Gregg Masters 00:04 This episode of PopHealth Week is sponsored by Health Innovation Media. Health Innovation Media brings your brand narrative alive both on the ground in in the virtual space for major trade show conference, and innovation summits of our signature pop up studio. Connect with us at www.popupstudio.productions. I’m Gregg Masters, Managing Director of Health Innovation Media publisher of ACOwatch.com and your PopHealth Week co-host with my partner, co-founder Fred Goldstein, President of Accountable Health, LLC, a Jacksonville, Florida based consulting firm. On today’s show, our guest is Dexter Shurney, MD MBA mph the chief medical officer and senior vice president of clinical affairs for Zipongo, the San Francisco based digital health and wellness company that focuses on enabling healthy eating Dr. Shurney. He is the former chief medical director and executive director for global health benefits and corporate wellness for Cummins Incorporated. Dr. Shurney he also serves as the current sitting president for the American College of Lifestyle Medicine. He has extensive background in Healthcare Management and policy and has distinguished himself as a recognized leader in his profession. Prior to Cummins, Dr. Shurney was the chief medical director of the employee health plan for Vanderbilt University and Medical Center. During his tenure at Vanderbilt. He also held joint faculty appointments as assistant clinical professor division of Internal Medicine and Public Health and adjunct faculty Owens Graduate School of Management. So, Fred, over to you help us get to know Dr. Dexter Shurney,
Fred Goldstein 01:51 thank you very much, Gregg and Dexter, welcome to PopHealth Week.
Dexter Shurney 01:54 Thanks for having me.
Fred Goldstein 01:55 Yeah, it’s a pleasure, always a pleasure to talk to you. You’re always doing some interesting work. So why don’t you give the audience a little bit of of your background and some of the work you’re doing now?
Dexter Shurney 02:04 Absolutely. Well, I’m a physician. And I was initially trained in general surgery. And I gradually made my way to what I’m doing now, which is lifestyle medicine. I’m also board certified in preventive medicine. And one of the things that I I thought early on in my career is that a lot of the things that I was treating as a surgeon that we’re really preventable, and that’s what really led me to preventive medicine. And then in preventive medicine, I realized that a lot of the things that we were doing in preventive medicine really didn’t prevent much. It was more along the lines of early detection and screening, which was good, which allowed us to treat things at an earlier stage. But other than vaccines and immunizations, we really weren’t providing much in terms of you know, testing for prostate cancer with PSA tests, or mammography is for breast cancer, those weren’t really preventing breast cancer or prostate cancer. Again, it was early, early detection, which is good, but we weren’t really getting at the root cause of why these individuals are getting those diseases. And that’s how I made my path, to lifestyle medicine, and really now trying to get at the root cause of a lot of those conditions. So that it’s even taking prevention to another face, so to speak. So that’s some of the work that I’ve been doing. And most recently, I’ve been doing this in the in the telehealth world, as many of us have been with COVID. And really doing this with tele-nutrition since nutrition is such an important aspect of how we stay healthy. And I’m also the current president for the American College of Lifestyle Medicine, the tele-nutrition piece, I’m the CMO Chief Medical Officer for Ziponogo tele-nutrition.
Fred Goldstein 03:52 Fantastic. So, you know, I’m sure everybody recognizes sort of the major areas of focus specialties, you talk about being a surgeon and preventive medicine, those that did you sort of get into lifestyle medicine, and what that’s looking at and where that’s gotten to? I know, there’s a lot of questions, you see a lot of stuff about lifestyle out there, and all these companies throwing these things out. So could you discuss that from the medical professional side?
