The Reasons We Need A New Approach To Medicine
At Parsley Health our doctors help you get to the root cause of what’s bothering you, and take a whole-person approach that includes nutrition, lifestyle, mental health and knowing your personal story.
1. We are all living ourselves sick.
of our diseases today are chronic
& lifestyle driven
- 86% of our disease burden today is due to chronic and lifestyle driven. This includes 117 million people (50% of adults) in the United States who are living with at least one chronic condition — such as heart disease, asthma, cancer, diabetes, hypertension, autoimmune disease, COPD and depression — and 1 in 4 Americans are living with multiple such conditions(2). Chronic disease is by far the #1 killer of Americans.
of all adults now have at least one ‘chronic’ health condition
- Our high stress sedentary lives are compounding this problem, accelerating it in younger and younger populations – half of all adults now have at least one chronic condition, with nearly one quarter having more than 2
- And yet mainstream medical care is designed to band-aid the problem and send you out the door, not to look at the big picture and spend the time with you to fix it. We are bankrupting our system this way. It’s time for a change.
2. Medical care is designed for insurance companies not people
- Most people are unaware of the true costs of health care. Large hospitals and medical provider groups and pharmaceutical companies set prices that are negotiated with insurers. This pricing system lacks transparency, and most people don’t know how much their services actually cost. In addition because of lack of transparency pricing for the same services ranges widely across the country — the same knee surgery in Alabama could cost twice what it costs in Illinois. An MRI could have 4 different prices in one state alone. Quality ranges wildly, too.
Health expenditure, total (% of GDP)
- Meanwhile few people have a primary care doctor who acts as quarterback guiding them through this difficult to traverse system. Instead, more and more people use their primary care doctor for minor issues like urgent care, for a flu or a sinus infection, or perhaps an annual physical, which has been shown to be of little value. Then when something is really wrong they jump right to specialists skipping primary care for high cost unnecessary procedures from doctors who make money from doing more high cost unnecessary procedures. Or they bounce in and out of ERs, perpetuating a cycle of waiting until sickness overtakes them before they get help.
- In large part this is because because primary care doctors aren’t paid or equipped to handle chronic conditions like diabetes which always outstrip any drug’s ability to manage if the underlying drivers (diet and exercise) aren’t corrected.
- Not only are most doctors not trained in nutrition and lifestyle change, the average primary care doctor spends 15 minutes per year with each patient – not enough time to know very much of anything about you. This is because primary care is driven by volume – most primary care doctors have to manage panels of on average nearly 2400 patients per year and see 20-30 patients a day just to make ends meet.
“Why are we in this situation?
Because insurance pays primary care doctors peanuts and pays specialists a lot.”
- Meanwhile the US only two in five doctors visits is to primary care – in other places with far more cost efficiency in their health care system (see chart above) it’s four out of five.
- What we need to reverse these trends is a system where primary care is practiced as a specialty, and reimbursed as such. We need primary care doctors who spend time with you and know your life story, who are backed up by health coaches who monitor and support you. We need medicine that addresses your whole-life and how its adding up to making you sick, rather than playing a game of whack-a-mole with problems as they come up offering only medications or referrals out to expensive specialists. We of course need drugs and referrals to specialists when necessary, but only when necessary.
- Today this medicine exists – some call it Functional Medicine, others Lifestyle Medicine. But historically doctors practicing this way have been outside the system, unaffordable, and few and far between. And so far only a handful of academic centers like the Cleveland Clinic have embraced it.
3. As a result of #1 and #2, we are over-medicated and under-treated.
- 80% of primary care doctors visits result in a prescription drug, resulting in over 4 billion prescriptions being filled each year at US pharmacies. Of special note is that over 75 million of these are for anti-anxiety drugs like Xanax and Ativan alone – conditions which are for the most part better managed by non-addictive behavioral approaches like meditation and exercise while avoiding caffeine and stimulants like refined sugar.
- Meanwhile when we talk to employers and insurance companies, they often define success as people “taking their medicine.” In fact, medication adherence is a KPI (key performance indicator) for health care startups and medical systems alike – so much so that medication non-adherence has been labeled a “significant public health issue.”
- Yet most people don’t need medicine. They need to change the way they eat, move, manage stress, and sleep. For example, the reason you aren’t sleeping isn’t an Ambien deficiency. The reason could be your anxiety, your diet, your stress level, or another deeper problem. But of course with 15 minutes per patient encounter, it’s faster to give someone a prescription for a drug, even if it’s addictive and has serious side effects.
