Migrants at the Border: US Citizens Head South for Cheap Medical Care

By Erik Goldman

There are a lot of anxious, needy people eager to cross the line that separates the US from Mexico. Go to the border towns of Southern California and Arizona, and you’ll see them--- US citizens heading south to Mexican clinics and farmacias, seeking lower cost surgeries and cheap meds.

Medical and pharmacy “tourism” to Mexico is a large and growing phenomenon, one that has received little attention amid the bitter political rancor over immigration policy and border control.

California Mandates Disclosure of Physician Sexual Misconduct

By Erik Goldman, Editor

As Dr. Christine Blasey Ford and Judge Brett Kavanaugh faced off in the Senate, the state of California quietly passed a major piece of legislation on sexual misconduct, one that could provide patients with far greater protection against predatory physicians. The Patient's Right to Know Act will require any California physician placed on probation for sexual wrongdoings to disclose this fact to any and all patients before an appointment.

Gawande to Head Amazon Healthcare Initiative

By Erik Goldman

Amazon, together with Berkshire Hathaway and JPMorgan Chase, has named Atul Gawande as the CEO of its new joint venture in employee healthcare.

Since December, when the three companies announced a plan to do “something” in healthcare, the medical world has been abuzz with speculation, adulation, and nay-saying about what this trinity of Fortune 500 companies might do.

While the companies have still not revealed much about the specifics of their initiative, the selection of Gawande to lead the effort suggests that it will be strongly focused on reducing healthcare cost disparities from region to region, minimizing unnecessary care, improving efficiency, and emphasizing prevention.

Atul GawandeAtul Gawande, MDGawande, an endocrinological surgeon based at Brigham & Womens’ Hospital in Boston, is best known to many Americans as the author of Being Mortal: Medicine and What Matters in the End---a deeply thoughtful meditation on death-and life—in an era of high-tech “solutions”.

Parallel with his surgical career, Gawande has always had a strong interest in public health and big-picture issues. In 1992, he interrupted his medical school training to work on healthcare issues during Bill Clinton’s campaign, and later became a senior advisor to the Department of Health & Human Services under the Clinton administration.

A gifted writer, Gawande sent shockwaves through the healthcare world with a 2009 article in the New Yorker, documenting the extreme cost disparities for the same healthcare services between two communities in Texas.

His message was that a medical culture dominated by corporate profit-making fosters a lot of unnecessary, ineffective and expensive “care,” and that costs could be reduced, and care vastly improved if more healthcare systems adopted the efficiency models championed by systems like the Mayo clinic.

Gawande’s work greatly influenced the Obama administration’s vision for reform. It also attracted the attention of Charlie Munger—Warren Buffett’s business partner—who sent Gawande a thank-you gift of $20,000, which the surgeon donated to the Brigham & Women’s Center for Surgery and Public Health.

In an official statement released by Amazon, Berkshire, and JPMorgan on June 20, Gawande says: “I have devoted my public health career to building scalable solutions for better healthcare delivery that are saving lives, reducing suffering, and eliminating wasteful spending both in the US and across the world. Now I have the backing of these remarkable organizations to pursue this mission with even greater impact for more than a million people, and in doing so incubate better models of care for all. This work will take time but must be done. The system is broken, and better is possible.”

Combined, the three companies have nearly 1 million employees---a very sizable health insurance pool all its own. The companies’ leaders believe they can find ways to improve employee healthcare that existing insurance plans have been unwilling or unable to do.

But in a statement on May 24, Berkshire Hathaway chairman Warren Buffett stressed that the trio of companies have no intention of building their own insurance company.

“The motivations are not primarily profit-making. We want our employees to get better medical service at a lower cost…..we do think that there may be ways to make real significant changes that could have an effect.”

Buffett’s statements seem to suggest that whatever the triad does together in healthcare, they will keep it “in house.”

But given Amazon’s history of disrupting industries, there’s no reason to believe the impact of an Amazon-Berkshire-JPMorgan healthcare play will be limited to its own employee base.

Amazon CEO, Jeff Bezos, recently said, “I think healthcare is going to be one of those industries that is elevated and made better by machine learning and artificial intelligence. And I actually think Echo and Alexa do have a role to play in that.”

