World Health Education Initiative



First they ignore you,
then they laugh at you,
then they fight you,
then you win. Mahatma Gandhi


Print      |       Back   Note that this site contains numerous links which will be lost in the printed copy.  After you read this, please go back to the site and follow the links to get a more accurate picture.

A Mindful Approach  
Many people believe that health-care reform is the highest priority issue in the United States today.  Although there has been an enormous struggle to discover a solution, answers have not been found, largely because people have been looking in the wrong places.  Having both practiced medicine for many years and experienced substantial illnesses, I have seen the system from both sides. 

If we reexamined the antiquated educational requirements currently needed to practice medicine, we could have a plentiful supply of creative, compassionate, and reasonably priced physicians.  PPO's, socialized medicine, rationing treatment, or legalistic approaches do not solve the problem.

However, once the root cause of the current medical system's ineffectiveness is thoroughly examined, the outlook for the future becomes extremely favorable.

Most Pre-Medical Education is Irrelevant:
The M.D. degree requires twelve years of higher education, most of which has little value to the future practicing physician.  In many schools, the educational pattern is memorize, pass the test, and forget.  The pressures encountered by medical students are mentally damaging, and waste many valuable years.  By the time the doctor graduates, he has forgotten most of what he has learned.

Patient Centered Learning:

The solution is to bypass rigid institutions, utilize free internet programs, and have medical students assist practicing physicians by taking patient
histories.  These students would offer valuable, free services to doctors.  At the same time, they would have a vivid learning experience by spending several hours each day interacting with actual patients.

The Cost Of Medical Education Would Be Negligible:
The expense of health care is directly proportional to the cost of the doctor's education.  With the institutional bottleneck gone, there would be a greater number of doctors, and the cost of healthcare would plummet.  Doctors would have ample time to devote to their patients, keep abreast of new developments, and conduct research.  This equates to more time and care per patient at a lower cost.


The Problem with Healthcare Delivery
It is far too expensive; the wait is too long; and often, physicians seem rushed, spending negligible time with their patients, and reacting insensitively to the needs of those entrusted to their care.

The biggest problem, however, is that doctors frequently cannot diagnose or treat a patient's illness. Suppose you go to your doctor because you have been feeling tired.  He does a physical exam and orders some seemingly high tech lab tests.  The results are normal, and you are led to believe that there is nothing physically wrong.  After all, modern medicine is very advanced, isn't it?

The Health-Care System Is Far More Primitive Than It Looks:
Compared with the complexity of the human body, the practice of medicine is in the Stone Age.  We have yet to cure the common cold, much less a whole host of other diseases.  As for feeling tired, there are thousands of possible physical causes that modern physicians, even with the aid of lab tests, cannot diagnose or treat.  Some such diseases are known only by a handful of experts, but many remain unknown.

Biological Warfare Is An Imminent Threat For Which We are Unprepared:
Much of our lack of preparation stems from the inability of our current medical system to provide care for our entire population.  We can deal with the threat of bioterrorism by taking away civil liberties and rights to privacy, or by fixing our health-care system which would also solve a multitude of other problems.

It's not the fault of doctors.  The system is in terrible disarray.

The microorganism mycoplasma is one of a myriad of pathogens that can reside in the body undetected for years.  It can disrupt biochemical functioning, leading to fatigue and other symptoms.  Dr. Garth Nicholson is one of many researchers working on the detection and treatment of this and other diseases.

Dr. John Martin is investigating what he terms "stealth viruses."  Knowing these doctors first-hand, and having tested positive for both of these debilitating illnesses, my stake in this matter is highly personal.

The System Could Be Drastically Improved:
A medical system that could diagnose and treat any illness is a distinct possibility, but contingent upon the restructuring of medical education.  One of the most lamentable wastes of our natural resources is the mismanagement of our young people's minds in a rigid educational system.

Let's compare Microsoft with the medical system.  The requirement to work at Microsoft is simply the ability to do one's job.  The requirement to be a medical doctor, however, is to spend valuable years in an irrelevant, expensive, academic setting followed by several more years of incomplete training.  After enduring more than a decade of this insanity, of course doctors will charge more money for their time. 

It is not that doctors are intentionally taught to be uncompassionate; the medical educational system is intrinsically dehumanizing.  If Microsoft operated like that - requiring it's employees to undergo over a decade of irrelevant training - the corporation would collapse.


Shame: A Major Reason Why Most Medical Doctors Don't Change Their Views
Frank Davidoff

In the 1960s the results of a large randomized controlled study by the University Group Diabetes Program showed that tolbutamide, virtually the only blood sugar lowering agent available at the time in pill form, was associated with a significant increase in mortality in patients who developed myocardial infarction.

The obvious response from the medical profession should have been gratitude: here was an important way to improve the safety of clinical practice.  But in fact the response was doubt, outrage, even legal proceedings against the investigators; the controversy went on for years.  Why?

An important clue surfaced at the annual meeting of the American Diabetes Association soon after the study was published.  During the discussion a practitioner stood up and said he simply could not, and would not, accept the findings, because admitting to his patients that he had been using an unsafe treatment would shame him in their eyes.  Other examples of such reactions to improvement efforts are not hard to find.

Indeed, it is arguable that shame is the universal dark side of improvement.  After all, improvement means that, however good your performance has been, it is not as good as it could be.  As such, the experience of shame helps to explain why improvement, which ought to be a "no brainer", is generally such a slow and difficult process.

What is it about shame that makes it so hard to deal with?  Along with embarrassment and guilt, shame is one of the emotions that motivate moral behavior.  Current thinking suggests that shame is so devastating because it goes right to the core of a person's identity, making them feel
exposed, inferior, degraded; it leads to avoidance, to silence.

The enormous power of shame is apparent in the adoption of shaming by many human rights organizations as their principal lever for social change; on the flip side lies the obvious social corrosiveness of "shameless" behavior.

Despite its potential importance in medical life, shame has received little attention in the medical literature: a search on the term shame in Medline in November 2001 yielded only 947 references out of the millions indexed.  In a sense, shame is the "elephant in the room": something so big and disturbing that we don't even see it, despite the fact that we keep bumping into it.

An important exception to this blindness to medical shame is a paper published in 1987 by the psychiatrist Aaron Lazare which reminded us that patients commonly see their diseases as defects, inadequacies, or shortcomings, and that visits to doctors' surgeries and hospitals involve
potentially humiliating physical and psychological exposure.

