Healthy Aging w/ Dr. Madeleine Biondolillo

Episode Information

April 19, 2021

Dr. Madeleine Biondolillo talks about the impact of COVID on seniors, their family members and healthcare workers, precision nutrition, QUEST 2020, and more.

Topics Include:

• How she had extremely painful ear infections as a child and how her pediatrician provided exceptional care and inspired her to become a doctor
• How she thought she would become a pediatrician because she had two children during medical school, but how she chose not to because it was too close to home
• How she led a practice that focused on continuum of care for adults with complex medical and social needs and also community-based geriatrics.
• How COVID has been devastating for elders because of the isolation and devastating for their family members who have not been able to visit and care for them
• How we have no societal mechanisms to keep frail older people integrated and how this contributes to their frailty
• Her work as vice president for academic initiatives and quality innovation for a company called Premier
• How America, in comparison to other developed countries, spends more and more on healthcare, and how they getting less and less from the standpoint of the health outcomes, partially because they don’t integrate social care and healthcare
• A bit about precision nutrition, the epidemic called Diabesity and how we don’t yet have enough precision focus nutrition for this disease
• How QUEST 2020 brings many hospitals together so they can collaboratively share their data and everyone can then improve by learning from what works for other patients/hospitals
• How Doctorpedia is a very powerful mechanism because it brings people together so that they can share their experiences, whether it’s their data that they’re using to evaluate themselves and they can compare with each other, whether it’s their stories of what works and what is on the horizon, and really enables people to learn from each other.
• Her role as Founding Medical Partner and Chief Medical Officer for Doctorpedia’s Healthy Aging channel

Highlights

• “I was a little kid that had ear infections and that’s just one of those conditions that’s incredibly painful. And I had a fantastic doctor, a pediatrician who was very accommodating. Speaking of bad weather, one day I had a terrible ear infection, very bad pain. And the doctor actually made a house call in the middle of a snow storm. And I remember seeing him walking, looking out the window, being in agony and seeing him in his coat and hat and boots, walking to our house.”
• “I remember sitting on the crinkly exam table paper and I remember thinking, ‘This pain is so bad. I can’t do anything else. And this is the most important thing that anyone can do to stop this pain. If I could do something like this, it would be the most valuable thing I could do.'”
• “When I went to medical school in Boston, at Tufts University School of Medicine, I already had one child and I had another during medical school. And so I thought, “Well, I’ll probably be a pediatrician”, but when it came time to actually do pediatrics, I realized I could not be a pediatrician because it was just too close to home. And of course when you care for kids in hospitals, it’s not earaches. It’s much more significant. So I pivoted a little bit and then I decided I wanted to care for adults.”
• “It’s really problematic that when people get old and frail, we tend not to have societal mechanisms to keep them integrated, and we know that social isolation is another thing that makes people frail. So it is a vicious cycle once it starts. And one of the things that practice of medicine for older people in the community, and then eventually, if need be in a nursing home or other congregate living situation, has really taught me is how important it is for all of us to think about aging as early as possible, and do our best, do whatever we can to keep that process on the healthy side as much as we can, because it really is up to us.”
• “There were heartbreakingly numerous stories of people in nursing homes when the visitation had to stop. And from a public health standpoint, you completely understand why in the beginning, there was a push to stop visitation because these are older frail people. There really weren’t therapeutics. There wasn’t a vaccine yet, and they were at risk. And so we knew that limiting visitation was likely going to be helpful, but so many people basically said, ‘I can’t take the isolation. I would prefer if I have to die, to die from the disease and not from the isolation.’“
• “We underfund public health for ever and ever and ever, because we don’t really know what it is. We don’t educate anybody about it. It’s mostly a process of preventing bad things from happening. So when they don’t happen, no one knows and there’s no media attention. There’s nothing there to point to, to say, “Let’s fund this” because what is this?”
• “We know who got most severely affected by COVID – people who had to live in very tight quarters or people who were homeless or people who lived in nursing homes because it’s congregate housing. So if you didn’t have adequate air, if you didn’t have adequate space, if you didn’t have the ability, the resources, the financial resources to say, “Yikes, I live in the Bronx and I’m in a very, very closed space because it’s New York City and it’s very expensive and I have very few square feet, but I can’t leave the city. I don’t have the resources. I don’t have a country house.” Well, the rate of mortality in the Bronx was enormous. And that’s because folks didn’t have the ability to leave. And more than that, in order to continue to have an income, they were the essential workers. They had to go to work and be on-site and use public transportation. And so they were taking all kinds of risks just to live. And that’s the social issues.
• “In the realm of healthy aging, we think about a handful of factors as being really mission critical to focus on. A nutritionist is certainly one. Things like fitness which is relevant for an aging body is really important, the whole phenomenon of mind-body medicine which is things like mindfulness practices like meditation and yoga and its influence on how our bodies are healthy. And the whole issue of social isolation and connection to people and how important that is.”
• “QUEST 2020 is a wonderful initiative. It’s one of the national quality improvement collaboratives that I mentioned I had been overseeing as part of my work at Premier. QUEST 2020 is an initiative that brings many hospitals from across the country together. They share their data transparently. They literally say, ‘Well, Madeleine’s hospital has X percentage rate of infections for this procedure and Danny’s hospital has Y percentage. Gee whiz, Danny, you’re doing so well, what are you doing that I’m not doing, can I learn from you?’ And they share their knowledge and so everyone improves.”
• “I wish the experts had all the answers – they don’t yet. So some of the learning comes from people just trying stuff on their own and saying, ‘Wow, this really worked for me.'”
• “One of the main things that can be very helpful is just do what you can. Don’t try to do everything. And certainly don’t try to do everything all at once and don’t try to do everything for a long time. You have to do small bits.”
• “The really important thing that I do first thing, last thing every day is the mindfulness stuff. In my case, it’s a combination of prayer and a gratitude litany that I go through all the time, because I have a lot to be grateful for.”

Relevant Links

• Doctorpedia Doctor Profile
• Press Release About Quest 2020
• Premier Bio

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

Daniel Lobell: (00:28)
Hello, and welcome to the Doctorpedia podcast. I’m your host, Daniel Lobell and I’m honored to be joined on the line today by Dr. Madeleine Biondolillo. How are you?

