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What is Health?
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We all live in a world of disease. Think of all of the resources that disease—as an industry—consumes every day, every week, every month, every year. Billions of dollars. An impossibly huge real estate footprint. Affiliated networks that many people have come to view with fear, suspicion, and even anger—Big Pharma, “health” insurance, government oversight agencies. In the middle of all this, each of us stands alone as an individual. How do you navigate the system, yet still chart your own course?
James Maskell: 00:00 Hello, and welcome to the very first episode of the Big Bold Health Podcast, making health personal in a world of disease. I am here with my co-host, Dr. Jeffrey Bland. He is a nutritional biochemist, known to some as the godfather of functional medicine and a protege of Dr. Linus Pauling, who is the only man to win Nobel Prize in two different categories. Dr. Bland, we are here for the Big Bold Health Podcast, what’s the point in all of this? What are we doing here?
Jeffrey Bland: 00:36 Well, thank you James. First of all, I want to thank you. I think ability to team up with you and exploring this extraordinarily important topic, which is what is health and how do we allow it to be manifest in every human being that desires to be healthy—is not only a worthwhile aspiration, but something that for the last four decades I’ve been very excited about doing. And to do it with someone of your background and enthusiasm is going to make this evermore successful in its penetration and its applicability. So, thank you. What I would say about this question of what is health, is that we have to go back and look at the history of how our healthcare system has really evolved, which is really as a disease care system, as we know. And in fact, as I looked at my own training, and that of my colleagues, and virtually every health care professional, educator, researcher that’s gone through training, the way that we’re taught about health is it’s the absence of disease.
Jeffrey Bland: 01:33 Now, what does that really mean? It means that health is subordinate to or secondary to that of disease. The disease is the primary thing that’s the attractor. The second system is that below it, the diminutive is health and therefore everything is disease focused. Disease focus for reimbursement, for coding, for fear based patient worries because no one wants a disease. And so, this whole mentality, which we say health is the absence of disease, is really disease owned. So a second party or a stepchild is health. And then I said, why is that? The reason it is, is that we haven’t de-docked health from the disease discussion. And this podcast is going to do that. We’re going to say no, hold on just a minute, let’s go back to 1946. The World Health Organization, which they tried to define health as being more than the absence of disease, but the presence of full function of your physical, emotional, mental, and metabolic or physiological capabilities.
Jeffrey Bland: 02:43 Now, that particular definition was criticized for some period of time because people thought it was too aspirational, and it didn’t have enough granularity to it to be really executed upon. So it’s been modified slightly over the decades to now be said that really health is defined as the capacity that people have to adapt to change, so that it allows them to maintain through the course of living their full function. Now that is a really interesting definition of health. It’s very different than the absence of disease, and it’s that definition that we really want to explore in the Big Bold Health Podcast because it takes us into 21st century understanding of what is function.
Jeffrey Bland: 03:27 And, it allows us to start to define in a metrizable or quantitative way how we can actually measure health just like we measure disease. And wouldn’t it be nice if we had an equal table set where both disease was at that table and health was at that table with their own body of knowledge, their own ways of assessing their outcome, and their own treatment modalities that would really deliver health at the same level of professionality as is delivered personalized disease treatment? And that’s where we’re going. We are going to birth the generation of personalized health using this new model of comprehensive personalized assessment.
James Maskell: 04:10 So if the world’s been hip to this since 1946, why is it necessary for it to be big and bold right now?
Jeffrey Bland: 04:19 Well, I think what happened since 1946, is this concept got shoved over into what I call the public health system. And the public health system is a very great system. It’s like Pap smears, and immunizations, and wear your seat belts, and new cholesterol screening, and low salt diets, and things that make general sense, but they’re not personalized to the individual. And what I’ve come to recognize, and I’m sure you do as well, in fact, I would say anybody watching this podcast probably recognizes that health is very intimate. It’s very personal. It’s one person at a time. Group health doesn’t occur as a consequence of the group. Group health occurs as a consequence of each individual in the group making some decision about how they’re going to manage their function throughout the course of their living.
Jeffrey Bland: 05:08 And so what’s happened to this aspiration that was expressed in the 1946 World Health Organization definition of health was it got relegated over into community health, into public health. And we can see how effective that is in certain areas. It really doesn’t deliver the goods to the individual. Now in certain places, I’d have to say, I don’t want to throw the baby out with the bathwater or throw anybody under the bus, public health has been advantageous. Look at smoking cessation, that was really an effort around a public good, which is to try to reduce or eliminate smoking.