Patients respond by avoiding the healthcare system, withholding information, complaining, and suing. Doctors too can feel shamed in medical encounters, which Lazare suggests contributes to dissatisfaction with clinical practice.

Indeed, much of the extreme distress of doctors who are sued for malpractice appears to be attributable to the shame rather than to the financial losses.  Also, who can doubt that a major concern underlying the controversy currently raging over mandatory reporting of medical errors
is the fear of being shamed?

Doctors may, in fact, be particularly vulnerable to shame, since they are self-selected for perfectionism when they choose to enter the profession.  Moreover, the use of shaming as punishment for shortcomings and "moral errors" committed by medical students and trainees such as lack of sufficient dedication, hard work, and a proper reverence for role obligations probably contributes further to the extreme sensitivity of doctors to shaming.

What are the lessons here for those working to improve the quality and safety of medical care?  Firstly, we should recognize that shame is a powerful force in slowing or preventing improvement and that unless it is confronted and dealt with progress in improvement will be slow.  Secondly, we should also recognize that shame is a fundamental human emotion and not about to go away.  Once these ideas are understood, the work of mitigating and managing shame can flourish.

This work has, of course, been under way for some time.  The move away from "cutting off the tail of the performance curve" that is, getting rid of bad apples towards "shifting the whole curve" as the basic strategy in quality improvement and the recognition that medical error results as
much from malfunctioning systems as from incompetent practitioners are important developments in this regard.

They have helped to minimize challenges to the integrity of healthcare workers and support the transformation of medicine from a culture of blame to a culture of safety.

But quality improvement has another powerful tool for managing shame.  Bringing issues of quality and safety out of the shadows can, by itself, remove some of the sting associated with improvement.  After all, how shameful can these issues be if they are being widely shared and openly discussed?

Here is where reports by public bodies and journals like Quality and Safety in Health Care come in.  More specifically, such a journal supports three major elements: autonomy, mastery, and connectedness.  These motivate people to learn and improve, bolstering their competence and their sense of self worth, and thus serving as antidotes to shame.

British Medical Journal 2002;324:623-624 March 16, 2002 

The American Healthcare System is the Third Leading Cause of Death

Barbara Starfield, M.D. (2000)
Summary by Kah Ying Choo

This Journal of the American Medical Association article illuminates the failure of the U.S. medical system in providing decent medical care for Americans.

In spite of the rising health care costs that provide the illusion of improving health care, the American people do not enjoy good health, compared with their counterparts in the industrialized nations.  Among thirteen countries including Japan, Sweden, France and Canada, the U.S. was ranked 12th, based on the measurement of 16 health indicators such as life expectancy, low-birth-weight averages and infant mortality.  In another comparison reported by the World Health Organization that used a different set of health indicators, the U.S. also fared poorly with a ranking of 15 among 25 industrialized nations.

Although many people attribute poor health to the bad habits of the American public, Starfield (2000) points out that the Americans do not lead an unhealthy lifestyle compared to their counterparts.  For example, only 28 percent of the male population in the U.S. smoked, thus making it the third best nation in the category of smoking among the 13 industrialized nations.  The U.S. population also achieved a high ranking (5th best) for alcohol consumption.  In the category of men aged 50 to 70 years, the U.S. had the third lowest mean cholesterol concentrations among 13 industrialized nations. Therefore, the perception that the American public’s poor health is a result of their negative health habits is false.

Even more significantly, the medical system has played a large role in undermining the health of Americans.  According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments:

• 12,000 deaths per year due to unnecessary surgery

• 7000 deaths per year due to medication errors in hospitals

• 20,000 deaths per year due to other errors in hospitals

• 80,000 deaths per year due to infections in hospitals

• 106,000 deaths per year due to negative effects of drugs

Thus, doctor-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.

One of the key problems of the U.S. health system is that as many as 40 million people in the U.S. do not have access to health care.  The social and economic inequalities that are an integral part of American society are mirrored in the inequality of access to the healthcare system.  Essentially, families of low socioeconomic status are cut off from receiving a decent level of treatment.

By citing these statistics, Starfield (2000) highlights the need to examine the type of health care provided to the U.S. population.  The traditional medical paradigm that emphasizes the use of prescription medicine and medical treatment has not only failed to improve the health of Americans, but also led to the decline in the overall well-being of Americans.  Starfield’s (2000) comparison of the medical systems of Japan and the U.S. captures the fundamental differences in the treatment approach.  Unlike the U.S., Japan has the healthiest population among the industrialized nations.  Instead of relying on sophisticated technology and professional personnel for medical treatment as in the U.S., Japan uses its technology solely for diagnostic purposes.  Furthermore, in Japan, family members, rather than hospital staff, are involved in caring for the patients.

The success of the Japanese medical system testifies to the dire need for Americans to alter their philosophical approach towards health and treatment.  In the blind reliance on drugs, surgery, technology and medical establishments, the American medical system has inflicted more harm than good on the U.S. population.  Starfield’s (2000) article is invaluable in unveiling the catastrophic effects of the medical treatments provided to the American people.  In order to improve the medical system, American policymakers and the medical establishment need to adopt a comprehensive approach and critically examine the failure of the richest country in the world to provide decent health care for its people.

Starfield, B. (2000, July 26). Is US health really the best in the world? Journal of the American Medical Association, .


Patterns of Dysfunctional Education
Far from expensive, the solution would actually save billions of dollars.  The essential change would be a shift from external force to motivation from within.  Relevancy and priority are among the foundation values.

We are in an age of information explosion, made possible largely by the internet.  The problem, however, is that most of this information does not filter into the rigid institutional curriculum of our universities.  Required medical education today consists of four years of high school, four years of college, and four years of medical school.  Throughout these twelve years, a common pattern emerges: memorize data, pass a test, and forget what was learned.  This pattern runs counter to lasting learning and inhibits the development of creativity.  If one has a bad product, one must examine the way in which it is manufactured.

A Plan for Functional, Fast-Paced, and Enjoyable Medical Education

  • Provide a common-sense medical-education program on the internet.
  • Begin with a broad-based general science program, without the esoteric trivia.
  • Provide a general overview of disease, prevention, medication, the doctor-patient relationship, and patient history taking.

This would be available to the student at his own pace, allowing the most intelligent, self motivated students to complete this phase of their training in a short period of time.

