Pimped

Out
Nichole Grimwood
.

How to Prevent Big

Brother and Big Medicine
From Taking Advantage of
the Rest of Us to Line
Their own Pockets
© Nichole Grimwood, 2018. Printed and bound in the United States
of America. All rights reserved. No part of this book may be
reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or by any
information storage and retrieval system without permission in
writing from the author. For information, please contact Nichole
Grimwood at nichole.grimwood@gmail.com.

2
 Important Caution—Please Read This!

Readers are strongly cautioned to consult with a trusted

healthcare professional before making any healthcare decisions.
Please consult with your healthcare provider before adopting
any of the information contained in this book to your own
wellness regimen, and use such information to complement your
own needs and limitations.

This book is based on information from sources believed to be

reliable, and every effort has been made to make the book as
accurate as possible, based on information available as of the
publication date, but its accuracy and completeness cannot be
guaranteed. Despite the best efforts of the author, the book may
contain mistakes, and the reader should use the book only as a
supplemental guide, and not as the ultimate source of
information about any health or nutrition practices.

This book is not intended to reprint all information available to

the public on the subject, but rather to complement and
supplement other available sources. The reader is encouraged to
read all available material and to learn as much as possible about
the subject. Some of these materials are listed under Suggested
Materials elsewhere in this book.

The author is not engaged in rendering diagnoses, and the book

is not intended to diagnose or treat medical or physical problems.
If medical, professional or other expert assistance is required by
the reader, please seek the services of a competent expert.
This book is sold without warranties of any kind, express or
implied, and the author disclaims any liability, loss or damage
caused by the contents of this book.

4
 Table of Contents
Introduction .............................................................................................. 7
Part I: A Whole New World~ My Introduction to the Sickness
Industry .............................................................................................. 11
Chapter 1: A Picture that Would Change the Course of my History ........ 13
Chapter 2: When Dreams Collide with Reality ........................................ 25
Chapter 3: More than Financial Costs ...................................................... 36
Chapter 4: Refusal .................................................................................... 46
Part II: Learning the Ropes~ Getting to Know who Has the Largest
Stakes in the Sickness Industry ............................................................. 51
Chapter 5: Paying for Health Care~ Who Holds the Purse Strings when It’s
not the Consumer? .................................................................................... 53
Chapter 6: Human Commodities .............................................................. 60
Chapter 7: The Runaway Costs of Runaway Symptoms .......................... 70
Chapter 8: Stone-Cold Normal ................................................................. 83
Chapter 9: Eyes Wide Open ..................................................................... 97
Chapter 10: Lobbyists ~ The Justices of the Peace When Congress and
Healthcare Wed ...................................................................................... 105
Chapter 11: When Consumers Look out for Their Own Best Interests .. 114
Part III: Setting My Stakes~ Creating my Own Path to Wellness ... 121
Chapter 12: What This Consumer has Tried .......................................... 123
Chapter 13: Opportunities ...................................................................... 143
Chapter 14: Solutions ............................................................................. 158
Chapter 15: Making Changes ................................................................. 171
Appendix: What is Single-Payer Health Care ................................... 180
Suggested Reading, Websites, and DVD’s........................................ 1920
Endnotes ................................................................................................ 203
About the Author ................................................................................. 244

6
 Introduction

“Egotistically, patients believe that you will do

everything you can to heal them. Their primary view is
that healthcare organizations are places where healing is
the mission. Television and advertisements can reinforce
this view. Health care is often presented as a place where
restoring or protecting health is the primary mission.
Seldom is there any mention of the business aspects of
health care or the resources needed to stay in business.”i

The sentences seared into my consciousness as I read

them. I was pursuing my Master’s degree in healthcare
administration. The above quotation sat in my Ethics textbook.
Having spent twenty-five years as a patient, I was hurt that a
healthcare administration ethics professor could write such a
statement. And while I read the rest of the textbook, and
understood that there was more to the writer of the text than that
statement, and that she should not be defined by a mere four
sentences taken out of context, that was the paragraph that
tattooed itself into my brain.
When I was four my family doctor diagnosed me with
Crohn’s disease. When my doctor diagnosed me my family had
no idea what the disease was. Our family physician referred me
to a specialist who told my family that in 1979, at the time of my
diagnosis, I was the youngest person on record to be diagnosed
with the disease.
 Over the next twenty-five years I underwent regular
colonoscopies, barium series X-rays, office visits,
hospitalizations, surgeries and medications.
Crohn’s disease is an autoimmune disease. Because my
disease resisted steroids and surgeries, for a while doctors
prescribed a leukemia drug in an effort to suppress my out of
control immune system in its war against my own body.
In my twenties, while living in Columbus, Ohio, I
frequently drove to Cleveland for intravenous Remicade
treatments.
My disease only grew stronger and side effects resulted
from all of the medications and surgeries. Between the disease
and the treatments, I believed I would not live to see forty.
In college I pursued a Bachelor’s degree in political
science and psychology. I envisioned myself advocating for
patients’ rights and healthcare reform.
As I reviewed statistics from the World Health
Organization’s website I could not help but wonder how so many
other countries spent less per person on healthcare, but their
people lived longer on average than we do in the United States.
I had always believed that we had the world’s best healthcare. I
had always believed that I was seeing some of the best specialists
in the world for my condition.
I worked for a chiropractor for a while, then did an
internship in a Congressman’s district office. That particular
Congressman supported a bill to pass a single-payer healthcare
system in the United States.
I began researching the lifestyles and diets of people in
some of the countries and cultures where people lived healthier
longer than they do in the U.S. I began making changes to my
own diet and lifestyle. Slowly at first. As my symptoms abated I
made more and more changes.
Over time I obtained certifications in medical billing, as
a personal trainer, a senior fitness specialist, and as a fitness and

8
nutrition specialist. I also completed my Master’s degree in
healthcare administration.
I have sat on the outskirts of an organization trying to
enact a single payer healthcare system in the U.S. I have worked
for my family’s unskilled home care company. I been insured
and I’ve been on Medicaid. I’ve seen some of the most revered
clinicians in the world and I’ve been to a homeopath and a
traditional Chinese medicine, or gua sha, practitioner.
Most importantly, I’ve been in remission and off
prescription medications for nearly fourteen years, and I recently
turned forty-three. All without the assistance of an allopathic
physician, insurance, or Medicaid. I’m not saying these results
are typical or trying to offer anyone false hope. I’m saying that
this has been my personal experience.
When people discuss health care policy they often talk
about three different aspects of health care, sometimes described
as a three-legged stool. These three characteristics are access,
quality and cost. One of the things that makes health care policy
difficult to reform is the belief, not necessarily true, that if one
of these attributes is improved then another attribute must
necessarily compensate in some way. For instance, if we want to
reduce costs but we expand access to include more people, the
fear is that we will then increase costs. So the simplistic response
to reducing costs ends up being reducing access. Or, people
argue that if we improve quality we’ll increase costs. Again, this
is not necessarily true, but some arguments boil down to these
simplistic statements.
Throughout my story, I hope that you will consider these
three stool legs and how they pertain to your life or the lives of
those you love.
I will also look at some of the stakeholders involved in
the discussion for health care reform. A second factor that makes
health care so difficult to reform is that we are all affected by it.
In my experience it’s difficult to plan an event around ten
people’s schedules and preferences, let alone change policy that
affects 320 million people each with their own experiences,
feelings, and opinions involved in the process.
Finally, I will share my thoughts and my hope for our
healthcare system.
Although this book is not primarily a discussion about
whether or not I think we should have universal health care in
our country, I have included an appendix in the back of the book
about health care financing systems in other countries. I believe
there are some misconceptions that there is only one form of
universal health care and that is socialized medicine. In actuality,
that’s not the case. The United States of America is the only
developed country I’m aware of that does not have some sort of
universal health care system. Considering, then, how many
countries do have universal health care, it is important to
understand that all of those various countries have various
approaches to universal health care. I share just a little bit of this
information, primarily in the appendix, for those who are
interesting in knowing more.
I have experienced health care from the patient side, the
political side, the student side, the complementary and
alternative side, the caregiver side, and the administrative side.
And I believe there’s hope.
This is my story.

10
 Part I: A Whole New World
~
My Introduction to the Sickness Industry

What gets us into trouble is not what we

don’t know. What gets us into trouble is what
we know for sure that just ain’t so.

~Mark Twain~
12
 Chapter 1

A Picture that Would Change the Course of my

History

A society will be judged on the basis of how it treats its

weakest members.”
~Pope John Paul II~

My finger twirled the string sticking out from behind the

button on the back of the couch. Grandma and I had just finished
reading my favorite story, The Monster at The End of This Book.
Sounds of laughter filtered through the window screens as my
brother and the neighbor kids ran outside. The end of summer
was closing in on us.
“Nichole,” Dad asked, “do you want to go to the fair with
us?”
“No,” I shook my head.
“Why not?” Mom joined. “You love the fair.”
“I don’t feel like it.”
“What if we take your wagon? You can ride in the wagon.
You won’t have to walk.”
 “No,” I mumbled as tears spilled onto my cheeks.
“That’s it,” Dad stormed to the hallway. His voice wafted
down the corridor as he called the doctor from our rotary phone
hanging on the wall.
“What in the world is wrong with my daughter?” he
demanded. “She’s lost ten pounds in the last ten weeks and now
she’s refusing to go to the fair. She’s only four. We’ve tried all
the medicines you’ve given us; nothing works. What if she has
cancer? What if we lose her? ....Well, please find out, or refer us
to someone who can!”
A few days later we went to the hospital. Someone gave
me something to drink. The staff called it a pink milkshake, but
it tasted like ground-up chalk. Everyone kept asking me if I was
finished drinking the “shake” and telling me to hurry up and
finish. Finally, I managed to gulp down the whole unappetizing
concoction.
Oh no. As soon as I finished the drink my stomach started
to hurt. That was why we had come to the hospital this morning.
I had been getting really bad stomach aches all summer long.
Frequently I asked Dad or Mom to hold my hand when the pain
started. The pain’s intensity came in waves. At times I squeezed
my parents’ fingers so hard that afterwards you could see the
imprints from their wedding rings on their other fingers.
Grandma claimed that sometimes I went to the bathroom every
hour on the hour, all day and all night long, too.
Soon a nurse called my name. I said I had to go to the
bathroom but she asked me to try and wait a few moments.
We walked into a dark room. Goosebumps popped out on
my arms. Everywhere I looked I saw gray metal, except for a

14
small window into an office. Someone set a step stool in front of
me. I stepped up onto the “bed”. It felt more like a metal slab
than a bed, covered by a thin sheet of paper that unwound from
a roll at one end. Somehow that paper reminded me of the paper
towel rolls at school, and seemed only slightly more
comfortable.
I wondered why my parents weren’t allowed to come into
the room with me. My stomach cramped again. “Please hurry,”
I thought to myself. I really needed to go to the bathroom.
The clinician left the room but talked to me through the
window from the office. Meanwhile, the large X-ray machine
suspended from the ceiling moved over me.
“Hold your breath,” I heard. Then, a few seconds later,
“Okay, breathe.”
We repeated this breathing process several times as the
X-ray machine continued to move and stop, move and stop.
Finally, when I was sure I couldn’t wait any longer to go to the
bathroom, the worker returned to the room I was in and helped
me down from the table.
I thought we were finished until she said, “You can go
back and sit with your parents. We’ll take some more pictures in
a few minutes.”
A few days later we returned to the doctor’s office. His
big, dark eyes passed mournfully from my parents to me then
back to my parents. “I don’t know how this can be because she’s
so young and kids her age don’t get this, but your daughter has
Crohn’s disease. Here’s the number of a specialist in Cleveland.
He’s one of the best. I think you should get in to see him as soon
as possible.”

*****
 My parents met each other at a 4-H volleyball game in
middle school and had remained friends throughout their lives.
In 1974, nearly a year after they married, my dad was
serving in the National Guards. Upon finding out early that
spring that he was scheduled for a maneuvers and target shooting
training the weekend of my due date in September, Dad asked to
speak with his drill sergeant. “Sergeant,” he said, “I won’t be
able to go to Camp Perry until September 28th. My wife is
having a baby on Friday the 27th.”
Believing that babies are never actually born on their due
dates, the sergeant acknowledged the excited father-to-be’s
request, then promptly forgot their conversation. Spring turned
into summer and Dad and Mom planned for my arrival.
Sure enough, Friday, September 27th came. When my
mom’s contractions began, Dad delayed reporting for duty.
Punctual at an early age, I entered the world at 11:22 that night,
barely on my due date, a healthy 7 lb.15 oz. Dark brown hair
covered my head and my eyes reflected dark pools of chocolate
brown. After tossing the name Gregory, then considering Laura
Elizabeth, they dubbed me Nichole Anne, with the “h” and the
“e” so that my name would be different from other Nicoles, or
Anns, and people would not be able to nickname me, or so they
thought.
Early Saturday morning Dad drove to Camp Perry where
his drill sergeant was eagerly awaiting his arrival. His sergeant
asked where he had been; of course Dad handed him a cigar and
reminded his supervisor that he had told him his wife would be
having a baby on the 27th.

16
 “Congratulations, Grimwood,” he exclaimed, “finish
your shooting and go home to your wife and baby!”
A year and a half after I was born, my parents expanded
our family with the birth of my brother, Gregory Allen. After I
turned three we moved to a slightly larger, although still small
town within Ohio. Those first few years I played and laughed
like any child. Greg and I ran around outside all summer with all
of the neighbor kids, drew crayon figures on our bedroom walls,
and encapsulated limitless wells of energy.
When I was four years old my life changed. At the time,
no one could foresee the ripple effects that those changes would
generate.
Of course my memories of that time are fragmented.
What I remember is lying on the couch more and more
frequently while my brother and neighbor kids were playing,
getting up during the night to go to the bathroom and screaming
for one of my parents to come and sit with me because my
stomach hurt so badly, and rarely being able to eat without
experiencing severe abdominal pain. When I did eat, my
stomach cramped and pushed food through very quickly.
In my first few years of life I had experienced all of the
typical baby ailments but nothing unusual. The previous
summer I lived through a bout with chicken pox. My body
recovered very slowly from the virus. My rash abated, but I
continued to nap frequently and eat little.
However, in April of 1979 the term sickness took on a
whole new meaning for me. Chronic diarrhea befriended me.
Initially, I ran to the restroom eight to ten times a day. I drank
bottle after bottle of Paregoric, which was sold at the time as an
over the counter medicine to soothe upset stomachs.
 Unable to stop the diarrhea and fearing dehydration,
Mom hauled me in to visit our family pediatrician. His notes
from May 31st indicate that he put me on a clear liquid diet along
with the Paregoric. He wrote that I “slept most of day yesterday
and seems very draggy and tired.”ii
The summer passed and my symptoms continued. My
maternal grandmother, Grandma Thelm, moved in with my
family to share my room and help Mom nurse me through my
illness. Not sure what else to do, Mom journaled my daily
activity, food intake, medication, and bathroom trips, which
sometimes occurred as frequently as every 30-60 minutes.iii
By August I still drank Paregoric every day, sometimes
even several doses a day, to no avail. Lacking the energy to play
outside with Greg and the neighborhood kids, Grandma Thelm
taught me to read that summer. Books provided an escape to
imaginary worlds where everyone found happy endings.
On September 21, 1979, six days before I turned five, my
doctor diagnosed me. In addition to my Azulfidine, he scribbled
a prescription for the steroid prednisone.iv
Crohn’s causes the immune system to attack the lining of
the digestive tract, causing symptoms similar to what one would
experience with a GI infection: abdominal pain, diarrhea,
nausea, fatigue, fever, weakness and loss of appetite. However,
absent a known cause there is no cure for Crohn’s. Rather than
resolve with time or antibiotics as an abdominal infection would,
the immune system overcompensates and perpetually attacks the
lining of the intestines and other organs along the digestive tract.
At the time of my diagnosis, Crohn’s was rare enough
that in our small town few people had ever even heard of the

18
illness. Certainly, no one in the immediate vicinity had the
expertise to treat a child who developed the disease while still so
young. Over thirty years later, despite the fact that autoimmune
disorders collectively are the number two cause of chronic
illnesses in America and the third leading cause of Social
Security disability,v they continue to hide behind a shroud of
mystery from much of the general public.

*****

Realizing that I needed more specialized care than he was

able to provide, our family pediatrician referred me to a
specialist at a larger hospital. By then, the Crohn’s had increased
its symptoms to include vomiting, puffiness, and a bloated
abdomen.
However, once I started taking prednisone, my energy
level and appetite improved and my abdominal activity slowed.
By the middle of October, just after turning five years old, I had
gained eight pounds in just four weeks.vi The prednisone caused
so much bloating, though, that my doctor soon decreased my
prescription by half. Immediately my symptoms returned and
my heart pumped harder, raising my blood pressure. In October
my blood pressure rose to 140/98, and in November remained at
132/80.vii
By the middle of November, my cramps returned, my
body temperature rose, and the doctor again increased my
prednisone. As my negative effects of my symptoms and
medications fluctuated, my moods also fluctuated. My parents
and Grandma Thelm perused every article and pamphlet they
found related to Crohn’s disease. Many articles eroded hopes for
recovery and normalcy, obliterating dreams of a cure. Adding to
my emotional roller coaster came a hopelessness of ever feeling
healthy and normal again.
Today people joke about pharmaceutical commercials
listing potential side effects in their television advertisements,
cautioning consumers about some of the double-edged sword
effects of taking such medications.
Maybe it’s not such a laughing matter. In 1981, the FDA
permitted the pharmaceutical industry, (Big Pharma) to begin
advertising directly to consumers. Less than two decades later,
in 1997, the government relaxed some of its rules regarding this
advertising.viii Once these rules were relaxed, between 1994 and
2000, marketing campaigns increased.
According to a San Francisco Medicine article cited in
Overdosed America, in 1997 alone the advertising budget just
for the allergy medicine Claritin was greater than that of
Budweiser Beer or Coca-Cola. But it paid off. In 1997 sales of
Claritin were $1.4 billion. Just three years later, in 2000, sales
were $2.6 billion.ix Another article in Overdosed America,
originally published in the New York Times, revealed that
pharmaceutical advertising is so profitable that in 1998, for each
dollar that the largest prescription drug companies spent on
advertising, they reaped $22.50 in sales.x That is a pretty good
return on investment.
Perhaps, we tell ourselves, we’re immune to such tactics.
In such cases Kevin Trudeau reminds us that cigarettes used to
be advertised on television, until they were proven to be so
effective at subconsciously motivating people to buy cigarettes
that cigarette companies were banned from advertising on tv.xi

20
 My diagnosis occurred before the FDA approved such
advertisements. Instead, we researched and often stumbled
across information in random newspaper articles, warning
against the effects of medication like Prednisone on the immune
system; as well as its potential contribution to ulcers,
osteoporosis, mood swings, muscle weakness and other possible
complications. Such articles also warned that one should know
in advance how long the medication would be taken.
Unfortunately it quickly became obvious that none of us,
practitioners or patient or patient’s parents alike, could possibly
predict how, when, or even if my disease would respond to any
of my medications, let alone how long I would take them. In my
mind I viewed an indefinite future filled with prescriptions and
doctor visits.
Even on the medication my temperature continued to
fluctuate, with a temperature of 102.5 not uncommon. In
February of 1980 my doctor wrote, “Medicine does not seem to
be helping—appetite ↓ Has severe cramps.”xii
Despite the medicine’s failure to alleviate my symptoms,
my parents felt reassured that we now had a specialist in whom
we could consult. Pediatric gastroenterologists around the
United States recognized him as a leading expert in his field, so
my parents adhered to his instructions faithfully. My specialist
often called me his favorite patient, though I made it very clear
that the affection was not mutual. Still, our frequent family trips
to his office became outings. If I had an appointment in the
morning, we would get up early to leave the house. My mom
felt that since we were going to see a specialist in the big city an
hour from home, we should dress up and look nice for the
occasion. For me, though, these outings frequently involved
colonoscopies and barium series X-rays, so it was often to my
advantage to dress as comfortably as possible.
Although those few months waiting for a diagnosis
seemed long to my family, in fact, I was fortunate. It is not
uncommon for patients to see several doctors and wait several
years for an accurate diagnosis of an autoimmune disorder. I’ve
even read one story of an unfortunate woman who lived with
lupus for twenty-five years before finally finding a doctor who
could tell her what was wrong with her.xiii
I was also fortunate to live only an hour away from
someone who was considered a top expert in the field of my
illness, and that we weren’t at the time, part of the tens of
millions of uninsured in America.
Unfortunately, not everyone in our great country is as
fortunate. According to a paper by the United States Office of
Technology Assessment, patients who do not have easy access
to health care are more prone to wait too long to see a doctor,
increasing the severity of their illness and need for
hospitalization, advanced disease stage at diagnosis, avoidable
hospitalizations, lower chance of cancer survival, low birth
weight, and infant mortality.xiv
Sometimes access to care depends on where you live.
Rural communities are underserved, especially for those in need
of specialists. Even when it has been illegal to deny people
access to care, it has happened. Robert Lee Maril writes of a
largely migrant community in the Rio Grande Valley where
uninsured patients would enter emergency rooms. Although they
could not legally be turned away if they had medical conditions
requiring emergency care, business office personnel would bully

22
and intimidate them, allegedly with the sole purpose to “drive
the service seeker from the hospital,” indicating “poor people are
more easily intimidated than those who are more affluent and/or
better educated, and in the end many, regardless of their medical
needs, leave the emergency room without treatment.”xv
At any rate, we had access to what was considered high
quality care.
Still, sickness is no fun no matter how good the care
you’re receiving. Perhaps God knew how badly my family
needed something worth celebrating, for in the winter of 1980
Mom became pregnant. With seven children, Grandma Thelm
already had twenty-two grandchildren, and knew that Julie
would be her last. She prayed for a red-headed, blue-eyed girl
and on November 13, Julia Elizabeth was born, an answer to
Grandma’s prayers.
As an adult Julie faced her own fears as a mother-to-be
when told that her unborn daughter had spina-bifida. Her doctors
told her that the baby may not live long past delivery, if Makayla
survived until then, and encouraged Julie and her husband at the
time, Jewerl, to consider abortion. Jewerl and Julie chose to keep
their baby girl, whose name Makayla, means miracle. Nine
years later Makayla is a joy, and along with the rest of her
cousins, is definitely making her mark on the world.
When considering such types of moral dilemmas, Nancy
Mairs writes,
“If a woman, upon learning that her fetus has spina
bifida, may choose abortion, then she ought also to feel free
to decide without apology, to bear and rear the child, certain
that she will have the same access to medical care and
educational programs that a nondisabled child
enjoys…“But provisions for these people cost money,”
fiscal conservatives squeal, “and why should I pay for
someone else’s misfortune?”…Because that’s what human
beings do: take care of one another…Let me point
out…being something of a fiscal conservative myself, that
we’re not talking huge amounts here, nothing like the
billions squandered on Star Wars and the B-2 stealth
bomber, which plenty of people believed we could afford.
If the money is spent wisely, it will constitute not a drain
but an investment. Their potential contributions to culture
are impossible to gauge. (Alexander Pope and Toulouse
Lautrec were hunchbacks, after all; Milton went blind;
Beethoven, deaf, and so on, and so on. We can ill afford to
kill off all of our geniuses, and every live birth holds such
promise.”xvi

24
 Chapter 2

When Dreams Collide with Reality

Like most little girls, I dreamt of life as a princess. Just

like Cinderella, one day my prince would come riding up to me
on his beautiful white horse (or motorcycle), sweep me off my
feet, and we’d ride off into the sunset to his castle. Sitting in the
bathroom of my hospital room I was a long way from living my
fairy tale.
Instead of royal robes, a hospital gown clothed my six-
year-old body. Rather than a tiara, a tube flowed out of one arm,
and a thicker tube emerged from the side of my neck. As I
finished up in the bathroom and walked back to bed a beam from
the hall light illuminated my route through a crack under my
door.
I overheard voices from the nurses’ station, and the
muffled sounds of a television set someone had left on down the
corridor. At 1:30, I had already been up to the bathroom twice
that night, while the rest of the pediatrics floor remained quiet.
 I tiptoed around my mom’s cot and climbed into bed,
maneuvering my rubber conduits and IV pole, half afraid of
yanking one of my tubes, wondering what further atrocities I
would endure if anything pulled out of place.
Usually my mom would have been awake by now,
recording in her log what time I had gotten up to go to the
bathroom, and checking to see if I needed anything. She must
have been too tired this time, I thought, as I burrowed under my
blanket, the side of my neck ejecting tubing turned upwards and
my IV arm laid out flat on top of my blankets. I dozed off with
visions of my prince and our castle, wondering why at six God
already hated me so much that He wanted me to suffer like this.
I arose twice more that night before the nurse came to
wake me at ten minutes after 7:00 in the morning. I heard her
come in, but too tired to open my eyes I played possum, hoping
she would permit me a few more minutes in Dreamland. She
didn’t. Finally I got up and allowed the nurse to weigh me before
I took my meds.
Because the TPN line fed me intravenously no dining
staff brought me my breakfast tray that morning. I listened to the
food cart jangle down the hallway, the smell of eggs and sausage
intended for other patients drifting into my room as food trays
were transported down the hallway.

*****

In May of 1980 my disease flared and my doctor

increased my prednisone. At a follow up appointment on June
10th, he decided that since my symptoms were not improving I

26
should be admitted to the hospital on June 15th for tests. Once
he admitted me, however, he realized how malnourished I had
become and decided to keep me in the hospital indefinitely. The
day I was admitted, Mom journaled, “She’s now at a low point.
She’s not active at all and today we admitted her. Two of the
interns examined her and talked with us. About 8:00 pm they
drew blood but as of yet we know little more than before
coming.”xvii Listless, weak, and emotional, I was quiet and
reserved. My parents’ footsteps echoed down the hallway that
night, as I sank into my first night in a hospital bed.

*****

Malnutrition is common in patients with all types of

inflammatory bowel disorders. Two naturopathic doctors,
drawing on several studies, write that although dietary causes of
Crohn’s disease are hardly considered in most standard medical
and gastroenterology texts, several lines of evidence strongly
support dietary factors as being quite important.xviii
They go on to explain the many causes of malnutrition in
patients with intestinal bowel disorders. These causes include
low appetite and decreased oral intake, restricted diets without
supplementation, malabsorption, especially in surgical patients,
loss of protein and electrolytes via rapid elimination, certain
medications, and fevers and increased cell turnover affect
utilization and nutrition requirements. From my perspective,
they shared one silver lining. They explained that fat
malabsorption is particularly common. The non-silver lining of
this is because fat malabsorption is common, they explained,
there can be a loss of fat-soluble vitamins and minerals, such as
vitamin D.xix
 *****

On Tuesday, June 16th, an orderly escorted me at 8:30

a.m. to the radiology department for X-rays. I drank the barium
and the technicians began taking pictures. At 1:30 that afternoon
they allowed me to eat some crackers and drink ginger ale, then
continued with the X-rays.xx That night my parents began taking
turns staying with me. Each night one would stay while the other
returned home to be with my brother and sister.
My appetite barely existed and my meals consisted of
amounts like, “all of OJ, all of milk, 2 bites bacon, 1 bite
oatmeal”xxi for breakfast. While I was in the hospital I continued
to use the restroom frequently and displayed little energy.
However, my parents borrowed a hospital wheelchair and
wheeled me outside to tour the hospital grounds and to revel in
the summer air.
Seeing no improvement the first few days that I was
hospitalized, the doctors nearly doubled my daily prednisone
requirements. My appetite increased to two chocolate milks, one
half of a vanilla cupcake, one third of a steak, some potatoes, and
a little bit of salad for dinner. However, on the same day I ate
that much I went to the bathroom ten times, then again multiple
times that night.xxii

*****

Growing up, my parents and I watched a television movie

about a child with cystic fibrosis, based on the book Alex. While

28
my parents and Grandma researched Crohn’s, I read Alex’s
story. The author, Frank Deford, writes of his daughter’s losing
battle against cystic fibrosis, and a conversation that takes place
between his daughter Alex and his wife. Alex tells her mom how
much she longs to have just one day of being free of her disease,
and knowing what it’s like to not wake up with any pain for just
one morning.xxiii
My memories of life before Crohn’s were fading. I slowly
accepted the fact that I would never again know what it was to
be healthy, and I too wished for just one day free of pain and
suffering.
On Sunday, June 21st, Mom journaled, “Nichole woke up
perky but by noon was really wearing down. Dave and I were
really depressed and feel like we’re getting nowhere. Just when
we think she’s improving she takes a step back.”xxiv
The next day orderlies wheeled me to a procedure room.
After one week in the hospital, my doctors had decided that the
best way to give my bowels a rest was to insert the Total
Parenteral Nutrition (TPN) line into one of my veins. I knew as
the door swung into its latch that Mom was in the hallway, but
the doctors did not permit her in the room for the procedure. Dad
stayed home with Greg and Julie that morning. (Years later
surgeons would do this same procedure while I was sedated, but
not that first time.) Wide awake I laid on a table with a Chux
absorbent pad draped over my head and neck. A nurse held my
hand as the doctors cut through the Chux and inserted the TPN
tube into what was supposed to be my jugular vein. I felt every
stitch as they threaded my skin to hold the tube in place and
screamed as loud as I could for my mom, hoping that she would
ignore the closed door, or that the doctors would surrender and
admit her into the room with me. They did not.
 Unfortunately, the first attempt at a TPN insertion at
11:30 that morning failed. The doctor attempting the procedure
inserted the line into the wrong vein. The second insertion also
failed, but the third insertion at 6:00 p.m. that evening
succeeded.xxv
I only visited the restroom twice that day, causing my
parents to wonder if they had acted too quickly in authorizing
the TPN. The tube provided nutrients directly into my veins,
so all I was allowed to eat was one Popsicle a day, eight to ten
pieces of hard candy, and enough water to swallow my
medication. Thankfully my family kept me well supplied with
butterscotch Life Savers.
On July 4th I lay in my hospital bed and watched the
fireworks on television. Finally, on July 7th, my doctors removed
my TPN line and the next day discharged me, at the end of my
23-day stay. They sent me home on a relatively small daily
regimen of steroids and antibiotics.xxvi
Despite the medications, I continued to fight
malnourishment as chronic diarrhea pushed out fluids,
electrolytes, protein and other nutrients. A CCFA (Crohn’s and
Colitis Foundation of America) pamphlet offered further
enlightenment on this subject, cautioning, “If fluid intake does
not keep up with fluid loss via diarrhea, kidney function may be
affected. Patients with ileitis and colitis have an increased
incidence of kidney stones, partly related to this problem.
Dehydration and salt loss create a feeling of weakness.”xxvii To
minimize these complications I also took vitamins. My doctor
instructed my parents to call his office every week with updates,
and return with me for an office visit in three weeks.

30
 My family tried different diets to reduce my symptoms,
but a CCFA pamphlet offered little hope: “While certain foods
may aggravate symptoms of these diseases, there is no evidence
that the inflammation of the intestine is directly affected.” xxviii
Attempts at finding agreeable foods quickly digressed to a
constant knowledge of where the nearest restroom was and when
the next opportunity would be to use it, preferably in a private
setting.
Contrary to what I learned later from my own research
reading articles like the ones by the naturopathic doctors,
booklets I read in my youth, such as the Crohn’s and Colitis
Foundation pamphlets, reinforced my natural inclination toward
independence. One brochure posed the question, “Can these
diseases ever be cured?” The response was plain: “We don’t
talk about a cure for these diseases because we don’t know the
cause. Both Crohn’s disease and ulcerative colitis are diseases
you have to get used to.”xxix
Another question in the same brochure demanded, “Will
the disease make me grow more slowly?” “It might, for a while.
If you become sick as a young child, you may now be shorter
than others in your class.” This was definitely true for me! The
prednisone and the disease’s ability to deprive me of nutrients
delayed development. While my sister is 5’ 7” and my brother
towers at 6’ 7”, I am a mere 5’4”. In fact, because of medications
and nutrient deficiencies, growth failure occurs in seventy-five
percent of Crohn’s disease pediatric patients.xxx
Finally, the CCFA brochure stated simply, “Sometimes
you may feel that there isn’t anyone who really understands how
badly you feel.” It seems to me that this is especially true with
bowel disorders. While people may discuss symptoms from
other illnesses, as a young person with Crohn’s, in a world where
Crohn’s was still relatively rare, I frequently attempted to hide
my symptoms out of embarrassment.
By the time I was in middle school, I trained my body to
eat as little as possible before and during school so that I would
not have to use the restroom until I arrived home after school.
This was obviously not healthy, and in the long run contributed
to more complications with the disease, but the humiliation
became more than I could handle. Having little control over my
own body, I sought ways to gain control. At times it felt like
food, which sustained other people, was instead my enemy.
I resented my illness and often felt envious of my siblings
and other children who did not appear to suffer the way that I
did. I never wished my illness on anyone; I just wished it off of
myself. Sometimes I rebelled and refused to take my
medications. Occasionally when I had to fast before tests I snuck
food. I suffered the consequences of this also.
One spring when I was in middle school I had a
colonoscopy scheduled. Grandma had made fried chicken, one
of my favorite dishes that she made, and I decided to sneak a
piece. Unfortunately when I went in for the colonoscopy my
body was not prepared for the scope. I drank a cleansing agent
before the procedure, but it was not enough to empty my colon.
When the doctors began the exam they were unable to push the
scope through and I had to return a few months later for another
attempt. For the repeat test the doctor recommended I be placed
on a liquid diet for seventy-two hours before the study and have
an enema the night before and the morning of the exam.xxxi That
cheating was not worth it!

32
 Unfortunately, when the test was repeated that summer,
the disease had created an obstruction and the scope was still not
able to navigate a pathway. The doctors sent my parents a letter.
It stated that due to the obstruction caused by scar tissue, I could
possibly be facing surgery in the future.xxxii
Despite the obstruction, that summer of 1988 I had more
fun than I had had since my diagnosis. My parents never allowed
me to let my illness control my life. It was always a factor, but
they understood that if I stopped doing things because I didn’t
feel well, I would never experience anything. They worked hard
to fill our holidays and other family times together with fun.
During most of my high school years we lived a few miles west
of the city limits on seven acres of open land. For Labor Day at
the beginning of my freshman year, Dad devised a scavenger
hunt to entertain Greg, Julie and myself.
Despite the fun that I had that summer, one danger of
prednisone is that it can be very effective in masking symptoms
even as illness progresses. Once the holiday passed the disease
demanded attention once again. One test doctors rely on to
determine the stability of autoimmune disorders is a SED rate
test, which measures the immune system’s response through
blood work. Normally, if a patient is not having an immune
reaction, the SED rate falls between zero and twenty. That
October mine was twenty-six.xxxiii A number this high indicated
that my disease was active. Slowly, I unwittingly shed pounds.
Even with the high SED rate number and the weight loss
I made it all the way until Election Day before taking a sick day,
which I considered a major feat. However, because of the
continual onslaught of the disease I had developed
complications and an infection. To counteract this, my doctors
introduced a new antimicrobial into my regimen. Also, due to
the prolonged course of steroid use, I developed mild arthritis in
my knees and ankles. Arthritis and skin maladies are both
common in Irritable Bowel Disorder (IBD) patients, particularly
those with colon involvement.xxxiv
Despite having access to some of the best specialists in
the country, and insurance, my quality of life was greatly
diminished. One routine procedure required three attempts and a
full day to complete, longer than future surgeries would require.