Jeffrey Bland: 05:41 But, if we look at the granularity of how a person actually advocates for their own health, it’s not directly tied to community health. It’s tied to their own individual state of function, which is tied to what? The genes that they were born with, their book of life, which is unique, never been formed ever and never will again, our unique book of life and how our book of life interacts with our unique lifestyle and environment. That’s a new model of 21st century healthcare that’s different than public health or community health. It’s precision personal health, and that’s what we’re going to be talking about.
James Maskell: 06:15 Yeah, one of the things that stands out to me about that conversation is that in this world of functional medicine that I’ve been working in as well for the last 15 years. I see that one of the things that has to happen at the beginning of these conversations, is the practitioner has to kind of get from the person going through the process, what’s your purpose for being healthy? Why are we here? What are you doing? There’s a shift from sort of an external focus where the doctor had the solutions and he was bestowing those solutions on to the patient. Whereas now it’s a much more participatory story. And ultimately, if you’re going to bring out a participatory story, let’s go directly to the participants.
Jeffrey Bland: 06:55 Oh boy. You’ve just said right there the golden pot at the end of the rainbow. I think that that is such an insightful comment, because when I first started in my training, which would have been the ’60s, hard to even say that now, but it’s true, in the middle to late sixties, the concept was, in essence, I’m kind of saying this in a dramatic way to make the point, that patients came as victims to the seat of practitioners who were rescuers. So, the psychology of medicine was a rescue-the-victim space. Victims came on bended knees asking for the divination from a practitioner who was the provider omniscient about disease care, that would then write in allegeable bit of writing on a piece of paper called a script and send them to the pharmacy to get it filled.
Jeffrey Bland: 07:50 The patient would genuflect and feel very pleased that they got this universal knowledge as they backed out of the examining room, thinking the solution to their problem has now been given to them, bequeathed by the knowledge-holder of all good. Only to find out later in many cases, not all cases, that this is a disillusioned sense of confidence. They didn’t get better, their conditions to continue to progress, and it led to what we see now in our society: a variety of people who feel that they’re lifelong victims and they have dossiers of medical histories that are quite thick and they’ve not found solutions, and they’re very disillusioned, and they’re looking for some other kind of answers. And, the answers they’re going to find will not come from the disease care system. Let me say it again. The answers that will find the solution to their problem will not come through the disease care system.
Jeffrey Bland: 08:41 The disease care system is really good at what it does and that is to treat, in a hospital-based model, a terminal illness or very serious illness. It’s good at that. It is really not rooted in an understanding of how to manage chronic problems that are related to dysfunction and chronic health problems. We’re asking something of the disease care system that’s not realistic when we expect that we would go and they would be able to answer that question, because that’s not what they’re trained to do. Disease care is trained to treat disease. Unfortunately, we put healthcare under disease, and that’s become the problem. So now we say, how does that person then find a solution? Let me give an example. This is a little abstract, the way I’ve been describing it. Now I’ll give a tangible example.
Jeffrey Bland: 09:25 Just today, I got a text from one of my close associates about an example of what we would consider a highly successful midlife gentleman in his fifties, actually in the disease health care system, very successful, who had come down with a condition that we call type two diabetes. So, he’s given a name of a disease. There are 14 different drugs that had been approved to treat that disease. He’s been treated with the standard of care with four of those drugs, as if those drugs would treat his disease, he has not gotten better. And in fact, those drugs actually made him feel worse. But, his numbers continue to be bad and he continues to progress towards what will ultimately be a much more serious problem, which will be a nephropathy, a neurological problem, an ocular problem, a cardiovascular problem, something that could be a very serious disease, that then the hospital will be there to rescue him. So what do we do before that?
Jeffrey Bland: 10:26 Well, obviously the standard of care trying to provide a drug to treat a functional condition has not been working for him—four drugs have not worked. So, he gets into a program that’s involved with what we’re going to be talking about: a big bold health advocacy program, personalizing his care based upon lifestyle intervention, diet intervention, and things that will allow him to be in charge of his own health. Not a victim, but a participant in his health. Now what’s happened? What’s happened in four short months, I just got an email saying that his measurement of his diabetes, which was very, very high, has gone down, and his medications have been completely eliminated, and he is now free of what was considered diabetes. He’s in complete control of his health. That’s a healthcare system.
