Chapter Content
Okay, so, um, this is kind of a heavy topic, but it's really important. It's about trusting yourself, maybe even more than your doctor, especially when it comes to your health.
It all started, like, during the most important thirteen days of my life. Basically, I had to ignore a whole team of doctors. You see, my mom got diagnosed with pancreatic cancer, and, boom, a medical team from Stanford and Palo Alto Medical Foundation just, like, appeared. They had this whole list of stuff they wanted to do – surgeries, biopsies, blood transfusions, a liver stent – all this invasive stuff. And normally, most people would just say "okay," right? I mean, it's Stanford! These are supposed to be the best doctors in the world.
But something didn't feel right to me, based on what I knew about medicine. So I started asking questions, and what I found out was… unsettling. Apparently, there was only a 33% chance these procedures would even extend her life, and even then, only by a few months. There was another 33% chance it would actually shorten her life! And another 33% chance it wouldn't do anything at all, except keep her stuck in a hospital room…alone because of COVID protocols. And, you know, she was already so weak. Her liver was failing, and her body was basically destroying her own red blood cells. This just made the prognosis even worse, and the procedures even riskier. Plus, we were in the middle of lockdowns, so she'd have to go through all this alone.
My mom, she was really clear about what she wanted. She wasn't afraid of dying, but she just wanted to avoid unnecessary pain or nausea in her final days. But the system…it just kept pushing these procedures that would cause exactly what she was trying to avoid. They were practically shaming us for questioning their approach.
It's not like the doctor was trying to give her bad advice on purpose, but, you know, those procedures… they generate tons of money for the hospital. And I knew that the doctor's pay was kinda tied to booking those procedures. So I straight up asked him, "Are you really recommending this invasive procedure that, at best, will only give her a couple more months, and risks her dying alone in the hospital? Even though we’re pretty sure it’s stage 4 pancreatic cancer based on her blood test and CT scan, and her liver’s failing?” And he just said, “Yes, that’s what we’re recommending.”
So, with my family's support, my mom decided to skip the procedure and spend her last days at home with us. It felt like the procedure was more about checking boxes for the doctor, you know? Like an algorithm or a chart note template…and definitely not about what was best for my mom. It made me feel sick for all those families who don't have someone to advocate for them, someone who understands how the system works and knows the right questions to ask.
Instead of leaving her in the hospital, we took her home. And those last days… they were everything. On her last day, she wasn’t doing so great but had a moment of energy and asked us to take her to where she wanted to be buried, a place she loved with an ocean view. We took her there in a wheelchair, and she just looked around at the ocean and the trees and said how perfect and beautiful it was. She and my dad exchanged this look, like they were saying everything without words, a final embrace. And then, minutes later, she lost consciousness. Two days later, she died at home, surrounded by her family.
Those final thirteen days, seriously, they were the most meaningful days of my life. And if we had listened to the doctors, they never would have happened.
It made me think about something a friend, a cancer surgeon, told me years ago: "If you walk through the doors of this surgical oncology department, you are going to get an operation, whether you need it or not." It’s true. I remembered her being upset because patients were pushed into unnecessary surgeries. She would suggest palliative care, but the senior doctors would always reject that. Her boss would “lose his mind” if she suggested that. And if a patient didn't want surgery, they had to sign an "Against Medical Advice" form and were left with fewer options.
It's such an unbalanced relationship, doctor and patient. The patient is scared, and they trust the doctor offering a cure, whether it's for diabetes, heart disease, or cancer. Now, look, I don't think doctors are evil. They don't go into medicine to get rich. It's a long, hard road, and most of them, they dreamed of curing diseases. They studied like crazy, they had all these idealistic visions. But then, something happens. That idealism kind of… turns into cynicism.
I remember my colleagues in residency questioning their sanity, wondering if it was all worth it. I knew surgeons who’d drafted resignation letters, others daydreaming about becoming bakers. Many of them were desperate to spend more time with their families. I even saw doctors break down in the operating room because they were missing their kids' bedtimes. It was tough. It made me understand why doctors have such high burnout and suicide rates.
And, you know, they all said the same thing: they feel trapped in a broken system. They can't just change paths because of debt and their identity being tied to that "MD" title. They’re stuck in a system where every institution – hospitals, pharma, medical schools, insurance companies – they all make more money when you're sick and less when you're healthy. It's a crazy system that's actually hurting patients.
Imagine you're an alien, right? And you see that, like, 75% of deaths and 80% of healthcare costs are from preventable diseases like obesity, diabetes, and heart disease. You ask that alien to allocate $4 trillion, which is what we spend on healthcare every year, to fix the problem. No way would that alien say, "Let's wait for everyone to get sick and then prescribe drugs and do procedures that don't even address the root causes." But that's exactly what we're doing because it makes money.
