So much great stuff here in how to build a low overhead practice, some of the technology that she's learned how to use through the Evolution of Medicine Practice Accelerator, how to keep a low overhead practice, how to build a connection with local integrative providers that now pay her rent, and just so many other ways in which Sonza has built such an amazing practice. I think there's value in here, no matter what kind of practitioner you are, and I really hope you'll enjoy it. This is part of our Success Leaves Clues podcast series, enjoy.
Jordan Reasoner: Hi, and welcome to the Revolution Health Radio show, brought to you by ChrisKresser.com. Steve is out today at a meditation retreat, and I’m your guest host Jordan Reasoner, from SCDlifestyle.com. With me is integrative medical practitioner, healthy skeptic, and New York Times bestselling author, Chris Kresser. But before we dive into this week’s show, I wanted to let you know, if you haven’t been over to ChrisKresser.com, you’ll notice on the front page, Chris is again giving away his 9-Steps to Perfect Health eBook. This eBook was taken off the market for a while and Chris has re-released it. It’s a 63-page eBook, and in it you’ll find the nine steps that Chris has been talking about for perfect health for quite a bit of time. Now, Steve and Chris have recorded a number of podcasts on these steps, but if you want to get the greater detail—including specific steps to take back your health, right now—head over to ChrisKresser.com. Put your name and email in the box and you’ll get instant access to your free eBook.
The physicians drew upon a great store of knowledge in the Peri-Ankh, the Houses of Life; here, students were taught and papyri documenting procedures were stored. Physiotherapy and heat-therapy were used to treat aches and pains, and Ancient Egyptian medicine included repairing and splinting broken bones, as shown by successfully healed skeletons. Priest-doctors also practiced amputation, using linens and antiseptics to reduce the chance of infection and gangrene, and there is some evidence that they employed prosthetics where needed.
James Maskell: Dr. Larry Palevsky is speaking, and he’s speaking on the pediatrics day. He’s an awesome doctor. He was lecturing about the microbiome five years ago, before the human microbiome came out. And so I asked him, he spoke at my Functional Forum, and he brought up some concepts that were new, and I was sitting next to storied integrative medicine doctors who were just sort of blown away. And his thought is this: We all know now that 99% of our bacteria and fungus and viruses and so forth are mutually beneficial, and they help us, and they help with metabolism and digestion and immunity. That’s our sort of main understanding. So I asked him, “Dr. Palevsky, what are we going to learn next? What are we really going to understand next about the microbiome that we don’t understand now?” And he basically—you have to listen to it on the summit, but he basically says this—“We have trillions of non-redundant viruses in our chromosomes, in our DNA. So these are trillions of viruses that we’ve evolved with over time.” And so his question is, “When you get a viral illness, how many more viruses have to come into the body for you to get a viral illness? 10? 20? 100?” I mean, when you look at the numbers compared to what’s actually in our chromosomes and in our DNA, the numbers just don’t add up. His thought is, and his concept is, that these viruses, there’s different transmission mechanisms. His thought is that the next understanding that we’re going to have of the microbiome, the next level of understanding is going to be that the body and these viruses work together to be able to return the body to homeostasis. So when you get to a point where the body is just so stressed and there’s too many toxins and things for it to deal with, and it can’t get back to homeostasis by itself, it communes with viruses to be able to instigate what we think of as a viral illness, to be able to get the patient to just slow down, so that we can get back to homeostasis. And it made such an impression on me because I had a friend last year who got viral pneumonia. And what was happening before viral pneumonia? She was working for three months on a project about 15 hours a day. And suddenly, it finished and she did great with it, and then she was sick for a month with viral pneumonia. So what, pneumonia just came along and attacked at that moment? Obviously, not. So I’d love to get your thoughts on that. Because when he shared that, I was like, “This seems so obvious.” And I’m really excited to think what our understanding is going to be like when we start to appreciate that our evolution with viruses is a big part of our evolution, and that there may be a lot more to it than thinking a virus is just something that comes from outside all the time.
The first medical schools were opened in the 9th century, most notably the Schola Medica Salernitana at Salerno in southern Italy. The cosmopolitan influences from Greek, Latin, Arabic, and Hebrew sources gave it an international reputation as the Hippocratic City. Students from wealthy families came for three years of preliminary studies and five of medical studies. The medicine, following the laws of Federico II, that he founded in 1224 the University ad improved the Schola Salernitana, in the period between 1200 and 1400, it had in Sicily (so-called Sicilian Middle Ages) a particular development so much to create a true school of Jewish medicine.
c.484 – 425 BC Herodotus tells us Egyptian doctors were specialists: Medicine is practiced among them on a plan of separation; each physician treats a single disorder, and no more. Thus the country swarms with medical practitioners, some undertaking to cure diseases of the eye, others of the head, others again of the teeth, others of the intestines,and some those which are not local.
