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Robin Daly
Hello and welcome to the Yes To Life show on UK Health Radio. I’m Robin Daly and as well as being the host for this show, I’m the founder of the UK charity of the same name, helping people with cancer learn about and access integrative medicine as a means to recover their wellbeing, not only physically but also mentally, emotionally and spiritually. My guest this week is someone well known for his activism in working to change the model of healthcare to one that’s better equipped to meet the rising needs of our increasingly sick population, James Maskell. His is a model that embraces integration and lifestyle medicine fully and so is the direction we at Yes To Life totally support. And speaking to James in the US. This is really great, thanks so much for being my guest on the Yes To Life show.

James Maskell
Great to be here with you, Robin. Thanks for having me.

Robin Daly
So I heard you speak just the other day at the integrated and personalized medicine show and I absolutely loved your common sense approach to the massive issues facing healthcare so I’m completely delighted to get a chance to talk to you about it all. What I heard you saying was putting forward the outrageous idea of people directly helping one another to get well and that being a far superior model to our current doctor, a patient one. So you know what do you say if you’re on the spot to come up with a quick answer and you need to respond to a critic who’s saying that what you’re suggesting is a crazy and dangerous idea.

James Maskell
Well, I mean, we’re in a crazy and dangerous situation right now. I mean, if you look at the costs of health care, the outcomes of health care, especially in America, you know, where I am, you know, we have a significant dip in life expectancy, which is unprecedented in human history. So just continuing with the plan that we have right now, I would say is crazy and dangerous. A pharmaceutical first approach to chronic disease has failed, is failing in front of our eyes, and ultimately, you know, I think it’s time to really radically rethink, you know, what we do. But ultimately, it’s not really a radical rethinking. It’s really just the way that we used to do things. And I think that there’s, you know, it was community supporting each other. It was, you know, using the value of the people in the community that, you know, had wisdom and passed that wisdom on. There’s certainly a place for conventional medicine and dealing with acute illness. And you know, there’s been some significant gains from that, actually, even in cancer. You know, the numbers in cancer are actually in some ways better than other diseases, like autoimmune diseases. But ultimately, you know, if we want to create robust health outcomes, we really need to think again. That’s what I’m all about.

Robin Daly
Brilliant. All right, good answer. So I want to hear a lot more, of course, about your ideas, but I wondered if you’d mind if we started off with a little dive behind the scenes to hear about you and your background. On your website, you’re described as a community builder, a healthcare entrepreneur, an author, a speaker, and a podcaster. None of those sounds like any kind of conventional healthcare professional that I recognize. You know, how did you get into all this? What brought you to this work?

James Maskell
Well, if you pull those things together, I would kind of see myself as an activist, but like I got a bit bored of just being active and wanted to actually build the new systems that make the existing systems obsolete, as Bucky Fuller would advocate for. So that puts me into podcasting and writing books and creating communities and starting companies because I, you know, I’m looking to actively solve this, you know, solve the problem. And it seems like those are some of the tools that could get us there. I had a very unconventional childhood with regard to the health care that I was given by my parents. So I had a chiropractor and a homeopath growing up and didn’t really realize that that was abnormal until I went to school and realized that no one knew what those things were. I was the only kid in school whose parents had to be consulted before being given antibiotics. I remember going into the school nurse’s office and there was a sort of a post-it note saying, James Maskell, do not give antibiotics before calling parents. And it was the only note there. Right. I would guess that if you went into that school nurse’s office today, there’s probably a hundred notes of all different types of things, because that was 1988 when I was eight years old. And, you know, since then, we’ve seen the biggest growth in chronic pediatric illness in human history. So it would be a very different look today. But back then, I think, you know, what my mother understood was that every action has an equal and opposite reaction. And if you, you know, if you deploy an agent to kill everything, which is the meaning of the word antibiotic, there will be some negative side effects. And we’ve obviously seen that. So, you know, through some of my own personal journey along the way, it really started to come back to the question is like, what did my mom know? How did she know? She didn’t have any medical training. What was, what was this all about? And how was she right? Like 30 years before the science came around to the fact that you shouldn’t be overusing antibiotics. And that took me on a journey to one, understand alternative medicine in all of its weird and wonderful forms to try and really understand the answer to one key question, which is, is chronic disease reversible? And I came to that question from my health economy, health economics training, I went to university in England, I did economics with a focus on health economics. And I learned during my three years at university that in my lifetime, you know, both the NHS and England, where I grew up and in America, where I was born, both health systems, seemingly, you know, divergent in the way that care is paid for and how the whole thing set up have one big thing in common, which is an exponential rise in the cost of care that is driven off the back of the rising cost of chronic illness, which is driven off the back of rising rates of chronic illness treated with a pharmaceutical first approach.