Real Medical Education Begins with Patient Interface

When the student felt ready, he would contact an available doctor of his choice, either directly, or through an internet matching program.  While providing a free service to the doctor by taking time consuming medical histories, the student would learn first-hand about diseases and their symptoms.  Actual person-to-person contact would create a lasting a vivid learning experience. 

Students would have 'apprenticeships' with a great many doctors, working in various styles of practices, and lasting up to six months.  If, on a given day, the student deals with patients for four hours, he would spend the rest of the day immersed in the study of medicine through the internet, meeting with his peers, or in discussion groups.


HEALTH-CARE REFORM: A Vision of the Future
The problems in medical and energy research lie in understanding and controlling events at a sub-microscopic level.  If we can build machines (link) atom by atom, the possibilities are endless.  One such possibility would be a medical system that could cure any disease.    

The only question is: "How long will it take?"  This depends primarily upon the efficiency of our educational and governmental systems and our ability to communicate these ideas to the public.

Nanotechnology (link) is the science of building tiny machines; machines that could enter the human body and act as single-cell laboratories to detect and repair any problems.  For example, Swedish scientists Edwin W.H. Jager and Olle Inganäs are developing nanostructures called actuators - mechanical devices that can move or control things - to handle biological materials such as single cells, bacteria, or molecules in liquids like blood plasma, and cell culture medium.

The tiny machines - extremely durable and capable of a wide variety of tasks - are being developed and studied in scores of laboratories all over the world.  This is critically important, because at present we don't have the capability to measure many of the microbiological processes in the body. 

Lyme disease, for example, is a chronic and crippling disease caused by several types of bacteria.  At present, there is no reliable test for this illness, and no cure.  We must develop tools that can decipher the vast array of events that occur within our bodies on a molecular level, and nanotechnology offers very promising assistance.

Chip technology doubles every eighteen months:
By the year 2020, chips will likely have the raw processing power of the human brain, and will forever exceed it after that.  We already place chip implants in inner ears to improve hearing and in retinas to give limited sight to the blind, yet when one goes to a doctor seeking treatment of a chronic illness, the doctor is likely to simply take the patient's blood pressure; poke him a few times; and with some guesswork, write out an expensive prescription that may or may not work. 

In light of the technology discussed above, a blood pressure instrument seems a very primitive tool, most commonly used as ritual, rather than to gain useful information on the patient's condition.  We have proven that we have the capacity to work miracles, and yet for the most part, our methods are clumsy and ineffectual.


Exploring The Alternatives
Today, in order to become a doctor, one has to go to a medical school, which is a four-year program costing hundreds of thousands of dollars.

According to one survey, for every dollar that the medical student pays, there are four dollars that come from other sources of funding.  Most people don't realize that 90% or more of the M.D. faculty members are volunteers.

They aren't paid.  I find that incredible to contemplate.  The real heart, the essence, of medical school is provided free of charge. It is the institution itself - the rigidity - that is so expensive.  

Conservatively speaking, there are thousands of people with chronic illnesses who have educated themselves about their conditions via the internet.  They quickly managed to become more familiar with their diseases than the physicians who treat them.

There is a wealth of non-profit web sites dedicated to medical subjects and authored by non-physicians.  Though often extremely information rich, they typically post a disclaimer stating that their information should not be considered medical advice, and that the reader should always consult a physician.

Such a disclaimer is appropriate for legal reasons, but usually ludicrous, because these sites are often generally more substantive and accurate than the information provided by most licensed doctors.

This is not a criticism of physicians, but of the medical system.  When doctors are seeing thirty patients a day, they have little remaining time for researching new medical developments. 

After having been programmed by years of education to practice with a particular style, their potential for creativity and growth is severely hindered.

Traditional institutional education is rigid and non-creative, directed toward learning information that is mostly irrelevant and obsolete.  Replacing the current structure with a system that focuses on live patients and allows ample time for the student to devise creative solutions via internet information resources, technical support, and a worldwide communication network would greatly improve the quality of healthcare.

The role of the teacher is not to lecture, but to be available when the student is having difficulty or requires advice.  Lectures can be conducted via the internet.  Today's doctors tend to use ritualistic, formulaic approaches: weigh, measure, take blood pressure, conduct a superficial examination, write a prescription, and then move to the next patient.  Good medicine is a creative process; a process which must be developed from the beginning.


Health-Care Reform And Medical Education
The process of becoming a doctor does not start in high school.  In fact, there is very little coursework at the college level that is designed to prepare an individual for medical practice; there is no college "medical" major.

Many students intent upon becoming a physician will major in biology or chemistry, but medical schools do not hesitate to accept applicants who have excelled in any other academic area of study.  Regardless, a majority of things learned at the undergraduate level has no relevance to the practice of medicine.

After college and upon acceptance to a program, the would-be doctor enrolls at a four-year medical school.  Upon graduation, he is awarded the doctor of medicine degree: the M.D.

In the first year of medical school, students cover the basic sciences, including anatomy, biochemistry, and physiology.  For students who have studied science at the undergraduate level, these courses are largely a duplication of material already covered, however, much of what was learned in college is no longer remembered.  There is a huge amount of factual information to be memorized, and as a result, most of it is soon forgotten - much like in college - after the tests.

The second year of medical school - containing a similarly large volume of factual information - is devoted to the study of disease and medication.  Practically the entire focus of the curriculum is dedicated to life threatening diseases, with essentially no emphasis on either nutrition or many of the seriously debilitating 'garden variety' illnesses frequently encountered by doctors.

Like all other medical students, I spent my third year of school at a teaching hospital.  Approximately 65% of the diseases that I saw were severe liver and lung conditions; the result of smoking and alcohol abuse.  Students assisted in surgery, delivered babies, and managed out-of-control cases of diabetes.  The most common conditions that cause people to seek medical attention, however, were neglected.

The fourth year is a continuation of the hospital clinical experience, and includes work in orthopedics and pediatrics at other specialty hospitals.  After graduation, most doctors complete their residency, which is an additional four years spent in the supervised practice of their medical specialty at a hospital.

By today's standards, the educational process of becoming a physician is extremely arduous and expensive, taking twelve or more years, and costing in the hundreds of thousands of dollars.  Although the student is taught by literally hundreds of physicians, most of whom freely donate their time as a purely charitable gesture, the majority of the student's medical studies take the familiar form: memorize, pass-the-test, and forget.  The process is so inefficient that most of what is learned - even relevant information - is forgotten by the time it is over.