Advanced technology will no doubt play a role in whatever healthcare system does emerge from this large-scale collaboration. But the selection of Dr. Gawande—a clinician with a deeply compassionate perspective—is a promising sign that the three companies are trying to balance the technological thrust with a strong humanistic hand.


doTERRA, the Essential Oil Titan, Launches Healthcare System

By Erik Goldman, Editor

doTERRA, one of the world's leading marketers of botanical essential oils for healthcare uses, is launching a healthcare system.DoTerra Healthcare

Guided by a bold vision of transforming American healthcare, the company is planning a nationwide network of integrative medical clinics wholly owned and overseen by doTERRA, that would operate on a membership or concierge-style model, in which "patients pay a monthly membership fee that covers the cost fo their clinical care." These clinics will be completely insurance-free, according to the company's website.

Though the plan is still in an early stage, doTERRA says the company is looking for teams "of dedicated doctors (MDs and DOs), nutritionists, essential oil experts, and wellness coaches" who will "ensure that patients receive the highest levels of care." Those patient will have 24/7 access to their practitioners via a telemedicine practice, and "more face time when they meet with their doctors in person."

The proposed medical services include: complete primary care, urgent care, wellness coaching, nutrition counseling, essential oil therapies, and genome testing.

The Utah-based company is appealing to the public's clear and persistent frustration with mainstream care delivery, by promising comprehensive services that integrate conventional allopathic care with holistic alternatives, including of course use of essential oils as adjunctive therapies. They're simultaneously tapping practitioner desire for a more humane, less-abusive, and more fiscally healthy mode of practice.

A Ready-Made Market

doTERRA has over 400 full-time employees, and claims upward of 3 million distributors (which the company refers to as "wellness advocates") its multi-level marketing system. That's a sizeable ready-made market of individuals who've self-selected for interest in botanical medicine, and other non-pharm alternatives.

Doterra oilsA survey conducted by the company suggests that 85% of Americans want integrative solutions, including essential oils, from their medical practitioners, and 85% would be willing to join a membership-style practice that offers these alternatives. Yet currently, only 15% of respondents have doctors who are providing the sort of care they seek.

According to the company's site, nearly 50,000 people have already pre-registered to join doTERRA Healthcare.

The company has not released any specifics about the membership costs, the fiscal relationships between clinics and the company's administrators, or how exactly the doTERRA clinics will deliver high-quality primary care imore effectively than mainstream clinics. doTERRA declined Holistic Primary Care's request for an interview at this point. A company spokeswoman stated that it is too soon to reveal details, but that the full plan will be revealed later this summer.

The flagship clinic will be located in Pleasant Grove, UT, to serve doTERRA's on-site employees, followed by a roll-out of clinics across the US later this year.

The effort is being led by Brannick Riggs, MD, a family physician who trained in integrative medicine at the University of Arizona, and David Hill, DC, a chiropractor with broad interests in holistic modalities. Both have extensive experience with essential oils, and with doTERRA as a company.

If doTERRA is able to develop an effective and replicable practice model, it is likely to appeal to many holistic and functional medicine physicians who currently struggle with fiscal and practice development issues.

In it's new initiative, doTERRA is certainly making bold promises. But that should not be surprising. The company--founded in 2008 by former employees of Young Living, another essential oil MLM--has been known for its envelope-pushing claims. On occasion, that's drawn ire from regulators.  In 2014, doTERRA received warning letters from the FDA ordering the company to cease promoting essential oils as treatments for cancer, autism, Ebola, and other diseases.

It remains to be seen how doTERRA will meet the very complex challenges of primary care delivery, and whether they will ultimately come up smelling sweet. But the company clearly has considerable resources,  management know-how, and a committed ecosystem of bright, independent-minded people who are seeking healthcare alternatives.These factors bode well for the success of doTERRA Healthcare.





Help celebrate our 20th year at TPC Forum at the TWA Hotel April 23 at 6pm
Help celebrate our 20th year at TPC Forum at the TWA Hotel April 23 at 6pm