Mending Healthcare from Confounding Interests: To What Extent Do Profits Interfere with Wellness in the Modern Healthcare Model?
12:22 PM
The Permanente Medical Group’s top-floor conference room boasts glass windows and a vantage point overlooking Pleasanton, California. Swivel chairs span the border of the rustic conference table, and a handwritten sign taped to the door welcomes guests: “Room booked: Future Directions of Healthcare @ 12:30 PM.” An easel stands in the peripheral of the doorway, briefly detailing the meeting’s concerns for curious onlookers: “The Permanente Medical Group is fortunate to be hosting the pharmaceutical industry’s leaders, esteemed physicians, and a renowned professor for a roundtable discussion on Kaiser Permanente’s trajectory in the next decade. We hope to understand the many variables and dimensions of health from the perspectives of our acclaimed guests, grapple with the current landscape of healthcare, and apply our insights toward future business models.”
Maria Ansari is the sole occupant of the conference room thus far; she claims the head of the table, donning a blazer, pantsuit, and hopeful expression as she glances at the doorway in anticipation of her guests. Ansari is the CEO and Executive Director of The Permanente Medical Group, an Assistant Clinical Professor of Medicine at UCSF, and a former cardiologist.
12:24 PM
Casey and Calley sport business casual apparel, smiling as they enter and seat themselves at the head of the table near Ansari.
Maria Ansari: And the siblings have arrived! Hi, Casey and Calley; it’s a pleasure to meet you both in person after months of coordination. Thank you for making the trek from Los Angeles and Arizona to participate in this discussion.
Casey Means received her BA, with Honors, in Human Biology from Stanford University in 2009 and an MD from Stanford University School of Medicine in 2014. She left medicine during her training as a surgeon and has since founded Levels, a health-tracking app. She became a published and New York Times bestselling author with her release of Good Energy: The Surprising Connection Between Metabolism and Limitless Health.
Casey Means: It is our pleasure! We wouldn’t miss this discussion for the world; you know how the saying goes: if you’re not on the table, you’re on the menu. I foresee some turbulence in this conversation as we configure future possibilities across, perhaps, opposed interests, but fruitful outcomes are often founded upon initial disagreement.
Calley Means received his BS from Stanford University in 2008 and his MBA from Harvard Business School in 2015. He co-authored the New York Times bestseller Good Energy: The Surprising Connection Between Metabolism and Limitless Health with his sister, Dr. Casey Means. Means is also the Co-Founder of TrueMed, a payment tool that allows patients to use their Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) to buy healthy food, exercise, and supplements.
Calley Means: I hold the same sentiment as Casey: it is an honor to have been invited to such a pivotal discussion on the future of healthcare. While healthcare can be viewed as a mere term referencing medical services, it represents the nation’s largest industry and sector in the economy; beyond the economic confines of healthcare, healthcare is about caring for patient’s health, and I believe we have invariably skewed our interests toward profit at the expense of the mentioned care. It may even be appropriate to dub modern health care as sick care. And, as Casey mentioned, turbulent disagreement may be in our collective best interest to reform the broken system we find ourselves meddled in.
Ansari nods earnestly, attempting to mask her nervous glances between the door and her watch as the meeting time approaches.
Maria Ansari: Certainly, I understand that there are many perspectives on healthcare, so I’m excited to see how to best mesh our collective understanding of health and business in alignment with each stakeholder’s interests.
At the mention of stakeholder interests, Casey and Calley slightly stiffen and exchange discreet expressions of disappointment and annoyance.
12:26 PM
Elizabeth Klodas enters the room with a confident grin, wearing a formal dress with complementary gold jewelry.
Maria Ansari: Ah, Dr. Klodas! I was munching on a lemon almond bar from my stash of Step One Foods bars earlier today. We’re honored that you made the trip from Minnesota to join us today.
Elizabeth Klodas is the Founder and Chief Medical Officer of Step One Foods, a company that aims to use whole food ingredients to lower cholesterol levels while upholding the taste and quality of their food products. Klodas is a cardiologist trained at Mayo Clinic and Johns Hopkins, the founder of the Preventive Cardiology Clinic in Minneapolis, MN, a nationally sought-after expert on heart disease prevention, and an author.
Elizabeth Klodas: Thank you for arranging this critical discussion. It is my honor — and, if I may add, my absolute pleasure — to escape the sub-freezing weather in Minnesota and, of course, be here with you all.
12:30 PM
Christopher Gardner enters hastily, clutching a briefcase and sporting a khaki blazer with a matching pantsuit.
Christopher Gardner received his MA and PhD in Nutritional Science from the University of California, Berkeley, in 1993. He is the director of nutrition studies at the Stanford Prevention Research Center and the Rehnborg Farquhar Professor of Medicine at Stanford University. He was appointed to a leadership position in the AHA Nutrition Committee. He appeared in the 2024 Netflix documentary You Are What You Eat: A Twin Experiment, about his Stanford University twins study. Gardner is an advocate and researcher of plant-based dietary patterns.
