Aug. 8, 2025

The Silent Crisis Costing Americans Their Health with Dr. Marschall Runge

The Silent Crisis Costing Americans Their Health with Dr. Marschall Runge

Send us a text Healthcare in America is in crisis and Dr. Marschall Runge isn’t afraid to say it. In this episode, we explore how AI, policy, and genomics are reshaping medicine and what it will take to build a system that truly serves people. Is American healthcare built to keep us sick? It’s a question more practitioners are asking—especially with the U.S. ranking 60th in healthy life expectancy despite having the highest spending. In this powerful conversation, Dr. Tamar Lawful sits down w...

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Send us a text

Healthcare in America is in crisis and Dr. Marschall Runge isn’t afraid to say it. In this episode, we explore how AI, policy, and genomics are reshaping medicine and what it will take to build a system that truly serves people.

Is American healthcare built to keep us sick?

It’s a question more practitioners are asking—especially with the U.S. ranking 60th in healthy life expectancy despite having the highest spending.

In this powerful conversation, Dr. Tamar Lawful sits down with Dr. Marschall Runge, CEO of Michigan Medicine and author of The Great Healthcare Disruption, to talk about what’s broken in the system—and the bold changes we must make now. From transforming primary care to incorporating AI and genomics, Dr. Runge offers both a diagnosis and a hopeful prescription for the future of healthcare.

BY THE TIME YOU FINISH LISTENING, YOU’LL DISCOVER:

  • Why U.S. health outcomes continue to decline despite high costs
  • How AI and pharmacists can work hand-in-hand to improve care
  • What sleep, food, and environment are doing to your genes—and what that means for your health

Healthcare doesn’t have to stay broken. This episode will show you what’s possible when we blend science, policy, and human connection.

CONNECT WITH DR. MARSCHALL RUNGE

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  • Loved the episode? Screenshot and tag me @drtamarlawful I’d love to repost your takeaway!


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...

00:00 - Breaking the Healthcare Mold

03:20 - America's $4 Trillion Healthcare Problem

11:32 - Dr. Marshall Runge's Healthcare Vision

16:55 - The Need for Bold Disruption

22:01 - Genetics, AI, and Home-Based Care

27:44 - The Crisis in Primary Care

35:49 - Genetic Medicine's Breakthrough Applications

WEBVTT

00:00:00.861 --> 00:00:10.612
If you read about AI, their goal is to replace healthcare providers in all areas, and I absolutely do not want to have an AI bot as my pharmacist, as my doctor.

00:00:10.612 --> 00:00:13.728
So I think that we have to be realistic about that.

00:00:14.760 --> 00:00:19.413
If you want to break the mold of traditional pharmacy and healthcare, you are in the right place.

00:00:19.413 --> 00:00:26.033
Welcome to the Pivoting Pharmacy with Neutrogenomics podcast, part of the Pharmacy Podcast Network.

00:00:26.033 --> 00:00:27.625
Here's a little truth bomb.

00:00:27.625 --> 00:00:36.253
We're all unique, down to our DNA, so it's no wonder we react differently to the same medications, foods and environment.

00:00:36.253 --> 00:00:48.343
Here's a million dollar question how can you discover exactly what your body needs, which medication, what foods or supplements and which exercises are right for you?

00:00:48.343 --> 00:00:53.654
How can you manage chronic conditions like diabetes without more medications?

00:00:53.654 --> 00:00:57.387
How can you lose weight and keep it off?

00:00:57.387 --> 00:01:04.784
How do you tap into your genetic blueprints so you can stop surviving and start thriving in health and life?

00:01:04.784 --> 00:01:08.950
That is the question, and this podcast will give you the answer.

00:01:08.950 --> 00:01:12.656
I'm your host, dr Tamar, lawful doctor of pharmacy.

00:01:12.656 --> 00:01:19.923
Let's pivot into genomics and bring healthcare to higher levels.

00:01:19.942 --> 00:01:26.912
Hello and welcome back to Pivoting Pharmacy with Neutrogenomics, where we explore the science and soul of what really moves the needle in healthcare.

00:01:26.912 --> 00:01:35.743
I'm your host, dr Tamara, lawful, doctor of pharmacy and certified nutritional genomics specialist.

00:01:35.743 --> 00:01:39.533
Let me paint a picture for you, friends you live in one of the most medically advanced countries in the world.

00:01:39.533 --> 00:01:50.828
If you're in the United States, a place where technology is cutting edge, specialists are world-renowned and billion-dollar hospitals rise like temples in every major city.

00:01:50.828 --> 00:02:01.141
Every year, we pour more than $4 trillion into our healthcare system on medications, surgeries, devices, insurance plans and diagnostics.

00:02:01.141 --> 00:02:23.567
And yet, despite all that investment, all that expertise and all that innovation, if you're living here in the United States, you are statistically more likely to live a shorter life, suffer from more chronic disease and spend more time in poor health than people in dozens of other countries, many with far fewer resources.

00:02:23.567 --> 00:02:26.611
We're not just spending more.

