Modern healthcare is broken, why do we still use it?

I grew up in a medical household, the son of two physicians, two MD-PhDs actually, so there were four doctorates between my two parents, and I had the greatest respect and admiration for Western medicine. But fate threw me a curveball when in my early 20s I developed life-obliterating ulcerative colitis, and Western medicine, despite the best efforts of some brilliant doctors, wasn't really helping me. I got really desperate. And in your desperation, you're willing to try a lot of different things that you think, you know, this probably won't work, but what do I have to lose? And that drove me to experiment with different dietary approaches, eventually coming to a ketogenic diet, which put my disease into biopsy-proven remission and really gave me back my life and my future. We'll zoom ahead to my conclusions as to where this leaves me. Actually, I have a lot of conclusions, but I want to focus on one in this video. And that a core issue is that Western medicine prides itself on being evidence-based. Am I challenging the idea that being evidence-based is bad? Well, not really, not directly. Of course we want evidence-based to help direct recommendations. But the idea of being evidence-based needs to be taken in a very particular context. It needs to be interrogated in the context of our biomedical research infrastructure and our cultural norms. And caveated appropriately. There's a great business model in selling efficacious drugs. Some single blockbuster drugs can gross tens of billions of dollars per year, continuously, if patients stay on the treadmill of modern medicine. And that's not controversial, that's not doctor bashing, it's not saying anyone is evil or doctors want their patients to stay sick, which they certainly do not. It's just a commentary on the financial incentive of our current system, especially as relates to research. There is financial incentive to pour money into pharma research. That's just a truth. By contrast, the business model for lifestyle or metabolism-centric medicine isn't as obvious. How do you make money, at least in the short term, of healthy people? You could argue that in the long term there'd be healthcare cost savings and that healthy populations would bolster work efficiency and bolster the economy, and you'd actually be right. But that requires a long-term perspective, which we don't take. So the result is that there are order of magnitude more money being poured into drug trials, and the results are flaunted as statistically significant and higher-tier level of evidence, the large-scale human RCTs. By contrast, it's much, much harder to do diet and metabolic health trials because there just isn't the same amount of money and because it's much more difficult to recruit and get compliant patients, in part because of social norms, which we'll get to in a minute. But in terms of the relative financial pools, bear in mind I'm not a biomedical economist, so take everything I say with a grain of salt, but the numbers I hear floating around me make the point pretty clearly. For example, I was in a research meeting recently with a highly esteemed professor at a rather well-known institution who was fantasizing about a study he wanted to do, a metabolic health study, saying that the results could be the crowning achievement of his career and that he'd need about $10 million to do this metabolic health study. Which sounds like a lot, but compare that to Novo Nordisk's market cap of $600 billion. That's like comparing the mass ratios for this study of a cairo spiny mouse to the masses of two adult hippopotamuses. You can do the math out if you want, I'll drop it in the show notes. But seriously, like, these are order of magnitude different financial pools. As a result, these studies aren't being conducted, these strong dietary trials, these high-tier evidence metabolic health studies., and thus one can't claim the same evidence for, say, a clean ketogenic diet for inflammatory bowel disease as there is for the next generation of biologics. It doesn't mean the former, the diet, wouldn't work as well or even better with fewer side effects. Rather, it's just that the study hasn't been done because of the structure of our research ecosystem. The point being, absence of evidence isn't evidence of absence, and this gets confused. Often people go to doctors and, let's continue with that example of diet for inflammatory bowel disease, they'll get the line, "Oh, diet doesn't help in inflammatory bowel disease." That's factually incorrect. But it would be correct to say, "We haven't shown that a particular diet can cure inflammatory bowel disease." But those are two very different statements, because it's important to highlight, well, the question really hasn't been rigorously tested because people aren't pouring money into the trials needed to test it. So that caveats what we can conclude. And the business model of biomedical research further conspires with social norms. Because it's normal to eat a balanced diet and consume high glycemic index carbs daily. This was a post on X, on Twitter, the FDA. It says, this is National Chocolate Covered Anything Day. Everything is up for grabs. What does that say about the state of our country and our cultural norms? In fact, it's almost heretical to challenge the idea that this way of eating, being sugar, sugar everywhere and not a hard-boiled egg to eat, is a problem. And what's more, it's assumed that people just can't do it, that it's too hard. And this becomes a self-fulfilling prophecy. If you tell a person, if you tell a patient, "You won't be able to eat a clean low-carb diet indefinitely, it's unsustainable," and on top of that you give them minimal support and constantly inundate them with negative social messaging about their way of eating, and statements from federal bodies saying it's okay to eat pizza dipped in Nutella, then yeah, they're probably gonna fail. But it's not because the diet itself is intrinsically hard, but because our food and social ecosystems are situationally conspiring against success. Point being, we have developed a research and food and social ecosystem that are situationally favoring drug interventions over lifestyle and metabolic health. But this truth can be covered by what amounts to virtue signaling, like claiming drug X is more evidence-based than metabolic health therapy Y, which is technically a correct statement. But by analogy, it's kind of like saying I threw a cannonball further than I threw a tennis ball, but I never actually tried to throw the tennis ball at all. It's technically correct, but it's a little bit misleading. So how do we fix the problem? First, we need to acknowledge the factors at play, and that's what we're doing here. Two, we challenge social norms. All of us can do this every day. And on top of that, we can build a community to make lifestyle interventions, metabolic health interventions, more sustainable, more feasible for people when they're willing to try them. And three, we need to change the research ecosystem. And how do we do that? Well, honestly, I don't have a very good answer for you, but what I can tell you is that that's why I'm where I am now and doing what I'm doing. I want to make metabolic health mainstream from inside the mainstream. And if you want to know the truth, I'm more optimistic now than ever. While it might seem sometimes like I'm the black sheep, there are a lot of closeted metabolic health experts and enthusiasts here at Harvard and elsewhere. So I see a little bit of a healthcare system mutiny afoot, and I suspect it'll happen in my career time. I hope you're around to see it.