Dr. Madeleine Biondolillo: (00:38)
I am very well. Thank you for asking

Daniel Lobell: (00:41)
Your cool last name that you explained to me before we went on the air is Sicilian, meaning white Lily?

Dr. Madeleine Biondolillo: (00:49)
That’s exactly right. Sometimes it’s easier to pronounce a multivowel multisyllable name when you know what it means. [Laughs].

Daniel Lobell: (00:57)
Having a name like that, you must have had to explain it a million times to people.

Dr. Madeleine Biondolillo: (01:02)
I used to like to say it’s a demonstration of how much I love my husband, because I married the name and when your name is Biondolillo, every time you utter it, you have to spell it. And sometimes – many times.

Daniel Lobell: (01:19)
Was your maiden name a much simpler name?

Dr. Madeleine Biondolillo: (01:24)
It was a simpler name. It was an Ellis Island-transformed name that was Ukrainian and became Catan.

Daniel Lobell: (01:33)
Okay, well, at least it wasn’t a name like White or Smith, which is like a super simple name to go from.

Dr. Madeleine Biondolillo: (01:39)
Yeah, it was a much shorter than Biondilillo, but it wasn’t that simple.

Daniel Lobell: (01:44)
So I like to hear a little bit about the doctors as they grew up and get a little bit of a bio and then I’m excited to transition into what you do because it’s so unique and we haven’t had anybody on the show quite like you yet. Perhaps there’s nobody quite like you on the show but let’s go back to your childhood. Where did you grow up?

Dr. Madeleine Biondolillo: (02:12)
I grew up in the Bronx in New York city and also for some period of time in the suburbs of Washington DC. I am definitely a city kid though I’m not a kid anymore, except in my heart. I went to college in Montreal at McGill University. And I went to medical school in Boston, which is where I stayed and practiced medicine and did my public health work.

Daniel Lobell: (02:41)
My friend, the comedian Mark Schiff also was raised in the Bronx and has this great line about the Bronx, where he talks about it being the only borough that has the word ‘the’ in front of it. And you know, it’s not the Queens or the Brooklyn, but the Bronx feels so big about themselves or something. They’re the Bronx. [Laughs].

Dr. Madeleine Biondolillo: (02:59)
[Laughs]. Yeah, we’re special.

Daniel Lobell: (03:00)
I loved the Bronx growing up. My grandparents on my father’s side were both born in the Bronx. And I found out recently when my grandma passed away that her father actually had a little old style Jewish bodega in the Bronx many years ago, where he had barrels of pickles and wood chips on the floor, and I love the imagery of that. What was the Bronx like for you growing up?

Dr. Madeleine Biondolillo: (03:34)
It was really great. As I said, I’m a city kid and I would have loved to go to your grandparents’ bodega. It’s a huge melting pot. By population, it’s the largest borough in New York city. So of the five boroughs, not that your grandparents aren’t special, I had grandparents there too, and my other grandparents were in the other borough, where just about everybody has at least one grandparent, which is Queens, but the Bronx is a wonderful place. It’s a very socioeconomically challenged place in a lot of ways. That was not the case for me growing up. I was a pretty middle-class kid from a family that was quite fortunate, but it was great from the standpoint of everybody being together with everybody. So for me, that was much appreciated.

Daniel Lobell: (04:37)
I grew up in the Queens initially and my grandparents, who were of the Bronx had made that huge pilgrimage from there to Queens. And we all lived in the same apartment tenement when I was a kid, in Flushing with my great-grandmother, my grandparents and my parents and me. And then a few years later, my brother Josh joined, but those are some of my fondest memories. I love the city. I love the city life. I was devastated when my family moved to Long Island. I thought it was just the biggest mistake in the world. I’m like, “Why would you leave the city? The city is where it’s at.” I had a view of the New York skyline from my window, which I found out has since been blocked by the New York times building, but it was a magical place for me. I just love Queens. I loved going to the Bronx zoo as a kid. That’s the extent of the Bronx that I knew, but I miss those times and those places.

Dr. Madeleine Biondolillo: (05:44)
Well, it is a magical place. You’re so right. And those are some good experiences. And I think your point about the Bronx [laughs] and your joke about the Queens is reflected in the fact that we New Yorkers and no matter how long you’ve lived outside New York City, you are a New Yorker by definition. We call it the city, which is what you just did. It’s the city as if there was only one, but it’s just the city.

Daniel Lobell: (06:13)
[Laughs]. That’s so true. When I moved to LA, I was so snobby and I’m not as much anymore, but I was so snobby about New York that I said, “Where’s the city?” And they said, “You’re in it.” I said, “This isn’t the city. What are you talking about?” Has nobody told anybody here what a city is? I couldn’t wrap my mind around the fact that the city of LA is called the city. Now I get it. It is a city, but I just had one definition of what a city was, it’s New York and anything that tries to be close to New York is trying to be a city, and anything else is not. [Laughs].

Dr. Madeleine Biondolillo: (06:52)
No, you’re so right. And I think it’s a great analogy for lots of things. You know, we’re all people, but boy are we different. I’ve been to LA a few times and I would have been one of the folks who would have said “City? Really? Where?” But you’re right. It is a city. I went to Boston for medical school and stayed there throughout my medical career. Boston of course is kind of sweet and hilarious in a way, because we’re so little compared to the city, but we call ourselves the hub of the universe, which I always found obviously a little ridiculous. It’s a wonderful city, but to say that you’re the hub of the universe when you’re a few hours from New York, takes a lot of presence.

Daniel Lobell: (07:46)
A lot of chutzpah. [Laughs].

Dr. Madeleine Biondolillo: (07:46)
Yes, chutzpah, exactly. [Laughs].

Daniel Lobell: (07:50)
Where do you live now?

Dr. Madeleine Biondolillo: (07:51)
I live in Miami Beach, which is pretty amazing. I go back to Boston a lot and I’m in New York a lot too, but my home is Miami Beach. That’s a pretty fantastic place.