*****

This is one of those questions that stumps health care

reform advocates because quality is composed of different
things for different individuals. A national conference of state
legislatures shared that while some consider choice a key
component of quality care, others consider good outcomes, or
providers who can boast of good outcomes in care.xxxv If you are,
or were the patient, or your child were the patient, what would
you consider quality health care?
Incidentally, serious medical errors are so common that
they are a leading cause of death in the United States. A report
released by the Institute of Medicine in 1999 estimated that
medical errors cause somewhere between 44,000 and 98,000
deaths each year. This total places medical errors as the eighth
leading cause of death in the U.S., ahead of breast cancer, AIDS
and motor-vehicle accidents.xxxvi This research is rather dated.
Sadly, though, some researchers believe that the numbers have
worsened since the IOM’s report. This means that every day
more than 250 people die in America because of medical

34
errors.xxxvii A more recent report, done by the Leapfrog Group in
2013, estimated that at the time hospital errors were the third
leading cause of death in our country, behind only cancer and
heart disease.xxxviii While this number of medical errors is high,
it does not include the number of medication errors and incorrect
diagnoses that occur outside of hospitals but still as a result of
healthcare. It is estimated that when fatal and unfatal errors are
summed up, healthcare causes over a million preventable
adverse events each year.xxxix
 Chapter 3

More than Financial Costs

Crohn’s ravaged my body throughout my sophomore

year of high school. Desperately longing to ignore my
symptoms and hide my disease, I fought valiantly to conceal the
devastating effects as Crohn’s waged its internal war. Terrified
of surgery, tired of endless medical appointments, unsure that
anything would ever control my illness, I suffered in silence.
I had already read that cures for Crohn’s were not
discussed so surgery seemed pointless. My mind raced with
questions of what my future held. What kind of long-term impact
faced me? What if the doctors started cutting me up at fifteen
and the disease returned? At what point would it end? Would I

36
eventually have no intestine left and be attached to some feeding
tube machine? What if they decided the best way to slow down
the progression of the disease in the future was to give me a
colostomy bag?
Years later, in answer to the question as to whether or not
surgery was necessary with Crohn’s, an article published by the
National Digestive Diseases Information Clearinghouse would
state, “Surgery to remove part of the intestine can help Crohn’s
disease but cannot cure it. The inflammation tends to return next
to the area of intestine that has been removed…Because Crohn’s
disease often recurs after surgery, people considering it should
carefully weigh its benefits and risks compared with other
treatments.”xl
As hard as I tried to hide my symptoms, sometimes the
disease bested me. One day, walking down the school corridor,
I doubled over in pain as my stomach cramped and nausea
waved over me. With fists clenched I walked by a teacher. She
noticed the look of agony on my face and asked if I was okay.
“Yes,” I replied, “I’m fine,” and continued walking.
My parents also recognized my silent suffering.
Unbeknownst to me they scheduled a doctor appointment. To
ensure my keeping my appointment, they waited until the day
before our trip to the gastroenterologist to inform me. I visited
my doctor in April. My SED rate had risen to twenty-nine and I
had lost six pounds despite an increase in height since January.
I was weak and tired. Arthritis swelled my left ankle. Blood
work revealed that I was quite anemic and slightly
undernourished. My specialist increased my prednisone again
and put me back on my antifungal, Flagyl. He also advised that
I eat some kind of protein with every meal and decided that we
needed to schedule a colonoscopy for as soon as school released
for summer break.xli
In preparation for my colonoscopy, my parents fasted
with me. My Dad even sampled the nasty milk of magnesia
doctors required I drink to cleanse my system. On September
18, 1990 I underwent my colonoscopy. In the past I had been
sedated enough to be relaxed for these exams, but the doctors
put me completely under to perform the test this time.
A week after my colonoscopy, as my family prepared to
celebrate my 16th birthday, the phone rang.
The fan swirled overhead and the birds chirped lazily on
that sunny afternoon. With no air conditioning, the open front
door allowed a nice breeze to wave through the house. I had
picked the restaurant at which I wanted to eat, and was already
anticipating my favorite meal there when the phone rang.
“Hello,” my mom answered. “Mm-
hmm….yes….okay, I understand. We’ll talk to her.”
The fact that she took the earpiece to the rotary phone
around the corner into the kitchen told me that I would not like
the content of this conversation.
When she hung up the phone, she could not have kept the
doctor’s recommendations from us if she had tried. My dad and
I both wanted to know what he had said, although Dad may have
been more optimistic than I.
“Well..?” we both asked.
“They weren’t able to finish the colonoscopy. You have
so much scar tissue built up along the wall of most of your large
intestine that they couldn’t get the scope through. Your doctor

38
wants to do some more tests, but he says that you need surgery,
and the sooner the better.”
With Crohn’s, a person’s immune system attacks
intestinal lining. Over the years so much scar tissue had
accumulated that the scope had been obstructed not just by the
currently active disease, but by accumulated scar tissue.xlii
I felt defeated. Of course I knew I was sick. At times the
pain was excruciating. I would imagine that I was in labor and
make myself “breathe” in short punctuated breaths, or grab onto
the towel bar in the bathroom and squeeze with all my might,
just to have something to concentrate my energy towards rather
than the pain. That worked to a degree until I tore the bar out of
the wall.
As much as I tried to ignore the disease and hide it from
other people, no one knew better than I just how miserable I had
become. For years, though, we had tried different tests and
changes in my medications. Even though a part of me had feared
the surgery, I had hoped this time would be the same—more
medicine. Instead, the Doctor recommended surgery. What did
that even mean? What kind of surgery would they do? What kind
of scar would I have? Would I feel better afterwards, or would I
still have the disease? My dad knew someone at work who had
an ostomy bag. (With this device the end of the intestine is pulled
through the abdominal wall and the bowels empty into a
disposable plastic bag.) Would I have to have one of those? I
was just turning sixteen. How could I live with something like
that? What teenage boy would ever like a girl with a big scar on
her stomach, or worse yet, a bag of stool hanging from her belly?
How could I celebrate now? I sulked through dinner and
through most of the weekend. I hated all of the unknown factors.
My brain swam with unanswered questions all weekend.
 The next week Mom called to schedule the meeting with
the surgeon. She and I took a trip to New York City that
November—in part to celebrate my birthday, but I thought of it
more as a final fling before going under the knife. After we
returned, and after Thanksgiving, we met the surgeon.

*****

The force of oxygen aroused me with a start. I reached for

the mask over my mouth and nose, but still groggy with
anesthetic, my arm felt weighted down by an invisible brick. My
hand finally reached its intended destination, only to encounter
the mask was strapped to my face. Surrendering to the fact that
I couldn’t do anything to slow the nearly smothering sensation
of oxygen being pumped in, I reached instead for my abdomen.
The afternoon before, after hours of debating with the
surgeon whom I had just met, he promised me that he would
make every effort to refrain from giving me an ileostomy in the
operating room today. I had finally ceded to his authority and
agreed to be admitted to the hospital the previous day in order to
have the surgery first thing this morning.
Now I lay in the recovery room, wondering how things
had turned out in the O.R. I reached for my abdomen, which felt
huge, but I could not determine any new shapes or appliances
attached to me.
“Everything went fine, Nichole,” I suddenly heard Dad
say. “He didn’t have to do the bag.” Relieved, I dozed off until
the nurses came in to check my vitals and ask how I was feeling.

40
 Finally the surgeon checked in with us. His sober brown
eyes never wavered from mine while he explained how the
procedure had gone. As we had already known, the majority of
my large bowel had been obstructed. Therefore, he had removed
most of the colon, along with a few inches at the bottom of my
small intestine. In addition, several polyps had developed
throughout my large intestine that could have morphed into
cancer over time if not removed. He had stapled the remaining
ends of each intestine together with staples that would dissolve
into my intestines in a few weeks after they had grown back
together. I was so relieved not to have the ileostomy that
everything else seemed inconsequential to me. Well, all but one
thing.
“Did you take the pictures?” I asked. Although
considered one of the best colorectal surgeons in the world, my
battle weary doctor’s eyes twinkled and one side of his mouth
curled up as he assured me that yes, he had taken the pictures.
After years of grueling tests, a grueling disease, and
medications with sometimes distressing side effects, I wanted to
see exactly what had caused me so many years of misery. Part
of our pre-surgery negotiations had included my request to keep
the removed section of bowel as a souvenir. The surgeon was
silent for a moment when I asked, then told me that he had never
had such a request. He remarked that the lab would keep the
bowel for further research. However, he would take pictures of
it for me so that I could at least retain those keepsakes.
Now, in the recovery room, he assured me that he had
taken the pictures, and once they were developed he would make
sure they reached me. Relieved that the worst was over, and I
would soon be getting my pictures and hopefully living disease
free, I settled in, expecting an uneventful few days of recovery
in the hospital.

*****

By Tuesday evening, the day of surgery, nurses assisted

me with sitting up in the chair next to my hospital room bed. By
Wednesday I roamed the halls. My clinicians wanted to see
evidence of my healing, and I was eager to demonstrate such
proof. I realized that the more quickly I showed recovery the
more quickly my doctors would release me to return home.
However, despite the strength of my post-surgery pain
medications, I complained that I felt worse than before my
surgery. The pain constantly shot waves through my abdomen,
as if the surgeon was repeatedly cutting me, every time I moved
my stomach or engaged my abdominal muscles.
Doctors explained that in removing the majority of my
colon they had in essence rearranged my abdominal cavity and
had shifted my internal organs around. Unused to such
treatment, the organs and muscles were swollen, causing
abdominal bloating and pain. Something did not seem right but
that explanation sounded logical. After a few days a new
symptom materialized as fluid seeped through my scar.
Clinicians assured me that it’s relatively common for
someone who’s just had abdominal surgery to experience a small
amount of wound discharge. My doctors recommended that we
keep an eye on things and if the discharge increased or changed
color, or if I developed a fever, they may be required to take
further action.

42
 Friday night the pain elevated to a new level.
Dad and I had just said good-bye to my mom, brother and
sister, and I was considering a quick nap. Suddenly nausea
joined a searing pain and I leaned over the side of the bed just in
time to vomit into the trash can.
I lay back on the bed as Dad leapt up, asked if I was okay,
and pushed my call light button. My nurse came in to help us
clean up, then returned a few minutes later with a dose of
antiemetic medication.
That stomach pain was more intense than the pain I had
experienced earlier in the week. In my mind the intent of the
surgery was to remove the effects of the disease. After having
surgery I had hoped to finally feel somewhat normal, minus my
scar, which would usually be hidden under clothing. Getting sick
at four I retained little memory of what it felt like to be healthy,
and this surgery had seemed like my only opportunity to revisit
that feeling. That opportunity lost its promise of hope that
evening.
After that one bout of nausea Friday night I made it
through the rest of the weekend fairly uneventfully. My incision
continued draining, but again, no one thought there was anything
to worry about. I did not have a fever, and I continued to walk
and eat as prescribed, so we all thought I was progressing.
Until I returned home.
Once I was home my recovery deteriorated. The
mysterious drainage through my scar increased. I grew so feeble
that I would shower then lie down swaddled in towels before
dressing or even brushing my hair. Although I developed an
aversion to taking pills that I didn’t have to take, I finished off
my Percocet prescription within a week. And even though I tend
to always be cold and it was December in Ohio, I repeatedly
asked my parents to turn down the heat in our home.
My parents called the hospital a few times. Without
seeing my condition personally the doctors did not think that my
symptoms sounded unusual for someone who had just had major
surgery.
However, after a week at home with increasing
symptoms, my parents took matters into their own hands and
drove me to the hospital, despite the doctors’ reassurances.
Immediately when he saw me my surgeon realized what
had happened. The small intestine had torn away from where it
had been stapled to the few remaining inches of my large
intestine. Because of the separation, stool was leaking all over
my organs, causing a massive infection. While I sat in the
doctor’s office, he reached his fingers through an opening in my
incision, and reconnected my intestines with a large safety pin.
He admitted me to the hospital right away. The next morning
orderlies once again wheeled me down to the O.R.
Surgeon Atul Gawande shares how common surgical
errors alone have become. In his refreshingly humble and candid
book Complications: A Surgeon’s Notes on an Imperfect
Science, Dr. Gawande asks respected surgeons he knows from
top medical schools to share about mistakes they had made in
the previous year. This is what he says,
“In one, a general surgeon left a large metal instrument
in a patient’s abdomen, where it tore through the bowel and
the wall of the bladder. In another, a cancer surgeon
biopsied the wrong part of a woman’s breast and thereby
delayed her diagnosis of cancer for months. A cardiac

44
 surgeon skipped a small but key step during a heart valve
operation, thereby killing the patient. A general surgeon
saw a man racked with abdominal pain in the emergency
room and, without taking a CT scan, assumed that the man
had a kidney stone; eighteen hours later, a scan showed a
rupturing abdominal aortic aneurysm, and the patient died
not long afterward.…all doctors make terrible
mistakes….Every one of them had a story to tell.”xliii

When I came out of that second surgery I reached for my

stomach again. There it was. A plastic bag attached to my
stomach. In order to rest my bowels for a few months my
surgeon had created a temporary ileostomy. Since a colostomy
is an ostomy bag attached to the large intestine and most of my
large intestine had been removed, my surgeon had created an
ileostomy attached to my small intestine. I commonly referred
to is as “the pouch”.

*****

The school year passed, and on April 3rd my surgeon

reversed the temporary ileostomy. Surgery and recovery
transgressed smoothly. That time, after just five days in the
hospital, I returned home and immediately went back to school.
One night I stretched out on my stomach to fall asleep. After
months of fearing compressing the bag and causing a leak, I
journaled about how wonderful it felt to be able to sleep on my
stomach once again.
Relieved to be free of the pouch, I enjoyed the summer
before my senior year more than I had enjoyed any in a long
time. I had lived through four months of something I had
absolutely dreaded, and I had survived. While I lived with it, I
had even developed friendships with two men in my youth group
at church. One of them I was quite smitten with, and the other
quickly became one of my best friends.
Despite the joy of being ileostomy free, Crohn’s
reminded me that it’s not considered a chronic illness for no
reason. In the middle of the summer we took a family vacation.
During that vacation, Crohn’s reintroduced itself into my life.

Chapter 4

Refusal

Grandma used to say, “Sticks and stones may break my

bones, but words will never hurt me.” While it sounded good, I
never believed her. At times it was difficult to look at my peers,
and even my brother and sister, and not feel animosity towards
them. Sure, they could sympathize with me, but they never had
to endure what I endured. How had I picked such a short straw

46
in life? And sometimes I felt like people avoided me. They didn’t
know what to say or how to comfort me, so they comforted
themselves by dodging interactions.
After the surgeries were completed during my junior
year, my illness returned, as one of my pamphlets had predicted.
Steroid use continued to exacerbate the arthritis in my knees and
ankles. My specialist prescribed another medication to treat the
arthritis.
As I began my senior year of high school, I frequently
arose during the night to visit the bathroom. The second week-
end in September, as the fair began again, I was losing blood in
my stool. I had been hemorrhaging like this off and on for a few
weeks but had effectively kept the problem hidden up until that
point. When it happened during the night my bedroom was next
to the bathroom so I would return to my room and collapse into
my bed. My family was renting a two-bedroom condo while
building a new house. In that small space it was not a far trek
from the bathroom to the living room couch or dining room table
if I needed to sit down in a chair when I was downstairs.
Although my new medication, an aspirin, was coated to reduce
the risk of intestinal bleeding, my doctor later said it likely
contributed to this hemorrhaging.
One evening the bleeding surpassed my ability to hide it
anymore. Mom and Julie were at the fair but I had stayed home
with Dad and Greg. I ran to the bathroom. Weakened by blood
loss, after sitting in the bathroom for a while I still could not
muster up the strength to walk out to the couch.
Once again, we made the trip to the emergency
department. I was admitted for several days and received four
blood transfusions.
 In October, pain once again immobilized me. Once again
I lost blood in my stool, but not as much as the previous month.
I returned to the hospital, where doctors again admitted me.
They recommended more surgery, likely another ileostomy.
This time I refused.
Doctors diagnosed a blockage in my intestine caused by
more scar tissue. They insisted that I did not realize how
dangerous this blockage was and the necessity of this surgery.
They predicted that if the blockage was not surgically repaired
my intestines could again burst, cause another infection, which
could possibly become fatal. Still, I refused. My parents did
everything that they could to persuade me to allow the surgeon
to operate.
I wearied of the same old routine. The surgeries of the
previous year hadn’t cured me; why would this one? I hated the
ileostomy and was not willing to risk its return. I held my
ground. Although I am not recommending going against
medical advice, or testing God, in that circumstance God saw
my determination and graciously granted the physical reprieve
that I needed. After a few days I returned home from the hospital,
the symptoms miraculously working themselves out.

*****

For the first time, in the fall of my senior year, my weight

reached 121 pounds! Despite the fact that my stomach
considered food a mortal enemy, my friends and I loved to eat.
Being teenagers, we especially enjoyed junk food. Since one of
the CCFA journals later stated that “[n]o special diet has been

48
proven effective for preventing or treating this disease,”xliv I had
no qualms about eating pizza, ice cream and chocolate. I
willfully ignored another comment in one pamphlet, that one
should follow a nutritious diet.xlv After all, my entire life I had
been told that I needed to gain weight. I considered this
justification for eating high calorie foods.
Upon graduation, I received a letter from my doctor:

June 3, 1992

Dear Nichole:

Congratulations on your graduation from high school.

As I think back over the last ten years, I know that life
has not been easy for you because of your Crohn’s
Disease. I believe, though, that you have managed your
life well and very few of your friends really know how
difficult it has been for you coping with this illness as it
related to everyday life. You have done extremely well
and all of us are very proud of you.

I hope you will continue towards your goals in

education, as I know your good brain and sheer
determination will allow you to do almost anything your
heart desires. My very best to you.

Sincerely,
WMM, M.D.xlvi
50
Part II: Learning the Ropes
~
Getting to Know who Has the Largest
Stakes in the Sickness Industry

Of all the forms of inequality, injustice in

health care is the most shocking and
inhumane.

~Rev. Dr. Martin Luther King, Jr.~

52
Chapter 5
 Paying for Health Care: Who Holds the Purse Strings
when It’s not the Consumer?

I had experienced so many symptoms in high school

while still achieving good academic results. I graduated at
seventeen, the recipient of an honorable mention Presidential
academic achievement award, and I had also been invited as a
student ambassador to Europe. However, upon entering college
I struggled to pass the majority of my entry level courses.
Given my history and symptoms my first December at
University my doctors felt that I could be experiencing a
bacterial overgrowth. They recommended a small bowel series
and possibly a breath hydrogen test.
Maintaining my prednisone and Azulfadine twice a day,
my doctors reinitiated the antifungal medication, Flagyl, three
times a day to my daily medicine regimen. Although we did not
discuss it, I later read that patients with inflammatory bowel
disorders typically show signs of dysbiosis, or altered intestinal
microflora. I think of this microflora as a blend of bad bacteria
and the naturally good bacteria that helps fight the bad. When
out of balance we experience a myriad of symptoms, digestive
and otherwise. These are the bacteria that the acidophilus in
foods like yogurt help to balance.
However, rather than discuss these things, the doctor
prescribed an antifungal medication. I did not have the bacteria
test, so in all fairness, he did not know whether the Flagyl would
have been beneficial or not. But I’d been on Flagyl before, and
may have developed an immunity to it, or it may not have

54
targeted anything that was out of balance, or could have even led
to a greater imbalance.
I felt like a gerbil spinning around on a wheel. I ran
through a continuous loop of treating and re-treating the disease
the same way, to no avail. Not having any answers that made
sense to me, feeling angry and frustrated, I drank and rebelled. I
flunked out of Ohio State my second semester. I appealed Ohio
State’s decision to expel me, and graciously, they agreed to give
me a second chance.
I only saw my gastroenterologist once the summer
between my first and second years in Columbus. He cautioned
that my job in a pizza and ice cream shop might not provide the
best environment for me to stay healthy. He also suggested that
standing all day at work might be causing some of the recurring
pain in my knees.
He encouraged me to continue taking my medicine
consistently. He also added another medication, Advil, to my
regimen as needed. He anticipated that if I was faithful in taking
my Azulfidine and my Flagyl as prescribed, I might be able to
go off of my prednisone within a few weeks. Unless things
changed I would not need to see him again until Christmas break
of my second year at Ohio State.xlvii Unfortunately, instead of
eliminating the prednisone, I developed a persistent allergic
cough causing my primary care physician (PCP) to maintain my
prescription.
Returning to Columbus in the fall provided an
opportunity to spend time with friends with whom I could
temporarily ignore my illness. For the first time I felt like I
belonged amid my friends, instead of being that girl with the
disease. However, after watching my academic career unravel,
my parents cut me off financially at the end of my second year
in Columbus. Embarrassed, I returned to Wooster.
For a while at least, after my move to Wooster, the
medications seemed to reduce my symptoms. In a few months’
time my doctor slowly tapered me off of the steroid.
Although I experienced periodic bouts of abdominal pain
and vomiting every few weeks, my day-to-day health improved
to the point that we discontinued my medications for a while. I
felt so well, in fact, that a friend invited me to apply to be a camp
counselor for a week at my church’s summer camp.
In mid-June I drove to the campsite for a two-day
training. Driving back to Wooster Saturday severe pain forced
me to pull the car over as I doubled over at the steering wheel.
“Here we go again,” I thought. The weekend had been so
refreshing. Now I found myself on an abandoned country road,
with no gas stations or payphones in sight or walking distance.
What should I do? What could I do? I was about an hour away
from my parents’ house. The best option I could see was to suck
it up, ignore the pain, and keep driving.
Once I finally made it home, I collapsed on the couch.
Even though I was inside the air-conditioned house, perspiration
continued to break out on my face, arms and neck, followed by
periods of goose-bumps. To focus my energy off of the pain I
started kneading the back of the couch cushion with my toes
while lying on the couch. Throughout the night, every time I
woke in pain, the toes returned to that same spot. By Sunday
morning stuffing erupted from the back of the couch where my
toes had worked a hole in the seam.

56
 I vomited over a dozen times Sunday. I didn’t want to go
back to the hospital. I kept looking at the clock, thinking maybe
by noon I would feel better. By noon, I hoped that by mid-
afternoon I’d feel better, then dinnertime, then primetime.
Finally surrendered to the idea that my body was not
working out whatever was happening without medical
intervention, at 12:30 am Monday morning I asked my parents
to call the E.D. Of course the clinician in the E.D. suggested Dad
and Mom bring me in. As had become our habit over the years,
we packed a light bag, notified Greg and Julie where we were
going, and piled into the car for another hour-long trek.
Once registration personnel processed our paperwork and
transferred us to our emergency department room, clinicians
inserted an IV in one arm and an NG tube down my esophagus.
Although I was no longer a pediatric patient, due to the
fact that my specialist was a pediatric specialist, the doctors
admitted me to the pediatric unit of the hospital. Suspecting an
obstruction the E.D. doctors called in a surgeon for a
consultation. My previous surgeon was unavailable, so another
surgeon was brought in to examine me. He determined that there
was no immediate need for surgery that evening, but admitted
me to the hospital in the wee hours of Monday morning with a
small bowel obstruction and slightly elevated white blood cell
count.xlviii He also let us know that he had been called away from
a formal dinner to come into the E.D. that evening.
Seeing my continued misery on Tuesday my GI again
called in the surgeon to consult. My gastroenterologist suspected
that adhesions had formed from previous surgeries. The surgeon
examined me under anesthesia. When he found that both the
Crohn’s and an infection caused my distress, he moved me from
the exam room directly to an operating room where he created
my second temporary ileostomy.
Despite the IV, a TPN line, a catheter, and NG tube
protruding from me, I ironically finally found myself
comfortable enough to sleep Tuesday night. The doctors
discharged me nearly a week later, on Father’s Day.
Although I had not been taking any medications prior to
my surgery, I was discharged on six different medications--two
antibiotics, a steroid, Percocet, Pentasa and Lomotil--and told to
follow up with the surgeon in about a month.
Pentasa was a new medication that had demonstrated
promising results in clinical trials. Doctors hoped that putting
me on Pentasa might prevent further exacerbations in the future.
I took twelve 250 mg capsules of this new medication per day.
Once again I had an extra appendage on my stomach that
I still hated. While my family attended the fireworks on
Independence Day upon my urging, I mourned on the couch and
wondered if I had enough Percocet to take away my physical and
emotional pain. Although I’ve had other moments when I
wondered if I had the strength to keep fighting, that was the only
time that I actually considered how I might attempt to take my
life. I didn’t take any pills; I just wondered.
As someone who enjoys reading and history, I read about
Abraham Lincoln. Lincoln failed twice in business, was rejected
the first time he applied for law school, suffered a nervous
breakdown, lost eight elections, and experienced the death of his
first fiancée before they married. Yet he never gave up, and
became one of the greatest presidents in our country’s history.
In a speech he once said, “The path was worn and slippery. My

58
foot slipped from under me, knocking the other out of the way,
but I recovered and said to myself, ‘It’s a slip and not a fall.’”
As long as I continued to persevere, though I sometimes slipped,
I would not allow myself to fall.
In addition to the disease itself, as the facility where my
dad worked prepared to close, for the first time I faced the
financial realities of living with a chronic illness without health
insurance. I had been terminated after I called off the night I was
admitted to the hospital. Although my employer rehired me once
they understood that I had truly been sick, I knew that my body
was not prepared to work third shift full-time.
One summer evening I sat on my parents’ couch while a
guest explained the procedures to apply for Medicaid. We had
never been wealthy. In fact, I sometimes wondered how my
father provided the way he did as a teacher. Yes, we drove our
cars until they died, but we took family vacations and lived in
homes that I considered nice. He often worked summer jobs to
earn additional income. I never knew need, or feared missing
any meals or holiday gifts. I certainly never imagined that I
would have to apply for government assistance.
Few things are as humiliating as sitting across from
someone you graduated from high school with as they intake
your application for government services. Thankfully, with the
help of my surgeon’s notes, the Ohio Medicaid program
retroactively approved my application. Ohio generously paid for
my surgery and my medications.

*****

As fall dawned I once again craved independence. Eager

to make a new start I returned to Columbus.
 On a September afternoon I walked down to get the mail.
I quickly tore open the envelope from the Ohio Department of
Jobs and Family Services. The state had written to notify me that
my Medicaid would terminate at the end of October instead of
the previously predicted date of March 31st. Since my ileostomy
had been done in June, my surgeon would not reconnect me until
December. This meant that the new Medicaid end date would
leave me uninsured for surgery.
Devastated, I called the surgeon to ask him to reverse the
ileostomy early. He wisely refused, keeping the date in
December rather than my proposed October date. Heart-broken,
I hung up the phone. Eager to rid myself of the ileostomy more
quickly, I renewed my hunt for a full-time job with benefits to
pay for a surgery in December. Little did I understand then that
I needed to provide my services to a company for a longer period
of time before I could qualify for insurance and take time off for
any planned hospitalizations.

60
 Chapter 6

Human Commodities

On Sunday, October 1, 1995, I watched a story on 60

Minutes regarding HMOs rationing patient care. My parents and
I had never discussed the costs of my medical care. Dad had
always carried insurance through his employers. Until that
summer I remained blissfully ignorant of medical care costs. The
idea of anyone rationing care baffled my mind. In fact, my
providers had always suggested more medications, tests and
treatments than I desired. After watching the 60 Minutes
episode, I recorded in my journal that it seemed to me that
HMOs treated people as commodities.
I had no idea how much money even the media has
invested in healthcare. According to an article in the New York
Times in 2002, three of New York’s largest advertising firms
were invested in for-profit companies that performed clinical
trials.xlix
At the time I applied for Medicaid, Ohio law required that
I also apply for social security disability. Although I couldn’t
imagine a life on permanent disability, I conceded to the
requirements. I knew I needed Medicaid at least long enough to
pay for that summer’s surgery and my medications after the
surgery. The Disability Department denied my application for
assistance. Ineligibility for disability also made me ineligible for
maintaining Medicaid.
I began praying that my Medicaid would be extended and
my surgery paid for. By October 28th, when I still had not heard
from Medicaid, I once again felt discouraged and like God was
turning His back on me. Finally, on November 7th, the
Department of Jobs and Family Services reopened my Medicaid
case. Thrilled, I scheduled my ileostomy closure for December
16th!
In December, I entered the hospital for surgery. The
surgeon noted that I had done well in the intervening period, with
complete recovery and no signs of recurrent Crohn’s in the small
bowel. In fact, I had been well enough to taper off of my
medications after my surgery in June. Leading up to the
December surgery I was not taking any medicine. I was
discharged without incident three days after surgery, with only
three temporary prescriptions. Two weeks after my discharge I
returned to the surgeon for my post-operative check-up. He said
that everything continued to look good. He suggested I stop
taking my prednisone. Then he removed my staples.
My Crohn’s roller coaster ride continued as my health
again deteriorated in March of 1997. My stomach regularly
urged me into the bathroom fifteen to twenty times a day. As if
that weren’t enough, I often got up five or six times during the
night. Uninsured and now ineligible for Medicaid, I put myself
back on some leftover prednisone that I had at home. I hoped
this solution would at least mask some of my symptoms short-
term. I finally returned to the doctor who increased my
prednisone and put me back on Flagyl. He also helped me apply
for a patient assistance program which helped low-income
patients receive Pentasa directly from the pharmaceutical
company.
The arthritis also flared. Work became more and more
difficult with fatigue and constant trips to the restroom. The

62
Pentasa that doctors had previously recommended to minimize
flare-ups was especially expensive. As a newly patented
medication, pharmacies charged $250 for a month’s supply. A
generous but anonymous friend heard about my plight. I
received a mysterious envelope with money to pay for one
month’s worth of this new prescription.
Unfortunately, in the spring of 1999 my symptoms again
worsened. Once more I went on the antifungal for three months.
Blood work revealed that my iron was slightly deficient. A new
GI offered me a prescription to correct this. Although my
Vitamin B12 was within normal limits, he said that it was in the
low end of normal and also recommended Vitamin B12 shots.l I
started taking iron supplements, but did not feel that it was
necessary to pay for shots for something that my body was not
deficient in. If I had been deficient, I would have preferred
nutritional counseling before supplementation, especially
considering the fact that B vitamins are largely water soluble,
and filter through the kidneys rather than remaining active in
your system. It is sometimes true that patients without large
intestines have difficulty absorbing vitamins, particularly the
water soluble vitamin B12.li However, my number was within
the normal range, so from my perspective a few simple questions
about my diet at the time could have alleviated a need to charge
the insurance company for regular shots.
My doctor requested that I visit his office in four weeks
after re-starting the Pentasa and prednisone. Feeling hopeless, I
no-showed to my follow-up appointment. I despaired that the
medications and treatments we had spent years experimenting
with were pointless and largely ineffective. I prayed for God to
help me find security in Him, since I had been unable to find it
in health, professional success, financial stability or romance
 One morning Mom drove me to the clinic. Dad was
working. Today’s procedure wouldn’t be very invasive, so we
let him off the hook for the day. I didn’t say much during the
drive. With the radio turned low I looked out the window.
These drives were always tough for me. I never said much
on the way there, wary of what the doctor would say. Today’s
anxiety was compounded by the fact that we would be trying a
new medication, one that had to be administered intravenously
in an outpatient setting.
The medication itself was fairly new. We had little
information as to what kind of results we might be able to expect.
Sometimes dehydration made me a tough stick, so I never knew
what to anticipate from IVs anyhow. We knew most of the day
would be consumed between the drive to and from the clinic, the
infusion, and the wait before and after infusion.
My pediatric GI had retired. After so many years working
with a pediatrician, I had graduated to an adult GI. His soft-
spoken demeanor would have instantly put me at ease in any
other setting. I had gone to see him when my abdominal pains
began increasing again.
He asked about my previous surgeries. I expressed
concern that I would have to endure more surgeries. I asked him
about non-traditional options such as ginseng. He discouraged
that option, explaining that because Crohn’s was an autoimmune
disorder, and people took ginseng to empower their immune
systems, it might only add to my problems. Upon doing my own
research I later learned that at least some herbs modulate the
system. They strengthen weakened immune systems and calm
hyperactive immune systems.lii

64
 He had instead suggested that we try Remicade, a fairly
new immunosuppressant that was administered intravenously. It
could be administered every few weeks at the clinic.
It seemed my last option for any sort of improvement. My
doctor explained the known effects, although I would be one of
the first patients on the medication, and we proceeded. One of
the potential risks included lymphoma. Still, I was desperate. We
also initiated the leukemia drug, Purinethol. Although it was
initially intended to treat patients with leukemia, because of its
immunosuppressive properties, it is sometimes used to treat
Crohn’s. And we started the antifungal again.
Since I was living in Columbus at the time, I drove up one
evening to Wooster. The next morning, July 6, 1999, Mom drove
me to Cleveland. Nurses inserted my first tube of Remicade. In
addition they hooked me up to a blood pressure and pulse rate
monitoring device for the duration of the infusion.
“Mom, do you see that blood coming back in my line?”
“Yeah, I wonder why that is.”
“I don’t know.”
“Do you want me to say something to the nurses?”
“No, let’s wait a little bit and see if it continues.”
A few minutes later a nurse popped into check on us. I
showed her the line. “Hmm, that’s strange.” She tried readjusting
the tubing to no avail. The medicine refused to go in, and more
blood backed into the line. “I’ll be right back.”
Soon she arrived with the doctor. He had been seeing
patients in another wing on the same floor, but she had asked
him to come and look at my IV.
He looked at my arm and exclaimed, “Oh no, that’s in an
artery.” Immediately he applied pressure and pulled the IV. As
blood splattered on him and around the procedure room, he
reassured us that he always brought a change of clothes to work
for incidents such as this.
A few moments later a nurse restarted the IV in my other
arm. The rest of the infusion continued without any further
incident, and I left the clinic a few hours after its inception.
The infusions seemed to have some impact, as my
nighttime bathroom runs decreased. We therefore repeated the
infusion three weeks later, and again in August. My doctor
refused, however, to continue my prescriptions for the
Purinethol, as I did not comply with the necessary lab work when
taking this medication. Purinethol can cause liver disease and
pancreatitis, so patients who take it are required to regularly have
blood work to check liver enzymes. With all of the poking and
prodding I was already subjected to on a regular basis, I did not
comply with those additional tests.
I began experiencing symptoms that were not directly
related to the Crohn’s but could be indirectly explained. For
instance, I occasionally became short of breath, which I
attributed to anemia. Without a large intestine, in theory, I was
not absorbing water and nutrients as well as people with large
intestines intact.
Regardless of these new symptoms, more and more
frequently I refused procedures at my doctor’s office. Although
this was not reflective of him personally, his office felt like a
place where I was perpetually violated. I constantly had fingers
and other things being stuck into me and I was tired of it. And to
what end? None of the torture led to any real relief.
The antifungal no longer seemed to help. The disease
again roused me several times throughout the night and rushed

66
me to the restroom several times a day despite the medications
that I consumed. Another new symptom that I experienced was
a persistent rash covering various parts of my body. With little
appetite I drank Ensure, hoping to replenish the fluids and
nutrients I quickly pushed through my system.
I continued with the Remicade infusions. With still no
real improvement, despite the infusions, the doctor re-instituted
and increased my Purinethol in July 2000.liii With increased skin
and sinus problems, including constantly itchy and red and
watery eyes, I started wondering what kinds of allergies might
be causing these new problems.
Adding to my discouragement, I eventually read a
brochure from the company which made Infliximab (Remicade),
my new wonder drug, dated October 2000. The information
sheet declared that Remicade tests had not revealed incredibly
high rates of short-term or long-term success. In fact,
improvement rates were just moderately higher than those with
patients treated by placebos. In addition, according to the
brochure, one in five people in clinical studies experienced
reactions such as rashes and itchy skin.liv Was this why nurses
had begun administering Benadryl into IVs before administering
Remicade to me and other patients at the clinic who were
receiving the treatment?
Periodically my doctor ordered stool sample tests. I
assumed these were routine for Crohn’s, until I later requested
my records and saw that he had been ordering C-diff tests. I
wondered then what his reasoning was for these tests.
According to a 2008 study by Pricewaterhouse Cooper’s
Health Research Institute, wasteful spending accounts for one
half of the $2.2 trillion spent annually on healthcare in the U.S.
Although various factors contribute to this extraneous spending,
one factor is variations in treatment. Dr. Brent James, the chief
quality officer for Intermountain Healthcare, stated, “…[T]he
incentive is to do more. To generate more fees.”lv I couldn’t help
but wonder if the C-diff tests had been a way to generate more
fees.
As my new GI had previously practiced in Canada, we
discussed some of the differences between the American and
Canadian healthcare systems. Even though many consider the
Affordable Care and Patient Protection Act to be healthcare
reform, a recent study looking at data from such esteemed
organizations as the World Health Organization indicates that
although the U.S. spends more of our Gross Domestic Product
and more per capita than other industrialized nations do on
healthcare, our life expectancy and indicators of health outcomes
rank us towards the bottom of many quality of care lists when
compared to other industrialized countries.lvi
On November 15, 2000, I woke around 3:00 in the
morning in severe pain. Once I threw up I knew I should go to
the hospital. I was living in Columbus at the time, but still
receiving care in Cleveland. I quickly packed a bag and drove
north to my parents’ house. From there, my parents drove me to
the Clinic.
The emergency department physician noticed the
worsening of my rashes and wrote that my skin was very dry and
scaly, stating “Scaly, thickened skin in the face with double fold
of the inferior lidlvii.” Although in continued embarrassment I
constantly applied and re-applied lotion to my face, the skin was
so raw, flaky and scaly, that applying anything, including water,
burned. And nothing seemed to help. The more ointments I put

68
on, the more my skin flaked. Make-up was completely out of the
question. I still attempted to wear foundation, but it just caked
and peeled off with my skin. What made this even more
frustrating was that I was one of those few lucky people who had
great skin through her teenage years. Now, as an adult, my skin
was a fiery mess.
We arrived at the E.D. early enough that we were seen
quickly. Assessments indicated no obstructions in the bowel,
thankfully, just another exacerbation of the Crohn’s. After
receiving a liter of fluids, I was released on my medications and
instructed to follow up with my doctor.
As my complications expanded past my skin problems to
cardiovascular problems, my thoughts regarding traditional
American medicine continued to evolve as well. A friend
suggested that I pray for God to heal me. My dad also offered to
pray over me for healing. It was difficult to imagine that healing
could come so easily after all of my years of illness. I had no
reason to believe that I would ever live without Crohn’s and all
of the suffering that accompanied it.
However, I had nothing to lose. So I prayed.
It occurred to me that besides the power Crohn’s held
over me, multiple people were empowered in making decisions
regarding my fate. My doctors made recommendations. Without
knowing other options, I usually went along with their
recommendations. Those paying for my care made decisions.
Payers included insurance companies, the government through
Medicaid, and charitable providers, whether healthcare
organizations or pharmaceutical companies offering samples.
Since I was the one forced to live with the consequences
of those decisions, good or bad, I decided that it was time for me
to start doing my own research and making my own decisions.
That’s when things began to change.

