First, an anecdote.
When I moved from the United States to Spain and created Jazztel in 1998, I opted to offer health insurance to my employees—a very North American concept. I asked them if they would prefer that Jazztel pay for a private health insurance plan, or instead, that I give them that money directly. It wasn’t substantial, something like 60 euros (75 dollars) a month. It surprised me to learn that hardly anyone chose the private health insurance plan, that few were interested in private health care, that they were remarkably content with the public health system and that they preferred to earn 60 euros more a month.
Later, I was given the chance to check out the Spanish public health care system for myself, partly due to my mountain biking injuries and also because of my children’s various accidents. I saw firsthand that it was really very good and very free. Especially coming from the US where health care costs some 600 euros (750 dollars) per month and, you have to pay for additional things that are included as insured here in Spain.
Now, let’s “fast forward” to 2012.
We have a bankrupt Spain being bailed out by the EU day-to-day. A bankrupt health care system and with massive defaults, but still with good quality medicine and full of new hospitals freshly equipped with the latest “bubble” models from when we still had credit. All this accompanied by a great debate over the topic of copays and the plan to charge 710 euros (890 dollars) a year to illegal immigrants. Seeing the situation and being an entrepreneur, it occurred to me to make a business out of this tragedy.
Or let’s just say: make the tragedy less tragic by constructing a business to help it.
Spain is the fourth largest tourist destination in the world. We receive almost 60 million tourists per year and almost all of them come from countries where medicine is more expensive. Why don’t we sell our medical services—that are so good and so cheap—to our tourists? Why don’t we launch medical tourism to a larger scale? Why don’t we transform public health care into an export-oriented industry?
How do you do this? The government could launch a big publicity campaign in which they offer medical insurance to foreigners and allow them access to public health care for 100 euros per month. And for those foreigners who travel here without an insurance plan, they would be charged 40 euros (50 dollars) each time they wanted medical attention and not be seen for free as they are now. North American friends that had health problems in Menorca, for example, couldn’t believe it when after receiving medical treatment, were released without being charged. They were willing to pay 100 euros for a consultation; 40 euros would seem like a bargain. Foreigners don’t expect it, but they receive free medical treatment in Spain.
From here we can start to promote medical tourism. Come get yourself treated with the Spanish national health system! We are the longest-living of all big countries in the world!
If the government ensured that one million of the 60 million tourists pay this medical tourism insurance, it could obtain 1.2 billion euros (1.5 billion dollars) a year. To North Americans, being able to come to Spain and while here, go to the doctor for free, all for an insurance premium of 1,200 euros annually, would be very beneficial. The Germans pay 300 euros a month for insurance. And we won’t even speak of the uninsured people in many countries who have money but not enough to afford insurance in their country. In Argentina, for example, insurance that provides the same quality of service as Spanish health care costs about 300 euros per month. I know that getting a million customers isn’t easy, but the market has 60 million. Later we will have to determine the costs of treating these patients, but I find it possible to make a profit. Especially when there is so much infrastructure already in place.
I think the Spanish government has a possibility to finance a part of the health of its people with medical tourism, and that this opportunity should at least be studied. I know many Spanish people think that health care should be free for everyone, but it isn’t—we pay for it ourselves and we can find more customers overseas. It’s time to be creative and sell medical insurance to foreigners with the Spanish national health system.
Most people who are concerned about the health effects of food are concerned about the quality of the food they eat. But in the vast majority of cases where food sickens or kills people, it is not the quality of the food they eat but the quantity. Why are all diets about eating something different of what people normally eat? Why isn’t there a simple diet that says, eat whatever you normally eat but less. And not much less, not starving less, but just a little less, so you may get into a new eating habit for the rest of your life and not just during the diet. So you change nothing but eat a slightly smaller amount. That is my diet. My weight is incredibly constant over the years, I just eat the same diet every day. And when I don’t work out, I just eat the same but in smaller amounts.
It’s not what people eat that kills them, the global obesity epidemic and its toll on life is happening because of how much people eat.