Christopher Gardner: Right on time! I will cite my students’ lack of punctuality to class as my unfortunate influence. It seems like we’re just waiting on our Big Pharma pals; is that right?
Maria Ansari: Welcome, Dr. Gardner! Yes, it appears they may be running late. Oh-
Joaquin Duato, Robert Davis, and Chris Boerner enter the room with suits and ties; each holds a disgruntled and defeated expression.
Joaquin Duato is the CEO of Johnson & Johnson, Robert Davis is the CEO of Merck, and Chris Boerner is the CEO of Bristol Myers Squibb.
Joaquin Duato: Apologies for the delay on our behalves. We had to testify before a Senate panel before our arrival.
Maria Ansari: That sounds incredibly eventful and provides the perfect segue into our discussion about the future of healthcare, including how pharmaceutical companies currently mold our perception of health and the influence of such perceptions on our nation’s health outcomes. As we’re all aware, our country spends about twice as much — over $100,000 — per capita on healthcare compared to Canada, Australia, and Europe (Ansari). Yet, we have the poorest health outcomes in relation to the world’s most developed countries. In the last few years alone, the cost of prescription drugs has reportedly increased beyond the scope of inflation, inciting a sense of helplessness among Americans and likewise establishing a fundamental rift between the supposed accessibility of wellness our nation attempts to bolster and the relentless ascent of prices. This ascent of prices has spurred discontent among the public primarily due to the observance of the same side effects that existed before the price changes; therefore, there is a lack of transparency in the destination and allocation of the additional funds Big Pharma has been provided. While I don’t intend to diminish the worth of prescription drugs in healthcare, given their notable contribution to global advancements in health, I plan to question the recent economic burden drugs appear to pose on the American people and how we can amend this reality to serve the wellness of our nation while upholding the financial stability of the corporations that underlie healthcare services.
Chris Boerner: Let’s step back before defending or attacking practical approaches to illness. As you mentioned, Dr. Ansari, healthcare is a multifaceted industry; it leans on pillars of wealth, customer appeal, and customer wellness. I purposefully differentiate appeal and wellness because they cease to provide a shared outcome: we live in a society of instant gratification and convenience, propelling how we collectively make decisions. Especially in an era of TikTok, Instagram, Youtube, and other social media services that incessantly reduce our attention spans and alleviate our curiosity, demand for entertainment, and general queries in mere instants, how do we suppose the effectiveness of a model void of instant gratification? The entertainment industry’s influence is no longer confined to entertainment; it has conclusively claimed the rhetoric of reality. Journalists front-load information that will retain readership, marketing- and ad-related products are rising in relevance and scale, billboards attempt to deliver stories in snippets, and even people are pressured to present themselves as instruments of value in 30-second networking pitches. Objectively, lifestyle medicine is ideal and harmonious with the state of our being, but can it sustain the health of a population unlikely to comply with a long-term healthy diet? And will health outcomes be shifted if we develop a healthcare model based on research performed in medical settings that don’t apply to the variable pressures and contexts of the modern world?
Elizabeth Klodas: Quite frankly, yes. Before I begin my spiel, I would also like to amend your argument: the problem isn’t compliance when patients shift from prescription drugs to healthy diets. Instead, it’s taste. Pills still require compliance for change. Diets, however, require shifts in eating habits and compliance. At the risk of presenting myself rather bluntly, it’s almost as if your pitch was curated for my counter-argument and introduction of Step One Foods. Step One Foods creates science-backed food as medicine with the precise amounts of key nutrients necessary to lower cholesterol and improve cardiovascular health (Klodas). As a cardiologist, I wanted to ensure the credibility of my venture by subjecting the Step One Foods products to the same degree of scrutiny as prescription drugs, so I co-conducted a randomized clinical trial at the Mayo Clinic and the University of Manitoba. The findings confirmed the effectiveness of my experimental recipes in supporting healthy weight loss, improving digestion, stabilizing blood sugars, and helping lower blood pressure. While this may speak to your point about the artificial compliance of healthy diets in clinical trials, Step One Foods has created products that are on par with the taste and quality of common alternatives, such as Cliff and Nature Valley products. Patients, therefore, don’t have to sacrifice their initial diets or eating habits, ensuring higher levels of compliance. In short, the ideal response to instant gratification is not pills. As a trained and practicing cardiologist, I’ve seen both sides of the paradigm: the instant gratification that couples the modern human experience and the effect of pills on patient well-being. No matter how many medications I prescribed and no matter how perfect I got my patients’ “numbers,” none of them looked or felt any better. Many were telling me that all the drugs they were taking were making them feel worse. So, while the appeal of arriving at an elevated state of well-being in an accelerated timeframe existed prematurely in many of my patients, the merit of this appeal quickly subsided after, even with compliance to their pills, my patients experienced a dissonance between the numbers different medical instruments would suggest and how they truly felt. This dissonance was addressed with Step One Foods, an easier way to comply with a healthy, nourishing diet.
