A Future Cast Narrative: 2025-2040
Disclaimer: This is a “future cast,” a fictional exploration of one possible future based on current trends and emerging technologies. While the companies and technologies mentioned are real, the events described are speculative fiction intended to help visualize potential outcomes. Like any forward-looking statement, actual results may vary significantly. This is not investment advice, predictive analysis, or a guarantee of future events. Consider it a thought experiment in what could be possible if current innovations in food, agriculture, and health converge in transformative ways.
PROLOGUE: THE VIEW FROM 2040
April 12, 2040. Rochester, Minnesota.
Dr. Marcus Chen stood at the podium in Mayo Clinic’s Gonda Building, looking out at 3,000 physicians, researchers, and healthcare executives who had gathered for the 15th Annual Metabolic Health Summit. The irony wasn’t lost on him. Fifteen years ago, Mayo’s cardiology department had nearly fired him for suggesting that food could do what pharmaceuticals couldn’t.
Now they were giving him their highest honor: the Distinguished Achievement in Healthcare Transformation Award.
“They’re calling it the greatest shift in American healthcare since the discovery of antibiotics,” the host announced. “Under his leadership, we’ve seen Type 2 diabetes incidence drop 67% nationally. Cardiovascular disease mortality has fallen 54%. And the Medicare trust fund, which was projected to be insolvent by 2035, now holds a surplus of $847 billion.”
Marcus adjusted his glasses. At 62, he still found mornings difficult, though for different reasons now. Not because of the chest pain that had awakened him that February night in 2025. Not because of the depression that followed his diagnosis. But because there was so much left to do.
“The greatest discovery I ever made,” Marcus began, his voice carrying through the silent auditorium, “wasn’t in a lab. It wasn’t in a peer-reviewed journal. It was in a grocery store parking lot in Tulsa, Oklahoma, where a woman in a cowboy hat named Erin Martin handed me a bag of locally grown carrots and told me to stop being an idiot.”
The audience laughed. Those who knew the story smiled knowingly. Those who didn’t lean forward.
“This is the story of how we stopped treating chronic disease and started eliminating it. It’s a story about food, about farmers, about a healthcare system that had to break before it could heal. But mostly, it’s a story about what happens when you stop asking ‘how do we manage this?’ and start asking ‘why does this exist at all?’”
CHAPTER 1: THE ORDINARY WORLD
February 2025, Rochester, Minnesota
Marcus Chen had been practicing cardiology for twenty-three years. He was good at it. His patient outcomes ranked in the top 5% nationally. His research on statin optimization had been cited over 2,000 times. He served on three FDA advisory committees and had trained more cardiology fellows than anyone else at Mayo.
He was also, by every clinical measure, a walking time bomb.
The chest pain started at 2:47 AM on a Tuesday. He knew the time because he’d been tracking his sleep with an OURA ring, part of an ongoing study on physician wellness and integrating wearables into clinical workflows for patients. The data would later show his heart rate variability had been declining for months. His resting heart rate and respiratory rate, had been creeping upward since Thanksgiving. Even his glucose levels were on the rise as documented by the Continuous Glucose Monitor he had been wearing as part of the study.
He sat up in bed, analyzing his symptoms with the clinical detachment of a man who had seen ten thousand cardiac events. Substernal pressure. Radiation to the left arm. Diaphoresis. He knew exactly what was happening. He just couldn’t believe it was happening to him.
His wife, Jennifer, found him sitting on the bathroom floor, Googling “atypical MI presentation in physicians.”
“Marcus,” she said quietly. “You’re having a heart attack and you’re doing research?”
“The data doesn’t fit,” he muttered. “My LDL has been under 70 for eight years. I take rosuvastatin. I exercise three times a week. My coronary calcium score was 12 last year. This shouldn’t be happening.”
But it was.
The cath lab confirmed a 90% occlusion in his left anterior descending artery. A stent restored blood flow. His ejection fraction, measured the next morning, was 48%. Not catastrophic, but damaged. Measurably, permanently damaged.
For three days, Marcus lay in a hospital bed, surrounded by colleagues who didn’t know what to say. He was the doctor who fixed hearts. Now his own was broken.
“The protocols I’d spent my career perfecting had failed me,” he would later tell congressional investigators. “I did everything right according to the guidelines. I optimized every biomarker we measured. And I still ended up on that table. That’s when I realized we weren’t measuring the right things.”
CHAPTER 2: THE CALL TO ADVENTURE
March 2025, The Recovery
The depression arrived exactly when the textbooks said it would: three weeks post-procedure, right as the initial crisis faded and the reality of chronic illness settled in. Marcus knew the statistics. Thirty percent of MI patients develop clinical depression. He knew the treatment protocols. He’d prescribed them a thousand times.
Knowing didn’t help.
What helped was an email from a name he didn’t recognize: Carter Williams, managing partner at something called iSelect Fund.
“Dr. Chen,” the email began. “I heard about your situation from a mutual colleague. I’m sorry. As you know so well, what happened to you happens to six hundred thousand Americans every year. Most of them don’t have your training, your resources, or your access to world-class care. And like you, most of them were doing ‘everything right’ according to current guidelines.”
