Pharma Whistleblower Reveals Who Really Runs American Healthcare w/ Brigham Buhler

Summary

Summary of "Pharma Whistleblower Reveals Who Really Runs American Healthcare" with Brigham Buhler

Podcast: The Dr. Hyman Show
Host: Dr. Mark Hyman
Guest: Brigham Bueller
Release Date: August 6, 2025

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1. Introduction to the Broken Healthcare System

The episode delves deep into the systemic failures of the American healthcare system, highlighting the alarming statistics and underlying issues driving poor health outcomes despite exorbitant spending.

Key Points:

• Chronic Disease Epidemic:
  • Statistics: 6 out of 10 Americans have a chronic disease, 93% are metabolically unhealthy, and 75% are overweight.
  • Impact on Youth: Rising rates of obesity and depression among children.
• Healthcare Spending vs. Outcomes:
  • The U.S. spends more on healthcare than any other industrialized nation but ranks 48th in life expectancy.

Notable Quote:

• Brigham Bueller [05:28]: "We are really, really bad at stopping chronic disease from developing... it's not a political thing. This is humanity."

2. Corporate Capture and Its Consequences

The conversation emphasizes how corporate interests have infiltrated regulatory bodies, leading to policies that favor profit over patient health.

Key Points:

• Influence on Regulatory Agencies:
  • FDA and NIH Compromised: Brigham discusses his firsthand experience witnessing the FDA's leniency towards pharmaceutical giants like Purdue Pharma.
  • Revolving Door Syndrome: Nearly all FDA heads move to work for the pharmaceutical industry after their tenure.
• Economic Incentives Misaligned:
  • Profit from Sickness: Healthcare entities, including insurance and pharmaceutical companies, profit more when patients remain sick, perpetuating a cycle of chronic illness.

Notable Quote:

• Brigham Bueller [08:51]: "It's because there's so much money being made off chronic disease... as an executive at an insurance company and a big chunk of my revenue is you being on prescription drugs."

3. The Role of Pharmacy Benefit Managers (PBMs)

PBMs, acting as intermediaries between insurers and drug manufacturers, play a significant role in inflating drug prices and influencing prescription practices.

Key Points:

• Profit Margins:
  • PBMs capture almost 30% of profits from the opioid crisis by negotiating rebates with pharmaceutical companies.
• Incentivizing Expensive Medications:
  • Example: Insurance companies push drugs like GLP1s due to substantial rebates, despite cheaper, equally effective alternatives being available.

Notable Quote:

• Brigham Bueller [16:28]: "They went from negotiating down the cost of drugs to negotiating up the cost of drugs... They've aligned the incentives of the insurance companies to profiteer and monetize prescription drug care and chronic disease."

4. Case Study: The Opioid Crisis

Brigham shares his personal connection to the opioid crisis and uncovers systemic failures that allowed it to flourish.

Key Points:

• Personal Impact: Brigham lost his brother to the opioid crisis, motivating his shift from a pharmaceutical representative to healthcare entrepreneurship.
• Regulatory Failures: The FDA facilitated the introduction of highly addictive opioids like oxycodone, exacerbating the crisis.
• Insurance Complicity: Withdrawal of insurance coverage for safety measures like pharmacogenetic testing and toxicology screenings left clinicians without critical tools to prevent opioid misuse.

Notable Quote:

• Brigham Bueller [11:12]: "The FDA allowed Purdue Pharma to ramrod a dangerous drug into the market... everything pivoted from proactive, predictive, and personalized care."

5. Suppression of Medical Innovation

The healthcare system prioritizes treatments that generate recurring revenue over innovative, long-lasting solutions.

Key Points:

• Orthopedic Surgeries:
  • Issue: Joint replacements have a limited lifespan, necessitating repeat surgeries, which sustains hospital revenues.
  • Resistance to Better Solutions: Innovating longer-lasting joints is financially unattractive to hospitals reliant on repeat procedures.
• Peptide Therapies:
  • Example: Brigham discusses the FDA's crackdown on peptides like MDMA-assisted therapy despite their efficacy in treating conditions like depression and PTSD.

Notable Quote:

• Brigham Bueller [38:20]: "If we were to innovate a joint that lasts longer, would you use it? Yes, of course not."

6. Grassroots Movements and Policy Change

The episode highlights the growing grassroots efforts to combat the entrenched interests within the healthcare system and the potential for meaningful policy reforms.

Key Points:

• Public Advocacy: Collective actions, such as petition campaigns and public demonstrations, are driving companies like Kellogg's to reform their product formulations.
• State-Level Legislation: Over 30 states are introducing bills aimed at removing harmful additives from food, signaling a shift toward better regulatory standards.
• Insurance Reform Proposals:
  • Health Savings Accounts (HSAs): Advocating for increased HSA contributions to empower individuals to take charge of their health through preventive measures.

Notable Quote:

• Casey Means [33:00]: "Change doesn't happen in Washington. It doesn't start in Washington. It ends in Washington."

7. Regulatory Influence on Food and Health Guidelines

The interplay between government agencies and industry interests skews public health guidelines, often to the detriment of genuine nutritional science.

Key Points:

• Dietary Guidelines Manipulation:
  • Dairy Council's Influence: Government collaborated with the Dairy Council to promote milk consumption despite lacking scientific support.
• Front-of-Package Labeling:
  • Current Challenges: Attempts to implement clear, honest labeling are stymied by industry lobbying and insufficient regulatory willpower.
• Environmental Impact of Food Production:
  • True Cost of Food: Highlighting the hidden environmental and societal costs of cheap, processed foods subsidized by government policies.

Notable Quote:

• Casey Means [49:11]: "You can tell what the heck it is you're eating. Is it good for you? Is it bad for you? It shouldn't have to be a PhD in nutrition science to figure this out."

8. The Path Forward: Aligning Incentives and Empowering Individuals

Both Brigham and Casey emphasize the necessity of realigning economic incentives within the healthcare system and empowering individuals to advocate for their health.

Key Points:

• Value-Based Care:
  • Shifting from volume-based to outcome-based healthcare models where providers are rewarded for patient health improvements.
• Educational Initiatives:
  • Empowering the public through education platforms to make informed health choices and advocate for systemic change.
• Policy Recommendations:
  • Implementing tax incentives for preventive care, increasing transparency in drug pricing, and insulating regulatory bodies from industry conflicts of interest.

Notable Quote:

• Brigham Bueller [32:05]: "If we could somehow have a shared risk pool where it didn't matter if you're United or Cigna or Aetna... we could give sovereignty and accountability back to the patient."

9. Conclusion and Call to Action

The episode wraps up with an optimistic outlook, stressing the power of collective action and informed public advocacy in driving meaningful healthcare reforms.

Key Points:

• Unified Effort Needed: Overcoming the entrenched interests of big pharma, insurance companies, and regulatory capture requires a collective, persistent effort.
• Empowerment Through Knowledge: Educating the public and enabling them to make informed health decisions is crucial for systemic change.
• Hope for the Future: Grassroots movements and increasing public awareness signal potential for significant reforms in the coming years.

Notable Quote:

• Casey Means [73:07]: "Change doesn't happen in Washington. It doesn't start in Washington. It ends in Washington."

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Final Thoughts

In this compelling episode, Brigham Bueller offers an insider's perspective on the myriad ways corporate interests have undermined the American healthcare system. From the manipulation of regulatory agencies to the profiteering from chronic diseases, the discussion underscores the urgent need for systemic reforms. By highlighting both the challenges and the grassroots movements striving for change, the episode serves as a crucial call to action for listeners to become informed and advocate for a healthcare system that prioritizes genuine health outcomes over profits.

Transcript

[Dr. Mark Hyman]

Coming up on this episode of the Dr. Hyman Show.

[Brigham Bueller]

It's not freedom if you're going to hide and mislead the American people. If you're expecting the insurance companies or the big pharmaceutical companies to look out for you, you're in trouble. Pharma whistleblower Brigham Bueller now exposes the industry's broken incentives and fights to put patients back in control.

[Casey Means]

How does it look like behind the scenes in terms of what's happening in our agencies that govern our health and healthcare?

[Brigham Bueller]

We are really, really bad at stopping chronic disease from developing.

[Casey Means]

You only really succeed when people are.

[Brigham Bueller]

Not well and it's because there's so much money being made on chronic disease. This is to me, it's not a political thing. This is a humanity.

[Casey Means]

Is there hope? Is it's just not fixable.

[Brigham Bueller]

I think we have to.

