so, i'm working on a cistern intake valve, and the guy hands me a locknut wrench. no way! i'm like, what is this, a drainpipe slipknot? wherever your business takes you, nobody keeps you on the road like progressive commercial auto. [ flo speaking japanese ] [ shouting in japanese ] we work wherever you work. now, that's progressive. call or click today. try e-mail marketing from constantcontact. it's the fastest, easiest way to create great-looking custom e-mails that bring customers through your door. sign up for your free trial today at constantcontact.com/try. it was only a few short

months ago that we watched nasa space shuttles head to museums, grounded. it sounds like mankind's trek into space was put aside for a while. but quickly, testing rockets, some have been delivering supplies to the international space station. just last weekend we talked to a couple who may be the first to slingshot around the red planet. one of the guys is elan musk. he says it's future may lie in rockets that could be used more than once. he gave the world the first look at a step in that direction. it's called a grasshopper. this is a test video from this week. the plan is for the rocket to launch a spacecraft out to the earth's atmosphere and flip around, sprout landing gear and return intact on the launch pad. it could make space launches 100 times cheaper.

must also hint at commercial launch sites for rockets like these, which could begin construction as early as next year, incredible. i'm don lemon, thanks for don . thanks for watching. thanks for watching. good night. -- captions by vitac -- www.vitac.com good evening. i'm dr. sanjay gupta. up next cnn films presents "escape fire." the fight to rescue american health care. stay tuned. because afterwards we're going to have a very important discussion regarding what we can all do to live longer and healthier lives and maybe avoid unnecessary costs and procedures. so now, "escape fire," the fight to rescue american health care. in 1949, a forest fire broke

out in montana. smoke jumpers were parachuted in a team of 14 headed by a foreman named wag dodge. the fire exploded, moving over 600 feet a minute, faster than most people could ever run. so 15 firefighters were trapped. wag dodge had an idea. he knew that they would lose the race back to the top of the ridge, so he suddenly stopped. he lit a match, and he lit a fire at his own feet. and the fire spread around him. i imagine the other smoke jumpers thought the guy was crazy, but his idea was this. if i burn the fuel around me, when the fire comes and overtakes me, i'm safe. i'll be in what came to be known as an escape fire. he tried to get the other smoke jumpers to join him, and nobody did. the fire overtook the crew, killing 13 men and burning 3,200 acres. wag dodge survived, nearly unharmed, in his escape fire.

it's just tragic to think of the answer being there, but just in the -- in the moment not able to see it. that's how embedded people get in the status quo. they can't recognize an invention when it's among them, and they can't give up their old habits. we're in mann gulch. health care, it's headed for really, really bad trouble. the answer is among us. can we please stop and think and make sense of the situation and get our way out of it? it's the same challenge. >> we have had enough! >> what do we want? >> health care! >> when do we want it? >> now! >> all i hear is how we're going to give more people access to the present system and how we're going to pay for it. to me, that's not the only issue.

the present system doesn't work and it's going to take us down. we need a whole new kind of medicine. health care reform was a good place to start, but it will do little to address the root problems. we don't have a health care system in this country. we have a disease management system. >> people often think it has to be a new drug or a new laser or something really high tech and expensive to be powerful. they have a hard time believing the simple choices we make in our lives each day can make such a powerful difference. >> we're in the grip of a very big industry, and it doesn't want to stop making money. >> at the executive level, what's most important is meeting wall street's expectations, and they have to. these for-profit companies by law have to serve shareholders. you almost forget that what

you're doing is providing health care. >> the health care system is unsustainable. we're spending almost twice as much in america as any other country on earth. we're really mortgaging the future. not just the health of health care, but the health of the i got to go to work. >> what are you going to do at work? >> what i do every day, buddy. i love you. >> i love you, too! >> bye! >> bye!

>> at a community health center like where i work, you see chronic illness. people that are unable to afford their medications, lots of psychiatric illnesses. >> i think we have about 25 patients for today for dr. martin. i think five or six of them are on the waiting list. >> if they're an easy 15 minutes, i'm sure we can probably squeeze them into the skemg yul. >> hello, mr. fields. let me take a listen to you. all right. who's next? instead of basing things on outcomes, on how good of a job we're doing, the government sets the reimbursement completely on

the number of patients that we see. it doesn't matter how complicated they are, how much time that we spend on them, it's just a number, one, two, three, four, five. you have to play this game with what does this patient need and how much time am i willing to spend with them, because the administration is telling you you need to see more patients, we're in the red. and if you try and buck the system, someone says, what can we do to get your productivity up? i'm not interested in getting my productivity up. i'm interested in helping patients. >> in the year of for-profit medicine, the time allowed for patient visits has shrunk to a point where you've got seven minutes with a patient. >> can you feel this? >> yes. >> barely? >> yeah. >> okay. losing the sensation in your feet is part of the progression of diabetes, okay? >> it could get worse. people talk about two-minute doctors.

literally, 30 patients an hour. things could move in that direction here, and this is not the choice of the doctor. >> as a primary care physician, we're supposed to be the people that are making sure the patients don't get sick and that they have everything that they need to maintain health. but we end up being this revolving door. people come in and you try and fix one thing and they come back for the same thing over and over and over. you just never get to the bottom of what's causing all of these problems that they are having. >> michelle? tell me what happened. >> i just -- >> what were you trying to do? >> i just wanted to just end it. i'm tired of it. i'm so tired of it. >> are you taking your medication? >> yeah. >> a great deal of what's done in conventional medicine is put band-aids on things or suppress symptoms. >> have you cut yourself before?

