Interview with Kumara Sidhartha, MD, MPH

Kumara Sidhartha, MD, MPH
Emerald Physicians, LLC, Cape Cod, Massachusetts

Q: When did you know that the practice of medicine was your destiny?

A: When I was 12. My dad is a family practitioner in a semi-rural part of India, called Salem. I was inspired by his brilliant medical care, his humility, and above all, his compassion.

Q: What is your educational background?

A: My K-12 school and medical school education was in India. It is worth mentioning that my medical school curriculum was entirely of a Western model, with barely any nutrition education. I moved to the US in 1998 and completed Residency in Internal Medicine at Lincoln Medical and Mental Health Center (an affiliate of Cornell University, NY). I studied European Biological Medicine for two years through the Paracelsus Klinik in Lustmuhle, Switzerland and the Marion Institute in Marion, MA. Meanwhile, in 2003, I started using wholefood, plant-based [WFPB] nutrition treatments in my medical practice on Cape Cod, MA. In 2009, I earned my Certificate in Plant-Based Nutrition through eCornell and the T. Colin Campbell Center for Nutrition Studies. I was seeing incredible health benefits in many of my patients and wanted to multiply this effect by taking it outside the four walls of my practice, reaching a broader audience at a county, state or national level. This drove me to study public health and nutrition research through the Master of Public Health in Nutrition (MPH-N) Program at the School of Public Health and Department of Nutrition at the University of Massachusetts, Amherst, MA.

Q: What led to your practice on Cape Cod?

A: After training in New York, I wanted to find a laid-back place that will suit my mindset. Job search led me to wash ashore the idyllic Cape Cod where I joined Emerald Physicians, LLC.

Q: You consider yourself a PlantBasedDoc; please share what led to your ‘enlightenment’ about the efficacy of whole food, plant-based nutrition as a therapeutic intervention?

A: The seed was planted in 2002 when I read a book entitled The Food Revolution by author John Robbins. By then, I had completed medical school in India, practiced medicine in India, completed residency training in the US and had practiced on Cape Cod for one year. And yet, I learned more about health and nutrition from this book than I had from my entire educational era up until that time. The book piqued my curiosity but didn’t quite convince my skeptical and evidence-based approach to knowledge. I became a ‘believer’ in 2003, when I saw the first-hand results of positive health among my patients who started enjoying whole, plant-based lifestyle. Subsequently, further education and secondary data from scientific literature cemented this belief.

Q: How has this knowledge impacted your life and the lives of your patients?

A: Personally, my health is at its best after switching to a WFPB lifestyle. I have incredible energy to tackle the many projects in which I’m involved. Professionally, I have an abundance of job satisfaction — something that can be elusive in primary care. This satisfaction comes from knowing that I am able to tell the truth to my patients and help navigate them through their doubts and dilemmas — all the while continuing to stand with them during their moments of joy and success as well as trauma and tribulations. The beauty and sacredness of physician-patient relationship is lifted to a new level when healing occurs through wholefood, plant-based nutrition.

How does this impact look like practically in patient’s lives? It looks like blood sugar level safely dropping from 417 to 100 without insulin or medications, or an 84 year old heart shifting from having pain when walking five steps to now being pain-free after miles of walking — rejuvenated just after two months of WFPB lifestyle; it looks like the hoops of basketball played with grandson after being told, years ago, to get “urgent” bypass heart surgery and then never having to undergo that surgery because of WFPB diet; or it can look like gardening and painting the home with one’s favorite colors using what once used to be crippled wrists ridden with arthritis; it can even look like the smile on a young mother’s face who is given the news that her brain scan no longer shows multiple sclerosis lesions after adding WFPB dietary change to her existing medications. In every success story I have seen, the patient is truly the protagonist. I play the mentor and the compass.

Q: You’re spearheading a new working group for The Plantrician Project, tell us about this?

A: The WFPB Nutrition Research Working Group is an idea that emerged out of a discussion I had with Dr. Scott Stoll. The vision I have for it is the creation of a platform or a framework that acts as a guide or information resource for healthcare professionals — who have never done research — to design and conduct studies using standardized, robust research methods. Such research conducted with scientific rigor and published will add to the existing body of evidence to inform policymakers and practice guidelines. It is too early now to predict the scope and shape of this initiative. I see the need for folks looking for such guidance. I also believe that there is enough talent among the conference attendees which, when pulled together under one framework like this working group, will create a lot of possibilities. We have 40+ people signed up during the last conference showing their interest in learning from this initiative or wanting to contribute their talent to this effort. Those interested who hadn’t signed up yet can email the Plantrician Project with their name, email, phone number and practice/profession. An email will go out to them by early January with a survey link to explore this further. That will be the first step.

Q: When physicians say that the research doesn’t support a plant-based diet, what’s your response?

A: First, I will ask more questions to understand how they arrived at that conclusion. They may not be aware of any of the existing evidence supporting WFPB nutrition treatments. Or perhaps they themselves are not practicing that lifestyle so may subconsciously deny rather than explore the validity of this claim and consider changing their own lifestyle. More human research is never a bad idea in the field of emerging science and inquiry. We now have a convergence of evidence from various methods of scientific inquiry — population studies, controlled trials, cohort studies and biological plausibility supported by laboratory corroboration. The result is the collection of enough data to know that WFPB nutrition intervention has a high likelihood of being an effective treatment for chronic diseases such as cardio vascular disease and diabetes in addition to having only positive side effects. How many pills and procedures can make that claim and not bankrupt the healthcare system and not drive patients to choose between copays for pills and heating bills? Equally vital is the question of how many funders and foundations are ready to fund larger scale studies to further explore WFPB nutrition’s effect on chronic diseases?