Bruce Aylward Global erradication of Polio #ted
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At first he shows a picture of polio patients in iron lungs. Speaks about the polio vaccine. The last polio case was in 1980 in USA. Polio still exists in some parts of Africa, India, Pakistan and Afganistan. And in 2 countries that had not had polio for a long time polio came back. In Russia they got polio again. But epidemics is being controlled. We need to completely erradicate polio. Polio can only survive in people so we have to make people polio free. We are doing a global partnership to erradicate polio. Disease erradication os the venture capital of public health, great risks but great rewards. Smallpox erradication was an incredibly successful investment, it pays off every 26 days again and again. Same would be true with polio. But the polio vaccine is very fragile and deteriorates in warm climate. And as opposed to smallpox that is so easy to see because of the rash, polio does not show itself when it first strikes, you can’t see the enemy.
To erradicate polio we have to create a 20 million people social movement. They are vaccinating half a billion children every year. It is oral and easy to administer but the problem is to reach all children of the world in the worst places and conditions. They have to operate in war conditions. This is foreign aid at its most heroic. Rotary international is doing this, with over i million volunteers. Results are good.
Polyo Type 2 has been totally eradicated. There’s been 99% reduction 1000 kids in the whole world now, a lot but nothing compared to 20 years ago. But even with 1000 now if we don’t eradicate the disease in 2030 we will have 300K kids again with polio again. A new polio vaccine was developed, old one was 50 years old. New vaccine is much better. Northern India is the perfect storm when it comes to polio. Sanitation is terrible. But with the new vaccine not a single got polio.
In 2007, Loic Le Meur and I came up with the concept of La Fatera. It is described here. The idea was a scale that would share your weight over the internet and help you lose weight socially. At that time the plan was that Fon makes the Fonera and the Fatera. But while at Fon we stuck with the Fonera, a successful strategy (this year alone we sold close to 2 million), others picked up on the concept of the Fatera. The most successful implementation is Withings the WiFi scale. And new social sites to lose weight keep appearing. Fatdrop is a good example.
The obvious reason for the success of the scale and the weight losing sites is the obesity epidemics. 20% to one third of the population of developed countries obese or overweight. Interestingly obesity is so global and popular that in the world now there are as many obese people as hungry people, an estimated billion of each. But other than obesity the psychology of overeating lends itself more to sharing the activity socially to stop it than other addictions. Drug addictions, alcoholism are generally treated in secret in places like AA because taking drugs alters your behavior and there is a shame factor associated with it. Few people tweet something like “I have gone 134 days without shooting heroin”. Yet many people are tweeting their weight with Bob Metcalfe the creator of ethernet is a good example. Over eating is an activity that can be done in public, without shame and that other than the occasional barfing it does not produce any obvious social problems (it’s legal to drive after you overeat for example). But in this case, the shamelessness nature of over eating is a big plus for society to get you to stop. And sharing your weight over the internet is the objective measure of your eating. I see tremendous potential in weight sharing as a way to socially lose weight.
The Global Fund, the largest NGO you haven’t heard about
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Since its start in 2002, The Global Fund to Fight AIDS, Tuberculosis and Malaria has spent $19bn and saved 4.9 million lives. And you have not heard about them. Or at least I had not heard about them. And that was fine. Until now. That is because The Global Fund is in the process of organizing its next commitment round for another estimated $20bn. But what is interesting about this new campaign is that The Global Fund is not asking for your money. Or, at least, it is not asking for your money directly. And that is because, knowingly or unknowingly, you are already a contributor to this campaign, as a taxpayer wherever you live.
In these times of huge government deficits, however, it is important that your voice be heard. That you let your government know that you believe that saving lives around the world, that preventing the spread of AIDS, tuberculosis and malaria is a worthwhile use of your tax money, that you are in favor of what The Global Fund is doing.
The Global Fund is starting a campaign on May 19th that will attract personalities from around the world to alert citizens of donor nations to how important it is that these efforts go on. And you will be asked to sign a digital petition saying that you endorse these efforts. Your signature counts in the sense that governments need to know that their citizens care.
On May 19th I will sign. I hope you do as well.
Avian Flu and the Blogosphere
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Avian Flu is proving that blogs may provide adequate balance to global media coverage of important issues such as the Avian Flu. Initially, when global media was not covering the Avian Flu, news were appearing in many blogs as to the dangers that the disease posed to humans. Now that the national media and Bush himself has gone overboard with the dangers of the Avian Flu, blogs are toning the whole issue down and putting it into the right perspective.