>> when i was a kid. >> you used to cut? lexapro's the only thing you're on right now? >> mm-hmm. >> this is a problem with a lot of our suppressive treatments. they may keep the disease process going and they may strengthen it over time. it's much better to try to work at a deeper level. >> i'm going to make a phone call and try and get some wheels in motion so that we can get you the help you need. okay? >> okay. >> so, we need the crisis counselor, then. yes, this is dr. martin over at la clinica. i need to speak with the crisis worker. there's no crisis worker at lunchtime? i have an acutely suicidal patient in my office that i need help with. >> she's still taking her l

lexapro, but it's obviously not -- not doing the job. >> where i'm at right now, patients are in desperate need of care. the way that the system is set up, you can't be effective. i became a doctor because i care about patients and working here, i can't help them. to feel that way when you come home is demoralizing. there has to be a different way of doing things. so, i decided to leave. it's hard to say good-bye to the patients. i took care of them and i was responsible for them and just worrying about if somebody else is going to do for them what they need. i want to give to people and i want to help people, and i

wasn't able to find that here. i'm going to go look for it. we spend a spectacular amount of money on health care. the really astonishing part about the fact that we spend more is we have worse health outcomes. [ anouncer ] ihop is in time square to compare new griddle-melts to your usual breakfast sandwich. a lot more flavor. [ anouncer ] ihop's new griddle melts... made fresh and hot! hand crafted just for you. it's like a sexy sandwich. [ anouncer ] compare new griddle melts yourself. just $4.99. it's an epic breakfast sandwich. you name it...i've hooked it. but there's one... one that's always eluded me. thought i had it in the blizzard of '93. ha! never even came close. sometimes, i actually think it's mocking me. [ engine revs ] what?!

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...and we inspected his brakes for free. -free is good. -free is very good. [ male announcer ] now get 50% off brake pads and shoes at meineke. the history of how the american health care system grew is not one of order, it's one of sort of haphazard chaos. >> everybody's doing what makes sense to them individually. we pay hospitals to be full, so they try to be full. we pay doctors to see patients, so they see a lot of patients. we create a public expectation that more is better, which isn't

actually true. so people seek more. everybody's doing their job, we just designed the jobs wrong. >> physicians are well intentioned. even when bad things happen, it's not because people have bad intentions, it's that our system is all fouled up. >> we spend a spectacular amount of money on health care. just sheer numbers, $2.7 trillion per year. the average per capita cost of health care in the developed world is about $3,000. in the united states, it was around $8,000 annually. we spend one heck of a lot of money. >> the health care system isn't affordable anymore. who pays for that? where does that money come from? this is all coming out of our pockets. it's your money. >> the really astonishing part about the fact that we spend more is we have worst health

outcomes. >> if you need real serious technology today, like a complex cardiac surgery, you're lucky to be in this country. rescue care is second to none. as an overall system, no, we're not anywhere near at the best in the world. i mean, look at our results. our life span isn't even in the top 20. >> we have a disease care system, and we have a very profitable disease care system. and the disease care system actually, i mean, if it really was honest with itself, it doesn't want you to die and it doesn't want you to get well. it just wants you to keep coming back for your care of your chronic disease. >> most of this huge effort of the health care industry is devoted to intervention in established disease and the majority of that disease is lifestyle related and preventible.

i mean, to talk about how we shift toward -- away from disease intervention to prevention and health promotion, that requires a massive rethinking about medicine and health care at all levels of society. it has to do with expectations of patients. it has to do with the training of physicians. it will require a huge effort. what's wrong with medical education is that it simply doesn't address whole subject areas that are absolutely essential to understanding human beings, health, illness, and treatment. i mean, an obvious one is nutrition, which is almost omitted from medical education. so, in 1994, i started a fellowship for people who had completed medical school to retrain physicians. >> we want to expose clinicians to a broader way of seeing the patient, a deeper understanding

of healing, and a larger toolbox from which to choose for therapies. >> where are you from? >> i'm from virginia. i actually practice emergency medicine at the university of virginia in charlottesville. >> great, good. >> there have been some trends in health care that make me uncomfortable. i felt like there's got to be something different, something better. >> my medical training was just focused on giving these patients pharmaceuticals or giving them expensive tests to treat the condition after it occurred. i had no knowledge of ways to prevent heart attack or stroke or cancer or things like that. >> i had to do the fellowship, because it was kind of my little ray of hope that things could be better, things can be done differently. and somebody's going to teach me how to do that, so i'm going to do it. >> in western medicine, all of our effort is on dispelling evil. if somebody has an infection, we give antiinfectious agents. if somebody has hypertension, we

give anti-hypertensive drugs. it's getting rid of the bad thing. we do nothing about supporting the good, that the body can and wants to be healthy. both of these approaches are necessary, but it would be great if we had a better balance in western medicine. >> the kinds of interventions that we have come to favor in this country are inherently costly because they are dependent on expensive technology, and that includes pharmaceutical drugs. i think there's some very good drugs out there, i think drug treatment has its place. i take a pharmaceutical drug myself, but if there's one thing that i would love to see you begin to implement in your own practice and teach others about, it's to try to change this mindset that has so completely taken hold in our culture on the part of both doctors and patients that drugs are the only legitimate way to treat disease. i mean, where did that idea come from?