[Dr. Mark Hyman]

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[Casey Means]

Dr. Mark so Brigham, welcome to the podcast. We had a chance to get together at a dinner at my house with a number of state senators talking about how we fix our problem of chronic disease in America. And we got to testify the next day at the Texas Health and Human Services Committee talking about what needs to be done to address some of these issues and background. You're not a practicing physician or a practitioner, but you've been involved with insurance, with pharmacies, with delivering healthcare. And you have a very unique perspective on our healthcare system. And we all know it's broken. Like, there isn't anybody who goes, wow, healthcare in America is just rocking it. It is the best healthcare system in the world, and in some ways it is right. The best doctors are here. For the most part. You can get access to extraordinary treatments and surgeries and interventional treatments. And yet we're suffering. And the whole country is sick. I mean, six out of 10Americans have a chronic disease, 93% are metabolic and healthy, 75% overweight. We've got kids struggling with obesity and depression. And the whole system is just kind of not working. You spent your life really deep in the weeds in it, understanding it, understanding the challenges of it, how it's just kind of messed up and we're getting poor health despite spending more than double any other industrialized nation or 48th in life expectancy. And something's wrong. So the question we're going to talk about today is what's wrong? And not just that we have a crappy food system and all those things that I talked about forever, but in the healthcare system itself. And you talk about that FDA and NIH and many other regulatory agencies are really not impartial, but they're influenced by corporate interests. And there's this sort of this concept going around in the ether called corporate capture. I've also heard of this concept of corporate kleptocracy, which means that, you know, are, are basically government has been taken over by corporations.

[Brigham Bueller]

Yeah, so true. I love that.

[Casey Means]

For the people, by the people, of the people. It's for the corporations, of the corporations, by the corporations, you know. And I was working on risk policy issues for a long time and I met with someone who'd been in, in the Obama administration who was working on the food program and food systems program issues. And he says, look, Mark, everybody who came to us was from industry. No one came to us talking about how we need to improve our food supply and food system or what we could do, or with ideas or policies or regulations. And yet, you know, when the food industry comes, or they come with stacks of an insurance industry and farm industry and you name it, they come with literally stacks of, quote, scientific evidence to back their point. They come up with the written legislation that they want to have passed, they come up with the written regulations that they want implemented. And for the most part, with some tweaks, it gets done because they're so compelling at what they do and they have such a clear strategy. So how does it look like behind the scenes in terms of what's happening in our agencies that govern our health and healthcare?

[Brigham Bueller]

I think you did a great job of laying the groundwork because it's a deep, deep, dark, sinister hole and being in it. So my experience is right out of college, I got hired to be a drug rep for Eli Lilly. And this was 25 years ago. Not to date a drug dealer, but yeah. And I thought, oh my gosh, this is going to be amazing. I'm going to help people. I. This is like I get a company car, an expense account. Like, this was a really good job right out of college. And it took, it took me probably 18 months to really start to see. Oh man. I was a little blinded because I launched Cialis, which was the Viagra competitor. So that was a little different because everyone loved that and it was fun and all that. But as soon as, after about 18 months, I did well and they moved me to antidepressants. I remember distinctly going to training and asking at one point when this doctor who's a paid consultant for the company is going over the placebo trials versus the non placebo control and versus the control. And it was literally like a fractional difference. I can't remember. Just it was like a 4 or 5% difference. I remember asking, wait, placebo was this high, this close. And you know, they had their talk track to talk you out of why that wasn't a big deal. But then now we look at that, what, 25 years later and we see the data and the statistics. Deaths of despair at an all time high, depression at an all time high, anxiety at an all time high. All of these things, what we were doing is not working. And you use the words corporate capture, that's what I used in front of my Senate testimony, I quoted Eisenhower's speech where he talked about the military industrial complex. But the second half of the speech, he does talk about the scientific industrial complex. And what happens if we allow the capture of our institutions. We would lose the garage tinkerer, the innovator, the creator. Before we went on air, you and I were just talking about products like HCG that have been off, off, you know, patent forever, but they're getting charged 8, $900 a month. And big pharma still trying to find a way to keep a stranglehold on these life changing treatment modalities for people who are trying to have children or have fertility issues. So my experience was going from a drug rep to then a med device rep. I worked in the operating room with some of the best and brightest surgeons in the world. You also had alluded to we have some of the greatest practitioners. And I agree with that. I think we are really, really good at treating and triaging like major catastrophic events. We are really, really bad at proactive, predictive preventative care, at stopping chronic disease.

[Casey Means]

From developing or even reversing it once it occurs.

[Brigham Bueller]

Right, absolutely. And it's because there's so much money being made off chronic disease.

[Casey Means]

Yeah.

[Brigham Bueller]

And people will try and argue that that's a conspiracy theory. I lived it. I saw it firsthand.

[Casey Means]

Well, unpack that. Like, how is. How is sickness profit making enterprise? It doesn't seem like that's right. There's something wrong just conceptually with the idea that companies are going all the way to the bank with giant bags of cash. And basically the more sickness we have, the better they do. Whether you're a pharmacy company or a pharmaceutical company or insurance company, or a hospital or healthcare company, you only really succeed when people are not well.

[Brigham Bueller]

And the problem is everything pivoted from. I talked about this on Joe's podcast. Originally, doctors knew the family. You know, they came out with their little bag, leather bag. They knew the mom, the dad.

[Casey Means]

I have one of those.

[Brigham Bueller]

That's awesome. And that was healthcare. You took pride and had ownership and accountability of your patient population. And as we pivoted to an insurance model and HMOs, clinicians ability to make decisions and autonomous choices alongside their patients. And those families were severed. And clinicians are now in a system where they have six minutes on average with a patient. And so everything is so siloed and even the way we've become so specific and niche in the way we practice medicine. Casey Means talks about this and does an eloquent job of laying it out. But we don't look at a person holistically anymore. You know, a primary care has six minutes and they're just looking at what prescription drugs you're on. And they reach for the tool in the tool belt and it's. And so I'm not trying to make it as sinister as they're implicitly conspiring.

[Casey Means]

They want to do the right thing. I mean, I remember being coming out of medical school and thinking that I knew everything that there was to know about medicine, that anything that wasn't included in medical school wasn't actually real medicine. It was fringe or quackery or whatever. And we kind of gave lip service to diet and exercise, but it was more like eat well and exercise less and that was about the only thing. Or have a balanced diet, whatever that means. And I remember just realizing I was just handing out prescriptions. I was really good at matching, diagnosing and then matching the drug to the disease. And never once did I go, is this the right treatment for this particular problem? Is this dealing with the root cause or am I just putting a band aid on it? Bingo.

[Brigham Bueller]

And that's the challenge with primary care. Because the way the model's built now, a primary care has a hard time getting to the root cause of chronic disease. And I think I've heard you say this. I've heard a bunch of clinicians say, if you really want to treat the root cause, you first. Or if you really want to treat and prevent chronic disease, you first have to uncover the root cause. You don't treat the symptomology. But we've built an ecosystem that incentivizes profiteers and makes an exorbitant amount of money off of treating symptomology. How does that work? And I can give you real world examples, like if we look at the opioid crisis.

[Casey Means]

Yeah.

[Brigham Bueller]

How I pivoted to becoming an entrepreneur in health care and broke away from being a med device rep was I lost my brother during the opioid crisis. And it was, it was crazy because I had already spun up a pharmacy and was working on my first project where I was going out and educating clinicians on how catastrophic opioids were. And there were so many options that could have prevented these catastrophic deaths. If we look at the failure of our three letter Alphabet organizations like the fda, people have gone through this a million times, so I'll make it fast. But the FDA allowed Purdue Pharma to ramrod a dangerous drug into the market. Not only ramrod, it but gave them the goose that laid the golden egg. Met with Purdue Pharma in a private hotel room, and the head of the FDA signed off saying, this is a less likely to be addictive opioid, which was a fallacy because oxy was eight times more addictive than hydrocodone. And we moved them to oxy. Why did that happen? Because the shell game of big Pharma, people say, big pharma innovates, and they create all these drugs, and that's why we pay so much. America innovates for the world. We do, but it's through taxpayer dollars.

[Casey Means]

And they spend more for marketing than they do for R and D. Bingo. So when you look at the dollars spent by pharma, there's a disproportionate amount spent on marketing, both on television ads, on marketing to doctors, and continuing, quote, medical education conferences, which are I would call continuing pharmaceutical education conferences that are basically funded by. I remember I was on a chairlift and skiing once, and I. And I was sitting next to someone. You're a random person. So what do you do? And we start chatting. I put on continuing medical education conferences. I'm like, oh, really? Who you work for? I was like, oh, I work for, you know, Pfizer Lilly pharma company. Like, wait, wait a minute. These are medical conferences. And you basically set them up, run them, pick the doctors, give them the slides. I literally remember, like, going to a conference and seeing these slides, and I'm like, wow, how did you. And I went up to the presenter, like, these slides are amazing. How did you create these incredible PowerPoints and these slides? Oh, the pharma companies give them to us. And I'm like, what?

