When Casey Means’ mother was diagnosed in 2021 with stage 4 pancreatic cancer, she and her brother Calley were suddenly given a front-row seat to the American healthcare system. It was a world they already knew well professionally—Casey is a Stanford-trained physician, and Calley is a former consultant for the food and pharmaceutical industries; both have gone on to found separate health companies. Now, as they watched their beloved mother navigate doctor checklists and medical recommendations, they realized just how broken our healthcare system has become—reliant on sick people needing treatment rather than helping patients truly feel well.
In their new book, Good Energy: The Surprising Connection Between Metabolism and Limitless Health, Casey writes that the rates of most chronic conditions “are going up at the exact time we are spending trillions of dollars to ‘treat them.’ ” Here, in an excerpt from the book, Casey explains why she and her brother believe that American medicine no longer has our best interests at heart.
The most important thirteen days of my life came from ignoring a team of doctors.
In January 2021, when my mom was seventy-one years old, she was taking her daily hike with my dad near their home in Northern California. Suddenly, she felt a deep pain in her belly and experienced uncharacteristic fatigue. Concerned, she visited her primary care doctor, who conducted a CT scan and ran lab work. One day later, she received a text message with her results: stage 4 pancreatic cancer. She FaceTimed me with tears running down her face saying she wouldn’t meet my future children.
Right after the diagnosis, a medical team out of Stanford and Palo Alto Medical Foundation jumped to action, recommending a laundry list of surgeries and procedures—biopsies, blood transfusions, and a liver stent. In most cases, the patient would have agreed to these procedures, and the meeting would wrap up quickly. These recommendations were coming from some of the most prestigious institutions in the world, after all.
But based on my experience in medicine, I started asking questions. I learned that these procedures had about a 33 percent chance of extending her life a few more months at most, a 33 percent chance of shortening her life span, and a 33 percent chance of not impacting her life span (yet keeping her away from the family). In all cases, the invasive route would mean that my mom would need to sit in a hospital room alone, because of Covid-19 protocols, and potentially longer if the surgery had complications, as they often do with immunocompromised cancer patients.
Additionally, her cancer was causing her liver to fail by the day and her body to destroy its red blood cells, making the prognosis numbers even worse, potentially complicating her recommended procedures, and making her dependent on every-other-day, multi-hour blood transfusions in the hospital, despite being so weak she could barely leave her bed. We were amid Covid lockdowns, and we also knew that she would be forced to check in for the hospital procedures alone and might not come out. My mom made it clear to the oncologist that she was not afraid of her rapidly impending death, but she wanted to minimize unnecessary pain or nausea in her final days. Despite being clear, the system pushed the exact procedures that would yield pain and nausea and aggressively shamed our family for questioning the full-court press approach.
The doctor was not consciously trying to recommend a suboptimal procedure, but I knew the invasive route would generate hundreds of thousands of dollars for the hospital, and this doctor’s pay was tied to booking these procedures.
I confirmed with the oncologist: “You are recommending an invasive diagnostic procedure that would under no scenario extend her life more than a couple of months and risk my mom dying alone in a hospital room? Even though we are certain that this is stage 4 pancreatic cancer based on the CA 19-9 blood test and CT scan, and that she has liver failure and almost no red blood cells left?”
“Yes, that is what we’re recommending,” the doctor replied.