Social Networks Unexpected Solution for Heath Care & Diabesity - Dr. Hyman
Social networks may be an unexpected solution to our heath care crisis. 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!
Then one day I found Pastor Rick Warren from Saddleback Church in Southern CA in my office wanting to get religion about health. After his appointment we went to dinner and over a bowl of cabbage and beet soup, I asked him to tell me about his church – being a Jewish doctor from NY I didn’t know much about evangelical churches. He told me his church had 30,000 members and they met every week in 5000 small groups to study, support and grow together.
It wasn’t a mega church it was thousands of mini-churches. And the light bulb went off in my head here was a chance to test out this idea of peer support for creating health. I said why don’t we put together a healthy living curriculum and deliver it through these small groups. Rick said yes because he had recently baptized 800 church members and after about the 500th one, he said to himself, “Wow, we are a fat church, and I am fat, and we need to do something.
We didn’t need highly trained health experts – except in designing the program… So a little more than a year ago with Rick and Dr. Oz and Dr. Amen, a Christian, Jewish and Muslim doctor – which sounds like the beginning of a bad joke we launched The Daniel Plan – a social experiment to see if community support was more effective than medication or conventional medical care for treating and reversing disease and creating health.
The Daniel Plan (after Daniel the Prophet from the Bible who resisted the kings temptation of bad foods) is a wellness program delivered through small groups in the church.
We thought a few hundred people would sign up. In the first week 15,000 people signed up and over the last year they have lost an estimated 250,000 pounds – or the equivalent of 10 tractor-trailer trucks loaded with soda. Thousands of people and many churches around the world signed up.
In fact I met recently with church leaders in Atlanta and Bernice King, Martin Luther King, Jr.’s daughter who said that she thinks disease is a form of violence –and health is a basic human right. She said that health is a form of non-violence to your self and that she wanted to make this part of the King Center’s curriculum on non-violence. And our social experiment worked.
We got biology to change by using the principles of functional medicine – the science of systems medicine, of network medicine, the science of creating health, through lifestyle-based interventions that optimized our BIOLOGICAL NETWORKS. But we got behavior to change by using community and the power of positive peer pressure and SOCIAL NETWORKS.
Not only did they lose a quarter of a million pounds, but they also used less medication, and many stayed out of the hospital and didn’t need to go to the doctor as much. And the program was free. And people reported more energy, better sleep, better blood pressure, better mood and even better skin and a better sex drive.
One man told me last year he was in the hospital 4 times and on 9 medications and this year he stayed out of the hospital and is only on one medication. People lost 125 pounds, 90 pounds, 80 pounds, got off insulin and diabetes, and high blood pressure medication – it was like a gastric bypass without the pain of surgery, vomiting and malnutrition. And those who did the plan together lost twice as much weight as those who did it alone.
E.O. Wilson in his new book, The Social Conquest of the Earth that it is our drive to join a group that makes us human. It is the longing to belong – and the power of peer pressure that can be the force for both good and evil – It can drive war and violence, but it can also be a force for healing. Here was the big insight for me: the community was not just a delivery system for health education. The community was part of the cure and the group was the medicine.
So what did we do? We created an interactive curriculum delivered through multiple media – online education, videos, articles, recipes, webinars all done in small groups and community events. We did this at Saddleback by changing the culture – Pastor Steve, who was born again, again went from serving ribs and donuts for breakfast to being a health champion, grabbing donuts out of the mouths of the men in his small group.
Over a thousand people showed up and volunteered to be health champions for their group. We changed what was served at bible breakfasts, the menus in the refinery and even what people served in their homes and their small groups. People learned to create health together – to shop, cook, eat, exercise and play together. We didn’t treat disease. We didn’t create a weight loss program. We taught people self-care and combining that with caring for each other they created a small miracle – something heath care or health care reform has not been able to achieve.
In the most unlikely place, a large Church, we demonstrated that a community-based solution is more effective in treating and reversing chronic disease than our modern health care system. People helped each other create health. I think this is the seed of a bigger possibility. In every home, community, school, workplace or faith based organization there are health champions waiting to be asked to show up and to help each other to take back our health.
We have a vision to scale this to a billion people and turn health care upside down.
And this is possible not just in rich countries. Peers for Progress created pilot programs in the poorest of countries to treat diabetes in Cameroon, Uganda, Thailand and South Africa based on peer support. The peer support group models were more effective than conventional medical care for improving the health of diabetics and health care costs decreased 10 fold.
So after the meal of the skinny Haitian chicken and the beet and cabbage soup – I thought, what if we could tackle this problem not one by one by one in the doctor office and clinics but by the tens of millions in people homes, and churches, and schools and workplaces.
What if we could take the 36% of Americans who are eligible for work but NOT working – and create a Health Corp like President Kennedy’s Peace Corp or a call to action that would be the equivalent of getting a man on the moon by the end of the decade. And create millions of community health workers, engage our world’s latent health champions because they are out there in every community, in every organization, of peers, people helping people that with a little training has been proven to produce better results than doctors or our health care system for the worst problems of our era.
Maybe I thought – this isn’t a medical problem like an infection or broken bone, maybe chronic diseases like diabetes and obesity are social diseases and we need a social cure. Maybe it is the power of each one of us supporting each other that will help us all take back our health. Acute disease can be left to the hospitals, but creating health and healing of chronic disease seems to happen best in the community – with people helping people, where each one of us lives – where we eat, cook, learn, work, play and pray. That is where health happens.
When I was at Paul Farmer’s mountain clinic in Haiti – there was a plaque in French that said, “The happiest man is the one who makes others happy.”
An old African proverb says that if you want to travel swiftly travel alone but if you want to travel far, travel together.
Let’s all do this together!!
What do you think we can do to take back our health?
If you already are part of a community would you share your experiences?
Please leave your thoughts by adding a comment below.
To your good health,
Mark Hyman, MD - dedicated to identifying and addressing
the root causes of chronic illness
through a groundbreaking whole-systems medicine approach called Functional Medicine. He is a family physician,
a four-time New York Times bestselling author
, and an
international leader in his field
.Through his private practice, education efforts, writing, research, and advocacy, he empowers others to stop managing symptoms and start treating the underlying causes of illness, thereby tackling our chronic-disease epidemic. More about