[Brigham Bueller]

And then they, they. When they say they innovate what they'll do. And I've saw this a lot. You. When a. When a patent's about to expire, pharma finagles ways to extend the patent. And you can do that a couple of ways. You can find a new indication on the drug. So now all of a sudden, it's gonna be good for anxiety versus depression. And you apply for that new indication, like, you know, a year before to make sure you get it to extend the patent to protect the revenue stream. The other thing you do is you slightly shift the compound. And so like, with oxy and Purdue Pharma, they were gonna lose their. Their goose. That laid the golden egg. Hydrocodone. They push oxy into the market knowing it's eight times more addictive. The head of the FDA at a time gives them that golden goose label. Eighteen months later, the head of the FDA went to go work for Purdue Pharma. So that was step one. The system failed. Step two, what are the checks and balances? We would go out and educate clinicians. At the time, Obama's team had guidelines for opioids and those guidelines said you should pharmacogenetic test. You should do a test to identify is this patient a slow, fast or moderate metabolizer, are they at an increased risk of addiction? Which cytochrome P450 pathway is this molecule going to take in this unique individual? Insurance quit covering that. So that safety net was removed. You were also supposed to toxicology screen, meaning let's make sure this patient is not diverting or transferring the medication somewhere else or abusing the medication. Let's make sure we're not prescribing an opioid to a cocaine addict. Insurance quit covering that. That was gone. So now you're left with one more lifeline, the final lifeline, non abusive, non addictive, topical for any orthopedic related injury. Which is a lot of where opioids start is somebody gets an ACL tear or hurts their back and they're waiting to get in with the doctor and they go on a pain pill. Well, a topical was a solution to subvert and avoid that. Insurance quit covering that.

[Casey Means]

Top of like what?

[Brigham Bueller]

Yeah, like a ketamine based pain cream that could help with an orthopedic knee injury or anything like that. So all those safety nets were gone. The three letter organization that was supposed to protect us colluded with industry. Now let's go to the final piece of the puzzle that nobody is talking about the insurance companies themselves. This isn't me telling you this. This article came out I think in December when Trump was Talking about the PBMs and the pharmacy benefit managers. One of these articles released showed that almost 30% of the profitability of the opioid crisis ended up in the hands of the insurance company's pharmacy benefit managers because they negotiate rebate deals with the pharmaceutical supply company. And so that's the thing I've been ringing the bell on for years because.

[Casey Means]

Somehow this is a backup so people understand what you're talking about. PBMs or pharmacy benefit managers gonna decide on what the formulary of drugs that you're allowed to prescribe are. Whatever your insurance company is, you got it. And then they'll push the ones that they want to push and then they'll get rebates from the drug Companies when they prescribe those drugs.

[Brigham Bueller]

Bingo. The challenge with that is it's tear placement. Right.

[Casey Means]

And they're a middleman. They're kind of.

[Brigham Bueller]

They were supposed to negotiate on behalf of you and me, the average American who is trying to make our prescription medications affordable for our grandmas and grandpas.

[Casey Means]

And.

[Brigham Bueller]

And at some point, they got corporately captured. The buzzword you used earlier. By who? The five big insurance companies. People don't understand. United, Cigna, Aetna, Blue Cross, Blue Shield, CVS Caremark. They control 90% of the prescription drug care in our country. You're going through one of those big five insurance companies to get any prescription drug care.

[Casey Means]

What you're saying is insurance companies own the pharmacy benefit manager.

[Brigham Bueller]

You got it. And they went from negotiating down the cost of drugs to negotiating up the cost of drugs, which sounds insane, but you go, why? Because they wanted rebates. So they go to, let's just say, a big pharmaceutical supplier, and they say, hey, rather than charging me the $130 for a vial of insulin, charge me $300 for a vial of insulin and give me $150 rebate, and we'll hold it at our pharmacy benefit manager company. Does that make sense?

[Casey Means]

Yeah.

[Brigham Bueller]

And so now what we've done is we've aligned the incentives of the insurance companies to profiteer and monetize prescription drug care and chronic disease. So if I'm an executive at an insurance company and a big chunk of my revenue is you being on prescription drugs, and I look at a, you know, a pain cream that's compounded that I don't get a rebate on versus an opioid that I do get a rebate on. Or we can go down dozens of drugs, peptides, you know, like any of these different things. GLP1s. Why is there this GLP1 boom? Why would insurance companies want us to support GLP1s 2? Right. There's a massive amount of revenue. And so the last puzzle piece, just so people understand the flow of the money, because a lot of people listening will go, wait a second. The insurance company still paid for it. Because even if they paid the markup, that's the final fallacy. Most Americans are employed, and their insurance coverage comes from their employer. I employ almost 300 people. At the end of each year, I have to sit down with the insurance companies and renegotiate our contracts for all of our employees. And they say, well, Joe Bob was on a GLP1 all year. It cost us $12,000. We're going to raise your premiums, your CO pays your deductibles, your out of pocket expenses. We can't afford this. But they paid a fraction of what they're showing you on the balance sheet.

[Casey Means]

So they're basically lying.

[Brigham Bueller]

And anywhere else, we call it a kickback. If a clinician gets renumeration directly, indirectly, yes. Overtly or covertly, call the Stark law, you go to prison.

[Casey Means]

If you have a lab and you recommend someone to go to that lab or an imaging center, you recommend someone to go there, then that's called a violation of the Stark law and it's illegal.

[Brigham Bueller]

But they're doing this every day, almost like legalized. And now the average American's on four or more prescription drugs. Right. Chronically riddled with disease and sickness, depressed, anxiety ridden. And you look through the system and it's like from our food that you've done such a good job of educating people on to regulatory organizations, to the clinicians. Unfortunately, the clinicians are hogtied. It's, they want to help. Even covering orthopedic surgery, those are, they're good guys. Like I worked with some of the best guys in the country for orthopedic surgery and they would say, what am I supposed to do? You know, I'm, I come out of med school and then I go to residency and then I go to fellowship. And now I'm in my mid-30s, finally getting a paycheck, and I'm working at an institution where I'm an employee and I got to do surgeries. That's how I make my living. And I got to justify my role at this, you know, hospital system.

[Casey Means]

Yeah.

[Brigham Bueller]

And so I'm not saying they're doing surgeries, they shouldn't, but I'm saying people will absolutely show me the incentives. I'll show you the outcomes.

[Casey Means]

Yeah.

[Brigham Bueller]

To a hammer.

[Casey Means]

Everything's in gastroenterology. We call it scoping for dollars. You know. Yeah, you need another colonoscopy. You know, there it's like, you know, doctors are humans too. And if incentives are misaligned, they're not going to act always. You know, they might think they are, but they might not always act in the best interest of the patient because, you know, it's like they'll get a little extra.

[Brigham Bueller]

And it also puts, almost builds an obstructionist mindset. The age old additive that science evolves one funeral at a time. I really did see that if something new came out that was innovative, let's say a new orthopedic group opened up across town and they're doing something unique. That's cash pay.

[Casey Means]

Yeah.

[Brigham Bueller]

The rest of the community would candidly shit on them and they'd go, oh, that's pseudoscience. Or oh, those guys are a bunch of whack jobs. Because what they're doing was innovative and didn't fit into the insurance model. And it challenged your status quo because you are making decisions off what insurance will cover. Right. And so in so many parts of health care, we're doing not what's best for the patient, but what we can get the insurance company to approve. And the problem with that is the insurance company doesn't give a crap about that. They care about that quarterly earning, that quarterly profit, hitting that number for Wall street.

[Casey Means]

And they're getting it coming and going. Right. So you're getting it through these kind of backroom deals with kickbacks from pharma. They inflate their profits and they're also saying, oh, we can't afford to take care of your cohort of population because they're sick and they're using all these drugs. So then they basically have to raise the premiums, which is pure profit. Yep. And so it's like the more healthcare costs, the better they do because they make a percentage as a fixed percentage that they can get as their profit.

[Brigham Bueller]

Got it. And there's no money in diet, lifestyle, nutrition, sunshine, grounding, being outdoors, taking care of yourself, spending time with your family. The basic bread and butters that. And my thing is knowledge is power. And that's one of the things I appreciate about what you're doing at Function Health. And you know, what we do at our company is we try to look at you and say, hey, let's give you the knowledge and the tools to drive your own health. Take you out of this broken system, take you out of this insurance model.