00:02:26.611 --> 00:02:38.566
We're getting less Fewer preventative solutions, more medication dependency and growing gaps in access to care, especially for marginalized and rural communities.

00:02:39.367 --> 00:02:45.587
Something isn't adding up, and today's guest, dr Marshall Runge, isn't just asking why.

00:02:45.587 --> 00:02:48.040
He's actually offering a way forward.

00:02:48.040 --> 00:02:56.302
He's the CEO of Michigan Medicine, a physician, scientist and the author of the Great Healthcare Disruption.

00:02:56.302 --> 00:03:05.150
He's led all the intersection of clinical care, genomics, technology and health policy, and in this conversation, he doesn't hold back.

00:03:05.150 --> 00:03:19.686
We're talking about why the united states has fallen behind in health, life expectancy, what it really looks like to disrupt a broken system, and how ai, precision medicine and, yes, even sleep are reshaping the future of care.

00:03:20.087 --> 00:03:24.866
Plus, marshall shares the real life story that inspired his medical thriller coded to kill and what it revealed about electronic health record security that every Plus Marshall shares.

00:03:24.866 --> 00:03:30.931
The real-life story that inspired his medical thriller Coded to Kill and what it revealed about electronic health record security that every provider and patient should know.

00:03:30.931 --> 00:03:40.943
So if you're ready to stop accepting the system as it is and start imagining what healthcare could look like when we raise a script, then you're in the right place.

00:03:40.943 --> 00:03:45.762
Listen in, marshall.

00:03:45.762 --> 00:03:48.816
Thank you for joining us on Pivoting Pharmacy with Neutrogenomics today.

00:03:48.816 --> 00:03:50.944
I'm so excited to dive into our conversation.

00:03:51.608 --> 00:03:56.144
Well, it's great to be on your show, Tamara, and I really appreciate it and look forward to speaking with you.

00:03:56.465 --> 00:03:57.045
My pleasure.

00:03:57.045 --> 00:04:04.590
Now I want to start with your story, because behind every transformation is a person who saw what others didn't see, and you've had a remarkable journey.

00:04:04.590 --> 00:04:06.734
Physician, researcher, ceo.

00:04:06.734 --> 00:04:11.625
What was your original vision stepping into your leadership role at Michigan Medicine?

00:04:12.266 --> 00:04:26.867
I've been in Michigan for 10 years now and the big attraction for me coming to Michigan in addition to the football, of course was the breadth of research, the breadth of education and clinical care, everything from primary care to the most advanced coronary care.

00:04:26.867 --> 00:04:29.872
But the opportunity was twofold.

00:04:29.872 --> 00:04:33.283
One was to help link those areas together.

00:04:33.283 --> 00:04:36.389
So 10 years ago, how much genetic medicine was there?

00:04:36.389 --> 00:04:41.891
There wasn't a lot of medicine around genetics, but we had that platform and I thought that was very exciting.

00:04:41.891 --> 00:04:56.053
We also, I'd have to say, michigan had been a great place for a long time and had gotten maybe too comfortable and I felt like we needed to work together and there were things that we could do and accomplish that few other places could.

00:04:56.053 --> 00:04:59.730
So it was an exciting time to be here with great people to work with.

00:05:00.259 --> 00:05:00.761
I love that.

00:05:00.761 --> 00:05:10.216
Now was there a defining moment that actually made you realize that the healthcare system wasn't just in need of improvement, but it needed a bold disruption.

00:05:11.180 --> 00:05:21.992
Well, yes, I've been thinking about this for several years and then, about a year and a half ago, forbes Books contacted me and they said was I interested in writing a book with him?

00:05:21.992 --> 00:05:23.442
And I said, sure, what do you want me to write about?

00:05:23.442 --> 00:05:24.365
And they said healthcare.

00:05:24.365 --> 00:05:26.310
And I said what about healthcare?

00:05:26.310 --> 00:05:27.593
And they said whatever you want.

00:05:27.593 --> 00:05:36.048
And so, as I started thinking about it, I realized that, while there's so much great about healthcare in the United States, there also is so much that needs to be done.

00:05:36.769 --> 00:05:44.788
And, to take a little bit of a tangent, everyone knows that healthcare in the United States is very expensive it's the most expensive of any of our peer countries.

00:05:44.788 --> 00:05:54.300
But when you look at outcomes and one of the outcomes that's measured is a healthy average life expectancy so it's not just how long you live, but are you living a good life?

00:05:54.300 --> 00:06:00.555
And we rank currently, shockingly, 60th in the world among nations.

00:06:00.555 --> 00:06:15.033
And if we don't change some of what's going on and I think some of that can change, through nutrigenics, for example if we don't change some of that, the epidemiologists say that we'll be 110th in the world or 120th in the world by 2050.

00:06:15.033 --> 00:06:23.689
So I thought, man, this is a time that we need to think about how to positively disrupt the way that we think about health and think about this.

00:06:24.791 --> 00:06:34.769
Indeed, if we're in the 60s, for a country like the United States to rank so low and then potentially in the future even rank lower, there definitely needs to be some change.