James Maskell: 11:12 That is a healthcare system. And, you would expect that these results happening over a significant amount of time would have permeated everything a little bit more quickly. But I think what you said that was really clear is that there’s this sort-of architecture that has been created for disease care that is ultimately at odds with the architecture of this new emergence of health creation. What are some of the sort-of roadblocks that have stopped this moving a lot more quickly?
Jeffrey Bland: 11:42 Well, I think the biggest roadblock of all is that of the way that we’ve been educated, because we’ve been educated to assume that the diagnosis and treatment of the disease will give the person the health that they’re looking for. So, we have developed a whole self-consistent philosophy about the provider in absentia to the patient’s engagement being in charge of their disease, not in charge of their health. Assuming that if by the standards of what they have been trained, which is a disease that has standards that they deal with those appropriately, that the patient will go home, and their health will improve, and they never checked back. I mean, there is no mechanism within the system, actually built in, that looks at outcome variables, that’s actually asked the question, you as a patient, how satisfied were you? Did you really feel like your health improved or did just your numbers improve? Or did just the doctor say that your risk to a disease was improved?
Jeffrey Bland: 12:44 And so, I think this process by which we’re going to be giving back control to the patient, to the individual for their health and redefining what health means is extraordinarily important step forward. And that’s why people will say, well, why is this big and bold? It just seems so obvious. It’s big and bold because we have knowing this silently for some years, but never had a system upon which it can be operated or delivered. And secondly, we’ve always felt apologetic bringing it up saying, oh, please think about health when you’re thinking about disease. Won’t you be so kind to really consider health? And we’re saying, no, we’re not going to go silently in the night in hope that we get someone to pick this up. We’re going to say it is time, the technology is there. We can quantify health as well as we can quantify disease, and we’re going to put the control of this in the hands of individuals to manage their own personalized health.
James Maskell: 13:39 I heard a rumor that when you were trying to think about who the co-host was, you said to your team, you said, “Get me the biggest, boldest guy you can find.” And here we are. Why are we doing this together? Why am I here?
Jeffrey Bland: 13:51 Well, I think that there’s many, many reasons. First of all, I think you’re a very sharp thinker. I think you’ve got yourself in the right place to open your ideas, open to new concepts and not be wedded in that, which I was trained in the ’60s. Third, I think that you are a very good communicator and you have a wide reach of different voices that you’re listening to and you’re assembling. And then lastly, I think that you have a strong advocacy. And I believe at this point in my life, at 73 years of age, it’s time to be polite and courteous, but also to have extraordinary advocacy.
Jeffrey Bland: 14:27 I say it’s a time to take no prisoners, because people really need to know what we know and they need to be able to implement it in their lives. They need to not feel victims. They need to be in charge. They need to recognize that the locus of control resides in places out there that they can find services to help them be the master of their own destiny, not just feel that they’ve got to be rescued for something they know nothing about. That to me is the kind of energy that you bring, that I’d like to say at this phase in my career, in my life, that I want to bring. And, I want to be less apologetic, and more direct, and maybe a little bit edgy about this, because my patience grows thin. I have grandchildren coming up—I want them to be in a world in which they’re in charge of their health. They’re not feeling a victim of somebody else’s agenda.
James Maskell: 15:13 I knew my impatience would be a virtue at some point in my life and I’m glad that it’s been recognized. Well, one of the things that we’re going to do throughout the Big Bold Health Podcast and on the Big Bold Health website is ask people what does health mean to them? So, maybe we can finish this episode, the first episode that we do just by sharing what it means as a 73- year-old man living in America today. What does health mean to you?
Jeffrey Bland: 15:35 Yeah, I think that’s a really, really good question. And, I think it’s a very personal question. As I’ve often said, health is one of the most personal, intimate things that we ever have to deal with in our lives. It’s not somebody else’s problem. It’s our own individual definition. So, the way I would define health at 73 in the same body that was at one time 25, would be different than at when I was 25. At 25, my hope is that I would be healthy enough and functional enough that I could start a career, I could give my children and family a reasonable quality of life, that I could start learning how to be a professional in my chosen discipline, that I could engage in all sorts of competitive athletics that I was involved in back then, including basketball, and skiing, and running, and marathoning, and so forth.
Jeffrey Bland: 16:27 Those are all extraordinarily important parts of my definition of health. Many of those I would say, still are part of my distant memories and I would still aspire, but I’m not going to run marathons like I did at 25, I’m not going to be skiing like I did at 25, I’m not even trying to build a career. I’ve already built a career. I’ve already seen my family grow up and now I have grandchildren.
