Building healthcare from scratch | James Maskell | TEDxStPeterPort


Translator: Fierah Livingstone
Reviewer: Rhonda Jacobs Such a pleasure to be here in Guernsey, listening to all these
amazingly disruptive speakers about envisioning Guernsey
as the best place to live in the world. And I would say, in order for Guernsey
to be the best place in the world, it has to be the healthiest
place in the world. Now I’m going to make some
pretty radical suggestions about how we’re going to get there today. And it’s going to include drinking wine, getting dirty,
and meeting new people. So I just want to prepare you
for that ahead of time. You know, one of the reasons why
you’re in such a great position here in Guernsey is you don’t have to ask anyone
for permission. We’re not asking Brussels for permission,
we’re not asking London for permission, we just have to do. For the last ten years,
I’ve been in the trenches of health creation in America. I’ve met thousands of doctors
and I’ve had the opportunity to interview everyone
from Fortune 500 CEOs to internationally respected gurus. And one of the biggest
problems that people – one of the biggest frustrations
that people share consistently is that medicine is evolving too slowly
to overcome the chronic diseases that are now epidemic in America
and all over the industrialized world and Guernsey is no – that’s what’s driving all of these costs
that Mark just mentioned, is these chronic diseases. You know, five years ago, I was angry. I wanted to rebel. I wanted to get in touch
with my representative. And I wanted to… I wasn’t sure exactly what to do about it
but I’d read this quote, and this quote has been
so powerful over the last five years, and it’s really driven my intention of what I’ve been looking to do
for the last five years. And that quote is by
Richard Buckminster Fuller. And he says, “You never change anything
by fighting the existing reality. To change something, build a new model
that makes the existing model obsolete.” So what is this new model? Community, and not medicine,
creates health. The first place that we see
that community, and not medicine, creates health is the Blue Zones. These are areas
in different parts of the world where people live
consistently to 100 years old with much lower incidence
of chronic disease. From Okinawa, Japan to Sardinia in Italy to Nicoya in Costa Rica. Now, all of these areas have
certain things in common, but by far the most powerful
and exciting is community. In all of these areas, the groups
work together and support each other as part of the tribes. They eat together, they cook together, they play together,
and they pray together. Now, you might say, “James,
there are certain other things – there are a lot of other things
that happen in Blue Zones. It’s not just community. You know, the Okinawans are eating
tons of fermented soy, and the Seventh-day Adventists
in Loma Linda don’t eat one day a week. What is it about community
that you think is so powerful?” In his book, Malcolm Gladwell,
in Outliers, he talked about this really interesting community
called Roseto, Pennsylvania. And in Roseto, Pennsylvania,
it was discovered in the 1950s as a small community that had
remarkably less chronic disease than the towns and cities around it. And what they found was this was a group
of Italian-Americans that had come from Italy to Pennsylvania and had maintained the same
social and community structure. And there were some changes,
there were certain changes that were different
from their life in Italy. They ate a lot more animal fat,
animal protein. They also smoked and drank as much
as the other towns around them in America. But the outcomes remain the same. In fact, they had lower levels
of heart disease in the 1950s when heart disease
was absolutely epidemic in America. And so the strongest thing
that they had going for them was community. But yet they had significant changes
in their food since then. And so the other thing that was
so important to them was community. Now, in the next generation,
when the kids Americanized, when they left this social structure, they were left like just
every other American town: fat, sick, and nearly dead,
as the saying goes. So, what the Blue Zones
and what Roseto, Pennsylvania show us is that it’s community, not medicine,
that creates health. Now, another area where we can see
that community, and not medicine, creates health, is with regard to the microbes that live
on, in, and around us all of the time. Germs. It’s quite an onomatopoeic word,
isn’t it, “germs,” when you say it. But we can talk about microbes
if you prefer. But the new science on microbes
is absolutely astounding. You know, if you think
about the 20th century, it was all about our interaction
with germs. It’s all about the human race
dominating germs. And through a combination
of sanitation, nutrition, and antibiotics, we conquered the germs
that live on, in, and around us. But there’s a natural limit to this. So much so, that the Deputy Director
of the CDC recently said, “We have reached the end
of antibiotics. Period.” So, in 2011 there was a remarkable study called The Human Microbiome Project. And in that study, it should’ve really
shook the foundations. When I said earlier, you know, that the speed of evolutionary
change is too slow, they say that it takes 17 years
for new information to make it into everyday
clinical practice. 17 years, even today. And The Human Microbiome showed
that more than 99% of all of the germs that live on, in, and around us
were mutually beneficial, aiding our digestion,
immunity, and metabolism. And we needed them, and they needed us. And since then, in the last four years, there’s been a wealth of science to show
that germs, particularly in our gut affect the health outcomes
from our brain to our joints. Furthermore, by killing off these germs,
particularly in our gut, we’re actually driving chronic disease. All the inflammatory diseases,
autoimmune disease, the epidemics of allergies
were all being driven by killing all of these microbes,
particularly in our gut. There is an emerging field in medicine – a niche in medicine, or niche, I’ve started saying niche
since I moved to America – but it’s called functional medicine and it respects the inner
ecology of the body, the relationship between us and our germs. And functional medicine, you know,
for years the prevailing paradigm has been to identify symptoms and to use drugs
to suppress those symptoms. But in functional medicine,
it turns everything on its head. And it uses symptoms as a way
to be able to understand what’s going on
and the root cause of dysfunction, and then be able to remove that root cause
and allow the body to heal. Now, functional medicine