>> we spend $300 billion a year on pharmaceuticals. that's almost as much as the rest of the world combined. $300 billion on drugs. >> in the 1950s, americans took pharmaceutical medication at about 10% of the rate they do now. >> with the commercials on television, why do we need to wait, we can just take a pill right now. >> when i watch the networks, half the ads are for pharmaceutical agents. that isn't true in canada. it's not true in the united kingdom. it's not true in france and germany. the only other country, by the way, is new zealand. new zealand and the united states, the only two countries in the world where you can advertise prescription drugs. what does that do? well, it drives demand. the ads always end with the same phrase, ask your doctor. and people do. and doctors wanting to please their patients will often prescribe it.

he was issued the bottle today with 20 in it and ten are missing. >> okay, i need some help over here. >> what?

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problem in society and the military is no exception. >> this is a national problem for us, you know, we're seeing the military just being a microcosm, i think, of the problems society's having. >> soldiers' use of prescription drugs has tripled in the last five years. >> the army says this is all linked to the rising number of soldier suicides. in fact, more soldiers died last year from non-combat injuries than during war. >> i can see why there's a link between opiates, dependency, misuse, and suicide. i was taking 64 pills a day of combinations of roxicet and oxycontin. there's a contradiction to what we do. you as caregivers are told you've got to keep me paying,

you're going to do that. we have to be mindful to those points in time where you can intervene and say enough's enough. we have to find the right mix of treatments for the guys, and the answers are not in a sack of pills. if it happened to me, it happens to a whole lot more people that are almost invisible to the system. >> being shot this deployment. eight ieds just this deployment. carry a lot of weight because i'm infantry. mountains of afghanistan are not easy to climb, so compressed my back. treated for sciatic nerve, back, l-2, l-3, l-4, l-5, swelling

left side of my brain, and extreme ptsd. >> with ten years of ongoing wars, the amount of suffering that's going on in the military right now is tremendous. when you go over into a war zone where you see your buddies die or you get injured, that's going to tax anybody. and we see that suffering. during the aerovacs of wounded soldiers, the approach to pain that currently exists is to get medications. >> do you have any pain right now? okay, i can see what you can have for pain, all right? he asked for pain medication. >> they don't say how much they gave him. he can have anywhere between five and ten milligrams of morphine. >> i want to see what they've

given him. >> he's sleepy? >> yeah. it's very hard for us as nurses to treat for pain, because there's no thermometer we can stick in and say oh, 7 out of 10 pain. we have to basically treat the patient for whatever they say, and a lot of times patients become so drowsy they are not aware of how much they're taking. >> so uncomfortable and i need to pee again. >> you need to pee? all right. okay. i need some help over here. the patient just fell off. >> did he try to get up without anybody knowing? >> no. he was trying to get up. he just rolled himself out. he's really not listening very well. >> you don't want him to fall again. put him on the bottom on the other side. >> i'm going to check his chart real quick and find out what he got at the casf. >> let me get that jacket away from him.

he's, like, clutching his head. here you go. this is what he's got left. of the morphine. >> he was issued this bottle today with 20 in it. ten are missing. he's taken ten tablets. >> take it away. that's ridiculous. >> he's a little high right now. >> at some point he could stop breathing if he took too much narcotic. we're going to be doing cpr on a patient. at this point, we won't administer the medication. >> take them away from him. >> do you want to do a pill count with me? >> we'll do it at the front. >> okay. ten allotted. okay. this is prazosin. he's got lunesta and also has valium, lortab, naproxen. he has percocet and he has lortab which is percocet. >> i'm not sure what is what.

>> not in there? >> these are all name brand. >> oh. >> the only thing we can do is separate them out, because there's no way for us to tell which is which. >> these are all one person's? >> they are all combined. we don't know what they are. >> where are you coming from? >> afghanistan. >> afghanistan? how long were you there? >> nine months. >> nine months? glad to have you home. do you want to tell me about some of those that you lost? >> a platoon of 23.

came off the mountain with eight. >> came off the mountain with only eight? you've seen a lot. you know, i'm only 34 years old. i can't be having heart problems. well, i went into the hospital, and they told me i had had a heart attack. the patient, presented with

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dark matter is a discovery by astronomers that there is a huge amount of the universe that we can't see. it's not visible, but it's there. we know it's there. and in some ways, i think of a lot of what's happening in health care is kind of dark matter. it's unseen, but it's there and it's very, very powerful. we tend to see just the light of health care, we see the goodness of health care, the potential for helping. when i was at "u.s. news & world report" i wrote cover stories about how great the newest and greatest treatment and pill and procedure was. but, in fact, the more i looked the more i found that there's all this stuff in medicine that we don't think about that is actually harmful. when a team from dartmouth medical school mapped medicare payments, it found disconcerting differences from one part of the

country to another. for example, in 2007, the average medicare recipient in miami tallied more than $15,000 in health care bills, whereas a recipient in minneapolis only cost the government about half that amount. and it wasn't because procedures were more expensive in miami than in minneapolis. the dartmouth study showed that patients in places like miami were receiving more care. more tests, more drugs, more time in the hospital, more invasive operations than patients in other parts of the country even though the patients in miami weren't any sicker than their neighbors. but so what, right? we want more specialists. we want more procedures. we want more tests. or at least we think we do. and that's the problem. because what we think is best for us often isn't. what the dartmouth group discovered is that the patients in the most costly regions where

medicare spent more money on patients, those patients did not have better health outcomes, and, in fact, they were more likely to die. >> if you look at health care in america, you're twice as likely to get your knee replaced as you are in western countries with the same standard of living. you're two or three times as likely to get a heart catheterization or have a stent in your coronaries. we've set up a system that often pushes physicians and hospitals in the entire health care system into doing more. driven by these perverse economic incentives, we are doing a lot of procedures to people that they don't need. to a man with a hammer, everything looks like a nail. >> okay, ready? now you're going to get the scissors.