Dexter Shurney 04:16 Yeah, well, it’s a good question, Brad. And it’s really something that I think is misunderstood. And so the American College of Lifestyle Medicine, which I’m pleased to be the president of at the current time, we’re about 4,500. Actually, we’re going to about 5,000. We think by the end of this year, providers that are practicing lifestyle medicine, and really the medicine that we practice, is it’s already in the clinical guidelines. So this is all evidence based. If for example, you look at the guidelines for cholesterol put out by the American Heart Association and the American Cardiology, American College of Cardiology, they talk about lifestyle, and in fact, it’s one of the first things they talk about, but then if you look the guidelines, I think the most recent one was about 50 pages or so they only give about a half a page to lifestyle. And the rest of the guidelines are all about which therapeutic drug to use. And so what we do is we actually spend a little more time on that lifestyle piece of what is recommended, even in the guidelines. And we still use the pharmaceutical medications. But if you think about it, in terms of a step therapy, we actually spend more time on the lifestyle, almost like when you use a generic before you go to a brand in the pharmaceutical world, we’re actually relying a lot more on lifestyle, what we find is that, when you do it that way, you actually are practicing one of the most powerful forms of medicine, and I’ll be happy to expound on what I mean by that. But that’s really what we do. And so I’ll just, I’ll just in this little piece of what I’m saying, with the fact that let’s go back to diet, and if you have a child or a grandchild, or whatever, or just even a friend style, and they came to you, you know, they’re like three years old, and they said, Hey, you know, Fred, I just want to eat a cake and ice cream all day, pretty tight three meals a day, what would you say you would say, no, that’s not healthy, that’s gonna make you sick. And so we all understand that, right? And that’s really what lifestyle medicine is about. It’s about eating the right foods. And, and, and even adding foods to which are already eating. So we can talk about that a little bit too, and getting the right amount of sleep, because we know if we don’t get enough sleep, and we become depressed, and we don’t do well, we know if we don’t exercise, you know, our bodies, you know, deteriorate on us, we know if we don’t manage our stress correctly, we know if we, you know, use tobacco and some of these other substances, and drink too much to death, not healthy either. So all of these things are things that we kind of understand and physicians kind of understand. But unfortunately, in medical school, we don’t really dive deep enough into how to use these things on a personal basis to really benefit the patient. And so we have lifestyle medicine physicians that are reversing type two diabetes, and by just using lifestyle. And so what that means is a personalized prescription for what you need to eat, how you need to sleep, how you need to exercise all of these things together in a prescription for the patient. And, and this is so powerful, because oftentimes we say, well just you know, eat better or just, you know, exercise a little more, but we don’t really give them prescriptions based on their individual needs. And then we say that it doesn’t work or lifestyle doesn’t work. And so another way to think about this is that there’s a therapeutic dose that has to be met with lifestyle medicine in order for it to be effective. And so if you think about aspirin, and you have a headache, or you have a backache, you have to take a therapeutic dose of aspirin, you need to have, you know, 650 milligrams, and, you know, two to 325 milligram pills in order to really effectively treat your headache, if you only take a milligram or two milligrams of aspirin is the headache or the backache isn’t going to get much better. But it’s not because the aspirin is ineffective. It’s because the aspirin has been delivered in a sub-therapeutic dose in order to be effective. And we do that all the time with lifestyle. So we say, well, we changed our diet, or we exercise more, but we haven’t done it at a level that’s therapeutic, in order to get the benefits that we can see with these physicians that are practicing lifestyle medicine. And that’s one of the things that the college does is really gets physicians up to speed into how to apply these principles on a personalized basis for their patients.
Fred Goldstein 08:34 And you said something early on, that I think is critically important. And people talk lifestyle and say, Oh, yeah, look at these crazy ads on TV or this telling me to do this or told me to do that. But you talked about you said evidence based? So can you talk about some of the evidence for these types of changes?
Dexter Shurney 08:54 Absolutely. And what you’ll appreciate is that it’s really hard to do a randomized clinical trial on lifestyle, because how do you how do you blind people to what they’re doing? And there’s so many elements of it, too. So it’s not like a therapeutic clinical trial, where you get where you only change one variable, right? You give somebody this pill, and and you see how they perform versus those who don’t get a particular pill or get a placebo? Well, it’s really hard to do that in lifestyle, because as I mentioned, it’s how you sleep and it’s how you eat. And it’s all of these things together. So try to control for all of that. And a trial is very difficult. And so but what you have to think about then is well what other things can we use, and we really looked at in large observational trials for the data. And so if you think that many people are familiar with Blue Zones, where Dan Buettner with the National Institutes of Health and the National Geographic he looked at all the places in the world where people you know, routinely live to 100 And live a full life. They’re not, you know, in the hospital on respirators or in a nursing home, they’re actually vibrant, you know, centerians. And what you find is that they have certain lifestyle habits, they have certain kinds of diets, they exercise a certain amount, they don’t go to the gym, but they have this routine exercise that they do just, you know, as part of their life. And those are the kinds of things that we point back to there. Also, we just actually the college just did a literature search on reversal of type two diabetes. And there are some trials out there that also point to this too. And the trials that are really using a therapeutic dose of lifestyle medicine actually had a 49%, reversal and remission of type two diabetes. And the definition is a person that