Daniel Lobell: (08:03)
I love Miami, another really cool diverse city. And I’m dying to go back to those Cuban coffee shops and sit outside there and probably against doctor’s advice, smoke a cigar and have a nice Cuban coffee. But what kind of things do you do in Miami when you’re not working?

Dr. Madeleine Biondolillo: (08:26)
So I’m with you on the coffee. That’s, for me, a huge avocation, not so much cigars but I can understand why it’s so appealing. It’s a wonderful place. it’s a physical culture, which I love. When you spend a lot of time in the Northeast and a place like Boston, you live in really, really cold weather clothes all the time. And in Miami Beach you can live in shorts and t-shirts, put your sneakers on in the morning and never take them off and go for your run and do your daily work if you’re lucky enough to be able to work from home in that getup, which I really appreciate being able to do. It’s certainly very, very hot in the summer, but it is just magical and in the US winter. So I feel very lucky to be able to be here.

Daniel Lobell: (09:26)
So now I’m like a bit of a snob about LA, because I guess it’s part of me whether I like it or not. And now I look at winter as like obsolete technology sometimes. I look at people in winter, and I go, “What? We moved on from winter? What are you still doing?’ [Laughs]. Being in California, I think, winter is something that we were supposed to move away from.

Dr. Madeleine Biondolillo: (09:50)
I think the world is going in that direction, a little alarmingly. I think a lot of the population movement is definitely a reflection in our country that it’s just hard in those cold weather climates. I know folks in Boston are very proud of themselves and they should be, that they’re so tough that they can make it through those really difficult winters. I have some pretty hilarious photos from the year that we got so much snow, that you couldn’t even see the person high parking meters and you really could not walk anywhere. And it was really calamitous because the transportation was absolutely not available for a month and people lost jobs. So there are some huge challenges with the climate. But that’s part of the blessing of being able to be in a place like LA or a place like Miami is just you know how it can be tough and you feel for everyone, but it’s from a distance.

Daniel Lobell: (11:01)
By the way, I love how optimistically you summed up global warming. Between the two of us, I think we presented it in a way that maybe we could get people to start funding it happening more rapidly. I don’t know. [Laughs].

Dr. Madeleine Biondolillo: (11:14)
Well, yeah, a little scary, right?

Daniel Lobell: (11:17)
It’s just the progress of humanity. We need to get rid of winter. It’s the world correcting itself. So let’s go back to your childhood. At what point did you decide you wanted to go into medicine?

Dr. Madeleine Biondolillo: (11:30)
I guess everyone has the story of their moments. So for me, really personally, it was significant. I don’t know how significant it is for the broader group, but I was a little kid that had ear infections and that’s just one of those conditions that’s incredibly painful. And I had a fantastic doctor, a pediatrician who was very accommodating. Speaking of bad weather, one day I had a terrible ear infection, very bad pain. And the doctor actually made a house call in the middle of a snow storm. And I remember seeing him walking, looking out the window, being in agony and seeing him in his coat and hat and boots, walking to our house.

Dr. Madeleine Biondolillo: (12:24)
So a little bit of that was a function of the time and happily, we’re getting back to that to some degree these days. But some of it was just a function of who he was as a person, as a professional and just as an incredibly caring pediatrician. So that made a huge impact both on me and my mother and then another time years later, but still unfortunately for anyone who has your infections, I had another, and that time we were able to go to the doctor’s office. And I remember sitting on the crinkly paper, the exam table paper that Jerry Seinfeld talks about. [Laughs]. So funny with his great jokes. And I remember thinking, “This pain is so bad. I can’t do anything else. And this is the most important thing that anyone can do to stop this pain. If I could do something like this, it would be the most valuable thing I could do.” So it was really a powerful moment for me. And I felt like that probably was a little eight year old kid thinking, “Yeah, I want to do this too”.

Daniel Lobell: (13:38)
Yeah. It’s kind of incredible – thank God for your ear infections because so many people have benefited. Had you had healthy ears, think about all the people who might not be healthy today.

Dr. Madeleine Biondolillo: (13:52)
Yeah. It’s an interesting way of thinking about it and I appreciate the kind words. It’s one of those things that I think we all have to look at negative circumstances as potential opportunities, and it’s a good way of you identifying an outcome that’s actually a positive thing. I try to make it a positive thing. It seemed very negative at the time, but it really could be turned around.

Daniel Lobell: (14:20)
You just made me pro ear infection and pro global warming in the same span of 10 minutes. [Laughs].

Dr. Madeleine Biondolillo: (14:25)
[Laughs]. It’s such a contrarian impact I’m having.

Daniel Lobell: (14:31)
Pretty interesting, pretty cool. You get inspired by your own ailment and the people who come and take care of you and you tell yourself, “I want to do this. I want to help people.” At what point do you enroll in medical school and then let’s get to your very unique specialty and what you do and how you came to that decision.

Dr. Madeleine Biondolillo: (14:58)
I was impacted tremendously by this pediatrician and I continue to just give him so much gratitude to this day. But when I went to medical school in Boston, at Tufts University School of Medicine, I already had one child and I had another during medical school. I actually took a year off in the middle between third and fourth year to have my second of three. And so I thought, “Well, I’ll probably be a pediatrician”, but when it came time to actually do pediatrics, I realized I could not be a pediatrician because it was just too close to home. And of course when you care for kids in hospitals, it’s not earaches. It’s much more significant circumstances. So I pivoted a little bit and then I decided I wanted to care for adults.

Dr. Madeleine Biondolillo: (15:54)
I ended up focusing on adult medicine and particularly primary care and focusing particularly on adults and older adults who had very complex medical conditions and social conditions, because those are very interrelated oftentimes. So I did a few things. I ran a primary care practice that was affiliated with one of the Harvard hospitals and it specialized in those patient populations. So community-based geriatrics, but it really was the gamut of just older adults living in the community. And then we all worked in nursing homes and we did home health care for folks who had aged in place and couldn’t come into the office. We were the last practice in the city of Boston that cared for our own patients in the hospital. So it’s a wonderful specialty, what they call hospitalist medicine. These are doctors who only practice in the hospital and they’re really specialists at the kind of care that people need when they’re sick enough to need to go to the hospital.