70
 Chapter 7

The Runaway Costs of Runaway Symptoms

Two months after that trip to the ED I returned to college.

I finally had figured out what I wanted to do. I applied as a B.A.
student majoring in political science and eventually added a
second degree in psychology. I decided that I wanted to advocate
for patients’ rights and health care reform. I had seen enough of
health care as a patient, insured and uninsured, with medical
errors and some of the best and most qualified physicians and as
a patient of one of the most renowned health care institutions in
the world. I’d seen politicians talk of health care reform and
political and economic forces prevent its passage. And I’d read
of countries that spent much less per person on health care than
we do in the U.S., but whose citizens rate their quality of life
higher on average than ours, and who live longer healthier lives.

*****

According to a report by the Centers for Medicaid and

Medicare Services, we experienced a 300% increase in the
percentage of our Gross Domestic Product in healthcare costs
from 1960 to 2003, as we increased spending from five percent
of our Gross Domestic Product (GDP) to fifteen percent
(adjusted for inflation).lviii
By 2004, at $6280, U. S. health care costs per person were
the highest of any country in the world, with as much as twenty
percent of the U.S. population having no financial access to
care.lix
By 2014, ten years later, and four years after the
Affordable Care Act passed, the U.S. spent about $3 trillion, or
$8900/per capita, on health care. The next highest spender, Norway,
spent a much lower $5670 per person.lx
As total health care costs climbed, spending on prescriptions
skyrocketed. According to an episode of Lunch Break, with Tanya
Rivera, cited on the DVD Big Pharma: Market Failure, in 2015,
Americans spent $1025 per person on medications, while other
industrialized countries spent an average of $515 per person, about
half of what we spent in the U.S.lxi

*****

In March 2001, I attended my first dermatologist

appointment. Although his suggestions did not stop the rash and
flakiness, he prescribed a two-week dosage of another antifungal
medication with a retail price of $214.98.lxii
In addition my GI reinitiated the leukemia drug,
Purinethol, into my daily regimen for Crohn’s. Without financial
assistance, the monthly retail price for this medication was
$205.72; with Medicaid I paid nothing.lxiii My Medicaid benefits
were scheduled to end once more at the close of that month. By
the end of March none of my symptoms had abated, and my
blood pressure increased to 131/80.lxiv
As of March 31, I lost my Medicaid. However, at the time
healthcare organizations which received federal funding (such
as Medicare payments) were required to provide charity care

72
programs. With this assistance, my GI re-instituted my
Remicade infusions on April 6th.
Since my rash continued, my doctor determined that it
was not an allergic reaction to the Pentasa, and the clinic shipped
me a month’s worth of Pentasa samples. I re-applied for
Medicaid that summer.
For three years, while living in Wooster and going to
school in Cleveland, I worked in an organization through which
I purchased health insurance. While I am grateful for the
assistance I received from Medicaid, having private insurance
relieved some of the distress of being a public/charity case.
With insurance, I sought the advice of new physicians to
treat some of my mystery symptoms. In October 2001, I tried
another dermatologist after switching over to baby shampoo and
a new prescription corticosteroid cream. My face continued to
burn and flake. My sinus symptoms worsened. My blood
pressure crept up to 145/90.lxv
When I awoke one morning with my face swollen and
burning, my GI prescribed another steroid to minimize those
symptoms. Again we stopped the Pentasa, this time with some
relief after a week.
Two new symptoms began at this point in my life:
tachycardia (irregular heart-rate) and dizziness.

*****

I stayed in my office at work, hoping no one would notice

my latest contraption attached to me.
A cardiologist had prescribed a King of Hearts monitor. I
wore it under my clothes everywhere I went for forty-eight
hours. In addition to the tachycardia, I also began experiencing
headaches and numbness in my face, hands and feet.
My rash spread from my face to other areas of my body.
In November 2001, when the lesions on my scalp were draining,
I went to my previous PCP. I had tried different brands of
personal care products, still to no avail. The last dermatologist
had not thought it worthwhile to pursue allergy testing, although
his notes suggested he thought I might have both contact
dermatitis and scalp psoriasis. My PCP referred me to a third,
nationally-recognized, dermatologist.
On November 19th I met the new dermatologist. She
diagnosed me with conjunctive eyelids and cradle cap. I also
began a food and activity journal. My symptoms included
fatigue and sluggishness, headaches, tingling in extremities,
blurry vision, aches and pains in my chest and throughout the
rest of my body, nausea and lightheadedness.

*****

At the end of 2001 my primary care physician (PCP)

started me on atenolol at 25 mg daily for hypertension. She
wondered if I was experiencing a reaction to the Remicade. I
returned to the dermatologist. She had given me Derma-
Smoothe/FS Oil, which she noted was dramatically improving
my face, and beginning to soften the thick folds on my scalp.
Only working part-time while attending school, in
December, I was once again eligible for Medicaid. Blood work
continued to look good with normal vitamin B12 levels and

74
folates way above recommended numbers in February.
My blood pressure finally returned to a healthy 110/70. lxvi
Thinking that years of ingesting prednisone may have
affected my adrenal glands, contributing to some of my
symptoms, my new PCP ordered a catecholamine test to check
my cortisol levels. While it seemed like a long shot, my long-
time use of steroids and even the Derma-Smoothe/FS that I was
then using, which warned of possible adrenal suppression,
contributed to her suggestion that we check for adrenal
insufficiency. My blood cortisol levels were checked before and
after a cortisol injection. My baseline levels, however, were
within a healthy range, and even a little higher than the still
normal levels after medication.lxvii Although the cortisol levels
remained typical, she suggested that I see an endocrinologist. I
felt like she was grasping at straws. I did not follow through on
her suggestion.
I returned to the dermatologist at the end of April. Not
only was the rash erupting on my face and scalp, but it spread to
my arms and abdomen. Patches of skin would become red and
inflamed, creating a burning sensation, then they would become
dry and flaky and itch and peel. The cycle continuously repeated
itself. Before flaking, sometimes the skin would ooze.
Previously, the symptoms seemed to have worsened after doses
of Remicade. However, by then it was April, and my last drip
had been in November. The doctor wrote in her notes that even
my eyelids were “scaly.”lxviii I was miserable. I plucked most of
my eyelashes because the hair follicles in my eyelids itched so
badly. I had such a large lump of dry scaly flesh on my scalp that
I had to comb my hair to cover it.
My skin burned so badly at night that I couldn’t sleep,
reminding me of Job: “When I lie down I think, “How long
before I get up? The night drags on, and I toss till dawn. My body
is clothed with worms and scabs, my skin is broken and
festering” (Job 7:4-5).
My GI wrote in his notes, “…not great response to
conventional rx…discuss clinical trials.”lxix Since conventional
treatments weren’t working, he called to see if I was interested
in the new clinical trials for IDEC and Immunex. I wasn’t. I felt
like my symptoms had increased too much when I was taking
the immune-suppressants. On them the dizziness, rashes and
tachycardia began. Nor did they improve my Crohn’s symptoms,
or if they did impact them it was not for long. I felt we were
compromising my immune system, with a high price tag, for no
good reason. I told his office that I was “just not interested”.lxx
My PCP recommended that I see a local GI. He ordered
a small bowel series of X-rays and suggested I start back on
prednisone or Remicade. Without proof of active disease I
refused.
My GI in Cleveland corresponded with the GI I went to
see in Wooster. My Cleveland GI referred to me as “a most
pleasant woman”.lxxi He encouraged the local GI to persuade me
to have an exam under anesthesia to determine the location of
any possible strictures or narrowed sections of the colon.
Further, he wrote that he understood my frustrations with
the ongoing treatments and disease, but he believed that my
quality of life could be improved with more treatment. I felt
more and more irritated with the whole situation, fearing the
ideas of either living with an ileostomy again or being on
steroids for the rest of my life.

76
 I registered for my small bowel series and gulped down
the chalky pink barium. It rushed right through me, leading the
radiology technician to write “very rapid small bowel transit,” as
the barium was ready to exit my system within the first picture
after drinking the cocktail.lxxii He noted what he thought might
be postoperative scar tissue, and contrast in places besides the
intestines, but no other complications or currently active disease.
Because of the additional symptoms, when I began
having vomiting episodes I called the local GI to see if his notes
indicated anything going on besides Crohn’s. Although the
Derma-Smoothe/FS was improving my flakiness, my skin
continued to burn. It seemed worse right after I ate or took my
medications.
The dermatologist wanted to apply thirty-two allergy
patches to my back, at a cost of $15/patch. In addition, she
continued prescribing new creams and ointments on my face and
eyes. Everything seemed to increase the burning sensation. After
trying one option with no relief, I would move down the list to
the next alternative. During the times that Medicaid was
inactive, every dollar I earned seemed to go toward a gerbil
wheel of treatments and diagnostic tests, with little or no results.
At a loss as to what else to try, In August 2002, my GI
referred me back to the surgeon. I had lost five pounds in the
previous two weeks. Lomotil did nothing to stem the tide of
diarrhea, which continued to cause several visits to the restroom
at night and increased blood loss. My heart rate was again
tachycardic; my skin problems still raged on. Although I had
been off of my steroids for five years, arthritis had returned to
my ankles and one wrist.
Unable at that point to stop the runaway train I was on,
doctors performed surgery number six on the morning of August
14th. Once again, they created an ileostomy. This time they
informed me that it would be for an indefinite period of time. I
had no end date to anticipate its removal. Thankfully, I returned
home on the 19th with no complications.
The ileostomy pouches only added to my skin problems,
causing such a severe and weeping rash that the flange (sticky
square used to attach the pouch to the skin) would not stick to
me. The pouches are meant to be changed every three to five
days, but the weeping from the rash prevented my pouches from
sticking, so I sometimes changed them one or two times a day
instead. At that rate, I would have paid $300/month for pouches
without Medicaid. Thankfully, upon returning to the clinic the
Ohio Department of Jobs and Family Services once again
approved my Medicaid application.
Upon returning home I went back to the dermatologist
and a nurse who specialized in assisting patients with ostomies.
Although the dermatologist had prescribed sulfasalazine,
which I had been taking three times a day for a month, there was
no improvement to my scalp and face at the time. I stopped using
all of the ointments, and stuck with plain water to wash my face
with. When I explained that a burning sensation and sometimes
a warm sensation preceded the flaking, she considered referring
me to another doctor. Eliminating the sulfa, she recommended
using plain Vaseline.
This letter from a dermatologist at the Clinic describes the
list of treatments we tried, along with the detail of my skin
condition:

78
 “… treatment resistant seborrheic dermatis for
the past two years. She has failed to improve
with Derma-Smoothe/FS, DesOwen, Protopic,
Plexion Wash, and metroLotion. Prior patch
testing was negative…Physical examination
revealed erythematous plaques with a greasy
scale involving the eyebrows, ears, behind both
ears, and scalp. Her stoma site was fissured with
eczematous plaques.”lxxiii

*****

I sat outside the lab and drank the shake, this time much
tastier than the Barium shakes I had become accustomed to.
My PCP had suggested we try this test to see if it gave us
any answers regarding some of my non GI symptoms.
Over the course of the morning, after drinking my sugary
shake, I had my blood sugar tested multiple times.
Although normal blood sugar levels are between 70 and
110 my number only reached 100 once. Otherwise, I stayed
consistently in the 60s throughout the course of the test, despite
the sweetened beverage I drank.lxxiv While she considered these
results borderline hypoglycemic, they didn’t raise any alarms.
Upon further cardiologic testing, I was diagnosed with
Postural Orthostatic Tachycardia Syndrome (POTS).lxxv One of
the recommendations for treatment of this diagnosis was to eat
more salt; my doctor also suggested that we might want to
further investigate a metabolic/endocrine cause of an irregular
heartbeat.
At one point my blood pressure reached 170/109, despite
my 124- pound frame.lxxvi Searching for reasons for this
hypertension, blood work revealed low levels of proteinuria.
Doctors thought this was likely benign, but wanted to follow up
just in case. In retrospect, as I later read papers by naturopathic
doctors, perhaps with my history, an imbalance of electrolytes
and intestinal microflora, in addition to dehydration, contributed
to my irregular heartbeat and blood pressure readings.
At another doctor visit, a nurse measured my blood
pressure at 168/118. The doctors thought perhaps I had white-
coat-syndrome. This phenomenon occurs when a patient’s heart
rate elevates in the presence of clinicians. The monitor I
wore outside the doctor’s office demonstrated that my blood
pressure was elevated regardless of whether or not I was in the
presence of the clinicians. Blood pressure medicine stabilized
my blood pressure, so I asked a new doctor to check if my
proteinuria had also improved. I continued to have slightly
elevated proteinuria. However, my doctors were not concerned
about this since I did not have any other symptoms at the time
indicating kidney failure.
By 2003, I had been off of any IBD (inflammatory bowel
disease) medications for about one year. Although my surgeon
recommended I consider taking something as maintenance
therapy, he knew the history of regimens I had already tried, and
I told him that I didn’t think anything we had tried had helped.
However, with no other visible solutions for the hypertension, I
continued taking atenolol to maintain my blood pressure.
I stopped using all fragrances and lotions because I did
not want to use anything that might exacerbate my skins
symptoms.

80
 The doctor prescribed another antibiotic, Tetracycline,
and offered me a spray for around the stoma site. As usual, he
ordered blood work. No SED rate tests were ordered. All other
labs came back within normal ranges. I complained of pain in
my upper middle abdomen that sometimes seemed to “radiate
belt fashion” to the back and the chills.
The doctor suggested that we restart the Purinethol. Out
of pocket that prescription alone would have cost me $247.88
for a month’s supply of sixty pills in February 2003.lxxvii My
atenolol had been discontinued, and my blood pressure and pulse
once again escalated. The doctor also ordered my Vitamin B12,
iron, folic acid, folate, and ferritin blood levels be checked.lxxviii

Upon return of the blood work, my doctor recommended

that I take an iron supplement three times a day. He cautioned
that my vitamin B12, at 254, was at the lower limit of normal,
although an average person’s lower limit of normal is 231. He
once again recommended vitamin B12 intramuscular injections
and that my levels be rechecked in three months.lxxix I still felt
that the numbers were within normal ranges, and preferred to use
food as a source of the vitamin than a shot.
In addition to the abdominal pain, nausea and headaches
plagued me, especially prior to my monthly cycle. My OB put
me on birth control pills in the hopes of managing some of these
symptoms. Plans were implemented for more abdominal
surgery. This time, as my health was not improving, the surgeon
decided to make the ileostomy permanent.
On Wednesday December 3, 2003, I went in for my
seventh, and hopefully final, surgery. My exam under anesthesia
in August stated that I had residual sepsis and numerous fistulas
and adhesions.lxxx I had lost fourteen pounds over two months
that summer.
A normal red blood cell count ranges between 4.2 and
5.4, but the morning after my surgery my red blood cell count
was 2.25. No one mentioned this to me, but I felt particularly
lethargic after this surgery. Two days later my RBC still had not
rebounded but had fallen slightly lower to 2.14. After my GI
repeatedly and eagerly encouraged me to supplement and inject
shots for low but normal vitamin B12 levels, my surgeon was
slow to respond to a red blood cell count well below normal
limits. Perhaps a shortage of blood donations caused this
slowness to action. Actually, I did not receive any transfusions
until one of the interns thankfully called in the order for two
transfusions on Sunday, five days after my surgery. After these
transfusions I immediately began to perk up.
While working on my bachelor’s degree I also completed
a correspondence course in medical billing.
Although I rarely received a bill that merited questioning,
this was another area in which I was fortunate. One aspect of
healthcare that contributes to rising costs is billing itself. The
American Medical Association blames errors on claims for an
additional $17 billion in costs in one year. They claim that
twenty percent of the claims they receive back from insurance
companies contain errors.lxxxi In a series of articles on medical
billing in the Cleveland Plain Dealer staff journalist Sarah Jane
Tribble quotes Stephen Parente, a professor of health finance and
insurance at the University of Minnesota. Parente claimed that
his research on medical bills found that up to forty percent of
claim statements passed between insurers and hospitals have

82
errors. He went on to say that up to fifteen percent of all claims
have “outright waste, fraud and abuse.”lxxxii
In 2011 alone hundreds of people filed medical billing
complaints with Ohio Attorney General Mike DeWine.
Unfortunately for the consumers, DeWine enforces the
Consumer Sales Practices Act, which exempts nearly all medical
billing disputes.lxxxiii
Mark Rukavina, the director of Access Project, a
nonprofit group that helps people with medical debt issues, is
hesitant to call problems with medical bills simply errors.
Instead, he insists, it is a gray area where some are simple
mistakes but others are purposeful and bordering on fraud.lxxxiv
Kevin Theiss, Vice President at Summa Health System,
admitted that there are approximately 289 places where
something can go wrong with your hospital bill, and estimated
that 250 people or more could play a role in creating a single
patient’s hospital bill.lxxxv
 Chapter 8

Stone-Cold Normal

A wave of nausea had served as an unwelcome alarm

clock at home earlier that morning. I had rolled into a fetal
position until the first wave of pain passed, then tiptoed to the
kitchen to find a plastic bag. Carrying the bag, I stopped in the
bathroom for a wet washcloth and a towel, then slipped back into
bed. Before long the nausea turned to vomiting. After disposing
of the bag I woke my parents.
Once again we were in the emergency department, this
time in Wooster. The hospital gown and sheet provided little
protection from the emergency department air conditioning
system that morning as I gazed up at the clock on the wall.
The E.D. was quiet this morning so the hospitalist, the
doctor assigned to admit patients from the E.D. to the hospital,
was in the room with us within a few minutes. Eight months had
passed since my last surgery.

84
 “Good morning,” he greeted us, and offered his hand. I
felt silly being there. I had only vomited once; maybe we didn’t
really need to come in this time.
“What brings you in this morning?”
I briefed him on my history and my symptoms.
“Sounds like your Crohn’s is acting up. I’ll start you on
prednisone.”
Feeling exasperated, I objected, “The thing is, I don’t
think it is Crohn’s, or not just Crohn’s. It feels different. With
Crohn’s, I have pain, I go to the bathroom, then I feel better. This
doesn’t really feel better if I vomit or go to the bathroom. I’ve
been having these episodes for a while now. The pain lasts for
days to weeks. I think something else is going on. I don’t want
to just take the prednisone to feel better without figuring out
what’s really causing these symptoms.”
“Okay,” he agreed. “I’ll do some blood work. I’ll do the
SED rate test. We’ll take a look and go from there.
The phlebotomist came in and drew blood. Then we
waited.
A short time later the doctor returned. “I don’t have the
SED rate test back yet,” he informed us. “But your white blood
cell count is high enough that I want to admit you for two days
on IV penicillin. While you’re here we can do a CT scan and
take a stool sample. That will give us a clearer picture of whether
or not we’re dealing with Crohn’s disease.”
I had been having these episodes periodically for several
months. I would experience excruciating pain, then vomit for
two days or so, then begin to feel relief. Although the pain
usually lasted for several days, the vomiting typically passed
after one or two days. Initially I had waved them off as Crohn’s
as well, but given the fact that I was having other symptoms that
weren’t Crohn’s, and given the fact that Crohn’s hadn’t usually
caused vomiting in the past, I had stopped believing that these
symptoms were a result of Crohn’s.
Usually I just waited the symptoms out. Following the
previous month’s episode I had decided to come to the E.D. this
time. After I’d vomited the month before my mom told me that
my sister had been scared when she saw me because she said
she’d never seen anyone throw up so much at one time. My PCP
and I had attempted to find out what was causing the nausea.
She, like the hospitalist, and anyone else who heard my history,
immediately thought Crohn’s. But I knew this was different. I
hoped that coming into the emergency department when the
symptoms were at their worst would lead us to some answers.
The next day the hospitalist came to visit me in the
hospital. As I sat on my bed he pulled a chair up closer. “Well,”
he said, “I’ve got all of your lab work back. On your SED rate
test you got a seven, nowhere near the tell-tale number twenty
which typically indicates an autoimmune response. As far as
Crohn’s goes, you’re stone-cold normal. Absolutely no sign of
active Crohn’s. You have some kind of infection, but I don’t
know where it’s starting from or what’s causing it. It’s
responding to the penicillin though. I would recommend that you
just follow up with your PCP when you get out of here.”
Time seemed to stand still for a moment. Absolutely no
sign of active Crohn’s? Stone-cold normal? Finally, I had proof
and felt vindicated. I couldn’t believe that someone had finally
confirmed that this wasn’t Crohn’s. What was going on with me
then? If it was an infection why did it keep coming and going?
Still, I wanted to tell everyone I knew that I didn’t have Crohn’s.

86
 A few weeks later I sat in my PCP’s office. Again I
relayed to the nurse, then the doctor, what all of my symptoms
had been, how I had ended up in the hospital, and what the
hospitalist had said.
“Wow,” she exclaimed, reviewing my chart, “You
certainly did have an infection. But you know,” she said,
“Crohn’s can cause infections.”
Incredulous, I objected, “But the SED rate test said no
Crohn’s.”
“Well, sometimes that test has to be repeated to be
accurate.”
Feeling unheard I began to cry. “But what about the stool
sample and the CT scan? There was no evidence in either of
those that what I was experiencing was caused by Crohn’s.”
“I can’t explain that, but I think you should go see your
doctor in Cleveland. Maybe you’re depressed.”
“No. I’m sorry, but I know this is not Crohn’s. And it isn’t
clinical depression either. You wouldn’t give someone sugar to
treat their fatigue if they were tired because they had been up all
night the night before with a sick infant. There is a difference
between chemical causes and circumstantial. I have every right
to my feelings right now. I’m frustrated because you’re not
listening to me, and I’m tired of doctors not listening to me. How
can you find the right treatment to something if you don’t even
know what it is you’re trying to treat? If you think the SED rate
test needs to be repeated then please just repeat it!”
While I believe there is a time and place for
antidepressants in our society, I also believe that at times doctors
find it easier to prescribe antidepressants while ignoring a
patient’s feelings, just as they prescribe cholesterol-lowering
statins and insulin rather than advising patients on how to lose
weight, lower cholesterol or reduce their need for insulin. And
as statins don’t always get to the heart of the solution, and in
some cases cause more harm than good, antidepressants can do
the same in too many situations. But they’re a big seller for
pharmaceutical companies and an easy solution for doctors.
According to a report from the National Institutes of
Health, in 2001, antidepressants were the best-selling class of
prescription drugs.lxxxvi That year alone, Americans spent $12.5
billion on antidepressants. This averages out to about $43.85 per
person.lxxxvii
This is one of those medical technologies that comes at a
cost that isn’t just financial. One study examined two groups of
people considered depressed. One group was given placebos, the
other group was given a newer brand of antidepressants. In
Overdosed America, Dr. Abramson reports that twice as many
people taking the new antidepressants successfully committed
suicide as those taking placebos.lxxxviii I sincerely hope this study
wasn’t allowed to go on very long.
Not every country in the world prescribes antidepressants
as readily as we do in the U.S. According to a study done by
Harvard Medical School, Germans are twenty-five times more
likely to take St. John’s Wort than a prescription antidepressant.
The study suggests that seventy-five percent of the time that
antidepressants are prescribed in the U.S. they should not be.lxxxix
An article in Lancet explained that in Great Britain
medical authorities were so alarmed at the increased rate of
suicidal thoughts of adolescents after they began taking Paxil
that they advised doctors to stop prescribing Paxil to anyone
under the age of eighteen.xc

88
 In the U.S. we approach things differently, I suspect
partly because it’s easy, and partly because selling newly
patented medications is more profitable than advising exercise
or herbal remedies. Studies show that exercise is at least as
effective, if not more effective than antidepressants, in treating
many, although not all, cases of depression.xci
Pharmaceutical companies sell stock on the stock
exchange. This means that as the quote at the beginning of my
introduction alluded to, their primary motive is not patient well-
being, but profit. They answer every quarter to their
shareholders, and they are in business to show a profit each
quarter. To do this, they collaborate with doctors; pharmacies;
the media via advertising, press releases, and articles in
esteemed medical “scientific” journals; and even the
government. When the manufacturer of Paxil did nine studies of
the use of its medication on adolescents, and eight of the studies
showed that the patients became less emotionally stable while
on the drug, Paxil’s manufacturer simply covered up eight of the
studies, and only published the one that could be spun more
favorably.xcii
When a pharmaceutical company wants to sell a new
prescription drug they must first perform drug trials and get the
medication approved by the FDA before it goes to market. In at
least one instance, one of the FDA’s drug reviewers raised
concerns that children taking antidepressants became more
suicidal on the medications. He advised that the FDA should
discourage doctors from prescribing these medications to
children. But many of the FDA reviewers have financial ties to
the companies they’re reviewing, and therefore are at least
potentially at risk of having conflicts of interest. When a
dissenting epidemiologist wanted to voice his concerns at a
public hearing, the New York Times reported that the FDA went
so far as to ban him from the hearing so that he could not raise
any concerns about the antidepressants in a public setting.xciii
In addition to financial ties to the government,
pharmaceutical companies have financial ties to doctors and
medical students. Doctors, like many professionals, have to
complete ongoing continuing education courses to stay up to
date on the latest and supposedly best trends in health care. Dr.
Abramson cites an article in the Journal of American Medicine
that pharmaceutical companies fund up to seventy percent of all
continuing education for doctors, or $1500/year on average per
doctor in the U.S.xciv
I know that my doctor was suggesting what she was
trained to suggest, but once again, I felt let down and
disenfranchised with the healthcare system, like she was entirely
missing the point and giving me what was for her the easy
answer. As surgeon Dr. Gawande writes, “We are all, whatever
we do, in the hands of flawed human beings.xcv
One nutritionist asks, why, “instead of pausing to
consider the deeper implications of the widespread diagnosis of
depression, we simply treat it with pharmaceutical drugs.”xcvi

*****

From that office visit, downstairs I went to the lab with

an order for another SED rate test.
A week passed and I heard nothing.

90
 After another week, I called the doctor’s office to inquire
about my results. The desk nurse informed me that my test had
come back even lower this time, a six.xcvii
A month earlier I had decided that if I wanted new results,
I needed to try new options. At that point I willingly paid
$285.65 out of pocket to see a homeopath.xcviii By then, I had
spent four years thinking there was something going on besides
Crohn’s, with two more surgeries in the interim, and still little
relief. At the time I was not taking any medications, and had
been off of them for about two years.
The herbalist referred me to his in-house traditional
Chinese medicine (TCM) practitioner for gua sha massage
therapy with acupuncture in my ears. In hope of some relief, I
happily paid the $125 out of pocket in August 2004 for this new
procedure.xcix As the TCM practitioner completed her gua sha
massage we discussed my results. She looked at me and said,
“When people use all western medicine, no good. When people
use all eastern medicine, no good. When people combine
western medicine and eastern medicine, it’s very, very good.”
While such non-traditional options were once considered
complementary and alternative, they are becoming more and
more commonplace. And although insurance reimbursements
have not always kept up with consumers’ wishes, some patients
are willing to spend their own dollars rather than wait for
insurance companies to approve such care. According to the
Department of Health and Human Services’ own numbers, in
1997 alone, Americans spent over $35 billion on complementary
and alternative therapies. Since Medicaid and health insurance
companies don’t cover many of these treatments, consumers
were willing to pay for approximately half of those expenditures
out-of-pocket.c
 More than sixty percent of U.S. adults claim to have tried
some form of “integrative medicine”, incorporating
complementary and alternative medicine (CAM) into their
wellness regimes.ci Not wanting to lose out on this profit
potential, pharmaceutical companies are introducing their own
products into the market. Perhaps to help their friends in the
pharmaceutical industry outsell herbal companies that sell over-
the-counter, the FDA has been preparing new guidelines for
CAM companies with new costly regulations.cii
Seeing the public’s growing interest in CAM and
traditional medicine’s inability to contain healthcare costs, and
growing incidence of lifestyle-related illnesses, and the cost of
medical errors and opioid overdoses, Congress has even created
a new institute under the Department of Health and Human
Services, a National Center for Complementary and Alternative
Medicine.ciii

*****

My family joined the serving staff in singing “Happy

Birthday.”
It was my 30th and once again we were out for dinner. My
brother Greg and his wife Cara bought me a set of books for
aspiring writers, one of which was called “They Have a Word
for It.” We were perusing the books, deciding on desserts, and
they told me about the chiropractor they had been seeing.
“Actually, he’s looking for a new staff member, someone
who would be outgoing and cheerful. Would you be interested?
We could pass along your information.”