The Wizard of Oz
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I am sure that he´s been called that before. Mehmet Oz, I mean. Still, to me he is the Wizard of Oz and so I will call him that. This is how the Wizard of Oz is described in the classic book:
“So Oz brought a pair of tinsmith’s shears and cut a small, square hole in the left side of the Tin Woodman’s breast. Then, going to a chest of drawers, he took out a pretty heart, made entirely of silk and stuffed with sawdust.”
“Isn’t it a beauty?” he asked.
L Frank Baum
The Wizard of Oz
And it perfectly suits my friend, Mehmet Oz, who one recent morning became a Wizard to me when I saw him perform two open heart surgery operations in a row. This was the closest thing to its art form I had ever seen!
Mehmet is American, of Turkish Origin. He may be Turkish, but when he speaks he sounds like a full-fledged New Yorker. If you do a google search you will be amazed at all the material and sites on the net about him. He is both a great surgeon and a very well known “popularizer” of medicine.
Recently, I was in NYC with my family. One warm afternoon we went for brunch with Mehmet Oz´s family. After we were all seated in a nouveau Mexican restaurant on Park Ave South, my curiosity piqued, I began asking a few questions about that which he had dedicated much of his life to, heart surgery. My interest was met with an invitation. “How would you like to come to Columbia Presbyterian Hospital tomorrow and see me perform open heart surgery?” Mehmet´s overture caught me by suprise.
Given my family history, the offer hit an exposed, but generally well-guarded nerve. I come from a family in which my grandfather, my father and my uncle died in their 40s and 50s of heart attacks. Being in my 40s and consciously working to avoid a similar fate, I was propelled into a temporary stasis. My brain basically split in two. On the left side, my interest in attending the procedure was overwhelming. On the right, I was simply terrified. In the confines of a moment, as it usually happens with me, excitement eradicated fear. “Sure, I would love to go.” “9 am,” he said, and left it at that.
We went on to talk about renewable energy and a conference he had just attended on the subject at the Aspen Institute. Yet, a subject change to windmills and solar panels just didn’t cut it. I could not stop thinking about my crazy acceptance… about hearts, about life and death.
On the morning of the scheduled procedures, I got off to a late start. My internal conflict had not yet been resolved. I fluctuated wildly between some very basic human emotions. Excitement, fear. Fear, excitement. Fear. Taxi, West Side Highway, 170th St and Ft Washington. Excitement. Fear. It was 9:10 when I got there.
Mehmet had already gone from his office down to the operating room. His secretary was expecting me. She told me to scrub up and go down from the 7th floor to the 4th floor, dressed as a surgeon myself. She gave me a pass and pointed me to the hospital personnel elevator. To patients walking around the hospital I was suddenly transformed into a doctor. I immediately felt their gaze of respect. I felt like an impostor.
When I made it to the fourth floor where all the operating rooms were, a nurse greeted me and led me to Mehmet. Dressed in scrub, with a mask, on I hardly recognized him. There were 8 additional people surrounding the still body that lay on the operating table. Nurses, surgeons, heart and lung machine operators, anesthesiologists. This entrance into a situation I had never been exposed to before shocked me. I was reminded of my first flying lesson when the instructor had me stall the plane in mid-air to see if I would be able to put up with the rest of the course. I almost threw up. But I did become a pilot. That day in the hospital was a similar experience. An much like flying that plane, I was not about to fail in my endeavor to witness the event that was to take place before me. However, I had assumed that I would observe the operation from a safe distance, through a glass window. But the reality of it was quite different.
As I approached Mehmet he said, “If you were a resident you would be fired by now, but as you are my friend you can come over and see what we´re doing.” He then pointed to a stool that allowed me to stand virtually on top of the patient. My face not more than 2 ft away from the abnormally still, open heart.
What was to come next defies description. I realize it must be normal to doctors, but to me it was anything but. The patient was covered in green fabric with only the heart area exposed. I was immediately aware that while the doctors and nurses could not see the patient´s head from where they were, it was practically in between my legs.
I started to feel sorry for him. The patient was a man in his 50s. He looked dead to me. He was as pale as I had ever seen anyone who still had breath in his body. His heart was not beating, nor were his lungs contracting. He was connected to a heart and lung machine that did all this work for him. Given that I walked in 15 minutes late to the 90 minute aortic valve replacement procedure, I did not see how this patient´s heart had come to a stop. It seemed to me as though Mehmet was operating on a dead person. His body was cut wide open, his bones broken to accommodate the surgery. How on earth was Mehmet and his team going to put 53 year old, gray hair Humpty Dumpty together again?