James Maskell
And ultimately, I wanted to really understand, is there another way? And so 18 years, I left England, I moved to America, and I spent, you know, the first nine years really like trying to understand if chronic disease reversible, under what format is it reversible? And then the last nine years have really been starting to put a plan into place to reverse it at the scale that it exists.

Robin Daly
Fantastic. What took you to the US out of interest?

James Maskell
Well, in England in 2005, there wasn’t a lot of innovation happening in care delivery. There were small practices of people doing what I would now call integrative or functional medicine, but it was very small and niche. You had this dominant health system, the National Health Service, which is a gem in so many ways, but certainly doesn’t drive innovation. I don’t think many other people were aware of the sort of coming issues that would be arriving that we’ve seen in the last 15 years of inability to contain costs, massive growth in chronic illness, lifestyle-driven chronic illness, but that was the topic of my dissertation. I went to America because, well, I knew people who were in that world in America. I had an American passport. I knew that I wanted to follow a different path. I always wanted to work in America, and in particular, I wanted to live in New York. It just always appealed to me. So I left with the opportunity to work in a clinic that was pitched to me as sort of like the future of primary care, which was essentially integrative medicine being delivered in a spa environment in Georgia. So I moved, and for the first year and a half, I worked in that clinic, and I saw things that I know that most people weren’t aware of. I saw chronic disease being reversed. I saw someone coming in, and six months later, they weren’t taking all the medication. They looked visibly different. I saw people whose whole look had changed because they had reversed their chronic illness. I knew at that point that I was in on a secret in a certain way that chronic disease was reversible under certain circumstances, and that was my first step into this world. Then over the next few years, I wanted to see, was this a one-off? Are there other clinics that do it like this? Does everyone do it the same? Do other people use different services? What is Chinese medicine? What is Ayurveda? What is homeopathy? What is integrative medicine? What is naturopathy? That was the early part of the journey to really understand how do these things work? How do they work with each other? How are they paid for? Are they scalable? What is the data behind them? Try to understand the whole industry. The next job that I took was actually as a sales rep selling to doctors who were doing this innovative work. In that job, I got a crash course in all of those topics and very quickly started to understand what was real, what wasn’t, and an idea of the state of the game in 2009 in those industries.

Robin Daly
Amazing. So a real journey and very interesting. So maybe we can look now at the kind of breadth of your work. It seems like you know you’ve got a very broad vision, obviously a very big vision what you’re aiming for and so it’s quite difficult probably to focus that down to where you actually put your attention, where you put your effort, what’s the most important place to place your attention and so maybe you want to tell us what it is that you’ve built, what you’ve been working on the last few years.

James Maskell
Yeah, sure. Um, well, look, the actual, the question is always the same and it’s still the same today. The mission is the same. The question is still the same, which is how do you bend the cost of healthcare costs and the curve? How do you flatten the curve of healthcare costs? How do you create a broadly resilient, healthy population from a population that is going in the other direction, right? How do you facilitate that? That’s always been the question. So the first question is, you know, is there an operating system of medicine by which you could, you know, is there an operating system of medicine by which you could get groups of practitioners to work together to reverse chronic illness? And that’s what led me to functional medicine. Um, you know, functional medicine is, uh, is that operating system. It, it allows groups of practitioners to work together. It creates sort of like a common language for practitioners. And so the first thing that I did, you know, after a number of other like fits and starts and learnings along the way, the first notable thing we started something called the functional forum in 2014. And it started as a meetup for doctors in New York who were interested in functional integrated medicine. And it, it just was the right thing at the right time. You know, we were the first people really to put medical education on this topic for free online. And we added this live show format that still persists to this, this year. It’s always, it’s always the same. Um, it’s a, it’s a, uh, on the first Monday of every month. And the last one that I just recorded was sort of a wrap up of the conference that we met at. Um, so it had, you know, some of the other speakers there. Um, we actually, you know, off the back of that show, one group in New York turned into, at one point we had about 400 different decentralized communities around the world of doctors coming together to watch the show, to connect, to learn about functional integrated medicine. And that was the sort of the first thing that we did. Um, and look, if, if just learning about it could change medicine completely, then that would have happened already because, you know, we’ve had millions of views of our videos and lots of doctors have, have viewed the content and have seen other doctors just like them, you know, reversing chronic illness and teaching others how to do it. But that’s, that doesn’t change everything. There’s still a lot of friction in, you know, in the transformation of healthcare. And so, you know, um, once we had put out all this content and got good at distributing content, we did summits, we did two summits called the evolution of medicine summit, 2014, 15 in 2016, I brought out a book called the evolution of medicine. And the goal was if I gave that book to a conventional doctor, if they read it in three hours at the end of reading it, would they be like, I should be doing this. This is like my calling. And so that was, um, you know, that’s the next thing.