92
 A month later I gave my notice to my employer in
Wooster and began commuting to work for a chiropractor in a
Cleveland suburb. The chiropractor loaned me books from his
office library to read about the effects of common chemicals and
environmental factors on our health. I also met with his wife,
who was knowledgeable about nutrition and women’s
hormones. Before our appointment I prayed, “Please help
someone to help me get healthy soon. And help me to trust that
you have a plan for my life, and that you’ll work everything out
in your time.”
I moved to Cleveland while working for the chiropractor.
Still, I continued to have vomiting spells. One Friday I felt so
terrible I left work early and drove to Wooster. I lost twelve
pounds that weekend. I was so dehydrated and weak by Saturday
morning that Mom called the local emergency department to see
what kind of payment plans they had, stating, “My daughter is
deathly ill.”
I refused to go to the E.D. that weekend though. I knew
once the vomiting stopped I would be able to rehydrate. I had
already been told that the symptoms were due to an infection. I
did not want to just keep taking antibiotics, destroying my own
immune system in the process. Although I had insurance through
my employer, due to the size of the company we had high-
deductible plans. I could not afford to pay the high deductible
for one visit to the hospital, especially if that visit still produced
no answers. So I waited the spell out and returned to work on
Tuesday.
In addition to work, I had been attending school full-time,
and preparing to start an internship as part of my college
curriculum. In order to focus on completing my degree, I
resigned from my position with the chiropractor.
 *****

I found myself reading books like The Okinawa Program,

and Autoimmune Epidemic. The authors of these works offered
data and theories similar to the books the chiropractor had lent
me regarding autoimmune disorders and other health problems
as well.
Growing up I had never envisioned myself visiting a free
clinic, except maybe to volunteer or make a donation. I never
thought that I would have to rely on government programs or the
kindness of strangers in order to obtain healthcare. Yet in
October 2005, I made my first visit to a local free clinic.
In addition to the vomiting and lightheadedness, my
stomach contracted like someone was cinching a rubber-band
around my upper abdomen. It did not usually hurt, but felt very
tight and constricted. Again, I lost weight unintentionally, and
my blood pressure rose. I completely stopped drinking alcohol
because within twenty minutes of having just a few sips I felt
miserable. Sometimes I felt shaky after I ate. My symptoms
seemed to worsen, also, after eating sweet or fatty foods, so I
tried to cut back on anything rich. On bad days I limited my
intake to water, tea, Ensure, ginger ale, and mashed potatoes.
My blood pressure elevated again: 162/110 standing and
148/108 sitting. Still, my SED rate remained a very low two,
glucose still low, and urine protein slightly high. My pancreatic
enzymes were also slightly high.civ Although I hated the idea of
treating the hypertension without knowing the underlying reason

94
for it, clinical staff persuaded me that it needed to be treated
while searching for the cause.
I returned to the free clinic shortly after my initial intake
appointment. Within two weeks I had lost seven pounds and my
blood pressure dropped to 96/68. We stopped the hypertension
medication. Life was truly a roller coaster. My protein levels
were high again, perhaps because I had just been sick and my
system was somewhat acidic.cv
After procrastinating for a while, I finally got rated to
receive charity care at the hospital to which the free clinic
referred me. I met with a new primary care physician who
thought my headaches and nausea may be repeated migraines. I
still felt something underlying was causing everything so I
disregarded that idea. Based on my urine lab results, she referred
me to a nephrologist within the hospital. By the time I saw the
nephrologist, my blood pressure and heart rate were both high.
Again, I was treated for my hypertension. Upon doing an
ultrasound the doctor discovered I had kidney stones.
Apparently they were very small, or I had such a high pain
tolerance at that point that I had not realized I had them.

*****

The American Hospital association claims that they offer

$39.3 billion annually in free care for the poor. However, when
hospital rates are compared to the Centers for Medicare and
Medicaid Services charge-master, it actually costs hospitals less
than $3 billion to provide this care, which is less than 1% of all
U.S. hospitals’ profit margins.cvi
While free clinics rely on donations and grants, hospitals,
including non-profits, are a completely different story. Non-
profit hospitals are exempt from paying taxes, but that’s
basically the extent of their difference from other hospitals. The
only other difference is that non-profits are not responsible for
paying profits to stockholders.
In fact, according to an article by Steven Brill in Time
magazine, their tax exemptions help make non-profit hospitals
more profitable than their for-profit counterparts. For instance,
he shares that The Cleveland Clinic Foundation, the second most
profitable non-profit hospital in 2012, behind only the
University of Pittsburgh, had an annual operating profit of
$572,298,875. The Clinic’s CEO alone earned $2,564,214.00.
Another non-profit, MD Anderson Cancer Center in Houston,
boasted a 26% profit margin in 2010.cvii It’s no wonder,
considering that they charged one patient $48,900 due in
advance for a six-day stay to assess him before they would even
consider formulating a treatment plan for him.cviii
Although these non-profits hospitals are exempted from
paying taxes that regular hospitals pay, their profits still benefit
Uncle Sam, or at least Congress. In 2012 the American Hospital
Association spent $1,859,041 on lobbyists, in one year alone.
According to data from the Center for Responsive Politics cited
in an article in Time magazine, the pharma and health-care
product industries, combined with organizations representing
doctors, hospitals, and nursing homes, health services and
HMO’s, spent $5.36 billion between 1998 and 2012 on lobbying
in Washington. In contrast, the oil and gas industries only spent
$1.3 billion in the same period, and the defense and aerospace
industries spent $1.53 billion.

96
 Brill writes, “Hospitals may be the most politically
powerful institution in any congressional district. They’re
usually admired as their community’s most important charitable
institution, and their influential stakeholders run the gamut from
equipment makers to drug companies to doctors to thousands of
rank-and-file employees. Then again, if every community paid
more attention to those administrator salaries, to those non-
profits’ profit margins and to charges like $77 for gauze pads,
perhaps the political balance would shift.”cix
In other words, I, and I presume most of my readers,
cannot afford to spend $5.36 billion over the course of fourteen
years, or even over the course of my entire lifetime, lobbying
Congress. While hospitals charge $77 for gauze pads, I doubt
that any one person will be willing to spend $77 for a copy of
this book. So Congress, perhaps, doesn’t respond as quickly or
easily to my wishes or needs as they may respond to the wishes
of a non-profit hospital’s CEO who’s making millions of dollars
a year.
 Chapter 9

Eyes Wide Open

“About forty-five thousand people die in America every

year because they have no health insurance.
“I am partly responsible for some of the deaths making
up that shameful statistic,” begins Wendell Potter’s Deadly
Spin.cx
Potter spent two decades as a public relations
representative for Humana and then CIGNA, in a health
insurance system he now considers “to be an evil system built
and sustained on greed.”cxi
In doing my undergraduate internship in political science,
I learned from my supervisor the staggering number of lobbyists
employed by healthcare companies in Washington, D.C. In 2014
one study counted insurance companies as spending over $40

98
million lobbying Congress to campaign on their behalf.cxii A
study by the Center for Public Integrity showed that 1,750
companies hired 4,525 people to influence Congress regarding
health care reform bills in 2009.cxiii This number represents
nearly ten health care lobbyists per member of Congress.
Medical debt is brought on by various reasons.
Unfortunately, prior to the passage of the Affordable Care Act,
some insurance companies discontinued patients’ enrollment
statuses when they were diagnosed with catastrophic illnesses.
Some people lose income due to their sicknesses. And finally,
some people simply cannot afford adequate care, even when
they’re covered by insurance.
In an effort to fill the gap, organizations have begun
fundraising campaigns to help meet the costs of medical care.
However, many autoimmune disorders seem to suffer from a
lack of awareness in fundraising in comparison to the effort
made to raise money for those fighting illnesses like cancer.
Although there are bicycling and walking fundraisers for
Crohn’s, Colitis and MS, many people are still unfamiliar with
most other autoimmune disorders. While the efforts to pay for
care for cancer patients is laudable, in 2007 the estimated cost of
direct medical care to cancer patients was $70 billion, while the
estimated cost of direct medical care to patients with
autoimmune diseases was $120 billion.cxiv
When I reduced my work hours to part-time to
accommodate my school schedule, I attempted to apply for
insurance on my own. The first insurance agent I spoke with
declared that no company would underwrite me as a single with
my health history.
At the time, Ohio law required health insurance
companies to offer open enrollment periods one month out of
each year. During these periods, the state commanded insurers
to accept anyone who applied for coverage, regardless of past
medical history. At the time, short of returning to Medicaid or
receiving charity care through a hospital, open enrollment
periods were my only option.
I called two insurance companies and requested
applications. One company’s application never showed up in my
mail. The second company’s application arrived at the end of the
open enrollment period, in July, 2005, with a quoted monthly
premium of $1181.80.cxv As a returning college student
employed part-time, that quote exceeded my budget.
By the spring of 2006 I had begun writing this book, and
received a publishing offer. But the story was still taking shape
in my mind and I declined the offer.
By March, 2007, living in Cleveland, I tried meeting with
two more new doctors: a GI and an OB. My blood pressure
escalated once again to 181/103.cxvi The OB scheduled me
for exploratory surgery at 7:00 a.m. one morning. Mom drove
up to Cleveland to take me to the outpatient clinic. We left the
house a few minutes early to give ourselves plenty of time to get
to the clinic. Traffic was light and we made good time. We
parked on the street, right across from the hospital. The morning
seemed to be off to a smooth start.
I hesitantly grabbed my yellow highlighted map I had
been given three days prior. Hopefully we wouldn’t need it since
we were already at the hospital, but I grabbed it just in case we
needed assistance navigating through the various buildings. The
bright yellow marker had slashed a path through the hospital

100
diagram, along with the paragraph next to the map leading me to
the O.R.
Mom and I followed the path marked out on the map.
Inside we saw no signs to the surgery center, only to a cafeteria.
Then I looked at the map to see that the paragraph highlighted
was labeled “from surgery center to cafeteria.” “No problem,” I
thought, “we’ll just backtrack.”
We finally made our way into the surgery center
registration/waiting lobby, and I signed in at the unmanned desk.
Mom and I sat down to wait. I picked up a book but could not
focus to read. The television was turned on to Good Morning
America, but the anchor’s words were gibberish to me.
Suddenly, I heard my name called with a hint of a
question mark behind it. I strolled to the registration desk where
an attendant had arrived and was looking on her computer for
my information. She asked if I was to have surgery that day, and
I replied that I was scheduled to have an exam under anesthesia.
She checked again for my information on her computer.
Still nothing. Then she checked the spelling of my last name and
looked again. Aha. I was in the wrong place, she said.
She handed me another map, this time circling directions.
I asked her how long it would take to get to the other building
and she estimated less than ten minutes. While flying down the
stairs to the hospital’s main entrance doors I explained to Mom
what had happened. I pulled out my phone to call the receptionist
at the next facility to let her know that we were on our way. She
said that the doctors were waiting for me and asked if I knew
how to get there. I responded that I had a map and should not
have any more problems.
Quickly Mom and I returned to her car, jumped in, and
headed for the interstate. After a few minutes without seeing our
exit I started to worry that we were again heading in the wrong
direction, so I checked the map again. Unfortunately, I realized
then that the map was actually a map back to the building we had
just left. I called the receptionist again. I told her that we had
the wrong map again. She confirmed that we were at least
driving in the correct direction. She said that when we got off
the exit we should go right, then right again after we passed
Speedway. Almost as soon as I hang up the phone I saw our
exit.
I told Mom to turn right when we exited onto the ramp.
We approached a traffic light where the road teed, and I saw no
Speedway. We tried tuning left. When we realized the address
numbers were going in the opposite direction of the number we
were looking for we turned around.
Finally, we made it to the procedure office. Again, the
exam showed stool migrating to systems outside of my GI tract,
but no visible fistulas, or routes the stool was taking. The OB
also advised me that because of my history I might have a
difficult time in the future carrying an infant to term. He
suggested that I consider IVF or even look for a surrogate if I
wanted to have a child that was biologically mine.
After this exam I was fortunate to find a new GI who
understood my history well. Upon our first meeting she offered
me a prescription for prednisone. When I expressed my opinion
about taking the prednisone while the disease was in remission,
she humbly agreed that, given my history, I probably knew as
much about the disease as she herself knew.

*****

102
 I sat in my living room listening to the sales pitch. A
friend had introduced me to a direct sales company that billed
itself as the #1 natural nutrition company in the U.S.cxvii
Although I wasn’t interested in the supplements at the time, after
reading Autoimmune Epidemic…I was interested in learning
about household cleaners and personal care items that didn’t
contain a lot of chemicals.
Author Ginger Garrett shares research by Marianne
Marchese that in the last forty years there has been an increased
incidence of women’s cancers, autoimmune disorders, and
conditions like fibromyalgia which primarily affect women. At
the same time, we’ve increasingly been exposed to chemicals
like pesticides, herbicides, insecticides and manufacturing
byproducts.cxviii
The Toxic Substances Control Act went into effect in
1976. Any chemicals that were already in use in consumer
products prior to that date likely have not been tested for effects
on human subjects. While the FDA requires tests on
pharmaceutical products before they go on the market, the EPA
works under different rules. The EPA only tests products once
they raise a concern. Since enacting the TCSA the agency has
studied only about 200 of 83,000 chemicals in use and put
restrictions on only about five chemicals.cxix
The FDA regulates ingredients in cosmetic products, but
they’ve only banned eight ingredients, while the European
Union has banned more than a thousand.cxx In contrast to the
approach we take in the U.S., in Europe the burden of proof is
on the chemical companies.cxxi
One type of chemical, called a paraben, is a by-product of
oil processing. They are considered a cheap form of a
preservative, which makes them a popular ingredient. However,
studies show that they accumulate in human tissue, potentially
contributing to tumor growth. Over 13,000 products regulated
by the FDA contain parabens. According to a survey of 215
cosmetics published in the London Independent, ninety-nine
percent of those designed to be left on the skin contained
parabens.cxxii
Whatever you apply on the skin can be absorbed into the
body. Nicotine and birth control patches work on this
principle…”many beauty products are specifically engineered to
penetrate the skin’s barrier to deliver the chemicals and create
“results”’.cxxiii
Many scientists are not concerned about the use of BPA
and phthalates because they are excreted from the body rather
quickly. But we are exposed to them through so many products
that we renew our exposures almost daily.cxxiv Consider that
when we take vitamins we take them daily because we want to
keep them in our systems.
In addition to what many suppose is a genetic
predisposition for developing an autoimmune disorder, research
by the Centers for Disease Control suggests that an increase in
the use of chemicals in our modern society has contributed to the
rapid increase in incidence of these disorders. In a 2004 study of
blood and urine samples of 2500 people across the country, the
CDC found 116 chemicals in the participants’ tissue samples. In
addition, studies of fetal cord blood in both the U.S. and the
Netherlands have shown over 280 industrial chemicals and
pollutants in fetal cord blood.cxxv This is blood of infants who

104
have not even lived in the real world yet, but are being exposed
to chemicals in utero through their mothers’ systems.
With this knowledge in hand, I continued building on the
lifestyle and dietary changes I had already been making. I still
experienced skin problems and other complications, but I
refused to continue taking medications without justifiable cause.
They felt like Band-Aid solutions. I still believed there had to be
a root cause to the seemingly endless myriad of symptoms
plaguing me.
Even chemicals that we think of as benefiting our health
can have negative consequences. For example, according to a
press release by the FDA titled “Antibacterial Soap? You Can
Skip It—Use Plain Soap and Water”, the FDA declared that
OTC consumer antibacterial soaps and body wash products (not
no-rinse hand sanitizers or antimicrobial cleansers used in
clinical care settings) containing ingredients such as triclosan
could no longer be marketed because manufacturers had been
given three years to provide safety and efficacy data and had
been unable to do so. Theresa M. Michele MD of the FDA
Division of Nonprescription Drug Products stated “If you use
these products because you think they protect you more than
soap and water, that’s not correct. If you use them because of
how they feel, there are many other products that have similar
formulations but won’t expose your family to unnecessary
chemicals.” The EPA regulates the use of triclosan as a pesticide.
Other ingredients under FDA review are benzalkonium chloride,
benzethonium chloride, and chloroxylenol.cxxvi
 Chapter 10

Lobbyists ~ The Justices of the Peace When

Congress and Healthcare Wed

In August 2007 my roommate married and I moved back

to Wooster. While there I went to the local free clinic a few times
for medicine refills and follow up appointments. After I had been
in Wooster for two years, I received a phone call one day from
someone at the clinic.
“How are you feeling?” the caller asked.
“Pretty good.”

106
 “Really? Because I have your lab results. Your pancreatic
enzymes are high and your kidneys are not functioning…”
At that moment my phone battery died.
We played phone tag a few times, then on Friday,
November 13, 2009, I received the following message, “Glad to
see you’re doing okay. Won’t worry about you anymore.”
I wondered who to turn to. I had been managing my
symptoms fairly well through diet. In fact, I had been working
full-time for a while at that point. My faith in doctors had eroded
quickly. Still, I wanted some evidence to either prove or disprove
any problems with my kidneys and/or pancreas. With my
history, I decided to schedule an appointment with a new GI in
Wooster.
When I explained that my blood work results from the
clinic had prompted me to schedule our appointment, he insisted
that the blood work had actually been completed at his facility.
He continued to tell me that the lab results had been lost but that
he did not think they pointed to anything serious. I scheduled the
endoscopy he recommended, then returned to the free clinic
myself to request the lab results. Within five minutes they were
in my hands. My lipase (pancreatic enzyme) was indeed ninety-
seven, well above a healthy person’s high of fifty-nine. My
creatinine, or kidney protein, was slightly high at 1.3. A healthy
person’s high level should be 1.0. The creatinine was equally
high when the new GI tested it.
In fact, I requested my records from my encounters with
him. His notes state “referred by…Free Clinic….The blood
work from the…Free Clinic was actually done here at the C…
C… Wooster, and we cannot find the results…”cxxvii An
ultrasound later revealed a contracted gallbladder with wall
thickening and polyps.cxxviii An endoscopy showed nothing
more. The pancreas was of normal size, and he decided not to do
a CT scan to check for pancreatic calcifications.
There are two phenomena in healthcare, occurring at
increasing rates since healthcare organizations have begun
advertising and rating themselves on quality of care. These
phenomena are referred to as cherry-picking and lemon-
dropping patients. When cherry-picking, providers choose to
treat healthier and better insured, or better able to pay, patients.
When lemon-dropping, providers “dump” patients with poorer
insurance or predictably poorer outcomes.cxxix I cannot say if that
is what happened with this provider or not, but I continue to
wonder why he insisted that the blood work had been done at his
facility and had been lost, even though he also stated that I had
been referred by another facility and I so easily obtained the lab
results on my own.
In October 2007 my blood pressure reached 166/110
when I was at my OB’s office. On my way home from that
appointment I called the nephrologist to request a new
prescription for an anti-hypertensive. Fortunately, she returned
my call before I made it back to work. I asked her if she could
write me a new prescription for atenolol. She said that she would
not recommend that drug but offered me three other choices.
The first choice was a diuretic. I reminded her that I do not have
a large intestine (which absorbs fluids into our bodies) and that
I have a history of Crohn’s disease, so a medication that causes
one to lose fluids probably would not be the best one for me.
Another option would have cost $70 a month. (My previous
prescription had only cost me $4 a month at a local pharmacy.)
The third option would have required follow up lab work to

108
check my potassium levels. I would have had to drive over an
hour each way to have this lab work done, or pay out of pocket
for it.
I asked again why I could not take atenolol. She offered
another suggestion, but said that I would have to take multiple
prescriptions for that one. I told her that I am not a fan of
pharmaceutical drugs and only wanted to take one. She said with
my blood pressure so high I needed to take something. I
reminded her that that was why I had called her. She said that
she was not comfortable prescribing atenolol because it does not
decrease morbidity, only hypertension. Essentially, she said, it
masks things. I queried, “Isn’t that essentially what a lot of
pharmaceuticals do?” And since we do not know what caused
my hypertension, but I do not have coronary heart disease, or
high cholesterol, nor am I overweight or have extensive family
history of hypertension, can we expect anything more than a
mask, or suppression? Many drugs are called anti-something
because they suppress or hide things without getting to the root
of the problem.
Finally, she declared that she had a meeting to go to and
if we needed to discuss things further we would have to do so
later. I told her that I would be at work later and would not be
able to talk then. She said, “Oh, well then we can’t,” and hung
up on me without giving me the prescription she had insisted that
I needed.
My blood pressure again went up to 160/110.
Rather than trek to Cleveland from Wooster, I again went
to the free clinic in Wooster, where I was given a prescription
for atenolol.
In 2010 I decided to continue pursuing my education. I
enrolled in online courses to complete my Master’s degree in
healthcare administration. My sister, knowing some of my
antipathy and mistrust for our healthcare system’s practices to at
times put profits before patients, and easily prescribe
medications rather than look for natural preventative solutions,
suggested that I work in a healthcare setting, trying to change the
system from the inside out.
I, however, feared that doing so would only make me a
greater enemy for the people I would then be working with, and
would not underestimate how someone might damage another’s
life for the sake of profits. One need only consider the fact that
the pharmaceutical industry has been sued by several
municipalities, states and county governments for contributing
to the opioid, epidemic, now the #3 cause of deaths in the U.S.,
with overdoses having doubled in the last two years alone, to see
that profit is sometimes more important than people’s lives. One
county alone sued just one pharmaceutical company for $1
billion, with a “B”, dollars for that pharmaceutical company’s
contribution to the opioid epidemic just in that county’s
jurisdiction. And if we doubt that pharmaceutical companies are
culpable for those who’ve fallen prey to this devil of an
epidemic, consider that prescription companies are able to
purchase information from local pharmacies to find out which
doctors are prescribing what medications. In this way they can
more accurately discern how effective their representatives are
in making sales when they bring lunches and other gifts to local
doctors’ offices.cxxx I’m no business major, but I imagine that if
you sold a product and its sales doubled over two years, you
might notice. Certainly stockholders benefited, if not the people
who lost their lives.

110
 We need not worry that pharmaceutical companies’
profits will suffer because of the opioid epidemic. Indeed, now
they are profiting in a whole new way by offering medications
to treat overdose patients and help them break their addictions.
All of those profits are going to good use too.
Pharmaceutical company executives and public relations
representatives tell us that profits are used to fund research. In
fact, according to one article just one of the most prominent
biotech companies spent $236 million dollars lobbying Congress
and the Obama administration between 2009 and 2013. That’s
almost $1 million per year per state. So, if you live in the state
of Utah, we’ll say, in the year 2009, near the passage of the
Affordable Care Act, the pharmaceutical industry spent around
a million dollars lobbying your senators and federal
representatives in that year alone. Just one of those companies,
Roche, and its subsidiary Genentech, took in $1.65 billion in
Medicare reimbursements. This company had spent nearly $30
million in lobbying in five years, and I’m sure uncoincidentally,
reaped nearly twenty-eight percent of all of Medicare’s 2012
expenditures on medications and vaccines.cxxxi In all fairness,
you may ask what Genentech makes that Medicare is willing to
pay so much for for so many patients. It makes Lucentis, for
which Medicare paid $956 million in 2012, more than it paid that
year for any other drug, which treats age-related macular
degeneration. Now, I certainly don’t want any senior to miss out
on an injection that might help preserve their sight. However, as
one who’s made her share of financial mistakes, I have to
wonder what makes Lucentis, at $2000 per injection, more
effective than Avastin, which costs only $50 per injection, and
some say is just as effective.
 What can lobbyists possibly be spending $236 million
on? One hopes not what two pharmaceutical sales
representatives admitted to spending marketing dollars on to
influence doctors. The Department of Justice investigated a
manufacturer of spinal fusion hardware for giving kickbacks to
surgeons who used their hardware.cxxxii The sales reps admitted
to enticing surgeons with expensive trips, nights on the town that
cost up to $1000, and sometimes even visits to the local strip
club.cxxxiii I think it’s fine when people don’t want to support
abortions or certain other unnecessary medical treatments with
their own dollars, but those people may very well own stocks in
pharmaceutical companies who are supporting these types of
behaviors.
Pharmaceutical companies like to reassure us that the reason
they keep increasing their prices is to pay for research and
development, which is intended to benefit us, the American public.
Sadly, though, very little research and development money
actually comes from pharmaceutical companies. In an interview
with an economics professor recorded on the DVD Big Pharma:
Market Failure, a substantial percentage of research funding
comes from taxpayers and donations via foundations.cxxxiv
Because universities attached to teaching hospitals are
often the center of such research, pharmaceutical companies
provide money for patenting drugs that are already being
developed in academic centers before biotech companies invest.
Drug companies are then able to keep researchers and their
information under their control. Dr. Drummond Rennie, then
deputy editor of the esteemed Journal of American Medicine
once said, “They [academic institutions] are seduced by industry
funding, and frightened that if they don’t go along with these gag

112
orders, the money will go to less rigorous institutions. It’s a race
to the ethical bottom.”cxxxv
In 2000 pharmaceutical industry profit margins were
nearly four times the average of Fortune 500 companies.
According to information submitted by pharmaceutical
companies to the Security Exchange Commission, Merck,
Pfizer, Bristol-Myers Squibb and Schering-Plough corporations
all spent two and a half times on advertising what they spent on
research and development in 2000. Abbott Laboratories and
Allergan, Inc. both spent more on marketing and administrative
costs than on research and development.
Pfizer CEO’s compensation reached $40,191,845;
Merck’s executive vice president earned $26,454,600. Both of
these executives had unexercised stock options in addition to
their salaries. Bristol-Myers Squibb’s CEO had $227,869,513in
unexercised stock options; Merck and Company’s CEO owned
$181,252,976; Pfizer, Inc.’s chairman owned $130,944,439; and
the vice chairman of Bristol-Myers Squibb owned $84,282,547
in stock options.cxxxvi These executives all claim that they are
only earning what other executives in the industry earn. While I
believe that people have a right to earn money, I can’t help but
feel for people who can’t afford their needed medications, or
wonder how many opioids these pharmaceutical companies have
sold in recent years.
Drug companies and their Washington lobby group, the
Pharmaceutical Research and Manufacturers of America
(PhRMA) have carried out a misleading campaign to scare
policymakers and the public, according to the NIH.
Pharmaceutical companies claim to spend our dollars on
research and development, but in fact, U.S. taxpayer-funded
scientists conducted at least fifty-five percent of the research
projects that led to the discovery and development of the five
top-selling drugs in 1995.cxxxvii
Besides the stocks that insurance and drug companies sell
on Wall Street, investment bankers keep their hand in the
medical money pot as well. From 2014-2015 investment banks
financed 300 mergers and acquisitions in the world of
biotechnology and pharmaceuticals, to the tune of $550 billion
in investments.cxxxviii Many people might find it difficult to pay
for their prescriptions, but when Big Pharma and Congress
benefit from rising healthcare costs, so does Wall Street.
Why wouldn’t an insurance company intervene, I
wondered. Why wouldn’t they look at these numbers and not try
to cut these costs? I watched two DVDs made by a mid-sized
company owner in Pennsylvania. One DVD is titled Fix It:
Healthcare at the Tipping Point. The other is Big Pharma:
Market Failure. Entrepreneur, pursuer of the American dream,
Richard Master points out that American companies are losing
the financial battle by not embracing universal health care. In an
interview with the previous insurance company public relations
executive, Wendell Potter answers these questions.
This is how I understand it. Pharmacy benefit
management companies negotiate prices with drug
manufacturers. Healthcare companies own these management
companies. For instance, United Healthcare owns Optum RX.
After we, or the government, or our insurance companies, pay
for our prescriptions, the drug manufacturers give rebates to the
management companies, based on backroom deals made with no
oversight. Because the insurance companies own the

114
management companies, they reap benefits from these
kickbacks.
Mylan Pharma, the manufacturer of Epipens, made news
in 2016 because in seven years the price of Epipens grew from
$100 to $608. Three hundred of these dollars went to the
pharmaceutical benefit management companies, who then
shoveled the money to insurance companies. In an interview on
Bloomberg News, the CEO of Mylan Pharma had the audacity
to say, “Our healthcare is in a crisis. It’s no different from the
mortgage financial crisis back in 2007.”cxxxix
So, as the CEO of one of these companies making more
profits than other Fortune 500 companies, am I to believe that
she’s comparing herself to a president of a mortgage lending
company?
 Chapter 11

When Consumers Look out for Their Own Best

Interests

In May of 2012, while working on my Master’s degree, I

became certified as a personal trainer. I’m hardly the athlete in
my family. My dad was a college decathlete and football and
basketball coach, my brother played for a team that made it to
two March Madness tournaments, and my sister set a few
records as a college soccer goalie. I took gymnastics lessons
when I was little. But personal trainers complement healthcare.
When asked what one thing he could change about the
fitness industry, here’s what one trainer replied:
“I would love to see increased respect from the medical
community in terms of acknowledgment that fitness
professionals can be and should be a part of the medical and
healthcare model. Many, if not all, personal trainers work
on a regular basis with people who deal with some sort of
medical issue or condition, whether orthopedic, metabolic
or neurologic. While our place may be a lot further down
the chain than the physician’s, we are still part of our
clients’ care….my clients regularly ask me questions that
they should be asking their physicians. I understand my role
and scope of practice, so I am very careful with the answers
I give. However, I can see why they ask these questions.

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 They have regular access to me, and they know that I have
an extensive background in anatomy and physiology. They
also know I will listen to them and that I am not trying to
hurry off to my next patient…..My job is to assist clients
with their health goals…Just because we don’t submit
claims to medical insurance doesn’t mean that we don’t
play a vital role in the health and well-being of our
clients.”cxl

An article in the Journal of American Medicine estimates

that a lack of regular physical exercise contributes to about
250,000 deaths per year in the U.S.cxli In an odd coincidence, this
is about the same number of deaths attributable to medical errors
each year in another article of the Journal of American
Medicine.cxlii One of the fathers of modern medicine,
Hippocrates, said, “If we could give every individual the right
amount of nourishment and exercise, not too little and not too
much, we would have found the safest way to health.”cxliii
More than 5000 people are newly diagnosed with
diabetes each day in our country.cxliv Perhaps those who cannot
afford personal trainers or wellness coaches should be able to
receive vouchers from the government or insurance companies
to help pay for their services. This is a step towards what I would
consider true health care reform. And I’m not alone in my
thinking. Legislation has been proposed to include physical
activity as a form of illness prevention so that consumers could
use pre-tax funds, such as HSAs and FSAs to pay for physical
activity expenses, such as sports league fees, personal trainer
services, and health club memberships.cxlv Sadly, no one is
paying for lobbyists to influence enough members of Congress
to pass such reform.
 One month after passing my personal trainer exam I
completed my studies for my Master’s degree in healthcare
administration. My final thesis was on veterans returning from
Iraq and Afghanistan with PTSD, the impact that had on their
lives, and the VA services that were available to assist them.
Although I have not served in the military and have no one in
my immediate circle who’s served in Iraq and Afghanistan I saw
that there was a need for such a study.
People are concerned that having a single-payer
healthcare system would cost too much. It seems to me that
whether insurance companies or the government pays for
healthcare, we are wasting our resources at the expense of many,
and lining the pockets of a few.
Without Medicaid, I don’t know how I would have paid
for care during those difficult years. Numbers vary, but
according to a 2013 study by NerdWallet, since passage of the
Affordable Care Act, medical expenses are the number one
cause of bankruptcies in the U.S., accounting for more than fifty
percent of all declared bankruptcies.cxlvi (If you are interested in
assisting people who cannot pay for medical bills, please check
out the crowd-funder site: www.giveforward.com.)
At one point, people recommended that I consider
medical bankruptcy. According to a Harvard study cited in The
Wellness Revolution: How to Make a Fortune in the Next
Trillion Dollar Industry, about forty-six percent of personal
bankruptcies in 2005, before the passage of the Affordable Care
Act, were medically driven. Of those, about seventy-five percent
of the people had employer-sponsored health insurance when

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they became ill. The majority of them owned houses and had
attended college.cxlvii
According to a student paper, Mark Jewell, the CEO of
Anthem was awarded a bonus of $42.5 million stock and cash
incentives over a three year period. Why so much? He had
exceeded his company’s established goal of 15% growth in the
company’s net income for each of three years. In fact, he did
better than hoped for, and Anthem’s profits grew an average of
41% per year during the 3-year period. So, since his $1.04
million salary and $2.3 million bonus and other 2003
compensation of $273,000 was not enough of an award for that
kind of sustained growth, he received a $42.5 million stock and
cash incentive package. According to a filing with the
Securities and Exchange Commission, Anthem’s executive vice-
president and chief legal and administrative officer David R.
Frick also was to receive $16 million in long-term payouts and
stock awards, and Michael L. Smith, the executive vice-
president and chief financial and accounting officer would also
receive $16 million, along with Keith R. Faller, the president of
Anthem Midwest, who was to receive a total of $11.8
million.cxlviii
Cancer care is the #1 cause of bankruptcies in America.
According to Marc Fishman, M.D., and CEO/Founder of
Oncology Analytics, chemotherapy cost less than $200/month
when he started practicing. Now, one medication, such as
Omacetaxine, can cost $160,000/year. At least four others cost
well over $100,000/year. Because these drugs are administered
as injections in doctors’ offices, doctors receive a 6%
commission on them. The data shows that oncologists switch
drugs, even to less effective ones, when prices go up, meaning
that commissions go up. Across the country, one medication can
cost $100 for an injection in one part of the country, and $10,000
in another part of the country. One fourth of all hospitals are now
putting in cancer care centers. Cancer is big business.cxlix
In his book “How We do Harm: A Doctor Breaks Ranks
About Being Sick in America” the chief medical and scientific
officer for the American Cancer Society, in protest of how things
are done, writes, “Some of my colleagues are willing to play the
game, realizing that care—even useless and inappropriate
care—makes cash registers emit pleasing sounds. We doctors
are paid for services we provide [generally speaking], a variant
of “piecework” that guarantees that we will err on the side of
selling more, sometimes believing that we are helping,
sometimes knowing that we are not, and sometimes simply not
giving a shit.”cl Again, I do not believe that this one quote is
representative of this person, and in context he was exposing the
culture of medicine, not saying that he himself does not give a
shit.
While I appreciate St. Jude, and all they do for children,
my heart bleeds for families when I see signs for spaghetti dinner
fundraisers for families who may be on the verge of bankruptcy
paying for these chemotherapy treatments that may or may not
be covered by their insurance companies.
In addition to his salary and bonuses, Mark Jewell was to
receive $42.5 million in his incentive package over three years.
That is enough to pay for 265 years of Omacetaxine. I can’t help
but wonder how many of the 600,000 families could have been
saved from bankruptcy with Mark’s bonus?
Christopher Robertson, an associate professor of law at
the University of Arizona, studies causes of foreclosure and their

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links to medical bills. In 2008 one small survey found that the
medical crisis contributed to one-half of all home foreclosures in
four states.cli
The more I learned about health care, first as a political
science student, then in my medical billing course, working for
a chiropractor, trying alternative treatments, getting certified as
a personal trainer, and having spent years as a patient, the more
interested I became in investigating less mainstream options.
In 2013 I decided to once again pay out-of-pocket to visit
a naturopath. His assessment gave me targeted information
regarding nutritional solutions that fit my individual needs. That
same year I also became certified as a fitness and nutrition
specialist.
122
 Part III: Setting my Stakes
~
Creating my Own Path to Wellness

It is the glory of a free society that a man can

write a book ....It is arrogance to presume that
in any field of knowledge, whether dealing
with health or otherwise, all the answers are
now in.”clii