So, you know how most health books tell you to "consult your doctor?" Well, when it comes to preventing and managing chronic diseases, I think you shouldn’t always trust the medical system. It might sound pessimistic, but understanding the system’s incentives is the first step to taking control of your health.
My mom, she had what people would consider the best medical care in the world. Mayo Clinic, Stanford Hospital… she went to all the appointments, did all the tests. But her cells never healed. The doctors just tweaked her biomarkers with meds, but those drugs didn't fix the underlying issues. Pancreatic cancer, like many chronic diseases, is largely preventable with the right habits. But nobody ever gave her strong recommendations about how to fundamentally improve her cellular function. They only got aggressive when she was, like, already at death's door.
And people say, "But the medical system has produced so many miracles! Life expectancy has doubled!" And yeah, life expectancy has increased, but mainly because of sanitation, infectious disease control, emergency surgery for acute issues, and antibiotics. Almost every medical "miracle" is a cure for something acute, something that would kill you immediately. And economically, acute conditions aren’t great for the modern system because the patient gets cured too quickly.
Starting in the '60s, the medical system took the trust they got from those acute innovations and used it to basically tell patients to not question their authority on chronic diseases. It's been a failure. We've siloed diseases, and we have a treatment for everything. High cholesterol? Statin. High blood sugar? Metformin. ADHD? Adderall. Depressed? SSRI. Can’t sleep? Ambien. Overweight? Wegovy. But the rates of all these conditions are going up, even as we spend trillions to "treat" them.
It doesn’t make sense. We've been told not to ask questions for the past fifty years, right when chronic disease rates exploded. And this whole system is, like, by design. There was this doctor, Dr. William Stewart Halsted, who created the concept of residency. He believed the most important thing in a hospital was a surgeon cutting into a patient’s body. He thought aggressive interventions were heroic. He even engaged in multi-day surgical benders with residents.
And then there's John D. Rockefeller, who realized he could use oil by-products to make pharmaceuticals. He heavily funded medical schools to teach an intervention-first curriculum. One of his employees created the Flexner Report, which prioritized interventions and stigmatized nutrition and holistic remedies. Congress even made it official, saying that any credentialed medical institution had to follow this intervention-based model.
At first, I agreed with Halsted. I wanted to "solve" problems with surgery. I thought becoming a doctor was a privilege, and it should be tough. I judged people who complained about the grueling schedule.
I didn’t learn in medical school that Dr. Halsted was addicted to cocaine and morphine. He would go on drug-fueled binges and then have psychotic breakdowns. He couldn’t even perform surgeries because his hands were shaking. But the Flexner Report…it hasn’t changed since 1910, and it still defines U.S. medicine.
So, here's the truth: listen to the medical system if you have an acute issue, like a broken bone or a life-threatening infection. But when it comes to chronic conditions, question almost everything, especially nutrition or chronic disease advice. Just follow the money and incentives.
The dean of Stanford Medical School, Dr. Philip Pizzo, was appointed to lead a panel on chronic pain. Nine of the nineteen people he appointed had ties to opioid manufacturers. He also got a $3 million donation from Pfizer, an opioid maker. The committee recommended lenient opioid guidelines, and look at the crisis we have now.
NIH grants went to thousands of researchers with financial conflicts of interest, millions of dollars. Deans of leading institutions took millions in direct payments from pharma companies.
When the Affordable Care Act was passed, doctors had to learn about the Merit-Based Incentive Payment System (MIPS). The idea was that doctors would get paid more if they met certain quality-of-care criteria. You'd think "quality" would mean patients getting better, right? But the quality metrics were mostly based on whether doctors prescribed drugs regularly or did more interventions! A government incentive program focused more on whether doctors prescribed long-term pharmaceuticals and less on whether patients were actually healthier. Pharma spends way more on lobbying than the oil industry, and they've influenced almost every piece of healthcare legislation.
Doctors would talk about their pay being based on relative value units (RVUs), a measure of their productivity. Hospitals incentivize doctors to increase their RVUs. Doing bariatric surgery on someone gets more RVU points than counseling them to eat healthily. RVUs are an explicit measure of the economic value a doctor drives to the hospital. Interventions, measured by RVUs, are how hospitals make money. This leads doctors to not question root-cause solutions and to recommend surgery more than they should. I was even told to learn to bill properly, because as a surgeon, "you eat what you kill."
And if I suggested a dietary intervention, I was reprimanded. "We didn’t become surgeons to give dietary advice." Even if it means traumatizing terminal patients and separating them from their families, doctors are trained to do whatever it takes to keep patients alive, even if it's just for a few more days in the ICU.