[Casey Means]

It's such a screwed up system. I mean, I had United Healthcare and now I have Medicare, but I had surgery last fall and I just was sort of stunned at the way in which they handled it. First of all, I needed rehab after I really needed a rehab and physical therapy and I couldn't walk. And it was quite a serious back surgery. They paid for the surgery and they paid for the hospitalization, but they wouldn't pay for me to go to a rehab center to do rehab for three hours a day, for a week or two to kind of get back on my feet. And I was like, wow, you really, you're going to make me pay $7,000 a day to go to a place where I'm doing Physical therapy for three hours a day and staying in a hospital bed and eating crappy food. And I'm like, this didn't make any sense. Thankfully, I could afford to stay in a hotel and hire a private physical therapist to come to me, which was far cheaper than staying in that place. So it worked out in some ways for me. But, you know, I. I just also got a bill for my surgery, and I was looking at it, and it didn't make any sense to me. And I think, you know, this is where healthcare is so screwed up. You know, I got a bill for $140,000 for my surgery and my procedure. You know, $61,000 for the surgery, $11,000 for pharmacy. I don't know what the hell they gave me, what kind of drugs they gave me, but in like two days. That's a lot of drugs. But they didn't get that many drugs, trust me. Then they. The insurance discount was like $129,000, and the final bill was 11,000, down from 140. And then I had to pay a thousand, whatever co pay. But it just was like, this whole system is so messed up. And then, you know, what you get in one place is different than another place. Previous surgery, where I wanted to hyperbaric oxygen after the surgery to heal my wound and to repair faster and recover. And I found a hyperbaric center. And they said, well, yeah, we can come in. I said, how much is it? He says, $5,000 a session. I'm like, $5,000 a session? That's insane.

[Brigham Bueller]

That's crazy.

[Casey Means]

He's like, can I talk to the medical director? And he says, yeah, yeah, that's what we charge Medicare. But you're paying cash. It's $175. So imagine $175 cash versus 5,000 that they bill insurance of which they'll pay 30%. You got it right. And so the whole incentive system, the whole payment system, it's so opaque, it's not transparent. Even though I've been in health care for 40 years, it's still, like, fuzzy. And most doctors have no clue how things work. Yeah. And you've gotten on the inside and see the inside ball of what happens when you have misaligned incentives across pharma, across insurance companies, across hospital systems, insurers. It's like. It's like, really a problem. So how do we start to think about dealing with this? Because, you know, there's really no accountability. There's no checks and balances that. I mean, the price of Healthcare keeps going up and up, and it's true, we spend more than twice as much as any other nation, sometimes three or four or five times as much, and we get far worse outcomes. You know, Cuba, I think is better life expectancy than we do. Albania does, you know, like, it's what. Yeah.

[Brigham Bueller]

Cali talks about Italy, you know, where you drink a lot of wine, eat a lot of carbs, and, you know, he's like, are the Italians healthier than us or is there something wrong in our system? I think one of the things you do is you get proactive, predictive, and personalized. You've got to take sovereignty and accountability over your health and realize that nobody's going to do it but you. If you're expecting the insurance companies or the big pharmaceutical companies to look out for you, you're in trouble. I've said this on a bunch of different podcasts, but if you live the average American lifestyle, you eat the average American diet, you go to the average American doctor, don't be surprised when you get diagnosed with the average American chronic disease. And if we really want to drive Health Span, it starts with taking a look under the hood and doing the deep dive and understanding what's going on with you so you can make those lifestyle changes. But unfortunately, the system's not built to do that. And so if we could get rid of a lot of the things that you and I have fought for with the Maha movement. You know, I know Bobby's talking about, you know, pushing back on the PBMs, like, we should not allow the insurance companies to profiteer off of prescription drug care.

[Casey Means]

Why do there have to be PBMs? Why can't you just get a prescription from your doctor and go to the pharmacy and get it and not have to go through a middleman?

[Brigham Bueller]

I agree. I mean, it's insanity. And I understand, you know, the saying, the highway to hell was paved with the best of intentions. I do think when they started this, the thought was, hey, these middlemen will help us negotiate down the price. But where that gets even more sinister. Just like when we look at when does mega chronic disease happen? Like, when do the big ticket items happen? It's as we age. Right. And so after the age of 65, when you're the taxpayer's problem.

[Casey Means]

Yeah.

[Brigham Bueller]

And so again, we go back to the insurance company, push it off to the taxpayer. They just wait. And so if I knew that, you know, again, Joe Bob is pre diabetic, it's going to be a seven to eight fold increase in the cost of care. If we let him transition to diabetes, why would we not pay for him to see a nutritionist? Why would we not encourage him and treat him with even something as simple as metformin that's been on the market forever and prevent him from transitioning from pre diabetes to diabetes? Because I know in 24 months when he reaches diabetes he's going to switch employers and be somebody else's problem. And then when he has that catastrophic heart attack or the cascade effect that follows, he's going to be the taxpayer problem. And I'm just worried about hitting my quarterly earnings.

[Casey Means]

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[Dr. Mark Hyman]

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[Casey Means]

You're not powerless against cold season and back to school bugs. You can get in control with function.

[Dr. Mark Hyman]

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[Casey Means]

The problem?

[Dr. Mark Hyman]

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[Casey Means]

This is really a key problem you're hitting on, which is that there's a lack of transferability of risk. In other words, there's not a collective risk sharing. And when you have an insurance company, like you said, you negotiate with your insurance company, they're not doing the right things for patients because they're incentivized not to. Because if I pay for a health program where I reverse a disease or I improve people's health or whatever, I mean, I got the benefit because next year you might switch insurance companies. Right. And then. So we need a system where. And I don't know if anybody's really solved this. I've heard some different theories and ideas, but, you know, if we could somehow have a shared risk pool where it didn't matter if you're United or Cigna or Aetna or any of the other big insurance companies, that you would actually kind of collectively share the risk and the reward of getting people healthy. Because right now, you're right. There's no incentive for doing anything proactive or preventive. And I was just kind of talking this morning to a benefits manager for employers who helps advise them on which programs to use and which things to do. And they were like, yeah, they're following the American affordable. I mean, the Affordable Care act guidelines, which is almost no screening and almost no prevention and really reducing the economy, like reducing what you're allowed to do. And they're frustrated because the employers want to have more productive employees. They don't want to pay these high premiums, but they're also stuck in this vicious cycle. So is there any way out of that?

[Brigham Bueller]

I think there is. One of the things that, in my talks with Cali is how do you. With his company, True Med, how do you increase HSA amounts? Right. If we could give the power back to the patient, where the patient or even the insurance company. There's got to be a way to incentivize being healthy.

[Casey Means]

Yeah.

[Brigham Bueller]

Rather than incentivizing chronic disease, can we give tax incentives or quality care incentives that allow patients accessibility to being predictive, proactive, and preventative? And what. I mean, like, if. If we had a. Let's just say a $15,000 a year HSA. Right. Or whatever the number is that you get a tax benefit on, how much chronic disease could we prevent? If it gave somebody accessibility to quarterly blood work, to nutritionist to the ability to go to a gym and then you have all the other items, like red light and all these other things. Choose your own adventure. To each their own. We do know definitively that diet, lifestyle, and exercise are the biggest leading opportunities for us to fix. And we've got to give that sovereignty on autonomy back to the patient. And so many times I've heard clinicians go, well, my patients don't give shit. They just want to. They just want a man.

[Casey Means]

Not true.

[Brigham Bueller]

And I. It infuriated me. It's because they just want help. Yeah, they want help, and they view you as the thought leader and they're asking you for help. You hear, they're asking me for medication. They're asking you for a cure. And if you took the time to talk to this patient and have empathy, if the insurance company would allow you to do this. And that's where HSA.

[Casey Means]

Yeah. Health savings accounts.

[Brigham Bueller]

Yes. If somebody could have $300 to sit with their clinician for an hour and really talk.

[Casey Means]

I think we have this incredible moment to think about this all again and to change what's happening and to educate the American public about some of the challenges with these systems that are filled with perverse incentives and to realign those economic incentives so people do the right thing. You know, the old, you know, Chinese doctors used to get paid when their patients were well, but when they were sick, they wouldn't get paid. Yeah, we might want to think about something like that.

[Brigham Bueller]

Then there's got to be some sort of insurance reform that would allow patients to drive their choice, because right now, patients are driven by the insurance company's selection. Right. So you can't get that MRI if the insurance company doesn't approve it. Yeah, the insurance company's not going to approve it. Somebody made a joke. It's like. It's like doing a rain dance. Jump on one leg, shake a stick in the air and hope that it rains. That's what it's like trying to get anything approved through an insurance company.

[Casey Means]

Take a medication where I was super expensive and I had totally legitimate reasons for taking it. And I had to work with my doctor with writing up long, you know, scientific reports on why I need this and why the indications were there and what my genetics were and why I was like a whole thing. And it was recommended. The letter was written by the. By the physician, and I still got denied. And I even met their criteria, which they say I needed to meet in order to actually get paid for this drug. I was like, they said I'd have to do these things. I did these things. And they still said no.

[Brigham Bueller]

Yeah.

[Casey Means]

So the denial of claims is a huge business.

