Introduction

1. The State of the Evolution

When I published my first book in 2016, I had high hopes that empowering physicians to get to the root cause of illness would help eradicate chronic disease. To do this, we needed a different operating system of medicine: one that predicts future disease, prevents issues before they arise, personalizes treatment to the individual, and empowers participation from patients. I argued that this aspiration of “P4 Medicine”—personalized, predictive, preventive, and participatory—is best activated today as functional medicine.

An October 2019 study in the Journal of the American Medical Association showed how “functional medicine patients exhibited significantly larger improvements” in outcomes “than were seen in patients treated at a family health center.” If only we could inspire enough physicians to understand this emergent way of treating lifestyle-driven disease, make it easy to evolve their practices and support patients affordably, and help them fall back in love with practicing medicine, the rest would take care of itself.

The number of physicians who have made the switch to functional medicine continues to grow quickly, technology to support these practices has improved, and more and more institutions are jumping on the bandwagon. This paradigm shift isn’t just limited to the medical system, as communities, organizations, employers, and even sovereign nations realize the current paradigm of care isn’t working and see the need for a radical transformation—one that moves away from disease management and toward its reversal, through health creation.

So, in some ways, The Evolution of Medicine: Join the Movement to Solve Chronic Disease and Fall Back in Love with Medicine has been a success. Since its publication, I’ve spoken to thousands of health professionals—at conferences, events, and on our 2018 tour, many of whom have made the switch and seen tremendous value from it, both in their practices and in their personal lives. Yet, like you, I’m still waiting impatiently for the large-scale transformation we all hope for.

In fact, it’s really easy to argue it’s getting worse.

Instead of lowering rates of chronic disease and increasing life expectancy, we’re witnessing an accelerating decline in the health of the population, with life expectancy falling year over year for the first time in recorded history. Physician suicides and malaise continue to grow and the people that truly need access to care aren’t getting it.

Recently, Blue Cross Blue Shield released a report outlining how Millennials now have higher rates of health conditions than their predecessors at the same age, with their health peaking at age twenty-seven before declining. Not only is this unacceptable from a societal standpoint, it will also prove to be incredibly costly on the healthcare system, which is already overly burdened with baby boomers and chronically ill Gen Xers.

The fundamental processes that lead to changes in life expectancy and chronic illness have either not shifted or haven’t shifted quickly enough. Yes, the food system is slowly improving (albeit with growing racial disparities), more people have access to stress-reduction strategies like meditation and yoga, more and more people are waking up to the link between lifestyle and disease, and, dare I say it, being healthy is actually becoming cool. These are all lead indicators of future change. But the most significant determinant of disease continues to spread.

We have an epidemic of loneliness.

The smartest people in healthcare are recognizing the impact that the loss of community has on our society, economy, and health. Over the last few years there has been a glut of books, articles, and exposés showing the incredible impact of social isolation on our mental and physical health.

A 2018 survey completed by Cigna, showed that half of Americans feel alone, isolated or left out at least some of the time, with Millennials and Gen-Z being the loneliest generations ever. Douglas Nemecek, MD, the Chief Medical Officer of Cigna, is quoted as saying that being lonely, “has the same impact on mortality as smoking fifteen cigarettes a day, making it even more dangerous than obesity.”

How did this happen?

In his book The Third Pillar: How Markets and the State Leave the Community Behind, Raghuram Rajan chronicles our collective history right back to the Dark Ages, and how technology—accelerated through the industrial revolution and subsequently the information technology revolution—have ripped apart the fabric of traditional communities. Formerly the chief economist of the International Monetary Fund, the author shows that although we are more interconnected in certain ways, we are largely much more isolated than ever before.

For thousands of years, multiple generations lived under the same roof or within the same town. It really wasn’t all that long ago that people sourced everything they needed from where they lived, trading and bartering for goods and services with locals. People knew their neighborhood grocer or had personal relationships with shopkeepers and tradespeople. Communities were interdependent—relying on one another for survival.

Now, the majority of goods we purchase or consume are sourced from individuals we don’t know. The invention of the automobile allowed people to move into the suburbs and live in isolated single family homes. Bustling downtown streets went quiet, and brick-and-mortar businesses in city centers were superseded by shopping centers and strip malls. Within just a few decades, all of this was replaced by the internet, which allows us to source anything we could ever imagine online, without ever having to step foot outside our homes. While this has many advantages, it has dramatically altered the context and experience of togetherness.

Charles Eisenstein’s seminal work Sacred Economics describes how we’ve shifted from the gift economy into an age of separation, one in which we are “helplessly independent.” We’re self-sufficient to the people we know, but totally dependent on strangers living miles, if not oceans, away.

With families and communities no longer meeting the majority of our needs, it has led to total commodification—meaning we need ever more money to pay for our babysitters, grief counselors and elder care, once a burden shared by the community itself.

As a result we are constantly looking to the economy, the market, the state, or the government to solve our problems. The death of community has led to a myopic view of the world, in which the market and government are our only two options for solutions.

This is especially poignant when it comes to healthcare. 2020 is a watershed moment for the United States, as the Republicans and Democrats elected this year could change the trajectory of how we solve this problem. Will it be the markets or government that will solve for the healthcare we need?

This outlook ignores what Rajan calls The Third Pillar: community.

What if we stopped waiting for other people to solve the problem, and build the solution around this third pillar?

In my first book, I gave the example of the Blue Zones: five regions of the world where the population lives longer with little evidence of chronic disease, independent of access to sophisticated medical systems. In Sardinia, Okinawa, the Nicoya Peninsula of Costa Rica, Icaria, and the Seventh Day Adventists in Loma Linda, California, these populations eat well, engage in physical activity, and lead lives with low stress. But one of the key components of Blue Zones are strong communities. Not only is having a supportive community healthy in itself, but the culture reinforces the ongoing healthy behaviors that lead to long-term health. Their resilient networks are what drive their health outcomes—not medical systems.

We’ve known for a long time that Blue Zones aren’t a fluke. They’re a perfect example of a biopsychosocial model, where social factors like relationships, peers, and socioeconomic status play an equal role to biological and psychological factors.

A 1988 study published in Science by House, Landis, and Umberson showed how mortality risk decreases as social integration increases, across multiple countries and cultures. Furthermore, a 2010 study in PLoS Medicine concluded “the influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.” Not just comparable; in most cases, social isolation is a bigger determinant on health and disease than any other factor.

With ever-improving technology, we’re learning more about the mechanism: what’s actually happening. George Slavich, PhD of UCLA Laboratory for Stress Assessment and Research, has taken our understanding of this to the cellular level with the emerging science of Human Social Genomics. For instance, if you are subject to a targeted rejection—a very...