has an ecological system and just last year, this functional medicine showed
that it was ready for prime time, with the Cleveland Clinic, one of the most respected and innovative
health organizations in the world, building a new functional medicine center. And betting on it for the future
of chronic disease management. So again, we see that it’s
a community of microbes, and not medicine, that creates health. I just want to talk a minute about
the use of community in medicine. Does the medical system right now take any advantage,
or maximum advantage of community? Not really. The majority of your interactions
with a doctor are one-on-one. So the question we have
to ask ourselves is, Are there any examples of community
being used successfully in medicine, starting from scratch? And the answer is a resounding “Yes.” We are now standing at the intersection
of community and medicine. There was an amazing project
in America called The Daniel Plan. And leading functional medicine doctors
came together with the Saddleback Church to create The Daniel Plan. And 15,000 of the people
that go to the church lost a combined 250,000 pounds. And enjoyed extremely
positive health outcomes by working together in small groups
to empower behavior change. Furthermore, some of the most
exciting results that we’re seeing in functional medicine
are in a non-traditional style. In the old system, one doctor
would just go room to room to room seeing patients individually. In group visits, two providers
see patients in groups. There’s so much power and value,
in people working together with a group of your peers. In terms of empowerment
and vulnerability and support. Now, this is all what’s happening now. But the most exciting thing, and what could really
scale this up, is technology. Technology is coming along and empowering
communication in new and exciting ways. And one of the biggest
beneficiaries of that is communication. Seamless communication. I have a friend who lives in Iceland and even though
we’re not together physically, he is challenging me every day,
with the number of steps that he walks, or the miles that he runs, to be able to challenge me
with his fitness tracker. And I’m not the only person
that he does this with. He has a whole community
of people all around the world that egg each other on to be healthier
through technology. We’ve also had the opportunity
to work with lots of medical clinics that create online forums
and discussion meetings where patients are able
to communicate with other patients and provide peer-to-peer support. You know, just imagine how much value
and how much knowledge a mother accumulates having
a child on the autism spectrum over ten years
of looking after that child. And then imagine how much value
is created when they can communicate what they’ve learnt over a period of time
to other parents in the community who may be completely overwhelmed
with an autism diagnosis. This is all free and powered by technology and completely scalable. Now what about doctors? For the last hundred years, a combination
of reductionist science and industy have driven doctors’ behavior
and told them what to do. So much so that it’s almost
a joke in America now, how pharmaceutical reps
come and tell the doctor what to do with each of their patients. But I’ve been to Silicon Valley,
and I’ve seen the future, and it’s democratization. It’s doctors working together in real time
giving feedback and best practices between them and the groups
and contributing to a hive mind aggregating best practices. So you can see, that it’s community,
and not medicine, that creates health. So what can we do right now,
all of us in this room, to start this process
of building community in Guernsey and developing the healthiest
place to live in the world? How can we make Guernsey
the sixth Blue Zone by 2020? Well the beauty of the functional
medicine operating system is that it’s participatory. The future of medicine isn’t
going to be something that’s done to you, and you’re just a passive patient
taking what the doctor gives you. You’re an active participant
in your health. So right now you don’t have
to ask anyone’s permission to eat more plants, to think
differently about your stress, and to move regularly. You also don’t need
to ask anyone’s permission, to be able to improve
your internal microbiome. You can take a probiotic,
you can get into nature, get a pet. One of the best things – the emerging
science that’s coming out right now, Citizen Science Project,
is showing the best way to improve your internal microbiome
is to get your hands in the dirt. Start planting a garden. Topsoil is one of the most
precious resources that we have. And I think getting our hands in the dirt,
and coming to connection with that, is something that we can all
do for free right now. And what about doctors? You can start to take
advantage of this community and do things like group visits,
to be able to start to take benefit of the peer-to-peer communication and peer-to-peer support that’s available
through that type of model. Get together groups of doctors
to learn about functional medicine. Learning is easier in community too. It’s community, not medicine,
that creates health. Now, what is the most evidence-based
thing that you could all do today to start this process
of developing community and creating better health outcomes? Dan Beuttner, who is the person
responsible for the Blue Zone research, they’d been trying
to create Blue Zones already. For the last five years
since they’d worked it out, “How can we create Blue Zones?” And what they found
is the most evidence-based strategy, the most effective strategy for anyone
to start in a community like this, is to take people who are ready to change
and introduce them to each other, to form new communities. Now I would bet that the kind of people
that come to a TEDx event like this are those people within a community
that are ready for change. So what I’m going to recommend today is you’re going to start the process
of meet – just look around. Meet five people in this room today. Share a couple of glasses
of wine this evening, just like the Sardinians do
in their Blue Zone every day. And feel the power of new community. One of my favorite quotes that really embodies what I think
is the strategy that we can use to really change health here in Guernsey, comes from and is attributed to
Thich Nhat Hahn, and he says, “Community is the guru of the future.” I trust that Guernsey
will be a 65,000-person petri dish for the future of medicine. A community that empowers each of us
to be healthy and reduce chronic disease. Because it’s community, and not medicine,
that creates health. Thank you. (Applause)