Now, it´s not that I am unfamiliar with medicine. One of the companies that I started, Medicorp Sciences, enabled me to spend 3 years working with immunologists. But the world of biotech immunodiagnostics has very little to do with live people, with denuded organs, with real hearts. Columbia Presbyterian…the whole situation..was something else. I was in front of a male in his 50s whose aortic valve, the traffic police of the heart, was failing. Interestingly, because of this it had to do much more work to achieve the same results as a healthy heart, causing it to become greatly enlarged. Mehmet explained to me that surprisingly, enlarged “tough” hearts are very dangerous and heart attacks on them tend to be fatal. He also explained that it was harder to restart an enlarged heart. The restart was supposed to happen in the next half hour.
I believe it was then, while Mehmet was explaining to me the high likliehood of fatality when an enlarged heart undergoes an attack, that I started to faint. Until then my family´s ghost had not been mentioned – HEART ATTACK; but when those magic words were uttered, my blood pressure collapsed. What I do remember was, that as this started happening, I panicked. All I could think was that I would fall forward, on top of the patient and the millions of stitches around his heart, the myriad connections to the heart and lung machine, the sonogram probe, the anesthesia catheters, would all be in disarray, and I would kill him. It was this thought that prevented me from actually fainting. New doctors have to swear that they will not harm patients. In this case I felt the hypocratic oath applied to fake doctors as well. I was of enough mind to say something like, “I am going to rest,” and moved back and sat on the floor somewhere. I was advised to put my head between my legs, as that was supposed to lift my blood pressure from its hurricane lows. It worked. A few minutes afterwards I started to feel the blood flow through my veins again. I went back to the operating table.
The following 90 minutes were not as difficult. Human beings have an amazing capacity to adapt to a wide array of situations in a relatively short timeframe. What was debilitating the first 10 minutes, became less so the second 10 minutes and even less so the second hour. And horror gave way to enormous intellectual interest for my unusual surroundings and the deftly performed functions of the professionals around me. Mehmet was truly inspirational. Not only was he rebuilding Humpty Dumpty with tremendous precision and speed but he was also extremely helpful at explaining to me all that was going on around me.
This is what I understood. Some people have defective heart valves. Heart valves manage the flow of blood through the heart. When these valves leak the heart works imperfectly having to pump much more blood to achieve sub par results. After years of doing this, hearts build up like body builder arms. If these enlarged hearts fail they have a very hard time restarting, leading to massive heart attacks. What Mehmet and his very able team do is open the chest of the patient, inject an anticoagulant so the blood does not clot during the operation, get to the heart, connect the heart to a heart and lung machine, disconnect the heart from the rest of the circulatory system so it stops pumping, open up the heart, cut the defective biological valve, replace this defective valve for a man made valve (that looks as simple as a faucet stopper but has taken decades to develop), install the artificial valve with tremendous skill and tens of stitches, sew the heart back together, restart the heart, restore the ability to coagulate, close the chest. All this while the patient is under total anesthesia, unable to feel anything, unaware of what is going on around him.
After we were done with our first patient Mehmet asked me to put surgical gloves on and handed me the malfunctioning real valve for me to see. He pointed out to me how calcified it was; and it did indeed look very calcified. Upon closer examination it seemed as if the cartilage had grown a bone. As useful as bones are, they do seem a bit out of place inside a heart. Mehmet also said something about the human soul residing in the place where the valve belonged. Being more European than American I felt as uncomfortable mixing religion and medicine as I do when I hear Bush mixing religion and politics so I said nothing.
Bringing this man back to life was a two stage process. First, the heart then the lungs. These two vital organs were “reborn” in two very different manners. The heart started beating slowly. A heart beating, one imagines, is some kind of jerky movement. In reality, is a much slower and awing process. The heart inflates and deflates while moving sideways. The lungs however, are a whole different thing. They appear and disappear, changing tremendously in size as they do. While I was mesmerized seeing the heart and lung machine being disconnected step by step, first the heart and then the lungs, Mehmet surprise me with the following comment on the lungs. He picked up the lungs as they were breathing and asked me “Do you see these black stains here?” “Yes, I responded, looking at these ugly marks that made the lungs appear as if they had fallen on a dirty floor and were stained. I instantly assumed that the man had been a smoker. But as it turns out, I was wrong. The patient was not a smoker. What Mehmet explained to me is that anyone who lives in a large polluted city like New York has those stains and that people who live in the countryside do not. Sufficed to say, I was taken aback by at the severe repercussions of environmental preference.
