D. Man

In a burst of energy before she died, my mom urged us to take her to where she'd be buried. Cupping my dad's face, she talked about how magical their life was together. It was the most profound moment of my life, and it wouldn't have happened if we listened to her doctors. Just 13 days before, in January 2021, my mom was apparently healthy. She felt a pain in her stomach during her morning hike and got a scan. Stage 4 pancreatic cancer. She called me and said she wouldn’t meet her future grandchildren. The family rushed to her side. My sister @DrCaseysKitchen and I learned three things over those next 13 days... Lessons that we think provide an explanation - and solutions - for the largest issue our country faces: the fact that we are getting sicker, fatter, more depressed, and more infertile at an increasing rate while bankrupting our country with healthcare costs. The first was that the predominant incentive in medicine is to intervene after you get sick. Right after my mom's unexpected cancer diagnosis, a medical team out of Stanford and Palo Alto Medical Foundation jumped to action, recommending a laundry list of surgeries and procedures—biopsies, blood transfusions, and a liver stent. In most cases, the patient would have agreed to these procedures, and the meeting would wrap up quickly. These recommendations were coming from some of the most prestigious institutions in the world, after all. But based on my sister's experience in medicine (Stanford MD and surgical residency), she started asking questions. We learned that these procedures had about a 33 percent chance of extending her life a few more months at most, a 33 percent chance of shortening her life span, and a 33 percent chance of not impacting her life span (yet keeping her away from the family). In all cases, the invasive route would mean that my mom would need to sit in a hospital room alone, because of Covid-19 protocols, and potentially longer if the surgery had complications, as they often do with immunocompromised cancer patients. My mom made it clear to the oncologist that she was not afraid of her rapidly impending death, but she wanted to minimize unnecessary pain or nausea in her final days. Despite being clear, the system pushed the exact procedures that would yield pain and nausea and aggressively shamed our family for questioning the full-court press approach. Thank God we had my sister - who had routinely seen doctors push unnecessary surgeries to terminally ill patients during her training - who had the wherewithal to push back. In 99.9% of cases, my mom would have died alone in a hospital room and we would have missed the life-changing final days with her. The second lesson was that my mom's cancer was not "random." Her oncologists said it was "bad luck." It wasn't. In the decades leading up to my mom’s cancer diagnosis, she was informed her rising cholesterol, waistline, fasting glucose, and blood pressure levels were conditions that she could “manage” for life with a pill. But instead of isolated conditions, all of the symptoms my mom experienced leading to her death were warning signs of the same thing: dysregulation in how her cells were producing and using energy. But through decades of symptoms, my mom—and most other adults in the modern world—are simply prescribed pills and not set on a path of curiosity about how these conditions are connected and how the root cause can be reversed. The third lesson was that there is a better way than our current system, and it starts with understanding that the biggest lie in health care is that the root cause of why we’re getting sicker, heavier, more depressed, and more infertile is complicated. Depression, anxiety, acne, infertility, insomnia, heart disease, erectile dysfunction, type 2 diabetes, Alzheimer’s dementia, cancer, and most other conditions that torture and shorten our lives are actually rooted in the same thing. And the ability to prevent and reverse these conditions—and feel incredible today—is under your control and simpler than you think. After leaving traditional medicine and working with patients to understand their biomarkers and take simple root causes actions - my sister routinely saw quick reversals of formerly intractable conditions. The siloing and medicalization of chronic disease in the past fifty years has been an abject failure. Today, we’ve siloed diseases and have a treatment for everything: ✅High cholesterol? See a cardiologist for a statin. ✅High fasting glucose? See an endocrinologist for metformin. ✅Depressed? See a psychiatrist for a selective serotonin reuptake inhibitor (SSRI). ✅Can’t sleep? See a sleep specialist for Ambien. ✅PCOS? See an ob-gyn for clomiphene. ✅Erectile dysfunction? See a urologist for Viagra. ✅Sinus infections? See an ENT for an antibiotic or surgery. But what nobody talks about—what I think many doctors don’t even realize—is that the rates of most of these conditions are going up at the exact time we are spending trillions of dollars to “treat them.” In the face of these unprecedented trends happening to our brains and bodies across our life span—which all have metabolic dysfunction as a root—we are told to “trust the science.” This obviously doesn’t make sense. We have been gaslighted to not ask questions over the past fifty years at the exact time chronic disease rates have exploded. The truth: we should consider listening to the medical system if we have an acute issue like a life-threatening infection or broken bone. But when it comes to the chronic conditions that plague our lives, we should distrust almost every institution giving the advice. The answers are much more simple and under our control. ___ In the days following my mom's death, my sister and I affirmed to devote our lives to changing these broken health incentives. And Casey expressed a passion to write a book with lessons she's learned working inside and outside the medical system. I have helped her write this book over the past several years and it will be coming out in May. A lot of issues will be discussed as we enter 2024, but the most important is that our human capital in America (particularly kids) is being decimated by preventable and reversible metabolic conditions. Thank you @bariweiss @TheFP for publishing an excerpt.