6 Replies to “Building healthcare from scratch | James Maskell | TEDxStPeterPort”

  1. WONDERFUL. Functional medicine IS ready for primetime!  

    This is such a great panoramic of what's happened in the last few years. Thank you.

  2. Take the next step in your analysis. Community is not something that makes you healthy or not. Your community is part of your health, it is part of your family's health, it is part of your government's health – your governments are communities. Communities can be very strong, and very healthy – they can also be very strong, and very unhealthy. Health does not end at the body, the mind, and the spirit. It rises to community, as defined in the Hierarchy of Healthicine. People's community health has two parts. Their contribution to their communities is one part, the other part is the actual community, which exists as an entity separate from the individuals, and in many cases outlives them.

  3. After watching this lecture, I would like to thank Mr. Maskell for his fascinating insight on another part of the healthcare system that does not get the attention it deserves. When he gave his opinion about how a community's aspects can affect the health of a singular person, I was a little confused, but curious to listen more. Thank goodness I did, because I found myself agreeing with his views about how a group of people meeting with health providers at the same time could work very well. Now, when I think of a group coming together to discuss personal problems, I think of an AA meeting, and usually that is met with thoughts about whether those group interactions actually work for people. However, taking a closer look at the intent for support and encouragement, I think that matches Maskell's idea perfectly. The trace of beneficence that is contained in this speech is found when observing the possibility of helping multiple people. The healthcare providers that are willing to meet with a group of people, would benefit them the most by implementing a supportive atmosphere, and helping establish trust between provider and consumer.

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