~FTC Commissioner Elman~

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 Chapter 12

What This Consumer Has Tried

Bzzz vibrated my phone, alerting me of a new text

message. “Can you make it to my party tonight?”
“What is it for?”
“Essential oils.”
I went. Another direct-sales presentation. This time,
though, I was a little bit familiar with the product, if not the
brand.
The instructors called themselves wellness advocates.
Although they educated us on various oils they assured us that
they weren’t anti-doctors. In fact, the company they represented
was started in part by doctors who felt they weren’t able to give
their patients satisfactory results with just allopathic
(pharmaceutical and surgical, or what some call traditional) care.
 The consultants instructed that the basis of any wellness
regime begins with eating right and exercise. The oils are just a
nice complementary addition.
I was sold. I had already tried my hand at making my own
chap-stick and what I call foot fizzies but some people call bath
bombs. I figured it would be nice to have an oils company I could
order directly from.
Because of my history with an autoimmune disease and
my previous skin problems I had become increasingly interested
in “natural” hair and skincare products, as well as candles made
with essential oils.
I had picked up a couple of books along my research way.
One was called Don’t Go to the Cosmetics Counter Without Me.
From that book I learned about the Campaign for Safe
Cosmetics, an organization that collaborates with companies
that refrain from animal testing and avoid using parabens and
other petroleum-based products. The Campaign has a Red List
on its website that offers information regarding what ingredients
to avoid in what products, if you’re interested in such
information.
According to the FDA, all manner of materials, including
slaughterhouse waste, can end up in our personal care items,
unless you buy products which are specifically labeled “No
animal by-products” or “100% vegan.”cliii The FDA states
“A cosmetic manufacturer may essentially use any raw material
in a product and market it without prior FDA approval.”cliv It’s a
scary thought that we put these products on our skin on a daily
basis. What’s even scarier is that some of these chemicals found

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in cosmetics are listed by EPA and the State of California as
carcinogens or reproductive toxins.clv
I’ve heard people laugh off the idea of using essential oils
for any real health benefits, but in Acts 17:11 Luke writes that
the Bereans were of more noble character than the
Thessalonians, because rather than just take for granted
whatever was preached to them, they searched the Scriptures out
for themselves to find out the truth.
When my Crohn’s was at its worst, a friend offered me a
book on natural healthcare. I laughed. I thought my body would
always be dependent on pharmaceuticals. But I decided to do my
own research. I’ve been off prescription medications for years,
and my Crohn’s disease has been in remission for fourteen years,
as of December, 2017.
I’m not saying that you should stop taking your
medications and use oils. I’m not advising you to do anything.
But I do think that people have a right to information.
I was desperate to try an alternative solution because
traditional healthcare was not working for me. So, if you are
interested in trying something new, I would advise you to talk to
people who are informed and can help you make a good
decision. But I would also encourage you, as someone who has
a Master’s degree in healthcare administration, that you have
rights as a patient. You have the right to autonomy, which means
that means you make decisions, not your doctor. You have the
right to informed consent. And you have the right to refuse
treatment. For me, I decided that the doctors did not have to live
with the consequences of side effects and ileostomy bags, I did.
So if I was the one living with the consequences, I had the right
to make the final informed decisions about what went into my
body and what didn’t.
 So one of the things that I learned about was oils.
Essential oils can be ingested, inhaled, or applied topically.
Usually, though, it is recommended that all of these methods are
used with small and intermittent doses of oils to avoid
cytotoxicity and/or negative reactions. When used properly,
though, essential oils are so effective, that doctors in France
sometimes prescribe them rather than antibiotics.clvi
Essential oils have gained popularity in the last few years.
They’ve become mainstream enough that you can even find
them at Walmart. They have pros and cons just as supplements,
over-the-counter and prescription drugs and foods do.
As with all things, it’s good to do your research and buy
as quality of a product as fits your budget. And, it should be
remembered, that just because a product is natural, does not
mean that you won’t react badly to it. Essential oils come from
plants, so if you’re allergic to a plant you may be allergic to the
oil derived from it. One advantage to oils, from my perspective,
is what I’ve heard from people who use and sell products for the
company I bought my household cleaners from, rather than side
effects they have “side benefits”. And, as the ancients used to
say, “Everything in moderation.” Just a small dose should be
enough.
If you’re interested in learning more about essential oils
please feel free to check out my website
www.mydoterra.com/nicholegrimwood, or the government’s
website which highlights articles of medical research, including
research being done with oils, www.ncbi.nlm.nih.gov/pubmed, or
the book Modern Essentials, which can be purchased through

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Amazon’s website. In the meantime, I’ll share a little bit of
information that I’ve read to get you started.
First, here’s a neat little experiment you can do at home.
I’ve tried this with two different brands of essential oils and it’s
worked with both brands, so I believe any quality brand would
work. As I’ve already written, many personal care items have
petroleum-based ingredients. When these chemicals accumulate
in our systems they cause all kinds of nasty problems. To see
how lemon essential oil breaks down petrol components and
helps flush them out of our systems, blow up a balloon, drop a
drop or two of lemon essential oil on the balloon, and wait a few
seconds to see what happens. Once you do this experiment,
you’ll understand why if you use lemon essential oils you should
use glass and not plastic containers.
Essential oils have been in use for millennia. When King
Tut’s tomb was discovered thirty-five alabaster jars believed to
have been used for essential oils and unguents were found inside
his tomb.clvii The Bible says that two of the gifts the wise men
brought the infant Jesus were the oils of Frankincense and
Myrrh. While these oils may have been used for reasons other
than perfumes and lotions, as someone in my DoTerra upline
says, “If Frankincense was good enough for Jesus, it’s good
enough for us.” In fact, I haven’t counted them but there are
supposedly 188 references to essential oils in the Bible.clviii
Oils have between 200-800 chemical constituents, but so
far only 200 have been identified.clix This is akin to polyphenols
and flavonoids that we hear about in plant- based foods. For
instance, red grapes and red wine have resveratrol, and tomatoes
have lycopene.clx Essential oils have their own chemical
constituents. I think of plants as having their own in-grown
pharmacies, sort of like we have our own in-grown immune
systems. Plants fight off bacteria and viruses to survive just as
we do. In the process they develop antimicrobial agents. These
antimicrobials can be beneficial to us, without causing super
bugs that man-made antibiotics and anti-bacterials create,
because they minimize microbes rather than killing them.
Because oils are lipid soluble and small enough to penetrate cell
membranes they’re also able to metabolize and transport
nutrition to cells to stimulate our immune systems.clxi
The chemical components of plants and oils include
hydrocarbons, made up of monoterpenes, sesquiterpenes, and
diterpenes; and oxygenated compounds, made up of esters,
aldehydes, ketones, alcohols, phenols and oxides.clxii
One of the monoterpenes in lavender essential oil is
called linalool. Linalool blocks the growth of Candida
albicans.clxiii
Linalool can also significantly inhibit glutamate uptake,
and inhibition of glutamate is a method to reduce occurrence of
epileptic seizures.clxiv
Another chemical constituent, a phenol known as thymol,
is found in thyme and oregano oils. It’s considered so effective
at fighting E. coli and staphylococcus aureusclxv that Purdue
chicken farmers feed it to chickens in their water to alleviate the
need for antibiotics.
Crohn’s is an embarrassing disease; often difficult to
discuss with those who are not close friends or family members,
contributing somewhat to its mystique. Despite this shadow
existence, according to one study cited in the American Journal
of Public Health in 2011, autoimmune disorders are the leading
cause of death in women.clxvi In fact, some research indicates that

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if one were to add the number of women living with breast
cancer, and the number of women living with coronary disease,
the sum would still not equal the number of women living with
autoimmune disorders.clxvii These disorders include diseases like
multiple sclerosis, type 1 diabetes, rheumatoid arthritis, lupus,
scleroderma, ulcerative colitis, and over eighty other diagnoses.
For those of you suffering in silence, you are not alone.
In John 5:6 Jesus asked, “Do you want to get well?”
Again, I cannot diagnose or treat anyone. This is just a memoir
in which I’m sharing my story and research and opinions that
I’ve read.
But if you’re interested in making changes, and with the
help of professionals decide on a course of action you’d like to
try, how do we make changes? I’ve heard one trainer advise
people to first commit to making a change for four days. She
believes that you can give up almost anything for four days. I
believe that once you stop a behavior for four days you can stop
it for one week. Once you stop it for one week you can stop for
three weeks, then one month, then six days. And I’ve heard that
if you make dietary changes and keep unwanted weight off for
two years, then you’ll keep the weight off.
For me, weight was not the issue, but my health spiraled
out of control. Some people find that they can take a whole new
approach to eating all at once. I am not one of those people. I
have spent years making dietary changes, and learning about
new household cleaners and personal care items, and I’m still
learning. I follow the 80/20 rule with my diet. Eighty percent of
the time I try to eat well, twenty percent of the time I splurge.
But I know that not everyone has that luxury. Everyone has
different needs and to some degree you have to figure out what
works for you. Sir William Osler said, “It is much more
important to know what sort of patient has a disease than what
sort of disease a patient has.”clxviii
Because my skin on my face reacted so badly and
remained relatively resistant to multiple dermatologists’
suggestions, my gastroenterologist advised that I stop taking one
of my Crohn’s prescriptions, thinking that I might be having an
allergic reaction to it.
After I stopped taking that medication I noticed a very
small decrease in skin symptoms. I started wondering if I might
have food allergies. I never had any clinician test me for allergies
or suggest that I get tested that I can recall, despite the fact that
I had a digestive illness for twenty-five years. Only once, when
I was growing up, did I meet with a registered dietician.
While I would hope this is not the primary reason, surgery
and medications no doubt create greater revenues than
diagnosing potential food allergies. Anyhow, Crohn’s disease
has been increasing in cultures consuming the “western” diet,
while it is virtually non-existent in cultures consuming a more
primitive diet.clxix Over the last fifty years, we have made
considerable changes in dietary habits, with many more
processed and quick and easy meals available.
One study found that before the onset of disease, Crohn’s
disease patients had eaten corn flakes more frequently than
controls. Perhaps this is because corn flakes are high in refined
carbohydrates, which stimulate insulin and therefore immune
responses, and are derived from a very common allergen,
corn.clxx Not only is corn a common allergen, but if you read
Michael Pollan’s “The Omnivore Dilemma: A Natural History
of Four Meals” you see how pervasive corn is in preservatives

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and binding agents in so many processed foods. And corn is a
food that is commonly genetically modified.
I tried cutting back on processed foods, which frequently
contain common allergens like corn, soy and food colorings. I
also started cutting back on refined wheat products, sugar, and
dairy products. Refined wheat, not whole wheat initially, and
sugar because refined grains spike insulin levels which triggers
immune responses. I cut back on dairy because dairy increases
mucus production. With an overactive immune system I hardly
felt that I needed additional mucus in my system. I also try not
to consume a lot of dairy because if you read The China Study:
Startling Implications for Diet, Weight Loss and Long-Term
Health (Campbell and Campbell), the authors discuss research
in which the amount of casein (protein in cow’s milk) that one
consumes directly correlates with growth of tumors.
There are a few theories as to what causes Crohn’s
diseases and other autoimmune disorders. It seems to be believed
that people have a genetic predisposition. What I believe, from
my reading, is that there is what is called a “barrel effect,” also
discussed in Nakazawa’s The Autoimmune Epidemic: Bodies
Gone Haywire in a World Out of Balance and the Cutting-Edge
Science that Promises Hope (pp. 72-75). This means that over
time the body is exposed to triggers. Depending on your
predisposition, and the number of triggers you’re exposed to, at
some point, the barrel overflows and the immune system over-
reacts and loses control. Again, I’m not a doctor, but as a patient,
this is what I perceive and believe.
In addition, particularly among practitioners and
scientists who research natural causes, preventions and
treatments, there seem to be a few common triggers.
 In addition, as more cultures consume the standard
“western” diet, or standard American diet (SAD), and people are
exposed to more and more chemical based products in their
environments, more and more people are diagnosed with
autoimmune disorders. This could be because of food allergies,
or immune responses as insulin levels increase, or immune
systems being overwhelmed by unnatural elements being
introduced to the system, or because of imbalance in intestinal
microflora (dysbiosis). Again, I think every individual is
different, and for me, the “barrel effect” introduced a perfect
storm of bacteria, chemicals, genes and dysbiosis.
Besides diet, antibiotics can cause dysbiosis,clxxi which is
why yogurt manufacturers promote the probiotics in their
products. The probiotics help regulate microflora. And while we
may not think we’re being exposed to antibiotics if we’re not
directly taking antibiotics, farmers medicate cows with
approximately sixteen million pounds of antibiotics each
year,clxxii so if you’re eating beef or consuming dairy products
that are not organic, you may be ingesting more antibiotics than
you realize.
Some probiotics can assist in rebalancing the intestinal
microflora. However, some probiotic capsules are broken down
by enzymes in stomach acid before they reach the intestine,
where they are most needed. So if you’re shopping for
probiotics, it may be wise to invest in ones that are created to
withstand stomach acid.
If you’d rather try to get your probiotics directly from
food you can try eating things like fermented foods like yogurt,
kefir, cheese, miso, wine, sourdough, kombucha, raw honey,

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fresh sauerkraut, prebiotics—onions, garlic, bananas, whole
grains, honey, artichokes.clxxiii Some foods have prebiotics,
which help our bodies build probiotics. When probiotics and
prebiotics are combined they are symbiotic. Yogurt and kefir are
considered symbiotic because they contain live bacteria and the
fuel they need to thrive, according to Mayo Clinic.clxxiv If you
have problems digesting milk products, nutritionist Natalia Rose
suggests trying raw goat milk yogurt or kefir in place of
dairyclxxv. I’ve also tried yogurt made from coconut milk. It’s a
bit of a pricy substitution, but less expensive than Pentasa and
Remicade drips if it helps keep me from being dependent on
prescriptions. Again, I can’t diagnose or treat you, and certainly
if you’re taking something that works for A but you have B, then
the product may not be as beneficial for you. But for me, these
are the things that have worked, and these are things I’ve read of
nutritionists, MD’s, and naturopathic doctors recommending,
just not any of the MD’s or the nutritionist I personally saw.
The ancient doctor Hippocrates said “Let food be thy
medicine and medicine be thy food.” I try to follow that advice.
One nutritionist I’ve read eats a raw plant-based diet. However,
she says, “my goal is clean cells and a body rich with Life Force
Energy, not conforming to a label for the sake of being officially
“raw”… What keeps me going strong year after year is the
freedom to always have what I want.”clxxvi
Joel Fuhrman, MD, who has written “Eat to Live: The
Amazing Nutrient-Rich Program for Fast and Sustained Weight
Loss,” and “Eat for Health: Lose Weight, Keep it Off, Look
Younger, Liver Longer”, avoids labels as well. Although he
recommends plant-based eating, he reminds readers that
vegetarians can adopt unhealthy eating styles by replacing
animal products with rich, starchy desserts. Rather, he calls
himself a nutritarian, and recommends eating foods based on
their nutritional values.clxxvii In Eat for Health Dr. Joel Fuhrman
proposes using MANDI scores. With his program dieters give
themselves points for things like drinking water, exercising, and
eating fruits and vegetables, and lose points for things like eating
too many refined grain products or consuming too much
caffeine, rather than counting calories to lose weight.clxxviii
Personally, if you have a food addiction, I think the practice of
counting calories defeats the purpose. When you count calories
you focus on food. You wouldn’t tell an alcoholic to focus on
alcohol and count ounces of alcoholic beverages, so why tempt
someone with a food addiction by having them count calories?
For health, community and environmental reasons I’m
grateful that I live in a community where I have easy access to
fresh and locally grown foods of all types and grass fed and free
range animal protein sources.
As for starches, personally, I don’t care for quinoa. I’ve
tried it a few different ways, and I just don’t care for it. I eat
sweet potatoes, brown rice, oats, sorghum, rice based pastas, and
the occasional potato chip. When indulging in potato chips I try
to stick with the ones whose only ingredients include potatoes,
sunflower or safflower oil, and sea salt. I drink green tea nearly
every day, and regularly eat dark chocolate. What is
counterintuitive to some instructions for people with IBDs is that
I eat a lot of fiber. I drink water, although lacking a large
intestine I should drink more. I make fresh ginger tea by grating
an inch of ginger, steeping it, and adding the juice of half of a
lemon and a teaspoon of fresh raw honey. A friend of mine came
up with the ginger tea recipe. I frequently make my own salad

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dressings. And because of what I’ve read about the connections
between Crohn’s and cancer, and foods that help prevent cancer,
I eat turmeric, and cruciferous vegetables. Actually, this is one
reason why I eat a lot of fiber. I eat a lot of beans, and a lot of
fruits and vegetables because they are full of polyphenols.
One thing that is different about how I eat now compared
to how I ate when my Crohn’s was active, is that I spend more
time planning. When you have Crohn’s, there is a near
immediate response between what you eat, or what medication
you take, and your body’s response. If you eat a food that
triggers a reaction, within a short time you’re doubled over in
pain.
But retraining your immune system, which is largely in
the gut, takes time. There is no immediate gratification with this
system. I can get away with eating not so healthy foods for a day
or two, but over time my system gets further out of balance.
There is some research that indicates that people who
have delayed food sensitivities or reactions, and even some of
the food allergies common today, may be due in large part to
microfloral imbalances and “Leaky gut syndrome”. Some
researchers believe that once your microflora is more balanced
people are less prone to food allergy responses. Again, I’m no
doctor. Please do your own research and speak with your own
specialists on these matters, especially if you have severe food
allergies.
People ask me all the time if I take vitamins or
supplements. I honestly don’t like taking supplements, maybe
because I had to take so many medications for so many years.
And I’ve had some trouble finding supplements that don’t
include some form of corn as a starch or preservative or binding
agent. The more corn I eat the more issues I have. I’ve heard that
corn has a similar molecular identity to gluten and so people who
have trouble with gluten may have trouble with corn. I think not
having a colon definitely puts me at a disadvantage as far as
maintaining my intestinal microflora and seems to have
increased food sensitivity issues for me.
But this is what I tell people when they ask. There are a
lot of reports and discrepancies in the literature about the
effectiveness of supplements. People with Crohn’s are advised
to take up to five times the amount of recommended vitamins to
supplement poor nutritional intake and the body’s quick
elimination of foods. But not all vitamins are equal.
There are blood tests that can be done to get an idea of
what vitamins and minerals you may be lacking. From there you
can come up with more targeted solutions. I think it’s always
best to start with what God gave us, food. But because of
changes in soil and production, our diets, and our own bodies,
sometimes food needs to be supplemented. I, along with others,
refer to supplements and vitamins as supplements, because that’s
exactly what they are. They’re not intended to replace a healthy
diet. They’re intended to supplement our own diets in areas
where we may be lacking. When taking supplements I believe
that those that are closest to whole food supplements are the best
option. For more information on these check out Shaklee’s
website or visit your nearest natural food stores.
For myself, this is the information I have gathered. First
off, dysbiosis, and then leaky gut syndrome, can lead to
candidiasis, or an overgrowth in the system of Candida albicans.
Besides the linalool in lavender oil, which can be ingested,

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inhaled, or topically applied, caprylic acid in organic unrefined
coconut oil kills candida fungi.
One supplement or food component that I’ve read about
for Crohn’s patients and others suffering from autoimmune
disorders is Omega 3 essential fatty acids. The standard
American consumer typically ingests more omega-6 fatty acids
than omega-3s. Although we need both, we’re driving ourselves
in the wrong direction where these oils are concerned. One
advantage of eating grass-fed beef is that it typically has more
omega-3 fats than grain fed beef.
Various studies show that for patients with Crohn’s,
supplementing with Omega-3 fatty acids can decrease the need
for steroids like Prednisone, reduce inflammatory chemicals in
the system, and increase the length of remission for those in
remission.clxxix Besides fish, another great source of omega-3 is
flaxseed oil.clxxx
I know I said that food and supplements don’t show
immediate results for me, but there are a few exceptions. One of
them is supplementing with zinc. Zinc deficiency occurs in
approximately forty-five percent of Crohn’s disease
patients.clxxxi If I’m having certain problems, particularly rashes
or skin problems, I feel relief within an hour of taking zinc. The
zinc that I take, though, does have to be taken with food or I feel
queasy for a short time after taking it.
Because of malabsorption and quick elimination issues
with a history of Crohn’s and the lack of a colon, research
suggests the potential loss of electrolytes, fat-soluble vitamins
and protein. I do believe that evidence to support plant-based
eating is plentiful for both the environment, animals, and our
own health. I have tried going vegetarian, but when I did, it did
not work for me. So, I make an effort to eat organic, locally
raised, grass-fed meats as much as possible.
As for electrolytes, I have had bloodwork and urine
samples showing discrepancies in potassium. And I’ve been
advised by a doctor to eat more sodium when I was having spells
of light-headedness with P.O.T.S. Because I had high blood
pressure for a while, which has been under control without
medications for a few years now, I go easy on sodium. If I do
think I’m eating a lot of foods that are high in sodium, I try to
make sure that I’m also getting foods with potassium,
magnesium, and/or calcium, as the ions in these minerals work
to balance each other out, from what I understand. So, besides
dairy, broccoli and leafy green foods orange juice, cantaloupes,
canned tomato products, avocados, bananas, and potatoes are
good sources of some of these nutrients.
Finally, fat-soluble vitamins. Vitamins B and C are
largely water-soluble, and vitamins A, D, E, and K are largely
fat-soluble. One book that I read indicated that Vitamin D is so
important in preventing and treating autoimmune disorders that
the further a person lives from the equator the greater their
chances of being diagnosed with multiple sclerosis.clxxxii Because
of vitamin D deficiencies, and long-term steroid use, IBD
patients are also at greater risk for bone problems.clxxxiii One
provider found via X-ray that I’ve lost one third of cartilage on
one of my hips already. For this reason I rather inconsistently
take a bone building supplement, that includes calcium,
magnesium, vitamins D and K.
Naturopaths Murray and Pizzorno report on research
demonstrating that low serum retinol levels (vitamin A) are

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found in approximately twenty percent of Crohn’s patients and
are correlated with activity indicative of the disease. Vitamin A,
they explain, can profoundly affect the metabolism and
differentiation of the intestinal lining. While they remind readers
that long-term use of vitamin A does not have a therapeutic
effect on many Crohn’s patients, certain patients may find
positive results, especially when taken along with zinc
supplementation, as zinc is a necessary component of retinol-
binding protein.clxxxiv
Vitamin A and E supplements have gotten their share of
negative publicity in recent years. I have noticed an overall
improvement to my well-being when taking a supplement that
includes beta carotene (a precursor to vitamin A), alpha
carotene, and lycopene.
With vitamin E supplements, however, so far I’ve noticed
more problems. Again, I can’t diagnose or treat you. I can only
share what I’ve experienced and read. From what I understand
the reason that some vitamins get mixed reviews in the media is
the way the studies are done on them. Selenium is supposed to
help your body metabolize Vitamin E. So far I’ve only tried a
supplement without selenium included. Perhaps if I tried the
supplement with selenium I might experience better results.
I might also benefit from taking enzymes. I have a bottle
but I’ve only tried them a few times and have not noticed a
significant difference when I do take them. I don’t tend to eat
three or four meals a day though. Instead I typically eat smaller
amounts throughout the day.
This will help explain why I prefer whole food
supplements. Probably a lot of us have heard that the
phytochemical lycopene, in tomatoes, helps reduce the risk of
developing prostate cancer. In response, manufacturers offer us
lycopene supplements. However, a balanced diet including
multiple daily servings of fruits and vegetables introduced our
bodies to some 5000 to 10,000 different phytochemicals.clxxxv
When we take supplements we run the risk of getting just
one or a few isolated components of the original plant. Science
is still working to understand all of the different phytochemicals
that exist and how they work together to create benefits. So when
we rely on the supplement rather than all of the benefits that
tomatoes offer us, we sell ourselves, and the food God has given
us, short.
This corresponds to what I’ve read regarding vitamin E
studies. Vitamin E has been shown to reduce free radical
damage.clxxxvi However, in nature Vitamin E is actually a
combination of eight different fat-soluble nutrients. The same is
true, by the way, for B and C vitamins. When we isolate one
component of these vitamins we don’t get the same benefits as
when they all work together in the original plant package in
which God put them.clxxxvii
Folic acid deficiency exists in between 25-64% of IBD
patients.clxxxviii One medication, sulfasalazine, increases a
patient’s susceptibility to folic acid deficiency. A folate
deficiency in turn causes more malabsorption problems. A
significant correlation exists between vitamin B12 absorption
and the extent of intestinal surgeries one has experienced. To me,
the added risk of dehydration intuitively makes me think that
there is an added risk of low vitamins B and C in IBD
patients.clxxxix

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 Low vitamin C intake is considered particularly
important in preventing and treating certain IBD
complications.cxc
When it comes to food components, curcumin has been
shown to suppress rheumatoid arthritis and help control
ulcerative colitis. In one set of tests researchers found that sea
anemone extract suppressed cytokine overproduction in
rheumatoid arthritis patients at a rate similar to what was seen in
pharmaceutical drugs. Finally, glucosamine may be helpful for
arthritis patients and those with MS.cxci
This is by no means an exhaustive list. Please do your
own research and consult with your healthcare provider. Other
studies have looked at the use of grape seed extract, evening
primrose oil, willow bark, ginger, devil’s claw, cat’s claw,
boswellia (Indian frankincense, from the Boswellia serrata tree),
and green tea extract,cxcii and ginko bolobo.cxciii Even
pharmaceutical companies are taking notice as they invest
money in researching what industry insiders call
“nutraceuticals.”cxciv
I personally have had success with a resveratrol
supplement. Resveratrol is the component in red wine and grapes
that is thought to be beneficial in preventing heart disease and
fighting cancer.cxcv It can also be found in supplement form. I’ve
also taken CoQ10. CoQ10 is beneficial to immune,
cardiovascular and neurological systems. It helps the body to
create ATP, which is used for all processes in the body which
require energy.cxcvi
Bromelain, an enzyme derived from pineapples, has
helped resolve acute attacks of Crohn’s disease and ulcerative
colitis. I prefer to just eat the pineapple, personally. And
quercetin, found in onions, has shown promise in animal
studies.cxcvii
Finally, in a pinch, I eat a half a teaspoon of baking soda
and chase it with cold water. Baking soda has many health
benefits. Baking soda helps neutralize the PH balance in both
our stomach and blood.cxcviii
In addition to foods, I’m no longer afraid to say “I
appreciate the offer, but no, thank you.” And I rest when I need
to. I figure that if God, who only had to say “Let there be light”
and there was light, rested after six days, we all need to take time
to decompress and refresh from time to time.
I still am not the athlete that my family members are,
despite having once been certified as a personal trainer, but I do
try to exercise in some way at least a few days each week. And,
like everyone, I do my best to minimize and cope with the stress
in my life. For me that means walking, journaling, cooking,
playing with my essential oils, reading, writing, and serenading
my poor but unconditionally loving cats with my dreams of
being a country music star.

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 Chapter 13

Opportunities

When you write a book, especially when you spend

eleven years writing it and talking about it, people ask you a lot
of questions. People have asked me if I’ve enjoyed writing, and
what my purpose is for writing.
 I believe one of the reasons that it’s taken me eleven
years, despite my education along the way, is that it has taken
me several years to decide what question I’m trying to answer
with this book.
It’s no secret that I’m dissatisfied with our current
healthcare system. That doesn’t mean that I’m a socialist or anti-
capitalist. I would like to think that the average person would not
be satisfied with a system where someone gets a $42.5 million
bonus for causing someone with cancer to file for bankruptcy or
foreclosure. I would like to think that none of us are satisfied
with a pharmaceutical industry that pays millions of dollars to
executives who are behind the third leading cause of death in the
United States, and pay $1000 to take Congressmen out on the
town to strip clubs, while the Centers for Disease Control reports
that twenty million Americans don’t purchase prescription
medications, or don’t take ones that are prescribed as directed,
because of their costs.cxcix
I would like to think that none of us are satisfied with
those things. Maybe I’m wrong. I’ve had people imply that I’m
not a team player. But frankly, I don’t want to play for a team
that takes one out of every six dollars spent in the U.S. and uses
them to drive people into bankruptcy court, out of their homes,
and to overdose on drugs, all while paying politicians to
maintain the status quo. That just is not a team that appeals to
me.
I’d much rather see consumers start creating their own
teams. I’d rather see teams that include naturopaths,
chiropractors, homeopaths, dietitians, health coaches and
personal trainers.

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 I’m not anti-insurance companies. I have life insurance
and car insurance, and if I ever own a home I’ll have home-
owner’s insurance. But insurance is intended to minimize risk.
Being the number one cause of bankruptcies in the U.S. is hardly
an advertisement for a health insurance industry intended to
minimize risk.
Consider what economist Paul Zane Pilzer writes about
health insurance. By allowing third parties to pay for more than
ninety percent of our medical expenses we’ve allowed
employers and insurance companies to become our nation’s
healthcare gatekeepers, deciding, in advance, instead of us the
consumers, what type of medical care we should receive.cc
He compares health insurance to other forms of
insurance: “Consider how inefficient it would be if you could
only buy gas or have your car maintained at a particular service
station where your insurance company had negotiated a
discounted rate for such services.”cci
He compares healthcare insurance companies and
providers to “mass merchandisers and category-busters” like
Home Depot, PetSmart and Staples. Because of a free market
system, he says, these companies exist to offer optimal selection
and competitive prices.ccii
“The real issue,” as Steven Brill puts it, in an article in
Time magazine, “isn’t whether we have a single payer or
multiple payers. It’s whether whoever pays has a fair chance in
a fair market….our largest consumer product by far—one-fifth
of our economy—does not operate in a free market.”cciii
Healthcare differs from other commodities. For one
thing, as health care costs go up our demand is not necessarily
reduced as it might be with non-necessity items.cciv
 The Declaration of Independences pledges to protect our
rights to life, liberty and the pursuit of happiness. Rewarding
someone for preventing cancer treatments with a $42.5 million
bonus is hardly protecting our rights to life.
But Pilzer does have a point that if we are, as health
insurance companies are quick to claim whenever any politician
suggests the idea of a single-payer health care system, a free
market, then we as consumers should have the right to decide
our healthcare, not an executive earning a $42.5 million bonus
for denying us care.
When I get my car serviced, I only contact the insurance
company if the service I’m requesting costs more than my
deductible. And when I make that contact, my car insurance
company is legally bound to pay for or reimburse me for those
services, not tell me that the services are too innovative and
they’re denying payment.
People assume that I think the government would do a
better job than corporate CEO’s. I don’t. I think absolute power
corrupts absolutely regardless of who holds the power. I hope
I’ve shared enough in my writing to demonstrate that neither
corporations nor the government are above reproach in this area.
So here’s why I’m writing this book. While the
government has certain duties and responsibilities to us, we can’t
wait for the government to solve our problems. And we can’t
wait for our insurance companies or pharmaceutical companies
to solve our problems.
Many people both in Congress and in healthcare may
have good intentions, but they also have their own agendas. They
can’t possibly please 320 million people. If we want change, if

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we want a Congress or a healthcare system that prioritizes our
needs or wishes, in a Capitalist democratic republic, it’s up to us
to make that happen.
Although I majored in political science, it’s been nearly
two years since I’ve voted. Perhaps like you, I don’t feel like my
one vote out of millions carries much weight.
But what impacts people who earn $42.5 million
bonuses? What motivates people who the pharmaceutical
industry spends half a million dollars lobbying per year? Money.
If we “vote” with our dollars eventually they will listen.
Healthcare organizations continue to merge and form
monopolies, further reducing our choices as consumers. “Most
experts agree that further consolidations are likely, rivalry will
intensify, and still more [individual] providers will not survive.”
Says one text, “In the Cleveland [Ohio] market, consolidation
has resulted in two large integrated systems with high fixed costs
and extremely high strategic stakes.”ccv
One thing that contains at least a percentage of health care
costs is eating healthy.
Seeing a growing interest in healthy food consumption,
even traditional food manufacturers are investing in healthy
options. In 2016 Tyson Foods earned $37 billion in annual sales
by selling 35 million chickens, 125,000 cows, and 415,000 hogs
per week. Despite these mammoth numbers, they also purchased
a five percent stake in Beyond Meat, a plant-based protein
company. The dairy company, Dean Foods, also recently
invested in flax milk company Good Karma.ccvi
After ninety years in the dairy business, one company,
Elmhurst, stopped dairy production and now focuses on
producing nut milks such as almond milk and cashew milk.ccvii
 Perhaps because in the previous year the sale of plant-
based milk products had grown nine percent, while the sales of
dairy products had dropped seven percent. The dairy industry
did okay in 2015, though, with $17.8 billion in sales compared
to the $1.9 billion in sales for the plant-based milk industry.ccviii
Money talks when it comes to food. In the same year the
meat processing and products industry spent more than $4.5
million lobbying Congress, and the dairy industry spent $6.5
million.
Eating healthy can be an adjustment. And while there are
ways to save money, like eating brown rice, sometimes eating
well is costly, as well as investing in personal care items from
companies that choose to refrain from animal testing and petrol-
based ingredients.
I did have Crohn’s disease for twenty-five years. And
when I changed my diet and as I’ve changed lifestyle factors I’ve
saved thousands of dollars. I’ve saved on health insurance, I’ve
saved on hospitalizations, I’ve saved on sick days missed from
work, and I’ve saved on medications.
Different members of Congress have proposed legislative
efforts through the years to focus on single payer systems and
community wellness. They don’t pass. They don’t pass because
pharmaceutical and insurance companies lobby and donate to
campaign funds, and those dollars are louder than our votes.
Even for those who don’t receive lobbying incentives and
campaign contributions, how many politicians are invested in
pharmaceutical and insurance company stocks?
While I do believe in single-payer systems, which again
is not necessarily socialized medicine, and while I think

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Germany and Switzerland’s ideas of incorporating spa
treatments into their health insurance coverage is simply
brilliant, I don’t believe that a single-payer system is the solution
to all that ails us.
The Institute of Medicine (IOM) revealed that 98,000
Americans are killed each year by medical errors. “Many
doctors, nurses, and other professionals are alarmed at these
figures but are also concerned that the reports represent only the
tip of the iceberg: Counted errors are almost always in hospital
settings, leaving the outpatient setting, where the bulk of care in
the United States is provided, largely unmonitored.”ccix
The same year that the IOM released this report, the
World Health Organization published its own statistics.
Unfortunately, they found that despite Australia being the
second leading country in preventing unnecessary deaths, the
probability of suffering from an error in an Australian hospital
is 16.6%. The probability of suffering from a medical error in a
hospital in Denmark was around ten percent.
The U.S., therefore, is not alone in our risk of medical
errors, although ours may be more catastrophic and more
expensive. Single-payer systems may guarantee access, and in
some countries broaden people’s choices. While so far costs are
lower in other countries where people live healthier longer, and
where it’s sometimes illegal for health insurance companies to
not be non-profit, simply being single-payer is not the means to
improving quality and containing costs.
What has worked for me, and what I believe will work for
all of us, is not allowing Congress, or insurance companies, or
pharmaceutical companies, or doctors, or food advertisers to
have more influence over my decisions than I myself have. A
medical doctor can advise me, just as a naturopathic doctor or
chiropractor can, and a pizza company can entice me with their
aromas, and I can choose to treat myself, but they don’t have the
right to own me because I occasionally indulge in a slice of pizza
or visit a doctor’s office.
I was watching an episode of Britain’s recent remake of
Father Brown this week and heard “The Titanic was built by
professionals, the Ark was built by an amateur….perhaps some
things are too important to leave to the professionals.”ccx I don’t
want to downplay or disrespect the amount of studying and
research that professionals undertake, and the amount of money
they invest in their studies. I do think we should seek their
professional input and in acute situations we certainly need their
assistance. However, rarely does anyone else have my best
interests at heart, especially when money becomes involved. It
is human nature for people to have their own agendas. Because
of this, when a situation is chronic or non-emergency, or when
there is a potential for errors, or thousands of dollars at stake,
where my life and well-being are involved, my voice have a right
to be heard as well.
Isn’t that a democratic and basic human right? One judge
declared, “No right is held more sacred, or is more carefully
guarded, by the common law, than the right of every individual
to the possession and control of his own person, free from all
restraint or interference of others, unless by clear and
unquestioned authority of law.ccxi
I also think that professional voices that may not be part
of conventional medicine, such as naturopaths, have a right to be
heard and paid for their professional opinions, and we should all
have access to such voices.