After Humpty Dumpty was magically put together again, real heart beating, valve working and making a funny noise (it seems that the patient will have to get used to it because he will hear that noise for the rest of his life) I felt prepared for anything. What could be worse than witnessing open heart surgery? Well, I got my answer rather quickly. Witnessing the next operation, a triple bypass, was worse.
By osmosis I had learned that bypasses are done by taking veins away from other parts of a patient’s body and grafting them around the blocked arteries near the heart. But hearing and seeing are two very different things. While the other patient had his chest open while covered with cloth; the bypass patient, an Indian man also in his 50s, was having two operations simultaneously. Two Japanese surgeons, colleagues of Mehmet, operated around the heart while another American surgeon operated on the leg. He was not really covered. The sight of a fellow man having simultaneous surgery, exposed leg and heart, was extremely challenging. This time I managed to keep myself together and made it through the procedure.
The second operation turned out to be less predictable than the first. When the Indian patient was opened they discovered that there was a hole between his ventricles that was not supposed to be there. One of the surgeons proceeded to explain that this surgery was not supposed to involve the use of the heart and lung machine. But given the congenital defect that had to be corrected, the patient needed to put on the machine. So this time I had the opportunity to see what I had not seen during the previous surgery. I watched first hand, a temporary suspension of life…the heart and lungs being brought to a halt and replaced by a synthetic machine. If it hadn’t been that I had already seen that the reverse process actually worked, I would have been petrified. But this time I trusted the Wizard of Oz and his team. I simply watched the heart stop beating and the lungs stop breathing. And because Columbia Presbyterian has all these machines that not only show measurements on screens as pilots do, but replicate the sounds of the heart as the heart beats, I was able to see both the heart stop and most impressively, ceased hearing that comforting beating sound. No sounds have been added to the artificial heart, nor have any efforts been made into making this machine resemble anything close to a heart. So to the untrained eye, when a heart is stopped for surgery it simply looks like the person just died. But he hasn´t died. As soon as the heart was still, the two Japanese surgeons worked deftly, both to correct the hole and graft the veins from the leg and chest around the clogged arteries of the heart, performing the three bypasses. Seeing their hands work with such accuracy and agility was extremely assuring. They could sew the finest of stitch in the closest proximity to the other. There was a Frankesteinian element to the whole thing, particularly as more and more grafts were applied around the heart. These surgeons made it all look like a maki in which different things looked as if they were made to be together. After an hour of work the Indian patient was sewn back and his bypassed heart was working.
Between watching this phenomoenon and listening to one of the surgeons so clearly explain to me what they were doing, I failed to notice that Mehmet had left the room.
When I got to his office I was in for yet another emotional twist in the complicated world of medical science. Mehmet was still in his scrubs, but he was no longer the life saving surgeon performing his delicate art on the operating table. He had transformed into a disseminator of knowledge. “I dont want to sell fifty thousand copies this time, he was saying, “I did that with my last book and as much as I learned in the process, I want to get a million out there.”
Still under the spell of this Wizard of Oz, I looked around his office and took note of the many articles he had been in, the many magazine covers he had graced. Not only was Mehmet a master surgeon, I suddenly realized that he was also an amazing educator and popularizer of medicine itself. The old cliche, “prevention is the best medicine” holds true here. And what better way to prevent then trough the promotion and popularization of its benefits?
And it appears as though he was right about the million copies. This afternoon I went to Borders bookstore with my kids, and there it was.. Mehmet´s book, You: The Owner´s Manual…right next to Harry Potter!
Food for Thought
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I read in Bill Bryson´s book that our brains makes only 2% of our body mass but demands 20% of the energy we consume. And not only that. Since the brain manages how energy is distributed around our body, when there´s an energy shortage the brain makes sure that other organs suffer first. Not unlike elaborate computer chips, our brain seems to have tremendous energy requirements to function properly. If this is so, here is an idea for a new diet….think more and less of your food will become fat.