Dr. Madeleine Biondolillo: (17:11)
They know how to get people the kinds of tests they need very efficiently and get them to be able to be discharged as efficiently as possible. And those are very important thing., In our practice, because we cared for such complex patients, both medically and socially, we tended to feel like those folks were best cared for with a lot of continuity. So if somebody was sick enough, we would admit our patients to the hospital and see them in the hospital. And then if they needed more care after they left the hospital, we all were medical directors in nursing homes. So our patients could go and also be cared for by us after the hospital in a rehabilitation facility and then be discharged home. And we could even see them in their homes and then they could come back to the office. So it was really a continuum of care practice long before that was considered a really important standard of care for complicated patients. It was a wonderful group of practicing physicians who believed in that model. It was very challenging, but it was very satisfying.

Daniel Lobell: (18:34)
I can only imagine and I can only imagine what’s been going through your head over the past year, as we’ve all sat back and witnessed the horrific treatment that seniors have received, as this virus that they’re particularly vulnerable to has ravaged nursing homes.

Dr. Madeleine Biondolillo: (18:56)
It’s beyond heartbreaking for both the seniors themselves and their families being so devastated by not being able to visit and provide care, the staff in the nursing homes being devastated because caregivers of residents in nursing homes provide an enormous amount of benefit to the nursing home, because it’s very hard to provide all the care that’s necessary to do, so those folks who are lucky enough to have family members or other loved ones who can help with the care, not only do they benefit greatly, but everyone does. So this year has just been terrible. I was fortunate enough to be asked to help out with a process in Massachusetts, because I was there for a good part of 2020 due to COVID. And the Massachusetts Nursing Home Association essentially pulled together a task force to try to bring together folks who are knowledgeable about that industry to help the industry because it was a devastating time. Massachusetts did not do as badly as some places, but no one did well. And despite honestly Herculean efforts to try to do well.

Daniel Lobell: (20:27)
It’s tragic and I’ve worked in nursing homes myself and it was very meaningful work. I had a story that actually I did on a storytelling podcast that went a little bit viral about it once. One of the things I would talk about and that I’ve always felt is that it’s devastating the way we treat seniors in this country. And the culture towards seniors in this country is just very sad. We discard them and rather than cherish them and look to them for wisdom and all the amazing life experience they can share with us, people tend to just throw them to the side. And I remember I had a bit for a little while in my standup where I would do a commentary on this where anything is collectible as it gets older, except for people. If you have a lunchbox and a person you love in your house every year, that goes by, you’re more likely to keep the lunch box. So it’s a sad thing and the work that you do there is important and appreciated.

Dr. Madeleine Biondolillo: (21:40)
That is a wonderful way of thinking about it. And I think those kinds of reframing of the issue, anything that gets older is collectible, unless it’s a person, that’s a really powerful way of expressing the issue because it really brings it home to something that feels very palpable to all of us. And I think part of the issue that we have in our culture that lends itself to that, and it’s really challenging. It’s really problematic as you indicate, that when people do get old and frail, we tend not to have societal mechanisms to keep them integrated, and social isolation we know is another thing that makes people frail. So it is a vicious cycle once it starts. And one of the things that practice of medicine for older people in the community, and then eventually, if need be in a nursing home or other congregate living situation, has really taught me is how important it is for all of us to think about aging as early as possible, and do our best, do whatever we can to keep that process on the healthy side as much as we can, because it really is up to us.

Dr. Madeleine Biondolillo: (23:19)
We have not built a society that has figured out how to keep folks integrated. And so you do have that, where you’ve got your lunchboxes, but your grandmother or great-grandmother is probably not all that accessible and you’re right, the COVID pandemic just absolutely brought that home in a very painful way.

Daniel Lobell: (23:43)
My understanding is that isolation, especially amongst seniors, can contribute to an increase in the deterioration of Alzheimer’s and dementia because the brain isn’t being stimulated. Is that correct?

Dr. Madeleine Biondolillo: (24:00)
That’s absolutely correct. It’s an intellectual phenomenon and it’s an emotional phenomenon. There were heartbreakingly numerous stories of people in nursing homes when the visitation had to stop. And from a public health standpoint, you completely understand why in the beginning, there was a push to stop visitation because these are older frail people. There really weren’t therapeutics. There wasn’t a vaccine yet, and they were at risk. And so we knew that limiting visitation was likely going to be helpful, but so many people basically said, “I can’t take the isolation. I would prefer if I have to die, to die from the disease and not from the isolation”. And that is just unbelievably heartbreaking, but it brings home the point that you’re making.

Daniel Lobell: (24:56)
Yeah. I used to also do a bit about working in the nursing home. People would ask, “What’s the number one thing that kills you when you get old?” And I’d say, “It’s not poor diet, and it’s not lack of exercise, and it’s not an accident with a car or anything like that. It’s falling. People just were totally fine. One day then they walking down the hall and they fall and they’re done.” And, the joke was that one day I’m going to build a nursing home in a bouncy castle so everybody there will live forever, but it is true, isn’t it? That falling is the number one killer when you get old?

Dr. Madeleine Biondolillo: (25:37)
Yeah, it is true. I like the bouncy castle idea. We should really think more about that.

Daniel Lobell: (25:42)
[Laughs].

Dr. Madeleine Biondolillo: (25:42)
It’s also the number one reason why people end up going into a nursing home. It’s really a cascade of things that happen. So someone falls – if they survive the fall, they will often need hospitalization for surgery, or for just getting better from their fracture or for helping them gain more ability to move around, better mobility or strength, and maybe not fall again. But the fear of falling is enormous after one has had a fall. And when one has had a fall, because of the cascade effect, whether or not you’ve had to go to the hospital, the number of infections builds up and all kinds of need for support for the activities of daily living.