James Maskell
Um, and you know, we’ve helped a few thousand doctors over the last 10 years, make the switch from practicing conventionally to practicing in this new way. And I’m very proud of that. But again, if that was able to do the job to do the mission, it would be over. Like we would have just done that and healthcare would have changed and we would have reversed chronic illness, but you know, just the model by which, you know, if you, if you help a doctor make a switch to that kind of medicine automatically, because of the sort of inefficiency, you know, that the time that it takes to really get to know someone, really understand their story and really get to the root cause of their health dysfunction, it’s just really inefficient. And it just means that like most, it can’t be deployed at the scale that it’s needed to, to, you know, really make an impact at the scale that we need to make the impact with. And so that’s when, you know, I started to sort of branch out, but yeah, the first, the first part of it, which I would broadly call the evolution of medicine, it’s a book, it’s summits, it’s the functional forum was all about helping doctors make the switch to see the light and learn to practice in a new way. And we created, we, you know, we shared some innovation, we spread the word on a new model of practice, not just clinically, but also it was just around the time that telemedicine was becoming popular 2014-15. And so we sort of created a framework for doctors to practice in a way that could reverse chronic illness, but also step out of employment and start their own, you know, private practice, doing this for members of the community.

Robin Daly
A brilliant scheme and that’s still running, even though in some ways you’ve moved on. Yeah, that’s still running.

James Maskell
It’s not that I moved on. I just, I found a home for it where it could continue to run and I wouldn’t have to be spending all my time doing it because, you know, it, but one of the things I’ve learned along the way and, and, you know, I’m still learning all the time, I think is just that, um, yeah, it takes team work, it takes discipline, you know, it takes organization. And so, you know, that, that business continues. We now have communities. In fact, one of the things that we did while I was in London, when I met you is we had relaunched the London functional forum. So that’s now a quarterly meetup for doctors who are interested in that. And we’re looking to really build like permanent new communities in each city around the world of doctors to think like this and want to meet others that are like them. And, you know, the, the goal to help doctors make the switch still, still continues, you know, but there are a lot, there’s also a lot of other people now doing that, right? There’s, there’s dozens of doctors who have made the switch who can teach you how to do that. And so, you know, I feel like we accelerated it, we got it going, and there’s other people that can sort of take that on. And now it’s onto the next question, which is like, I just saw the flaws in that plan. Once you get into it, and once you start executing, you realize the flaws, which is that, I mean, not to put too much finer point on it, but like, poor people can’t get access to that care, right? Because typically those doctors now have a cash practice because they can’t do it inside the system. And that means that the majority of people who, you know, are not able to pay cash for medicine are now going to have to, you know, are now going to, you know, are not going to be able to avail of that care in that model.

Robin Daly
So yeah, you’re right, you identify the real problems, the affordability and also the other thing you mentioned is the sheer resource that’s needed in order to give the amount of attention that’s needed within the usual doctor-patient model. Everybody’s sort of seen that coming like, well, what on earth are we going to do? We want to go this way. It’s got such obvious benefits from a healthcare point of view, but how on earth do we deliver this? So this is where you’ve stepped in with really a bit of genius thinking, I think.