[Brigham Bueller]

Oh. And what happened is now those denials have climbed, inclined. And the reason the insurance companies do it is they have all these algorithms. They know, they know if they deny a claim that less than 10% of people will dispute it. So now they're, they're, they're like, game plan is deny, delay, depose. Like what, what that kid Luigi wrote, like, terrible message, terrible delivery. What he did was horrible. But it was an example of the frustration of these patients in this country saying, I can't get the care I'm paying for. I can't. Like why?

[Casey Means]

Yeah, while I needed rehab after my surgery with United healthcare, they made $22 billion in profit and I couldn't get paid for a week of rehab after my surgery, which, yeah, just didn't, didn't make any sense to me.

[Brigham Bueller]

It's sad. It's sad. And that's, that is literally. It's not the exception, it's the rule. Which is sad to say, but you're spot on. Like that's, that's just the ecosystem we live in and there's got to be a way to improve it. And that's where I hope that, you know, with everything that you're fighting for and all these folks are fighting for, that there will be that change coming.

[Casey Means]

Yeah, we hope that change is coming. We hope that trains coming down the station, you know, but the forces are right against it, are pretty big. You're talking about, you know, a, you know, humongous industry with so much at stake and so much to lose unless the incentives get aligned. And they are, get, they make more money when they do the right thing. I mean, that's what has to happen. When you do the right thing. You should get paid more. And there are systems like that, like Geisinger Kaiser, which are essentially HMOs or accountable care organizations, where they're internally kind of covering their own patients or both the payer and their provider. So their incentives are aligned. But that's not most of healthcare. That's where we were moving towards in terms of Obamacare, value based healthcare, which is getting paid on results, not getting paid on doing more stuff. Right now, doctors and everybody gets paid. Hospitals, the more surgeries you do, the more procedures you do, the more business you have, the more things you do, the more you get paid, as opposed to incentives that are changing that where you get, let's say you get, you're a hospital system Like Cleveland clinic, you get $20 million a year to take care of your diabetic patients. If it costs you 30, you lose money. If it costs you 10, you make money. Right? Yeah. And so what are you going to do in that situation? You're going to make sure your diabetic patients are extremely well cared for, that their diets are great, their exercise is great, that their medications are properly monitored and tracked, that they're involved in good primary care. I mean, it's not hard to solve these problems. We know how to solve them.

[Brigham Bueller]

And you can see it in every aspect of health. Like another example I can give you is my years as an orthopedic republic. Why do joints have the life cycle they have? You're telling me over freaking 35 years we haven't evolved a joint that's going to last more than seven, eight years? It's because it's a race to the bottom. Every year, the insurance companies pay the hospitals less and less for joint surgery. So every year, the hospitals do more and more joint surgeries to keep up with their overhead and their expenses because they're going to make less off the joint surgery. And then if you were to ask an executive at a hospital, why wouldn't you buy a joint? That's. If we were to innovate a joint that lasts longer, would you use it?

[Casey Means]

Yeah, of course there's not. But that's not what. That's not what healthcare.

[Brigham Bueller]

In their model, there's no incentive now because they'll go, well, I'll get a new joint in eight years. And that's another revenue stream for us. And if the insurance isn't going to reimburse me more for a better joint, and every year they're going to cut my reimbursements by 8%, I'm going to go back to the manufacturer and say, you need to cut my joint price by 8%.

[Casey Means]

Yeah.

[Brigham Bueller]

And then the manufacturer is going to say, why am I going to innovate a joint that nobody will buy?

[Casey Means]

Yeah.

[Brigham Bueller]

And so we go back to that Eisenhower speech. If we allow the corporate capture of our healthcare and scientific institutions, it's essentially a race to the bottom.

[Casey Means]

And we. And we know that things work that aren't paid for, like medically tailored meals for chronic illness. You know, 5% of the Medicare population accounts for 50% of the costs. And if you take those people with heart failure and diabetes and kidney issues and all the chronic things that they pay for and you provided them meals that were designed to treat or reverse or optimize their health that you would save thousands of dollars. In one study in Cleveland clinic, they saved $12,000 just in a small cohort that was given free food. And people say that's a cost over cost. It's a cost to give people. How much is it to give them the medication. And I think people just don't even realize that. I mean, I have one patient whose copay was $20,000 a year. I don't know what her actual pharmacy bill was, but that if you gave her $20,000 of food a year to reverse her diabetes and heart failure, well, guess what? That would be a net savings, right? Yep. And so we know what to do. And there are initiatives out there that work, but you know, they're not being paid for. I mean, we found out that group shared medical visits worked three times as well for the same disease treated by the same doctor at far less cost. And we actually had to use a physician in the process, even though I think it would be equally effective. It was delivered by a health coach who wasn't paid a fraction of what a doctor would be paid. But we had to do it because we had to game the system in order to get reimbursed for Medicare from insurance. We had to bill for a shared medical visit which wasn't even necessary, and we could have achieved the same outcome. So we know that these models are out there. Most of the healthcare system is not incentivized to use these or doesn't leverage them because it's sort of against their own interest. And it makes sense. Why would you act against your own interests? If you were a pharmacy company or a pharmaceutical company and if you're an.

[Brigham Bueller]

Executive at one of those companies and you try. I think you said this at the dinner. I want to say you brought this up at the dinner. One of your buddies at a food company attempted to drive meaningful change.

[Casey Means]

Yeah.

[Brigham Bueller]

And good luck keeping your job.

[Casey Means]

Yeah. Yeah.

[Brigham Bueller]

Because if meaningful change doesn't, you're on such a short timeline and leash to produce for the organization that if profits take a dip at all, chances of you getting to the finish line are slim to none.

[Casey Means]

Yeah, right. There's no long term thinking, right? Yeah. No ten year plan or five year plan. It's like next quarter, what are our earnings? Are we going to make our share holders happy? Who cares if people are sicker and dying? It's like it's a whole bucked up system. How do we hold these corporations accountable? How do we hold policymakers accountable to sort of not perpetuate the Cycle of sickness and the cycle of perverse incentives.

[Brigham Bueller]

You and I just did that testimony, I guess, what, two weeks ago. And I thought the whole time, one of the things that resonated with me, because I've never been political, is Tulsi Gabbard told me at one point, brigham, people think that politicians drive change, people drive change. And it starts with people having a voice. You have to use your voice, because if the people will speak up, the policymakers will act. But it takes people fighting for what they think is right. And you look at what's happened with the health movement and the food movement. These are things you've been preaching for how long? How long? I mean, it's been a while. And there is meaningful momentum right now.

[Casey Means]

Yeah, there is.

[Brigham Bueller]

And. And politicians may get the credit, and. And they. They are this. They are the tip of the spear that are driving this forward. But it's people, people like you, podcasts, people having discussions and open forums and being honest and having integrity and calling people out and asking, why are we not doing these things better? And that's how we start change. It starts with a little spark that becomes a fire, that becomes a movement that's unstoppable. And so I am optimistic that we can drive change. But like we said with medicine, you gotta find the root cause and you gotta start treating the root cause and not the symptoms, because otherwise we're just playing whack a mole.

[Casey Means]

Well, that speaks to the whole food industry and also how they. They're profiting from millions. In fact, what really struck me was when I learned that insurance companies invest in fast food and junk food companies. I didn't know that as a hedge against their profits, because if people get sicker, maybe they think they won't make as much money, but they'll make more money if people are eating more junk food. The whole thing is crazy, right? So back in the 70s, there was. The big tobacco companies were starting to buy the food companies like Philip Morris, Kraft and Phil Altria or. Or Rgierno Bisco, which was another one. And they basically designed these food products to become biologically addictive. And there are these significant tactics they use to infuse, to obfuscate, to muddy the waters, to put out fake science, to deny and deflect. I mean, it's pretty amazing. And it makes the lawmakers confused because they're hearing all this, quote, I would say, pseudoscience about how these products are not harmful, how there's no evidence, how we need to provide safe, affordable food that's Convenient for people who are discriminating and racist and being bad people if we don't offer all this crap to everybody. And it's, I mean, I think today or tomorrow there's a testimony in Arizona on bills that are going to get rid of soda and snap and junk food and snap, which I think is going to be hard to do on a state level, but it's coming from the periphery. Now. I think there's 30 or more states that have bills that are directionally toward fixing these problems. I'm curious to hear what your thinking is about this, because I think, will the states be able to kind of leverage this momentum? Will that drive the change in Washington? Even though you've got someone like RFK Jr. Whether you like him or not, you know, he's, he's beginning to address these issues. You know, the problems at the fda, the problems the nih, the problems with Medicare, Medicaid, the problems with our food companies, the problem with, you know, these, these regulating compounds in food that shouldn't even be there. We have 10,000 chemicals in the U.S. there's 400 in Europe. And you could say, well, you know, some of those 10,000 are lumped together. And maybe it's not 10,000, maybe it's 5,000, but still 5,000 versus 4,000 or whatever it is. It's a lot. And so how do we sort of kind of move forward? Because I feel like we're at this critical time, but it's really fraught with danger, but it's full of possibility.