“I’m an investor. My firm focuses on companies that are trying to fix what I call ‘System B,’ the sick care system that failed you, even though it employs you. The system that diagnoses disease once present and treats your symptoms in lieu of the underlying root cause.
We see the $5 trillion healthcare burden differently than most. We believe the $4 trillion America spends annually on treating chronic disease, at least $1.9 trillion due to poor nutrition, represents the largest market opportunity in human history. Not by perpetuating the monetization of sickness but because it represents an unconscionable failure of systems thinking.”
“My partner Ellen Brown spent thirty years building healthcare systems from the inside, working with hospitals, health plans, and managed care organizations. Six months ago, she called me and said, ‘Carter, I’ve spent my career optimizing a machine that makes people sicker. I’m done.’ She’s now helping us build what comes next.”
“I’d like to introduce you to some people who are building what we call System C. They’re farmers and gerontologists and food scientists and entrepreneurs who believe that your heart attack, like most chronic disease in America, was preventable. Including Dr. Ajay Joseph, an interventional cardiologist who doubles as a Lifestyle Medicine doctor. Fixing the results of the diseases he also eliminates. Not through better pharmaceuticals. Not through earlier diagnostics or interventions. But through food and lifestyle.”
Marcus almost deleted the email. It sounded like a pitchslap and wellness industry nonsense, the kind of thing he’d spent his career debunking. But something in the provocative accuracy caught his attention. He’d never seen anyone quantify the healthcare cost of poor nutrition with such precision.
He Googled Carter Williams. What he found surprised him.
Williams wasn’t a wellness guru. He was a former Phantom Works engineer who had helped build stealth aircraft before moving into venture capital. His fund had invested in agricultural technology, food science, and healthcare delivery companies. His testimony before the Senate HELP Committee had been cited by researchers at Tufts and UCSF.
Then he looked up Ellen Brown. Thirty years that spanned from leading strategy for a $3B Blues plan, creating a strategy arm for a formidable consulting firm that had a successful exit and most recently founding her own consulting firm that was responsible for leading payment transformation and value-based care engagements with some of the most formidable health care companies in the country. She knew the healthcare system’s underbelly better than almost anyone alive. And she all but walked away from it.
Marcus replied with a single question: “What causes aren’t we addressing?”
The response came within an hour: “All of them. When can you fly to Tulsa?”
CHAPTER 3: REFUSAL OF THE CALL
April 2025, The Skeptic
Marcus didn’t fly to Tulsa. Not immediately.
Instead, he returned to work. His colleagues had cleared his schedule for six weeks, but by week four, he was back in the cath lab, back in the clinic, back in the familiar rhythms of intervention and management and disease progression. The hospital had a new Chief Medical Officer position opening. His name was on the shortlist.
“You could shape care delivery for the system,” Jennifer said one evening. “Change the entire approach and experience for patients.”
“I’m a clinician,” he replied. “I help individual patients. That’s what I’m good at.”
But the numbers haunted him.
He started tracking them obsessively. The 600,000 MIs per year. The 1.4 million Americans on dialysis for diabetic nephropathy. The 8 deaths per minute from Type 2 diabetes globally. The $5.6 trillion annual healthcare spending in 2025, the most recent figure from the CMS Office of the Actuary . The fact that 94% of Americans were metabolically unhealthy by at least one measure.
He calculated his own contribution. In 23 years, he had performed approximately 8,000 cardiac interventions. Each one represented a failure, the majority of them from human bodies so degraded by chronic disease that they required mechanical repair. Thousands of failures. Not his failures, exactly. System failures.
One night, unable to sleep, he pulled up the email from Carter Williams again.
“What if we started small?” he typed slowly, “what if we could eliminate even 10% of these cases? What would the numbers look like?”
The reply came in the wee hours shortly thereafter. Williams was apparently also an insomniac.
“10% prevention would save 60,000 MIs annually. It would save $480 billion in direct healthcare costs. It would add approximately 1.2 million life-years to the American population each year. But here’s the thing, Dr. Chen: we’re not aiming for 10%. We’re aiming for 60%. Because the data shows that’s what’s actually achievable. Ellen and I can prove it. Come to Tulsa.”
Marcus stared at the number. Sixty percent. Three hundred sixty thousand prevented heart attacks per year. From his own specialty alone.
He booked a flight for the following week.
CHAPTER 4: MEETING THE MENTORS
May 2025, Tulsa, Oklahoma
The FreshRx Oklahoma warehouse sat on the edge of Tulsa’s medical district, a low-slung building that had once been an auto parts distribution center. The transformation was immediately apparent: loading docks now received wooden crates of vegetables from local farms instead of catalytic converters from China. The smell of cardboard and machine oil had been replaced by the earthy scent of freshly harvested produce.
Erin Martin met Marcus in the parking lot. She was smaller than he expected, barely five feet tall, wearing a black cowboy hat that seemed too large for her frame. She was eating a carrot, holding a Tulsa FreshRx flyer in her other hand.
Next to Erin stood Dr. Ajay Joseph, an interventional cardiologist and Lifestyle Medicine Diplomate who practiced in Tulsa, leading a small but mighty lifestyle medicine clinic serving patients from across the country, helping them end the diet & lifestyle-related chronic diseases they had been told prior were a life sentence. Marcus was stunned. How did he not know there was another way until today!
