population of the United States. In fact, the citizens of the United States represent 4.6% of the world’s population but consume more than 80% of the world’s available painkilling drugs and 99% of the world’s hydrocodone. That equates to about 110 tons of addictive opiates each year treating chronic pain at an overall cost of $2000 per U.S. citizen.

In the United States, pain is graded by an intensity of pain scale where one denotes very mild pain and ten refers to an unspeakable level of pain.  Back pain is the leading cause of disabling pain among Americans under 45 years of age. Interestingly, only one in seven people complain of chronic pain internationally, down significantly from the one in three in the United States.

What’s contributing to so much pain in the United States?  It could be inactivity, obesity, a lack of appropriate diet, exercise, and stress management as well as a lack of societal attachment, and absence of understanding as to what pain really is in our lives.

For many that prescription of opioid drugs can become an addictive dose, and because heroin and fentanyl are less expensive, the addiction then moves to unregulated street drugs.

The traditional path to treating chronic pain is with surgery, injections, opioids, occupational and physical therapy. It is a rigid adherence to these treatment methodologies that has often proven to be incomplete. World health has always taken a broader approach to pain management by utilizing additional treatments.  Per Circa Interactive, complimentary treatment options include acupuncture, natural products, deep breathing, yoga/Tai Chi/Qi Gong, chiropractic techniques, meditation, massage, special diets, homeopathy, progressive relaxation, and guided imagery.

With over two-thirds of our physicians admitting to inadequate knowledge of pain treatment and opioid dependency management, it is time to focus on both physician and patient education and also on complementary opportunities to address chronic pain. We are being terrorized by a lack of knowledge, greed of big business, and lack of open mindednesses.

If not now? When?

Otherwise, it’s 911 forever.



True Greatness Is Within Your Grasp

September 5th, 2017

Years ago (during the 1970s to be more exact), as I stood in front of a classroom teaching music to high school students, I never thought that I would eventually become a healthcare executive nor—even more astonishingly—rely on what I learned in that classroom to revolutionize and reorganize hospitals.

But that is exactly what happened. And now, as I stand much closer to the end of my professional journey than its beginning, I wonder, genuinely wonder, why so many of my peers seem unable to see what I see when it comes to such issues as Transparency, Kindness and Compassion, and Patient, Student or Employee-centeredness. These are topics I’ve been writing about, involved in, and literally living for decades now.

My passion for this philosophy has not waned during that time, not even for a nanosecond. Its core is centered on humanizing experiences and on being transparent, engaged, supportive and nurturing. It is all about focusing on employees, staff, students or patients in ways not previously considered even before the United States government began to attach reimbursements to patient satisfaction scores in hospitals.

The good news is that hospital by hospital, school by school, and business by business some individuals—often against incredible opposition—are working toward a kinder, gentler world. Will they be successful? Can they change a structure that has long since been openly criticized as dysfunctional?

I believe that many of them will be successful. In fact, this effort is directed toward all of those who believe that they can and will find a better way to deliver care and, in the process, make life better for all involved.

For me, the journey began years ago.

I started my professional life dreaming of becoming a great trumpet player. Eventually, that dream morphed into a teaching job, which lasted ten years. During that time of trying to instill the same passion I had for music into a roomful of teenagers, one thought kept playing over and over again in my mind:  “How would you like to be treated?”

My teaching led to a discovery that seemed unique at the time, at least to me: junior high and middle school aged students had an unbelievable capacity to learn and to excel. This breakthrough in my thinking back then was affirmed recently in an article which appeared in a special edition of U.S. News and World Report, “Secrets of Your Brain,” by Nancy Shute entitled, “How to Deploy the Amazing Power of the Teen Brain.”

Until Ms. Shute’s article, I had no scientific evidence to back it up what I discovered as a young teacher. Before the use of MRIs beginning in the 1990s, it was impossible to know what nuanced changes were occurring in the brains of teenagers. Of course, the neurologists still don’t understand the myriad details of those changes, but they can make certain not-so-speculative statements about these changes. According to the article, what they found astonished them: The brain’s gray matter, which forms the bulk of the structure and processing capacity, grows gradually throughout childhood, peaks around age 12, and then furiously prunes underused neurons.

Because these changes begin in the back of the brain and move forward, sensory and motor skills mature first. These are followed by the prefrontal cortex, which is responsible for judgment and impulse control. According to the scientists at the National Institutes of Health, the prefrontal cortex isn’t done developing until men are in their early 20s. The following quote from the article, however, should be the basis for all of the arts education in the United States: “Neurons, like muscles, operate on a ‘use it or lose it’ basis: a teenager who studies piano three hours a day will end up with different brain wiring than someone who spends that same time shooting hoops or playing video games. “

When we consider that during the teenage years, emotion and passion also heighten attention and tramp down fear, that brief time period presents the perfect opportunity to master new challenges. According to Frances Jensen, a neurologist at Children’s Hospital in Boston, “They (teens) can do things now that will set them up later in life with an enhanced skill set.”