[Brigham Bueller]

It's jarring. Like, I, I, I knew there would be a counterpunch. I didn't know it would be that big of a counterpunch. Like, even when you and I testified in front of the Texas State Senate, you know, they're telling us that big conglomerates like BUC EE's and H E B, which are legends here in Texas. I grew up in Texas. This is my home state. I love Buc EE's. I love H E B. It's very dish. Disheartening and disappointing to know that they're working behind the scenes to block something as simple as label disclosure. Just label disclosure. And then who testified with us? Grace. Brilliant young girl. I don't know if you remember Grace, but she posted about how the American, I think, was the American Heart Association. I don't want to be, I don't want to quote the wrong. One of these organizations is supposed to be supportive of, you know, health and wellness is, is testifying against these bills. Like, what part of that makes any sense?

[Casey Means]

Well, it makes sense because they're funded by the companies, right? Yeah. I mean, American heart Association gets $192 million from Food and pharma companies. Right. A year.

[Brigham Bueller]

And then I go back to show me the incentives and I'll show you the outcomes. And so it almost goes back to, we have to realign and cut the head of the snake off. And that's going to be policymakers changing the rules. Like, I'm all for a free market. This is America. We should have a free market and free choice. What we have today, though, is the illusion of a free market.

[Casey Means]

Explain what you mean by that.

[Brigham Bueller]

These companies are ramroding your choices down your throat and pretending to tell you that you have the choice. In reality, you know, you don't. If you don't have the knowledge and the accessibility to know what they're feeding you, then how can you make an educated choice? That's not freedom. Freedom would be, tell me what you're putting in my food. Tell me, give me like the real story here so I can make the better choice for my family. To me, it's not freedom if you're gonna hide and mislead the American people on what you're feeding them and their children. Yeah, that's not freedom.

[Casey Means]

No, it's true. I mean, there's such a lack of transparency. And you know, many other countries have front of package labeling and my nonprofit Food fix, it's one of our key efforts is try to get transparent, honest, clear labeling on the front of your food. You can tell what the heck it is you're eating. Is it good for you? Is it bad for you? Is it okay to eat? Is it going to promote health? Is it going to promote disease? It shouldn't have to be a PhD in nutrition science to figure this out. And the way in which the food industry regulates these things is concerning to me. And I heard secondhand, but from a, someone who talked to Robert Califf, who was the former FDA commissioner under Biden, who said, you know, we're working on these front impact labeling guidelines, but don't, don't get your hopes up. You know, it's not going to be what it really should be, even though he was an advocate for real change.

[Brigham Bueller]

And look at what it did. You mentioned that they acquired that Big tobacco, went up and bought big food. Look at how impactful it was to put a warning label on the front of a pack a cigarette. It changed that industry. People looked at that and you, you don't see people smoking Everywhere like when I was a kid in the 80s. In the 80s people smoked on planes like they were. There was everywhere you went, people were chains.

[Casey Means]

Smoking section, that didn't make any sense to me. You got like a little curtain, the smoking section and non smoking section on a plane.

[Brigham Bueller]

And now that's a thing of the past because most, I don't know what percentage of Americans smoke, but it's way less than it was in the 80s, I promise you that.

[Casey Means]

Now there's nowhere to put your gum because in the ashtray and the airplanes anymore.

[Brigham Bueller]

And it's. But that's that to me, nobody's telling Americans what to do and not to do. And I think that's where they start to misunderstand and that's where these lobbyists in these big food industries try to trick the American people. What we're trying to say is let's make you aware of your choices so that you have true accountability and sovereignty over yours and your family's health. And you know when you're being bamboozled.

[Casey Means]

Yeah. And I think, I think front of package labeling is a huge opportunity because it's really not about saying don't eat this, don't eat that. Saying if you eat this, these are the known harms and you choose for yourself whether you want to do it or not. I know ice cream gives me runny nose and I mess up my stomach and I sometimes get pimples, but will I eat it occasionally? Yeah, because I like it. And I know it's going to have an adverse impact on my biology, but I'll do it and I won't do it all the time. If you don't know that something's causing a disease. And I think for most of the American public this is true. I'm shocked at how even educated people, highly educated people, don't understand what's in their food, don't know how to make the right food choices, feed themselves and their kids crap and think it's fine because it's part of our food supply and the government regulated if it wasn't healthy. And other countries, they don't do that. They have warning labels. If you go to South America, there's big stop signs on the front of food packages. I've talked a lot about this in my book Food Fix and Other Places. But you look for example at a Coke, right? Or any soda, it's filled with high fructose corn syrup. It's cheap. You can buy a 2 liter bottle for a buck or two. It's insane how Cheap it can be in some places. When you look at the true cost of that, what is the true cost of that? The Rockefeller foundation did a report called the True Cost of Food, which says that for every dollar we spend on food, there's $3 spent in collateral damage. So just take soda, for example. Wow. You grow the corn, the government pays for that through crop subsidies and basically crop insurance in different schemes. That growing of the corn in that way with the use of pesticides, herbicides and fertilizer cause environmental damage, kill the pollinators, lower biodiversity, destroy the soil organic matter, cause that to be released in the atmosphere, increasing atmospheric carbon, the nitric oxide. It gets released from the nitrogen. Fertilizer also causes climate effects as well as running off into the rivers and streams, causing eutrophication, which is the overgrowth of algae because of too much fertilizer. It sucks all the oxygen out of the water and kills all the fish. And we have dead zones the size of New Jersey and the Gulf of Mexico, or Gulf of America, whatever you want to call it now. And there's 400 dead zones like that around the world. And it's like, that's just one piece, right? So who's paying for all that environmental damage? That's. The society pays for that. We pay for that. Then you have those cheap calories that are artificially cheap getting put into processed food by the big food companies, into fast food foods. And then the government is paying for that again through the SNAP program. So they're paying $125 billion a year for food stamp or food assistance programs. Most of that is for junk food, 10% soda and 75% junk food. And then we pay for it again. When those people who are eating those foods on Medicaid or Medicare get healthy and they get chronic illnesses because they're eating that food, we pay again. So the taxpayer is paying four or five times for the same food product. And if we actually put a price on the coke, it probably would be a hundred dollars when you accounted all for all those things.

[Brigham Bueller]

It's so wild that you're saying that because you're literally describing the same offense that I try to articulate to people with prescription drugs. It's the same thing where most of the drugs innovated and molecules are innovated at the Human Health Services nih. And so those come from taxpayer dollars. And once a molecule reaches a certain point that it has a lot of promise, it's then licensed off and commercialized for pennies to a big pharmaceutical company like the GLP1s, you know, who make billions, and then they mark it up, then they've got to give their cut to the insurance company. Then we, the people who funded the molecule in the first place, who already paid for it once, now have to pay for it not only at the pharmaceutical level, but the insurance level. So we're marked up twice. Now we finally have accessibility to these medications, and it's like. But we're paying for it three times over. And then the rest of the world just gets to have accessibility to those compounds for pennies on the dollar.

[Casey Means]

It's quite crazy. And the FDA is problematic in my view, because some of their funding comes from pharma. And the rationale behind that is that in order to hire the best talent and to expedite the approval processes for devices and pharmaceuticals, we need high quality talent. We need a lot of it to be able to deal with the volume. And so they're offsetting that cost by providing that money. Pharma is to the fda. You can say, well, that's pretty conflicted, and it is. But you could also say that the scientists within the FDA hopefully be independent. They're personally not getting the money, but they're reviewing the science. But it's a little muddy.

[Brigham Bueller]

It's definitely hard because 10 out of the last 11 heads of the FDA went to go work for industry.

[Casey Means]

That's right.

[Brigham Bueller]

And that's a problem. Revolving door syndrome.

[Casey Means]

Yeah. Scott Gottlieb went to work for Pfizer, who was the commissioner of the fda, who was under Trump. So then you have other problems where things that should be approved, that have profound benefit, that don't cost a lot, that can solve problems that nothing else can solve, that have gone through phase three trials and shown better outcomes by orders of magnitude greater than existing treatments. And I'm talking here specifically about MDMA assisted therapy. So you're basically taking a compound that's off patent mdma, you're pairing it with therapies. You're not just prescribing the drug, but you're actually making sure you have a licensed, trained therapist to guide people through the experience in healing. It's dramatically more effective for depression, for ptsd, for anxiety, than any existing medication.

[Dr. Mark Hyman]

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[Casey Means]

Here's the challenge.

[Dr. Mark Hyman]

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[Casey Means]

The result?

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[Brigham Bueller]

In the stats on ibogaine and the future of all this stuff, it's like, pretty impressive.