has a hemoglobin A1c below 5.7%, and is on no medications, not even Metformin. So that’s the definition. And there are folks that are doing that. And then people that were practicing as sub therapeutic, we’re getting like a 7% reversal. And that should not surprise people in that we know that for some time, bariatric surgery can lead to reversal, type two diabetes. And we also know that the people come off their medications, even before they’ve lost a lot of weight, oftentimes, and so it’s not just tied to the weight, weight is kind of a byproduct of some of these other things that we’re doing at least up to diabetes. And it’s not the way necessarily itself, the weight probably doesn’t help us. But it’s not necessarily the weight, there’s some other mechanisms. And so what you find in these lifestyle medicine trials, that is that as we change diet and exercise along the lines that they do with bariatric surgery, even prior to the surgery, and we actually are getting these people to reverse their type two diabetes, I think the bariatric surgery rates around 40%. And we got 49% with lifestyle medicine. And so if you think about the step therapy that I mentioned, in terms of in folks using lifestyle will if they failed, and you can always do the surgery, you can’t go the other way. And so you know, why not use this as sort of a first step before you get to some of those other metrics,
Fred Goldstein 12:08 right makes a lot of sense. One of the issues we’ve been focusing on for the last couple months is this whole issue of health disparities. And what we’re seeing out in the community now with COVID, and things like that, obviously, as you’re taking these, you talked about type two diabetes, and there’s this huge, you know, disparity in the rates of type two diabetes amongst minority populations. And it sounds like lifestyle medicine would be something we want to take to them. But I would assume there are some difficulties even associated with that from the way the systems are set up. Now.
Dexter Shurney 12:40 That’s, that’s actually right. And so we know that the reason the rates of COVID severity and hospitalization and death is higher amongst young populations, is because they have a much higher prevalence of these pre-existing conditions that you just mentioned. And so if you know, one of the things we talked about is that it’s impossible to have a healthy immune system. If you’re not healthy in general, because one goes with the other, right, if you’re if your overall health is good, and your immune system tends to be healthier, too. And so that’s why we see this and COVID. And so the same issues that are causing these high prevalence rates of these chronic diseases in that population is also attributing to to COVID. And it’s really, it comes down to the social determinants of health, you know, the things that people having access to food and places to exercise. And also the stress component is very important here too, because we know that certain populations, due to racial inequities and things like that cause a higher level of chronic stress among individuals. And we know what that does to cortisone levels and glucose control. And there’s a term that I like that they use, it’s called weathering. And so over time, these these things just just chip away at you just much like, you know, the weather does on a stone or the rock of water, you know, and it makes you more susceptible to these things over time. And so these are, these are things that really need to be discussed. I’m glad that COVID has kind of brought this to light so that we now we can have these more serious conversations about how do we what do we do to change some of it?
Fred Goldstein 14:21 And you know, from from my work in Medicaid over the years, and this whole issues you talk about of lifestyle medicine, and those specific factors, you talk about food and exercise, and, you know, access all of those things that are just doubly worse off in these communities. And so, I would think that, you know, as you look at this, from your perspective, you’re saying, Wow, there’s a huge opportunity if we could make the changes in the community to bring lifestyle medicine to them to improve that health.
Dexter Shurney 14:53 Right.
Fred Goldstein 14:53 That’s sort of the focus.
Dexter Shurney 14:55 That is the focus, and we know that we know that this will work. Because those of us that have been practicing lifestyle medicine have seen in our populations that when you change these things for individuals, regardless of their ethnicity or their race, they improve. And so we know that, for example, Japanese women in the 1970s, when they came over to the United States, they had a 500% increase in types in breast cancer, because Japan had one of the lowest rates in the world in the 1970s. And they would track these women, they would come to the United States, and within the first generation, the first 20 years of their rates of breast cancer would increase by 500%. But wasn’t a gene thing. It wasn’t, you know, something that they inherited, it was what changed was their lifestyle. When they came to the United States, you see the same thing with Africans that come to the United States and parts of Africa, their rate of heart disease was like 4%, and the entire population, even among the old folk. And we know that heart disease for African Americans, when they’re in the US, is one of the highest. And so what changes, the lifestyle changes. And so we know that and we’re also they’ve done work on identical twins, where identical twins, the same DNA, they put them in different families, foster families, and they track them, they get different rates of obesity, different rates of cancer, etc, etc. So, lifestyle environment has a huge role to play in this though, what I would like people to understand is that we can do this, there is an answer, but to your point, and the tools that we have, and the access to those tools for these individuals, is what is really holding us back. And that’s what we really have to have to concentrate on. So yes, a large part of my work now is trying to figure out how to do that. I mentioned tele-nutrition, which is fantastic, and reaching out to the people that you know, may not have access to a registered dietitian, not be able to go see them. But the issue there is that a lot of these folks don’t have access to broadband, and they don’t have access to, you know, the technology to connect them. And so if you think about that, Fred, it’s almost as if your technical connectivity is almost another determinant of health in this new day and age where we’re using, rely more on that, to reach these individuals. So, you know, while it helps, in some ways, it it still doesn’t solve the entire problem.