00:06:34.769 --> 00:06:40.896
And you know that sense of boldness is something you really do bring to life in your new book, the Great Healthcare Disruption.

00:06:40.896 --> 00:06:42.901
So I want to unpack some of those ideas.

00:06:43.302 --> 00:06:44.103
That sounds great.

00:06:44.103 --> 00:06:45.625
Okay, thank you for the compliment.

00:06:45.846 --> 00:06:47.930
You are welcome Now, marshall.

00:06:47.930 --> 00:06:52.144
In your book you explore how technology policy and innovation are converging.

00:06:52.144 --> 00:06:58.122
But disruption isn't always straightforward, so you titled the book Great Health Care Disruption.

00:06:58.122 --> 00:07:02.612
What does that disruption look like to you right now?

00:07:02.612 --> 00:07:04.411
I mean, what changes are truly reshaping care?

00:07:04.411 --> 00:07:05.500
Well, some of what changes are truly reshaping care?

00:07:06.040 --> 00:07:18.418
Well, some of the changes that are reshaping care are rapid advancements in genetics and genetic medicine, in AI, the ability to do healthcare in different locations.

00:07:18.418 --> 00:07:41.827
Where people think about healthcare, they have to go to the doctor's office or they have to go to the hospital and be able to deliver the highest quality health care at home and keeping people out of the hospital, because it is both a comment and it's also valid that going to the hospital is not a good thing for people and they can acquire hospital and acquired infections, etc.

00:07:41.827 --> 00:07:51.591
I think one last comment I'll make is another thing that distinguishes us from countries across the world is the cost of healthcare.

00:07:51.612 --> 00:07:59.744
in the United States, we're the highest of any of our peer countries and I think there are lots of reasons for that and we can go into that if you'd like.

00:07:59.744 --> 00:08:05.951
But if you look at the amount of primary care and preventive healthcare in the United States, we're like at the bottom.

00:08:05.951 --> 00:08:11.341
So the amount of primary care and preventive health care in the United States, we're like at the bottom.

00:08:11.341 --> 00:08:20.425
So the number of primary care physicians per capita in the United States is lower than all of our peer countries, and I am a believer that the more we can do to improve health, that is the solution to our cost of health care.

00:08:20.425 --> 00:08:37.470
So if we get healthier, then we don't need to go to the emergency room, which is very expensive and inconvenient, or be admitted to the hospital, and we can prevent a lot of that by doing things that will improve our health, and there's a broad portfolio of those health and put more funding into that versus the acute.

00:08:37.490 --> 00:08:56.225
When someone actually has a diagnosis, then we're putting all the money into that and we rely a lot on medications when it comes to that point.

00:08:56.225 --> 00:09:03.445
But you also bring up a great idea of health care in the home, because we know, as you mentioned, the increased infections in a hospital setting.

00:09:03.445 --> 00:09:23.960
Also, there's a stress factor associated with being in the hospital and that stress impacts the ability to get better, to heal, so they can have prolonged stays in a hospital as a result of that, in addition to increased risk of infections among a whole bunch of other issues that they are exposed to in a hospital setting.

00:09:23.960 --> 00:09:28.371
So I definitely like the idea of pushing for health care at home.

00:09:28.371 --> 00:09:36.313
Now let's go into you mentioning reasons why you think that we are not focused so much on the preventative.

00:09:36.961 --> 00:09:44.234
Yes, and I completely agree with you and what you just said about there are ways that we can make our health care better.

00:09:44.234 --> 00:09:47.740
And what you just said about there are ways that we can make our health care better.

00:09:47.740 --> 00:10:01.551
So I think it's partly because our medical students and our other health care people training in health care, in all areas of health care, are reluctant to train in primary care once they learn or once they see what we see in terms of primary care.

00:10:01.551 --> 00:10:10.581
And so, to give you an example, about a quarter of our medical school class comes in and they are really invigorated, really excited about going into primary care.

00:10:10.581 --> 00:10:13.086
They see the value by the time they graduate.

00:10:13.086 --> 00:10:14.890
It's less than 10%.

00:10:14.890 --> 00:10:21.893
And what I mean in terms of primary care, it's family medicine, pediatrics, ob and general internal medicine.

00:10:21.893 --> 00:10:23.722
And why is that?

00:10:23.722 --> 00:10:37.929
Well, part of that is they're being trained in a big quaternary medical environment and for people that love primary care and want to see how they can change lives, that's not where they change it.

00:10:37.929 --> 00:10:49.989
It's in communities, whether it's in urban communities or in rural communities, and we and a lot of other medical schools have not been training our primary care students in those areas.

00:10:49.989 --> 00:10:53.846
So we need to change that, and we are changing that, and other medical schools are as well.

00:10:54.687 --> 00:10:57.442
The other has to do with debt and compensation.

00:10:57.442 --> 00:11:08.624
So primary care is the most poorly reimbursed part of medicine, and for your average medical student, it's very common for people to have debt of more than $200,000.

00:11:08.624 --> 00:11:23.248
I mean maybe not in the expensive real estate markets in the United States, but a lot of places that's the cost of a house, and they're worried about how are they going to pay that back if they don't get paid well, so I think we need to look at compensation also.

