Book Title: The Community Cure: Transforming Health Outcomes Together
Author: James Maskell
Publication Information: New York, Lioncrest Publishing, 2019, 220 pp., $13.89, paperback
James Maskell is a self-described, “serial healthcare founder, innovating at the intersection of functional medicine and community.”1 He is the cofounder of Functional Forum, described as “the world’s largest integrative medicine conference” and author of the 2016 book, The Evolution of Medicine: Join the Movement to Solve Chronic Disease and Fall Back in Love with Medicine, also previously reviewed in this journal.1-3 Maskell holds a certificate in secondary education and was previously faculty at George Washington University’s Metabolic Medicine Institute.
The premise of The Community Cure is that we are facing a profound and worsening epidemic of loneliness in our society that is exacerbating chronic disease, and Maskell argues that to counter this we should increasingly turn to group medical appointments. Maskell cites many examples of isolation as a social determinant of health including a 2017 questionnaire-based study in which Medicare recipients greater than 50 years who ultimately were defined as “lonely” (subjective isolation) experienced death rates 31% higher than their peers who did not self-identify as socially isolated.4 Obscuring our perception of this reality is the fact that unlike other similarly fatal diseases “loneliness doesn’t have a billing code” (p 31).
From there, Maskell depicts how group medical visits for various medical conditions and executed in multiple different fashions have shown powerful evidence as a treatment for the loneliness epidemic. He highlights Dr Jeffrey Geller’s early work with group medical appointments, which he started in 1997.5 Because he noticed that patients who lacked support systems accessed medical care at a greater rate, Dr Geller decided to create a support system by forming group visits with a cohort of diabetes patients. Ostensibly formed to specifically address diabetes, as the group continued meeting for 3 years it became clear that the group medical appointments also addressed isolation. Of their global outcomes, Geller stated, “People’s loneliness improved, people’s depression improved, they lost weight … blood pressure reduced by 5-10 points, and hemoglobin A1C also reduced” (p 34). Maskell goes on to point out how the biopsychosocial model introduced by George L. Engel in 1977 (p 46), a key tennet of family medicine, is the heart of the success of group medical appointments.6 He states, “The group visit is unique in its ability to treat each of these three aspects—biological, social, and psychological—simultaneously, with a synergistic effect” (p 47).
In addition to the book itself, Maskell presents many additional resources for those interested in starting their own group visits, primarily through his website, “Evolution of Medicine.”7 Here Maskell offers many free and/or introductory offerings to support the implementation of group medical appointments, in addition to guidance for transitioning to a functional medicine practice. These include patient handouts, group visit guides, practice development webinars, blogs, podcasts, and consultation services. Of note, these resources directly address each of the three primary barriers to availability of group medical visits at family medicine residency sites as noted in a 2019 study: resources; faculty expertise; and skills training.8
Community Cure was published in mid-January 2020 just prior to all of our lives being interrupted by COVID-19 and its inherent push for people to socially isolate. Recently, Maskell recognized the enhanced challenge stating, “COVID-19 has exacerbated loneliness,” yet he also accepts the new challenge to move group visits virtually—his next focus (J. Maskell, personal communication, July 29, 2020).
Maskell’s push and timing could not be better as the Accreditation Council for Graduate Medical Education has plans to overhaul family medicine residency guidelines in the near future and leading family medicine organizations are collaborating strongly to steer that change.9 Importantly, bold questions are being asked about what competencies should we be committing to teach in family medicine residencies, and topics such as lifestyle medicine, virtual medicine, genomics, and population health are being elevated for consideration. And the vision is not for what is needed in the next few years, but next 30-40 years! Especially with these pending changes in mind, Maskell seems to be achieving progressively firmer footing in increasingly turbulent times and deserves our attention.
