What keeps me up at night? Healthcare's strategy problem

He was wholeheartedly sorry that he'd run out of strawberries for the champagne, politely asked us to wait a second, and got back with a few tablets of chocolate and left them on the side of the jacuzzi for us to enjoy.

Icicles hanging from rooftops were telling that winter has finally arrived in November. It was obvious that getting more fresh berries at 9 pm is not going to happen.

We didn’t expect it. But he genuinely cared. And in his universe, in his hotel, he made sure that everyone was cared for and felt like a royal on a honeymoon.

Istvan Ostorhazi, Osti as everyone called him, a fellow martial artist for several decades, was running the Alfa Hotel, which rightfully was nominated as the best 3-star Hotel in Hungary.

I only knew him through short interactions, but one thing became clear instantly, that he was the most generous and humble man I have ever met.

In 2017 Osti started to experience muscle cramps in his legs and shaking in his hands. A good friend told me that Osti was diagnosed with ALS-like symptoms which was treated by radicut infusion therapy and hyperbaric oxygen therapy. He also got treated by large amounts of antibiotics for suspected chronic Lyme disease.

Even the center for rare diseases held a meeting to discuss his case at one of the top hospitals.

His condition got worse rapidly. Soon he was confined to a wheelchair. In hopes of finding a solution, he even published his own medical records online.

Then on a murky day in November 2019, he didn’t wake up anymore. 🏴 R.I.P. What a terrible loss, for family, friends, the whole hospitality industry, and fellow travelers.

Losing someone always feels devastating, especially if they have touched you, even if they weren’t immediate family. The feeling is even more exaggerated if you’re arrogant enough to think you could have helped.

Tribalism in Medicine separates specialties and builds walls. It is the identity politics problem of healthcare. It divides practitioners into sub-groups. It prohibits important information exchange and strategic thinking. Medicine desperately needs more inclusive and thoughtful conversations, not less.

What can we take away? The Strategy Problem of Healthcare

The healthcare system blatantly failed Osti: he got treated for things which weren’t problems like Lyme disease or ALS, where tests came back all right.

In contrast, he didn’t get any treatment for the obvious, being a diabetic for 15 years (7.8 mmol/l fasting glucose, above 7 it’s type 2 diabetes by definition) and consequently having blood-brain barrier damage (high glucose and albumin in his spinal fluid).

For those, who don’t speak Hungarian, here is a summary of what’s inside his published medical records:

This wasn’t a lack of information problem. You see every evidence and action on this graph is from published medical records.

The system won’t change until there is a dedicated architect overseeing the whole process, and everyone isn't just quietly laying bricks on their own accord.

Healthcare has a systematic strategic problem, treating a non-emergency situation like an emergency is definitely not a recipe for success. Being innovative on the spot in the latter may be as big of a problem as not testing and measuring properly in the former.

For the business minds, it is similar to managing a company of 100 the same as a team of 5. It is hardly going to work. Being mostly strategic in the latter, or micromanaging everything in the former is a surefire way to bring down any project.

You see the bottleneck is always changing, this is the Theory of Constraints. It prompts you to first and foremost know your goal, and then solve the biggest bottleneck, after which the constraint shifts to somewhere else.

When the elephant in the room is diabetes, you have to deal with it first. If solved, you can deal with the next biggest problem, say muscle loss, and so on down the line.

For non-emergency and uncertain situations, it is imperative to test. This is what Josh Mitteldorf is explaining in his Letter to an Incipient Cancer Survivor in general, that you can try out different approaches for 4-6 weeks and measure back whether it made a difference or not.

In Osti’s case a systematic approach would have looked like the following:

1. Chart out the problems and non-problems: long-standing diabetes vs Lyme
2. Draw interactions: diabetes even though is not yet manifested in retinopathy (loss of vision), it could definitely explain the blood-brain barrier damage [R]
3. Measure what enables rapid feedback of progress: blood glucose or ketone levels can be measured several times per day
4. Test: try to normalize blood glucose and insulin levels as fast as possible: keto diet, ketone esters, fasting, intermittent fasting, fast-mimicking diet, activating heat-shock proteins with sauna, etc.
5. Learn: keto may not work, but intermittent fasting may work like a charm or vice versa, we may never know what we never try

We shouldn't wait for more information and research until we become so sick that modern medicine can barely save us.

We desperately need to apply fundamentally different strategies for non-emergency healthcare.

Until then all we will get is sick care.

Change won't happen on its own. And it is keeping me up at night.