00:11:23.248 --> 00:11:33.552
I'll tell you, though, I've had experiences in the last several years that have absolutely convinced me that if we get our students into the right environment for their training, they're going to love it.

00:11:33.552 --> 00:11:38.288
The primary care doctors who are working in those environments are, so they're inspiring.

00:11:38.288 --> 00:11:39.871
I mean, they truly are inspiring.

00:11:39.871 --> 00:11:41.062
This is coming from a specialist.

00:11:41.062 --> 00:11:42.123
I'm a cardiologist.

00:11:42.123 --> 00:11:48.011
I might get kicked out of being a cardiologist if I keep telling primary care, but I really do think it's important.

00:11:48.572 --> 00:11:59.831
Indeed, you bring up some great, great points as to why that focus isn't there right now, on the preventative, and those are, I believe, changes that, if made, will make a huge difference in a healthcare system.

00:11:59.831 --> 00:12:07.474
Now, with all this change, marshall, is there an old school part of medicine you think we actually need to protect and keep?

00:12:08.179 --> 00:12:08.701
Absolutely.

00:12:08.701 --> 00:12:13.812
I'll jump to maybe one of the most exciting and controversial areas, and that's AI.

00:12:13.812 --> 00:12:37.389
If you read about AI and if you talk to people who are really into AI, their goal is to replace health care providers, whether it's doctors, nurses, pharmacists in all areas, and I absolutely do not want to have an AI bot as my pharmacist, as my anything, as my doctor, and so I think that we have to be realistic about that.

00:12:37.389 --> 00:13:01.613
And right now, for example, I've got a chapter in the book where I talk about medications and in pharmacy, and I think and this is a little bit of a throwback I think having pharmacists who interact with the people that they're providing medications for, and can give them advice and you train in that and you have such great advice that I think that can be so powerful.

00:13:02.299 --> 00:13:03.903
What we do in Michigan.

00:13:03.903 --> 00:13:07.393
We have pharmacists who round with us in the hospital and it's invaluable.

00:13:07.393 --> 00:13:16.626
But you don't see that in an ambulatory setting, and if you go to your local drugstore, the poor pharmacist is like cranking trying to get the medications filled.

00:13:16.626 --> 00:13:39.066
And so I guess what I'm trying to say is, I think, rebuilding that personal connection between people who need healthcare, need medications, need other kinds of healthcare, and the providers can really change the way that health care is provided in the United States, and it looks much like that in some of these countries that do so well with health care, because, I mean, somebody gets advice from me, they think, well, he's a doctor.

00:13:39.066 --> 00:13:49.562
But if they get advice from you or they get advice from a social worker or they get advice from a therapist, that all builds and people, I think, will really embrace it.

00:13:49.582 --> 00:13:51.222
Right, I agree with that.

00:13:51.222 --> 00:13:51.643
I love that.

00:13:51.643 --> 00:14:04.408
You said that you need that human connection, that personal connection that is actually part of the healing process when it comes to health, and AI cannot replace that whatsoever.

00:14:04.408 --> 00:14:18.592
I am aware of nurses who would just go to like chat, GPT and ask questions instead of calling the pharmacy I work in a hospital setting still or they'll go get the answer and then they'll call us and see what we say.

00:14:18.592 --> 00:14:20.933
So it's very interesting.

00:14:20.933 --> 00:14:33.298
But from a patient to practitioner dynamic, not having that personalization, that one onon-one, there's nothing that can really truly replace that whatsoever.

00:14:33.298 --> 00:14:35.219
So it's definitely needed in healthcare.

00:14:35.219 --> 00:14:43.092
Now, one theme in your work, Marshall, both in the book and in your leadership, is how we move from one-size-fits-all medicine to personalized care.

00:14:43.092 --> 00:14:45.541
So let's explore that a bit deeper.

00:14:45.541 --> 00:14:49.230
The future of medicine seems to be in our DNA, literally.

00:14:49.230 --> 00:14:52.407
But how do we get from data to decisions?

00:14:52.407 --> 00:14:57.322
Are there any clinical applications of genetic data that you're seeing emerge right now?

00:14:58.163 --> 00:15:03.120
There are and I think we'll see much, much more of it and I think it's so important.

00:15:03.120 --> 00:15:15.835
So we've been precision health or personalized health for 15, 20 years now, but I think these tools are really coming to the forefront now and I'll give you a couple of examples.

00:15:15.835 --> 00:15:18.061
So one is in developing therapies.

00:15:18.663 --> 00:15:33.027
There are quite a number of genetic diseases in children that are really debilitating or lethal, that a child might only live to be three or four or five years old and never have a well environment.

00:15:33.528 --> 00:15:38.043
And fortunately these are rare and they sometimes fall into what are called orphan diseases.

00:15:38.724 --> 00:15:54.653
But in the last several years there have been five or six genetic therapies that have been developed, tested and approved such that a child with one of these rare diseases can receive an mRNA therapy that will actually go in and correct.