Jeffrey Bland: 16:47 So for me, it’s maintaining high function so that I get up in the morning feeling alive and well and capable of bringing the wisdom of my years of experience to help others. It’s not having infirmities that prevent me from taking hikes with my grandchildren as I did recently, where we did a five-day backpack in the Cascade mountain. So, those are the things that for me define health, but they’re different in terms of priorities than they were for me when I was 25. So, I think we have to recognize personalized health has to do with quantifying the four functional categories that we all really fall under.
Jeffrey Bland: 17:24 And those four functional categories we’ll will be discussing in some length in the future issues of our podcast, are physical functioning, metabolic or physiological functioning—that’s number two. Number three is cognitive functioning, being able to think clearly, accurately, have our memory intact, be able to handle complex ideas, knowing our lives are very at times filled with many different things we have to do, we call it multitasking. And then the fourth is our behavioral or psychological functioning. All four of those are ways that we can define our function and we can qualify and quantify how we’re doing in each of those categories, and we can work in practice to get better in each one of them.
Jeffrey Bland: 18:08 But we may—James Maskell, may find that one of those categories for you is more important than, Jeff Bland has another category. So, how do we personalize so that our aspirations of what we consider to be health are realized by our functional performance? And that’s what we’re going to be talking about in the Big Bold Health Podcast. It’s a very, very different model than, oh, we’re going to try to prevent a disease and oh, we’re so worried about our risks that we got from our genetic testing that said we might get X or Y or Z as we get older, because all of those are avoidable if we improve our function.
James Maskell: 18:43 Absolutely. Yeah, I reflect on that for myself as a 38-year-old man with a family, in the middle to early section of my career, and I think for me, health is being able to be on mission and do what I’m here to do. I certainly resonate strongly with that. Have a young family and so being able to participate in a way that is good for them and good for me and good for my ongoing health and vitality. But, more than anything, I’m glad to bring this conversation to a wider audience, because I feel like it is so obvious to people who live in this world and more and more people are being drawn to live in this world by the state of disease care that we live in, that is clearly dysfunctional, it’s clearly really not working.
James Maskell: 19:35 Whether it’s where I grew up in the UK or the US, my father lives in South Africa. Very different health issues, but actually all the same health issue, is that by focusing on disease care and not focusing on health, we are leading to this epidemic of chronic disease that is bankrupting the health systems and the companies and the people within all these different systems. So, there is an urgency for this shift and that’s why I’m excited to participate.
Jeffrey Bland: 20:03 Yeah, I think that you said something there again, that really merits reinforcement and emphasis. When we watch media and advertising about the state of our healthcare system, this could be electronic media or print media. What do we often see? We see these major advances that are occurring within say things like cancer therapy, which are extraordinary. Like the PD-1 inhibitors now and the things that we’re seeing that unblocked the immune system and allow people to recover from cancers that were previously very, were life threatening of which we had no really good treatment, things like melanoma for instance, or certain forms of lung cancer. And, we’ve seen huge numbers of advertisements for these drugs, which by the way, are very expensive in the hundreds of thousands of dollars. But, they’re lifesaving drugs in people that respond favorably. This is wonderful. I celebrate these advances, but if we actually ask the numbers of people that are affected by these advances relative to the people that have chronic illness, and have lost their health, it pales in comparison to those numbers.
Jeffrey Bland: 21:07 I mean, we’re talking about a very small number of people, and we put so much resources into that, and so much energy and emphasis, and we’re so excited about it. But, how about for the literally millions and millions of people that every day they wake up not well, they wake up with the feelings of not being healthy? They don’t wake up seeking a cancer treatment, they wake up wondering why is it that they’re not healthy, what is stealing their function? And, it’s often said to them if they go to a practitioner, well, you’re getting older. It’s way, way more than getting older. And, these are the things that we’re going to be talking about. How do we redefine health in the personalization of that individual so that their aspiration to wake up and do what they want to do is fully available? That’s the Big Bold Health Podcast.
James Maskell: 21:54 Well, I am thrilled to be here. I’m super excited for everyone who is watching and listening wherever you are in the world. What a great time in humanity that this information can go literally anywhere, a billion people could listen to it at no extra cost at this exact moment where it’s needed, is the exact moment where it’s arriving, and we’re thrilled to be on the journey. So, this is the Big Bold Health Podcast, we’ve been talking about what is health. In the next episode we’re going to be talking about what is disease. But for myself, James Maskell, and my co-host, Dr. Jeffrey Bland, thanks so much for tuning in and we’ll see you next time.
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