[Casey Means]

But the point I'm making here is that the FDA denied the approval of MDMA assisted therapy and it didn't make any sense to me because the data was so strong. I mean, imagine, imagine if you have Lipitor that reduces the risk of heart attack by 20 to 30% and then you have another therapy that reduces the risk by 500% or 1000% and it's safe and there's no side effects and it works better than anything else ever discovered. And yet you're not going to approve it. That to me is just the ultimate in corporate capture.

[Brigham Bueller]

Do you think that's, oh, 100% and.

[Casey Means]

The people on the commission were, didn't really understand this drug. They also were very much had been involved with pharma and were conflicted.

[Brigham Bueller]

Oh, and you see all of that time and time and time again with Psilocybin all these different. It, it shouldn't be this difficult to bring a life changing molecule that's available in nature to the marketplace. You know, it's, it's pretty asinine to think like or even what I mentioned, what I started with ibogaine, it was around 8,000 years ago, used on the plains of Africa. You know, these are, these are available by, we call it, God, nature, whatever it is, there's not a pharmaceutical drug on the market that's been researched for 8,000 years. And when you look at the compelling data that, that Dr. Nolan, she's seen at Stanford University, and to do your credit, the MDMA trials and all of it, if we build a system where everybody's incentivized to shut down and prevent accessibility to alternative treatments that are honestly more efficacious than what big pharma is ramroding down our throats. It's the same thing with peptides. You know, people go, well, what happened with these peptides? Why did they get put on a dangerous list? Were there a bunch of side. There were not a bunch of side effects. What happened is Merck has applied for a patent on 200 different peptides. Peptides are the future of big pharma. They are attempting to capture and monetize peptides and they are using their ability to influence and impress upon the FDA to shut down pathways where patients were already utilizing these compounds. We were making BPC for the last five years. To my knowledge, we. Not even to my. We never had a single side effect other than injection site agitation. Like there's not a big catastrophic. This isn't an opioid crisis. What are you talking about?

[Casey Means]

It is a bit strange, you know, it seemed also strange that it seemed to coincide with the, that one of the biggest success stories in pharmaceutical. Which was a peptide.

[Brigham Bueller]

Yeah.

[Casey Means]

Called GLP1 Ozempic. Yeah. Right. Yeah, that's a peptide.

[Brigham Bueller]

And they go, oh my God.

[Casey Means]

And for those.

[Brigham Bueller]

A lot of money here.

[Casey Means]

That's right.

[Brigham Bueller]

We gotta block it off.

[Casey Means]

Yeah. Do you think it was that pernicious? Do you think that, that that's my, you know, kind of conspiracy theory in my head, but that, that all of a sudden there was a realization that there's thousands of peptides that could be turned into drugs. And the reason Ozempic is so expensive or these injectables are so expensive is because of the delivery mechanism, because they have a preloaded auto syringe. But if you actually just look at the peptide itself, it's pennies, right?

[Brigham Bueller]

Yes.

[Casey Means]

It's literally pennies.

[Brigham Bueller]

And we compound GLP1s for pennies on the dollar. And that's a pathway that rapidly Big pharma is trying to shut off. Actually today, I think, is the day that, the D day that if the FDA doesn't make a statement, you will be forced to buy GLP1s from Big Pharmaceutical institutions, which are thousands of dollars a month compounding. Pharmacies were compounding or less.

[Casey Means]

Yeah.

[Brigham Bueller]

Dirt cheap. Like a whole vial for $250 mail, dude. Which allowed you to titrate up and titrate down. It allowed you to customize your treatment plan. It wasn't a one size fits all approach. It was an ability to take the pros of the drug and minimize the cons of the drug. And it allowed patients to have accessibility because in reality, those compounds were meant for sick diabetic people. That's what they're meant for. And they got captured because big pharma does what it does and they go out and they grow the brand. How do you grow the brand? You grow the patient population. And how do you do that? You start having every mom in Malibu take it for spring break. And that's not what that compound was meant for.

[Casey Means]

And there are thousands. These peptides and the dosage that are used in the pharmaceutical versions are far, far higher and potentially with much more side effects than the ones that are used just for therapeutic prevention or for optimization or for other things. And I've used them inhabit various injuries. And it's amazing. BP157. Which you're talking about is a peptide that's been around for a long time. And it's part of what your body makes to regulate your normal functions. I mean, GLP1 is something your body makes. Yeah. But because of the food we eat and because of how we live, it's decreased in many of us. Our appetite's not properly regulated. So a lot of these things, you're just enhancing your body's own system. Right. It's like think about, if you're. If you're going through menopause, you might need a little hormones. If you're an older guy, you might need a little testosterone to optimize your level. It's kind of like that. And I think they're incredibly powerful compounds. And you think under this new administration that they're going to come back and be able to be deregulated like they were.

[Brigham Bueller]

I hope. I'm actually very optimistic on that because I. And we know that, you know, Marty's Dr. Makari's taken over the. As the head of the FDA. Well, if you get, if he procures the nomination, I guess is the right nomenclature. And then you've got Bobby, who's rfk, who's a big proponent of peptides. He's posted about it. I don't know if you saw his tweet. This was when he was running. He said fda, your war on peptides stem cells.

[Casey Means]

I saw that.

[Brigham Bueller]

Red light is over.

[Casey Means]

Right.

[Brigham Bueller]

I have a message for you. Save your records and pack your bags. Which was. That's a bold statement. And so I think the expectation is that we're going to free up and give the power back to the people to have those sovereignty and autonomy accountability over their health. Again. Why should a clinician not be able to talk to a patient, discuss the risk reward? Again, These are short chain amino acids. They've been around since the dawn of time. That's why big pharma is so interested. They're realizing there was a whole article about how big pharma is attempting to capture the peptide market because the risk profile versus the reward profile is way more beneficial than pharmaceutical compounds because you just have a much safer pathway.

[Casey Means]

That's right. I mean, insulin is the original peptide. Right. It's a mini protein. Peptides are just less than 20amino acids.

[Brigham Bueller]

Yep.

[Casey Means]

That's just how we define them. And if it's bigger than 20amino acids, it's a protein versus a peptide. It's just a mini protein. And they regulate. They're like the super highway communication system of your body that regulates so many of your biological functions from your sex hormones to your growth hormone to sex drive to immune function, to tissue repair. So the nerve function. I mean there's just so many that do so many things and we never learned about them in medical school. I mean, we learned about insulin. We kind of learned it was a peptide, but it was like it was a drug. Right.

[Brigham Bueller]

And if you go back to the system like what we were saying earlier, this is at ways two. Well, we use a ton of BPC and we also compound it. It was phenomenal. Like it really. It is phenomenal. It's a phenomenal compound for an orthopedic injury. A knee, shoulder, elbow, you know, something that's been bothering you for years. It does a phenomenal job. And what I saw is even my orthopedic buddies, they were all like, oh, it's pseudoscience. It's not real. Okay, Hammer, everything's a nail. Right? You're this is a threat to your revenue stream. Your pressured to do these surgeries, you need to be doing these knee, shoulder, elbow surgeries. Anything that comes into the marketplace that's a disruptor is immediately met with hostility. And you have to ask yourself, is it because it impacts my practice adversely or is it because I really believe what I'm telling these patients? Because the data is there. People say there's no studies, there's no this, there's. There's all sorts of stuff where BPC regrew spine damaged spines in mice. You know, I mean, I, I provided a dozen plus articles on Rogan. When we went through it, we did a deep dive into bpc because I was such. And this is like four years ago, but I was like, this is a really powerful compound with really compelling data. And China's done a lot of studies in humans. There's fascinating data there. And what we saw anecdotally at, you know, through our clinicians, in our clinician network was phenomenal feedback with no minimal to no side effect profile. So it's disappointing when the FDA makes choices and you gotta scratch your head and go, are those choices? I hate to be conspiratorial, but I just go, there's no way. This choice wasn't made for anything other than the pressure the pharmaceutical companies are putting on you. And the data that they're providing that's skewed to twist your arm to go this way because at the same time, they're attempting to patent all these things and monetize them themselves.

[Casey Means]

Yeah, it's interesting. Even, even N acetylcysteine was considered to be something that should be regulated, which is a supplement that otherwise known as nac, but it helps to boost glutathione, the body's main detoxifying compound. And yet it's something we use all the time in the emergency room. For people who had overdoses, you'd give them, you know, overdose of Tylenol, the treatment to save them from their liver basically dying. And them dying was giving them something called Mucomist, which I thought was a drug. You know, I didn't know when I was training. But it's a natural compound. It's biological compound made of free amino acids. And it's incredibly important for the body's biological functioning. And I'm like, why are they putting this on the kind of not approved list for the fda? Doesn't make any sense to me. So I think there's some weird forces at work and we can't always see what they are. Some of them, the incentives that are misaligned, are obvious like insurance companies or PBMs or sometimes the FDA. But it's like this Gordian nut has to get unraveled because if we don't realign incentives to make it profitable to be healthy, then the system's never gonna work. Right?

