Hi, this is Nicholas Webb and welcome to another episode of The Healthcare Cure podcast. You know, I’ve had an interesting journey in my career as a management consultant as a owner of various medical companies throughout the years. And, you know, I realized in my later life that I had the opportunity to start hearing different voices and getting different vantage points. And that’s really what I love about my opportunity to meet and work with people at the university I had a chance to evolve even at my ripe age of 62, I began to realize that we are inventing the wrong things. We’re inventing more gratuitous interventions and more treatments and more drugs and more and more and more. And many of these, of course, are important. But what about using our innovative prowess to invent more health in sort of more treatment? I think that to me is the thing that Dr. Power and I were most interested in when we started this process of Fixing Healthcare documentary film.

One of the most amazing people that I’ve had the honor to meet is on the screen today with us, and she is incredible. I, you know, I it’s so funny, because you think you write the books and you give the lectures and you think you know everything of you. The other day, we were talking, and she said, Yeah, Nick, so what about the, you know, the food pharmacy? And I’m like, Well, you know, I am a learned expert in this and wait, what, what’s the food pharmacy? And the next thing I know, my mind is blown. And Azaria taught me that there is a whole new way of looking at the prescription of interventions, and that resulted in this amazing, amazing, enlightening for me and hopefully for you the listener. But before we go into that, I’d like for Azaria to talk a little bit about her journey. She really is an amazing person. I wish that she was running for the President of the United States right now, because I would be her campaign manager, and she would be elected and in a heartbeat, she’s just has a beautiful spirit. I love the fact that everything that she talks about always is about being able to impact other people. And that’s beautiful. And unfortunately, we just don’t have enough of that right now. And I probably should stop doting on you Azaria. But why don’t we, why don’t you introduce us to your awesomeness by telling us about your journey.

Awesome. Thank you so much for that amazing intro. My name is Azaria Lewis. I am a second year at the College of Osteopathic Medicine of the Pacific at Western U. My journey so, I went to UC Davis as an undergrad and kind of experienced some some challenges academically, which led to my going to Charles R. Drew University, which is in Watts, California for post baccalaureate certificate. And you know, it was there that I really saw, you know what a food desert looks like what an underserved community looks like. And the impacts of that, right across the street from our university is the Martin Luther King hospital, which was known at the time as the killer King hospital because so many deaths happen at that hospital. And I think it was that that moment that I realized, how disadvantaged some communities of color and communities that are socioeconomically lower, socioeconomically lower status were impacted by, you know, social issues but also the health care system, how they kind of neglected in general. And you know, my childhood, early on, we would be considered lower socioeconomic status, my parents worked really hard to move us up the ranks, so I wasn’t really exposed until that moment, you know, attending that university for two years, so really opened my eyes and impassioned me. And my goal since then, has been to figure out solutions to the problem that impacts so many people of color and so many people who were low socioeconomic status. So that’s been my mission since and I was fortunate to get a master’s degree at Western U. And now I’m in my second year of medical school, and I’m so excited because you have taken on one of my passion projects, you know, since I’ve been kind of researching and discovered the food pharmacy, it’s always stuck in my mind. So I’m so thankful to you for actually making that a reality so much earlier than I thought it would be.

Well, thanks Azaria and I, it’s for me it’s this is my favorite project, right? This is something that I believe in personally and, and you know, live I live and have lived on a on a plant based diet for, well I started I became a vegetarian when I was just nine, I went to a packing house where my aunt worked vizeum in the Midwest, and boy, I’ll tell you, if that doesn’t turn you into a vegetarian. I don’t know why it wasn’t. It wasn’t just the cruelty of it, which for a nine year old was really impactful, but it was the, like, just seen gross, right? It just seemed really unsanitary. Right. So, you know, I, I, I’ll tell you, I think that what was most illuminating for me was I’ve been talking about diets and the impact of diets forever. But just all of a sudden, all of these connections started happening when you and I had that conversation. And these are these beautiful, strategic and text inflection points in our life when we meet somebody that is the connective tissue. And at that moment, I realized that I had to make this food pharmacy a reality. And now we’ve got all these amazing people, the people that you’ve brought in, we’ve got more people we’ve talked to this last week, and all of a sudden, we’re building a tribe around this. So people that want to make it happen, you know, there was a great book that was written by Paul Zane Pilzer, gosh, going on maybe 30 years ago, called God Wants You To Be Rich. And the book was talking about, in many ways, the economics of wellness and the name of the book was the next trillion. But one of the things that he pointed out, which I don’t think is talked about very much, and we’re trying to highlight this in our film, is the fact that it’s not just the lack of healthy food. It’s the dialogue. I think it’s the discussion. We have people well meaning people in many cases saying we demand more access for underserved communities, and that includes rural communities and intercity communities right. And and I was raised in San Bernardino. And in a very, you know, our, my family was the sub poor, the working poor and, and the concept of health wasn’t a thing, right? I mean, it just wasn’t. But one of the things that he talks about is you have the food industry that makes money by selling salty, sugary, delicious junk food. And then you have another industry that benefits from intervening from the net results of salty, sugary, high fat, delicious junk food. Right? And so you have a lot of marketing money, you have a lot of momentum, and then the people that are supposed to help these communities rather than talking about demanding health, the conversation unfortunately and I’d love your take on this, but unfortunately, it always seems to talk about how we provide more access to treatment doesn’t seem like the whole story to me.