The universe contains an inexhaustible volume of information, and to attempt rote memorization of even a small fraction of that volume is an extremely burdensome task.  Furthermore, it is impossible to predict what one will need to know in the future.  Granted, we need to have a general understanding of how the real world works.

If handled properly, without the dry details, students - seeing the relevance of such information - will be far more likely to retain what they are learning.  Beyond this general understanding, students should be given the freedom to explore their own interests without the constraint of rigid requirements.  Furthermore, the world of academics should be considered in cooperation with the non-academic world, offering bridges to that realm rather than posing roadblocks.


Money And Appearances In Health-Care Reform
My African Experience
This site was partially inspired by my trip to Africa, taken many years ago. I spent some time in a medium sized town, where I was virtually the only white person, and was besieged from all directions with requests for money and assistance of various forms.  It was quite a moving experience.  They were saying, in a very loud voice, "We need your help."  My conscience was aroused.

Money Was Not the Cure:
Even if I were rich, and handed out money by the basketful to those in need, I would be doing nothing to effect a long term solution to their problem.  There was something in their social system - something in their pattern of thought - that stood as an obstacle to their progress.

Dysfunctional Government: 
In speaking with the people, I learned of the corrupt schemes used by their government to extract money from the civilians.  A wall of red tape, which could only be penetrated through the use of bribery, blocked free enterprise.  This demoralized the entire population, whether or not they were involved in enterprise.

Unintentional Corruption Is More Destructive: 
There exist both intentional and unintentional forms of corruption.  Of the two, the unintentional form is far more destructive, because it is more deceptive and prevalent.  Furthermore, it allows for the existence of intentional corruption.  The entire experience led me to begin thinking in depth about social systems; a thought process which continues to this day.

Appearances Can Be Deceiving:
Though a system can outwardly appear to be extraordinarily efficient, it may, in reality, be utterly flawed.  I recall a story that a man once told me about his parents.  They lived in a beautiful home, had prestigious occupations, and were active in civic affairs.  Based upon superficial appearance alone, they seemed to be a model family.  His parents, however, were controlling, deceptive, and critical of his actions to the point where he literally went crazy.  These parents never recognized their own personality problems.  Their emotional discomfort led them to exhaust excessive amounts of effort on creating an appearance.

Money And Health Care:  
Our healthcare system - though on a much larger scale - operates in a similar way.  When viewed superficially, the system seems impressive.  Proponents of the system are constantly remarking, "If only we had more money, we could do so much better."   Desiring better healthcare, we believe this story, and give more money.  But regardless of how much we give, money is incapable of curing the system's ailments.  It is analogous to the aforementioned African illustration.

Take A Deeper Look: 
We must examine the system at a much deeper level.  We must look beyond appearances and good intentions, beyond intellectuality and sincerity.  Having been a student, doctor, and patient for a great many years, I can see right through the superficial guises of the system.  Unless you can understand the insanity of the present system, my proposals will make very little sense to you.

The Bottom Line:  
Trying to fix our healthcare system with more dollars is much like attempting to solve Africa's problems with money.  I see many caring, charitable people giving money to healthcare related causes, and it grieves me deeply.  Though these individuals have priorities similar to my own, our major difference is that I realize that the money could be much more wisely spent, if the system were changed.  I implore you to stand back and take a deeper look at healthcare.

A Specific Plan For Medical Education Reform

We must remove unnecessary obstacles in the system that increase cost, intensify stress, and consume valuable time.  We must emphasize preventive medicine, outpatient treatment, and functional medicine.    

Additionally, we must expand our focus to include nutrition.  Furthermore, we can eliminate the cost to the student and his family.

At present, a free, privately funded internet university, which will be open to all, is being formed.  This university will inevitably include medical education, with teaching methods essentially the same as those that I have proposed.  Additionally, there should be telephone and email support available, but we need not wait for that.  We can start now.

At what age should the medical education start? 
If conducted via the internet, there would be no minimum age.  Rather than begin with the medical student memorizing and then forgetting volumes of inconsequential information, he or she would begin with basic sciences that contain only relevant information.  By reducing the sheer volume of information, the overall rates of retention would be much higher.

Without the institutions (and their inherent rigidity or expense), this education would be essentially free of cost.  For a mere $29, students could begin their studies with a paperback book entitled by Patricia S. Hurlbut.  This book is extremely familiarizing with the basic routine of a doctor’s office.  Once the student has started his apprenticeship, I would suggest that he read .  This book will serve as an excellent reference tool, containing information on various diseases that the student will encounter.

Although some of the information in Current Diagnosis is incorrect, most doctors still rely upon it.  The student should be cautious of accepting any information at face value, and should always augment his information base by scouring the resources available on the internet, and carefully considering the information presented to him by motivated patients.  It is much easier to learn about diseases and medications when dealing with a patient who is actually suffering from that particular ailment.

Once the student has completed this independent study, entirely of his own initiative, he can approach his first prospective doctor-mentor.  The student's hands-on medical education would begin with the student taking patient histories.   Next he would learn the fundamental elements of disease and medication.

The student will essentially offer to act as the doctor's medical assistant in exchange for the doctor's willingness to associate with him.  Based on an interview to determine the applicant’s maturity and other personal attributes, and a standardized test administered to measure the student's understanding of basic medical concepts, the doctor may agree to such a partnership.  Both doctor and student would agree to such an arrangement.  The apprenticeship would be entirely voluntary on both sides.

Although the student  would not give medical advice or treatment, he would provide the valuable - and often time consuming service - of taking patient histories.  This would provide the student with a wealth of knowledge.

The doctor would confirm the accuracy of the key points in the patient histories and provide reports monitoring the progress of the students.  In contrast to current medical education, the student would begin in an outpatient setting, as it is less stressful.   Also, the monitoring of his progress would be more easily controlled.   In addition to apprenticeships with many doctors practicing in different specialties, the student's education would be augmented with conferences and discussion groups.