Dr. Hall shares what he was doing that wasn't working and how through his practice has evolved through working with Freedom Practice Coaching and the Evolution of Medicine programs. His journey includes learning new skills, getting comfortable speaking in front of people, and tracking his successes and how it has affected the delivery of care to his patients.
This week on the Evolution of Medicine podcast, we feature Marjorie Nass, Chief Wellness Officer and Heather Campbell, Chief Executive Officer of Ready Set Recover. Ready Set Recover works with your patient's friends and family, doctors and hospitals, and employers at the time of surgery to make recovery as easy as possible. Ready Set Recover is an action-oriented online program that helps surgical patients take positive steps throughout the surgical and recovery process.
In Britain, there were but three small hospitals after 1550. Pelling and Webster estimate that in London in the 1580 to 1600 period, out of a population of nearly 200,000 people, there were about 500 medical practitioners. Nurses and midwives are not included. There were about 50 physicians, 100 licensed surgeons, 100 apothecaries, and 250 additional unlicensed practitioners. In the last category about 25% were women. All across Britain—and indeed all of the world—the vast majority of the people in city, town or countryside depended for medical care on local amateurs with no professional training but with a reputation as wise healers who could diagnose problems and advise sick people what to do—and perhaps set broken bones, pull a tooth, give some traditional herbs or brews or perform a little magic to cure what ailed them.
Antibiotics were discovered too. Penicillin was discovered in 1928 by Alexander Fleming but it was not widely used till after 1940. Another antibiotic, streptomycin was isolated in 1944. It was used to treat tuberculosis. They were followed by many others. Meanwhile the iron lung was invented in 1928 and in 1943 Willem Kolff built the first artificial kidney machine. (The first kidney transplant was performed in 1950 by Richard Lawler).
Later Louis Pasteur (1822-1895) proved that microscopic organisms caused disease. In the early 19th century many scientists believed in spontaneous generation i.e. that some living things spontaneously grew from non-living matter. In a series of experiments between 1857 and 1863 Pasteur proved this was not so. Once doctors knew what caused disease they made rapid headway in finding cures or prevention.
Another great surgeon was Ambroise Pare. In the 16th century surgeons put oil on wounds. However in 1536 during the siege of Turin Pare ran out of oil. He made a mixture of egg whites, rose oil and turpentine and discovered it worked better than oil. Pare also designed artificial limbs. In 1513 a man named Eucharius Roslin published a book about childbirth called Rosengarten. In 1540 an English translation called The Birth of Mankind was published. It became a standard text although midwives were women.
In the paper, Radin explores how frozen colonial pasts operate in the service of biological futures. Radin’s research refigures sample collection, induction and cryogenic suspension as modes of colonial science. Following histories of frozen blood samples collected from indigenous populations in the postwar period, Radin reveals a cryopolitics of “not letting die,” in the service of some future biological development. Radin’s impressive body of work offers unique contributions to the study of Cold War, postcolonial technoscience, genomics, big data, climate history, extinction, science fiction and speculative futures.
At the University of Bologna the training of physicians began in 1219. The Italian city attracted students from across Europe. Taddeo Alderotti built a tradition of medical education that established the characteristic features of Italian learned medicine and was copied by medical schools elsewhere. Turisanus (d. 1320) was his student. The curriculum was revised and strengthened in 1560–1590. A representative professor was Julius Caesar Aranzi (Arantius) (1530–89). He became Professor of Anatomy and Surgery at the University of Bologna in 1556, where he established anatomy as a major branch of medicine for the first time. Aranzi combined anatomy with a description of pathological processes, based largely on his own research, Galen, and the work of his contemporary Italians. Aranzi discovered the 'Nodules of Aranzio' in the semilunar valves of the heart and wrote the first description of the superior levator palpebral and the coracobrachialis muscles. His books (in Latin) covered surgical techniques for many conditions, including hydrocephalus, nasal polyp, goitre and tumours to phimosis, ascites, haemorrhoids, anal abscess and fistulae.