[Brigham Bueller]

No, you're spot on.

[Casey Means]

Yeah. And so that's gonna be the challenge. How do we incentivize health versus disease? And there was an attempt through the Affordable Care act to do that with value based care, but it really didn't catch on. And it really didn't kind of work that well because of how it was implemented and because honestly, because even if you're a traditional healthcare system, all you know how to do is traditional drugs and surgery. And so it's hard to create real value, really, truly, to reverse disease and to not just manage it with a bunch of drugs or surgery, but truly reverse diabetes and heart disease. They're big cost drivers. I mean, Cleveland Clinic, there was a woman who was a nephrologist who was running a program on reversing kidney failure using lifestyle approaches, which was amazing because that's not something again we ever learned we could do. And she was seeing it all the time. And yet that wasn't reimbursed. You know, she had to do research, she had to get funding, she had to try to get, you know, donors. And it was just, it was just a hard slog. And yet that's what we should be paying for. So until somehow those incentives get changed.

[Brigham Bueller]

Through.

[Casey Means]

The government actually funding the kind of research that needs to get funded to show these are not only more effective, but cost effective, that I don't think things are going to shift or until we put up guardrails where there's insulation from conflicts of interest on the dietary guidelines and the FDA and on insurance regulators, I mean, the revolving door in government is so big and so wide and it's used sort of like a, you know, just a super highway for people to go back and forth between government and industry. That's problematic. You know, I mean, you got the Dairy Council, which basically has recommended us to have three glasses of milk a day as adults and two as kids. There's no scientific data to support that at all. And when scientists friends of mine from Harvard challenged the Dietary guidelines committee on this, because they were friends with some of the committee members, they said, you know, you're right. And politically we have to do this politically, not from a medical perspective. And the two time Secretary of Agriculture under Obama and under Biden Vilsack Tom Vilsack worked for the Dairy Council in between his agriculture jobs. And the dairy council was the one that put out those ads, Got Milk with the government. There's this program called the checkout program.

[Brigham Bueller]

I didn't know it was with the government.

[Casey Means]

Oh, yeah, the government has these programs to support at the usda, support industry and agricultural products. So the other white meat that was a joint program between the government, paid for by taxpayers and by the pork industry, or the white mustache ads, which claimed all these health benefits for dairy that weren't scientifically validated, was a complete scam and got everybody to drink milk where there was no evidence. And it was the government colluding with industry in the dairy council to come up with these things and promote them. Even the former Secretary of Health and Human Services down in Shalala under Clinton, she actually also had one of these mustaches on. And plus athletes. And they were getting paid a lot of money to do these ads, but there was no evidence. And finally the FTC said, no, this is not truth in advertising. You can't do this. This is illegal. You have to take these ads down. And now you don't see the got milk ads anymore. It's not because they didn't work. I didn't know anything because it was illegal.

[Brigham Bueller]

They went away.

[Casey Means]

Yeah, it's so bad. And the idea wasn't for the government to support to get money from industry and to use its own money to actually promote things that aren't scientifically true, even though that's what they did. Like pork, the other white meat. Really? Yeah. So I think. How do you see us going forward as this new administration sort of gets its foot on the ground? Is there hope? Are we still going to be stuck in this perverse incentive system? Is it so intractable and difficult that it's just not fixable?

[Brigham Bueller]

I mean, I always think. I always have hope. And I think there's the fact we're having the conversation, the fact all these podcasts are talking about it, all the things that you've discussed historically, you know, we're moving the right direction.

[Casey Means]

We're.

[Brigham Bueller]

We're uncovering the root cause now. We've got to treat the root cause so we can stop the symptoms. And that's going to take consistent, persistent action. And us as the people talking and acting with our pocketbooks, you know, we. We can drive change with policymakers. And I think we are. And I think RFK is going to try and he's going to fight, but it's going to require The American people standing behind and fighting for it as well. And we can also fight with our pocketbooks. Look at what happened to Kellogg's after the Senate testimony.

[Casey Means]

Stock went down pretty bad.

[Brigham Bueller]

Yeah. And that those, eventually, if we the people drive change through our pocketbooks, it resonates with these big industries. And at some point they're going to change their behaviors. But part of that is giving the knowledge to the people. And that's where I think platforms like yours and podcast are so important. Because if we can educate the public, they can fight for themselves, they can protect themselves, they can defend their families, while hopefully putting pressure on policymakers to drive policy change.

[Casey Means]

It reminds me of the quote from Margaret Mead, which is, don't believe this small group of highly committed people can't change the world. In fact, it's the only thing that ever has. Right.

[Brigham Bueller]

I love that.

[Casey Means]

And I think you see this with kellogg's. I mean, 400,000 signatures marching on their headquarters in Battle Creek, Michigan, demanding change in the Fruit Loops and other cereals they make to match the same type of cereal they produce in Europe without all the toxic chemicals. It worked because it hit them where it hurts in their pocketbook. And they're going to have to change now. They're not going to want to change. It's going to take them a little time. And we see this starting to happen where around the country there are bills being introduced to get these additives out of food and chemicals out of food. And I think that's going to be helpful. It still could be ultra processed food. So if there's not any focus on the starch and sugar content, I think it's going to fall short. But at least there's some shifts happening where these lawmakers are starting to stand up and go, wait a minute, one third of our state budget is Medicaid. Governors know this, this isn't hurting our state. We could be doing so many other things with this money if we didn't have to pay all this healthcare bills. And so there's this moment where I think there's some shift happening and I see it around the country. And that needs to get accelerated. The fans need to get flamed. People need to call their congressmen, call their senators, call their state lawmakers, advocate for these ideas, ask them to solve them. Tell your stories. It matters. I mean, whenever I talk to lawmakers about what actually moves the needle and what they're going to do, they're going to say, calls to my office. Yeah, you know, that's how RFK got Confirmed. Yeah.

[Brigham Bueller]

I remember Cassidy. Flood of calls.

[Casey Means]

There were 200,000 phone calls to Cassidy's office to confirm him for the HHS secretary. Whether you want him to be secretary or not, whether you agree with him or not, I'm making a point here, is that your voice matters and that our collective voice is very powerful and that things change through these powerful grassroots efforts that then move to the center. And I always say, change doesn't happen in Washington. It doesn't start in Washington. It ends in Washington. When you look at whether it's abolition or civil rights or women's rights or the women's vote or gay rights, whatever it is, that were massive, cataclysmic changes in society, that we all accept it as the norm, they changed because people were like, enough already. You know, I think Cory Booker once said to me, it feels like 1959 in the Civil rights movement in terms of what's happening in healthcare and food systems. And I hope that's true. And I hope we're gonna see in the next four or five years some big shifts, because I think they have to happen. We can't keep doing the same thing. People understand the emperor has no clothes, that we're in this really cataclysmic situation with our health and the economic impact of it. But, you know, it's a $5 trillion industry, and it's not gonna go down lightly.

[Brigham Bueller]

No. And that's where it's gotta be a unified effort. It's gotta be a unified effort. People have to realize chronic disease doesn't care if you're a Republican or a Democrat. It's killing all of us. Like, we have to work together and extend the olive branch and not let big industry divide us. They'd love nothing more than for us to be divided as people and fighting each other. This is. To me, it's not a political thing. This is a humanity thing. So everything you said resonates with me, and hopefully we can keep driving change.

[Casey Means]

Let's go. Let's go. Well, Brigham, thank you for your work. Thank you for being such a clear voice for some of the challenges and problems in the dark alleys of our healthcare system that you're bringing light to, like pharmacy benefit managers, how insurance companies work, the problems with the food industry, the cost of our broken healthcare system, the things that you really have sort of highlighted. It's so important to get these ideas out there, to get people to hear about them, to get them incensed and do something about it. So thanks so much for your work and being who you are.

[Brigham Bueller]

Thank you for having me, for giving me a voice.

[Casey Means]

I appreciate it anytime.

[Dr. Mark Hyman]

When it comes to supplements, you only want the best for your body. The kind with the highest quality, cleanest and most potent ingredients you can get. That's exactly what you'll find at my supplement store, where I've hand selected each and every product to meet the most rigorous standards for safety, purity and effectiveness. These are the only supplements I recommend to my patients, and they're also what I use myself. Whether you want to optimize longevity or reduce your disease risk, or you're looking to improve your sleep, blood sugar, metabolism, gut health, you name it, doctorhyman.com has the world's best selection of top quality premium supplements, all backed by science and expertly vetted by me, Dr. Mark Hyman. So check out Dr.hyman.com because when it comes to your health, nothing less than the very best will do. That's doctorhyman.com D R H Y M A N if you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at DrMark Hyman.

[Casey Means]

Please reach out.

[Dr. Mark Hyman]

I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultra wellness center.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.