At the end of the second and fourth years of the student's apprenticeship, he would be required to pass written examinations, prepared by a committee of various doctors.   Additionally, such doctors could, for example, create a finite set of medical multiple choice questions (between 5,000 - 10,000), from which a random sample would be drawn for the student's testing.  The student could also be required to make a contribution to the medical community in the form of preparing a web site on the diagnosis and treatment of a specific disease.  At the end of the four years, there would be a five-day oral exam, conducted by a committee of physicians who practice in the field of the student's specialty.  Upon successful completion of this process, the student would become certified in the practice of his specialty, but may elect to test for certification in other areas if he meets the specialty-specific requirements.

At the core of our "university without walls," is the mentor/apprentice relationship.  See the enlightening film, The Cider House Rules, and observe the relationship that exists between the doctor and his apprentice.  They relate to each other much like a father and a son.

I would expect that after reading this particular section, a number of questions would be raised with regard to the details of executing our plan of reform.  For this purpose, there is a discussion board where you can post comments and inquiries.  Please do not feel as though you need any specific qualifications to post to this forum.  We welcome the input of people from all walks of life.


Health-Care Reform In Medical Research
Although we are all different and learn in different ways, I believe that the best way to learn about medical research is to actually conduct such research.  There are many people who, from a very early age, pursue science as a hobby.  They love it until it is stuffed down their throats.

Granted, there is a basic fund of knowledge that all scientists must know, but this can be learned without 'stuffing.'  Even so, the essence of science remains exploration, rather than consumption of facts.  An ideal situation would be the creation of community research laboratories.

The most logical place for such laboratories would be in the schools.  It has been my experience that canned textbook experiments are unproductive as teaching tools.  They are often both tedious and quickly forgotten.  If an experience is not remembered, then real learning has not occurred.  Audiovisual tools are an excellent way of teaching science fundamentals.  They would make learning more enjoyable for students and less burdensome for the already overworked teachers.

Research within the schools should be facilitated by networked communication with other schools and research facilities.  Many researchers would gladly donate their time to explain their research processes to students.  Current research would be augmented by the combined efforts of millions of students worldwide; this could prove to be quite a powerful tool.  These students would be thrilled to know that they were actively involved in contributing to both medical and scientific discoveries.

Children instinctively know what they need.  As adults, our job is to listen, observe, and make ourselves available.  Our job is not, however, to control.  Those who are controlling are often mindless and damaging to other people.

Children do not require our control, but rather, our encouragement to explore the universe and express their uniqueness.  Once we understand the needs of the individual student, we can provide the kind of environment and the amount of structure that is most appropriate.  Our current system of educating young people is a dehumanizing rat-race of mindless over-activity.  Furthermore, it is a waste of human potential.

One day, we will truly listen to and understand the needs of others.  We will begin striving to attain mindfulness, much as we presently strive to attain athletic fitness.  One day, mindfulness will be a household word.

John Martin, M.D. Ph.D. operates his own community laboratory in Rosemead, California.  Volunteers are frequently invited to visit and participate in conducting research.  Although his equipment is mostly a surplus collection of remnants from someone else's government grant, it is very sophisticated.  Various people donate time, money, and equipment to make it a success.  A great many small research companies are being created across the globe; many of which welcome volunteers, much like the aforementioned laboratory.

Communication tools have become affordable, and widely available.  There is an incredible network of people who, driven either by a love of their subject or by the necessity of their illness, join together in an information exchange forum to discuss a countless array of subjects.  This is real education.  It is free.  It is from the heart.


Patient-Centered Learning Vs. Institutional Centered Learning
I learned far more about the practice of medicine AFTER I left medical school than in the classroom.  I let my patients teach me, and they loved me for it.

A critical problem with institutional learning is that the information taught within the institution is accepted as God-given truth.  Many patients, who are concerned with their conditions, will frequently present information about their illnesses to their physicians.

If this information contradicts what the doctor has learned within the confines of the institution (i.e. medical school), the patient is considered wrong, and devalued.

A better alternative, is PATIENT- CENTERED LEARNING.  By listening to the patient's stories starting very early in one's training, the patient becomes the focus.  This model has powerful implications. The student would be free to do web based literature research on the patient's condition, which would take him far beyond medical school programming.  Additionally he could devote much deserved time to the patients and explore non-drug, nutritional, and life-style therapies for their conditions.

Doctors are the third leading cause of death in the U.S. according to the July 26, 2000 issue of the Journal of the American Medical Association, Vol. 284.  The actual statistics are probably higher, due to treatments that harm, rather than help patients.  An over-reliance on prescription medication is the primary cause of such fatalities.  The new model would allow the student to change that pattern of negligence.

Volume 322 of the British Medical Journal, published on February 24th 2001, presented the results of a study that attempted to ascertain what patients want from their doctors.  The responses were not surprising.  They were things that we - doctors included - have known for decades.  Simply knowing them, however, has not been enough to effect change.

Patients want better communication.  Instead of receiving a physical examination or a prescription, patients would rather spend precious time with their doctors discussing their conditions and hearing about ways to stay healthy.  The researchers identified three specific areas that patients want their doctors to emphasize: communication, partnership and health promotion.  More than three-quarters of respondents wanted visits with their doctor to focus on:

  • communication between themselves and the doctor.
  • open discussion of their feelings about treatments in order to
    reach cooperative decisions
  • learning about ways in which they can improve their health or prevent future illness
  • Fewer wanted an examination (63%) and only a quarter of those surveyed wanted a prescription.

Doctors know what patients want, but their mindset is deeply ingrained into their character.  They feel that they deserve to earn a high income after enduring a tortuous educational process.  Rigid institutional requirements drastically reduce the supply of doctors, which equates to less time spent with each patient.  This reduced supply of doctors also serves to increase the cost of their services.  The lengthy, institutional, fact-stuffing process produces a mental rigidity that prevents these physicians from adapting to alternative styles of practice.  They feel like they need to give their patients something of value in the short time that they spend interacting.  This thing of value is usually a prescription.

The non-institutional, patient-centered educational plan would produce an abundant supply of compassionate, innovative, prevention-oriented doctors at an extremely low cost.  Additionally, the pace of medical research would be sharply accelerated.


Frequently Asked Questions
The following are reasonable questions, submitted by our readers, and our responses.  This page contains a living discussion.  It is updated frequently, and we invite your input.

Q. Don’t the twelve years of pre-medical education give the student a universal education?

A. Unfortunately, no. The student has little choice within the confines of his curriculum, which follows the familiar pattern: memorize data, pass the test, and forget.  It is damaging to the healthy development of mindfulness.  This question requires a complex response; an explanation that cannot adequately be provided in a few brief sentences.  Please go to the following websites: Education Reform and School Reform.  Read them carefully in order to receive an adequate answer to this inquiry.