Dr. Madeleine Biondolillo: (26:41)
And so oftentimes that’s the precipitating event whereby people do lose their independence in the community. And for many people, it’s a wonderful thing to go into a nursing home, they get great care, they have more activities than they might’ve had if they were alone, but a lot of people don’t like it. And so it’s really an important thing to do exactly what you say, which is try to figure out one way or the other to live in a bouncy house, whether it be external, whereby you try to eliminate the dangers of falling, or whether it’s internal, that similar kind of approach, but building up your own mobility and strength.

Daniel Lobell: (27:27)
Do you think it would be a good business for us to develop a robotic suit that you have to go in at a certain age that keeps you from falling?

Dr. Madeleine Biondolillo: (27:36)
I think it’s a great idea for an innovation. There are similar kinds of things where people try to prevent hip fractures by putting special – not robotic – but super padded pants on people. But as you can imagine, people don’t exactly enjoy wearing that, but I love your idea and I love the innovative spirit.

Daniel Lobell: (28:01)
[Laughs]. You’re too kind. So we didn’t actually tell the audience what your title is in medicine. Would you do the honors of doing that please?

Dr. Madeleine Biondolillo: (28:10)
I practiced medicine in Boston and led a practice that focused on continuum of care for adults with complex medical and social needs and also community-based geriatrics. So I was the executive director of a group called the Urban Medical Group that was at Beth Israel Deaconess Medical Center, which is one of the Harvard hospitals. I then spent several years working at the Department of Public Health. I was the associate commissioner of the department. It’s the country’s oldest public health department. And I really learned from the experts there all kinds of important issues related to public health, all of which of course have become nationally recognized as important in light of the COVID pandemic. And now what I do is I’m a vice president for academic initiatives and quality innovation for a company called Premier, which is based in Charlotte, North Carolina. And we do a number of things. I have led national quality improvement initiatives, with hundreds and hundreds of hospitals being members of groups that work together to address quality improvement opportunities in hospitals and in hospital systems. And I now work to develop programs, for example, the chief quality officers of various academic institutions across the country.

Daniel Lobell: (29:50)
I didn’t even know that was a title, Chief Quality Officer. I’d like to call myself one.

Dr. Madeleine Biondolillo: (29:57)
Yeah, you would be a good one. You have a natural way of thinking about it. Your point about innovation is really important. So all hospitals are measured on standard quality metrics, for example, infection rates. It’s just in the nature of the beast that when sick people go into a place to be cared for and have complex procedures that they need performed, there’s a certain number of infections that are going to happen, but obviously we want that number to be as close to zero as possible. And so there are ways to really try to provide the best possible care. And that’s what a chief quality officer does.

Daniel Lobell: (30:42)
So when they’re doing their job well, are they referred to as a chief high-quality officer or conversely, a low quality officer, if the hospital’s not doing great?

Dr. Madeleine Biondolillo: (30:53)
[Laughs]. That’s a wonderful way of thinking about it. We haven’t gone there yet, but as a former quality regulator for the Department of Public Health for the Commonwealth of Massachusetts, that is a way of managing improvement, which is to say that it’s thought that the more the public knows about how folks are doing, the better in general folks are going to do. So, for example, the federal government has websites where you can go and you can look up your hospital or your nursing home, and you can look at how they’re doing on the standard metrics of quality. So you’re right. That could be kind of a moniker that could be applied. We haven’t gone there yet. [Laughs].

Daniel Lobell: (31:47)
[Laughs]. I was also wondering, when you study adult medicine, do you go into a medical bookshop and they have like the adult section and it’s like everybody’s looking at you and you have to sneak in there to get the adult medicine books? [Laughs].

Dr. Madeleine Biondolillo: (32:03)
That’s pretty cute. It’s funny when you’re studying medicine, at least I’ll speak for myself. I guess there were some funny people. I was not one of them. So because I was the mother of one and then two children and working on the side, running a kind of a family business, I just ran in and got the books and did my best to memorize what I do. But yeah, that’s a good one. [Laughs].

Daniel Lobell: (32:32)
Did your kids wind up having your infections as well?

Dr. Madeleine Biondolillo: (32:36)
I was lucky that they really didn’t. I had some super healthy kids. I was a healthy kid too. I just had very small eustachian tubes. So that was unfortunate for me. No, I’m very, very lucky. I have three kids and three grandkids and knock on wood – everyone’s extremely healthy

Daniel Lobell: (32:56)
Alright here, I’m giving it a knock. To circle back to what you were saying about healthcare. I know that America spends more on healthcare than any other country in the world, and yet our rates of chronic disease and obesity are, I think the highest and life expectancy is declining. What are the factors in your opinion that are responsible for that?

Dr. Madeleine Biondolillo: (33:18)
Yeah, that’s the 64 zillion dollar question, right?

Daniel Lobell: (33:22)
I won.

Dr. Madeleine Biondolillo: (33:22)
[Laughs]. Well, if you solve it, you win. Good for you for starting to ask it. There’s a great book called The American Healthcare Paradox by a couple of authors, Bradley and Taylor. And it really describes how we in comparison to other developed countries do exactly what you just said. We’re spending more and more, and we’re getting less and less from the standpoint of the health outcomes. And why is that? So because I practiced medicine the way I described, primary care, adult medicine for folks with complex conditions and then worked in leadership roles in public health, I spent a lot of time learning the hard way, for my patients and for the citizens who depend on public health, how you really just can’t separate healthcare and social care.

Dr. Madeleine Biondolillo: (34:28)
In the United States, we just have this arbitrary, odd disconnect between social supports and healthcare supports. There was a joke in my family, if you can’t fix it with a hammer, get a bigger hammer.

Daniel Lobell: (34:47)
[Laughs].

Dr. Madeleine Biondolillo: (34:47)
Needless to say, that wouldn’t work, but that’s the way we approach American healthcare. We keep pumping money into a system that is great in many ways, really great. I mean, I’m a healthcare quality expert. I spent a lot of time with leaders all over the country and when it’s great, it’s great. But the reality is in terms of the output that you want to achieve, which is health, only 10 to 20% of a person’s health is influenced by the healthcare that they get, at least 80%, maybe 90% has to do with the way they live- the social determinants of health as we call them. And so the fact that unlike most other developed countries, we do not integrate social care and health care, it puts us in the position you described.