“You’re the cardiologist who had a heart attack doing everything right,” Erin casually stated. “Carter told me about you. I’m not a doctor. I’m a gerontologist. I spent years watching elderly people die from diseases they didn’t have to have. Then I got tired of watching.”
She handed him a carrot from the crate beside her. “Eat this. Tell me what you taste.”
Marcus bit into it skeptically. The flavor was unlike any carrot he’d had from a grocery store. Sweeter, more complex, almost buttery.
“That’s what food is supposed to taste like,” Erin said. “Grown in living soil by farmers who care about nutrition, not just yield. We test everything through Edacious. That carrot has three times the beta-carotene of a commodity carrot. Your body knows the difference even if your mind doesn’t.”
She led him inside, past stacks of produce boxes labeled with farm names and harvest dates, past a teaching kitchen where a group of patients was learning to prepare a simple vegetable stir-fry, past a small clinic where a nurse practitioner was reviewing lab work with a middle-aged man.
“We’ve enrolled 847 patients since 2020,” Erin explained. “All diagnosed with Type 2 diabetes. All were referred by local physicians who were running out of options. The standard of care wasn’t working for these people. Many were on maximum doses of metformin, some on insulin, some on GLP-1 agonists that cost $1,500 a month.”
“What do they get from you?” Marcus asked.
“Vegetables, knowledge, and self-worth.” Erin smiled at his expression. “Sounds ridiculous, right? But not just any vegetables. Produce grown by local regenerative farmers who optimize for nutrient density, not yield. I started this program because I watched too many people in senior care facilities waste away on institutional food. A master’s degree in gerontology taught me how people age. Five years running FreshRx taught me that aging doesn’t have to mean declining.”
She handed him a tablet displaying patient outcomes. Marcus scrolled through the data, his skepticism eroding with each chart.
Average A1C reduction: 2.1 points. Average weight loss: 23 pounds. Average medication cost reduction: 67%. Percentage of patients achieving A1C below 6.5 without medication: 34%.
“Your greatest A1C reduction?” Marcus asked.
“13.6 to 5.4 in six months. That patient had been diabetic for eleven years. Three different endocrinologists had told her she’d be on insulin for life. Our record weight loss is 111 pounds.”
“That’s not possible,” Marcus heard himself say. “That level of reversal would require complete beta cell regeneration. The literature doesn’t support it.”
Erin pushed her cowboy hat back and looked at him the way a patient grandmother looks at a child who insists monsters live under the bed.
“Dr. Chen, the literature is based on research done with commodity food. Nobody’s published studies on what happens when you feed people real food because nobody’s scaled real food until now. You’re a cardiologist. You understand that the heart is a muscle that can be strengthened or weakened. Why would metabolic function be any different?”
Ajay shared a similar story full of patient success stories, the same levels of magnitude from his lifestyle medicine clinic. Explaining their future plans for integrative pilots.
Before Marcus could respond, Carter Williams appeared at the warehouse entrance, accompanied by two others. The tall man in jeans and work boots looked like he’d spent his morning wrestling cattle. The woman beside Carter looked more like she walked out of a hospital boardroom as opposed to the produce warehouse.
Jesturing towards the man in jeans, “Marcus, meet Kelly Garrett. He farms 8,000 acres in northeast Iowa using methods that most agricultural scientists told him were impossible. His yields match or exceed conventional farms, while his input costs are 40% lower. More importantly, his crops test consistently higher for micronutrients.”
Kelly extended a hand that felt like it was made of leather and bone. “Heard you had a health crisis. Sorry about that. A lot of good people end up in your situation these days. Most of ‘em are eating food that was grown to be cheap, not to be nutritious.”
“And this,” Carter continued, gesturing to the woman, “is Ellen Brown. She’s spent thirty years in the belly of the beast, she knows exactly how the current system works because she helped build parts of it.”
Ellen shook Marcus’s hand firmly. “I also know why it’s failing. I spent three decades optimizing a machine that profits from keeping people sick. I didn’t believe that at first, and it’s still hard to stomach the idea. Risk stratification, care management, and population health make disease management profitable, not its reversal. I thought if we paid health systems to improve health, things would change, but instead, we got really good at managing chronic disease. There was no incentive to end it or prevent it.”
“What changed?” Marcus asked.
“I did the math,” Ellen said simply. “I calculated how many diabetics I’d helped manage into kidney failure. How many heart patients I’d helped manage into bypasses. The system I built wasn’t fixing anything. It was processing disease. Efficiently. Profitably. And pointlessly. When I found Erin and Ajay amongst others I realized we had the tools to end the chronic disease and when I met Carter and he said “I want to redesign the system so it becomes hard to make a bad decision at the grocery store, I realized I’d spent my career trying to fix a system that is designed just the way it was meant to operate.”
Marcus spent three more days in Tulsa. He toured Kelly’s operation via video link with a soil scientist from Ohio State who explained the microbial dynamics. He sat in on FreshRx patient consultations. He reviewed published literature on nutrient density variation in vegetables. He joined Dr. Joseph for a day with patients in the office, as well as participating in the sessions that were part of the Intensive Therapeutic Lifestyle Change program that was producing similar results.