James Maskell
I’m paying attention all the time, right? So I’m looking and listening to what I’m learning. I’m seeing what’s happening out in the field. And, you know, as an economist, I was always looking for, like, what is a more resource efficient way of doing the same thing, right? We can’t always have incredibly well-trained doctors spending incredible amounts of time with each patient. That model can’t scale. So what can? And in 2013, actually, before the Functional Forum started, I was speaking at a conference on practice management for functional medicine and heard a doctor called Shilpa Saxena talk about a group model that she had developed where, you know, instead of just, I think it all came about because she had eight patients in the afternoon and all, she was going to spend her, like, 10 minutes with each of them. And, you know, they all had type 2 diabetes. And so she, her nurse was sick. And so she just asked the front desk to say, look, have all of them come together and we’ll just do them all in a group. And she noticed a few things, like there was magic in that, the group model. They all had kind of similar questions. One person’s question was valuable for other people. And they all had an eight, 90 minute experience. So they all got a long, much longer experience. And that was the beginning of her journey to really think about, okay, is the group, is it valuable? And that was the first time I heard of the group. And so just perk my ears up because, like, one, I sort of grew up in community and I understood that function. But I was also aware of things like Alcoholics Anonymous, you know, which has a group function. And from then on, all the way through, really, we were always talking about this group function. In fact, my TEDx talk in 2015 was called Community Not Medicine Creates Health. And I talked about group visits on that TED talk. So it was always part of, like, what I was most interested in. And then, yeah, in 2019, my partner, who I built Evolution of Medicine with, passed away sadly. And I just had a moment of reflection to be like, okay, what did we do together? What parts of it were valuable? And really to take on what we had spent years talking about, which was that essentially the only scalable model to really deliver this was to do it in groups. And so I wrote my second book called The Community Cure. And in that book, just really looked at all the different ways in which… this new operating system of care, functional integrated medicine, when paired with a group model had transformed outcomes, you know, across, you know, across all the different sort of, uh, clinical areas where it had been deployed. So, you know, from type two diabetes to mental health to autoimmune disease, multiple sclerosis, even cancer, which is, I know, interesting to your listeners, you know, where had the group model been deployed and what were the outcomes and the further and further I, I dived into that, I realized one, the outcomes were sensational.

James Maskell
Um, second, it really was very resource efficient. And third, there was enough data to sort of justify this. And that data was coming from credible enough places to sort of move the needle on healthcare. So I wrote that book in 2019. Um, I started out by doing a podcast series where I interviewed like 13 of the leaders in this space. And the first interview was with this doctor called Jeff Geller. And from the moment that he spoke, from the first 10 minutes of us speaking, I was like, man, this has got to be its own book because it was just such an inspiring and powerful story. So that was it. And I, I brought out that book and you know, Hovid came, I brought it out January, 2020. I actually did an event in at the Birmingham functional for a meetup in 2019. I did an event called the community cure for the NHS and essentially talked about my thesis of applying this group medicine philosophy to the NHS and talking about some examples of how it had already worked. But sadly, you know, in a certain way, COVID came along and even, even before my idea could like really take hold, um, you know, all groups were destroyed overnight, right? You could sit in a room with a bunch of other people. And so I had to sort of, again, think about what am I going to do now? Because I’ve just put this into the world. I so strongly believe that this is it, right? This is the right operating system of medicine, because it can reverse chronic illness, the right delivery system in that not only does it, um, does it do it in a resource efficient way, but the, the knock on effects to the individual from the individual to the group, to the community, to the health system are all the positive benefits that we want, right? All the, all the positive benefits. If you apply this sort of like group model to the biopsychosocial health model, you see that there are incredible benefits for the individual, right? Self-efficacy, self-regulation of emotions, building skills, like all the things that you want to try and create a community or a society of healthy humans, but there are knock on benefits to the other people in the group. And then there are knock on benefits to the community as a whole. And if you look at what ails us more generally, I couldn’t help but see that if you, if you were able to scale this kind of care in groups, it would be extremely beneficial to society generally. And so that’s, that’s the community cure, essentially. The community cure is, you know, we need to solve loneliness. Loneliness is the biggest driver of all cause mortality. You know, it drives a lot of chronic illness. It drives a lot of mortality. And essentially if you cure it by doing health in groups and doing healthcare in groups with this particular operating system, empowering people together, the knock on effects are substantial to everyone in the group and to society at large. And that’s what we should do. And that’s basically the thesis.

Robin Daly
Brilliant. You’re right. Group work ticks so many of the boxes of the things that we’re suffering from. And it brings in so many different elements into one forum to support people and point them back towards a healthy life. Brilliant. You were saying there that actually there was significant data to back up your idea. Do you want to tell us a bit about that?