Q.  Aren’t tests relevant in order to measure what we have learned?

A.  Occasionally, tests are valuable.  But frequent testing coupled with forced memorization is damaging to healthy mental development.  Written tests only measure a small portion of what has been learned.  They are valuable as a learning tool when the atmosphere is friendly and non-coercive.

Q.  Aren’t the internet programs going to require the same tedious testing procedures?

A.  No.  In order to appreciate this, we need to reevaluate what healthy education consists of.  The internet would be used as an information resource and a teaching tool.  It would not provide testing.

Q.  If the internet programs are utilized then what will happen to the existing medical institutions?

A.  My speculation is that they will adapt their educational systems, making them healthier for aspiring physicians.  I believe in free choice, and would not attempt to force individuals into any particular system of learning.  Some people may choose the traditional educational route.  In all likelihood, the number of students following the traditional path will dwindle.  Medical schools will serve as research centers, holding seminars and workshops which students and practicing physicians can attend on a voluntary basis.

Q.  Instead of utilizing internet programs why not fight to lower the cost of medical schools?

A.  Medical schools are intrinsically expensive.  These institutions have many elaborate buildings, a large paid staff, and a number of other bureaucratic expenses.  Additionally, trying to fight a battle against an institution is as futile as banging your head against a brick wall.  Rather than attempting to change the medical schools, I advocate providing an alternative.

Q.  Doesn’t the competition in medical school also test the student's ability to handle the demands of being a physician?

A.  Long term stress is not healthy for anyone.  It is damaging to mindfulness as well as physical health.  Students shouldn't be putting in a 70 hour week and doctors shouldn't be seeing thirty patients a day.  Their lifestyle should be more leisurely, and this will be better for both the doctor and the patient.  The student will be able to choose his own specialty, and would not choose general surgery or emergency medicine unless that suited his temperament.

Q.  If that pattern of 'pass the test and forget' exists, then why not incorporate more hands on experience in medical school?

A.  We would still encounter all of the obstacles of changing an institution (mentioned above), and neither you nor I are powerful enough to do this.

Q. Will the broad-based courses provided online be sufficient enough to prepare the student to be a certified doctor?

A.  The scope of medical information on the internet is far more vast than that provided by any institutional program.  But we will not rely on these internet resources alone.  We will also have the doctor-student-patient interaction, starting very early in the educational process, and creating a very memorable, impacting experience.  Watch the film The Cider House Rules.  Put your views on abortion aside, and focus on the relationship that exists between the doctor and his understudy.  They related to each other like father and son.  Their interactions were rich and rewarding.

Q.  Instead of completely changing the medical requirements why don’t we focus on strengthening what we learn in medical school?

A.  The entire foundation of premedical and medical education is flawed from the ground up.  This would be like trying to build a house on a foundation of sand.

Q.  Are these distant online learning courses really going to fix the root-cause of the problem?

A.  No, the root-cause of the problem is more complex.  We need to reexamine what education is all about.


Frequently Asked Questions Part Two
Q.  The students in medical school often strive to be the best and most educated.  How could someone who surfs the internet have more knowledge about diseases and conditions than these students?

A.  Because they are not following the familiar model of memorizing data, passing the test, and forgetting.  They are engaged in self-motivated and self-directed medical study purely out of curiosity, or because either they, or a loved one, have an illness.  They are able to focus on learning without any bureaucratic distractions.  Love, rather than a desire for "success", motivates them.

Q.  Don't some people say that we should not believe all of the information that can be obtained on the internet?

A.  Yes, this is good advice.  Remember, some people also say that it is wise not to believe all of the information learned in schools.

Q.  Instead of getting rid of medical institutions and proposing an  entirely new system, why not simply require practicing doctors to continue their research on new diseases and conditions?

A.  We're not getting rid of medical institutions.  We are giving people  an alternative to the current model of education, which is damaging to creativity.  Furthermore, if the typical medical practitioner sees thirty patients a day, he usually does not have time to do research.

Q. Will these internet classrooms really provide the fundamental education for a medical student?

A.  Education is not something that you inject into somebody.  In the end, all students teach themselves.  The internet is only a resource, but virtually unlimited in it's scope, cost effective, and highly flexible.  It is available 24 hours a day, and 7 days a week. There is no need to commute to get there.  The internet is only one aspect of the program.  There would also be the student-doctor relationships, discussion groups, and other resources of the student's choosing.  The student would design a program that works best for him.

Q.  Don’t the existing medical schools determine whether or not the student is really ready to become a certified doctor?

A.  Partially, but not adequately.  In addition to the requirements of  each individual medical school, each state has written examinations that must be passed.  Also, each medical specialty has a board that administers it's own written and oral exams.  In my opinion, the examinations conducted by the specialty boards are the most relevant to what the doctor will actually be doing.  Written exams measure only a small part of whole-brain functioning, and our emphasis on them is at the very core of the dysfunction that plagues our educational system.

Q.  Instead of requiring a four-year college education, why don’t medical institutions let dedicated and successful high school students into their four-year program?

A.  Theoretically this is possible, and has happened in a few cases.  But because medical school admissions are so competitive, this is a rare occurrence.  In our culture, we believe the notion that an individual's worth as a person is dependent upon his graduating from college.  Many people attend college, not out of an innate desire to learn, but primarily because our culture places such a high value on formal education.  Unfortunately, college is expensive, inefficient, and often irrelevant to their lives.

Q.  Instead of focusing on rare conditions, why don’t medical schools make the more common diseases their main focus?

A.  The more common conditions are often the least understood.  Traditionally, medical schools have a base in a large teaching hospital.  Often this is a general hospital, which admits mostly indigent or severely ill patients, and in doing so, skews the patient population.  For example, a student might see a huge number of end-stage chronic alcoholics who are dying of delirium tremens and cirrhosis of the liver.  This same student may see common conditions very infrequently.

Q.  Instead of requiring so much money to go to a medical school, why not lessen the cost, and make it more affordable?

A.  Because institutions have a huge overhead.

Q.  Instead of providing free internet classrooms for pre-medical students, why doesn’t the government offer the medical institutions that exist today at a lower price?