Daniel Lobell: (35:49)
So what would that look like for you if I gave you the keys to the country, and I said, “You’re now in charge of implementing this in the way that you envision it.” What would that look like?

Dr. Madeleine Biondolillo: (36:01)
Well, it’s a great question. I had the unbelievable good fortune, actually just the last two days, of being part of a quality award visit that the American Hospital Association sponsors every year.

Daniel Lobell: (36:17)
Did it take place quality in Quality Inn? [Laughs].

Dr. Madeleine Biondolillo: (36:22)
[Laughs].That’s a really good marketing opportunity nobody has mentioned yet. So there is something for you to consider. It’s a great idea. And maybe they want to set one up near every hospital, but we were visiting actually a public hospital. So this is not a hospital that has huge sources of revenue. But they have wonderful leadership and they have a long standing, many decades commitment to high quality care. And they do understand the reality that I just described – the kind of 80/20 oppositeness reality, that 80% of health is not related to healthcare. So they’ve built all kinds of strategies, similar to the practice that I described in Boston, the Urban Medical Group, whereby we provide a great continuity. We had a terrific hospital that if you needed hospital care, you got the best, but as soon as we possibly could get you home, whatever home was, maybe it was your nursing home, maybe it was your house home, your assisted living or your congregate care housing situation, we got you home and we followed you. So there was this emphasis on not just continuity because that’s what folks need when they have complicated issues and serious healthcare needs.

Daniel Lobell: (37:54)
It sounds like stalking. [Laughs].

Dr. Madeleine Biondolillo: (37:56)
Yeah, it’s like a form of medical stalking with a benevolent goal. That’s exactly right. And the other elements of the stalking is we didn’t just stalk you ourselves as your doctor or your nurse practitioner, we pulled in all kinds of other people to stalk you too, we had your care manager, a meals on wheels person, you area on aging person, and all kinds of behavioral support services. So really it’s the wrap around kind of services. And that’s the social issues being addressed that are so important because the truth is how can we expect an older person who’s fallen, who needs to go into the hospital and maybe has a hip fracture, maybe they need surgery, maybe they don’t, how do we think they’re going to get better if they don’t have food, because nutrition is mission critical to their healing. And so we discharge them home. And if we don’t continue to stalk them, as you say, and stalk them with food and with health services and social supports, they’re not going to make it. So that’s the way it goes.

Daniel Lobell: (39:10)
Who are your consultants for this initiative? Former KGB agents? [Laughs].

Dr. Madeleine Biondolillo: (39:15)
[Laughs]. Yes. The Netherlands KGB. It’s a really important point that you’re making, because it really takes that dedication. You could maybe call it something else.

Daniel Lobell: (39:29)
[Laughs].

Dr. Madeleine Biondolillo: (39:29)
I like the way you think about analogies because this world is so separate from much of society until God forbid, this happens to somebody and I cannot tell you how many times people have reached out to me and said, “Oh, I know you do this for a living. I never thought this would be, the situation my family’s in and help. I need help from my mother, grandmother, aunt, whatever.” And it just is a universal phenomenon because we don’t get ahead of it. It’s similar to what’s happened with COVID, being a public health person, we underfund public health for ever and ever and ever, because we don’t really know what it is. We don’t educate anybody about it. It’s mostly a process of preventing bad things from happening. So when they don’t happen, no one knows and there’s no media attention. There’s nothing there to point to, to say, “Let’s fund this” because what is this?

Daniel Lobell: (40:41)
What is it, nutrition? Is it educating people in terms of how to be healthy?

Dr. Madeleine Biondolillo: (40:48)
Sure. So for example, from a public health standpoint, we know who got most severely affected by COVID. This is an easy example to talk about because the entire world just lived through this and we continue to live through it, but things aren’t getting better. Well, people who had to live in very tight quarters or people who were homeless or people who lived in nursing homes because it’s congregate housing. So if you didn’t have adequate air, if you didn’t have adequate space, if you didn’t have the ability, the resources, the financial resources to say, “Yikes, I live in, let’s say the Bronx and I’m in a very, very closed space because it’s New York City and it’s very expensive and I have very few square feet, but I can’t leave the city. I don’t have the resources. I don’t have a country house.” Well, the rate of mortality in the Bronx was enormous. And that’s because folks didn’t have the ability to leave. And more than that, in order to continue to have an income, they were the essential workers. They had to go to work and be on-site and use public transportation. And so they were taking all kinds of risks just to live. And that’s the social issues.

Daniel Lobell: (42:15)
Is the solution to make everybody rich. What do we do? How do you fix that?

Dr. Madeleine Biondolillo: (42:21)
It’s a really good question. And if we think about the American healthcare paradox, the studies that have been done of the United States versus 30 or so other developed countries, there is a financial support mechanism for people. It’s not limitless, but it’s enough, it’s sufficient so that nobody gets sick because they’re poor.

Daniel Lobell: (42:49)
Well, I’m for it. I say, “Let’s get people at least the basics that they need to stay healthy.” I do want to talk a little more specifically about nutrition because you and I, in our brief conversation before we started recording, talked a little bit about you working on an initiative for a more individualized nutrition that meets each person’s needs and each person’s genetics.

Dr. Madeleine Biondolillo: (43:25)
Yeah. It’s a real movement. In the realm of healthy aging, we think about a handful of factors as being really mission critical to focus on. A nutritionist is certainly one. Things like fitness which is relevant for an aging body is really important, the whole phenomenon of mind-body medicine which is things like mindfulness practices like meditation and yoga and its influence on how our bodies are healthy. And then you mentioned earlier the whole issue of social isolation and connection to people and how important that is. So those are some of the big broad areas that we think about when we think about making sure people can stay a person and not a patient for the reasons that we’ve been talking about.