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 Despite being told that we have the best health care in the
world, according to The Commonwealth Fund the U.S. ranks
fifth out of eleven developed countries for health-care quality.
This is calculated by such factors as quality, access, efficiency,
equity, and indicators of healthy lives.ccxii When it comes to
health care performance the World Health Organization at one
time ranked the U.S. all the way down the list to the 37th best in
the world.ccxiii
Six out of ten low-income adults have a risk factor for
cardiovascular disease. On the other hand, in high-income
brackets, less than four out of ten adults have any risk factors.
While overall deaths from cancer have decreased significantly,
deaths among those in lower socio-economic groups have
remained the same, and in some instances, increased.ccxiv
Between 1999 and 2014 opioid overdoses doubled. They
have doubled again in just the last two years.
Unlike medical schools, veterinary schools of medicine
have always taught the importance of nutrition, making
veterinarians sometimes more informed about nutrition than
medical doctors, and veterinary schools pioneered the research
in many of the human supplements, like glucosamine, that we
use today.ccxv
The processed food industry has what they call a “potato
chip marketing equation”. They market more than 90% of their
product sales to the less than ten percent of their customers who
weigh more than 200 pounds and earn less than $35,000 per
year.ccxvi Philip Morris, the world’s largest tobacco company,
also owns the world’s second largest food company.ccxvii And
they have every right to do so; I just may not assume that they
have my best interests at heart in their marketing strategies.
 Lobbying by pharmaceutical and other sectors of the
healthcare industry continues. According to Richard Master’s
DVD Big Pharma: Market Failure, from 2007-2016 the
pharmaceutical industry spent $2.4 billion on lobbying. That’s
$450,000 per member of Congress per year. This ensures that
nothing Congress does negatively effects the drug industry’s
profits. In 2009 alone drug companies spent more than any
industry has ever spent, $275 million, lobbying on a single
piece of legislation, the Affordable Care Act. According to a
Harvard School of Public Health survey sixty-nine percent of
Medicare enrollees want price controls on medications, yet
Congress is never able to act because pharmaceutical
companies lobby them and contribute to their electoral
campaigns.ccxviii
It would be nice to think that the Affordable Care Act,
referred to as health care reform, had reformed such spending.
Unfortunately, in a brochure accompanying Master’s DVDs he
reveals in data from the Center for Responsive Politics, that in
2016 alone, six years after the Affordable Care Act passed, the
drug industry spent $244 million paying 1300 lobbyists, and
insurance companies spent $145 million paying 850
lobbyists.ccxix
Dr. Abramson exposes a letter from Jim Nicholson, then
chairman of the Republican National Committee to Charles
Heimbold, then Chairman and CEO of Bristol-Myers Squibb,
made public because of legal challenges regarding campaign
financing, “We must keep the lines of communication open,”
says Nicholson, “if we want to continue passing legislation that
will benefit your industry.” The letter goes on to explain just how

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to keep those lines of communication open by requesting a
donation of $250,000 to the Republican National Committee.ccxx
Besides lobbying and campaign funds, pharmaceutical
companies have contributed greatly to the opioid epidemic. In
battling the opioid crisis, one county in Georgia filed a lawsuit
against more than thirty drug companies and individuals,
including Johnson & Johnson. States one of the plaintiffs, Bob
Ellis, “This case is about one thing: Corporate greed. Defendants
put their desire for profits above the health and well-being of
Fulton County consumers…in 2012 healthcare providers wrote
259 million prescriptions for opioid painkillers, enough to
medicate every adult in America around the clock for a
month…Opioids, once a niche drug, are now the most-
prescribed class of drugs. While Americans only represent 4.6%
of the world’s population, they consume eighty percent of the
opioids supplied around the world and ninety-nine percent of
global hydrocodone supply.”ccxxi
In West Virginia, where drug companies have already
paid out millions of dollar in fines for failing to detect, report or
stop questionable orders of drugs, they are now being told to
alert West Virginia State Police and the state attorney general’s
office regarding suspicious orders.ccxxii
Now that they’ve helped create a problem, drug
companies are selling drugs for overdose victims and to help
people in recovery from becoming addicted to their problems.
While they should be donating these medications, they have
made money off of Americans by creating a problem, and are
making money off of Americans by offering solutions.
It isn’t just the opioid epidemic that drug companies are
paying fines for. According to Richard Master’s Big Pharma
DVD, in 2012, before the opioid crisis became such big news
Pfizer paid $2.3 billion in legal fines for racketeering fraud and
other charges, GlaxoSmithKline paid $3.0 billion, and Abbott
Laboratories paid $1.5 billion. In 2013 Johnson and Johnson
paid $2.2 billion. In 2009 Eli Lilly paid $1.4 billion, and in 2011
Merck paid a measly $950 million.ccxxiii
Drug representatives wine and dine doctors and take them
to strip clubs. While they are enjoying their evenings on the
town, an evaluation of the “informational” materials these
representatives give doctors revealed that only thirty-nine
percent of the materials provided scientific evidence to support
their medical claims and forty-two percent of the materials were
in violation of Food and Drug Administration regulations.ccxxiv
Still, their profit margins never blink. According to the
National Institutes for Health Care Management, overall
spending on prescription drugs increased seventeen percent in
just one year.ccxxv Since 1990 spending on drugs has increased
by a full 500%.ccxxvi
Not all countries pay as much as we do for medication.
According to an article in Time magazine, prescription-drug
prices, which make up only ten percent of U.S. health care costs,
are fifty percent higher on average here than in other developed
nations.ccxxvii
For instance, while a prescription for the insulin Lantus
costs $186 in the U.S., it costs $63 in Great Britain and $47 in
France.ccxxviii Other countries pay less because, like the Veterans
Administration in the U.S, governments in other countries
negotiate prices with drug companies, based on effectiveness
calculations. The V.A. pays forty less than the rest of us do for
medications, and biotech companies still manage to profit. I

156
don’t think the V.A. should have to pay more, I think Congress
should not be afraid to negotiate prices for other sectors of the
population. Pharmaceutical companies have lobbied Congress to
make sure that neither Medicare payers nor the rest of us have
the ability to negotiate fair prices.ccxxix
It is estimated that if Medicare did negotiate drug prices
it could reduce federal spending by $230 to $540 billion over ten
years.ccxxx
Executive compensations continue to rise. According to
Brill’s piece in Time magazine, George Scangos, the CEO of
Biogen Idec, earned a twenty percent pay increase from 2010 to
2011, to the tune of an $11,331,441.00 salary.ccxxxi
Brill offers one brilliant, no-pun intended, suggestion. He
declares, “…we could require drug companies to include a
prominent, plain-English notice of the gross profit margin on the
packaging of each drug, as well as the salary of the parent
company’s C.E.O. The same would have to be posted on the
company’s website. If nothing else, it would be a good test of
embarrassment thresholds.”ccxxxii
At one time Americans could at least purchase
prescriptions for lower prices in Canada. But Big Pharma
lobbied Congress and made that illegal, claiming that the FDA
could not regulate those drugs and they might not be safe. At the
same time, drug companies transferred their own production to
foreign factories to save on labor costs, probably, ironically
enough, including cheaper health insurance costs.ccxxxiii
Federal law is supposed to prohibit most FDA reviewers
who have financial ties to products being tested from being
present on committees reviewing the products, but according to
a USA Today article, in two years’ time the FDA granted 800
waivers for analysts who had direct financial interests in the
drugs or topics they were evaluating.ccxxxiv
In addition to addressing pharmaceutical industry
lobbying and executive pay, two other areas of opportunities for
growth in the health care industry are evidence-based medicine
and medical errors.
After multiple test results demonstrated that my Crohn’s
disease was in remission but my primary care doctor continue to
insist that I should see my surgeon a friend asked me if I would
consider suing. Surgeon Atul Gawande claims that most
surgeons are sued at least once during the course of their
professional careers.ccxxxv
The American Medical Association says that defensive
medicine and malpractice insurance add $36 billion to
America’s healthcare costs each year.ccxxxvi
Unfortunately litigation seems to only compound the
problem. “Defensive medicine (self-protective) is believed to be
one of the most harmful effects produced by the threat of
malpractice litigation. Such medicine is practiced to forestall
potential litigation and provide and advantageous legal
defense…Defensive medicine often results in undertereatment,
perhaps by avoiding high-risk tests and procedures, or
overtreatment, such as the excessive use of diagnostic
tests.”ccxxxvii
Sometimes these errors occur because clinicians put their
assumptions and instincts over scientific training. Surgeon Atul
Gawande talks about the human factor in his book
Complications: A Surgeon’s Notes on an Imperfect Science.
Pertaining to our tendency to rely on instincts and human

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judgment, he shares how psychology has found that this
methodology is prone to error. Which is perhaps why my one
doctor kept telling me I still had Crohn’s disease, which I had at
one time, even when the hospitalist did three tests that showed
absolutely no signs of Crohn’s disease. Perhaps, also, this
tendency to rely on fallible instincts is one reason that so many
innocent people in our country are incarcerated, and why we
need an organization like The Innocence Project. But I digress—
perhaps that will be another book one day.
According to Dr. Gawande, expert panels asked to review
actual medical decisions have found that in a quarter of
hysterectomy cases, a third of operations to put tubes in
children’s ears, and a third of pacemaker insertions, not counting
other procedures, the science did not exist to say whether the
procedures would help those particular patients or not. He says
that it’s “hard to not be troubled” by these tendencies to go by
feelings over science.ccxxxviii
He elaborates on three decades of research by
psychologists showing that human judgment overestimates
danger, mismanages data, and is swayed by multiple variants
into misinterpreting data. In one study of doctors at the Medical
College of Virginia doctors overestimated infections when
ordering blood cultures for patients with fever 4-10-fold.ccxxxix
Dartmouth physician Jack Wennberg studies decision-
making in medicine. He has found that the likelihood of a doctor
sending you for gallbladder removal varies 270% depending
what city you live in; 450% for hip replacement; and as much as
880% in transfers to the I.C.U. in the last six months of life. A
patient in Santa Barbara, for instance, is five times more likely
to be recommended back surgery for back pain than in the
Bronx, NY.ccxl For information on how your local hospitals
compare, his website can be found at www.dartmouthatlas.org.
And so while doctors’ judgment may not always be
accurate, and at times we may be justified, or at least feel
justified in suing, Dr. Gawande reminds us that “Human error
is…not something that can be deterred by punishment.ccxli
While clinicians write prescriptions for antidepressants,
they themselves are not immune. It is estimated that thirty-two
percent of the general working-age population develops at least
one serious mental disorder…and there is no evidence that such
disorders are any less common among doctors…The aberration
may be a doctor who makes it through a forty-year career
without at least a troubled year or two…estimates are that, at any
given time, three to five percent of practicing physicians are
actually unfit to see patients.ccxlii

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 Chapter 14

Solutions

There is hope. Prior to the passage of the Affordable Care

Act (ACA), more than sixteen percent of our population was
uninsured.ccxliii The Affordable Care Act made it unlawful to
drop people, like cancer patients, when they become sick, to
prevent people from being insured because of pre-existing
conditions, and extended the age of young people to remain on
their parents’ insurance plans.
In addition, the ACA requires nonprofit hospitals to
complete community health needs assessment every three years.
The results of these assessments must be available to the public
on hospital websites. The hospitals must also develop
implementation strategies to meet needs identified in the
assessments.ccxliv
Those who enroll in Health Savings Accounts (HSAs)
reduce a fraction of the twenty percent, or a fraction of the half
of a trillion of the U.S. healthcare budget that go to
paperwork.ccxlv
Patients who admit to teaching hospitals average better
outcomes than patients who admit to non-teaching hospitals.
Although they make mistakes, because medical residents still
see themselves as learning, they are more inclined to ask
questions of their mentors. They also do not have the full load
and perhaps somewhat jaded outlook of their seniors, and are
more willing to take time with patients, generally speaking. ccxlvi
Also, having residents around keeps their superiors on their toes
and on the cutting edge of knowledge. In addition, teaching
hospitals are often linked to universities, where cutting edge
research is being done.
For those interested in complementary and alternative
forms of medicine the outlook is good also. The number of
chiropractors, naturopathic doctors and practitioners of
traditional Chinese medicine has grown in the past twenty years.
Even traditional, or allopathic, medical schools are offering
courses in complementary and alternative medicine for the one
out of three adults who have sought acupuncture, chiropractic
care and massage therapy from someone other than their primary
care physicians.ccxlvii
Still, costs increase, errors continue, and people overdose.
Part of the problem, some people would say, is that we rely more
on a sickness industry than invest in wellness. “Most of the one
out of six of the U.S. adult working population that work in the
healthcare industry today focus on treating the symptoms of
disease rather than on preventing disease. This is because it is
more profitable for medical companies to research and develop
products that create customers for life.”ccxlviii
Economist and health writer Paul Zane Pilzer asks you to
consider, if you were a member of the board of directors of a
pharmaceutical drug company, or a healthcare organization,
appointed to your position “for the purpose of increasing the
value of investment, would you direct the company to spend
millions of dollars in research and development to make a one-
time-use product costing fifty dollars per pill that could cure or
prevent a disease, or would you direct your company to spend
millions of dollars in research and development to make a

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product costing only three dollars a pill that consumers would
take every day for the rest of their lives, 365 days a year?”ccxlix
Pilzer and others call the sickness industry reactive.
People don’t choose to become customers, they become
customers out of necessity. The wellness industry, on the other
hand, is proactive. People voluntarily become customers. They
do so because they want to feel healthier, to reduce the effects of
aging, and to avoid becoming customers of the sickness
industry.ccl
Unlike the sickness industry the main reason that the
wellness industry continues to grow from what was once
considered a fringe movement, is because “of what happens once
consumers of any age have their first wellness experience—they
typically become voracious customers with an unlimited
appetite for more wellness products and services.ccli”
Pilzer shares the story of Rodale, the man behind
Prevention magazines. Rodale advised his readers to eat less red
meat and dairy products and to increase physical activity to
prevent heart attacks. In 1955 the Federal Trade Commission
ordered him to stop and scheduled hearings to prevent him from
writing these things. Rodale claimed his first Amendment right
to freedom of speech.
Although Rodale lost his battle with the FTC, a dissenting
FTC commissioner wrote, “Congress did not create this
Commission to act as a censor of unorthodox ideas and therein
books, whether they deal with politics or health. We should not
forget that, in both fields, today’s heresy may become
tomorrow’s dogma.”cclii
And if you think that today’s dogma may not be
tomorrow’s heresy consider that in the past doctors have used
such things as leeches and, during the Civil War era, blue mass
pills which contained elemental mercury.ccliii
Commissioner Elman continued, “It is the glory of a free
society that a man can write a book contending that the earth is
flat, or that the moon is made of green cheese, or that God is
dead, without having to ‘substantiate’ or ‘prove’ his claims to
the satisfaction of some public official or agency. It is arrogance
to presume that in any field of knowledge, whether dealing with
health or otherwise, all the answers are now in.”ccliv
Soon after Rodale’s death the federal government
reversed its position, stating the FTC would no longer require
advertisers of information-based products to establish the
efficacy of their claims.cclv
There is an old saying that “absolute power corrupts
absolutely.” Whether this power is in the hands of unscrupulous
clergy members, private organizations or public servants makes
no difference. The only way for us to prevent people from having
power over us is to stand up for ourselves. Do not be afraid to
assert your rights with your doctors. You have the right to
autonomy, informed consent, and the right to refuse treatment.
Ask your doctors and pharmacists to spend your money as if it
were their own.
General Motors advises its employees to ask, “What does
this mean now? Which labs provide the best quality and value?
What are the ideal results? What do I need to do to improve these
results? What are the side-effects? Is surgery a possibility, and
what do I need to do to avoid this? How can I prevent this
condition from returning?”cclvi

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 Thomas Edision said, “When you think you have
exhausted all possibilities, remember this—you haven’t.”
I read this morning that my home state of Ohio boasts the
second highest rate of overdose deaths in the nation. If I’m not
mistaken we are also home to such companies and organizations
as Wendy’s, Frito-Lay, The Cleveland Clinic Foundation,
Medical Mutual of Ohio, and SummaCare.
I enjoy the occasional Wendy’s single with cheese, and
the occasional Arby’s curly fry. And I hope that if I ever break a
bone I’ll be able to have access to a doctor who can set that
broken bone, preferably without my walking away with
gargantuan-sized medical debt. I believe that all of these things
have their places in our lives, but that they should not have the
power to run our lives for us.
Health care policy has been debated for over a century by
politicians, and frankly, they’ve proven that million dollar
lobbyists have more influence over them than average Joes and
Janes. While the Affordable Care Act brought about some good
changes for consumers, it also added more high deductibles,
more people paying insurance company premiums, more people
using more prescription drugs, and indirectly more people dying
from opioid overdoses. The war on cancer has raised millions of
dollars in research over the last forty years. Yet the five year rate
of cancer survivability has not diminished greatly. cclvii
More and more people struggle with weight, which leads
to cardiovascular problems and contributes to diabetes, which
lead to bypass surgeries, blindness, insulin dependency, renal
failure and in some cases, amputations.
More and more people struggle with allergies, food
allergies, and autoimmune disorders, including asthma.
More and more people suffer from medical errors.
 More and more people overdose.
And health care organizations and health insurance and
pharmaceutical companies make more and more money.
It doesn’t have to be this way. But the people in power
are unlikely to make great changes to a system that put them in
power.
So I’m sharing my story in the hopes of inspiring people
to have hope. I get that there is a lot of information out there, and
many of us have fewer hours in the day than we’d like and
constant demands and drains on our time and emotions.
Knowledge is power. I believe that if enough people are
given the tools to live healthier lives then we’ll take away the
power from people who are profiting off of making and keeping
us sick. We have to work together and help each other. People
in power will not want to lose power. But what we often hear is
that we don’t want socialized medicine. Ours is a capitalist
economy. In free markets consumers have information, and
power and choices. That does not reflect our current health care
system. One thing that helps me understand the difference is to
consider the difference between the V.A. and Medicare.
The V.A. is a form of socialized medicine. Not only does
the government pay for care, but the hospitals and pharmacies
are owned by the government. Medicare is not socialized
medicine, but a good percentage of care is paid by the
government within a certain population. Although Medicare was
created as a single-payer system, with the federal government
paying for services, the providers—hospitals, pharmaceutical
companies, and doctors—are not socialized because they are not
owned by the same entity paying for their services.

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 Don’t let other people get rich off of misleading you and
making you a statistic. I don’t want to take jobs away from well-
meaning hard-working people, the $13/hour, 40-hours a week
and sometimes overtime just to put food on their tables kind of
people. But I don’t want to give people $42.5 million bonuses to
people who helped turn other people into statistics.
Whether those statistics revolve around bankruptcies,
illness, obesity, medical errors, or overdoses, none of them are
okay. There have been enough justifications from people as to
why they should be entitled to such profits. In my mind, there
have not been enough justifications in return for why people
have to sell spaghetti to people in their communities to pay for
their chemotherapy, or for why so many municipal and county
government and health providers feel the need to file multi-
million and even billion dollar lawsuits against pharmaceutical
companies who’ve made their fair contributions to the opioid
overdose epidemic. To me, there can be no justifications that
make sense for such things.
When written in Chinese the word “crisis” is composed
of two characters—one represents danger and one represents
opportunity.cclviii Some call our fragmented healthcare payment
system with uncontainable costs a crisis. We can choose to allow
it to become more dangerous, or we can see it as an opportunity
to move forward.
There is more good news. The Centers for Disease
Control and Prevention say that the death rate from coronary
heart disease has dropped since its peak in 1968. The U.S.
Department of Agriculture reports that this is thanks in part to
our reduced red meat and dairy consumption per person.cclix
Thankfully, as a whole, our society is moving towards
greater understanding of food’s impact on our health, but we still
have a long ways to go. According to one text, physicians
themselves only receive nutrition education within a separate
class or take one nutrition course while in medical school.” cclx
Generally speaking, with so little formal education in nutrition,
in order to assist their patients with nutritional information,
physicians must refer them to registered dieticians, health
coaches or naturopathic doctors.
Given our knowledge of nutrition’s impact on such
illnesses as diabetes, hypertension, cardiovascular disorders, and
cancer, I applaud the growing trend of hospitals offering diabetes
support and nutrition groups, and doctors like Dr. Oz
encouraging cardiology patients to eat heart healthy foods and
participate in health improving activities like exercise and music
therapy.
A hospital in San Antonio joined with a local grocery
chain and The Culinary Institute of America to launch a culinary
health education program aimed at reducing obesity and
improving access to nutritious food for its patients and the
community. The program includes a teaching kitchen, a garden,
and a “Prescriptions for Produce” program that has physicians
writing farmers’ market prescriptions instead of merely
prescriptions for pharmaceuticals.cclxi
In fact, it will take more than hospitals, doctors and
pharmacies to help us change our approach to wellness. In 2015
America’s surgeon general Vivek Hallegere, M.D., M.B.A.,
stated that he believes the greatest impacts on public health will
come from sources other than traditional medicine—“from
friends and family, employers, schools, faith-based
organizations and community resources.”cclxii

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 The Affordable Care Act encourages communities to
invest in more community walking paths.
For too long, the wrong type of competition has driven
America’s health care problem. Rather than zero-sum strategies
that make insurance, healthcare organization, and
pharmaceutical company CEO’s and Congress the winners, we
need to measure success from the perspective of the patients,
consumers and society.cclxiii
One approach to putting the customer first is the Planetree
system. The system was designed by an Argentinian woman.
She married a man from San Francisco, and when she became
sick found herself appalled by the cold, impersonal manner of
medicine she received in a U.S. hospital in 1978.cclxiv
So she designed a new approach to healthcare based on
compassion, confidence, dignity, aesthetic beauty, shared
knowledge and freedom of informed choice. She named the
system for the tree under which legend says Hippocrates taught
his students.
The Planetree system’s website highlights its intentions
to use human interaction, interior and exterior design, nutrition,
patient education, social support systems, communities, human
touch, and spirituality to aid in the healing process. Planetree
aims to demonstrate that patient-centered care can be not only
empowering but viable and cost-effective.cclxv
Besides community assessments, managed care
organizations do regular surveys to measure customer
satisfaction outcomes.cclxvi The federal government requires
Medicare Advantage plans to have ongoing quality
improvement programs and to encourage providers to participate
in quality improvement initiatives.cclxvii
 Doctors and hospitals are encouraged to follow
scientifically-sound best practices. Many physicians believe that
diagnoses can’t be reduced to a set of generalizations—to a
“cookbook” as some say. Instead, they argue, it must take
account of the idiosyncrasies of individual patients. And while I
agree that we are not cut out of cookie cutters, Dr. Gawande’s
book shows that following instincts over science sometimes
“causes more mistakes than it prevents.”cclxviii
Following quality improvement initiatives and evidence-
based practices is intended to improve outcomes. In one study
reported in the New England Journal of Medicine, patients
received just fifty-five percent of recommended medical
care.cclxix We have room to improve in providing evidence-based
medicine that includes truly preventative measures like health
coaching and personal training, which is not just for competitive
athletes.
By the way, medical professionals refer to things like
mammograms as preventive, but mammograms don’t prevent
cancer, they help diagnose it.
We demand that cell phone and credit card companies
itemize our bills but we allow our health care costs to remain
shrouded in mystery. Healthcare organizations and insurance
companies limit access to price information and we receive
statements months after procedures occur. When third party
payers are selected for us, we spend more time researching the
purchase of a new computer or coffee maker than we do when
faced with serious medical procedures.cclxx
Few of us interview doctors regarding their qualifications
before allowing them to cut us open. Few of us inquire about

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cleanliness standards at hospitals, or question the costs or quality
of lab and diagnostic tests. It may be difficult to remember all of
the questions we should be asking when we’re sick or in
pain,cclxxi but it’s our right to ask questions and exhaust every
option. Perhaps we need more advocates in our healthcare
system, asking questions on our behalves.
One dietitian says that if we get a wedge of broken glass
in our finger, we know the solution is to remove the glass.cclxxii
The same is true in healthcare. If we know what contributes to
illness, we know how to remove it.
And the choices we as consumers make talks. So does
publicity. In 2004, the year that the documentary Super-Size Me
came out, McDonald’s discontinued its supersize menu.cclxxiii
Sales of foods with the word “organic” on their labels
have reached the rate of $35.1 billion annually. Low-fat, fat-free
or reduced fat labels sell $64 billion products annually.cclxxiv
Gary Collins, M.S., former FDA special agent turned
health advocate, and author of The Organic Caveman: How to
Make Natural and Sustainable Food Choices for Weight Loss
and Health says that when it comes to food labels people must
pick their issue. “For me, there are only two important things to
look for: the ‘USDA Organic’ seal, and the ‘Non-GMO Project
Verified’ seal. To me, these are the two terms that hold the most
legitimacy. I could go into a long-winded explanation why, but
I have just found these two are the hardest to get around by food
manufacturers. They are not perfect, but they are the best we
have today.”cclxxv
Says food blogger Marion Nestle, “My advice is to eat
real food and not buy packages with health claims on them.”cclxxvi
To truly resolve issues we must first decide what our
goals are. Do we want to live healthy longer, or do we want to
have good medical care when something happens? Do we want
access to frequent visits to the doctor, well-equipped and
accessible hospitals, and equal access to medical care by rich and
poor alike?cclxxvii
Says Dye, “The United States is the locus of the most
advanced medical research in the world, drawing researchers
from all over the world. This apparent paradox—the highest
quality medical care, combined with poor health statistics—for
the general public—[like ranking 37th on the World Health
Organization’s health performance list] suggests that our
nation’s health care problems center more on access to care,
education, and prevention of health problems than on the quality
of care available.”cclxxviii To some degree I believe that this is
true, but the number of medical errors indicates that quality of
care provided also has room for improvement.
Two legislators introduced a bipartisan bill called the
Enrich Act (Expanding Nutrition’s Role in Curricula and
Healthcare, HR 1411). The Bill would have established $15
million in grants to integrate nutrition and physical education
into medical school curriculum.cclxxix
I think we should also consider encouraging more
patients to go to compounding pharmacists.
I would love to see insurance companies pay for wellness
providers like naturopathic doctors rather than just for sickness
care, or have insurance companies only pay for catastrophes like
my car insurance company does, and leave the maintenance care
to me.
When you’re holding a hammer all the world is a nail.
While allopathic doctors are well trained to treat our sicknesses

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I believe that we would reduce our overall healthcare costs by
investing in more preventative and wellness measures.

Chapter 15
 Making Changes

Only you can figure out what motivates you.

For me, if eating a few less desserts and a few more
vegetables has any chance of keeping my Crohn’s disease in
remission, then please pass the salad.
If buying hand-soap that doesn’t have triclosan in it
means that I have a better chance of making the decisions about
what happens to my body than other people, then I’m thankful
for 98¢ hand-soaps.
If using an essential oil or eating cranberries rather than
taking an antibiotic has even a chance of making a dent in
revenues of pharmaceutical companies that profit more than any
other industry while opioids kill more people every year, then
please someone, write some more books essential oils.
If exercising one or two hours a week has any chance of
delaying my need to purchase medication from any drug
company, which will then provide kickbacks to any insurance
executive, who receives a bonus for causing people with cancer
to file for bankruptcy and foreclose on their homes, then I can at
least force myself to exercise a little bit each week.
If sharing this information can help just one person to
make one change that will help them rely less on drug companies
who spend millions of dollars a year wining and dining Congress
and the administration, or taking doctors out for $1000 nights on
the town and strip club visits, then I am willing to share this
information even if it makes me unpopular.
These are the things that motivate me.

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 Victor Frankl talked about this need for purpose in his
book Man’s Search for Meaning.cclxxx Trapped in Nazi
concentration camps he lost his family and his life’s work.
Frankl wrote that in the camps prisoners watched other captives
die in front of them when one thing happened: they gave up
hope. He wrote that as long as men still had something to hope
for—the idea that they might reunite with someone one day, the
idea of getting transferred to a “better” camp, anything, they
would hold on for life to whatever they were hoping for. When
his family died and his work was destroyed, he began writing a
new text in the camp. He decided to use what he observed to
develop a new branch of psychology. The hope of using his
experience when he left camp one day kept him alive through a
horrendous ordeal. Some people consider his theory of logos
therapy the basis of today’s life coaching.
When you figure out what motivates you then you won’t
need to count four days, or three weeks, or two years. For me, as
long as Crohn’s disease exists, and politicians and executives
prioritize profits over people, I’ll have my motivation. Money is
a powerful tool when wielded correctly, but Paul the apostle
wrote that the love of money is the root of all kinds of evil (1
Timothy 6:10). Well-intentioned or not, none of us is above
being tempted to choose money over people at some point in our
lives, or Paul would not have needed to remind us of that.
I’ve read, “The experience of being understood rather
than interpreted is so compelling one could charge admission.”
Only you can figure out what motivates you.
There are many health coaches and wellness advocates
available now. And we are more than happy to help you find
your motivation if you like.
In the meantime, here are a few tips.
 According to the Centers for Disease Control and
Prevention one-half of all deaths that occurred in the United
States in 2000 could be attributed to…largely preventable
behaviors and exposures.” The Institutes of Medicine goes
further to say that up to seventy percent of all deaths in the U.S.
could be prevented, or at least delayed until we get older.cclxxxi
Unfortunately, because we have a for-profit healthcare
system, the Robert Wood Johnson Foundation says that six
percent, or 144,000 deaths each year are attributable to
poverty.cclxxxii
It is estimated that inadequate medical care is responsible
for ten to fifteen percent of all deaths yet almost all of our health
care spending is directed at bio-medically oriented medical care.
Dr. Abramson protests, “Assuming that the primary goal of our
health care system is to improve our health, this allocation of our
resources is simply not rational.”cclxxxiii
One woman expressed her concerns to her doctor about
nagging hip pain. Although she weighed 316 pounds she says
her doctor never suggested she try losing weight. So, with some
trepidation, she approached a personal trainer for help. This can
be intimidating for people who are not used to exercise and don’t
think they like exercise, but she decided that her health was
worth it. Knowing that health is more than weight loss, her
trainer accompanied her to the grocery store for a ninety-minute
lesson on reading food labels and shopping for optimal health.
They began meeting once a week for thirty minutes of exercise
and fifteen minutes of nutrition discussion and planning. After
ten months, she lost seventy pounds.cclxxxiv

176
 Seeing a need in the community, trainers, coaches,
chiropractors and some grocery stores are offering such services.
It might seem funny to think that chiropractors are experts in
nutrition, but because they focus on the body’s innate abilities to
heal itself, they actually receive more nutritional training in
school than most traditional medical schools offer. Working for
a chiropractor for less than a year I learned more about nutrition
than I had learned in twenty-five years of visits to medical
practitioners.
Even if we could trust our doctors and insurers and
pharmaceutical manufacturers and hospital administrators and
legislators to always have our best interests at heart, one writer
reminds us, “Many of the leading causes of death today,
including heart disease, stroke, cirrhosis of the liver, accidents,
and suicides, are closely linked to personal habits and lifestyles
and are beyond the reach of medicine.”cclxxxv
For those who worry that by cutting back on animal
products they may lose out on needed protein, consider that 100
calories of many vegetables contain more grams of protein than
100 calories of meat and dairy products because the vegetables
do not have the additional saturated fats making up the 100
calories.cclxxxvi
For those interested in finding cosmetic and personal care
items that don’t contain parabens and other synthetic ingredients
and don’t test on animals, check out www.safecosmetics.org.
This website hosts a campaign for companies creating
environmentally safe and conscientious products. Their “red
lists” note which chemicals interested consumers can be aware
of in various product categories.
Long before food manufacturers offered us tasty meals at
every corner, our bodies learned to store fat. Ginger Garrett
references a Newsweek article that says that our fat cells,
unfortunately, can swell up to six times their normal size and
multiply to store that precious fat.cclxxxvii
And while we know that eating healthy can only benefit
us, sometimes it’s just so hard. Life gets busy, and discouraging,
and it’s quick, or comforting to grab a meal or snack that
promises to make us feel better or make life easier in the short-
term. But we suffer for it. Although one doctor says there are
seventy diseases linked to the non-consumption of fruits and
vegetables, he claims that “The average American eats only 1.4
servings of fruits and vegetables a day—and that’s if you count
French Fries.cclxxxviii
It’s easy to see why it can be so difficult to make healthy
eating choices despite all of the money we spend on gym
memberships and diet programs. One study by the Mayo Clinic
reports that fewer than three percent of us meet four parameters
of health, including healthy BMI, not smoking, eating a healthy
diet within a 24-hour period, and 150 minutes of exercise
weekly.cclxxxix
Just walking down a grocery store aisle taxes our brains.
Do we buy low-fat, fat-free, natural, hormone free, grass-fed,
cage-free, organic, non-GMO, or locally grown? And what
about our budgets? What’s healthier is arguably more expensive
than less healthy products. On average, we each make over 200
food-related decisions each day, “with many made on ‘mindless
autopilot’.ccxc
In 2012 companies spent $116 million on advertising
healthy fruits and vegetables. This sounds like a fair amount

178
until you read that the fast food industry spent $4.6 billion the
same year on marketing.ccxci
Sometimes we tell ourselves that if a food label sounds
healthy we can eat more of it, taking in more calories in the
process. Dr. Brian Wansink, author of Slim by Design: Mindless
Eating Solutions for Everyday Life, claims that we eat up to
forty-four percent more of foods that have healthy claims on
their labels.ccxcii
The word “natural” alone helps to sell over $40 billion a
year in food products. Sadly, what you think is natural may not
be what the food manufacturer means. The FDA does not
regulate this term on any products overseen by the FDA. The
USDA does regulate the word if it is on foods made from animal
products. However, it has no relation to the amount of hormones
or antibiotics the animal may have been exposed to.ccxciii
There’s much debate in healthy eating circles about GMO
foods. Genetically modified organisms, or GMOs are genetically
altered forms of plant or animal products. Although sixty-four
countries require food sellers to include information on their
labels regarding whether their food are genetically modified or
not, the U.S. is not one of those countries. If you are interested
in avoiding GMO foods, look for look for USDA Organic seal
of Non-GMO Project Verified.ccxciv
While figuring out what motivates us and changing
behavior patterns can be difficult there is hope. Scientists at
Tufts University and Massachusetts General Hospital found that
after six months of participating in weight loss programs,
individual MRIs revealed changes in the reward center
associated with learning and addiction of dieters’ brains. Taking
MRI scans before and after the six-month weight loss program,
people showed increased sensitivity to healthy, low-calorie
foods after six months, indicating increased sense of rewards and
more enjoyment of healthier food cues. Sometimes it’s just a
matter of learning the recipes that we like. They also showed less
enjoyment regarding unhealthy high-calorie foods.ccxcv
More good news is that we’ve successfully cut back on
our consumption of beverages high in sugar.ccxcvi
Final thoughts on change. There are six things adults need
to help us learn. They include goals to work towards, a way to
make our new learning relevant to our lives, practicality, the
ability to draw on our own knowledge and life experience rather
than just be told something, to feel that we have some ability to
direct our own learning and internal motivation, and a need to
feel respected.ccxcvii
In addition, coaches and trainers use what is known as the
Transtheoretical Model of Behavioral Change. These steps to
change do not necessarily follow a linear progression, but they
include pre-contemplation, contemplation, preparation, action,
maintenance and termination. Although not everyone agrees that
these steps correspond to everyone’s learning cycles, they are a
common approach. Sometimes people camp in one stage, move
on to another stage, fail, regress, practice, move forward again.
Learning, always, is a process, whether you follow these steps in
learning or not.ccxcviii
One technique practiced is to ask clients on a scale of one
to ten, where are you in relation to your goal? What would have
to happen for you to move, for instance, from a one to a five?ccxcix
Based on this information, your professional assists you
in setting S.M.A.R.T. goals. S.M.A.R.T. goals are specific,
measurable, attainable, realistic, and timely.