>> yeah. >> i started getting sick in my 30s. i started having really, really bad chest pain. >> there we go. a flower for you. >> oh, it's so beautiful. >> i just had been ignoring it because i thought, you know, i'm only 34 years old. i can't be having heart problems. but one evening, i sat straight up in bed with the worst chest pain. so, i went into the hospital and they told me i had had a heart attack. i was 35 at the time and was scheduled for open-heart surgery. and i thought, once i get this, i won't have the blockages anymore. they'll actually fix it. little did i know that it was followed by years of the same thing over and over and over again, a heart cath, get another stent. heart cath, get another stent. until my doctor said to me, i don't know what else to do for you. there's nothing else i can do. >> contrary to what most people

believe, getting a stent in your coronary, if you have stable chest pain, will likely relieve your pain, but it will not help you live longer, and it will not protect you from having a heart attack. it only reduces symptoms. and the problem is, some of those procedures will lead to bad outcomes. >> i'd started doing research about where in the united states do i have to go to get the best heart care, and ironically it was only two hours away at the cleveland clinic. >> how are you? >> i am great. look at the thinness. >> i know, you look really good. >> since last year i've lost 21 pounds. >> oh, my god. yvonne came to see me when she was sort of at her wit's end. she had had bypass surgery at an early age. 27 cardiac catheterizations and well over seven stents. this is just an unbelievable

amount of stents and cardiac caths. >> i'm sorry. it's going to get pretty tight. sorry. >> i can't tell you how shocked we were when we saw her first time. because here was a young woman whose diabetes was no well controlled. her clost roll was never well controlled. her blood pressure was never well controlled. if someone had talked to her, i think someone had really teased out her chest pain and shortness of breath, i think many of her cardiac catheterizations and stents would not have been necessary. you have all these stents, and you know, these stents, once they come in they never come out and they're a part of you. now we're kind of dealing with the consequences. >> when you reward physicians for doing procedures instead of talking to patients, that's what they're going to do, is do procedures. >> the vast majority of doctors in this country are paid by a fee for service system. that simply means they get paid

for each office visit. if they are surgeons, they get paid for each procedure. if it's a radiologist, they get paid for each ct scan they deliver. >> if i spent five minutes for you and put in one of these stents, i would get paid $1,500. for me to spend 45 minutes on an established visit with a patient to make sure they are doing their exercise, make sure their diabetes is going okay, and to try to figure out what their true problem is, i'd probably get paid $15. it's a completely irrational system. >> fee for service rewards physicians for doing more. it doesn't reward them for doing a better job. it doesn't reward them for keeping their patients healthy. it rewards them for delivering more care. >> i was trying to figure out

how much yvonne's care would have been over the years. and i think it's well over $1.5 million. but it's more than cost. it's just so much more than money. the psychological trauma of every one of those multiple cardiac catheterizations. every time she had a chest pain, coming into the e.r. unfortunately, there are lots of yvonnes out there. there's the bright blue slush. we have made all of this unhealthy food the cheapest and most available food. people eat what's cheap and what's available. ounds ] ♪ [ watch ticking ] [ engine revs ] come in. ♪

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hello, dr. ross. i am back in the chest pain center with a pretty sick patient, and i'm going to need you to call attending, too. the emergency department is the safety net of health care. we see a lot of the chronic conditions that affect many americans that have gone untreated for sometimes months, but sometimes years. and, of course, the natural end

point is going to be in the emergency department. >> let me just take a listen to you. >> it would be so wonderful if their chronic health conditions could be prevented through effective primary care. >> there's a saying in health care policy that 20% of the patients account for 80% of the costs, and the majority of those costs are when they are repeatedly hospitalized. they are patients with heart failure, they are morbidly obese patients, they are often poor patients, but not always. one of the ways to think about saving money in health care is to focus our energies on that 20% of patients and think about treating those people in a more effective way. >> i just want to review this pain. it's here, right in the center of your chest. okay. and is it still traveling into your neck? >> it's traveling down my arm, my neck, and my head and ears

are buzzing and ringing at the same time. >> what was it, mr. linton, that finally made you say, okay, that's it. i'm going to the emergency department. >> i've been to the emergency department a few times before, and the last time i was having chest pains, not like this. this is a lot worse. they sent me home with them. >> how long ago was that? >> that was, what, a month and a half ago? when i had my first heart attack, did the cardiac catheterization, put the thing up there and put a stent in my heart, because i had a clogged artery, and that worked for awhile. couple weeks, i felt like i was okay. then all of a sudden i started getting chest pains. so here i am going in and out of the hospital to find out what's going on. >> do you have any eating habits that you think -- >> no, i eat the regular food and stuff. >> what's the regular food? >> eggs, sausage, grits, bacon. >> what do you think about that? >> more healthy diet? yeah. >> what do you think about that? >> i would eat it if i had to.