00:15:54.653 --> 00:16:02.530
I won't go into all the mechanisms of it, but it corrects the abnormal gene sequence and removes it.

00:16:02.530 --> 00:16:15.692
And the data that we have is from clinical trials, the longer term data, but it's out to about 10 years that children who might have not lived past two or three years old now are totally normal at 10 years Now.

00:16:15.692 --> 00:16:17.705
Will they be normal when they're my age?

00:16:17.705 --> 00:16:23.327
I'm not saying I'm normal either at my age, but when they get to older ages we don't know yet.

00:16:23.327 --> 00:16:25.852
But what we do know is it changes their life.

00:16:25.852 --> 00:16:27.643
So that's one example.

00:16:27.643 --> 00:16:41.399
The other is and I know this is an interest of yours and I'd have to call it an emerging interest of mine I'm not an expert in this, but thinking about our environment and how it impacts our genes and how they're expressed.

00:16:41.799 --> 00:16:44.201
And so nutrigenomics is one example of that.

00:16:44.201 --> 00:17:05.450
But there are all kinds of things that we now appreciate that, for example, some of the food we eat, the highly processed food that is high in sugar and salt and lipids and cholesterol, those foods actually cause changes in which of your genes are expressed, and it's a field that you probably know a lot about, called epigenomics.

00:17:05.450 --> 00:17:12.332
But it's just fascinating, and more recently I've learned and I talk about it a little bit in the book is things that you wouldn't think about.

00:17:12.332 --> 00:17:17.781
So of course people would think well, exercise, regular exercise, will change gene expression, and it does.

00:17:17.781 --> 00:17:34.246
But the one that really caught me by surprise was regular sleep, and so it's now known that the more I won't say regimented, but the more consistent you are with sleep, that the more I won't say regimented, but the more consistent you are with sleep, go to bed at about the same time, get up at about the same time and get whatever you require.

00:17:34.246 --> 00:17:35.188
I don't know what you require.

00:17:35.228 --> 00:17:37.553
For me it's seven and a half or eight hours of sleep.

00:17:37.553 --> 00:17:41.230
That results in a genetic reprogramming.

00:17:41.230 --> 00:17:42.758
It doesn't change the gene sequence.

00:17:42.758 --> 00:17:48.390
What it changes is which genes are being expressed, and we kind of know that.

00:17:48.390 --> 00:17:52.203
You know if you get on a good sleep trajectory, you feel so much better.

00:17:52.203 --> 00:18:00.586
But it does affect genes that help with health, amplifies those, those that are damaging to you.

00:18:00.586 --> 00:18:02.128
It suppresses those.

00:18:02.128 --> 00:18:04.354
So we're learning about this.

00:18:04.354 --> 00:18:19.251
I think the next five or 10 years are going to be just incredible with what we learn, and one of my missions is that people will start thinking about that now, because we don't know it for every disease and there's so much stuff in the medical literature it's hard to sort out.

00:18:19.251 --> 00:18:28.903
So I think it's a tremendously exciting time as we understand how we in our genes, our unique genes, interact with our environment.

00:18:30.007 --> 00:18:32.972
I'm excited to see that and it's picking up.

00:18:32.972 --> 00:18:40.363
The interest in the use of genomics, the application of it, is picking up.

00:18:40.363 --> 00:18:55.011
But I know there's a lot of privacy concerns related to genetic information, especially what we've seen going on now with 23andMe, and also unequal access, because it's not necessarily an inexpensive test, these type of tests.

00:18:55.011 --> 00:19:04.902
So how do you think that these pitfalls can be avoided the unequal access or the privacy concerns while we're still pushing innovation forward?

00:19:05.423 --> 00:19:24.866
Well, I think access is such an important issue in all of medicine and people that don't have access whether it's because they live in an environment and just don't have enough doctors, or they don't have insurance, or they're on Medicaid or something that some doctors don't accept we have to fix that access problem.

00:19:24.866 --> 00:19:34.451
What I talk about in the grand healthcare disruption is I really firmly believe that the United States needs some basal level of government-sponsored healthcare.

00:19:34.711 --> 00:19:36.282
It doesn't have to be the gold plate special.

00:19:37.005 --> 00:19:43.326
And when you look at countries that get so highly ranked in healthcare, all of them have some basal level.

00:19:43.326 --> 00:19:49.348
And I mean, I've been here about Denmark forever about how great healthcare access is there and it is.

00:19:49.348 --> 00:19:50.992
They do have great health care access.

00:19:50.992 --> 00:19:58.713
But I think we have to realize that in addition, 40 or 50 percent of the people in Denmark also have supplemental private insurance.

00:19:58.713 --> 00:20:08.669
So you know, we shouldn't fool ourselves that we in the federal government can provide health care at a very, very high level, but it can provide health care so everybody gets access.

00:20:08.669 --> 00:20:13.852
I don't know if we'll get there, but it's been batted around for my entire career.

00:20:13.852 --> 00:20:19.108
So that's the access part is one issue In terms of the cost.

00:20:19.108 --> 00:20:25.970
We're currently starting a program at Michigan Medicine where we're going to do whole genome sequencing.