James Maskell
Yeah, so in the book, I talk about a number of different data points. There’s some great data in there. I’ll give you a couple of examples of ones that I talked about, uh, actually on stage at IPM. So the first is actually from the UK. So Dr. David Unwin, 2016 NHS innovator of the year, him and his wife. Um, he’s a GP in, um, Cheshire. They started a type two diabetes reversal group and in the British medical journal, I think January, 2022, uh, it, it basically showcases not just the fact that half the people that have signed up for his program have reversed their type two diabetes, but that the cost savings of diabetes drugs is extremely significant. And if, if that were scaled out to every population, it would save a quarter of a billion pounds, but that doesn’t take into account all of the other savings of creating healthier humans. That’s just the savings on the diabetes drugs. What about the savings on under, you know, less use of A and E, less use of doctors, surgeries, less use of other drugs, you know, for mental health or chronic kidney disease or COPD or all of these other diseases that go hand in hand with, with, um, with type two diabetes. So essentially, you know, that’s one example. And, um, you can look that up. I think that’s BMJ January, 2022. And then in America, the Cleveland Clinic center for functional medicine has actually been, you know, the first major medical institution to bank on functional medicine as what they saw as the operating system for reversing chronic illness. And so, um, they put out two pieces of data. The first, which is in JAMA in October, 2019 showed functional medicine, outperforming conventional medicine in the Cleveland clinic, as far as chronic disease, and that in April, 2021 in the BMJ, um, that their group delivered functional medicine, which they created something called functioning for life at the Cleveland Clinic, and they deliver functional medicine in groups there. And these like 10 week cohorts run by health coaches and, uh, PAs and dieticians. Um, they showed not only better outcomes, so better outcomes than one-on-one functional medicine, something that we think is so good, which is spending a lot of time with the doctor. It was even better than that, but also way more resource efficient because you’re not having to use doctors at all. In fact, there’s no doctors involved in the groups at all. And so, um, yeah, so that’s, that’s great. You can, you can check that out. So those are, those are two, there’s more, you know, developing all the time. There’s more in the book, especially in some really interesting areas. Um, we’ve seen it with MS. Jim Gordon went to, uh, Kosovo after the, um, the, uh, the war in the Balkans and, you know, was, did an incredible job with PTSD by having people do mindfulness based stress reduction in groups. Uh, so, you know, all across the board, there’s really interesting, uh, data for, for group work and, um, and particularly when you can have the group last long enough, that real human connection is created between the participants.

James Maskell
Which wasn’t the early groups, early groups is just, you know, a group of people together one time. This is like real connection between, between groups in that.

Robin Daly
Very important, fantastic. So where have things got to with creation of groups? I mean are there loads of groups in the States now?

James Maskell
Well, you know, COVID, as I said, like about two years, it took about two years for anything to happen. But, you know, I didn’t, I didn’t just stop for two years. I’ve been for the last two years, we’re working on a project to deploy virtual groups. Yeah. Because I recognize that, like, well, telemedicine thrived during COVID and now telemedicine was paid for by insurance. And I had seen some examples of virtual groups before the pandemic. In fact, in chapter seven of my book, I talked about one particular doctor under the topic of the future. That was the chapter seven, which was like, in the future, we’ll see virtual groups and we’ll see remote patient monitoring. And in fact, it ended up being, if you look at, if you look at COVID, one of the big problems with COVID was that you had all the sick people converging on physical locations, i.e. hospitals, right? Which meant that the spread of COVID between sick people was awful too. So actually what you want in COVID is you want decentralized care. You want people being taken care of in their homes. So what would be an optimal model? Kind of exactly what was shared there. Everyone at home, you know, higher risk people with like oxygen saturation monitors. If your O2 level goes below 95, you get a call from a doctor. If it goes below 90, a doctor comes to your house. And if you go behind below 85, maybe you do go to hospital, but essentially you can keep people out of the ER. You can keep people in their homes. And that’s what Dr. Rauner developed. And then you use the power of the group to actually, you know, to keep people connected in, you know, from home as well. So that’s where I, you know, so for the last three years, I’ve been working on a project called Heal Community, where we deploy virtual lifestyle medicine, functional medicine groups as a service to industry. And we now have two healthcare systems that are using it. And now we’re starting to get some interest from payers, insurance companies, bigger health systems, even the NNHS to deploy these groups. And you know, even though I would say an individual group session is better in person. I mean, I just feel like there’s something powerful about being in person. I’d be part of a men’s group for the last four years that meets in person every week. And, you know, we took a few weeks out during the pandemic to meet on Zoom. But in general, we meet in person. I know the power of in-person groups. However, I think in order to deploy group care across a whole population at scale, which I think is really the only way to solve the issues in the NHS as an example, I think the when it comes to scaling to a much larger population. And that’s one of the things that I’m a strong advocate for at this point.