>> if you had to? well, you have a stent in your heart, right? >> yeah. >> all right. and you've had heart attacks. and you're here today with chest pain. >> yeah. >> when do you think it would be good to try it? >> once i found out what was really wrong with me. >> we've become a culture where you drive up, you get what you want, you get it fast, you get it right away, and you drive off. and that being applied to health care just doesn't work. most diseases don't happen overnight. sometimes they are related to lifestyle habits. sometimes it's related to what the individuals actually have access to. >> i have no health insurance. sometimes i go to the hospital and that's the only health care i ever got. i never had a personal doctor, family doctor, nothing, all my life.

i stopped taking my medicine months ago. it's too much. can't afford it. if you go out and buy heart healthy diet food, it's going to cost you more money than anything. >> hippocrates said, "let food be your medicine and let medicine be your food." i think that's a good place to start. as a society, we have to make it easier and more affordable for people to make better lifestyle choices than worse ones. there's the bright blue slush. this is a major reason why we see kids getting fat in this country. let's see what we got here. one of the great contributions of america to world cuisine, you know, fake bread. we take grains and we've turned them into products like this,

which rapidly raise blood sugar, provoke insulin responses, cause insulin resistance and promote weight gain in genetically susceptible people which is most of us. some people, this is all they eat, food of this sort. it's not whole food as nature produces it. it's completely changed food. you know, our grandparents did not eat stuff like this. we have made all of this unhealthy food the cheapest and most available food. people eat what's cheap and what's available. >> mcdonald's put salads on the menu, but turns out the salad is $6, the burger is 99 cents. if you're on a fixed income, what are you going to do for your family? these calories are cheap only when you buy them, but when you look at the overall cost to society of these cheap calories that are so junky, they're really the most expensive. >> it's scary how fast obesity is spreading in our country. obesity leads to heart disease and strokes and diabetes.

>> if trends continue through 2020, up to 1/5 of health care spending or almost $1 trillion annually, will be devoted to treating the consequences of obesity. insurance companies have always been able to regulate the rates they charge. they can pretty much get away with increasing the rates as much as they want to. [ anouncer ] ihop is in time square to compare

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the american health care system, it's generating rivers of money that are flowing into very few pockets, and those are the pockets of the manufacturers of medical devices, the big insurers, pharmaceutical companies, and the owners of those pockets do not want anything to fundamentally change. >> i don't recall any time telling a lie, but i know that there were many times that i didn't disclose full information, and i was the company's chief spokesman. i was head of corporate

communications, which means i was the top public relations officer for the company. when you're in the inner circle of the health insurance company, what's most important is meeting wall street's expectations, and they have to. these for-profit companies by law have to serve shareholders. people go in and out of health plans. they may be a member of a health plan for a year and maybe no longer. you don't necessarily make a lot of investments in preventive care for someone who's not going to be a part of your health plan for a long period of time. it just doesn't work out financially. the only way that you can continue to make the profits that you are expected to make is to charge more for the policies. insurance companies have always been able to regulate the rates they charge. they can pretty much get away with increasing the rates as much as they want to.

you almost forget that what you're doing is providing health insurance. it's all about the numbers and how many millions of dollars, if not billions of dollars, you're earning in profits. in the summer of 2007, i read about a health care expedition that was being held by remote area medical a few miles from where i grew up. i decided out of curiosity to go check this out. all these folks have driven from 400 and 500 miles away waiting to get care that was being provided to them free. the folks who were there were not trying to shirk their responsibilities. they couldn't get insurance. they either couldn't afford it, or they worked for small

employers that had been purged by big insurance companies. it was either come and get care there or not get care at all. and every year they have to turn people away. it was like something that i could never have imagined i'd ever see in this country. and i knew what i was doing for a living was making it necessary for those folks to stand in line to wait for care in animal stalls and barns. i ultimately had a crisis of conscience, because i was not at all proud of what i was doing. i had difficulty sleeping at night. there were even times, honestly, that i looked in the mirror and said, how did you get here? i just could not continue doing what i was doing. >> good morning. >> our forefathers in medicine

were really about patients. it was about a passion for healing. when medicine became a business, we lost our moral compass, and i think we've gotten into a great deal of trouble because of that. >> managing type 2 diabetes can be hard. adding avandia can help. >> there was a drug on the market, avandia. it got fast tracked by the fda. got approved very quickly. it was massively marketed, and by 2006, this drug became the largest selling diabetes drug in the world. we're talking about a $3 or $4 billion a year drug. >> i got my blood sugar under control. >> he really did. can adding avandia help you? >> i was doing a google search, and what i found was a website in the united kingdom where the clinical trials done with avandia were actually partially disclosed.

and what i saw actually made me physically ill. as i looked at trial after trial, there were more heart attacks in the avandia group. it was so consistent. you didn't have to be a statistici statistician, or in the words of my old friend bob dylan, you don't have to be a weatherman to know which way the wind blows. there was obviously a problem. about a 30% increase in the risk of heart attack and related complications. and the company did nothing. they told no one. they did not tell physicians. they did not tell the fda, and they did not tell patients. >> cleveland clinic cardiologist dr. steven nissen decided to do his own review. >> now, the leading cause of death in diabetes is heart disease. 70% of all the deaths in

diabetes are due to heart disease. having a diabetes drug that increases the risk of heart attack by nearly one-third is a

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it's going to catch on fire and burn pretty soon and is going to be unsustainable because of the costs, the military system is already on fire. it is a burning platform and they see this. the costs are going through the roof, and the ability to help these service members and their families recover and repair and come back to a functional life is getting less and less. >> i was in the worst place in afghanistan. it's the most intense battleground that you can ever be in. i lost a lot of good men. still bothers me to this day. i'm 2 1/2 months out of combat. my very best friend from war, he was on narcotics. he overdosed. respiratory shutdown. i lost him.

and from that point on i realized that i don't want to be on this. i don't want to go down the same path. i came to walter reed. i was on valium just for the anxiety. i was on antidepressants. i was on trazodone. klonopin. i was so dependent on my pain medication. this -- medications i was on. you understand? that is how many medications i was on.

when you are injured, they feed you, feed you, feed you all this stuff. it's addictive. it is so addictive. i would rather be shot again than go through withdrawals. coming off that medicine. to have to go through this. >> as we pushed medical innovation to the leading edge of the battlefield and we can save their life, we have guys with horrific injuries and they are getting narcotics for a longer period of time, they are at risk to develop dependency and that's what we are trying to avoid. they established the pain management task force to look at alternatives to narcotics.