00:20:25.970 --> 00:20:27.381
So you know what that means.

00:20:27.381 --> 00:20:43.060
But for your listeners that means not just the genes that code for a protein, but those genes that affect the expression of those proteins, and that cost has gotten amazingly down to about $250 for a whole genome sequence now.

00:20:43.622 --> 00:20:48.430
And contrast that to when the human genome was sequenced in about 2000,.

00:20:48.430 --> 00:20:51.714
$3 billion for one human genome.

00:20:51.714 --> 00:20:55.290
So you know it tells you how technology is advancing so rapidly.

00:20:55.290 --> 00:21:29.868
The final thing you mentioned, which is one I feel really passionately about, is privacy and PHI protected health information and this has been something that has been, I would say, a achilles heel in health care and there have been many, many breaches where people's private information, whether it's and then I think in the future it will be your genetic sequence, but it includes all kinds of things your your name, age, phone number, everything a person needs to obtain a credit card that has your name on it and they're spending money on.

00:21:29.868 --> 00:21:41.030
So there are now and I will tell you what we use there are now AI programs that are fantastic in healthcare and they screen.

00:21:41.030 --> 00:21:47.625
At Michigan, they screen every single health record, which is now about 5 million health records we have every single day.

00:21:48.386 --> 00:21:53.914
And if your health record, if your physician has looked at it, that's fine.

00:21:53.914 --> 00:21:58.131
If a therapist or a consultant has looked at it, that's fine.

00:21:58.131 --> 00:22:05.806
But if someone who has nothing to do with your health care looks at it, it's flagged immediately, immediately, meaning real time.

00:22:05.806 --> 00:22:32.986
And since we started using this, I'll tell you, at the University of Michigan, when I first came here, we had over 100 really inappropriate access to health information and once we implemented this, it is down well below 10 per year, and I'd like to see us at zero and we'll keep working on it per year, and I'd like to see us at zero and we'll keep working on it.

00:22:33.006 --> 00:22:34.631
And actually I think the more we tell people it is.

00:22:34.631 --> 00:22:37.721
It is a felony to look at somebody else's health record if you don't have anything to do with it.

00:22:37.721 --> 00:22:46.531
I think it's an ongoing process, but you're right, we don't have it fixed yet and we need to have it fixed or people won't be confident in releasing their health information.

00:22:47.079 --> 00:22:47.902
Yeah, that is so true.

00:22:47.902 --> 00:22:55.931
That's one of the challenges I have with the program, the health coaching program I have, because it is genetic-based testing to guide their health journey.

00:22:55.931 --> 00:23:13.708
I do have an option without the genetic testing, because not everyone's comfortable with that their information being tested and kept somewhere for an extended period of time, regardless of what they're promised and the laws that are out there, and that's understandable.

00:23:13.708 --> 00:23:14.810
But one thing we'll get there.

00:23:14.940 --> 00:23:18.970
We'll get there, I think we'll get there, yeah, but it's a process.

00:23:19.069 --> 00:23:21.201
It definitely is, marshall.

00:23:21.201 --> 00:23:24.891
You know you've helped lead healthcare through one of the most transformative decades.

00:23:24.891 --> 00:23:27.848
I want to reflect on the leadership lessons you've learned along the way.

00:23:27.848 --> 00:23:37.467
We know that change requires courage and vision, and you've brought both what's been the hardest mindset shift within your organization or even within yourself.

00:23:38.048 --> 00:23:49.493
Well, I'm not going to call this a hard change for me, because it's something I generally believed in, but by really embracing it as I do now.

00:23:49.493 --> 00:24:00.776
It took some years, but I have absolutely no question in my mind that team care teams of health care providers is a major solution.

00:24:00.776 --> 00:24:17.321
So, tamara, to give you an example, for years I have spent a small amount, but working at clinics that are called federally qualified health centers and they're government sponsored and they do such a great job on what's called a medical home.

00:24:17.321 --> 00:24:20.691
So I used to work at one when I was in North Carolina.

00:24:20.691 --> 00:24:29.614
That was about 45 minutes outside of the main health campus and people could come there.

00:24:30.013 --> 00:24:35.585
It was in a really low socioeconomic status area, but people could.

00:24:35.585 --> 00:24:36.867
They could walk into the clinic.

00:24:36.867 --> 00:24:57.131
They might see their doctor, but they might not, but they would see somebody who's part of their medical home and, in fact, maybe they needed to see their pharmacist that day, or maybe they needed to see a nurse, or maybe they needed to see a dentist, and in that setup they also have a pharmacy so they can get their medications right there.

00:24:57.131 --> 00:25:08.961
And what that convinced me of is that, if we really focus and these are primary care, this is not.

00:25:08.961 --> 00:25:11.589
I went out there because they wanted me to provide follow-up for cardiac patients and do some stress testing.

00:25:11.589 --> 00:25:19.190
But the people who work in those clinics to me, they renew my faith that we're headed in the right direction in health care.