Of course, the 1970s in semi-rural America did not harbor all of the challenges that we now face for our teenagers, but challenges did exist. What I had discovered in my work was that, by treating teenagers more closely as adults than subservient children while still maintaining control, by allowing them to work with you to select and enumerate their goals, and finally by encouraging them along the way, their passions and intensity would take the music and their performances to heights that would have seemed otherwise incomprehensible.

Music arranged for teenaged performing groups typically was watered down and lacked both emotion and challenge. I chose to make musical scores available to them that would have been considered too mature, too challenging and too far beyond their comprehension. The trade off, however, was that we were careful never to let them hear any of those “too hard” descriptors.

The results were stupefying. The kids worked endlessly and tirelessly to make sure these musical scores were mastered. (A critical factor in this, I believed, was that their parents were, in many cases, second generation immigrants. So they worked to ensure that the kids had: 1.) Plenty of sleep, 2.) A healthy diet, 3.) No drugs or alcohol and 4.) Unconditional love.

The U.S. News article concluded with something that was instinctive to me: “Nature had a reason to give adolescents strong bodies, impulsive natures, and curious flexible minds.” It was the stuff from which scholars, great artists and future leaders were made.

It still sometimes astonishes me to think that a music teacher with a passion for the trumpet would someday find himself running a hospital and founding two genetic research institutes. But mostly, when people began to gravitate to our facility, (e.g., physicians, scientists, patients), it always felt like there was a greater power at work, a larger orchestrator, conductor and/or choreographer behind the scenes.

And for the two decades as a hospital senior leader, I prepared myself for work each and every day by playing the same digital recording in my mind in a continuous loop. What if it was your mother, your wife, your daughter or son who was being treated today?  How would YOU personally want them to be cared for by us?

It has been a lifelong mission for me to create an environment for employees, students, patients and customers that first and foremost acknowledged them as fellow human beings and then demonstrated respect for their dignity.  In teaching it was the immediate abandonment of the parent-to-child interactions that so frequently represented the style of my peers; in healthcare, my goal was to ensure that we provided a caring, compassionate, and nurturing environment for employees, families, and their loved ones.

The creation of a truly healing, nurturing atmosphere that empowered the workers and the customers–where patients had an opportunity to take part in their care and to make decisions about the type of care they received—was always my goal.  In my view, the perfect environment was one where the staff was embraced as the primary resource of the organization and then was rewarded for their efforts. It was about creating a place where Care Partners provided support for their loved ones and where they could actually participate in their loved one’s care.

Most significantly, this environment could not be superficial, the kind found in so many institutions that proclaimed the value and importance of the individual but who eventually would be exposed as frauds merely seeking “good PR.” On the contrary, for this to work it had to be genuine, from top to bottom.

Well, in 2001, a Harvard physician by the name of Dr. Wayne London visited us and explained it was no accident that a musician was in charge, because my instincts had led me to build an ensemble of players who, in a sense, could provide unique and beautiful healing sounds through their science and their work. He also advised me to stay humble because he believed something much larger than me was trying to work through me.

That was both humbling and a little scary to hear. Whether or not I believed it at the time, all I knew was that during my time in health care administration, the efforts of our team resulted in our infection rate dropping to a level that was, on average, consistently around or below 1percent, or eight points less than the 9 percent national average.  Additionally, our lengths of stay, readmission rates, restraint rates, and death rates were all well below our peer hospitals.

So what does it all mean?

Ask yourself this question: If you are in hospital administration and have little or no competition, what would happen if a new competitor arose who allowed patients to access their medical records; if loved ones were invited to stay and become part of care giving teams; if there was 24-hour-a-day, 7-day-a-week visiting hours; if employees were always treated with dignity and were respected, rewarded, and recognized for their work; if patients were always at the center of their own care?

What would that mean to your institution?

Perhaps a universal question focuses on whether or not our hospitals will go on treating “organs” or will they begin to treat people?  Will we focus on prevention rather than cleaning up train wrecks? Will we embrace kindness, openness, transparency, healing, and respect? Most critically, will we acknowledge that the value of a human being is not based upon the assessment of his or her estate but on an ability to give and receive unconditional love?  When this happens, your patients, your students, and your customers will come running to you.

Patient-, Employee- and Student-Centered Care should be the new world order and it represents a demystification process.  It represents an open spirit of communication that allows individuals to make the same types of informed choices that they have been entitled and encouraged to make in every other aspect of their lives.