Robin Daly
Well, we’ve ended up thinking much the same. We have groups and we deploy both kinds. There’s definitely huge benefits to real world groups, sure, but we’ve also found through having to create and use virtual groups that they have their own virtue, didn’t they? There are plenty of people who wouldn’t even make it to a group because they’re not very well or they’re living the outer Hebrides or whatever it is. For them, it’s an absolute lifeline. And as you’ve pointed, the power of these things is fantastic, especially when it’s a committed group that meet regularly.

James Maskell
Yeah. Um, I actually, I wanted to talk about, you know, there’s one group that I featured in the book, particularly with regard to cancer. They’re called healing strong and healing strong was a group for people is a group for people who are implementing integrative care modalities into their cancer treatment and are looking to meet with other people who are doing that. Because ultimately like that can be a testy time, right? There’s a whole spectrum of information about cancer and alternative therapies. And, you know, ultimately this creates a structure for people to connect together and ideally to help people, you know, um, make the right choices and to support them in doing health, creating modalities, right? A lot of, a lot of content that we’ve had with regard to cancer over the years on functional forum as an example, with regard to integrative oncology is that yes, your doctor will be very good at coming up with a disease care plan, but what’s your plan to actually have to be healthy? And those two things don’t need to be in conflict. Um, in fact, they can be, they can be synergistic. And probably if you’re looking at cancer care, you know, and you’re looking for optimal cancer care, you’re probably looking at some integration of, of, um, you know, uh, health creating services and disease, um, services. Uh, that’s my opinion.

Robin Daly
Now, I completely agree. I think they go together very well. As you point out, the conventional medicine does acute medicine really well. We all need that at times during cancer particularly, so it’s a great to offer to someone going through conventional care. I mean, it’s got a lot to offer for the stop, but that particular area of making conventional care much more manageable is something that, you know, I’d love to see more of, and we’re always pushing in that direction, but it’s a tough nut to crack, though, one.

James Maskell
Yeah. Well, I appreciate you and other people really getting after it, right? To try and lay that foundation. So yeah, it’s a teamwork.

Robin Daly
Yeah. So your group you’ve just described, is that a virtual group, your cancer group?

James Maskell
Uh, no, well, healing strong is, is something that existed and I talked about it in my book, it exists. You can go to healing strong.com. I think we have communities all around the world now. Now what I’ve created is called heal community. It’s, it’s a B2B tool. So we, you know, our tool is used by health systems to deploy virtual groups to their patient populations. And you know, we’ve been doing it for the last few years. We’ve got some really incredible data from it because we track all the outcomes. Right. So we’ve got great data. Um, we’ve had great success with it, but mainly serving like individual practices and a couple of health systems. We’re in the process of retooling it to be able to be deployed at the scale that it should be deployed at, which is in the millions of people. And so we’re rebuilding it, building the technology for enterprise with all the things that we’ve learned along the way. And, uh, we expect to, um, you know, to be able to deploy significant, uh, you know, to significantly larger populations in 2024 and beyond.

Robin Daly
Well, that’s what we need, you’re right, it’s a big problem, it needs big answers. So the completely radical thing about what you’re suggesting is, I mean, you described a situation which had no doctors in it at all and gave better results. You’ve got an entrenched business model of healthcare, it’s been built up slowly over decades. In the main, we’ve got doctors fully signed up to the system despite all its immense shortcomings. So the move away from vertical to horizontal model of care, it’s going to involve doctors stepping off this cosy pedestal they built up for themselves and being much more supportive, I suppose, more in the background. And for many, that’s never going to be an easy change to make. With patience, I think that the battle for hearts and minds of integration is well on the way to being one as it gets more and more public, the whole story of integration. But how do you go about persuading doctors that this is a good direction?