Absolutely. I think that’s such a good point. I think access to healthcare is important. It’s necessary. I think the steps taken to increase the amount of diverse providers in underserved communities are important. But you have to pair that with healthcare, that’s going to be about like you said prevention and health. Providers need to be armed with nutritional education. So they can provide their patients with that information to prevent disease, and maybe even as a treatment option for the one disease are already kind of established. When you think about how often you go to provider ideally, you want to try to minimize it, right? You want to see your doctor maybe twice a year just for a wellness checkup. That’s the idea. And and the point to pharmaceuticals and treatment would be in those dire situations, those genetic situations, those situations that you can’t avoid, and that’s a great thing. It’s necessary, but I think when it comes to the fact that we eat, you know, three plus times a day, I often say, food is either medicine or it’s poison. So that three to five times a day, you’re injecting yourself with either medicine or poison. So you’re going to do that far more often than you’re going to go to the doctor’s office. And with that being said, food is a very powerful source of health. And, and that’s why we need to educate patients about proper nutrition. But it starts with educating ourselves as future healthcare providers and current healthcare providers about nutrition so that we know what to advise their patients and how to guide them in that area.

Yeah, and there’s two sides to that coin. You know, if you take a look at education, you know, we’ve had some guests on the on the program that really talked about why are we using the FDA food pyramid as how we educate kids because they they go home and want to make sure they get their serving of, you know, animal based fat, right? Our protein, and so one part of it is is that maybe we need to have more of a thoughtful discussion about what really is education moving more towards plant based and more towards contemporaneous diets? Right. I think the other problem is, and this is something I know that you probably can relate to in a very practical way, is that it is amazing how much we don’t focus on prevention and wellness and diet and equip medical students with really the resources that they need to be able to even to have that discussion. Right.

Absolutely. You know, nutrition education isn’t really part of medical students curriculum. So you know, what it does is it creates a dependence solely on pharmaceuticals and other methods, instead of kind of incorporating nutrition as part of it as a treatment option that that providers could provide, you know, could give to their patients. So, you know, that’s one thing I’m thankful for at Western U we have the nutrition and medicine lecture series, which is a plant based lecture series, and it has been so helpful and informative to students that aren’t even plant based themselves, you know, it’s eye opening for them, but also it just educate us and give us another gives us another treatment option for our patients so that we can educate them with evidence based plant based medicine. And, you know, when we’re talking about chronic illness and, and chronic illness related to diet, essentially, there are one in two individuals who, sorry, one out of two deaths from heart disease stroke and type two diabetes in the US is linked to poor diet. You know, that’s a huge number. That means you could prevent half of the deaths related to chronic illness through diet. That’s amazing. And when we’re talking about you know, the numbers of Americans that have chronic disease, 6 in 10 adults in the US have chronic disease, 4 in 10 adults in the US have two or more chronic disease. And these diseases include heart disease, chronic lung disease, stroke, diabetes, chronic kidney disease, those diseases that I named are preventable, for the most part. Sometimes there’s a genetic predisposition. But that’s a very small percentage than what we’re seeing in the United States. These are preventable, meaning that with healthy diet, these diseases don’t even have to come to patients don’t have to ever experience this these chronic diseases, and then those who do have them can reverse them.

You know Azaria, one of the things that’s interesting is some experts are now saying that 70 to 80% of all healthcare costs come from self inflicted chronic disease, which is almost exclusively being overweight. Think about that, that imagine how much wellness and health and resources and treatment we could provide if we could save at 80% of healthcare costs by people just not eating their way into chronic disease, but there’s a trigger mechanism. If somebody presents themself to their primary care physician, they’re 45 pounds overweight, and they’re hypertensive and have diabetes and other weight related conditions. The automatic trigger mechanism is to write prescriptions. And oftentimes, they’re not even that effective, especially on the hypertensive side. And, and the reason for that is is that the economic models are wrong if we disincentivize caregivers to spend time and to and to have resources and and incentivize them to have these resources available. We could do some amazing things. It just doesn’t. It’s just not currently in the economic models.