Q: You’ve attended the inaugural, 2nd and 3rd annual Int’l Plant-based Nutrition Healthcare Conferences—how have they impacted your practice and knowledge?

A: The conferences have reinforced the nutrition work I do in my practice. The sharing of ideas by various experts in the field goes a long way to validate my perspective and update my knowledge in this subject matter. The experience has also pushed me to work on conducting WFPB research in my practice setting.

Q: What would you tell your colleagues about this conference?

A: Undoubtedly, it is an essential CME conference for doctors who care about their patients, who want to increase their job satisfaction, and who want to be prepared for the future of medicine.

Q: As we shift from a fee-for-service to value and outcome based system of healthcare delivery, how does a prescription for plant-based dietary lifestyle factor into the equation?

A: Managing chronic diseases using WFPB nutrition interventions is the best approach to take care of the triple aim of the future of medicine: Healthy population, optimal experience for the patient in the healthcare system, and per capita cost of healthcare.

The policymakers have realized that the existing healthcare system is financially unsustainable if the current trajectory of disease burden and healthcare spending continues. If we need to reduce the disease burden, WFPB nutrition can prevent most of these chronic diseases. If we need to reduce healthcare spending, WFPB nutrition can treat many of these chronic diseases at a fraction of the current cost per capita. Barbara Ormond et al published a simulation data that showed that if the national prevalence of diabetes and hypertension is reduced by a mere 5% using lifestyle changes, it would translate into healthcare dollar savings of $24.7 billion in excess spending [Am J Pub Health. 2011;101(1):157-164]. To transform healthcare where nutrition treatments become the mainstay of chronic disease management, what will make or break the deal is how the practitioner’s reimbursement is re-aligned to incentivize the newer approaches (such as WFPB) to managing chronic diseases. The fact is that most of us do what we are paid to do. There are early changes happening in this direction in newer systems such as Accountable Care Organizations (ACOs) where incentives reward efforts to keep the population healthy. The issue remains that even ACOs are not including WFPB interventions in their toolbox but are tinkering with diets of moderation. In the brave new world of outcome-based reimbursement medicine, moderation diets will yield only moderation outcomes, meaning moderation cash flow. Anyone for more cash flow? I suspect that the reimbursement and healthcare dollar savings of ACO-like systems will exponentially grow if WFPB interventions are put to use for their population health management. In other words, WFPB intervention is the overlooked key to the untapped treasure chest of ACOs and similar systems getting into outcome-based reimbursement. This, I believe, is the recipe for a thriving future of medicine with healthy patients, happy practitioners/payers, and a resilient healthcare system.

While the outcome-based reimbursement models are taking root and unfolding, it may be worthwhile for practitioners to start creating infrastructure, processes and workflow to test delivering WFPB nutrition interventions in their healthcare setting. There are a few ways to go about this and one is Shared Medical Appointments (SMAs) which I am familiar with. I have created a basic guide for steps to consider when implementing SMAs, and a process map for SMA using patient journey. I also recommend the group visit guide put out by MGH.

Q: When you envision the future of true “health” care, what do you hope it will look like five and even 10 years from now?

A: In 5 years, in the best case scenario, I see that medical schools across the board call for reviews to look at revamping the curriculum to include WFPB treatments for chronic diseases. CME credits on the subject matter of WFPB treatments become widely available. ACOs and similar systems embrace evidence-based WFPB protocols to pilot projects that measure metrics of healthcare outcomes, patient satisfaction, and healthcare expenditure. Insurance payers find ways to incentivize patients for their WFPB lifestyle. Primary care, specialists, dietitians and health coaches all have increasing opportunities to getting paid for doing the right thing – that is, WFPB interventions. Funding for large-scale WFPB studies see an increase. Cancer walks and heart 5Ks to raise funds for WFPB research gains traction. Patients are empowered and enlightened by healthcare teams. Patients’ built environment (restaurants, farmer’s markets, co-ops, places where people study, work, play and pray) shifts to making it easier to change food behavior.

In 10 years, I see a best case scenario where all medical schools include a great deal of WFPB nutrition treatments in the curriculum. CME credits on the subject matter of WFPB treatments become part of requirement for license renewal for healthcare professionals (Currently, risk management and end-of-life care CMEs are required). Healthcare systems value healthcare teams who practice WFPB interventions and reimburse them for doing the right thing. Healthcare is patient-centered and patient care is heavy on self-care using WFPB lifestyle where healthcare teams act as guides and experts to measure outcomes and recommend changes as and when needed. WFPB nutrition research funding is a national priority. People’s built environment is conducive to WFPB lifestyle.

Q: How is this message relevant to, not only the U.S., but the entire world?

A: This message is vital for other parts of the world. Chronic diseases are overtaking communicable diseases in third world countries where self-pay system is the predominant system rather than health insurance model. Fast food culture is now exported to those countries. Western food acculturation is leading populations away from their traditional plant-centered diets to animal-based, refined foods. In the next 10-20 years, the explosion of chronic diseases can cripple the health care systems of those countries and break families due to lost productivity. This can affect the larger economy of these countries. Getting this message out to other parts of the world is vital and urgent, before it is too late. The time to act is now.

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