Dr. Madeleine Biondolillo: (44:22)
But precision nutrition is a new area of real focus, which is very exciting. I mentioned that I went to Tufts University Medical School and Tufts has the best and biggest school of nutrition in the country as an example. So from early days, I had the really lucky opportunity to at least rub elbows with people who were some of the country’s superstars in that area. We don’t teach our medical students enough about it, but I got to see it as a really important pillar of health. And so interestingly, very recently, just in the last year or so, Dr. Francis Collins, who heads up the NIH, has allocated a lot of research funding to look at the very specific needs from a nutritional status standpoint of people in order to stay healthy. We think about medication very specifically for people with different kinds of conditions, for example, diabetes or heart disease, things of that nature, immune disorders. But we really don’t think about nutrition that way. And yet his own personal and professional experience has taught him that there’s a lot of opportunity there. So it’s an exciting research area.

Daniel Lobell: (46:01)
Yeah. As somebody who’s visited multiple nutritionists over the years, I’ve always thought, “Why is it such a broad field?” Like when I’ve gone to get running shoes, I’ve gone to an athletic shoe shop and they take so much time examining your specific foot. You stand on this machine, it scans your foot. It looks at the curve, the arch of your foot. I imagine that this is not just all a show that they’re putting on for me though. It could be. They individually tell you what kind of sneaker is good for you, but when it comes to nutrition, it seems like it’s a one size fit all situation.

Dr. Madeleine Biondolillo: (46:42)
Exactly. That is a wonderful way of thinking about this. Why would we put all that effort into our athletic shoes?

Daniel Lobell: (46:56)
Especially when you never use them after you buy them? [Laughs].

Dr. Madeleine Biondolillo: (47:01)
[Laughs]. I was going to say, “Well, if you’re a marathoner, I probably wouldn’t have to explain it to you.” But yes, exactly. We don’t think about what we put in our body that same way. And for a lot of reasons, but at least partly nutrition, we have an epidemic of what we’re now calling Diabesity, which is diabetes influenced by obesity, each separately are huge pandemic level issues. But we don’t have enough precision nutrition focus on that. We’re going to start to. We have what we call immune aging. So we’ve got this epidemic of immunologically mediated conditions. And very much the inflammation and immune system disorders are leading to exaggeration of aging, but inflammation is a hugely impactable condition by things like nutrition and some of the other things we talked about.

Daniel Lobell: (48:17)
I’ve started thinking about being overweight in terms of inflammation. I think the whole body’s inflamed – instead of just calling it fat, it’s just inflamed and I need to bring it down.

Dr. Madeleine Biondolillo: (48:29)
There are people who have for example, removed sugar from their diet. I had to do that in the last year because I was diagnosed with multiple sclerosis. So, you know, we’re doctors, but we’re patients too.

Daniel Lobell: (48:45)
I’m sorry to hear about that.

Dr. Madeleine Biondolillo: (48:47)
Oh, thank you. Well, I’m very fortunate in a lot of ways. I have really good healthcare, but also, like I said before, that’s probably 20% of it. 80% of it is these social factors. I’m lucky enough to have the ability to learn how to regulate my diet. And when I learned how significant sugar potentially could be in influencing the inflammation that’s so much at the heart of multiple sclerosis, I began the process of going from a two cupcake a day gal to a no cupcakes a day gal, and trying to find other things that wouldn’t completely substitute for that amount of sugar. And it has made a big difference.

Daniel Lobell: (49:37)
Maybe if you take enough of the unhealthy things out of your life like sugar, can you possibly bring it down to singular sclerosis?

Dr. Madeleine Biondolillo: (49:46)
[Laughs].

Daniel Lobell: (49:46)
[Laughs].

Dr. Madeleine Biondolillo: (49:46)
I love it. That’s my goal. I’ll let you know.

Daniel Lobell: (49:50)
Since you seemed to be a fan of my analogies, I’ll give you one more on the topic of nutrition, because it is something that I think about a lot. I feel like I have some kind of an education in it because of all the hours and money I’ve spent going to nutritionists and dieticians and the videos I’ve watched and the books I’ve read. I think if they had a degree in this, it would be as if I did all the coursework, for at least a level one degree in nutrition and I still know nothing. So, I’m going through the gas station this week and they have the regular and the leaded and the unleaded and all the four different options of gas and they relate to what kind of car you have. And again, I started thinking about this in terms of nutrition, because we understand even cars are not all supposed to run on the same fuel. And yet it’s not clear to people that we, who are much more complex beings than cars, haven’t figured it out and I’m so frustrated by that. So I’m very excited about this field that you’re talking about. And I can’t wait to hear what they have to say.

Dr. Madeleine Biondolillo: (51:13)
Well, me too. I would say that it’s just beginning to get a lot of traction, so to speak, considering the running shoe analogy and maybe the car analogy too. I love both those examples you use. We do seem to understand from a technology standpoint, the things that we care about, the themes that we care about, like shoes and cars, that it has to be specific, but we somehow miss that despite the fact that so much of American medicine is focused on medications, which are highly specific for conditions. We just haven’t gotten there yet completely with nutrition, but that’s the bad news and it’s the good news. It’s unfortunate because somebody like you who’s trying to self-educate and trying to get a handle on this, can’t really do it, but it does mean that there’s potential for progress. And the fact that the NIH is putting money towards this is hugely important. So it’s going to be important for us to track it.

Daniel Lobell: (52:22)
And I’ll give you one more thought, and I don’t want to dwell on this one topic, and I know your time is limited, but I have attention deficit disorder and I take Adderall. And the pill is so tiny. I don’t know if you’ve seen these little blue pills, but it’s microscopic and I take this tiny little pill and it makes the biggest difference in my day. And I’m a big guy and it’s a small pill. And I think to myself, “What is the food that I put in much larger quantities than this tiny blue pill, doing to me? If this is having such a noticeable effect on me, how come I don’t know the effects certain foods are having on me?”

Dr. Madeleine Biondolillo: (53:06)
It’s a great point. And that has to be true of every condition. So you have your condition. I described my condition, we’re just two people and we might have other stuff too. I got other stuff. So does just about everybody after a certain amount of time, right? And with medications, we think about, for example, drug interactions, we take the little tiny blue pill, maybe take something else. How do those things influence each other? There’s specific focus from the medication standpoint, we are not even scratching the surface one food at a time really, or one food substance at a time. But we will, that’s a really exciting opportunity to learn more about, and more will come on that.