On his last evening, sitting in a beloved Tulsa farm-to-table restaurant that sourced from the same farmers as Erin, with Carter, Erin, Ellen, Ajay, and Kelly, Marcus finally asked the question that had been forming since he arrived.
“Why isn’t everyone doing this? If the results are this clear, why isn’t it standard of care?”
Carter set his glass of water down. “That’s the four trillion-dollar question. Literally.”
Ellen leaned forward. “Because the current system is optimized for disease management, not disease reversal. I spent thirty years watching it from the inside. Every stakeholder profits from the chronic illness continuing. Pharma sells drugs. Hospitals fill beds. Insurance companies collect premiums. Food companies sell cheap calories. The incentives all point the wrong direction.”
“Nobody in the existing system makes money when people get better,” Carter added.
“Except the patients,” Marcus said.
“Except the patients,” Ellen agreed. “And the employers who pay for their insurance. And the food industry that sells the food that causes the disease. And the taxpayers funding Medicare. And the children who inherit healthier parents. If you take food and wellness into the equation, there’s $9 trillion a year on the table. The people who benefit from the current system control about $3 trillion of that. The people who would benefit from a new system control the other $6 trillion. The math is obvious. The politics is hard.”
Marcus flew home the next morning with a USB drive containing three years of FreshRx outcomes data, contact information for eighteen farmers and food scientists, and a decision he hadn’t expected to make.
He withdrew his name from the CMO search.
CHAPTER 5: CROSSING THE THRESHOLD
June 2025, The Leap
The announcement came as a shock to everyone who knew Marcus Chen. One of Mayo’s most respected cardiologists was leaving to join something called the Food is Health Collective, a newly formed organization backed by iSelect Fund and a consortium of health systems, insurers, and food companies.
“You’re giving up your practice to sell vegetables?” his department chair asked, genuinely confused.
“I’m giving up treating symptoms to address systemic root causes,” Marcus replied. “Every patient I see in the cath lab represents a failure of primary prevention. I can spend the next twenty years intervening in those failures one at a time, or I can spend those years trying to prevent the failures from happening.”
The Collective launched with an audacious goal: prove that a fully integrated food-as-health approach could reduce chronic disease incidence by 50% in pilot populations within five years. The founding partners included three regional health systems, two Medicare Advantage plans, a major self-insured employer, a retail grocer, an innovative CPG, and a coalition of regenerative farms spanning six states.
Marcus’s role was Chief Medical Officer. Ellen Brown oversaw the Collective, bringing her decades of healthcare system expertise to design the payment models and partner agreements. Her job was to design the use cases and make the new system economically viable within the existing healthcare infrastructure.
“We need to work within the system to change it,” Ellen explained at the first board meeting. “That means leveraging all of the outcomes based tools. It means getting creative about making nutrition affordable, sometimes covering food as a pharmaceutical benefit, other times offering retail incentives while also taking SNAP into consideration. It means having the entire value chain from soil to cell at the table to redesign. It means building the economic case that will make health plans want to participate.”
“We need randomized controlled trials,” Marcus added. “We need peer-reviewed publications in major journals. We need FDA acknowledgment that these interventions meet efficacy standards. Without that, we’re just another wellness fad.”
“That could take a decade,” someone objected.
“Then we’d better get started.”
The first pilot site launched in September 2025 in a former coal mining region of Appalachia. The population was among the sickest in America: obesity rates above 45%, diabetes prevalence over 20%, and cardiovascular mortality nearly double the national average. Standard healthcare interventions had been tried for decades with minimal impact.
The Collective’s approach was different. Instead of parachuting in with prescriptions and lectures, they started by listening. What did people eat? Why did they eat it? What would they eat if they had different options? What drove their daily lifestyle choices?
The answers revealed a system problem, not a behavior problem. Fresh produce was available only at a grocery store 45 minutes away. Local convenience stores stocked chips, soda, and processed meat. The Dollar General offered canned vegetables with more sodium than nutrition. People weren’t making bad choices; they were making the only choices available. Meanwhile, their insulin was delivered to their doorstep.
The intervention began with infrastructure. The Collective partnered with regional farmers to establish weekly produce distribution at community centers. They trained local residents as “food coaches” who could help neighbors navigate cooking and meal planning. The community organized weekly food prep group meetups. Ellen worked with the Collective members to create an outcomes-based program for their employees with Type II Diabetes and Heart Disease that focused on lifestyle change and produced results in which the disease was reversed, not simply treated. Framing it as a true incentive for health.
“We’re not asking people to change their behavior,” Marcus explained at a community meeting. “We’re changing their options. Right now, the healthy choice is the hard choice. We’re going to make it the easy choice.”
CHAPTER 6: TESTS, ALLIES, AND ENEMIES
2026-2027, The Resistance
Success bred opposition.
As the Appalachian pilot showed promising early results, the Collective attracted attention from unexpected quarters. A pharmaceutical trade group published a white paper questioning the methodology. A major hospital system that had initially expressed interest quietly withdrew after pressure from device manufacturers. An op-ed in a medical journal warned of “nutritional pseudoscience” infiltrating evidence-based medicine.