. >> very large randomized trials at multiple centers that demonstrated that accupuncture works so we started a study during the air e vacs to walter reid and other medical centers in the united states. >> the question was can we relieve their pain and reduce the medications they are on so by the time they get back, they are not snowed under. >> welcome to germany. you are headed home and you are excited. >> what seems like strange bed fellows, a hard core military actually is an opportunity that they jumped at because of the practicing maddic need and nature that the war his driven them to respond to. >> it wears on your lower back

wearing a 40 pound vest and it got to the point where the pain is back down to my hips and thighs. that's my nightly routine. >> first one is going in. >> how is your pain, sir? >> i feel like i'm warming up a little bit. impressive. impressive for it to reekd that quickly. . >> okay. >> pretty good. >> any pain? >> not when i'm doing that. >> normally you would? >> oh, yes. i don't touch my toes. >> i haven't gotten near my toes in months unless i do this.

>> how are you feeling? >> i have pain, but it's an annoyance. i'm sore. >> how do the needles, how do you feel now? >> i'm chomping narcotics. >> you would? >> oh, yeah. >> you haven't taken anything? >> no. >> that's good. >> 15 years ago, we did a consensus conference at the national institutes of health and asked a question do we have good evidence to show that accupuncture is safe and effective? they said absolutely, it's demonstrated that accupuncture is safe and effective with post operative and injury pain.

15 years later, you can't walk into the average hospital and get accupuncture after an operation. the problem is not that it doesn't work, but we haven't figured out how to get it into the system so that we can make it widely available to the population. >> when you are doing something that never has been done before, it's not universally accepted. with the huge steps and resistance, you have this radical intervention. is it radical to have your chest cut open? give me a break. [ anouncer ] ihop is in time square to compare

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>> in the last few year, a profound change has begun in medicine. >> dr. dean ornish has written about it in medical journals. >> the heart surgeon, we cut people off and bypass arteries and he would say they are cured and they eat the same junk food and smoke and not manage food or exercise and the bypasses would clog open. then we bypass the bypass multiple times. there has to be a better way. i spent more than 30 years of doing studies that showed heart

disease can be reverse and how much we exercise and how much love and support we have in our lives. in our model, the physician acts as a quarterback and here she assembles a team of 500 people. a nurse and a yoga teacher, exercise physiologist, registered dietician and clinical psychologist. when we work at that level, people are much more likely to make the sustainable changes and the patient learns how to empower themselves and transform their lives. >> 25 years ago, i had five restaurants in san francisco. it was a great life. i smoked six cigars a day. ten cups of coffee. a lot of wine. it was wonderful. i had a massive heart attack.

i was in the hospital for two weeks. i could hardly just about walk three steps and i had to stop and rest. i was popping 20 or 30 nitros a day. then dean ornish was starting the program see if i can reverse heart disease. he went to my doctor to see if he could approach me. he told dean how long was the problem. he said it was a year. my doctor said he wouldn't recommend taking me because he didn't think i would live a year. he figured i was going to die because i was in such bad shape. now 25 years later, i'm in pretty get shape. >> we sound after a year the men who made these changes. the physical heart disease improved.

it caused the blockages to be less blocked. that was the first study showing heart disease was reversible, but when you do something that has never been done, it's not universally accepted to say the least. it was a huge amount of skepticism and resistance. you have this radical intervention. like having your chest cut open? you empower people to change their lifestyle. if you can make it reversible, that brings it into the mainstream. as you know, heart and blood vessel disease changes anything more than disease combined. unless people are having a heart attack that 95% who get them or not don't prolong your or prevent heart attacks. we have a model by making changes in diet and lifestyles.

>> now to a new study that shows diet may be a key tool in the fight against cancer. it was conducted by dr. dean ornish who looked at early stage prostate cancer. more than half the men get a test to detect prostate cancer early. lots and lots of men who had a cancer that didn't need to be treated got treated anyway and it caused a lot of harm. >> there is little evidence they make you live longer, but many men think they are incontinent. >> we both wanted to try to bring the clinical testing to this hypothesis that lifestyle intervention can have an important impact on the early stage prostate cancer. i'm one of the busiest surgeons

in in the country, though i don't believe all the men need immediate treatment. you treat them at the first sign of progression. if you can delay treatment, that man is not at risk of side effects in that period of time. >> dr. peter carroll and i collaborated with the doctor who won the nobel prize in medicine and she said stress creates shorter telemers. >> they are at the end of the chromosomes that have our genetic information. they wear down and get frayed. genetic color gets messed up. that prevents tissues from renewing themselves in the body and diseases take hold. >> if bad things will make them shorter, good things will make them longer. we saw if lifestyle changes will

work on the telemers. >> the research found that embracing a low fat vegetarian diet, exercising a half hour a diand taking part in daily stress-reducing activities can change the regulation of genes that are key players in cancer development and contribute to better overall survival. >> the men who underwent lifestyle intervention, the psa rates went down and they were less likely to require treatment. >> the program increased the length and when you change your lifestyle, over 500 genes were affected. turning off the genes that promote breast and prostate and colon cancer. these lifestyle changes not only work as well as drugs, but often better at a fraction of the cost and the only side effects are good ones. . >> the doctor that has the

greatest impact on your health is primary care doctors. >> we're don't have enough primary care clinicians to provide that fundamental level of care.

after i left the clinic, i

joined this new practice. >> how are you? >> they promised me i could make the practice what i wanted it to be. i don't have to see six patients an hour. we are the only clinic in the county. so it's about 20,000 people and we are the only providers for them. >> we are part of the community. all of us live and work here. >> how are you today? >> good, how are you doing? >> good. >> there is a lot of change in me in that transition between the clinic and here. i can act more as a guide for patients, taking the time to educate them and having them understand there choices that they have the power to make for themselves. >> if you have that desire to quit smoking, we will get there. we have work towards that. >> patients really respond to that.