Our vision, our mission, our goals, and our communications are all based on the spiritual connectivity of humankind with one another and with a universe that is larger than any mere mortal can grasp. It’s based on a spirituality that embraces the thought that race, religion, nationality and political beliefs are all moot points here. It’s based on the unconditional love and respect that have become our drivers.

It’s within all of our grasps.

We merely need to be willing to reach for it.



August 30th, 2017
I had an opportunity to visit a friend in his basement office surrounded by make-believe, non-ice covered, kid-sized hockey mats, a kick boxing dummy, and half a dozen other large toys. In the corner of his makeshift office was a set up that looked just a little bit like the computer that ran HAL from 2001: a Space Odyssey. There were lights flashing and connecting wires going everywhere. When I asked him what it was doing, he said, “It’s trading in cryptocurrency.
I have never even figured out how day traders in the stock market do their thing, but this was even more mesmerizing. The screen on his monitor listed about 18 names like Bitcoin, Ethereum, Ripple, Litecoin, NEM, Dash, Ethereum Classic, IOTA, and on and on. In fact, as he scrolled down the screen, there were hundreds of names of currency exchanges, and the numbers were changing regularly and rapidly on all of them.
This guy is a smart guy, and he does understand computers, the stock market, and pretty much everything that I don’t  understand, but this was light years ahead of my knowledge base. While he is making, trading, and getting money in the supercomputer future, I’m  still stuck between a Commodore 64 and word perfect, 
He explained to me that his goal 10 years ago was to find a way to just keep making money while he slept, and he may be on the verge of doing that. His machines are mining bitcoin and bitcoin imitators 24-hours a day.
My knowledge in this area is so limited that I’m not even sure how to begin to explain what I learned, but that’s never stopped me before. So, between what I can remember and Wikipedia, here goes. Bitcoin is a digital asset and payment system created by a programmer or group of programmers under the name of Satoshi Nakamoto who may not even be a person or persons. It’s described as a cryptocurrency, and it was released as open source software eight years ago.
OK, if that’s  not complicated enough, it’s a peer-to-peer system in which all transactions take place between users without an intermediary or intermediaries. So, no banks, no governments, no brokers, no middle men. It’s mano-a-mano.
Well, at least that was the plan. There are numerous subtle ways that people insert themselves, and once the governments figure out that this could become the worldwide currency system without their involvement for taxation purposes, I’m sure they will become participants, too.
Besides being rewarded for doing what is referred to as mining, the participants can also exchange bitcoins or their equivalent crypto-currency for other services, for other currencies, or even for products (both legally and on the dark web). If you remember the news a few weeks ago, the computer shutdown that hit the world allowed their hostages to get their information back for $300 in bitcoins.
By 2015 there were more than 100,000 vendors or merchants that accepted bitcoins as appropriate tender for payment. Now there are around six million people using it as a crypto-currency.
I’m not sure how many of you are into this incredible new world of bypassing the world banking and monetary systems, but I’m thinking we should all have friends who either have a large stash of gold, or unless there’s a magnetic pulse that shuts down all electronics, we should have friends who trade and mine in bitcoins. It’s clearly the survivalist and smart investor’s path to financial independence in the future.
Both New York and Duke Universities, are offering courses on crypto-currencies. The United Kingdom’s University of Cumbria offers two certificates on crypto-currencies, and the University of Nicosia in Cyprus offers a master’s degree in digital currency, but my buddy learned everything he needed to know on YouTube. Maybe I should have worked harder on algorithms or paid more attention to YouTube?

Remember, we’re all animals

July 21st, 2017

Oh, my, I just read a very disturbing article published by the National Geographic about our pets. It was titled “Would your dog eat you if you died? Get the facts.”

This piece was a little like reading a Stephen King novel from the era when he was still using LSD. The title was a little misleading, however, because it was not limited to just your pet dog. It explored your feline friends as well. To save you the gory details, the answer was, yes. Yes, your pets will definitely eat you.

How is it possible that your loving, kind, beautiful, well-behaved pet would eat you? Well, let’s be honest, we’d probably do the same thing if the situation warranted it.

Remember the Uruguayan Air Force Chartered Flight 571 that was carrying 45 people, including a rugby union team, their friends, family, and associates? It was the basis of the movie “Alive.” The plane crashed in the Andes in 1972, and the survivors began eating those who did not make it, like the Donner Party on their trip through the Sierra Nevada Hasting Cutoff.

It was certainly a graphic depiction of anthropophagy, but the pet story reminded me that we are all animals, and we spend most of our human lives trying to not only suppress that fact, we spend our lives doing everything we can to hide from it. Dogs come from wolves, cats come from tigers, and hey, like them, the vast majority of us are carnivores.