Prize Citation: In “Digital Natives: How medical and Indigenous histories matter for Big Data,” Joanna Radin argues for critical engagement with “the metabolism of Big Data”. Radin presents the remarkable history of a dataset known as the Pima Indian Diabetes Dataset (PIDD), derived from research conducted with the Akimel O’odham Indigenous community in Arizona. Since the loss of their ability to farm the land, this community has an extremely high rate of diabetes. Reconstructing the circumstances of the dataset’s production and its presence in a Machine Learning repository where it is used in projects far removed from diabetes, Radin draws attention to the way that data is naturalised, and bodies and economic struggle are elided. Significant questions are raised about the ethics and politics of research in an age of Big Data, including the reproduction of patterns of settler colonialism in the research enterprise, and the community’s work to redefine the research encounter. The prize committee were impressed by Radin’s depth of research, quality of analysis, and the contribution to multiple literatures, and commend her for an inspired and inspiring article.
Louis Pasteur (1822–1895) was one of the most important founders of medical microbiology. He is remembered for his remarkable breakthroughs in the causes and preventions of diseases. His discoveries reduced mortality from puerperal fever, and he created the first vaccines for rabies and anthrax. His experiments supported the germ theory of disease. He was best known to the general public for inventing a method to treat milk and wine in order to prevent it from causing sickness, a process that came to be called pasteurization. He is regarded as one of the three main founders of microbiology, together with Ferdinand Cohn and Robert Koch. He worked chiefly in Paris and in 1887 founded the Pasteur Institute there to perpetuate his commitment to basic research and its practical applications. As soon as his institute was created, Pasteur brought together scientists with various specialties. The first five departments were directed by Emile Duclaux (general microbiology research) and Charles Chamberland (microbe research applied to hygiene), as well as a biologist, Ilya Ilyich Mechnikov (morphological microbe research) and two physicians, Jacques-Joseph Grancher (rabies) and Emile Roux (technical microbe research). One year after the inauguration of the Institut Pasteur, Roux set up the first course of microbiology ever taught in the world, then entitled Cours de Microbie Technique (Course of microbe research techniques). It became the model for numerous research centers around the world named "Pasteur Institutes."
According to the compendium of Charaka, the Charakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Suśruta, the Suśrutasamhitā defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Suśrutasamhitā is notable for describing procedures on various forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures. Most remarkable is Sushruta's penchant for scientific classification: His medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to aging and mental illness.
Evolutionary principles may also improve our vaccine strategy. Vaccines are another way to create selective pressures on infectious organisms. We may inadvertently target vaccines against proteins that select out less virulent strains, selecting for the more virulent or infectious strains. Understanding of this allows us to instead target vaccines against virulence without targeting less deadly strains.
If you've been following the Functional Forum, you know we've taken the show on the road to engage with as many members of our community as possible. As we bring the show to Chicago in September, DC in October, Miami in November and back to NY in December, the Future of Functional in 5 will give members of our tribe the opportunity to share and be heard.
Upon the outbreak of a cholera epidemic in Alexandria, Egypt, two medical missions went to investigate and attend the sick, one was sent out by Pasteur and the other led by Koch. Koch's group returned in 1883, having successfully discovered the cholera pathogen. In Germany, however, Koch's bacteriologists had to vie against Max von Pettenkofer, Germany's leading proponent of miasmatic theory. Pettenkofer conceded bacteria's casual involvement, but maintained that other, environmental factors were required to turn it pathogenic, and opposed water treatment as a misdirected effort amid more important ways to improve public health. The massive cholera epidemic in Hamburg in 1892 devastasted Pettenkoffer's position, and yielded German public health to "Koch's bacteriology".
Some 200 years later another doctor, Peseshet, was immortalised on a monument in the tomb of her son, Akhet-Hetep (aka Akhethetep), a high priest. Peseshet held the title ‘overseer of female physicians’, suggesting that women doctors weren’t just occasional one-offs. Peseshet herself was either one of them or a director responsible for their organisation and training.
Trapped in ice near Stadacona (the site of present-day Quebec City) in 1536, Jacques Cartier’s ships weren’t going anywhere. The crews, holed up in a makeshift fort with little access to fresh food, came down with a disease so gruesome that “their mouth became stincking, their gummes so rotten, that all the flesh did fall off, even to the rootes of the teeth, which did also almost all fall out.” They had scurvy, now known to result from a deficiency of vitamin C. Cartier had no idea what to do.
Humans evolved to live as simple hunter-gatherers in small tribal bands. Contemporary humans now have a very different environment and way of life. This change makes present humans vulnerable to a number of health problems, termed "diseases of civilization" and "diseases of affluence". Stone-age humans evolved to live off the land, taking advantage of the resources that were readily available to them. Evolution is slow, and the rapid change from stone-age environments and practices to the world of today is problematic because we are still adapted to stone-age circumstances that no longer apply. This misfit has serious implications for our health. "Modern environments may cause many diseases such as deficiency syndromes like scurvy and rickets".)