00:25:19.190 --> 00:25:30.919
So I think that concept of teams of health care providers, that has been something that's been a dramatic change in health care over the last 15 years or so and I think it's such a step in the right direction.

00:25:31.791 --> 00:25:32.555
I agree.

00:25:32.555 --> 00:25:33.498
I agree with that.

00:25:34.029 --> 00:25:38.642
I'll tell you one thing that has been the hardest, hardest change in Michigan medicine.

00:25:38.642 --> 00:25:45.042
We do have fabulous doctors and they're real smart and they are often leaders in their field.

00:25:45.042 --> 00:26:01.183
And almost all of them but not all of them, almost all of them are great with working with coworkers, but there's a handful who just aren't and they think they're God's gift to medicine and nobody should ever question anything they say and you probably have never met anybody like that.

00:26:01.450 --> 00:26:02.916
Never, ever, no, not me.

00:26:04.269 --> 00:26:19.055
And so I felt it was absolutely necessary to get some of those folks to embrace team care and to speak to it, so oftentimes they're the most subspecialized and they feel like nobody understands what they do.

00:26:19.055 --> 00:26:31.471
But it's turned out that if we get a few people who have moved from here being iconoclasts to here being a team player, they then talk to people, and so that's a transformation.

00:26:31.471 --> 00:26:39.576
I think it's happening slowly across healthcare in the United States, but I think it's a really important point to healthcare.

00:26:39.655 --> 00:26:41.817
I believe that is the best way.

00:26:41.817 --> 00:27:02.528
That is the best approach to have this integrative approach, rather than be solo or think that you're the only one that has the answers.

00:27:03.390 --> 00:27:22.680
Well, I have to tell you that my journey and I like to not think of myself as the most rigid and siloed person in the world, but I remember rounding with a pharmacist and so we had me cardiologist, we had residents, we had pharmacists, we had social workers and we had nurses.

00:27:22.680 --> 00:27:32.718
And I remember the first I don't know five or ten times pharmacists would say well, you know, there could be an interaction there and I'm like who are you talking to, man?

00:27:32.718 --> 00:27:46.885
But then the great part was they'd pull out a paper and say you know, I did some pre-rounding and it didn't take me very long to realize that I had a choice of either appreciating what they had to bring or looking stupid.

00:27:46.885 --> 00:27:48.634
So that was an easy choice for me.

00:27:48.634 --> 00:27:57.570
I didn't want to look stupid all the time, but I think you know for everyone, it's a little bit bruising of your pride to realize you do not know everything.

00:27:57.570 --> 00:27:59.680
And I'm the first to say I don't know everything.

00:27:59.680 --> 00:28:05.942
And working with teams of healthcare providers is much better for our patients and I learned a lot.

00:28:06.925 --> 00:28:08.511
Yeah, indeed, we can all learn from each other.

00:28:08.511 --> 00:28:16.560
Yeah, I remember when I did residency around it as well with the medical team, medical students and we learned a lot from each other, you know.

00:28:16.560 --> 00:28:20.940
So that's what it's all about, and ultimately, for the best interest of our patients.

00:28:21.622 --> 00:28:22.002
Absolutely.

00:28:22.002 --> 00:28:25.078
And our medical students today, I mean they embrace it fully, from day one.

00:28:25.078 --> 00:28:25.740
They get it.

00:28:25.970 --> 00:28:26.932
They're used to it.

00:28:27.634 --> 00:28:30.101
Yeah, people of my era it's a little harder to bring them along.

00:28:30.141 --> 00:28:34.876
Yeah, well, before we wrap up, marshall, I have to ask about your latest creative project.

00:28:34.876 --> 00:28:39.726
Going back into your book, you've also written a novel, coded to Kill right.

00:28:39.726 --> 00:28:44.095
It's a medical thriller which I am definitely going to read because I like medical thrillers.

00:28:44.095 --> 00:28:52.702
What inspired that crossover from nonfiction to fiction, and how does storytelling play a role in driving awareness or change in healthcare?

00:28:53.269 --> 00:29:01.746
Well, writing the novel took a lot longer than writing this Forbes book, so I started that first, and I started it for a couple of reasons.

00:29:01.746 --> 00:29:11.203
One is was that I got really interested in the security of our electronic medical records, and the reason I got so interested.

00:29:11.203 --> 00:29:17.674
I was at the University of North Carolina at the time and they had one of their great basketball teams national championship basketball team.

00:29:17.674 --> 00:29:28.314
So about two or three weeks before March Madness, one of the best players was out and nobody knew what was going on with him and people were saying is he going to be back for March Madness?

00:29:28.314 --> 00:29:38.346
And so, lo and behold, this was before these AI-based screens for wrongful use of electronic medical records, before they were around, these AI-based screens for wrongful use of electronic medical records before they were around.

00:29:38.346 --> 00:29:45.359
So it turned out that there were like 250 people who had looked at this basketball player's record and 50 of them were faculty, and so I had to talk to the faculty.

00:29:46.221 --> 00:29:46.883
That was my job.

00:29:47.329 --> 00:29:47.750
Great job.