>> did you go to the diabetes education. what did you think about that? >> it gave me more of an individual of what to eat. >> okay. you lost five pounds. >> i quit drinking too. >> how much were you drink something. >> 6 and over a day. for 25 years. >> wow. what made you decide to do that? >> it had to be something to do with my diabetes. >> i'm really, really pleased. you look different. that's rewarding for me. >> i feel different. i had to do something. >> i have to come back in a month or so. >> almost every study says that the doctor that has the greatest impact on your health in general, the greatest impact on the health of a population is primary care doctors. we need them. >> your thyroid is a little bit

big. >> we found ourselves in a position where we don't have enough primary care clinicians to provide that important fundamental level of care. >> when was your last mammogram and pap smear. >> 2008. >> why? we have underpaid on a chronic basis. we have underreward and overrewarded specialty and subspecialties. >> about two weeks ago because of the state budget crisis, we got told that medicare and medicaid reimbursement would be cut by about 25%. per they're got the difference and we are changing the shorter appointments and on track for that on tuesday. >> right now the only way we have to make up the difference is see more people.

>> great. >> that's a little -- it might be a culture shift too for the patients f. they have a relationship with you, feeling trunkated will be a little bit of a change. >> it's a financial necessity. that's the only reason we are making the change. you have to have the time to educate the patients. when they don't reimburse for nutritional counseling, we will talk to them about it still. >> we know there things you can do to make us feel good and we like to do them, but we will do bad if the doors close. . >> over the next two years we will likely go out of business. we are fighting for that not to happen, but it's because there is not the funding going into primary care. it goes to the other areas and it's not sustainable.

>> because of the bottom line and the cuts through the government, if it came to the point where they couldn't pay me, that would suck, but i'm not afraid. i have gotten a lot of inspiration from the fellowship. a different perspective that there is a different way of doing things that is possible. >> did you have a good day today? >> yes. >> i would probably leave health care before i went back to practicing the way i practiced last year. >> i chose to get off all narcotics and medicines. everything. >> take a couple of minutes to kind of arrive. take a breath. >> i'm a red neck. south louisiana boy. old hill billy, you know?

i don't believe in that stuff. eastern medicine. anybody else would laugh. what is that? hold me beer and watch this gator. i decided to give it a shot. >> we going to open up some chi? >> that's the way we look at it. >> because of this program that's here, do yoga. >> i will put the last one in. >> i meditate. it has opened up a whole new world for me. >> i will leave these in for to seven minutes, okay? >> okay. >> it's wonderful. >> a new study finds a growing number of combat veterans are battling mental illness, but many find it difficult to get the help they need. >> post traumatic stress

disorder, ptsd is a reaction to the exposures and experiences of war. war is hell. always hell. >> so you pick your spot. >> if they get a leg blown off, your medic will take care of you. if you have post traumatic stress. as visible as it is, it's as significant as a bullet wound to the head or chest. >> the first thing is to teach you a breathing exercise with a targeted effect on post traumatic stress. inhale. exhale. >> catching it very, very early after their exposure and allowing them to process that is critical in the long-term recovery. >> release the breath in a smooth even stream out. let's go into the medication practice. >> meditation is scary sometimes when you go.

you go to bad places in your head. >> i will be at your side should something challenging come up. >> it's a healing process. you are not bottling it up. it's going to a different section where you can start processing. >> feel yourself there in your safe place. and remember that you can return to this place at any time during meditation. let go of thinking and drop back in awareness and notice how a thought may show up. seemingly out of nowhere or an image may show up and disappear. feel yourself observing all of these constantly changing sensations and thoughts and feelings. recognize that you are this spacious, welcoming, open, awareness.

no matter what thought, no matter what feeling. no matter what sensation or circumstance happens to arise. your arm is heavy and leg is heavy. >> you have done some sweating. >> i was on medication just from nightmares. meditation takes the place of that. >> notice where you are and the people around. >> the pain, it's hard. it's really hard. you have to push through it. this program has just inspired me to press forward.

medication depresses you and makes you think that it's all you ever want to be in. >> we will end with the completing statements. may everyone be well, may everyone be healthy. may everyone be happy. >> if the military is able to successfully integrate accupuncture and meditation and yoga, then we will find that the culture at large will learn how to adopt it and it will have a transformative effect on our health care system. >> ready? >> without financial incentives,

no way i could get to where i am now. thousands by being healthier.

all right, give me a spot. you know my motto: safety first. they could be dangerous. i think we should call animal control. animal control? psh. to be safe... don't worry. i got this. it's a new motto. announcer: you don't have to be perfect to be a perfect parent. there are thousands of teens in foster care who don't need perfection, they need you. >> one company figured out how ho lower health care costs. an idea that received national attention. >> following the example of places like safeway.