James Maskell: Yeah. Well, obviously, you have, some of the ideas you talked about there are perfect I think. I just wrote a blog for The ZocDoc Blog about why doctors should curate their patient education. And curating resources is much more efficient than just telling people stuff. You don’t need people to do that, you just need to use the resources that are available. And so actually, one of the ways that we designed this summit was that it would be almost like the perfect thing for a doctor to curate for their patient—because there is a patient track. It’s going to basically teach the patient how to be a great patient and how to look after the four major modifiable causes of chronic disease: diet and stress, toxicity, immunity, and the microbiome. These are all things that patients have the majority of control over. This is not medicine that’s done to you. And so, we were just—so that’s part of the track in the doctor track. I think the curation of patient education can take a lot of the time out of the appointments, because you see one of the biggest things about functional medicine is that it takes a lot of time to do it, because you have to listen and so forth. So that’s one of the things. But like you said, technology can play a key role. And we have doctors in the summit that are talking about how they’re using technology even in poorer, rural areas of the country, where they’re building community-orientated practices that serve a blue-collar type of patient, and it’s working. And if it could work in rural Indiana, it can work anywhere. And that’s really exciting. You know, our vision for this, Chris, is just a nationwide network of remarkable community-orientated functional practices. In the same ways you saw the natural response to Walmart was farmers’ markets—you know, going directly to the farmer and having that direct interaction—I think the natural reaction to big medicine is these small micropractices that deliver exceptional value to patients in local areas into the community.
IFNA defines Integrative and Functional Nutrition (IFN) therapy as a leading-edge, evidence-based, and comprehensive approach to patient care that focuses on identifying root causes and system imbalances to significantly improve patient health outcomes. This emerging medical nutrition model combines the very best of modern science, clinical wisdom and critical thinking and is being driven by increasing consumer demand, advancing technology and the changing healthcare landscape.
As infectious diseases have become less lethal, and the most common causes of death in developed countries are now tumors and cardiovascular diseases, these conditions have received increased attention in medical research. Tobacco smoking as a cause of lung cancer was first researched in the 1920s, but was not widely supported by publications until the 1950s. Cancer treatment has been developed with radiotherapy, chemotherapy and surgical oncology.
China also developed a large body of traditional medicine. Much of the philosophy of traditional Chinese medicine derived from empirical observations of disease and illness by Taoist physicians and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or mystical, correlate as the expression of the natural order of the universe.
James Maskell: Yeah. So we have a couple of people speaking about tech. Specifically, Stephanie Tilenius, she’s written a lot for Forbes. And she’s high up at one of the biggest VC companies in Silicon Valley. She really spoke about a number of the things that you’ve spoken about there, wearables. I don’t know if you’ve seen in the US Open now, they have all the ball boys wearing the wearables, so that’s really expanding the interest. Dr. Robin Berzin, who was with me on The Huffington Post the other day talking about tech. She’s really talking about it from a patient’s perspective. I think, I’m sure you’ve seen this, Chris, but I think just for men; men need different incentives to take care of themselves. Women are generally better at it. They are generally better at taking care of themselves and feeling problems before they come up and get serious. Whereas men tend to wait until the very last moment, until there’s literally no other option apart from going to the doctor’s office. And so I think what’s really cool is that, for men, obviously we’re going to have these touch points. Medicine’s going to have these touch points to be able to catch things before they get really bad. And then on the other side of it, you have things that I find, that I’m quite competitive. I want to get competitive with my friend who’s in Iceland and who has a Fitbit, and he’s doing 120,000 steps a week, and he’s challenging me to do it, and we’re going back and forth. There’s some of the gamification aspect. There’s this really cool app called GymPact, which I’ve been following since I saw them at South by Southwest. And in that, you sort of put money, you bet on yourself to do your run, or to go to the gym, or to eat the right food. You bet on it. And everyone puts all their money in and the people that do what they say they’re going to do get paid out by the people that don’t. And so if it was going to give you $5 or $10 to actually go to the gym, there’s extra incentive that might be the next thing that gets the next generation of men to really be proactive with their health. What I think is cool and interesting is that at the moment, there’s a lot of apps that are being made by healthy 30-year-olds for other healthy 30-year-olds, which is probably not going to solve medicine’s biggest problems right now, but at least there’s starting to be iteration. And the most exciting thing is that once the iWatch comes out, in the same way that you saw the iPhone, the biggest apps—things like Instagram and Snapchat—where people are innovating on top of a hardware platform for software, just think about all of those people out there that are going to want to build apps for the iWatch. And what you actually have is the concentrated intention of way more people around the world looking for ways to engage people in being healthy. And that is exciting by itself.