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 For instance, I received a contract for this book in 2006.
But I sat on it, and revisited it from time to time, tried publishing
an e-version of it but didn’t feel satisfied enough with it to print
it. I contemplated, occasionally preparing and taking action, then
contemplating some more. Finally, a few months ago, I decided
it was time to stop allowing this unfulfilled dream to keep
hanging over my head, time to stop allowing other people to
decide their agendas for my life, and time to start creating more
of the life that I want.
In relation to the book, I looked at the material I had, and
the research I had done. I measured the number of hours I
thought it would take to finish compiling my research, writing,
and editing. Considering that health information is always
changing, I gave myself a time limit at which it would be time
to say I was finished, even if there was more information I
wanted to include. And I didn’t want to write a 500-page book
that would be too intimidating to be readable.
I measured the specific number of hours it would take me.
I gave myself a realistic and attainable deadline to work toward,
and I set my goal.
Now it’s your turn. In closing, I’ll ask you:
What are your top three health goals?
Where are you, on a scale of one to ten, in relation to
achieving those goals?
What would have to happen for you to move from the
number you’re currently at, to ten?
Now, set your goals, and if you need someone to help you
reach them, contact me or a friend, or a good health coach or
personal trainer, and go out and live life to the full (John 10:10)!
182
 Appendix

What is Single-Payer Health Care?

More powerful than the march of mighty armies is an idea

whose time has come.
~Victor Hugo~

Is universal health care socialized medicine?

In some cases, yes, but not necessarily. The VA would be
considered socialized medicine because not only does the
government pay for services through the VA but the government
owns the hospitals and pharmacies that comprise the VA.
Medicare, on the other hand, is theoretically a single-
payer system, but the providers and pharmacies that patients use
are based on a free-market system and not owned by the
government.
Virtually every developed country but the U.S. has a
single-payer system, but they are not all socialist systems.
Germany was the first system to enact a single-payer
enforced sickness insurance program in 1883. Otto von
Bismarck actually enacted the system as an antisocialist
program.ccc In the U.S. the first major public figure to discuss
offering health care coverage to all Americans was Teddy
Roosevelt during the 1912 election campaign.ccci
A few decades later, in his memoirs, President Truman
wrote, “I have had some bitter disappointments as President, but
the one that troubled me most in a personal way, has been the
failure to defeat the organized opposition to a national
compulsory health insurance plan.”cccii
 In 1935 California doctors participated in a program
through Blue Shield in which patients prepaid for services.ccciii
During World War II, to entice employees, employers began
offering health insurance packages. At the same time Henry
Kaiser developed the first true HMO as a means to provide
health care to all of his employees. President Nixon later enacted
legislation to make HMOs more widespread.
While Cuba, North Korea, China and Vietnam have
socialist and centrally planned healthcare systems, Thailand, the
Philippines and South Africa have more entrepreneurial and
permissive healthcare systems. Germany, Canada and Japan
have welfare-oriented healthcare systems and Great Britain,
New Zealand, Norway, Israel and Tanzania have universal and
comprehensive healthcare systems.ccciv Switzerland has a
consumer-driven healthcare system.cccv
The British National Health Service ensures free
comprehensive coverage for inpatient and outpatient care, loss
of income in some instances, eighty percent coverage of dental
benefits, and pharmaceutical products minus a modest copay.
The NHS also permits customers to purchase supplemental
health insurance.cccvi
Maybe you’ve heard that Canadians wait months at a time
to see their physicians. Previous health insurance public
relations executive Wendell Potter says that insurance
companies “look for the one or two uncommon stories about
long wait times and get people to believe that’s the norm.”cccvii
Perhaps there has been some truth, though, to these
rumors in the past as Canada has had a higher percentage of
primary care physicians per capita than we have in the U.S.

184
Perhaps Canadians have waited to see specialists as we’ve
waited to see general practitioners. Still, on the whole, eighty-
five percent of Ontario residents have claimed to be very or
somewhat satisfied with the way the system operates, and over
ninety percent have been very or somewhat happy with the care
they received.cccviii
To reduce wait times to see specialists Canada has created
incentives in medical schools to increase its supply and
availability of specialists. Vancouver Hospital even became the
first site in the world to offer cardiac CT scanning available
twenty-four hours per day.cccix While the U.S. has lost .1% of our
life expectancy in the last year, due to the opioid epidemic,
Canadian life expectancy has increased in recent years.cccx
In addition, Canada’s health care system is regarded as a
major contributor to the country’s number one world ranking on
the United Nations Human Development Index.cccxi
While the system is centrally financed, it is not
considered socialist as it is privately delivered.
It is seen as an “interlocking set of ten provincial and
three territorial health insurance plans”, incorporating
comprehensive coverage for medically necessary hospital, in-
patient and outpatient services. Each individual province or
territory is responsible for management and delivery of services.
However, doctors are not employed by the government. They
individually charge for services rendered, and submit claims to
their provincial governments.cccxii
Says one American doctor who moved to Canada:
“People seem to think that because it’s a single payer that you’re
working for the government, you’re an employee, they tell you
want to do. Nothing could be further from the truth.”cccxiii And
rather than submit claims to insurance companies, wait for
months to receive denials, then spend time appealing denied
claims in attempts to get obtain payments, as we do in the U.S.,
claims in Canada are paid two weeks after submission. In the
U.S., it’s not uncommon for nurses to lose thirty minutes of
patient care time on the phone with insurance adjusters
appealing denials.cccxiv
In Switzerland consumers choose their healthcare plans.
Everyone is required to purchase coverage but the government
subsidizes those who need financial assistance. Benefits that
insurance providers are required to provide range from hospital
care to visits to health spas.cccxv
Supplemental coverage can be purchased by those
interested in private hospital rooms or payments for child care in
case a parent becomes ill.cccxvi Because payment is mandatory,
insurance companies risk adjust each other. In America, if health
insurance companies risk-adjusted each other, a result might be
that if one year United Healthcare spent a higher percentage of
its premiums on medical care than Anthem, then at the end of
that year Anthem would give a share of its revenues to United
Healthcare.
Under our current system insurers are much more
competitive. In the U.S. employers renegotiate with insurance
companies and employees change jobs, losing their employer-
based coverage. Insurance companies have little incentive to
promote wellness when they know that their competitors may be
enrolling their customers in the future.
Doctors with private practices can spend $84,000 in one
year just maintaining eligibility with various insurance company
regulations.cccxvii Of the money spent on healthcare premiums,

186
about three cents for every dollar goes to the insurance agent,
twenty cents goes to sales and marketing and other
administration functions, including staff who deny care, and
about ten cents goes to paperwork and phone time for
preapproval demands, denials and other payment issues.cccxviii
Says Potter “What keeps insurance company CEO’s up at
night is the worry that other CEO’s will eventually come to
realize they add more cost than value to our health care
system….”cccxix
Doctors aren’t the only ones paying to keep up with
insurance regulations. One CEO of a 430 bed hospital estimated
that his organization spends about $8 million annually, requiring
a staff of 140 full-time workers to comply with regulations.cccxx
Perhaps this is one reason U.S hospital care cost thirty-four
percent more per patient than hospitals in Germany in 2004.cccxxi
I’m all for keeping people employed. I just think that these
employees could be used more effectively than the current
system permits.
Taiwan offers comprehensive prescription, inpatient,
outpatient and dental care. While the U.S. spends about thirty
percent of our operating budgets on administrative costs,
Taiwan’s universal system only spends one point six percent of
its operating budget on administrative costs. The rest of the
budget goes to enhancing patients’ well-being.cccxxii
To be sure, the passage of the Affordable Care Act (ACA)
got some things right. But there is a difference between true
reform and merely making some changes that improve some
areas and worsen others.
While the passage of the ACA reduced the number of
forty-six million Americans who are uninsured, Wendell Potter
of the Center for Public Integrity estimates that thirty-one
million remain uninsured. Adding to the remaining uninsured
Health Affairs estimates that the number of underinsured, or
those who spend more than ten percent of their income on
healthcare has increased eighty percent since 2003 to twenty-
nine million.cccxxiii And because large companies self-insure
rather than rely on outside health insurance companies, and
companies that self-insure are not regulated by the ACA, sixty-
one percent of American workers are not protected by many
ACA regulations.cccxxiv
By eliminating the profits of health insurance companies,
as well as the exorbitant salaries and bonuses of their executives,
and reducing administrative waste and extraneous paperwork,
my home state of Ohio alone could save $11.6 billion annually
with a single payer system.cccxxv On a national level we could
transfer $350 billion from paying insurance companies as
middlemen to providing needed care.cccxxvi This is more than
enough added funding to provide comprehensive care to
everyone, without deductibles or co-payments.
In a single year Medicare processes about one billion
claims. These claims total about $550 billion. The overall
administrative and management costs to process these claims
total about $3.8 billion or less than two-thirds of 1% of the
amount of the claims, or less than $3.80 per claim. According to
an SEC filing, Aetna spent $6.9 billion on operating expenses
(including claims processing, accounting, sales and executive
management) in 2012. That’s about $30 for each of the 229
million claims Aetna processed, and it amounts to about 29% of
the $23.7 billion Aetna pays out in claims.cccxxvii In most

188
developed countries health insurers are prevented from profiting
off of covering basic health care coverage.cccxxviii
Relying on individual states to administer Medicaid has
resulted in inequities in some states. For instance, in June 2013
Florida received a federal waiver allowing private insurance
companies to administer coverage for roughly three million
Medicaid enrollees. Payment rates to physicians were found to
equal only fifty-eight percent of what the public Medicaid
program would pay, threatening access to care even for those
nominally insured.cccxxix Again, governments can ensure access
to care, but they cannot solve all of our healthcare challenges.
While behavioral and lifestyle factors do affect health, a
2013 study by the U. S. Labor Department and the Department
of Health and Human Services showed that the wellness
programs employers offer have only led to an average weight
loss of one pound over three years and had no notable impacts
on cholesterol levels. While behavior and diet modification
undeniably contribute to our health and well-being, employers
and insurance companies alike lack incentives to help us create
lasting change as few people stay with one employer or one
health insurance company throughout the course of their work
years. Although corporate wellness programs provide little
impact, these programs can be extremely intrusive and
employers can charge employees up to fifty percent more in
insurance premiums if they don’t participate in corporate
wellness programs.cccxxx
It isn’t just workers who get the short end of the stick in
a for-profit system, but the business owners as well. Dann
Konkin, the President of a Canadian auto supply company in
Ontario decided against opening a facility in the U.S. after he
realized how much he’d have to pay to provide insurance to
American employees.cccxxxi
Says Gerald Friedman, professor of economics at the
University of Amherst in Massachusetts, “Why are we creating
an extra hurdle for business? It’s tough enough out there.”cccxxxii
In 1971 we spent seven percent of our national GDP on
healthcare. Today we spend about eighteen percent while our
care is rationed by bureaucrats. The rest of the world spends
about ten percent and everything is covered.cccxxxiii In the U.S.
we average about 4.2 visits to doctors per person per year. In
Japan they average about thirteen visits and live longer and
spend less money on medical treatments per person. “In every
study that’s ever been done single payer saves money.” But
rather than reducing care it shifts spending from waste to
coverage. And rather than lose jobs we save jobs because
companies don’t have to move factories overseas rather than pay
for health insurance in the U.S.cccxxxiv
Our current third-party payment system removes us as
consumers from making decisions. “Even the term ‘patient’
implies a passive person who patiently waits for service from
experts who know what that patient needs and who often provide
it without consultation with or explanation to the patient.” cccxxxv
How many of us are happy with our care being provided to us
without our consultation? In one survey published in Fortune
magazine, “Consumers gave hospitals only a sixty-seven percent
satisfaction rating, and compared with thirty-one other
industries, hospitals rank…just above the Internal Revenue
Service and ten percentage points below the tobacco
industry.”cccxxxvi

190
 Another survey says that many consumers fear that if they
become seriously ill their health insurance company will be
more concerned about saving money than providing the best
medical care.cccxxxvii If we have a free market system where
consumers have power and make decisions, and we feel this way
about things, why aren’t we pushing insurance companies to
provide better care? Because our current healthcare system isn’t
truly a free market system. By putting purchasing power into
someone else’s hands we’ve lost our own power as consumers.
A series of studies done by consulting firm McKinsey &
Co. nearly three years after the Affordable Care Act passed
demonstrated that we still spend more on health care than the
next ten biggest spenders combined: Japan, Germany, France,
China, the U.K., Italy, Canada, Brazil, Spain and Australia. We
spent $60 billion on clean up after Sandy. We spend half of that
in just one week on health care. “We spend more every year on
artificial knees and hips than what Hollywood collects at the box
office. We spend two or three times that much on durable
medical devices like canes and wheelchairs, in part because a
heavily lobbied Congress forces Medicare to pay twenty-five to
seventy-five percent more for this equipment than it would cost
at Walmart.”cccxxxviii
We rely on our doctors’ advice and judgment to help us
make decisions. But much like auto mechanics, doctors have
incentives to provide (and bill for) more services than absolutely
necessary and to provide those services with less than maximum
effort.cccxxxix Based on data by the U.S. Department of
Commerce, our health care costs are growing faster than the cost
of any other consumer goods and grew twice as fast as any other
major industry during the recent recession.cccxl
 According to the U.S. Commonwealth Fund, the U.S.
ranks nineteenth in our ability to prevent death, with France the
most effective country at stopping preventable deaths and
Australia the second most effective.cccxli
Our innovators have attempted multiple solutions. At one
point Xerox proposed giving each of its employees several
thousand dollars with which to shop for their own insurance.cccxlii
Oklahoma and South Carolina have created personal health
accounts, along with financial assistance and patient counseling,
for their Medicaid clients.cccxliii
Destiny Health offered health insurance coverage for
catastrophes only, along with Health Savings Accounts.cccxliv A
company in Washington state created a concierge medicine
program. Patients prepaid $60/month in order to have a doctor
accessible to them when needed.cccxlv
We’ve tried Flexible Spending Accounts, Health Savings
Accounts, and attempted to cut back on emergency department
visits by setting up minute clinics and urgent care centers.
Governor Romney and Senator Ted Kennedy worked
across party lines to create a universal coverage system in
Massachusetts.
State-level single-payer legislation has been introduced
in twenty-six states at one time or another. Many state
campaigns are currently very active, such as New York,
Massachusetts, Pennsylvania, California, Minnesota, Oregon
and elsewhere. Vermont has introduced and passed legislation
that instructs the state to develop a complete single-payer
implementation plan and put it into effect after receiving
necessary federal waivers.cccxlvi

192
 Prior to the passage of the Affordable Care Act a group
of businesses asked hospitals to voluntarily make their outcomes
transparent so that consumers could make informed decisions.
Unfortunately, large provider Cleveland Clinic Foundation did
not like being under the microscope and having it revealed that
“they weren’t shown to be the best at everything” and pulled out
of the program.cccxlvii
We’ve tried certified health plannerscccxlviii and integrated
webs of practice for those who have multiple diagnoses and
require collaboration among many clinicians.cccxlix
And yet, because despite all of these attempts we still
cannot access the care we want in our own country at affordable
prices, we pay tens of thousands of dollars to travel overseas to
get care. One-third of the million patients a year in Thailand’s
Bumrungrad hospital are international.cccl Sixty-five thousand of
those international patients are Americans,cccli and on average
those American patients pay one-tenth of what they would pay
for care if they remained in the U.S.ccclii
It seems to me that we have fewer stones to cast at
Canada’s supposedly long wait times when we consider such
things.
“For the working poor, it is harder to get a prescription
than to buy a gun.”cccliii
We want to deregulate, reregulate, nationalize health
care, manage competition, plan competition, and allow for free
competition. We underinsure, overuse, underuse and misuse. We
spend $220 billion annually on processing 1520 different types
of insurance forms.cccliv Countries with single-payer systems
have a few basic forms with which to process claims. While
seventy-eight cents of every American health dollar makes its
way to providers, in other countries ninety-five to ninety-six
cents of every healthcare dollar goes to patient care.ccclv
While the Affordable Care Act shifts the burden of
paying for healthcare to lower-income families whose incomes
are too high to make them eligible for Medicaid but who are
nonetheless required to purchase insurance coverage or pay a tax
penalty,ccclvi the Japanese base premiums on percentage of
income rather than actuarial risks.ccclvii
Representative John Conyers introduced House
Resolution 676, the Medicare for All Act. At one time the
legislation had over ninety co-sponsors but we are probably still
years away from being able to pass such legislation.ccclviii
Representative Jim McDermott and Senator Bernie
Sanders introduced the American Health Security Act, which
would enact federal guidelines and strong minimum standards
for states to administer single-payer health care programs within
their states.ccclix In my own state of Ohio it is currently
unconstititutional, per Ohio’s constitution, to enforce a single-
payer system.ccclx
Personally, I would like to see more insurance for
providers like naturopaths, personal trainers, dietitians and
health coaches. I’d like access to a health savings account
without the necessity of my HAS being accompanied by a high-
deductible insurance plan. I would like for consumers and
patients to be able to choose to use their HAS’s to purchase
products like essential oils and to enroll in school and
community athletic events. I’d like health insurance companies
to provide coverage for catastrophic care while I maintain the
freedom, or vouchers, to access the kind of routine care I choose-

194
-not the government, or my boss, or any executive choosing for
me.
What about you? If you could change one thing about
healthcare what would it be? On a scale of one to ten, how
important is that change to you? What would it take to get you
to a ten?

Suggested Reading

Abramson, John, M.D. (2004). Overdosed America: The broken

promise of American medicine. New York: HarperCollins Publishers,
Inc. A doctor reveals how the corporate takeover of clinical research
and medical practice is compromising Americans’ health.

Béliveau, Richard, Ph.D., & Gingras, Denis, Ph.D. (2007). Foods to

fight cancer: Essential foods to help prevent cancer. New York: DK
Publishing. The science behind food and their phytochemicals and
how they fight cancer.

Bloche, M. Gregg, M.D. (2011). The hippocratic myth: Why doctors

are under pressure to ration care, practice politics, and compromise
their promise to heal. New York: Macmillan Publishers, Ltd. M.
Gregg Bloche is a doctor, Gerogetown University law professor, and
was a health care policy advisor to President Obama. He warns that
doctors are slowly losing their ability to put patients over
commercialism.

Brawley, Otis Webb, M.D., & Goldberg, Paul. (2011). How we do

harm: A doctor breaks ranks about being sick in America. New York:
St. Martin’s Press. Chief medical and scientific officer of the
American Cancer Society discusses how doctors determine treatments
based on the payments they’ll receive.

Baroody, Theodore A., ND., M.A., D.C., Ph.D., C.N.C. (1991).

Alkalize or die: Superior health through proper alkaline-acid
balance. Waynesville: Holographic Health Press. A clinician’s look
at reducing internal acidity levels.

Brownlee, Shannon. (2007). Overtreated: Why too much medicine is

making us sicker and poorer. New York: Bloomsburg U.S.A. A
journalist lays bare the “perverse incentives” of providing healthcare
that pays more rather than improves health.

Buettner, Dan. (2008). The blue zone: Lessons for living longer from
the people who’ve lived the longest. Washington: National
Geographic Society. A journalists visits the regions of the world
where people live the longest.

Campbell, T. Colin Ph.D., & Campbell, Thomas M., II. (2006). The
china study: Startling implications for diet, weight loss and long-term
health. Dallas: BenBella Books, Inc. A staff of 200 carry out a
comprehensive study on nutrition in China.

Controversies in American public policy (3rd Ed.). Two commentaries

(2004): chapter 10—health policy 1) Physicians for single payer; 2)
Would Quality Survive? Articles and opposing viewpoints regarding
public policy issues.

Cutler, David M. (2004). Your money or your life: Strong medicine

for America’s healthcare system. New York: Oxford University Press,

196
Inc. A Harvard economist looks at how our healthcare system has
improved and the opportunities that still face us.

Dale, Theresa, Ph.D., N.D., C.C.N. (2005). Revitalizing your

hormones: Dr. Dale’s 7 steps to a happier, healthier and sexier you.
Hoboken: John Wiley & Sons, Inc. A seven step approach to restore
balance and reverse signs of aging.

Daschle, Senator Tom, Greenberger, Scott S., & Lambrew, Jeanne M.

(2008). Critical: What we can do about the health-care crisis. New
York: Thomas Dunne Books. Senator Daschle offers a blueprint for
solving healthcare questions.

Esselstyn, Rip. (2009). The engine 2 diet: The Texas firefighter’s 28-
day save-your-life plan that lowers cholesterol and burns away the
pounds. New York: Grand Central Publishing. A firefighter and
athlete explains the health benefits of eating a plant-based diet.

Esselstyn, Rip. (2013). My beef with meat: The healthiest argument

for eating a plant-strong diet. New York: Grand Central Publishing.
An athlete provides proof that if plant-based eating has enough protein
to build muscles in elephants and buffalo then it contains enough
protein to build our muscles too.

Faloon, William. (2011). Pharmocracy: How corrupt deals and

misguided medical regulations are bankrupting America—and what
to do about it. Mount Jackson: Praktikus Books. Newsletters and
writings regarding inflated prices and over-regulation by the FDA.

Fleckenstein, Alexa, M.D., & Weisman, Roanne. (2006). Own your

health: The best of alternative and conventional medicine—healthy to
100—aging with vigor and grace. Deerfield Beach: Health
Communications, Inc. This little book includes tips, checklists and
stories from clinicians and patients regarding common disorders.
Frankl, Viktor E. (2006). Man’s search for meaning. Boston: Beacon
Press. A Jewish psychiatrist who survived Auschwitz and three other
concentration camps but lost all of his family inspires us with his
foundation of logos therapy, the basis for much of today’s life
coaching.

Fuhrman, Joel, M.D. (2008). Eat for Health: Lose weight, keep it off,
look younger, live longer. Flemington, NJ: Gift of Health Press. A
medical doctor offers a prescription for nutrition with practical tips
and recipes for incorporating more plant-based foods into your diet.

Fuhrman, Joel, M.D. (2011). Eat to live: The amazing nutrient-rich

program for fast and sustained weight loss. New York: Little, Brown
& Company. A medical doctor’s nutrient-rich program for sustained
weight loss.

Garrett, Ginger. (2007). Beauty secrets of the Bible: The ancient art
of beauty & fragrance. Nashville: Thomas Nelson. Information about
personal care products and recipes to try at home.

Gawande, Atul. (2003). Complications: A surgeon’s notes on an

imperfect science. London, Profile Books, Ltd. The accounts of life as
a surgical resident.

Gawande, Atul. (2009). The checklist manifesto: How to get things

right. New York: Metropolitan Books. A surgeon advocates using
checklists to reduce errors in medical care.

Geyman, John, M.D. (2010). The road to single-payer in the

aftermath of stolen health care reform. Monroe: Common Courage

198
Press. A physician and health policy expert reveals what really
happened in the battle to reform health care.

Gibson, Rosemary, & Singh, Janardan Prasad. (2012). The battle over
health care: What Obama’s reform means for America’s future.
Lanham: Rowman & Littlefield Publishers, Inc. These authors
compare health care policy change to policies that shaped the financial
crisis leading up to 2008.

Gunther, John. (1949). Death be not proud: A memoir. New York:

Harper & Row Publishers, Inc. A father shares the story of his son’s
courage in the face of terminal illness.

Groopman, Jerome M.D. (2008). How doctors think. New York:

Houghton Mifflin Company. A doctor’s perspective on how
physicians reach decisions and their interactions with patients.

Hanley, Jesse Lynn, M.D., & Deville, Nancy. (2001). Rescue, Repair,
Rejuvenate: Tired of being tired. New York: Berkley Books. A
medical doctor looks at the interactions of stress and diet on our
energy levels.

Healthcare 101: A conversation about health care. (2005). General

Motors Corp. Information for consumers about the healthcare
delivery system.

Herzlinger, Regina. (2007). Who killed health care? America’s $2

trillion medical problem—and the consumer-driven cure. New York:
McGraw-Hill. Harvard business professor promotes a system to put
consumers in charge rather than executives or government
bureaucrats.
House Resolution 676 Legislation to propose a single-payer
healthcare system in the U.S., sometimes referred to as Medicare-
for-All.

Horowitz, Allan V., and Wakefield, Jerome E. (2007). The loss of

sadness: How psychiatry transformed normal sorrow into depressive
disorder. New York: Oxford University Press. Discusses the
increased incidence and medical treatment of depressive symptoms,
and looks at whether these symptoms should more often be
considered within the context of external circumstances.

Horowitz, Allan V., & Wakefield, Jerome C. (2007). The loss of

sadness: How psychiatry transformed normal sorrow into depressive
disorder. New York: Oxford University Press, Inc. Questions whether
sadness should be considered in the context of circumstances before
prescribing medications to treat it.

Huffnagle, Gary B., Ph.D. (2007). The probiotics revolution. New

York: Bantam. Information on using prebiotics and probiotics.

Edited by Kliever, Donnie L. (1989). Dax’s case: Essays in medical

ethics and human meaning. Dallas: Southern Methodist University
Press. Copyright by Concern for Dying, Inc. Ethical questions faced
by patients, survivors and clinicians when someone is seriously
injured or becomes seriously ill.

Lahita, Robert G. M.D., Ph.D., & Yalof, Ina. (2004). Women and
autoimmune disease: The mysterious ways your body betrays itself.
New York: HarperCollins Publishers, Inc. A specialist examines some
autoimmune diseases and looks at cutting edge research for
treatments.

200
May, William F. (1983). The physician’s covenant: Images of the
healer in medical ethics. Philadelphia: The Westminster Press. A
humanistic approach to ethics in medicine.

Modern essentials: A contemporary guide to the therapeutic use of

essential oils. (5th Ed.). (2014). Orem: AromaTools. The science
behind the therapeutic use of essential oils and suggestions for
everyday uses.

Morrison, Eileen E. (2011). Ethics in health administration: A

practical approach for decision makers (2nd ed.). Sudbury: Jones and
Bartlett Publishers, LLC. An ethics textbook for those pursuing
degrees in healthcare administration.

Nakazawa, Donna Jackson. (2008). The autoimmune epidemic:

Bodies gone haywire in a world out of balance—and the cutting-edge
science that promises hope. New York: Simon & Schuster, Inc. This
author shares her personal story and the cutting-edge research on
autoimmune disorders.

Oz, Mehmet, M.D., Arias, Ron, & Oz, Lisa. (1999). Healing from the
heart: A leading surgeon combines eastern and western traditions to
create the medicine of the future. New York: Penguin Putnam, Inc.
Cardiothoracic surgeon and co-founder of the Complementary Care
Center at New York’s Columbia Presbyterian Hospital combines
western and eastern medicine.

Pagano, John O. A., D.C. (2009). Healing psoriasis: The natural

alternative. Hoboken: John Wiley & Sons, Inc. A chiropractor offers
suggestions for treating the causes and symptoms of psoriasis.

Pilzer, Paul Zane. (2007). The new wellness revolution: How to make
a fortune in the next trillion dollar industry. Hoboken: John Wiley &
Sons, Inc. Economist and Presidential adviser discusses how wellness
services can offer products to those whose needs are not met by
allopathic care alone.

Pollan, Michael. (2006). The omnivore’s dilemma: A natural history

of four meals. New York: Penguin Group. A journalist looks at
various players in the food industry.

Potter, Wendell. (2010). Deadly spin: An insurance company insider

speaks out on how corporate p.r. is killing health care and deceiving
Americans. New York: Bloomsbury Press. A public relations
executive from Cigna and Humana reveals the dirty little secrets of
the health insurance industry.

Relman, Arnold S., M.D. (2007). A second opinion: Rescuing

America’s health care: A plan for universal coverage serving patients
over profit. New York: The Century Foundation. A physician
promotes universal healthcare.

Rooney, Anne. (2009). The story of medicine: From early healing to

the miracles of modern medicine. London: Arcturus Publishing
Limited. A detailed history of healthcare practices.

Rose, Natalia. (2007). Raw food life force energy: Enter a totally new
stratosphere of weight loss, beauty, and health. New York:
HarperCollins Publishers. A nutritionist’s thoughts on eating foods
rich in dietary enzymes.

Rubin, Jordan S. (2005). The maker’s diet. Lake Mary: Siloam. A

naturopathic and nutritional doctor shares how he overcame his own
battle with Crohn’s disease.

202
Schneider, Stephen H. Ph.D., & Land, Janica. (2005). The patient
from hell: How I worked with my doctors to get the best of modern
medicine and how you can too. Cambridge: De Capo Press. An
example of communicating effectively with your doctor to get the best
care possible.

Skloot, Rebecca. (2010). The immortal life of henrietta lacks. New

York: Crown Publishing Group. The story of a woman whose cancer
cells were used without her permission to further decades of profitable
medical research.

Starr, Paul. (2011). Remedy and reaction: The peculiar American

struggle over health care reform. New Haven: Yale University Press.
Princeton University sociology and public affairs professor offers “a
penetrating account of how health care became such treacherous
terrain in American politics.”

Starr, Paul. (1982). The social transformation of American medicine:

The rise of a sovereign profession and the making of a vast industry.
New York: Basic Books, Inc. Pulitzer prize winning book by
Princeton sociology and public affairs professor explains the history
of the American healthcare delivery system.

Trattler, Ross, N.D., D.O., & Jones, Adrian, N.D. (2004). Better
health through natural healing: How to get well without drugs or
surgery. (2nd Ed.). Australia: Hinkler Books Pty Ltd. This book
explains the principles of various brands of natural medicine, and
offers advice on treating common ailments.

Trudeau, Kevin. (2004). Natural cures “they” don’t want you to know
about. Elk Grove Village: Alliance Publishing Group, Inc. Trudeau
shares his opinions about medicine in the U.S.
Walters, Terry, & Epicune, Sterling. (2014). Clean start: 100 recipes
to inspire you to eat clean and live well. New York: ???. Tips and
suggestions for embracing a natural diet.

Washington, Harriet A. (2012). Deadly monopolies: The shocking

corporate takeover of life itself—and the consequences for your
health and our medical future. New York: Anchor Books. A journalist
examines the corporate patenting system for introducing medication
into the market and the effect profits has on this system.

Weil, Andrew, M.D. (1998). Natural health, natural medicine: A

comprehensive manual for wellness and self-care. New York:
Houghton Mifflin Company. A medical doctor promotes alternative
medicine.

Weintraub, Skye, N.D. (2002). The bacteria menace: Today’s

emerging infections and how to protect yourself. Pleasant Grove:
Woodland Publishing. How to effectively boost your own immune
system and protect yourself from environmental threats.

Willcox, Bradley J., M.D., Willcox, P. Craig, Ph.D., & Suzuki,

Makoto, M.D. (2001). The Okinawa program: How the world’s
longest-lived people achieve everlasting health—and how you can
too. New York: Three Rivers Press. Physicians from Harvard and
Japan embark on a twenty-five year study of the longevity of one of
the longest-lived people on earth in Okinawa, Japan.

Suggested Websites

www.fixithealthcare.com A documentary by a businessman on how a

single-payer healthcare system would benefit American businesses.

204
www.my.doterra.com/nicholegrimwood Information regarding
certified therapeutic grade essential oils.

www.ncbi.nlm.nih.gov/pubmed Over twenty-seven million citations

for biomedical literature, including pharmaceuticals, supplements and
essential oils.

Nicholegrimwood.myshaklee.com Information regarding products

for healthy foundations, healthy solutions, healthy weight, healthy
home and healthy beauty.

www.safecosmetics.org Offers information on cosmetic brands that

avoid animal testing and petrol-based ingredients.

www.spanohio.org Single payer action network is a non-partisan,

non-profit coalition of individuals and organizations advocating a
single payer healthcare system.

World Health Organization www.who.int The United Nation’s public

health arm. This website shares data regarding the performance of
health systems from around the globe.

www.worstpills.org Information regarding harmful and ineffective

medications, dangerous drug interactions and side effects and the drug
industry’s influence over the FDA.

www.zanebenefits.com Personalized pre-tax benefit plans.

Suggesged DVD’s

Fix It: Healthcare at the Tipping Point, Vincent Mondillo and

Richard Master, Unfinished Business, LLC. (2016).
Big Pharma: Market Failure, Vincent Mondillo and Richard Master,
Unfinished Business Foundation. (2017).