00:29:47.750 --> 00:29:55.796
So you know one that ranged from somebody coming in in tears saying okay, I guess I get fired, to which I said well, we don't have any rules right now, so don't get fired.

00:29:55.796 --> 00:29:57.076
But you know, you were wrong.

00:29:57.076 --> 00:30:04.655
To another guy who I knew because he was a fabulous sports fan, and he said I'm a doctor, you know.

00:30:04.655 --> 00:30:05.920
And I said, yeah, I know you're a doctor.

00:30:05.920 --> 00:30:08.239
And he said well, I think I could help this young man.

00:30:08.239 --> 00:30:11.240
I'm like I don't think that's why you were looking at his record.

00:30:11.240 --> 00:30:12.941
So I got interested in that.

00:30:13.560 --> 00:30:23.105
And what I really loved about fiction is, unlike what you and I do on a day-to-day basis, we look at facts and we look at database decision making.

00:30:23.105 --> 00:30:26.607
In fiction you can just make up anything you want and there's no fact checking.

00:30:26.607 --> 00:30:33.839
So that led me down a road to think what badness could come from somebody hacking into an electronic medical record.

00:30:33.839 --> 00:30:35.701
Somebody hacking into an electronic medical record.

00:30:35.701 --> 00:30:45.401
And I worked with some of my IT friends and fortunately I think we have firewalls to prevent everything that I've thought about for that novel.

00:30:45.401 --> 00:30:58.731
But it wasn't just getting in and digging up dirt on people who maybe were hiding something in their health, but also using the Internet of Things, so to speak, to get into the medical record and then to cause that patient to get a lethal medication.

00:30:58.731 --> 00:31:05.798
And you probably know this I didn't know this when I started writing that book that in a big hospital you think about those IV bags Most.

00:31:05.900 --> 00:31:07.973
I thought they were all mixed up by pharmacists or pharm techs.

00:31:07.973 --> 00:31:12.669
But in a big hospital it's robots, and so the robots mix it up.

00:31:12.669 --> 00:31:13.571
They're highly accurate.

00:31:13.571 --> 00:31:17.061
But I thought well, I wonder if you could reprogram the robot to make the wrong medicine.

00:31:17.061 --> 00:31:20.038
So apparently that is almost impossible.

00:31:20.038 --> 00:31:21.144
But I made it part of the book.

00:31:21.605 --> 00:31:22.789
Okay, well, lovely, lovely.

00:31:22.789 --> 00:31:26.784
Yeah, it depends on the hospital, because I work in a very big hospital and we still do things by hand.

00:31:26.784 --> 00:31:27.846
Oh, do you Well?

00:31:27.846 --> 00:31:28.470
Good for you?

00:31:28.470 --> 00:31:30.036
Yes, except for our TPNs.

00:31:30.036 --> 00:31:36.279
We have a machine we program that will just pump things out, but we still have to check in and make sure everything is right.

00:31:36.721 --> 00:31:40.923
Well, after you read the novel, you'll appreciate that you do that.

00:31:41.324 --> 00:31:45.287
Indeed, indeed, I am looking forward to reading Code it To Kill and you know what?

00:31:45.287 --> 00:31:50.057
We'll be sure to link the great healthcare disruption and Code it To Kill in our show notes.

00:31:50.057 --> 00:31:56.678
Marshall, thank you for sharing your time, your vision and your passion for transforming healthcare with us today.

00:31:57.098 --> 00:31:57.819
Thank you, Tamara.

00:31:57.819 --> 00:31:58.381
Thank you very much.

00:31:58.381 --> 00:31:59.522
It's a pleasure to be on your show.

00:32:06.069 --> 00:32:08.214
Wow, what a powerful conversation with Dr Marsha Rungy.

00:32:08.234 --> 00:32:13.165
If there's one thing I hope you take away from today's episode, it's this the future of healthcare isn't just high tech, it's high trust.

00:32:13.165 --> 00:32:25.605
Yes, ai, genomics and digital platforms are changing how we deliver care, but what truly drives better outcomes is the connection between people.

00:32:25.605 --> 00:32:44.960
Marshall reminded us that, no matter how advanced our tools become, nothing can replace the value of a practitioner who takes time to listen, who sees the whole person, or a care team that works collaboratively instead of in silos.

00:32:44.960 --> 00:32:59.098
So, whether you're a pharmacist, a doctor, a nurse practitioner or someone taking charge of your own health journey, don't underestimate the impact of showing up, being present and leading with intention.

00:32:59.098 --> 00:33:01.443
That's where real transformation begins.

00:33:01.443 --> 00:33:10.660
If you want to explore how to apply personalized genetic-based strategies in your practice or life, visit us at wwwthelifebalancecom.

00:33:10.660 --> 00:33:24.636
That's wwwthelifeedeallancecom, and, as promised, links to Dr Rangi's books the Great Healthcare Disruption and Coded to Kill are waiting for you in the show notes.

00:33:24.636 --> 00:33:26.000
Talk to you next Friday.

00:33:26.000 --> 00:33:32.971
Until then, always remember to raise the script on health, because together we can bring healthcare to higher levels.