The most dangerous threat didn’t come from the opposition. It came from imitation.
In early 2027, NorthStar Health, one of the largest integrated delivery networks in the Midwest, announced its own “Food Forward” initiative. The press release cited the Collective’s pilot results. The CEO praised “the pioneering work being done in Appalachia.” They hired a former Collective advisor as their program director.
Ellen saw it coming before anyone else. “They’re going to strip the model for parts,” she warned at a strategy meeting. “I’ve watched health systems do this for thirty years. They take an innovation, remove everything that makes it effective, and wonder why it doesn’t work.”
She was right.
NorthStar’s version looked similar on paper: produce prescriptions, health coaching, and patient enrollment. But they sourced their vegetables from the same commodity distributors that supplied their hospital cafeterias. They told their own Primary Care Physicians they had to support patients in changing their lifestyle with no training and the same 7 minute office visit schedule leading to burnout. No regenerative farms. No nutrient density testing. No partnership with local growers. No retail grocer or CPG supporting redesign. The cost per patient was 50% lower than the Collective’s model.
“We’ve optimized the program for scale,” NorthStar’s CEO told healthcare media. “The original approach was too boutique. We’ve made it enterprise-ready.”
Six months later, the results came in. NorthStar’s engagement rates were abysmal, and their patients showed it. A1C reductions of 0.2 points, less than 10% of what the Collective achieved. Weight loss averaged <5 pounds versus 23. The program quietly shut down, buried in a footnote of the annual report.
But the damage was done. Critics pointed to NorthStar’s failure as evidence that food intervention didn’t work at scale. “Another wellness fad exposed,” one healthcare analyst wrote. “The Collective got lucky with a self-selected population. Real-world implementation proves the model is fundamentally flawed.”
Erin was furious. She called Marcus from Tulsa, her voice tight. “They fed people garbage and blamed the concept when it failed. That’s like testing a car without an engine and concluding that transportation doesn’t work.”
“We need to name what happened,” Marcus replied. “Publicly. Before the narrative sets.”
Carter disagreed. “Don’t punch down. Don’t get into a war with a health system. Just keep producing results. The data will speak.”
It was Ellen who found the middle path. She wrote a detailed case study, published in Health Affairs, titled “The Nutrient Density & Lifestyle Gap: Why Food Quality & Lifestyle Modifications Determine Outcomes.” Without naming NorthStar directly, she documented exactly what happened when programs substituted commodity produce for regeneratively grown food. The paper was downloaded 50,000 times in its first month.
The lesson was clear: the model couldn’t be stripped for parts. The soil mattered. The farmers mattered. The training mattered. The clinicians mattered. The vertical integration from ground to patient mattered. Anyone who tried to shortcut the system would fail, and their failure would be mistaken for the concept’s failure.
It was a warning Marcus would remember eighteen months later, when the Collaborative faced its own supply chain crisis.
The attacks were predictable. What surprised Marcus was where they came from.
“It’s not pharma,” Carter explained during a strategy call. “They’re actually watching with interest because they see the GLP-1 disruption coming and want alternatives. It’s the traditional healthcare delivery system. Hospitals that need filled beds. Specialists who need chronic patients. The revenue model depends on the disease continuing.”
Ellen added the financial perspective. “I used to sit in rooms where hospital executives celebrated ‘heads in beds’ because it meant more revenue. They’d never say it that way, but the incentives were clear. Our program threatens that entire model. Remembering the story of the lifestyle medicine disease reversal program that couldn’t publish their actual results because their hospital partner feared board members being concerned about revenue disruption.”
The most sophisticated opposition came from within medicine itself. A respected endocrinologist published a critique arguing that food interventions were “blame shifting,” which implied patients caused their own diseases through poor choices. The critique went viral on medical Twitter.
Marcus responded with data. He published the first six-month outcomes from Appalachia: average A1C reduction of 1.8 points, average medication cost reduction of 52%, zero emergency room visits for diabetic complications among enrolled patients compared to a regional average of 8.3 per 100 patients, and hospital admissions half of what they were previously for those same people.
The endocrinologist dismissed the results as selection bias. The medical establishment largely agreed.
But something else was happening that the critics couldn’t dismiss: consumers were voting with their feet.
The direct-to-consumer health companies that Carter had identified as “Force One” of the chronic care disruption were exploding in popularity. Hims & Hers had grown to 4 million subscribers seeking alternatives to traditional healthcare. OURA and Levels popularized continuous monitoring, showing users in real-time how food affected their bodies. A generation of millennials and Gen Z consumers were bypassing the healthcare system entirely, building health habits through apps and wearables and food choices that their doctors never discussed.
“The market is moving faster than the institutions,” Marcus observed at a board meeting in early 2027. “We don’t need to convince the AMA. We need to build a system that works better than the one they’re defending. The evidence will speak for itself.”
The board approved a major expansion. Within six months, the Collective operated pilot programs in 12 states serving over 50,000 patients. They decided to launch a companion HSA marketplace and stripped down actual catastrophic product options to support those patients.