Sicko (6/22/07). Moore, Michael. Dog Eat Dog Films, The

Weinstein Company. A documentary on the complications of the
medical industry and how individuals and communities are affected.

Endnotes
Introduction
i
Morrison, Eileen E. (2011). Ethics in health administration: A
practical approach for decision makers (2nd ed.). Sudbury: Jones
and Bartlett Publishers, LLC, p. 66

Chapter 1
ii
R. M., MD. Medical Records, Healthcare Organization #1. 31
May 1979. Print.
iii
Susan Grimwood. Medical Diary. 18 June 1981. Print.

206
iv
R. M., MD. Medical Records, Healthcare Organization #1. 21
September 1979. Print.
v
American Autoimmune Related Diseases Association Press
Release 3. In Nakazawa, Donna Jackson. Autoimmune
Epidemic: Bodies Gone Haywire in a World Out of Balance—
And the Cutting-Edge Science That Promises Hope. New York:
Simon and Schuster, 2008. Print.
vi
R. M., MD. Medical Records, Healthcare Organization #1. 12
October 1979. Print.
vii
R. M., MD. Medical Records, Healthcare Organization #1. 2
November 1979. Print.
viii
U.S. General Accounting Office, “Prescription drugs: FDA
oversight of direct-to-consumer advertising has limitations”,
October, 2002, p. 8, as reported in Abramson, John, M.D.
(2004). Overdosed America: The broken promise of American
medicine. New York: HarperCollins Publishers, Inc., p. 150.
ix
Haddad, Jean, K., “The pharmaceutical industry’s influence
on physician behavior and health care costs,” San Francisco
Medicine, Accessed September 20, 2003 at
http://www.sfms.org/sfm/sfm602a.htm, as reported by
Abramson, John, M.D. (2004). Overdosed America: The
broken promise of American medicine. New York:
HarperCollins Publishers, Inc., p. 152.
x
Petersen, Melody, “Less return in marketing of medicines, a
study says,” New York Times, December 12, 2002, as reported
by Abramson, John; M.D. (2004). Overdosed America: The
broken promise of American medicine. New York:
HarperCollins Publishers, Inc., p. 159.
xi
Trudeau, Kevin. (2004). Natural cures “they” don’t want you
to know about. Elk Grove Village: Alliance Publishing Group,
Inc., p. 166
xii
R. M., MD. Medical Records, Healthcare Organization #1. 29
February 29 1980. Print.
 Nakazawa, Donna Jackson. (2008). The autoimmune
xiii

epidemic: Bodies gone haywire in a world out of balance—and

the cutting-edge science that promises hope. New York: Simon
& Schuster, Inc., p. 97.
xiv
Barton, Phoebe Lindsey. (2007). Understanding the U.S.
health services system. (3rd Ed.). AUPHA/HAP, Chicago/DC.,
p. 150
xv
Poorest of Americans: The Mexican-Americans of the Lower
Rio-Grande Valley of Texas, Robert Lee Maril, 1989
University of Notre Dame Press, Notre Dame, IN., p. 149
xvi
Mairs, Nancy. (1996). Waist-high in the world: A life among
the disabled. Boston: Beacon Press., pp. 122-123.

Chapter 2
xvii
Susan Grimwood. Medical Diary. 15 June 1981. Print.
xviii
Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
colitis). Specific Health Problems, 1335-1348, p. 1337.
xix
Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
colitis). Specific Health Problems, 1335-1348, p. 1341.
xx
Susan Grimwood. Medical Diary. 16 June 1981. Print.
xiv
Susan Grimwood. Medical Diary. 17 June 1981. Print.

xxii
Susan Grimwood. Medical Diary. 20 June 1981. Print.
xxiii
Deford, Frank. Alex: The Life of a Child. Viking Press. 1983.
Print.
xxiv
Susan Grimwood. Medical Diary. 21 June 1981. Print.
xxv
Susan Grimwood. Medical Diary. 22 June 1981. Print.
xxvi
Susan Grimwood. Medical Diary. 7 July 1981. Print.

208
xxvii
National Foundation for Ileitis and Colitis. Questions &
Answers About Diet & Nutrition. Crohn’s and Colitis
Foundation of America. 1986. Print.
xxviii
National Foundation for Ileitis and Colitis. Questions &
Answers About Diet & Nutrition. Crohn’s and Colitis
Foundation of America. 1986. Print.
xxix
National Foundation for Ileitis and Colitis. Coping with
Crohn’s Disease and Ulcerative Colitis: A Booklet for Children
and Teenagers. Crohn’s and Colitis Foundation of America.
1986. Print.
xxx
Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
colitis). Specific Health Problems, 1335-1348, p. 1346.
xxxi
W. M. M., MD. Medical Correspondence, Healthcare
Organization #2. 20 April 1988. Print.
xxxii
W. M. M., MD. Medical Correspondence, Healthcare
Organization #2. 11 August 1988. Print.
xxxiii
W. M. M., MD. Medical Correspondence, Healthcare
Organization #2. 20 October 1989. Print.
xxxiv
Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
colitis). Specific Health Problems, 1335-1348, p. 1340.
xxxv
Barton, Phoebe Lindsey. (2007). Understanding the U.S.
health services system. (3rd Ed.). AUPHA/HAP, Chicago/DC.,
p. 451.
xxxvi
Institute of Medicine. (1999). To Err is Human: Building a
Safer Health System. 1999. Web 14 July 2014.
<http://www.iom.edu/Reports/1999/To-Err-is-Human-
Building-A-Safer-Health-System.aspx>.
xxxvii
Healthcare 101: A conversation about health care. (2005).
General Motors Corp.
xxxviii
The Leapfrog Group. Hospital Errors are the Third
Leading Cause of Death in U.S., and New Hospital Safety
Scores Show Improvements Are Too Slow. 23 October 2013.
Web 30 August 2015. http://www.hospitalsafetyscore
.org/newsroom/display/hospitalerrors-thirdleading-
causeofdeathinus-improvementstooslow.
xxxix
Barton, Phoebe Lindsey. (2007). Understanding the U.S.
health services system. (3rd Ed.). AUPHA/HAP, Chicago/DC.,
p. 482.

Chapter 3
xl
National Diabetes and Digestive and Kidney Diseases.
Crohn’s disease. 1999. Web 13 May 1999.
<http://www.niddk.nih.gov/health/digest/
pubs/crohns/crohns.htm>.
xli
W. M. M., MD. Medical Correspondence, Healthcare
Organization #2. 30 May 1990. Print.
xlii
W. M. M., MD Medical Correspondence, Healthcare
Organization #2. 11 August 1988. Print.
xliii
Gawande, Atul. (2003). Complications: A surgeon’s notes
on an imperfect science. London, Profile Books, Ltd., p. 56.

Chapter 4
xliv
National Diabetes and Digestive and Kidney Diseases.
Crohn’s Disease. 1999. Web 13 May 1999.
<http://www.niddk.nih.gov/health/digest/
pubs/crohns/crohns.htm.>.
xlv
U.S. Department of Health and Human Services, National
Institutes of Health. Crohn’s Disease Fact Sheet, NIH
Publication No. 92-3410. 1992. Print.
xlvi
W. M. M., M.D. Personal Correspondence, Healthcare
Organization #2. 3 June 1992. Print.

210
Chapter 5
xlvii
W. M. M., MD. Medical Correspondence, Healthcare
Organization #2. 9 July 1993. Print.
xlviii
Healthcare Organization #2. Medical Records. 12 June
1995. Print.

Chapter 6
xlix
Petersen, Melody, “Madison Ave. has growing role in the
business of drug research, New York Times, November 22, 2002,
as reported by Abramson, John, M.D. (2004). Overdosed
America: The broken promise of American medicine. New York:
HarperCollins Publishers, Inc., p. 109.
l
A. B., MD. Medical Correspondence, Healthcare Organization
#2. 19 April 1999. Print.
li
Insel, Paul, Ross, Don, McMahon, Kimberly, & Bernstein,
Melissa. Nutrition (4th ed.). Sudbury: Jones & Bartlett. 2000.
lii
Weiss, Decker, NMD, FASA. Ask the Doctor, Cancer, the
immune system, and nutritional supplements.
liii
A. B., MD. Medical Correspondence, Healthcare
Organization #2. 6 July 2000. Print.
liv
Centocor, Inc. Remicade: Infliximab recombinant for IV
injection. Malvern, PA. 9 November 1999. Print.
lv
Bonifield, John. Health Care Industry Sick With Medical
Waste. CNN Health, 3 March 2010. Web 21 July 2014.
<http://www.cnn.com/ 2010/HEALTH/03/03/prescription.
for.waste/index.html#>.
lvi
Munro, Dan. U.S. Healthcare ranked dead last compared to
10 other countries. Forbes. 2014. Web 17 July 2014
<http://www.forbes.com/ sites/danmunro/2014/06/16/u-s-
healthcare-ranked-dead-last-compared-to-10-other-countries/>.
lvii
Healthcare Organization #2. Emergency Department Report.
15 November 2000. Print.

Chapter 7
lviii
Assistant Secretary for Planning and Evaluation, U.S.
Department of Health and Human Services. ASPE Issue
Briefings: Long-term growth of medical expenditures—public
and private, May 2005. Retrieved April 2008 from
http://aspe.hhs.gov/health/MedicalExpenditures/index.shtml as
reported by Lighter, Donald E. (2011). Advanced performance
improvement in health care: Principles and methods. Sudbury:
Jones and Bartlett Publishers, LLC, p. 2.
lix
Barton, Phoebe Lindsey. (2007). Understanding the U.S.
health services system. (3rd Ed.). AUPHA/HAP, Chicago/DC, p.
4.
lx
IDEA Fitness Journal, November-December 2014. 10 Things
Fitness Pros Need to Know About the Affordable Care Act,
Natalie Digate Muth, MD, MPH, RD, FAAP, p. 32.
lxi
Mondillo, V., & Master, R. (Producers/Director/Writers).
(2017). Big Pharma: Market Failure [Motion picture]. United
States: Unfinished Business Foundation.
lxii
Wal-Mart. Pharmacy Information Sheet. 7 March 2001. Print.
lxiii
Wal-Mart Pharmacy Information Sheet. 7 March 2001. Print.
lxiv
A. B., MD. Medical Correspondence, Healthcare
Organization #2. 27 March 2001. Print.
lxv
Healthcare Organization #2. Medical Records. 24 October
2001. Print.
lxvi
R. A. S., MD. Medical Correspondence, Healthcare
Organization #2. 11 February 2002. Print.
lxvii
Healthcare Organization #3. Laboratory Report. 13 May
2002. Print.
lxviii
H. T., MD. Medical Records. 29 April 2002. Print.
lxix
A. B., MD. Medical Records, Healthcare Organization #2. 5
April 2002. Print.

212
lxx
Healthcare Organization #2. Medical Records. 22 May 2002.
Print.
lxxi
A. B., MD. Medical Correspondence, Healthcare
Organization #2. 4 June 2002. Print.
lxxii
Healthcare Organization #3. Radiology Report. 11 May
2002. Print.
lxxiii
A. K., MD. Medical Correspondence. Healthcare
Organization #2. 13 November 2002. Print.
lxxiv
Healthcare Organization #3. Laboratory Report. 12 March
2002. Print.
lxxv
R. A. S., MD. Medical Correspondence, Healthcare
Organization #2. 6 April 2002. Print.
lxxvi
Healthcare Organization #5. Medical Records. 21 July 2006.
Print.
lxxvii
Wal-Mart. Pharmacy Information Sheet. 25 February 2003.
Print.
lxxviii
Healthcare Organization #2. Medical Records. 19 February
2003. Print.
lxxix
A. B., MD. Medical Correspondence, Healthcare
Organization #2. 2 March 2003. Print.
lxxx
I. C. L., MD. Operative Report, Healthcare Organization #2.
28 August 2003. Print.

lxxxi
Tribble, Sarah Jane. (2012, June 24). Medical billing, a
world of hurt: Error-prone system is headache for insurers,
providers, patients. Cleveland Plain Dealer. Retrieved June 25,
2012.
lxxxii
Tribble, Sarah Jane. (2012, June 24). Medical billing, a
world of hurt: Error-prone system is headache for insurers,
providers, patients. Cleveland Plain Dealer. Retrieved June 25,
2012.
lxxxiii
Tribble, Sarah Jane. (2012, June 24). Medical billing, a
world of hurt: Error-prone system is headache for insurers,
providers, patients. Cleveland Plain Dealer. Retrieved June 25,
2012.
lxxxiv
Cleveland Plain Dealer Staff. 2012. Medical billing errors:
What can go wrong? What can you do? Article posted to
blog.cleveland.com/health_impact/pring.html?
entry=/2012/06/medical_billing_errors_what_ca.html
lxxxv
Cleveland Plain Dealer Staff. 2012. Medical billing errors:
What can go wrong? What can you do? Article posted to
blog.cleveland.com/health_impact/pring.html?
entry=/2012/06/medical_billing_errors_what_ca.html

Chapter 8
lxxxvi
“Prescription drug expenditures in 2001: Another year of
escalating costs,” National Institute for Health Care
Management Research and Educational Foundation (2002, May
6). Accessed 2003, August 3 at
http://nihcm.org/spending2001.pdf as reported by Abramson,
John, M.D. (2004). Overdosed America: The broken promise of
American medicine. New York: HarperCollins Publishers, Inc.,
p. 117.
lxxxvii
IMS reports 11.8% dollar growth in 2002 U.S. prescription
sales IMS Health (2003, February 21). Accessed 2003, October
13, at http://www.imshealth.com/
ims/portal/frong/articleC/0,2777,1763_3665_41276589,00.htm
l. as reported by Abramson, John, M.D. (2004). Overdosed
America: The broken promise of American medicine. New York:
HarperCollins Publishers, Inc., p. 117.
lxxxviii
Abramson, John, M.D. (2004). Overdosed America: The
broken promise of American medicine. New York:
HarperCollins Publishers, Inc., p. 116.

214
lxxxix
Glenmullen, Joseph. (2005, May 9). “Prozac backlash:
overcomingthe dangers of Prozac, Zoloft, Paxil, and other
antidepressants with safe, effective alternatives,” Dr. Joseph
Mercola Online, accessed at www.mercola.com/
2000/apr/9/prozac_backlash.htm, as reported by Pilzer, Paul
Zane. (2007). The new wellness revolution: How to make a
fortune in the next trillion dollar industry (2nd Ed.). Hoboken:
John Wiley & Sons, Inc., p. 245.
xc
SSRIs: Suicide risk and withdrawal (editorial). (2003). The
Lancet, 361:1999, as reported by Abramson, John, M.D. (2004).
Overdosed America: The broken promise of American medicine.
New York: HarperCollins Publishers, Inc., p. 117.
xci
Kromhout, D., Menotti, A., Kesteloot, H., & Sans, S. (2002).
Prevention of coronary heart diseases by diet and lifestyle:
Evidence from prospecti cross-cultural, cohort and intervention
studies. Circulation 105:893-898 as reported by Abramson,
John, M.D. (2004). Overdosed America: The broken promise of
American medicine. New York: HarperCollins Publishers, Inc.,
p. 237.
xcii
SSRIs: Suicide risk and withdrawal (editorial). (2003). The
Lancet 361:1999, as reported by Abramson, John, M.D. (2004).
Overdosed America: The broken promise of American medicine.
New York: HarperCollins Publishers, Inc., p. 243.
xciii
Harris, Gardiner, (2004 April 16). Expert kept from speaking
at antidepressant hearing. New York Times, as reported by
Abramson, John, M.D. (2004). Overdosed America: The broken
promise of American medicine. New York: HarperCollins
Publishers, Inc., p. 243.
xciv
Relman, A. S. (2003). Industry sponsorship of continuing
medical education. Journal of the American Medical
Association 290:1150 as reported by Abramson, John, M.D.
(2004). Overdosed America: The broken promise of American
medicine. New York: HarperCollins Publishers, Inc., p. 119.
xcv
Gawande, Atul. (2003). Complications: A surgeon’s notes on
an imperfect science. London, Profile Books, Ltd., p. 105.
xcvi
Rose, Natalia. (2007). Raw food life force energy: Enter a
totally new stratosphere of weight loss, beauty, and health. New
York: HarperCollins Publishers, p. 72.
xcvii
Healthcare Organization #3. Laboratory Report. 20
September 2004. Print.
xcviii
Healthcare Organization #4. Treatment Record. 17 August
2004. Print.
xcix
Healthcare Organization #4. Treatment Record. 9 August
2004. Print.
c
Barnes, P.M., Powell-Griner, E., McFann, K., & Nahin, R.L.
(2004). Complementary and alternative medicine use among
adults, United States, 2002. Advance Data from Vital and Health
Statistics, No. 343. Hyattsville, MD: Centers for Disease Control
and Prevention (National Center for Health Statistics) as
reported by Barton, Phoebe Lindsey. (2007). Understanding the
U.S. health services system. (3rd Ed.). AUPHA/HAP,
Chicago/DC, p. 251.
ci
Originally written by Meredith Willard Luber, UNC Charlotte
MBA, from the National Center for Complementary and
Alternative Medicine website (http://nccam.nih.gov/) and its
strategic plan, Expanding Horizons of Healthcare 2001 to 2005;
updated from the website and P. Barnes, E. Powell-Griner, K.
McFann, and R. Nahin, “Complementary and Alternative
Medicine Use Among Adults: United States, 2002,” CDC
Advance Data Report #343 (Washington, DC: May 27, 2004);
and further updated from National Center for Complementary
216
and Alternative Medicine website and its strategic plan
Expanding Horizons of Health Care 2005-2008; Jane
Bainbridge, “natural attraction buoys value,” Marketing
(September 5, 2007), pp. 32-33; Amy Gillentine “Integrating
Alternatives into Western Medicine,” Colorado Springs
Business Journal (August 10, 2007), p. 1 and “FDA Seeks to
regulate complementary and alternative medicine: products such
as vegetable juice could be restricted for medical use,” PR
Newswire (September 5, 2007), pp. 3-4, as reported by Swayne,
Linda E., Duncan, W. Jack, & Ginter, Peter M. (2008). Strategic
management of health care organizations (6th Ed.). West
Sussex: John Wiley & Sons, Inc., pp. 99-100.
cii
Ibid., pp. 99-100.
ciii
Ibid., pp. 99-100.
civ
I. F., MSN, CNP. Medical Records, Healthcare Organization
#6. 25 October 25, 2005. Print.
cv
Progress Note. Healthcare Organization #6. 22 November
2005. Print.
cvi
Brill, Steven. (2013, March 4). Bitter pill: How outrageous
pricing and egregious profits are destroying our health care,
Time, 16-55, p. 29.
cvii
Brill, Steven. (2013, March 4). Bitter pill: How outrageous
pricing and egregious profits are destroying our health care,
Time, 16-55.
cviii
Brill, Steven. (2013, March 4). Bitter pill: How outrageous
pricing and egregious profits are destroying our health care,
Time, 16-55
cix
Brill, Steven. (2013, March 4). Bitter pill: How outrageous
pricing and egregious profits are destroying our health care,
Time, 16-55, p. 54.

Chapter 9
cx
Potter, Wendell. Deadly Spin. New York: Bloomsbury Press,
2010. Print, p. 1.
cxi
Potter, Wendell. Deadly Spin. New York: Bloomsbury Press,
2010. Print.,p. 3
cxii
Open Secrets. (2014, April 28.). Annual lobbying on
insurance. Retrieved July 22 2014 from the Open Secrets Web
site: . <http://www.opensecrets.org/lobby/indusclient.
php?id=F09& year=a>.
cxiii
Eaton, Joe. (2010, February 24). Lobbyists swarm Capitol to
influence health reform: Tally of 4,525 means eight lobbyists for
each member of Congress. Retrieved July 22 2014 from
<http://www.public integrity.org/2010 /02/24/2725/lobbyists-
swarm-capitol-influence-health
reform>.
cxiv
CDC Fact Sheet and American Autoimmune Related
Diseases Association Press Release, as cited in Nakazawa,
Donna Jackson. Autoimmune Epidemic: Bodies Gone Haywire
in a World Out of Balance—And the Cutting-Edge Science That
Promises Hope. New York: Simon and Schuster, 2008. Print.
cxv
CIGNA. Personal Communication. July 2005. Print.
cxvi
J. M. M., MD. Medical Records, Healthcare Organization #5.
1 May 2007. Print.
cxvii
Shaklee. Discover Vitalizer Information Brochure.
cxviii
Marchese, Marianne. (2004, July). Environmental influences
on women’s health: how to avoid endocrine disrupting
compounds. Townsend Letter for Doctors and Patients, accessed
March 21, 2006 at
http://www.findarticles.com/p/articles/mi_mOISW/is_252/ai_n
6112832 as reported by Garrett, Ginger. (2007). Beauty secrets
of the Bible: The ancient art of beauty & fragrance. Nashville:
Thomas Nelson., p 61.
cxix
Walsh, Bryan. (2010, April 12). The perils of plastic. Time,
44-54.

218
cxx
Garrett, Ginger. (2007). Beauty secrets of the Bible: The
ancient art of beauty & fragrance. Nashville: Thomas Nelson.,
p 61.
cxxi
Walsh, Bryan. (2010, April 12). The perils of plastic. Time,
44-54.
cxxii
Connor, Steve. (1998, October 7). Men being emasculated
by toiletries. The (London) Independent accessed at
http://www.findarticles.com/p/articles/
mi_qn4158/is_19981007/ai_n14195897 as reported by Garrett,
Ginger. (2007). Beauty secrets of the Bible: The ancient art of
beauty & fragrance. Nashville: Thomas Nelson, p. 67.
cxxiii
Garrett, Ginger. (2007). Beauty secrets of the Bible: The
ancient art of beauty & fragrance. Nashville: Thomas Nelson,
p. 67.
cxxiv
Walsh, Bryan. (2010, April 12). The perils of plastic. Time,
44-54, p. 50.
cxxv
Environmental Working Group and Papadakis, M. reports,
as cited in American Autoimmune Related Diseases Association
Press Release 3, as cited in Nakazawa, Donna Jackson.
Autoimmune Epidemic: Bodies Gone Haywire in a World Out of
Balance—And the Cutting-Edge Science That Promises Hope.
New York: Simon and Schuster, 2008. Print.
cxxvi
“Antibacterial Soap? You Can Skip It—Use Plain Soap and
Water September 2016 FDA Consumer Update U.S. Food &
Drug Administration. www.fda.gov/forconsumers/
consumerupdates/ ucm378393.htm
cxxvii
J. W. M., MD. Medical Records, Healthcare Organization
#7. 20 April, 2010. Print.
cxxviii
J. W. M., MD. Medical Records, Healthcare Organization
#7. 26 April, 2010. Print.
cxxix
Strong, Carson, PhD., & Bailey, Jim, MD, MPH. Cherry-
Picking Patients Leaves Sour Taste: Is it Ethical for Physicians
to Employ Health IT to Select Healthy Patients? Ethics Group,
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Chapter 10
cxxx
Abramson, John, M.D. (2004). Overdosed America: The
broken promise of American medicine. New York:
HarperCollins Publishers, Inc., p. 126.
cxxxi
USA Today 4/25-4/27/14 Medicare Lobbying Pays Off: 10
drug firms spent $236M; see billions in reimbursements Kelly
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Reuters, “Company News: Inquiry into Possible Kickbacks
at Medtronic Unit, NYT, September 9, 2003 as reported by
Abramson, John, M.D. (2004). Overdosed America: The
broken promise of American medicine. New York:
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cxxxiii
Reuters, “Company News: Inquiry into Possible
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America: The broken promise of American medicine. New
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cxxxiv
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cxxxv
Quoted in Knox, Richard A. (1999, March 30). Science and
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cxxxvi
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ACT UP: Off the Charts: Pay, Profits and Spending by
Drug Companies. 6 pages, printed 11/21/2005,
http://www.actupny.org/reports/drugcosts.html
cxxxviii
Big Pharma: Market Failure, Vincent Mondillo and
Richard Master, Unfinished Business Foundation. (2017).

cxxxix
Big Pharma: Market Failure, Vincent Mondillo and
Richard Master, Unfinished Business Foundation. (2017).

Chapter 11
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Fuhrman, Joel, M.D. (2008). Eat for Health: Lose Weight,
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Inflammatory bowel disease (crohn’s disease and ulcerative
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Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
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Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
colitis). Specific Health Problems, 1335-1348,p. 1343.
clxxxiv
Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
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clxxxv
Béliveau, Richard, Ph.D., & Gingras, Denis, Ph.D. (2007).
Foods to fight cancer: Essential foods to help prevent cancer.
New York: DK Publishing, p. 58.
clxxxvi
Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
colitis). Specific Health Problems, 1335-1348, p. 1343.
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Supplements? (Supplementation on a Budget p. 1-2) p. 2
HealthQuest: Today’s Developments for Tomorrow’s Health.
Special Supplement Issue #1, Dr. Bruce Miller, Dr. Frank M.
Painter
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Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
colitis). Specific Health Problems, 1335-1348. P. 1344.
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Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
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Murray, Michael T., N.D., & Pizzorno, Jr. Joseph E., N.D.
Inflammatory bowel disease (crohn’s disease and ulcerative
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Nakazawa, Donna Jackson. (2008). The autoimmune
epidemic: Bodies gone haywire in a world out of balance—and
the cutting-edge science that promises hope. New York: Simon
& Schuster, Inc, p.245.
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Nakazawa, Donna Jackson. (2008). The autoimmune
epidemic: Bodies gone haywire in a world out of balance—and
the cutting-edge science that promises hope. New York: Simon
& Schuster, Inc, p.247.
cxciii
Healing Colitis, Kathi Head, N.D., and Peter Barry Chowka.
Greatlife, January 2005, pages 32-34.
cxciv
Nakazawa, Donna Jackson. (2008). The autoimmune
epidemic: Bodies gone haywire in a world out of balance—and
the cutting-edge science that promises hope. New York: Simon
& Schuster, Inc, p. 244.
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Whitaker, Julian, M.D. 7 baking soda health benefits.
General Health, Last Reviewed 2014, March 28.

Chapter 13
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Mondillo, V., & Master, R. (Producers/Director/Writers).
(2017). Big Pharma: Market Failure [Motion picture]. United
States: Unfinished Business Foundation. Harvard Health Study,
based on CDC data, 2015.
cc
Pilzer, Paul Zane. (2007). The new wellness revolution: How
to make a fortune in the next trillion dollar industry (2nd Ed.).
Hoboken: John Wiley & Sons, Inc, pp. 137-141.
cci
Pilzer, Paul Zane. (2007). The new wellness revolution: How
to make a fortune in the next trillion dollar industry (2nd Ed.).
Hoboken: John Wiley & Sons, Inc, pp.142-143.
ccii
Pilzer, Paul Zane. (2007). The new wellness revolution: How
to make a fortune in the next trillion dollar industry (2nd Ed.).
Hoboken: John Wiley & Sons, Inc., p. 143.
cciii
Brill, Steven. (2013, March 4). Bitter pill: How outrageous
pricing and egregious profits are destroying our health care,
Time, 16-55, p. 54.
cciv
Health Care for All Ohioans. A health care reform primer:
Why do we still need it? p. 1.
ccv
Swayne, Linda E., Duncan, W. Jack, & Ginter, Peter M.
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ccvi
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Blumenfeld, Jenna. (2017, September). The plant revolution:
Why Americans are turning over a new leaf and growing the
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228
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Blumenfeld, Jenna. (2017, September). The plant
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growing the plant-based movement. Delicious Living, 29-35.
ccix
Lighter, Donald E. (2011). Advanced performance
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I believe this was an episode from season 2. BBC Worldwide
Ltd. Program 2013?
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Union Pacific Ry. Co. v. Botsford, 141 U.S. 250, 251 (1891)
as reported by Pozgar, George D., M.B.A., C.H.E. (2007). Legal
aspects of health care administration. Sudbury: Jones and
Bartlett Publishers, pp. 364-365.
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BenBella Books, Inc, p. 17.
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Ohio Single Payer Action Network. Poverty: Is it killing
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p. 2.
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Pilzer, Paul Zane. (2007). The new wellness revolution: How
to make a fortune in the next trillion dollar industry (2nd Ed.).
Hoboken: John Wiley & Sons, Inc, p. 214.
ccxvi
Pilzer, Paul Zane. (2007). The new wellness revolution: How
to make a fortune in the next trillion dollar industry (2nd Ed.).
Hoboken: John Wiley & Sons, Inc, p. 19.
ccxvii
Pilzer, Paul Zane. (2007). The new wellness revolution:
How to make a fortune in the next trillion dollar industry (2nd
Ed.). Hoboken: John Wiley & Sons, Inc, p. 22.
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Mondillo, V., & Master, R. (Producers/Director/ Writers).
(2017). Big Pharma: Market Failure [Motion picture]. United
States: Unfinished Business Foundation.
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Unfinished Business Foundation. (2017). Big pharma:
Market failure brochure.
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Letter from Jim Nicholson, chairman of the RNC, to Charles
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Mondillo, V., & Master, R. (Producers/Director/ Writers).
(2017). Big Pharma: Market Failure [Motion picture]. United
States: Unfinished Business Foundation.
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Stryer, D., & Bero, L.A. (1996). Characteristics of materials
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National Institute for Health Care Management,
Prescription Drug Expenditures in 2001: Another Year of
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conversation about health care. (2005). General Motors Corp.,
p. 10.
ccxxvi
Single-Payer Action Network (SPAN) Ohio. Our health
care system is broken~It’s time to fix it!
ccxxvii
Brill, Steven. (2013, March 4). Bitter pill: How
outrageous pricing and egregious profits are destroying our
health care, Time, 16-55, p. 31.
ccxxviii
Unfinished Business Foundation. (2017). Big pharma:
Market failure brochure.
ccxxix
Mondillo, V., & Master, R. (Producers/Director/ Writers).
(2017). Big Pharma: Market Failure [Motion picture]. United
States: Unfinished Business Foundation.
ccxxx
Healthcare-Now! The fight for Medicaid and Medicare, p.
12. Single-Payer Activist Guide to the Affordable Care Act.
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Brill, Steven. (2013, March 4). Bitter pill: How outrageous
pricing and egregious profits are destroying our health care,
Time, 16-55, p. 36.
ccxxxii
Brill, Steven. (2013, March 4). Bitter pill: How outrageous
pricing and egregious profits are destroying our health care,
Time, 16-55, p. 55.
ccxxxiii
The safety of imported drugs (editorial). (2003, September
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(2004). Overdosed America: The broken promise of American
medicine. New York: HarperCollins Publishers, Inc, pp. 160-
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Cauchon, Dennis. (2000, September 25). FDA advisers
tied to industry. USA Today, as reported by Abramson, John,
M.D. (2004). Overdosed America: The broken promise of
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Gawande, Atul. (2003). Complications: A surgeon’s notes
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Haas-Wilson, Deborah (1992). The regulation of health
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Pozgar, George D., M.B.A., C.H.E. (2007). Legal aspects
of health care administration. Sudbury: Jones and Bartlett
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ccxl
One can look up the information about the patterns of what
doctors in one’s own area did relative to doctors in other areas
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248.
232
 Gawande, Atul. (2003). Complications: A surgeon’s notes
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on an imperfect science. London: Profile Books, Ltd., p. 62.

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Ltd, p. 94.

Chapter 14
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How to make a fortune in the next trillion dollar industry (2nd
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to make a fortune in the next trillion dollar industry (2nd Ed.).
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to make a fortune in the next trillion dollar industry (2nd Ed.).
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p. 309.

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Senger, Megan. (2015, March). What you don’t know
about food labeling could undermine your health: Learn more
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Chapter 15
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broken promise of American medicine. New York:
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ccxcii
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33.
ccxciii
Senger, Megan (2015, March). What you don’t know
about food labeling could undermine your health: Learn more
about the nuances of food marketing and what front-of-package
labels may not be telling you. IDEA Fitness Journal, 30-38
ccxciv
Senger, Megan (2015, March). What you don’t know
about food labeling could undermine your health: Learn more
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labels may not be telling you. IDEA Fitness Journal, 30-38
ccxcv
Webster, Sandy Todd. (2014, November-December).
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Starr, Paul. (1982). The social transformation of American
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Herzlinger, Regina. (2007). Who killed healthcare:
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McGill University. Hann a Zowall Division of Clinical
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Norbert Gilmore Centre for Medicine, Ethics & Law,
McGill University. Hann a Zowall Division of Clinical
Epidemiology, Montreal General Hospital McGill University
Health Centre, Montreal (Quebec) Canada (n.d.) Threatening
inequality: The struggle to maintain Canada’s national
healthcare system. Retrieved from http://www.
bbk.ac.uk/11c/LCCS/LJCS/Vol_V17/Gilmore+Zowall.pdf.
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Mondillo, Vincent, & Master, Richard
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tipping point [Motion picture]. United States: Unfinished
Business, LLC
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Mondillo, Vincent, & Master, Richard
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Herzlinger, Regina. (2007). Who killed healthcare:
America’s $2 trillion medical problem—and the consumer-
driven cure. New York: The McGraw-Hill Companies, p. 194.
cccxvi
Herzlinger, Regina. (2007). Who killed healthcare:
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Mondillo, Vincent, & Master, Richard
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Mondillo, Vincent, & Master, Richard
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Mondillo, Vincent, & Master, Richard
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Single-Payer Action Network (SPAN) Ohio. The case for
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Healthcare-NOW. Single-Payer activist guide to the
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Healthcare-NOW. Single-Payer activist guide to the
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244
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Healthcare-NOW. Single-Payer activist guide to the
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Healthcare-NOW. Single-Payer activist guide to the
affordable care act: Single-payer legislation, p. 32.

246
 About the Author

After living with a chronic autoimmune disorders for

twenty-five years, Nichole has been in remission for fourteen
years.
She underwent seven major abdominal surgeries, TPN
lines, hospitalizations, outpatient IV infusions, blood
transfusions and a leukemia medicine to try to alleviate her
symptoms. None of these provided long-term relief.
 While pursuing her education with the goal of eventually
advocating for patients’ rights and health care reform, Nichole’s
studies led her outside the bounds of traditional American
medicine.
After making changes to her diet and lifestyle, and
undergoing her seventh and final surgery, her illness went into
remission and has remained there without the need for
prescription medications.
While these results may not be normal for everyone, she
believes that they hold promise for the many people in the U.S.
who suffer from autoimmune disorders.
She holds a Master’s degree in healthcare administration
from Ohio University, a certification in fitness and nutrition
from the National Academy of Sports Medicine, and is a
wellness advocate working with Shaklee and DoTerra
companies.
If you would like to contact Nichole you may do so at
nichole.grimwood@gmail.com.

248