Daniel Lobell: (53:59)
I have one more question if you don’t mind. I know you’ve been involved in a program called QUEST 2020. Can you tell me a little bit about it and what does it aim to accomplish?

Dr. Madeleine Biondolillo: (54:11)
Oh, sure. Yeah. You’ve done homework. QUEST 2020 is a wonderful initiative. It’s one of the national quality improvement collaboratives that I mentioned I had been overseeing as part of my work at Premier, and this one is wholly managed by Premier. There are actually quality collaboratives that Premier started, but that the federal government has picked up and run with, to their credit. So for example, the Center for Medicare and Medicaid Services runs a big one. But QUEST 2020 is an initiative that brings many hospitals from across the country together. They share their data transparently. They literally say, “Well, Madeleine’s hospital has X percentage rate of infections for this procedure and Danny’s hospital has Y percentage. Gee whiz, Danny, you’re doing so well, what are you doing that I’m not doing, can I learn from you?” And they share their knowledge and so everyone improves.

Daniel Lobell: (55:29)
That’s amazing. I’m surprised that that hasn’t been the standard always, but it’s great to hear that it’s happening. Why shouldn’t we be learning from each other in everything we do in every field?

Dr. Madeleine Biondolillo: (55:43)
Yeah, that’s one of the wonderful things. And that was my attraction for Doctorpedia because we cannot have enough opportunities in our society where we’re all struggling with so many of the same issues – COVID is a perfect example, right? It was an entire world dealing with and struggling with one area and we were desperate for information and that’s sadly an example of everything that goes on in healthcare. And so the more you can bring people together and have them share their experiences, whether it’s their data that they’re using to evaluate themselves and they can compare with each other, whether it’s the stories like we’re telling now of what works and what is on the horizon, this is how people learn. And so that’s what they want. No one is working in healthcare not to make things better. Everyone’s trying to make things better. The question is how, and so this is a very powerful mechanism.

Daniel Lobell: (56:48)
So what is some of the work that we can look forward to you doing with Doctorpedia and how can people find it?

Dr. Madeleine Biondolillo: (56:56)
I’m fortunate enough to be the founding partner and chief medical officer for the healthy aging channel. And so some of the things we’ve been talking about, like precision nutrition, like mind-body medicine, is a big part of what I look forward to featuring. One of the things that I enjoy very much and just speaking about the quality collaboratives that I’ve run in the past is I have the delightful experience of bringing people together as you do, as you’re doing now, who are experts in their various fields and just having conversations with them and asking them to please tell me what’s important to know about this. What’s on the horizon? How can we all benefit from this? And what’s the proof? The thing that’s really great about Doctorpedia and the thing that was so powerful about initiatives like QUEST 2020 is it’s a combination of what people have done themselves that has been very impactful and the best experts in the field. And you need both.

Dr. Madeleine Biondolillo: (58:05)
I wish the experts had all the answers – they don’t yet. So some of the learning comes from people just trying stuff on their own and saying, “Wow, this really worked for me.” I just told you about having multiple sclerosis and not eating cupcakes. Well, that’s not proven research, but I’m here to tell you it was very impactful. There is really good research on things like specific foods that if you consume enough of them over a period of time, by a certain age, you can reduce your risk of Alzheimer’s disease. Well, isn’t that an important social thing? And that’s the kind of thing that we’re going to be bringing to bear into increasing light with this work on healthy aging.

Daniel Lobell: (58:57)
Yeah. I’m excited. I think anybody listening will probably be excited to check that out on Doctorpedia. I’m going to ask you the question to round off the interview that I ask all the doctors, and you touched on it a little bit with the cutting out sugar, but more than that, what do you do to stay healthy?

Dr. Madeleine Biondolillo: (59:19)
I focus on diet. I also try to eat as much of a plant-based diet as I possibly can. Since I was a teenager, I’ve worked out every day. I do less now largely because of the MS, but I still work out to my best ability. Part of the reason why I made the decision to move to Miami from Boston is because I can swim a lot. And the kind of exercise is very important to me. I’m kind of a terrible swimmer, but it allows me to do something that works for the current condition of my body, so it’s very helpful. And then the really important thing that I do first thing, last thing every day is the mindfulness stuff. In my case, it’s a combination of prayer and a gratitude litany that I go through all the time, because I have a lot to be grateful for. And then some straightforward meditation.

Daniel Lobell: (01:00:24)
Any recommendations to the listeners of where they can get started if they say, “Hey, that sounds appealing. I want to be mindful too.”

Dr. Madeleine Biondolillo: (01:00:34)
Doctorpedia has some really good resources. There are a lot of apps. I personally use the app that’s called CALM. It’s a meditation app. And I think it’s very, very well done.

Daniel Lobell: (01:00:49)
Mostly heavy metal on there, right?

Dr. Madeleine Biondolillo: (01:00:53)
Right. Exactly. [Laughs].

Daniel Lobell: (01:00:55)
[Laughs].

Dr. Madeleine Biondolillo: (01:00:55)
It’s very nice. It’s a combination of going in the direction of stoic philosophy and really practical meditation tips and it’s very straightforward, very short little bursts. I think one of the main things that can be very helpful is just do what you can. Don’t try to do everything. And certainly don’t try to do everything all at once and don’t try to do everything for a long time. You have to do small bits.

Daniel Lobell: (01:01:29)
Oh, I thought you were telling me to procrastinate. Don’t try to do everything for a long time. Well, I’ll try in 10 years.

Dr. Madeleine Biondolillo: (01:01:34)
[Laughs].

Daniel Lobell: (01:01:34)
Dr. Biondolillo, thank you so much. I learned a lot. You truly are a high quality doctor and get some running shoes. What can I tell you? [Laughs].

Dr. Madeleine Biondolillo: (01:01:49)
I’m going to get some specific ones for me. You’re a high quality interviewer and it’s been a great pleasure to talk to you. Thank you so much.

Daniel Lobell: (01:01:57)
Thank you.

Daniel Lobell: (01:02:05)
This podcast, or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.