But the most impactful change to the old system is the transition to patient-centered diagnoses. Medicine evolving from a doctor-centered structure to a patient-centered structure and this reflects Dr. Galland's unique contribution to the operating system. In this podcast, Dr. Galland addresses how this new model was developed and why it's such an important part of the evolution of medicine.
The Byzantine Empire's neighbors, the Persian Sassanid Empire, also made their noteworthy contributions mainly with the establishment of the Academy of Gondeshapur, which was "the most important medical center of the ancient world during the 6th and 7th centuries." In addition, Cyril Elgood, British physician and a historian of medicine in Persia, commented that thanks to medical centers like the Academy of Gondeshapur, "to a very large extent, the credit for the whole hospital system must be given to Persia."
James Maskell: Yeah, absolutely. And it’s cool as well. So in this summit, we have a doctor track as well as a patient track. And in the doctor track, we’re actually talking about some of the ways that this is actually being delivered. And there are ways to deliver functional medicine on insurance. We’re featuring the group visit model in one of the doctor-specific tracks. That’s been very successful at bringing people together, developing a community around groups of people with the same disease. They want accountability. They want support. They want to hear from other people that have the same issues as them. So that’s working and that’s going to be included in the functional center at Cleveland Clinic. And then also health coaches. They’re looking at using different providers together, so you can have higher-cost and lower-cost providers working together. So it’s really exciting. I feel like once we get more and more organizations doing it that are credible, people will work out how to get this done on insurance and how to do this at a bigger scale. The first thing is just the clinical acceptance that’s been a long time coming.
The advances in medicine made a dramatic difference for Allied troops, while the Germans and especially the Japanese and Chinese suffered from a severe lack of newer medicines, techniques and facilities. Harrison finds that the chances of recovery for a badly wounded British infantryman were as much as 25 times better than in the First World War. The reason was that:
^ Houstoun, Robert; Cheselden, William; Arbuthnot, John (1723). Lithotomus castratus; or Mr. Cheselden's Treatise on the high operation for the stone: thoroughly examin'd and plainly found to be Lithotomia Douglassiana, under another title: in a letter to Dr. John Arbuthnot. With an appendix, wherein both authors are fairly compar'd. T. Payne. Retrieved 7 December 2012.
In the 1830s in Italy, Agostino Bassi traced the silkworm disease muscardine to microorganisms. Meanwhile, in Germany, Theodor Schwann led research on alcoholic fermentation by yeast, proposing that living microorganisms were responsible. Leading chemists, such as Justus von Liebig, seeking solely physicochemical explanations, derided this claim and alleged that Schwann was regressing to vitalism.
^ Bynum, W.F. (1974). "Rationales for therapy in British psychiatry: 1780–1835". Medical History. 18 (4): 317–34. doi:10.1017/s0025727300019761. PMC 1081592. PMID 4618306.; Digby, Anne (1988). "Moral Treatment at the Retreat 1796–1846". In Porter, Roy; Bynum, W.F.; Shepherd, Michael. The Anatomy of Madness: Essays in the History of Psychiatry. 2. London & New York: Tavistock. pp. 52–71. ISBN 978-0415008594.
Spearheaded by faculty in the HMS Department of Global Health and Social Medicine, a report by The Lancet Commission on Global Surgery reveals that 5 billion people are unable to access safe, timely and affordable surgery, leading to 18.6 million preventable deaths each year worldwide. The report also presents a blueprint for developing properly functioning surgical systems globally.
However, this all changed with Hippocrates, one of the most famous of all physicians, and his famous oath is still used by doctors today, as they pledge to 'Do No Harm.' His most telling contribution to the history of medicine was the separation of medicine from the divine, and he believed that checking symptoms, giving diagnoses and administering treatment should be separated from the rituals of the priests, although most Greeks were happy to combine the two and hedge their bets.
In this episode, we followed on from last week's Functional Forum and talked about the role of education in the future of medicine, and particularly the role of delivery of content. Danny introduces us to a great resource for practitioners who are interested in creating dynamic content. The book is available for download May 4th through May 8th at goevomed.com/teach. If you're listening to this podcast between May 4th and May 8th, go get it right now. We had a great half-an-hour discussion. Send us your thoughts and feedback!
Dr. Brandeis also shared why he has joined a technology startup called Orchestra One. Orchestra One's practice management platform runs your business online, in-office and everywhere in between - giving you more time to do what you do best, and also holds the potential to make billing insurance easier than ever. If you are interested in the intersection of technology and medicine, this should make great listening.