CHAPTER 7: THE ORDEAL
2028, The Crisis
The Medicare pilot approval should have been the turning point. After three years of lobbying, the Collective had convinced CMS to authorize a demonstration project: 100,000 Medicare beneficiaries in 15 states would receive food intervention coverage as a pharmaceutical benefit in concert with retail incentives and SNAP. The study would run for three years and determine whether the approach warranted national rollout.
Implementation began in January 2028. By March, everything was falling apart.
The problem wasn’t medical. It was logistical. Scaling from 50,000 patients to 100,000 required a supply chain that didn’t exist. Regenerative farms produced higher-quality food, but they couldn’t produce enough of it fast enough. The Collective had assumed they could supplement with conventional produce when necessary. They were wrong.
Testing from Edacious showed that conventional produce delivered, on average, 40% fewer micronutrients than the regenerative produce used in successful pilots. Patients receiving conventional produce showed less than half the improvement of patients receiving regenerative produce. The carefully constructed evidence base was collapsing.
“We scaled too fast,” Marcus admitted at an emergency board meeting. “We prioritized access over quality. And now we’re proving our critics right.”
Ellen, who had spent months designing the demonstration model, looked devastated. “If this fails, we won’t get another chance for a decade. CMS will point to our results and say food intervention doesn’t work.”
The board debated withdrawing. Some members argued that continuing with suboptimal results would do more harm than good, giving ammunition to opponents who wanted to kill food intervention entirely.
Carter Williams disagreed. “We don’t have a medical problem,” he argued. “We have a supply chain problem. Solve the supply chain, and the medicine works. That’s what entrepreneurs do. We fix constraints.”
What happened next would later be called the “Regenerative Sprint,” an eighteen-month crash program to transform American agriculture. The Collective partnered with major food companies, including Ingredion and Cargill, to accelerate regenerative transitions on conventional farms. They deployed Kelly Garrett’s methods through a network of trained consultants who worked directly with farmers. They invested $280 million in soil-biology testing infrastructure to verify regenerative outcomes at scale.
The results defied expectations. By late 2029, over 400,000 acres had transitioned to regenerative practices, with verified improvements in nutrient density. The Medicare pilot recovered. Final three-year outcomes showed exactly what the smaller pilots had predicted: 47% reduction in diabetes medication costs, 34% reduction in cardiovascular events, 28% reduction in all-cause hospitalizations.
“We almost gave up,” Marcus told a journalist years later. “At our lowest point, I thought we’d proven that this approach couldn’t scale, that it would always be boutique medicine for wealthy consumers who could afford premium food. What I learned is that you can’t scale by trying to scale. You scale by building the infrastructure that makes scaling inevitable.”
CHAPTER 8: THE REWARD
2030, The Tipping Point
CMS announced a national rollout in February 2030. Effective January 2031, all Medicare FFS beneficiaries with Type 2 diabetes, cardiovascular disease, or obesity had access to food intervention w/lifestyle change support benefits, and the required benefits for Medicare were updated to reflect the change. The coverage structure mirrored pharmaceutical benefits: copays for produce, deductibles for coaching services, and prior authorization for intensive programs.
The announcement triggered a cascade of corporate repositioning that transformed multiple industries simultaneously.
Kroger, the nation’s largest grocery chain, announced a $2 billion investment in metabolic health services. Every store would include a clinic staffed by certified lifestyle medicine practitioners who could prescribe food interventions covered by insurance. The company hired 12,000 health coaches and partnered with 3,000 regenerative farms to guarantee a nutrient-dense produce supply.
CVS merged its MinuteClinic division with Aetna’s care management platform to create what they called “Continuous Care,” a service that combined pharmacy, food prescription, and ongoing monitoring into a single subscription. Early pilot results showed 40% better adherence than traditional care models.
Novo Nordisk, reading the market signals, announced a strategic partnership with Season Health, a food-as-medicine startup. GLP-1 prescriptions would now include automatic enrollment in a food coaching program. The company’s CEO acknowledged publicly that pharmaceutical interventions alone were insufficient for sustainable weight management.
“The business model has flipped,” Carter explained at a healthcare investor conference, Ellen beside him, presenting the financial projections. “Five years ago, sick patients were the most valuable customers. Now healthy patients are. The companies that help people stay healthy capture lifetime value. The companies that profit from illness are watching their customer base disappear.”
The numbers told the story. Medicare spending on diabetes medications fell 23% in the first year of national rollout. Hospital admissions for diabetic ketoacidosis dropped 31%. The actuaries at CMS projected $340 billion in savings over the next decade.
For Marcus, the reward was more personal. His own health had continued to improve throughout the years of building the Collective. His ejection fraction had normalized. His coronary calcium score had stabilized. His continuous glucose monitor showed the flat, stable readings of someone with excellent metabolic function.
His cardiologist, bemused, reviewed his latest labs and imaging. “Whatever you’re doing, keep doing it. I’ve never seen this kind of regression in established disease.”
“I’m eating vegetables,” Marcus said.
“Real ones.”
CHAPTER 9: THE ROAD BACK
2032-2035, The Transformation
The next five years saw changes that even the most optimistic projections hadn’t anticipated.