Gregg Masters 17:20 And if you’re just tuning in, you’re listening to PopHealth Week, our guest is Dr. Dexter Shurney, the chief medical officer and senior vice president of clinical affairs for Zipongo and the current serving president of the American College of Lifestyle Medicine.
Fred Goldstein 17:35 Right, it’s absolutely getting to those underlying root causes, of of the situation. And, you know, it seems like we throw the funds at the health care piece of it, and we’ll have more doctors, we’ll have more telemedicine, we’ll do this, we’ll do it. But at the end of the day, if you don’t solve that internet connectivity, roads or someplace to get healthy food and you’re just not going to make a dent,
Dexter Shurney 18:00 you’re not going to make a dent. And one of the things we do at Zipongo is that we actually have food delivery. So if you don’t have that in your neighborhood, then we can deliver it to your door. But that doesn’t even solve the problem. Because oftentimes, these people live in homes that don’t really have, they don’t have the utensils to prepare food, they don’t have the stoves, they might only have a microwave. And in some instances when they deliver the food, before they can get home from work, or before they can get it, somebody steals it off of their stuff. And so it’s just really complicated. But again, you know, for some individuals, this works. And so we’re we’re, you know, we’re moving the bar, but we just have to figure out even even more solution.
Fred Goldstein 18:43 And are there some specific early things you would recommend we do to try to solve these social determinants and disparities that we’re seeing in the population?
Dexter Shurney 18:52 Well, I think, I think that there’s a critical role for education, and education, not only at the consumer level, but also at the provider level. So that more people really understand the necessity of doing these things, because of the power to really improve health, and actually, to, in some way, save our our society from the ever rising costs of health care, because that’s going to sink us over time. If these root causes aren’t taken care of, to your point, we just can’t keep adding more hospitals and more expensive medications to them, While there’s a need for that for certain things, you know, on a population basis, you want to make sure that you ensure the best health of that population, because it’s a no brainer, that healthy people need less services and less medication. And so that’s really where we need to focus our attention. But people need education in terms of what that really means and how to do that. And then there are a lot of bright people that can then start to try to figure that out and help us and how we structure our communities and where we spend our tax dollars and those kinds of things. whole concept is food is medicine means that if medicine is medicine, and we pay for it, and are there components of food that we should pay for to? How do we arrange our SNAP benefits and things like that to pay for healthy food and not to pay for junk food? So what are those kinds of things? How do we set policy in DC that, you know, high fructose corn syrup isn’t subsidized. So it’s the cheapest thing in the grocery store, versus these things that are much more healthy for us, you know, all of these kinds of things are areas that we can make a difference. But without the awareness, without people understanding the need for doing this, it’s really hard to move the needle.
Fred Goldstein 20:38 There’s been some changes, you know, some providers and payers, Medicare and others are beginning to say you can, you know, bill for or pay for one of the services, whether it’s, you know, meals to homes, or transportation or things like that, or even phones, do you think it’s feasible to do this through the fee for service system, or is value based care is going to make it more relevant for providers to consider these kinds of options, where they’re potentially at risk for cost and see this as a way to improve outcomes and lower that cost?
Dexter Shurney 21:11 Yeah, I think I think it’s value based care. Because if you think about it, this is the how the highest value that will lead to better health and fee for service, I think it’s fine when you fall down and break your leg and you fix that, and you get paid for that. But for these chronic conditions, and for maintaining the health of a population, I think we really have to go to value based care and and that, and I think that’s also good, because it’s a way to keep providers whole, if we cut, you know, type two diabetes by 50%. Or we could you know, the need for cardiac bypass surgery or stents by 50%, that’s going to put a big hurt on the health care system. And, and so you want to make sure that these people are on board with what you’re trying to do. And they’re not totally disadvantaged in terms of earning a living. And so we have to direct what they do so that they can still earn a decent living. But now we’re just pointing it at population health, through what you as you mentioned, the value based approach, versus just how much churn and, and, you know, you can generate through doing procedures. And
Fred Goldstein 22:18 that makes a lot of sense. As you look at this from both a physician perspective and a lifestyle medicine perspective, your personal perspective, the changes we’re seeing in the country now, are do you feel positive, we’re gonna make some of the moves that people are asking for, and we need to see.