4. Because the root cause of most of our health problems is diet: We are eating our way fat, tired and sad.
- Food is the key to health. Food is medicine. And yet the majority of our calories are coming from ultra-processed foods that by definition make us sick. The CDC projects that 1 in 3 Americans will have diabetes by 2050. And this is almost entirely preventable through diet
- And yet conventional doctors trained at top institutions like Harvard and Columbia only learn about nutrition as it pertains to feeding bed-bound patients through IVs and nasogastric tubes, meanwhile they get 500+ hours of training in pharmacology. As a result most doctors don’t feel they are equipped to give nutrition advice
“We can often cure autoimmune disease, heart disease, gastrointestinal disorders, hormone imbalances like PCOS, and even Alzheimer’s disease through dietary changes”
- This is unacceptable when we that know we can often resolve chronic conditions like eczema, heart disease, Irritable Bowel Syndrome, Polycystic ovarian syndrome and amenorrhea, and even Alzheimer’s disease through primarily dietary changes including eliminating refined sugars and carbohydrates as well as food-allergens from your diet. Food should be at the center of your medical care
5. Because mental health and physical health aren’t separate.
- Psychoactive foods like refined carbs and sugar have become the staple of most people’s diets. We rely on coffee to get us up, Adderall to keep us awake and benzos to help us sleep. Meanwhile we are sedentary 11+ hours a day and consuming media via screens that lower our ability to sleep 11+ hours a day. No wonder we are anxious exhausted and sad
6. Because it’s sad that Amazon knows more about you than your doctor.
- Smart technology that tracks your preferences, knows what you buy, where you are, if you’re likely to get the flu and if you’re pregnant has been pioneered by companies like Amazon and is popular almost everywhere other than healthcare.
- And yet from the orders you place on Amazon, to those you make at the grocery story or the corner pharmacy, to the articles you search for and read online, all of these data points carry insights that have implications for your health. For example if you’re shopping for newborn sized diapers and stage one bottles, you probably have a new baby at home, a fact which has implications for your health, your medical needs, your sleep, your productivity and your likelihood of getting more frequent common colds in 2 years when your child goes to daycare
- However, your health story goes beyond today’s searches and purchases, back to before you were born. It starts with family history like your mother’s autoimmune condition, continue with your birth – the fact that you were born c-section has implications for long term obesity – from there continues with the antibiotics you had as a kid for frequent ear infections, and includes the appendectomy you had in college after which you developed migraine headaches for the first time, the divorce you went through last year after which you started having insomnia, and the new job whose long hours in front of a screen precipitated 10lbs of weight gain, and all of the life events that have added up to today’s health picture. And yet your doctor who spends 15 minute with you has neither the time nor the technology to gather and synthesize these data points in a way that helps them give you better care
7. Because it’s 2017 and testing should be comprehensive, cutting edge and proactive.
- It takes 17 or more years for innovation in biomedical sciences to make its way into academic medical training and every-day health care services. There is no other industry stymied by this slow pace of innovation
- Meanwhile advanced testing in genomics, the microbiome, toxicity and continuous non-invasive blood sugar monitoring is readily available and in use by doctors working at the cutting edge of medicine. This kind of testing proactively looks at markers of and risk factors for dysfunction in the body as opposed to waiting until markers are so deranged they indicate disease
- Disease we know is a continuum, not a black and white. We shouldn’t have to wait until we are sick to know if our bodies are showing deeper signs of illness
8. Because medicine should be embedded in your life and come to you – through video, text and on demand-services – not the other way around.
- 77% of Americans own a smartphone and 95% have a mobile phone of some kind. Meanwhile the majority are using digital health tools from telemedicine to wearables
- And yet the barriers to offering digitally enabled care in medicine are widespread, and include poor or inequitable reimbursement from insurance for telemedicine services, antiquated state-level medical licensing rules that prohibit doctors from practicing medicine across state lines, and lack of technology infrastructure for life video consultations in the poor and geographically disadvantaged populations who are in greatest need of telemedicine based services
- Meanwhile historically medical providers, who incentivized by volume instead of outcomes, and who are only paid for in person visits, tend to layer their offices with in-person services that they can up-charge for at the expense of their patients’ convenience
9. Because the wellness generation is here to stay.
- The consumer health market was $160B in 2014 – meaning what consumers spend directly on health and wellness products – with alternative medicine making up $34 billion of this market. This includes acupuncture supplements fitness juice companies and therapy. 38% of consumers already use some form of alternative medicine and 50% take a supplement every day
- A lot of people are spending a lot of money trying to feel better. And yet medicine isn’t participating
10. Because the only way forward is to start over with something radically new.
- With a system whose incentives are misaligned with the needs of most people in the 21st century, we decided we had to strike out on our own to create something human, smart, ethical and better for our patients.