Casey Means: Excellent point, Dr. Klodas. As a medical school graduate who later quit her career in surgery, I want to briefly speak to the levers that motivated my departure and discuss my proposed remedies for our broken outcomes. As Dr. Klodas mentioned, pills may be a solution to addressing illness. However, why should we create an entire model reflective of the regression of our society’s attention span and attitude toward sustained progress of healthy behaviors? At the very minimum, why not complement existing approaches with dietary suggestions and encouraging pushes toward lifestyle changes? I was yelled at for advising my patients to make dietary changes because of my “limited expertise” in nutrition (Calley & Casey Means: How Big Pharma Keeps You Sick, and the Dark Truth About Ozempic and the Pill — YouTube). This daunting experience was a testament to the systemic corruption underlying medical systems, ultimately preventing patients from understanding their health holistically. While I firmly believe pills contribute to this black box phenomenon, in which the patient is unaware of the holistic factors contributing to their overall health and instead placed on a life-long pill treadmill, we should consider the consequences of fostering complete dependence on pills without small attempts at correcting the course of a poor system, as suggested by the current outcomes. If there’s one thread of common knowledge across this table, I hope we agree to amend the healthcare model to improve the pitfalls of the stagnant drug-dependent model that brought us into this room today.
Chris Gardner: Yes, yes, and yes. Doctors lacking nutritional education is another root problem in our broken healthcare system. As a professor who teaches nutrition-related classes, I’m allowed four 20-minute sessions with Stanford students throughout their medical school careers (Gardner). That’s 80 minutes of nutritional education for a doctor who treats patients for a lifetime. Casey, you may not have the complete nutritional expertise necessary to diagnose poor eating habits, but you weren’t offered an opportunity to pursue adequate dietary training in medical school. And even if you weren’t given the proper resources to acquire nutritional education, you shouldn’t have been scolded for your well-intended attempt to bolster your patient’s health by making a simple remark about improving their diet. The hostility you were shown is a testament to a system focused on numbers and finances, not holistic wellness and the patient-physician relationship.
Calley Means: I completely agree. Nutrition is at the heart of health, yet it is largely absent from physician training. To circle back to the supposed alignment of drugs with the lifestyle of modern Americans and the notion of instant gratification, as suggested by Chris, let’s consider that 33% of Americans cannot afford their prescriptions, and 83% of Americans blame the pharmaceutical industry’s profit-driven incentive structure for the lack of affordable medications (Pharmaceutical CEOs Testify before Senate Panel on Drug Prices | Full Video — YouTube).
Maria Ansari: Thank you for bringing up the affordability aspect of prescription drugs, Calley. It’s essential to consider the barriers to access before the finer details of convenience and gratification.
Robert Davis: Sure, drugs are expensive, but can we address the lack of a viable economic healthcare model if we rely solely on lifestyle changes?
Elizabeth Klodas: Surely. Our current model proposes a model that profits off illnesses: I wouldn’t make money as a cardiologist if heart complications weren’t as prevalent. However, the Big Pharma and Big Food industries propel these complications in tandem: ultra-processed foods induce cycles of illness, and doctors simply prescribe drugs to treat such complications (Klodas). This reactive approach, as opposed to a preventive lifestyle approach, ensures a constant cycle of surgery and sickness among Americans, funneling profits into pharmaceutical companies in the short term through a pill treadmill model but ultimately costing the nation billions of dollars to manufacture pills that ultimately lend disappointing outcomes. What if insurance companies covered healthy foods and physicians were paid in fixed intervals to prevent an incentive structure rooted in constant illness and fleeting wealth?
1:30 PM
Maria Ansari: Kaiser has been implementing personalized dashboards that track the social determinants of health for all patients to better align incentive structures. However, we have never considered the possibility of fundamentally shifting insurance coverage and breaking the pipeline between Big Food and Big Pharma.
The first pause ensues as everyone considers the proposed whirlwind of ideas and directions.
Maria Ansari: Well, thank you, everyone, for joining and contributing to this elaborate discussion on the future of Kaiser and national healthcare! While there is no finite conclusion, every bit of wisdom has helped define a potential future with outcomes that balance profit with wellness.
Maria Ansari takes a final glance around the room and taps her foot ponderously as she absorbs the weight of the discussion. While no decisive solutions emerge, one truth is clear: the future of healthcare demands a model that reconciles profit with prevention, access with affordability, and treatment with true wellness.