>> they're looked for a way to reign in spiraling premiums and hit on a win-win solution. >> in 2005, we had a billion dollar healing care bill rising at $1 billion a year. >> these are the costs of all our drugs in quarter. >> you can see how many scripts. >> what we discovered was that 70% of health care costs are driven by people's behaviors. >> at my heaviest, i was over 200 pounds. i had pizza and comics and dvds and that was the weekend. >> you realized day, i haven't worked out and haven't exercised and you get busy and it's the last thing you are concerned about. >> i was chronically coming down with colds and i knew there was

a history of cancer in my family and diabetes and heart disease. i was a walking dead man. >> i was a business guy and i thought if we could influence behavior of the 200,000 person workforce, we can have a material effect on health care costs. the easiest starting point was in the 30,000 nonunion workforce. i believe within four years, all of our employees will get this plan. all americans have accepted in the insurance industry. the driving record dictates premium and all insurance companies are saying your behavior should drive the premium. health care doesn't need to be immune to that. we provide incentives for people to engage in healthy behavior. the premium starts here and if

you have a bmi less than 30, you get a discount. if you are a nonsmoker, you have a discount. cholesterol and blood pressure under control, you get a discount. behavior is a form ever currency for people to accomplish their lifestyle changes. >> without financial incentives, i couldn't have gotten to where i am now with saving thousands of dollars over a few years by being healthier. >> all we did was develop this culture of health and fitness. >> did you bike to work today? >> i did yesterday and i will do it again on friday. >> if you talk to the employees who lost 35, 50, 60, 100 pounds, they will tell you without a doubt, they have a better quality of life. >> for a longed about of time, i

was hiding and shutting down emotionally. it's a struggle. when i'm running and it's a hot day and feel like giving up, it never fails. i will look up and see a person overweight cross the street. my first thought is that's why i'm running. that person used to be me. you can't say you are interested in the culture of health and fitness without providing a first class jim and a cafeteria that doesn't have calorie counts on it. our approach is holistic. >> the health care companies have remained flat compared to a 30% jump for other companies. >> 20% are no longer obese and they are less a burden on the future because they adopted to this culture of health and fitness. >> you encourage your employees

to be healthier and become more productive and your company is more competitive. i can't think of a single negative in doing this. if i am frustrated by anything, it's that more of the nation hasn't adopted this. >> safeway corporation has been able to bend the cost curve. those things have an impact. >> making money and doing good are not mutually exclusive. >> i lost 120 pounds over three years. even if i lose 30 more pounds which is my ultimate target, my energy level has gone away and i have a long time to spent. i will see my son grow older and go to college and all that fun stuff. >> the limitations of high tech

medicine have never been clear. at the same time the power and the low tech low cost intervention is becoming clear. we can do 1,000 studies with 1 million patients is o and be on the frinchls. it's all about the reimbursement. it's a game changer and we change practice and medical education. trying to get medicare to cover the heart disease program has been the hardest thing i have done in my life. most insurance companies will follow medicare's lead. if they cover it, everyone else will cover it. if everyone covers it, it's a standard of care. medicare will cover a heart disease program.

half of americans will be diabetic or prediabetic. half. if we can prevent it or reverse it, that's how we get true health care and the next time the system is so badly broken. i never looked after a healthy person. maybe it would be easier to take care of people and keep them from getting sick before they actually did get sick.

. if we can begin to change from paying for volume and how much you do to paying for outcomes and how well you do and how well the patient does, that will change the game. people say well, now the money is in health and well being and safety and vitality, not in more and more and more. there answers. we know what safe care looks like. it's not like you can visit it, you can visit a hospital that stopped infections and ending waste slowly. you can visit systems that coordinate care near perfectly.

>> the cleveland clinic was founded by four in addition physicians and realize they did better working as a team than individual practitioners and formed a group practice. they decided that they would pay themselves a salary and the money left over would go back into growing the organization. that model continued to this day. we are all salaried so the decision on what we do is dependent on what the patient needs and not on financial incentives. six years ago before i became ceo, i thought i never looked after a healthy person. maybe it would be easier to take care of people and keep them from getting sick before they actually did get sick. >> how are you? >> how are you in. >> people say it takes a village to raise a child. it takes a village to make an unhealthy patient healthy. it really does. >> she needs a follow-up every

three months. >> people with chronic disease who come in and out of hospitals and ers, they need someone to take an interest and hold them accountable and talk to them on a weekly basis. sometimes it was a daily basis. >> that requires so much work, but we do it because we are committed to having her stay out of the hospital, committed to her living longer and better. >> ddt and pull monhare -- >> we created a different system and the actual for care here is among the lowest in the country yet the out comes and survival rates are at the highest levels. we don't have to spend ourselves into poverty, we just have to do it differently. >> it's really easy to find articles or speeches in which

leaders were calling for change, unsustainable cost and problems in quality, but the economic imperatives are dealing with waste and health care. >> we only give lip service to prevention and we have to ask why as a society we are not working to prevent disease and promote health and how do we shift this huge enterprise of disease intervention in that direction. we need to change the nature of medicine. i hope our new generation of health professionals will catalyze the movement necessary and enough people get aroused enough about the situation and see it for what it is. then start a grass roots movement to change the balance in power. >> what i'm aurging for is not to make things tough on industry, but safe and putting patients first. we have a motto in medicine.

in latin it means above all do no harm. >> if i think about what health care could be like, it would have a lot more care in it. it would be a very different system that probably would be less high tech and more high touch. we have a lot more power over how healthy we are than we are willing to take credit for or willing to take responsibility for. and that is part of what a really great health care system would do. it would empower patients. >> so frustrating to know how easy the answers are. >> the answers are among us and only by accepting the fact that the american health care system is badly broken and the status quo is not working and it's

bankrupting our nation and we would be able to create a sustainable and patient-centered future. >> that's every signature that said you are good to go to get out of walter reid and move on with my travel. right there. going back home.