“Quite simply, the system doesn’t work.”
The background of what happens within the organizations that govern health and healthcare is a deep, dark, ominous hole—one I fell into right after college when I became a pharmaceutical representative for Eli Lilly.
I think we are really good at dealing with sudden acute events. Acute emergency management protocols are amazing, and medicine gained prestige and respect because of its ability to handle acute health problems, but we are truly bad at prevention—at stopping the development of chronic diseases and reversing them when they happen. And that’s because chronic diseases generate enormous amounts of money.
People say this is a conspiracy theory. We’re living it; I see it firsthand. And it is certain that the more diseases we have, the better it is for these entities—whether pharmaceutical companies, insurance companies, hospitals, or healthcare corporations. They only truly succeed when people are unwell.
“Everything has changed.“
The doctor used to know the whole family. With his small leather bag, he knew the mother, the grandmother—and that was healthcare. He felt pride in being responsible for his patient population.
As we shifted to an insurance-based model with Health Organizations, clinical doctors’ ability to make decisions and autonomous choices alongside their patients and families was cut off. Doctors are now in a system where they don’t have enough time with the patient. Everything has become so fragmented. We’ve become so specific and specialized in the way we practice medicine that we no longer see a person holistically. In primary care we have six minutes, and we simply look at what medications you’re taking.
I’m not trying to paint a dystopian picture, but indirectly the system conspires while trying to “do the right thing.”
I remember being fresh out of medical school, thinking I knew everything there was to know about medicine—and that anything not taught in medical school wasn’t real medicine. It was fringe, or quackery, or whatever. We vaguely supported diet and exercise—“eat right”—and that was supposedly all someone needed to achieve a “balanced diet,” whatever that means.
I remember the moment I realized that all I was doing was handing out prescriptions. I was good at matching a diagnosis with a drug, and not once did I ask myself: Is this the right treatment for this specific problem? Does this address the root cause, or am I just putting on a Band-Aid?
With the way our primary care model is structured, it struggles to identify the causes of chronic diseases.
If you truly want to treat and prevent chronic diseases, you must first uncover the root cause—not just manage the symptom. But we’ve created an ecosystem that incentivizes profiteers who make enormous sums by treating symptoms.
As a basic principle—that knowledge is power—we look you in the eye to give you the knowledge and tools you need to advance your own health. I think we’re at an incredible moment of opportunity to change what is happening and to educate the public about the challenges of these systems that are driven by distorted incentives—and to realign them so people can do the right thing.
You know, ancient Chinese doctors were paid as long as their clients stayed healthy. When they became sick, the doctor didn’t get paid. Maybe we should think about implementing something like that. Maybe we need some kind of insurance reform that allows patients to choose their own options, because right now patients are guided by whatever the insurance company offers.
“We hope that change will come.”
There is a massive industry resisting change—unless incentives are aligned so that doing the right thing pays more. That must happen.
At the moment, the more surgeries you perform, the more procedures you do, the more tasks you complete, the more you get paid. In contrast, when incentives shift—as in some hospital systems like the Cleveland Clinic—they might receive $20 million to care for diabetic patients. If it costs them $30 million, they lose money; if it costs $10 million, they gain money. So what do you do in that case?
You make absolutely sure your diabetic patients are cared for extremely well—that their diet is good, their exercise is good, their medications are properly monitored, and that they participate in proper primary care. It’s not hard to solve these problems—we know how to solve them.
We must cut this Gordian knot. If we don’t redefine the incentives so that health becomes profitable, the system will never work. That is the challenge—how do we incentivize health instead of disease?
At the Cleveland Clinic, there was a female nephrologist who ran a program for reversing kidney failure using lifestyle-based approaches. She had to conduct research, find funding, and secure donors—it was a very difficult process.
Until these incentives change somehow, the government will need to fund research that shows these methods are not only more effective but also cost-efficient. We will need to isolate conflicts of interest in dietary guidelines, the FDA, insurance structures, and regulatory bodies.
What I mean is that the revolving door between government and industry is so big and so wide that people move back and forth constantly—and that is deeply problematic.
For example, the Dairy Council recommends that adults drink three glasses of milk a day and children two, even though there is no scientific evidence supporting this. When scientist friends of mine from Harvard challenged the dietary guidelines committee about this—and because they knew some committee members—they were told: “You know, you’re right. But politically, we have to do it. Politically—not medically.”
I hope we see major changes in the next four or five years, because I believe they must happen. We cannot continue doing the same thing.
People understand that the emperor has no clothes—that we are in a catastrophic situation with our health and the economic impacts of it. This is a five-trillion-dollar industry, and it won’t go down without a fight.
We need to work together, extend the olive branch, and not let big industry divide us—turn us against one another. To me, this is not a political issue; it is a matter of humanity. And we hope we can continue pushing for change.
Mark Hyman MD
Senior advisor at the Center for Functional (Holistic) Medicine at the Cleveland Clinic.
He is also the founder and director of the Ultra Wellness Center, as well as an author and advocate of Functional Medicine.