A.  The government already subsidizes medical education to a large extent. Combined, the government and private donors spend four dollars per every one dollar spent by the student.

Q.  Don’t a lot of students prefer the in-classroom environment in order to learn the necessary information?

A.  I don't have any statistics, but my private polls tell me that the overwhelming majority of students would prefer the model that we have proposed.  Keep in mind that in this model, there is nothing to prevent an individual from taking classes.  The student should have freedom of choice, as long as the public is protected.

Q.  Won't the test required for the student who has completed his online education be exactly the same as the memorize, pass the test, and forget type?

A.  In the new system, there would be a much smaller emphasis on written exams.  An exception would be the use of tests as a teaching tool.  The tests would contain only relevant information with the trivial questions weeded out.  Students would be motivated by love and an innate desire to learn, rather than by a fear of failure.

Q.  What is the significance of the oral exam?

A.  Oral exams measure judgment and other aspects of mindfulness that written tests do not.  When the examiner is convinced that the student grasps a certain topic, he can change the subject and cover a lot of ground more quickly.  These exams frequently have people acting as patients.  The examiner can watch a student conduct an examination and evaluate his approach.  Oral exams tend to be much more relevant and meaningful.

Q.  What determines the length of the assistantship?

A.  Generally, the assistantship would end when the student felt that his rate of learning in that particular environment had declined and it was time for him to pursue other avenues.

Q.  Isn’t the information in the textbooks relevant to the child’s education in school?

A.  Frequently it is not.  Everyone learns differently.  For example some people are left-brain dominant, which means that they are good with words and numbers.  Others are right-brain dominant, which means that they are very creative, but often have difficulty learning from a book.  When a student is allowed to be in charge of his own education, he will choose the methods most conducive to his learning.

Q.  How can we be assured that the doctor will be competent and that the public will be protected?

A.  Today, a future doctor receives thousands of tests along his path toward receiving his M.D.  The only meaningful test, however, is the final exam, because it is the only tool that measures what he has remembered after his long educational trek.  Today, there are no oral exams required in order to become a licensed physician.  This is a defect in the system, because oral exams measure a much larger percentage of whole-brain function, including judgment and approach to the patient.  Our approach would require extensive oral exams.  Today, a license to practice medicine allows a doctor to practice in any specialty, including surgery.  Common sense tells us that no doctor is competent to practice in all specialties.  We would allow a doctor to practice only in those areas in which he has proven his competence.  Today, there are no assessments of character required in order to practice medicine.  The tedious required educational process is damaging to character.  We offer proof of this!  here.  (link)  Our proposal for medical education would offer a continuous evaluation of character in the form of close, continuous, intimate relationships with practicing physicians.  We believe that our proposal would produce physicians of much greater competence, compassion, and creativity, along with a more accurate verification procedure to assure quality control and protect the public.


Frequently Asked Questions Part Three
Q.  What do you mean by saying that doctors are the third leading cause of death in the United States?

A.  This statement is validated by the July 26, 2000 issue of the Journal of the American Medical Association, Volume 284.  These deaths are due to errors made by doctors in the course of their treatment.  Most often, these fatalities are the result of a doctor prescribing an inappropriate medication.

Q.  Are you suggesting a college "medical major"?

A.  No, I am suggesting a free, open system in which the student
designs his own educational program.

Q.  You state that there are a large number of non-profit websites on medical subjects authored by non-physicians.  You also state that many of these sites are extremely information rich, and usually more substantive and accurate than the information provided by most physicians.  Since anyone with basic HTML skills can create a medical website, how can the layman discriminate between valuable information and nonsense?

A.  We are referring to illnesses that are somewhat outside of main stream medicine, such as chronic fatigue syndrome.  In these cases it is frequently difficult for both doctors and non-physicians to distinguish which treatments are effective.  Furthermore, when dealing with such an illness, everyone responds to treatment differently.  In these instances, it is good to be part of a support or discussion group of patients who suffer from that particular condition.  Such individuals will provide a lot of valuable input pertaining to treatment options, and will do so without financial motivation, and in an unbiased fashion.  Often, these groups will contain some very scholarly people who have studied these medical conditions in depth and are good critical thinkers.

Q.  You state that the root-cause of our current healthcare problems resides in our system of medical education.  What are the first steps that need to be taken for us to revamp this flawed system?

A.  Since the general public does not understand that our system of medical education is at the core of this dysfunction, we must educate them on this matter.  We must also educate the existing army of healthcare reform activists, because this concept may be new to them.  We need to help such activists focus on root causes, rather than vague symptoms.  We need activists to deal with concrete solutions, rather than vague notions.  We must pass regulations at the state level that will allow for the creation of an alternative pathway for becoming a doctor, a pathway that we have described. Once one state does this, the rest of the country will follow.  It is likely that the rest of the world will follow our example.

Q.  Isn't rote memorization crucial for a medical student to learn the huge volume of knowledge necessary to practice as a physician?

A.  Please refer to our page on how memory works.  (link)  It is difficult to memorize material from books or lecture notes, and even more difficult to retain that information for a long period of time.  When the student is seeing live patients, face-to-face, he will read about illnesses and their treatments and associate this knowledge with actual patients.  Not only is this a more natural and pleasant learning process, this association process is far more conducive to long term memory.

Q.  I take issue with your arguing that the medical establishment should function more along the lines of the Microsoft Corporation.  Although Microsoft may be successful and cost-effective, it is brutally competitive and employs deceptive marketing practices.  Would you please respond to this?

A.  We didn't mean that at all.  We said that if Microsoft required competency plus proof of a long, formal educational process, the corporation would not be able to operate in a cost-effective way.  We did not say that the medical profession should emulate Microsoft.

Q.  In one section of your site you argue that most physicians impatiently prescribe a medication to their patients and bill them at a high fee.  Yet in another section you cite the fact that many doctors at teaching facilities donate their time for free.  What do you think?

A.  Both statements are correct.  All doctors are not alike.

Q.  In terms of the solution you suggest for improving the medical educational system, isn't the 12 years of education crucially important for students to learn the huge database of knowledge that every doctor must draw upon in helping his patients?

A.  Most of the information that the doctor learns in these twelve years is unnecessary and irrelevant to his ultimate practice.  Because this knowledge is acquired in the familiar model of memorize, pass the test, and forget, the great majority of it is forgotten by the time that the student begins to practice medicine.  It is true that a doctor must have a very large fund of knowledge from which to draw.  This knowledge, however, must be relevant, and acquired in such a way that it is committed to long-term memory.  The learning must be whole-brain, rather than left-brain learning.  Simply put, there is a difference between learning by doing and 'learning' by memorizing words.