It’s such an ironic evolution that we deal with every day. As a 10-year-old, I vividly remember our elementary school field trips. We would go to the Joseph Meat Packing Plant. They’d kill the cattle in front of us and then gut and butcher them. We absolutely knew where that hamburger came from for lunch. (I’m sure it would be considered child abuse now, but it was just a field trip for us.)

The book, “The Naked Ape,” by Desmond Morris takes a deep and long look at humans as animals. Morris was a practicing zoologist who dedicated this book to we humans as animals.

He very carefully outlined the numerous animal traits that we share, and then he illustrated how hard we work at making sure every day we aren’t seen as animals. Bathing, deodorant, shaving, and clothing are just a few examples.

If you think about the craziness of our world and equate it to packs, tribes, gangs, and such, things begin to make so much more sense.

It also explains some of our political, psychosocial, and personal decisions regarding tattoos, piercings, sports, and voting. We are pack animals. It’s why we run to wear our Tommy Hilfiger, Lacoste, and Under Armor clothing. We want to fit in with the rest of our gang, whatever that gang represents. It also explains our love of red meat, our sexuality, and what seems to be our madness. We’re animals disguising ourselves as humans.

Yes, we have spirituality and a more sophisticated brain, but smart people do some pretty dumb things. It actually gives me a little peace of mind when I’m trying to figure out why we’ve been at war forever or why we’re so hostile toward each other at political rallies. It’s our animal side.

So, the next time you look at Buddy, Chipper, or Miss Kitty, just understand that they’ll probably go for the soft tissue first, and it’s not because they didn’t like you or because there wasn’t food in their bowl.

Thank you, National Geographic, for absolutely terrifying me. I’m so glad I’m pet-less right now. Here kitty kitty.


Opioids and Capitalism

July 12th, 2017

When we first introduced Integrative Medicine practices at the hospital where I was the CEO, we basically embraced a code similar to the Statue of Liberty. It was, “Give us the patients you’re no longer able to help because if we are doing no harm and nothing else is working, why not?”

There have been more than 19,000 educational and scientific papers written on the efficacy of acupuncture, but there are still those hardline or uninformed who believe it’s somehow a fad or totally ineffective.

Of course, Integrative Medicine doesn’t always work for every individual, but goodness knows that traditional medicine has its challenges as well. The point is never to replace one with the other but to complement one another when possible or effective.

The Joint Commission on Hospital Accreditation has just opened the door to at least considering some forms of Integrative Medicine when dealing with the Opioid crisis. As one of my very closest friends recently wrote, “The failure of Pharma in pain management is monumental, and it is apparent to me that we are at the tipping point.”

He went on to say, “The Joint Commission has endorsed the use of independent licensed practitioners in the pain management journey, and Integrative Medicine brings a philosophy and clinical approach which is not well understood but is being received with greater acceptance. Clearly, economics and power have driven the country into this opioid crisis and have greatly delayed a transformation process that is not Pharma oriented.”

Back in the early 2000s, I had an opportunity to interact with the lead scientist from a major pharmaceutical company. He had visited our research center where we were endorsing both personalized and integrative medicine. As I drove him to the airport to board his company’s private jet, he turned to me and said, “You don’t understand the pharmaceutical industry.” My response was, “Clearly, I don’t” to which he responded, “The pharmaceutical industry is like the movie industry. We are only looking for the blockbusters. We want to give you a pill from the time you’re 5 until you’re 85 that never cures you.”

Well, they have succeeded beyond their wildest dreams with the opioid crisis. One of my emergency room physicians once told me that as little as one prescription of an opioid can cause addiction. Obviously, it depends on the pharmacogenomic profile of the patient, but some of us are addiction prone and our reactions to pain meds are dramatic.

One of the very sad examples of the savage capitalism involved in getting hundreds of thousands of patients addicted to these meds is that opioids also contribute to constipation. Consequently, pharma has come out with a new drug to sell the addicted that helps them with that drug caused problem as well.”Heal with a pill?”

I recently read a set of statistics that seemed not only overwhelming but also disconcerting and pathetic. The use of Vicodin has grown from 112 million doses in 2006 to 131 million in 2017. Per an ABC News report, the United States makes up only 4.6 percent of the world’s population but consumes 80 percent of its opioids and 99 percent of the world’s hydrocodone, and now that heroin is less expensive than Vicodin or other opioids, we have rampant drug addiction in our country.

More people are dying of overdoses in our country now than auto accidents, and, according to a quote from public health and law enforcement officials, painkillers are now responsible for more deaths than crack and black tar heroin in the 1970’s and 80’s combined.

So, the issue isn’t one of pain. We know that people have pain. The issue is how to treat that pain. The opioids were originally created to deal only with terminal patients.

When will the system recognize that mindfulness, acupuncture, visual imaging, controlled stretching, and other integrative modalities may be part of the answer? How about now?