Absolutely. And you know, just to go back to your percentage that you gave 70 to 80% of healthcare costs could be saved with improved diet. I’m just going to state a number here is that the leading cause of death, disability and leading drivers of the nation’s $3.5 trillion in annual health health care costs, that’s 70 to 80% of $3.5 trillion. That’s so huge that money could be redirected toward programs that are lifting underserved communities but also towards programs that are nutrition based, right? You know, and that’s such a, that’s such an important thing for health care providers to recognize that and giving value based care that may require a little bit more time you’ll ultimately be saving money. And that, you know, kind of brings us into the food pharmacies. There was a pilot study that was implemented at the Geisinger is fresh food pharmacy program, and that’s in Central Pennsylvania. And they’ve specifically focused on patients with diabetes. And just to give you that number $240 billion a year is associated with diabetes related costs, but it only costs about $1,000 per patient for a year to support in this food pharmacy $1,000 and what they found is typically if you see a decrease in the hemoglobin A1C of one point you’re getting about an $8,000 health care cost savings. What they found with this pilot program is after a year, on average, most patients had a three point decrease in their hemoglobin A1C, that translates to $24,000 you’re only spending $1,000 in that year to support this patient and you’re saving $24,000 per patient. So there’s there’s huge potential for cost savings, if a little bit more time and effort was put into resources like the food pharmacy to help mitigate chronic disease and create a healthier society.

Right. Well and you know, think about the human aspect right if you you know, think about feeling better and your life journey being better because you’re not injecting yourself with insulin and think about the, the true quality of life improvements. And and the numbers that you talk about are also the problem, right? So if we’re saving 80% of the cost, somebody is losing trillions of dollars. Right? And the people that are losing trillions of dollars are not really excited about this new discussion. And that is one of the biggest problems I think.

I absolutely agree. I think there’s got to be, like you, like you mentioned earlier, kind of a shift, I think the foundation of medicine should be rooted on value, you know, and the patient’s experience, we have to remember that medicine only exists because of our patients. Do you notice? So like, we have to remember, you know, part of the, the oath that we take is that we will do no harm, and we’re going to maximize the good we bring to our patients. So I think having nutrition as a part of the education, that’s a requirement for all medical schools, is is following that oath is, and it will, I think, inevitably shift medicine from being fully dependent on pharmaceuticals. And I’m not saying pharmaceuticals aren’t necessary, they are sometimes but I don’t think that there should be 100% dependence on pharmaceuticals. I think there should be more tools in our toolboxes as future health provide providers and current health providers. So having nutrition education as part of it will inevitably kind of redistribute where the funds are going and where the dependence lies with regard to the care we can give our patients.

Yeah. Well, you know, the headwinds that we face though, and researching my upcoming book, The Healthcare Mandate, what I found is is that the healthcare industrial complex is not very interested in talking about reducing sales, right. I mean, literally, I had people not willing to come on the film, because they didn’t want to be known as being associated with reducing the consumption, the gratuitous consumption of drugs and devices. I think that’s unfortunate.

I agree.

I think the other headwind that we have is you mentioned plant based diet. People, like you lose them. Right, or even a diet that has higher amounts of fruits and vegetables and is more thoughtful in terms of, of various nutritive balance, just that discussion, you lose a lot of people. So what we found in, in this in interviewing lots of people is that unfortunately, there are some pretty powerful headwinds that we’re facing to make this right.

Yeah. And, you know, to that point, I think that reinforces why it’s going to be so essential to incorporate this in the education that medical students receive, because it’s a little harder to shift the mindset of people who have been in, you know, physician for a while or in the industry and they kind of function in the system as it is, which has a heavy dependence on pharmaceuticals and and, you know, there’s a lot of money, you know, I, you know, on on with regard to, you know, how much can be made with high dependence on pharmaceutical as a treatment option. And so I think having cultivating medical students that have knowledge with nutrition education and can give that as a treatment option is going to be key because I think we can reframe the, we can have a bit of a paradigm shift, but it’s going to happen with those who are being educated now, they’re not in the field yet they haven’t operated in the system that’s that already has been established for all these years. And they can bring a different perspective and a different approach to medicine.