Q.  Your proposals seem very revolutionary.  Won't it take a very long time to implement them?

A.  The public is extremely motivated to find a solution to this vexing problem.  This site has aroused a great deal of interest, and ranks high using the search term "health-care reform" in Yahoo, Google, and LookSmart, based on numbers of site visits and links to the site.  This is evidence that motivated people are actively exploring this approach.


Frequently Asked Questions Part Four
Q.  How can you claim that our healthcare system is in complete shambles?  My doctor is wonderful. He spends lots of time with me. I couldn't ask for more.

A.  Granted, there are thousands of extremely dedicated doctors and healthcare workers.  But this doesn't change the fact that there are millions of people who do not receive adequate healthcare, and countless diseases that cannot be diagnosed and treated.

Q.  I'm a doctor.  Even though I have never used calculus
or organic chemistry to diagnose an illness or treat a patient, I'm not sure the process of learning was a waste of time.  Who is to say that that process did not make me a better student who was better able to digest the almost impossible volume of information presented to me in medical school?
A.  It is a question of relevancy.  In the game of life, we have to keep our eye on the ball.  We have to stop using denial.  One of the problems I face is that so many people will defend their educational experience with the same illogic as a Mooney or a Scientologist will defend theirs.  With many people, their educational background is intimately connected with their self worth.   A criticism of their education is taken as a personal attack.  This is a deep-seated emotional issue which in many people will override logic.  This is very complex and cannot be answered fully in a paragraph.   Please follow the links to get a more complete picture.

Q.  I disagree with your suggestion that medical students would offer a valuable service to practicing physicians.  Medical students (and junior-level residents) invariably slow-down experienced doctors due to their inefficiency.  I am a full-time academic physician who enjoys teaching, but sees firsthand how well-meaning but inexperienced students and residents will decrease your ability to see patients efficiently.

A.  Many doctors pay good money to hire medical assistants.  The function of the assistant in this proposal is to take patient histories, and record them in the chart. While he is doing this, the doctor is doing other things.  The student is primarily learning from the patient, not the doctor.  When the doctor sees the patient, he has the advantage of a detailed history that he would never have time to take himself.  Keep in mind that this is voluntary.  If the doctor doesn't wish to participate, he doesn't have to.

Q.  But aren't students already getting adequate patient interaction?  Most medical schools begin patient/student interactions late in the first year or early in the second year.  They are already spending time interacting with patients, although not several hours a day (until the third and fourth year).

A.  The student has had eight years of mostly irrelevant institutional learning before he even gets to medical school.  Furthermore, the patient interaction in the first two years of medical school is usually very minimal.

Q.  Community physicians will need some type of compensation due to diminished ability to see patients efficiently under your model.

A.  Most of the teaching physicians in medical schools, internships, residencies and teaching clinics are volunteering their time free of charge.  Furthermore, they are willing to commute a great distance do this.  Doesn't it make more sense to have this take place in the doctor’s office, where no commuting is necessary, and a more intimate relationship can be established?
Frequently Asked Questions Part Five
Q.  The most fundamental problem as I see it, is that we have moved the rationing decision away from the user of the service, to some third party.  Years ago, each person had to make the rationing decision, i.e. could they afford that care or not. Today, that decision has basically been moved to some third party.  The problem with this new scheme, is there is no way to effectively hold down the cost of medical inflation.  Before the advent of our modern health delivery system, medical cost inflation was lower than the overall inflation rate.  Since the move to this current system, the medical inflation rate has consistently been above the overall inflation rate.  As a result, these third parties come up with all kinds of schemes to hold down the rising cost of healthcare.  An economist would say, this is rationing.  But the problem is, this form of rationing never works, because you have not changed the supply/demand dynamics at work.  All you have done is bought yourself some time.  I see only two ways out of this problem.  One, is to return the rationing decision to the consumer (not very likely), or some dramatic productivity improvements that reduce the overall cost of providing that care.

A.  Before the days of HMO's, there were severe economic healthcare problems. HMO's were contrived as a solution - a solution which has failed.  This website does offer a dramatic productivity change, in addition to removing what now consists of a massive restraint of trade.  But in order to appreciate that, you have to read the entire group of sites, taking your time to digest the material.  You could say that HMO's are a cause, but not a root cause.  There is little that we can do directly about HMO's.  But if we communicate effectively the concepts on this web site, the root causes will be exposed, and in time, corrected.  Given that, society may have little need for HMO's.

A. Before the days of HMO's, there were severe economic healthcare problems. HMO's were contrived as a solution - a solution which has failed. This website does offer a dramatic productivity change, in addition to removing what now consists of a massive restraint of trade. But in order to appreciate that, you have to read the entire group of sites, taking your time to digest the material. You could say that HMO's are a cause, but not a root cause. There is little that we can do directly about HMO's. But if we communicate effectively the concepts on this web site, the root causes will be exposed, and in time, corrected. Given that, society may have little need for HMO's.

Q. More doctors do not lower price.  As current research confirms (from
Dartmouth), if there are a lot of doctors in an area, they simply double the number of required office visits.

A. That makes sense at the present time.  So we need a new breed of doctor. When a doctor leaves medical school now, he or she is $300,000 in debt and often damaged by the many years of forced memorization. The cost is passed on to the consumer.

You Can Change The System:  Just by using your mind
Today, political parties choose the candidates, not the people.  Our system selects out people who are most able to get elected, but not necessarily to govern.

Take a good look at that building over at the right.  A long hard look.  Because it belongs to you.  But unfortunately, some political parties and big money have taken control of it.  Your job is to take back what rightfully belongs to you.  

There is only one way that you can do it, and that is with your mind.  And when you do that, our government will be in much better hands.

Learn more about mindfulness.  The time will come when people will practice mindfulness like they engage in physical fitness today. 

We can and will have an extremely functional healthcare system.  We will be able to diagnose and treat any illness.  You can be a part of the process that will bring that about. 

All it takes is some attention to the things that are really important - things with lasting value.  It all starts with you, and it happens one day at a time.  You can help yourself while making a genuine social contribution.  This will lead to more functional personal, family, and social living.