Billing is based on doing something interventional, not on addressing why people get sick. You can code prescribing a pill or doing surgery, but you can’t code reversing diabetes or preventing cancer. Hospitals are incentivized to do as many procedures and have as many quick patient visits as possible. If you come to the hospital with a broken arm, they make more money if they prescribe you a narcotic in addition to treating your arm. The more you do, the more you get paid.
I saw a sign in the ENT workroom that said, “Fuck cancer!” I saw powerful, wealthy cancer patients praising their oncology team and saying they had the "best doctors in the world." And sure, it’s good to be motivated to beat a disease, but where was that motivation before, when these patients showed symptoms of diabetes, dementia, or hypertension? Cancer is often preventable, but the fervor to “fight” only comes after the damage has been done.
The truth is, the caliber of your doctor matters very little after a cancer diagnosis. They’ll prescribe the same thing as every other doctor, do the same chemotherapy, and perform the same surgery, all based on guidelines that are riddled with conflicts of interest. Saying "You have the best medical team" after a cancer diagnosis is like saying you have the best mechanic after totaling your car.
After my mother’s death, I spoke with one of her oncologists. I told her how frustrated I was that she recommended procedures that would take my mom away from her family without really helping her. I knew she got into medicine to help people, but she was so deep in the system, she couldn’t see any other way.
The most blatant example of this intervention-based system is that medical leaders are silent on the things that are actually making us sick: food and lifestyle.
If the surgeon general and the heads of Stanford Medical School and the NIH held a press conference tomorrow saying we need to cut sugar consumption among children, I think it would go down. People listen to medical leaders. But they’re silent on the true causes of our metabolic epidemic.
They don't sound the alarm that most young adults aren’t fit enough to join the military. They aren’t calling out media companies that lobby against regulating food ads to kids. They aren’t demanding later start times for schools. They aren’t decrying that some funding for nutrition groups comes from the food industry. They aren’t expressing outrage that some nutrition programs funds are spent on sugar-sweetened beverages. They aren’t calling for tighter regulation of synthetic chemicals in our food and products. They aren’t calling for a stop to agricultural subsidies that generate the components of processed food.
Obesity doctors aren’t calling to lower the recommended sugar for children; they’re saying obesity is a “brain disease” and that the government should subsidize bariatric surgeries. Cardiologists aren’t screaming to reduce processed food. The American Diabetes Association isn’t declaring a War on Sugar.
Our medical leaders aren’t protesting the USDA’s decision to ignore recommendations to lower added sugar in food guidelines. They aren’t calling for the reversal of the USDA’s decision to offer ultra-processed Lunchables in schools.
We’d expect the NIH, medical schools, and the American Medical Association to be ringing alarm bells about diet and lifestyle. We’d expect them to be calling for changes to our food system and launching a national effort to decrease sedentary lifestyles. But these institutions have stayed silent and profited as more patients have gotten sick.
I would often hear that patients are “lazy” and make bad decisions. That's a pessimistic view. People aren’t trying to be obese and metabolically unhealthy. They're being crushed by the devil’s bargain between the food industry, which wants to make food cheap and addictive, and the healthcare industry, which profits off interventions on sick patients.
This isn’t a conspiracy, it’s just economic reality. Your doctor benefits from your continued suffering, symptoms, and sickness. Your doctor probably doesn't understand the role they play or the strings controlling their education and the research.
The incentives of our medical and food systems pressure patients not to ask questions. These incentives also lead to the biggest lie in health care: that the reasons we are getting sicker and fatter are complicated. They’re not complicated. They all tie to good energy habits.
I respect doctors, but many are doing the wrong things, pushing pills and interventions when diet and behavior would do far more. Suicide and burnout rates are astronomical. Doctors have twice the rate of suicide as the general population. I think a contributor is a spiritual crisis about the efficacy of our work and a sense of being trapped in a system that isn't working but seems too big to change or escape.
This might not sound like it, but this is about optimism. We're in a health crisis. The good news is that our system can be fixed, and the crisis can end.
Not that long ago, starvation and early death were normal. If you transported someone from those times to today, they’d be shocked. Our system can produce positive results when focused on the right problem.
U.S. hospitals are filled with dedicated, intelligent, and hardworking professionals. But they’re operating in a system that has lost its way, one that now makes money when patients are sick.
The modern medical system has let us down in preventing and reversing chronic disease. In fact, life expectancy rates haven’t improved much if you take out deaths from infectious diseases.
We’ll all grow old before the system changes itself. But a revolution is happening where patients are better equipped today to take charge of their metabolic health. Let’s dive into specific ways to implement good energy principles to feel better today and prevent disease tomorrow.