I think so let’s hope that happens. Well, we’re running low on time here and I want to make sure we get our our discussion in about our project. Based on your inspiration, we put the Center for Innovation into high gear and started the process of conducting research to identify where there are community gaps within our area who’s delivering fresh, healthy food to to those who need it, and how we could create more of a clinical link linkage. I love that part when when you started sharing with me, and I’m ashamed of myself that I wasn’t even familiar with this is what it all of a sudden made me realize that if you can’t, if a doctor prescribes food, it’s a different thing than going on a diet or just deciding you know what I mean, it has up an authority to it, which probably drives higher degrees of patient compliancy. I’m not sure a study’s been done in that regard. But it certainly was exciting to see I think it was Steve Jobs and maybe he quoted from something else that said, if you don’t make food, your medicine, you’ll be making medicine, your food. And I think that the this project is really, really interesting every, the more we dig into the lay of the land and looking at the landscape, the two things that we’ve discovered is that number one, it’s desperately needed. And number two, it’s possible. So if we, if this could scale to where it’s just accepted that you’re likely going to get a food prescription for a chronic condition, that would be amazing. So why don’t you share with where we are right now in our journey of building out our food pharmacy and what you hope to see the the net outcome of that to me.

Absolutely. So to your point about being ashamed, don’t be ashamed. I think it speaks to the fact that how little known this is, even though there have been pilots that have been in place for a number of years now, it hasn’t really taken flight, you know, at most hospitals. And I think it speaks to what you were mentioning earlier that kind of where funds are allocated to when it comes to health care. So I’m super excited that that we’re going to build one with Western University. And essentially, the model will be that patients with we will choose patients with chronic disease and patients with chronic disease will see a provider who has partnered with our food pharmacy, and that provider will utilize the physicians Committee for Responsible Medicine, nutrition guide for clinicians, which has a very detailed nutrition guide per chronic disease, so you type in the chronic disease and it has a very detailed nutrition guide that providers can use as a tool, and it will kind of standardize the care. But that way providers who haven’t necessarily received this education as part of their medical school curriculum, have one source that has been standardized and vetted, and it’s very, very strong, and it will be their guide for for the nutritional prescriptions that they ultimately give the patient. The patient within will take that prescription to either on site or it will be a mobile form. We’re still working out that detail, but it will be a food farm, a suit food pharmacy, which really functions like a food pantry. They’ll take the prescriptions there, they’ll pick out the items that have been prescribed and these are geared toward health food items. Hopefully not super processed, but we’ll have to, you know, accommodate the lifestyles of these individuals as they will most likely be underserved and individuals and recipes will be given, lessons on how to cook the food will be provided. And most importantly enough food will be given to this patient has to feed their entire family for the week. And then they will come back the next week and fill that prescription again. And I think one important component also is that the these food that the food items will be given to the patients for free because it’s a prescription. And I think that we’re going to see dramatic changes in the lifestyles of these individuals. I think we might even see disease reversal, as that is the trend in established food pharmacies, and Pomona has a very large underserved community. You know, chronic disease definitely ravages underserved community. And I think that we’re going to see a huge improvement in the patients who have been enrolled and I’m super excited about it.

Yeah, me too. I think this is fun. Every time I talk to you, I learn something and I think that, you know, we want to even be innovative and maybe come up with some new models. We’re even looking at the possibility of retrofitting a really cool food truck and maybe even identifying ways to be able to do community demonstrations and cooking lessons and, and adding a big educational point, you know aspect to it and I, I think that will include some cultural specific ones I was raised in an area that was 80% Hispanic and, you know, they’re they have a cultural their cultural, appetite is different their their language is different and, you know, can we identify these various patient personas and respect them by by really being thoughtful about using a vernacular and in some cases, even in a language that really allows them to connect to the message. I think that would be a great part of it as well.

Absolutely. And to your point. You know, some people call that cultural competency. I like the phrase cultural humility. I think being well versed about the community you’re serving and being respectful of their culture, and having people that look like them. You know, provide this care is going to be important. And I love that that is something that we’re factoring in. And with a pandemic, having mobile services is going to be hugely important because when you’re talking about underserved communities, living in a COVID-19, era, transportation’s limited, store hours have changed. So food insecurity is even worsened in these communities. So I think having that mobile component is going to be hugely helpful.

Yeah, well, I appreciate it. You know, I, my goal is for me to contribute as much to our relationship as you have, as you have contributed to me, I’ve learned so much I love your spirit I love, I’d love that this is the physician of the future. I really do. There was a time where you exchange cash to be a doctor and then if you exchange that cash, you would be wealthy. Right and, and oftentimes, that’s been one of the major priorities and, and being able to do this in a way where that there’s a really a patient centric approach towards medicine and it’s just really a beautiful thing. Azaria, thank you so much for joining us today. I really, really appreciate it. And looking forward to working with you on our newly established soon to be newly established food pharmacy.

Awesome. Thank you so much for the invite. I can’t wait to see the work we do.

Thanks again.