James Maskell
Well, you know, it’s a good question. I mean, I actually don’t think the doctors are on the sideline or anything like that. I think doctors are critically important. I mean, I guess let’s talk about the NHS because it’s different in the UK, right? And then the US. So in the US, the way that we’ve got traction is that actually, I mean, using the most obvious incentive that doctors and health systems have, which is to make money. So in our model in America, doctors make more money by prescribing these groups than they do by prescribing drugs, right? That’s not that difficult to understand. Okay. So, you know, that’s the model that we, you know, have chosen in the US. In the UK, I actually don’t see that the doctors are in any way stepping away. Well, you know, right now, the pressure on doctors, whether they be in the GP or secondary care or in, you know, in hospitals is insane, right? There’s way too much demand, there’s not enough supply. So really, I mean, this is not the doctors stepping out the way. This is just having some other plan of keeping the chronic care seekers, the people who are coming in, you know, every week with the same issue and clogging up all of those sort of the places where you can go to care, GPs and hospitals, you know, it’s about finding a way to keep those people healthy. So they don’t clog up the system. And in, in, as I’ve spoken to GPs and shared my plan for this, which is essentially like, let’s take, you know, as an example, let’s take the 6 million or 6.7 million people right now that are waiting for some sort of therapy. They’re waiting for a, a, an operation. Let’s put them into these groups. You know, depending on what the issue is, you know, obviously, you know, there’s a, there’s a chance that they could not need that surgery. I mean, you’ve certainly seen with things like back surgery, if you reduce systemic inflammation, if you help people do certain exercises, which is included in the groups, I mean, there’s definitely examples of people who have needed surgery, not needing surgery. So could you reduce that number by 20, 30% by putting people into these groups? At the same time, the outcomes of the surgery for the people who do have surgery will be better because we’ve seen that again. If people are healthier, they have better outcomes from surgery. A lot of these surgeries are to do, you know, are being caused by excessive weight, the knee surgeries and the hip surgery. So if you lose a bunch of weight, um, I can help the outcomes of those surgeries. So that’s, you know, one example, when I share that with doctors, they’re like all about it because they know these people are in a waiting list for a reason. There’s too much demand. There’s not enough supply. So we’re not, you know, we’re not pushing doctors out at all. What we’re just doing is like deploying the right care for the right things. For lifestyle-driven chronic illness, you need lifestyle-driven care.

James Maskell
And that’s what’s delivered in these groups. And you know, for acute illness, you have doctors do what they’re best at. And it’s all about putting the right people in the right seats on the bus. The doctors have been in every seat because that’s just the way that it was created. And look, it’s, I just want to say one thing, Robert, it’s not wrong that we created the system that way, right? And if you look at the disease, the types of diseases that were around in the 1950s when the NHS was created, right? It was a lot of trauma, right? So it’s like car crashes and broken legs and that kind of thing. There’s a lot of infection, right? There’s a lot of acute issues. It’s totally reasonable to have a doctor-driven system for those kinds of issues because that’s what is, you need the best clinician to make the best diagnosis to get the care moved along. Cause these are acute in nature. If you mess up, the person dies. But the vast majority of what we’re dealing with today is not that. And so we just need to have an appropriate system for it. And when my experience with doctors, if I have an opportunity to sit down with them at all, they think this is totally reasonable and actually a much better use of resource. So I don’t see any sort of, I see it more as a synergy rather than any sort of conflict. Well, that’s great.

Robin Daly
Anyway, it’s a real light bulb, the fact, the thing you mentioned earlier is that actually the results from a group exceed the results from a single functional medicine practitioner one-to-one, which you’re right, there’s a tendency to think of that, well that’s the ideal if you could afford it, and actually a cheaper solution comes up with a better result, which doesn’t often happen, but that’s nice. So I just wanted to look back at the whole movement a bit to finish off, I mean for me I’ve been looking at integrated medicine for years and what drives it and what all the touch points are for moving things along, what all the sticking points are where we need to pay attention, and the one thing about it is that it seems to be overall it’s a patient driven movement, and one of the things that’s enabled that has been the advent of the internet where people have started talking directly to one another, it didn’t really happen before the internet came along as far as I can tell, and so you get from that dawning to the point we have now where there are thousands of Facebook groups or what have you talking about different conditions and sharing things with each other, and it’s definitely got some of the ingredients of your ideas in it, but at the same time it’s a complete wild waste, and it seems to me that you’ve picked up this idea of patients directly interacting with each other and moved it into a different place. So I just wondered if you wanted to summarise the ways in which you think the HEAL community harnesses all the positives of that community model that grew out of the internet and delivers them in ways that avoid those shortcomings of what’s evolved organically.