Dexter Shurney 22:37 Well, I certainly hope so, I try to be an optimist. And so I think that I think that we have a really good chance, as the President for the American College of Lifestyle Medicine, I can tell you that we’ve had conversations now with a National Quality Forum to try to change metrics, both. So for example, when a lifestyle medicine physician reverses type two diabetes, they’re actually being because they’re the patients no longer on meds, right. And there’s really no way to capture that in the system. And so the guy gets dinged for not, you know, their patients not adherent to medication. But you know, they don’t need it anymore, because their hemoglobin A1c is where it needs to be. We’ve reached out to the Congressional Black Caucus, and we had a very warm reception. We talked directly to Hakeem Jeffries. He didn’t give us his staff, he actually spent time with us. We’ve we reached out to HHS, again, we’ve had real conversations with these folks, NIH in terms of how do we further research to your point, can we even expand on some of this the research that’s already there, and the Senate Finance Committee, which is also helping us with some conversations with CMS. So, you know, from that standpoint, I’m very encouraged by the response we have gotten so far, the devil is always in the details, you know, have to align all the interests even more, I think in order to actually affect change, but I am positive for the conversations. Again, the college itself, I remember when I joined the American College of Lifestyle Medicine, and we had a couple of 100 physicians and people like Dean Ornish, you know, some of the names you might recognize, but now we have, as I said, almost 5,000 so it’s really growing and the next president that’s going to take over for me when I stepped down in October, is a cardiologist from Stanford, uh we have Kim Williams, who is the president for the American College of Cardiologists, he’s one of our members. So cardiologists are really gravitating to this because they see how powerful this is, as well as endocrinologist and even rheumatoid, all rheumatologists because they’re seeing how this anti-inflammatory approach that we take actually helps a lot of chronic inflammation that’s the night as for so many of these chronic conditions and so all of that encourages me because these are reputable people. We have folks from Harvard and and and so I think we’re starting to get some momentum. There’s some medical schools schools now that are really starting to teach lifestyle medicine as part of their curriculum. And so I think we’ll get there, I guess for me, because I’m a surgeon, I like the quick fix things quick. may take longer than I want. But we’re getting there.
Fred Goldstein 25:16 Right? Yeah, it’s like you and Dr. Nash talking about the move to population health and value based care. It’s been a longer road than he had hoped gets the look at. It’s similar with lifestyle medicine.
Dexter Shurney 25:27 Yeah, you know, you’d say duh, into obvious Right.
Fred Goldstein 25:33 Right. Right. Fascinating. Well, I think, you know, it’s it. As always, Dexter, it’s great to talk to you and get you on. I think, as you said, this is a growing area that can have a profound impact on our healthcare system, on people’s lives, and on some of the communities that really are suffering through some of these disparities, if we can get these types of services and and into there, I think we’d have a fantastic change.
Dexter Shurney 25:59 Absolutely. Well, thank you for allowing me some time and with your with your listeners. And, Fred, you’re doing a great job with this. You and Greg and I just really appreciate all that you’ve done for population health over the years.
Fred Goldstein 26:14 Well,thank you so much, Dexter. Its a pleasure to have you on PopHealth Week. And back to you, Greg,
Gregg Masters 26:19 and thank you, Fred. That is the last word on today’s broadcast. I want to thank Dr. Dexter Shurney, the Chief Medical Officer and Senior Vice President Clinical Affairs for Zipongo and the current sitting President of the American College of Lifestyle Medicine for his time and insights today. For more information on Dr. Shurney’s work in this space go to WWW.meetZipongo that’s Z I P O N G O.com and the college’s work at www.lifestylemedicine.org. And do follow them on Twitter by @Zipongo and @ACLifeMed respectively. For PopHealth Week, my colleague Fred Goldstein and Health Innovation Media This is Gregg Masters saying please stay safe everyone we here in this deep together and we will only get through this together if we toe the line on basic public health blocking and tackling social distancing, proper hygiene and do wear those masks in public. Bye now