Last week I gave a talk at TEDMED on how social networks may be an unexpected solution to our heath care crisis.
Here’s how my talk went…..
I want to tell you a story of how a skinny Haitian chicken and a bowl of beet and cabbage soup turned my world upside down and helped me think differently about how we might deal with the crazy explosion of lifestyle driven chronic diseases like heart disease, diabetes and obesity – what I like to call DIABESITY!!!
How can we even think about solving this problem that will cost the global economy $47 trillion over the next 20 years and by the end of this decade will kill 50 million people a year, killing more than twice as many people as infectious disease.
How do we think about a world—where now there are more people who are overweight than are starving?
How do we think about a world where there soon will be half a billion diabetics and almost a billion pre-diabetics and only a fraction of doctors and health care workers needed to take care of them? These are not just diseases of affluence, but are exploding in the poorest countries on earth.
So what does a skinny Haitian chicken have to do with rethinking how we approach chronic lifestyle driven diseases? My RE-thinking started on Jan 1, 2010 –the first day of the first month of the first year of this new decade. I had just finished a book about Paul Farmer, who successfully tackled the worst diseases in the worst places on the planet.
Paul Farmer successfully treated TB and AIDS — which everyone thought were untreatable in the face of extreme poverty in places like Haiti, Lima or Rwanda.
Paul realized we didn’t need a new advance in science, or a new medication but something very simple —- to rebuild community and connection in broken communities.
Paul’s genius was his insight that the key to solving insoluble health care problems was each other, was people helping people, or what some call peer support. Paul’s genius was the idea of accompaniment – accompanying each other to health, helping each other build back their communities with clean water, food, going to each others houses making sure their sick neighbor knew how and knew when to take their medication.
And it wasn’t just a better delivery model for the right drug or the right information. The community was part of the medicine, part of the cure.
That was how I spent that first day in January of the new decade — an auspicious day. Thinking about how Paul’s insight about infectious disease might help us solve our epidemic of chronic diseases like diabetes and heart disease.
And as this idea was shaking up my world, disaster happened. On January 12, 2010 just a few days later that massive earthquake hit Haiti.
Two days after that, I arrived at sunset with Paul Farmer who I just called out of the blue because I knew he would know where to go and asked him to come with us on a small plane with our small medical team. We arrived into chaos, devastation and overwhelming suffering, we unloaded our plane and went directly to the main public health hospital in Port au Prince.
After a week of 20 hour days amidst amputated limbs and amputated lives – I finally got to sit and eat a meal of rice and some skinny Haitian chicken with the director of the hospital – Dr. Alix Lassegue. As we had our first meal in days and tried to find some meat on that skinny chicken I asked Dr. Lassegue what was the most common admitting diagnosis here before the earthquake – here in the main public hospital in Haiti that served 8 million people!
I thought he would say – TB, AIDS, or malaria. But here in the poorest country in the Western hemisphere in one of the poorest countries in the world, it wasn’t TB or AIDS but diabetes, heart disease, high blood pressure — 90% of which are preventable and often reversible through lifestyle.
Those chronic diseases have reached every corner of the globe and touch everyone on the planet – it is you or someone you know or love. Most of these conditions – heart disease, high blood pressure, many cancers, and stroke, even dementia – are caused by the same ROOT problem.
DIABESITY — the continuum from a little bit of belly fat to pre-diabetes to full-blown type 2 diabetes.
I am thinking to myself while sitting in the crumbling hospital building in Haiti where diabetes was the main admitting diagnosis, “How do we deal with this crazy, overwhelming problem of obesity driven disease that’s getting worse and worse, and costing more and more despite our best efforts to treat it with medication and surgery?”
How do we deal with the fact that diabesity will soon affect 1 in 2 Americans – that’s EVERY OTHER PERSON IN AMERICA. And that full blown type 2 diabetes affects nearly 1 in 10 Americans and 1 in 5 African Americans and 1 in 4 Medicare patients. And that 1 in 3 Medicare dollars is spent on diabetes. And that 1 in 3 children born today will have type 2 diabetes in their lifetime.
And that 80% of the world’s diabetics are in poor countries and that half all diabetes and almost all of pre-diabetics are not even diagnosed.
So it was in the aftermath of being up to my elbows in blood, pus and broken bones, broken lives and broken hearts that I first understood what I had completely neglected over the last 15 years of diving deep into systems biology and genomics.
I was so hyper-focused on biological networks and systems medicine or NETWORK medicine as the answer to solving the puzzle of chronic disease — on turning the dials on biology for individuals –that I missed something much more important.
That most chronic disease is very often a SOCIAL disease and not just a problem of biology!!!!
We know that you are more likely to be overweight if your friend’s friend is overweight than if your parents are overweight. That the genetic threads that connect us may be less important than the social threads – that our social connections and our ancient need to be part of a tribe may be a way out of our epidemic of chronic disease…
That just maybe SOCIOGENOMICS – or how social networks influence health and disease and how social networks alter gene expression, are where we need to look for the solution.
In some places, gastric bypasses are being touted as a cure for diabetes. As if you could cut out a poor lifestyle like a wart. Is this really a solution for our 400 million diabetics at a cost of $30,000 per person – or $12 trillion?
We can’t medicate our way out of a bad diet. Taking a statin while downing a double cheeseburger, fries and a soda just doesn’t make any sense.
But there has been a new drug discovered – that can beneficially modulate thousands of genes and enhance the function of dozen of hormones and regulate tens of thousands of protein networks and can prevent cure and even reverse most chronic disease. And it works faster, better and is cheaper than any other drug discovered and it is available to almost everyone on the planet right now…
It is food – we now know that food is information, not just calories, and that it can upgrade your biologic software. The majority of chronic disease is primarily a food borne illness. We ate ourselves into this problem and we have to eat ourselves out of it.
High cholesterol is not a statin deficiency, and diabetes is not an Avandia deficiency. It is not doing the same things better. What we are doing is not really working. It is just rearranging deck chairs on the Titanic.
Statins increase the risk of diabetes by 48% in women. Avandia, the #1 blockbuster drug for diabetes, killed nearly 200,000 from heart attacks since it was introduced on the market in 1999.
So statins designed to prevent heart attacks causes diabetes and the drugs designed to treat diabetes cause heart attacks.
This is Pharmageddon.
Even if those approaches worked, we just don’t have enough doctors and hospitals and health care workers to deal with the massive number of chronically sick people on the planet.
After Haiti I realized that the answer had to be somewhere else. If social networks can promote unhealthy lifestyles, maybe we can use social networks to create health.
We know how to prevent, treat and even reverse diabetes and heart disease so why don’t we do it, why have we failed so miserably at this.
We can eradicate type 2 diabetes just like Larry Brilliant helped eradicate smallpox.
But people give up when they try to think about the obesity and chronic disease that’s’ killing most people on the planet.
It’s TOO overwhelming. It is TOO big. But I don’t think it is – I think it is a small problem, it’s a local problem, a community problem.
After I came back from Haiti I lay awake thinking about how are we REALLY going to deal with this I thought maybe we need to decentralize and democratize health care.
I realized that if you were sick, the best place to create health might NOT be the doctor’s office or clinic but your own community with a little help from your friends.
I realized that getting healthy is a team sport! Click here for Part II of the story.
Let’s all do this together!!
To help facilitate your journey to health, click here to join my online community .
Now I’d like to hear from you …
Do you think community is an effective cure for chronic illness?
Have you joined with friends or family to take back your health; how has that worked for you?
Please leave your thoughts by adding a comment below.
To your good health,
Mark Hyman, MD