James Maskell
Absolutely. So yeah, the first thing is, is that in heal community, it’s deployed as part of the health system. It’s not this other thing that is happening that the doctor doesn’t know about, and that the doctor has no oversight of. And I think that’s some of the biggest criticisms of those kinds of things, where it’s like whatever’s being said, there’s no third party evaluation of it. It’s deployed under the doctor’s nose, right? So it’s not being done by the doctor, but it’s an extension of the doctor’s care. And therefore, all of the issues that are going on with the patient, or if anything comes up, all of that data is going into the clinical record and patient records. So that can all be tracked on like a Facebook group. Second, Facebook and those kind of things are really not designed for health information. I mean, sharing your health information on those things is kind of like a, not a dangerous thing to do necessarily, but certainly the ads that you’ll be received if you do share, you know, will be slightly different, which is just the nature of the Facebook business model. And then, you know, it’s really about like organizing the value of peer to peer. Yes, you could look at something in the Facebook group and you could see someone share a story and you might even connect with them and you might at best, you know, start a friendship with them, a pen pal relationship or whatever, but you don’t know where in the world they are or where they came from, or you don’t know what you have in common with them. You know, in our model, we actually structure the benefit of peer to peer engagement, you know, into the model itself. So, you know, so we have a beginning part of the process where we create safety in the group. It’s a group of 20 or 16 eventually, but group of 16 to 20 people, they’re together for six months. So there’s enough time to really build trust. In general, those people are in a community together, right? They’re in a physical zip code or area code so that they can actually, you know, meet in person outside. We’ve had groups of people go to the farmer’s market together or actually, you know, building a lot at home together. So, you know, that’s, you know, I think it builds on the best of it without, you know, without sacrificing the benefit of it. And also, you know, there is a part of it that is emergent in that, you know, one person’s experience helps another person, you know, one person’s expertise helps another person, and there’s some emerging phenomenon in these groups that’s very exciting too. Like we have a structure that we’ve built and we’ve tested and we’ve tracked outcomes for, which is a, now it’s a 24 week initial episode of care. But if you look at some of the best groups that have had the biggest impact over time, they never stop. It’s not like you just go in and you do a six month group and then you disengage, you know, some of the groups that I talk about in my book are still going 20 years later. What started as a type 2 diabetes reversal group is now a salsa dancing and gardening club, because that’s what people like to do.

James Maskell
That’s how people like to be together and doing those things together is healthy. And it also creates the kind of accountability, support, friendship and communion that is necessary for people to live healthy lives.

Robin Daly
amazing, amazing, 20 years. Great, well it sounds like, I mean what better outcome, eh? You set something like the touch paper and 20 years later those people are living a great life. So yeah, brilliant. Well look, I completely, as I love all your thinking, all your work you’re doing, the direction of it seems completely intelligent and makes good sense to me and you’re clearly demonstrating that you can actually deliver the results by it as well. So I hope people in the UK here who are running things wake up to what you’re offering and embrace it. I don’t know how long that’s going to take but they certainly need some answers here very quickly. Things are going downhill unbelievably fast so yeah this sounds like a brilliant solution. So thanks very much for coming on today to talk about it. It’s been an absolute pleasure, really excited to hear about all your work.

James Maskell
Thanks, Robin. And yeah, keep up the great work. I know, you know, so many people depend on your efforts and, you know, obviously you’ve seen the same thing that I have, which is that if you find the right structure to put people together, you know, great things can happen. And I’m excited to see what comes from this conversation. And if people want to get in touch with us about heal community, go to healcommunity.com. Um, my website is jamesmaskell.com. And, um, you can actually download the book for free. So I kept the rights to the heal, uh, the community cure book. And if you go to the community cure.com slash audio book, you can actually download the book for free and I kept the rights for that second time around so that, um, I could, you know, have this go as far and wide. So if you’ve been inspired by this, download it, share it, do whatever you want to do, um, to get the word out there, because, um, we are facing a crisis. Uh, we didn’t really talk about, it is a physical health crisis, but there’s also an even bigger kind of mental health crisis and bringing people together and have them working on healthy behaviors together is a pretty elegant solution to a pretty tricky situation.

Robin Daly
Well that’s a brilliant offer with your book as well, thanks so much for that. No problem. Alright, many thanks James.

James Maskell
Thanks Robin. Bye bye.

Robin Daly
So good to hear about all James’ work and best of all that he’s producing the figures that take it beyond a great idea into the realm of a science-based direction for medicine. Do look up his book, The Community Cure, the audio version of which is a free download from thecommunitycure.com/audio book. A reminder also to check out yesterlifenualconference.org to see the great line-up of experts who will be speaking and leading workshops at the Yes to life Annual Conference which is on the 7th of October in central London. Thanks so much for listening today, I’ll be back at the same time next week with another Yestolife show.