The Complete Patient

One of the most interesting experiences I had last year while working with a young company testing out an online system for helping medical professionals monitor patient health online was visiting a medical office in New Hampshire to explain the concept. The physician in charge invited my colleague and me to explain our approach during a lunch meeting...and made it clear we were expected to provide lunch. So we picked up some pizzas at an upscale Italian restaurant, and made our call.

What especially surprised me was the reaction of the ten doctors, nurses, and other staff in the office when we appeared with the pizza boxes. There were no introductions, no questions about who we were or what company we were from. The conversation was all about, "What's for lunch?...Hey, nice pizzas...Ummm, pretty good, nice crust...(munch, slurp)." This was all part of a regular routine. 

Eventually, when the pizzas were well on their way to being devoured, we did explain our company and its mission. But the vibes couldn't have been clearer : this was just another day of free lunches, and we were just another couple of medical sales people.  The names and companies may have changed day to day, but what mattered most to the medical professionals was, What's on today's lunch menu? It all felt pretty jaded.

I was reminded of that experience by an article in today's New York Times reporting on how Big Pharma companies provide free lunches to much of the medical profession each day. As I sensed at the time, my single  experience was a miniscule blip within a huge marketing campaign by Big Pharma. The NYTimes article quotes a number of medical experts who are concerned about the corruptive nature of the practice, as well they should be. Not only does the cost get computed into the prices everyone pays for prescription drugs, but the practice keeps physicians focused on prescribing drugs as a substitute for investigating alternative healthier ways of treating patients.

I like to discuss the ideological divide of the healthcare establishment of MDs, Big Pharma, and the FDA versus providers of holistic care. Now there's another take on the conflicts within medicine, coming from investor Andy Kessler in a provocative new book, "The End of Medicine". Rather than an ideological divide, he sees a digital divide.

Not surprisingly, he views America’s healthcare industry, estimated at more than $1 trillion in annual revenues, from an investment standpoint. Healthcare as investment has been a risky arena, since there have been more than a few mirages and hiccups on the path to opportunity, including genetic engineering, nanotechnology, and computerization of medical records. Kessler predicts that healthcare will be revolutionized by digitally-based early-detection techniques that will alert patients and their doctors to signs of cancer and heart disease years in advance of current methodologies. Kessler in the book takes readers on a sometimes-tedious personal journey through a healthcare system still dependent on stethoscopes and rubber hammers tapped on kneecaps. Readers observe him being poked and prodded in humorous assessments of existing diagnostic technology, all part of a process designed to pave the way for appreciating the logic of the changes he concludes are inevitable. He visits medical research centers to explore leading-edge techniques for measuring chemical and structural changes within the body, and makes a strong case for a digital revolution that will lead to a revolution in medicine’s approach to diagnostics.

Like many outside observers, he has trouble making sense of Big Pharma, the FDA, and MDs.  He equates the FDA to the FCC, and Big Pharma to regional telephone companies--in other words, a questionable government regulation challenge. At the end of his journey, though, he is cynical, and excited. "Doctors use ancient tools, memorize symptoms and solutions, and a halfway decent search engine can leave them in the dust. But now, the days of doctors are over. How do I know? Go back to tellers. Almost everything a teller knew was embedded into the software of an ATM. Instead of paying $25,000 for a pleasant teller who would smile while counting out your twenties, you could put four of them outside the bank and run them 24 hours a day, Sundays, too."

So much has been written about Boston's $15 billion Big Dig fiasco that I hesitated to add to the verbiage. We know the whole thing is one of the great public works fiascos in American history, what with leaks and, most recently, pieces of ceiling concrete killing a motorist. The latest wrinkle--Gov. Mitt Romney's food fight with Turnpike Authority CEO Matt Amorello--produced an additional example of unseemly business and political maneuvering that  wasn't being covered, so I decided to write something. My newest column at BusinessWeek.com chronicles the tale of a big Boston law firm's pro bono work on behalf of the guv in his vendetta against the Turnpike CEO, and how it turns the term "pro bono" on its ear.

The entire Big Dig sitaution isn't just outrageous, it's sad. I use the Big Dig roads regularly, and have marveled all along at its promise for improving life in Boston. It radically improved the commute to Logan Airport for hundreds of thousands of people living west of Boston...until the ceiling came down. It removed a festering sore in Boston's Downtown area by putting roads underground.

But getting there has been so painful. Its' a classic example of a wonderful concept being totally corrupted by government ineptness. If Gov. Romney is successful in going after the Turnpike CEO and portraying himself as a savior and thereby boosting his presidential aspirations, I suppose it will be a small additional price to pay for getting the thing working again. Hey, we're into this for $15 billion, so what's a bit more finagling?

A number of the individuals who have responded to my most recent BusinessWeek.com column about the FDA's targeting of cherry farmers provide a wonderful additional dimension to the matter. I strongly suggest you take a look in particular at the comments by "Annie", "Big Red" and "Mike". Annie points out how the FDA's efforts have the effect of limiting our ability to learn about useful natural treatments and cures. She suggests also that because smaller companies are intimidated by the FDA, they shy away from active promotion. Big Red suggests, tongue in cheek, that we should just trust the FDA,

My sense is that the snake oil sales types are going to be pushing their wares no matter what the government does or doesn't do. Unfortunately, it's the serious law-abiding individuals, who have much to offer, who are going to shy away from letting the public know about useful approaches. Isn't that the way it always is? Law-abiding citizens like cherry farmers get stomped on by a government bureaucracy beholden to Big Pharma.

Last Sunday, the NYTimes' lead business article devoted more than a page of precious "all the news that's fit to print" space to trying to prove that high-fructose corn syrup <i>isn't</i> responsible for America's obesity epidemic. It found a few scientists who had tried to pinpoint high-fructose corn syrup, which is so widely pervasive in American foods, for the surge in obesity  over the last 25 years, and then spent hundreds and hundreds of words trying to prove them wrong. A big part of the argument? High-fructose corn syrup is no worse than sugar! But we now know that sugar isn't good for us either. It's a classic case of setting up a straw man to argue an otherwise questionable viewpoint.

The cause of America's obesity epidemic isn't high-fructose corn syrup. Few respected nutritional experts would try to make that simplistic argument. Rather, the problem is in the over-consumption of foods that raise blood sugar and stimulate insulin production. High-fructose corn syrup is merely one of many such foods that do a number on blood sugar levels, and thus are a prime factor in America's diabetes epidemic (which is a direct result of the obesity epidemic).

Dr. Mark Hyman, author of the recently published <i>UltraMetabolism</i>, categorizes all the sugar-raising foods (including sugar in any form, together with flour products like pasta and bread, and large starchy potatoes) as "high glycemic load" foods. He explains that "...the key to balancing your meals so that you don't develop insulin problems revolves around...the glycemic load of a meal...Eating meals that have a high glycemic load means that the combination of foods that you eat will cause all the carbohydrates in the meal to be absorbed very rapidly and raise your blood sugar just as rapidly."

The NYTimes article read almost like an investigative report. What a waste of resources.