In agriculture, regenerative practices went from a niche movement to an industry standard. The economics had become undeniable. Farms that had transitioned showed 35% higher profit margins due to reduced input costs and premium prices for verified nutrient-dense crops. The USDA, reversing decades of commodity-focused policy, began offering transition grants covering the 3-5-year period required for soil biology restoration.
Kelly Garrett’s methods, once dismissed as unscalable idealism, were now taught at land-grant universities. His consulting firm had trained over 4,000 farmers representing 12 million acres. A new generation of agricultural technology companies, backed by venture capital that once flowed exclusively to software startups, developed precision tools to measure and optimize soil health.
In food manufacturing, the reformulation wave that Carter had predicted became a competitive imperative. Major CPG companies discovered that products engineered for nutrient density actually tasted better, creating brand differentiation in categories that had been commoditized for decades. The Fairlife model, once an anomaly, became the template. Vertical integration around health outcomes replaced horizontal cost optimization.
In healthcare, the traditional system is fragmented along predictable lines. The redesign so desperately needed was finally underway. Acute care thrived with hospital systems investing heavily in trauma, cancer, and complex surgical capabilities. Chronic care collapsed, as patient volumes for diabetes management, obesity treatment, and cardiovascular maintenance plummeted year over year. And health became it’s own service line on the farm and in the retail grocery store.
The hospital system that had withdrawn from the Collective years earlier now filed for bankruptcy. Their CEO, in a remarkably candid exit interview, acknowledged that the organization had bet on chronic disease and lost.
“We optimized for the wrong outcome,” she said. “We built infrastructure to manage chronic disease when we should have been building infrastructure to reverse it and prevent it. We should have looked beyond the hospital and clinic walls. By the time we recognized the shift, our competitors had already captured the healthy patients. All we had left were the people too sick to be helped by food alone.”
Erin Martin’s FreshRx model, scaled nationally and internationally, served over 8 million patients by 2035. The program had evolved beyond simple produce prescription to include comprehensive metabolic coaching, continuous monitoring integration, and food-drug interaction optimization. Her cowboy hat was seen more giving conference keynotes while living on the farm with her own kids. Outcomes data now included twenty-year longitudinal tracking showing sustained disease reversal rates above 70%.
“We didn’t cure diabetes,” Erin explained at the tenth anniversary celebration. “We eliminated the conditions that caused it. There’s no medication that treats what happens when you feed a human body food designed to nourish it. There’s no pharmaceutical intervention for health.”
CHAPTER 10: THE RESURRECTION
2036-2038, The New System
The American College of Lifestyle Medicine achieved something unprecedented in 2036: its board certification became required for primary care licensure renewal in 23 states. Physicians who had spent careers prescribing medications for metabolic disease were now required to demonstrate competency in whole-person health, food intervention, behavioral coaching, and outcomes-based care. And compensation changed accordingly.
The backlash was immediate and short-lived. Within two years, physician satisfaction surveys showed the highest levels in decades. Doctors reported that treating root causes instead of managing symptoms restored the sense of purpose that had drawn them to medicine in the first place.
“For thirty years, I felt like I was bailing water from a sinking ship,” one internist told researchers. “Now I’m patching the holes. My patients actually get better. They thank me for helping them live instead of just helping them not die.”
Williams and Brown accomplished their objective. A redesigned system aligned for human outcomes, where it was hard to make a bad decision at the grocery store. Sure, there were books and TED Talks, but it was their impact on ending the chronic disease pandemic that mattered most.
“I know exactly how the old system worked because I helped build it,” Brown told audiences. “Risk stratification. Care management. Population health analytics. We got really sophisticated at “managing care”. What we never asked was why so many people were getting sick in the first place. That was the blind spot. And it cost us trillions.”
The insurance industry restructured around what they called “health optimization contracts.” Premiums dropped for subscribers who maintained metabolic health benchmarks. Some plans excluded cardiometabolic disease care altogether in lieu of reversal programs. Insurance became insurance again. The care of health became it’s own new product line with grocers becoming the type of clinic they were always designed to be, not the insertion of sterile clinics next to cereal boxes.
Life insurance companies, always the earliest actuarial signals of population health shifts, began offering premiums 40% below 2025 levels for applicants who demonstrated sustained metabolic health. The demographic that had once been most expensive to insure, middle-aged Americans with family histories of chronic disease, became profitable customers through prevention.
Employers, facing continued workforce shortages, competed on health rather than health insurance and salary alone. Companies that invested in employee metabolic health reported 23% lower healthcare costs and 18% lower turnover. “Our whole person health program is our recruiting program,” one tech CEO explained. “Gen Z won’t work for companies that make them sick.”
Food, wellness, and healthcare merged into a new industry centered on human outcomes, and investors had a field day as a $9 trillion market emerged.
The political alignment that had seemed impossible in 2025 had become reality by 2038. Conservatives championed food-as-health as a free market alternative to government healthcare expansion. Progressives embraced it as environmental policy and health equity in one package. Rural communities that had been decimated by chronic disease became showcases for regenerative agriculture and community health innovation.
The Make America Healthy Again initiative that had launched amid controversy in 2025 achieved its stated goal eight years ahead of schedule. Childhood obesity rates had peaked and were beginning to decline. Type 2 diabetes incidence in adults under 45 had fallen 58%. The chronic disease burden that had threatened Medicare solvency was no longer growing, and projections showed continued decline for decades.
CHAPTER 11: RETURN WITH THE ELIXIR
April 2040, Rochester, Minnesota
Marcus finished his acceptance speech to a standing ovation. The award ceremony was followed by a reception where he encountered faces from every chapter of his journey: the cardiologist who had performed his stent procedure, now head of Mayo’s Lifestyle Medicine department; the endocrinologist who had criticized his work, now a collaborator on metabolic research; the hospital administrator who had questioned his sanity, now running a health system built on the principles he’d championed.
He found a quiet corner and pulled out his phone to text Jennifer, who had stayed home to prepare for the grandchildren arriving tomorrow.
“Speech went well. Lots of people pretending they always believed in this. Lots of people genuinely surprised it worked. Coming home soon.”
Her reply came immediately: “Proud of you. Your heart rate looks good on the monitor. Vegetables for dinner.”
He laughed quietly. Some things hadn’t changed.
Carter Williams appeared at his elbow, Ellen Brown beside him, both looking older but still carrying the energy that had characterized them fifteen years earlier.
“We did it,” Carter said simply.
“We did something,” Marcus corrected. “The job isn’t done. There are still three billion people globally living with chronic diseases that could be prevented. The American model works, but we haven’t scaled it worldwide yet.”
Ellen smiled. “That’s why India is my second home these days. That’s what I love about this team. We spent years learning how to break the old system. Now we get to spend years building the new one everywhere else.”
They stood in comfortable silence, watching the reception wind down. Medical leaders who had built their careers on managing disease were now celebrating its prevention. Food company executives who had once optimized for addiction were now competing on nutrition. Farmers who had been told their methods couldn’t scale were now training the next generation.
“You know what changed?” Carter asked finally. “Not the science. We had the science in 2025. Not the technology. We had that too. What changed was the story. We stopped telling people what to fear and started showing them what to build. Fear creates resistance. Vision creates collaboration.”
Marcus nodded slowly. The hero’s journey, he reflected, was never really about the hero. It was about what the hero brought back. The elixir wasn’t a cure or a treatment or even a system. It was proof that the impossible was possible.
He had left Mayo fifteen years ago as a broken cardiologist searching for answers. He returned as living evidence that chronic disease wasn’t inevitable, that the food system could nourish instead of poison, that the healthcare system could heal instead of manage.
That was the elixir.
That was always the elixir.
EPILOGUE: THE NEW ORDINARY WORLD
2045, The Next Generation
Maya Chen graduated from medical school the same year her grandfather stepped down from the Food is Health Collective. She had grown up hearing his stories, watching the transformation unfold, eating vegetables from regenerative farms before she knew there was any other kind.
Her specialty was preventive cardiology, a field that hadn’t existed when Marcus began his career. Her patients came to her not because they were sick but because they wanted to stay healthy. Her tools weren’t stents and statins but continuous monitors and food optimization algorithms. Her outcomes weren’t measured in survival rates but in vitality scores.
“What was it like?” she asked her grandfather one evening, visiting him in the Rochester home where he and Jennifer had raised their children. “When chronic disease was normal? When most people just... got sick and stayed sick?”
Marcus considered the question. He was 87 now, still sharp, still walking daily, still eating the vegetables that had saved his life forty years earlier. The ejection fraction that had dropped to 48% after his heart attack had recovered to 62% and stayed there for decades.
“It felt inevitable,” he said finally. “That’s what made it so hard to change. Everyone assumed that aging meant declining. That chronic disease was natural. That the best we could do was manage the damage. We couldn’t imagine a world where health was the default.”
“But you imagined it.”
“I saw it,” Marcus corrected. “Other people had already built pieces of it. Farmers like Kelly Garrett. Program builders like Erin Martin with her cowboy hat and her carrots. System thinkers like Carter Williams. Healthcare thought leaders like Ellen Brown knew the old system was broken from the inside. Researchers who knew the science. Entrepreneurs who built the tools. We just helped connect them. The hero’s journey isn’t about one person conquering obstacles. It’s about each person recognizing that the obstacles were illusions all along.”
Maya reached for her grandfather’s hand, the same hand that had performed thousands of cardiac interventions, that had signed the papers launching the Collective, that had steadied itself on that bathroom floor decades earlier.
“So what’s next?” she asked. “What’s the next illusion we need to see through?”
Marcus smiled. “That’s your journey now. Mine was showing that chronic disease could be prevented and stopped in its tracks. Yours might be showing that aging itself can be optimized. Or that mental health follows the same patterns. Or something we can’t even imagine yet.”
He looked out the window at the garden Jennifer still maintained, rows of vegetables growing in soil rebuilt over decades of regenerative practice. The same soil-to-cell connection that had defined his life’s work, visible from his living room window.
“The only constant,” he said, “is that someone will always insist the impossible can’t be done. And someone else will always prove them wrong. Be that someone, Maya. Be that someone.”
The future described in this narrative is speculative, but every element is grounded in work already underway. The question isn’t whether this transformation is possible. The question is whether we will make it inevitable.
