While living in Detroit earlier this year, Brianna Snitchler wanted a cyst removed from her abdomen. But her doctor wanted the growth checked for cancer first. (Callie Richmond for KHN)
Brianna Snitchler was just figuring out the art of adulting when she scheduled a biopsy at Henry Ford Hospital in Detroit.
Snitchler was on top of her finances: Her student loan balance was down and her credit score was up.
“I had been working for the past three years trying to improve my credit and, you know, just become a functioning adult human being,” Snitchler, 27, said.
For the first time in her adult life, she had health insurance through her job and a primary care doctor she liked. Together they were working on Snitchler’s concerns about her mental and physical health.
One concern was a cyst on her abdomen. The growth was about the size of a quarter, and it didn’t hurt or particularly worry Snitchler. But it did make her self-conscious whenever she went for a swim.
“People would always call it out and be alarmed by it,” she recalled.
Before having the cyst removed, Snitchler’s doctor wanted to check the growth for cancer. After a first round of screening tests, Snitchler had an ultrasound-guided needle biopsy at Henry Ford Health System’s main hospital.
The procedure was “uneventful,” with no complications reported, according to results faxed to her primary care doctor after the procedure. The growth was indeed benign, and Snitchler thought her next step would be getting the cyst removed.
Then the bill came.
The Patient: Brianna Snitchler, 27, a user-experience designer living in Detroit at the time. As a contractor for Ford Motor Co., she had a UnitedHealthcare insurance plan.
Total Bill: $3,357.52, including a $2,170 facility fee listed as “operating room services.” The balance included a biopsy, ultrasound, physician charges and lab tests.
Service Provider: Henry Ford Health System in Detroit.
Medical Procedure: Ultrasound-guided needle biopsy of a cyst.
What Gives: When Snitchler scheduled the biopsy, no one told her that Henry Ford Health System would also charge her a $2,170 facility fee.
Snitchler said the bill turned out to be far more than what she budgeted for. Her insurance plan from UnitedHealthcare had a high-deductible of $3,250, plus she would owe coinsurance. All told, her bills for the care she received related to the biopsy left her on the hook for $3,357.52, with her insurance paying $974.
“She shrugged it off,” Snitchler’s partner, Emi Aguilar, recalled. “But I could see that she was upset in her eyes.”
Snitchler panicked when she realized the bill threatened the couple’s financial security. Snitchler had already spent down her savings for a recent cross-country move to Austin, Texas.
In an email, Henry Ford spokesman David Olejarz said the “procedure was performed in the Interventional Radiology procedure room, where the imaging allows the biopsy to be much more precise.”
“We perform procedures in the most appropriate venue to ensure the highest standards of patient quality and safety,” Olejarz wrote.
The initial bill from Henry Ford referred to “operating room services.” The hospital later sent an itemized bill that referred to the charge for a treatment room in the radiology department. Both descriptions boil down to a facility fee, a common charge that has become controversial as hospitals search for additional streams of income, and as more patients complain they’ve been blindsided by these fees.
Hospital officials argue that medical centers need the boosted income to provide the expensive care sick patients require, 24 hours a day, 365 days a year.
But the way hospitals calculate facility fees is “a black box,” said Ted Doolittle, with the Office of the Healthcare Advocate for Connecticut, a state that has put a spotlight on the issue.
“It’s somewhat akin to a cover charge” at a club, said Doolittle, who previously served as deputy director of the federal Center for Program Integrity at the Centers for Medicare & Medicaid Services.
Hospitals in Connecticut billed more than $1 billion in facility fees in 2015 and 2016, according to state records. In 2015, Connecticut lawmakers approved a bill that forces all hospitals and medical providers to disclose facility fees upfront. Now patients in Connecticut “should never be charged a facility fee without being shown in burning scarlet letters that they are going to get charged this fee,” Doolittle said.
In Michigan, there’s no law requiring hospitals and other providers of health care services to inform patients of facility fees ahead of time.
Brianna Snitchler’s procedure took place on campus at Henry Ford’s main hospital site. When she got her bill, with its mention of “operating room services,” she was baffled. Snitchler said the room had “crazy medical equipment,” but she was still in her street clothes as a nurse numbed her cyst and she was sent home in a matter of minutes.
With Snitchler’s permission, Kaiser Health News shared her itemized bill, biopsy results and explanation of benefits with Dr. Mark Weiss, a radiologist who leads MediCrew, a company in Flint, Mich., that helps patients navigate the health system.
Weiss said it probably wasn’t medically necessary for Snitchler to go to the hospital to receive good care. “Not all surgical procedures have to be done at a surgical center,” he said, noting that biopsies often can be done in an office-based treatment center.
Resolution: Hoping for a reasonable explanation — or even the discovery of a mistake — Snitchler called her insurance company and the hospital.
A representative at Henry Ford told her on the phone that the hospital isn’t “legally required” to inform patients of fees ahead of time.
In an email, Henry Ford spokesman Olejarz apologized for that response: “We’ll use it as a teachable moment for our staff. We are committed to being transparent with our patients about what we charge.”
He pointed to an initiative launched in 2018 that helps patients anticipate out-of-pocket expenses. The program targets the most common elective radiology and gastroenterology tests that often have high price tags for patients.
Asked if Snitchler’s ultrasound-guided needle biopsy will be included in the price transparency initiative, Olejarz replied, “Can’t say at this point.”
In addition to the pilot program to inform patients of fees, Olejarz said, the hospital also plans to roll out an online cost-estimator tool.
For now, Snitchler has decided not to get the cyst removed, and she plans to try to negotiate on her bill. She has not yet paid any portion of it.
“You should always negotiate; you should always try,” Doolittle said. “Doesn’t mean it’s going to work, but it can work. People should not be shy about it.”
“We are happy to work out a flexible payment plan that best meets her needs,” Olejarz wrote when Kaiser Health News first inquired about Snitchler’s bill.
The Takeaway: When your doctor recommends an outpatient test or procedure like a biopsy, be aware that the hospital may be the most expensive place you can have it done. Ask your physician for recommendations of where else you might have the procedure, and then call each facility to try to get an estimate of the costs you’d face.
Also, be wary of places that may look like independent doctor’s offices but are owned by a hospital. These practices also can tack hefty facility fees onto your bill.
If you get a bill that seems inflated, call your hospital and insurer and try to negotiate it down.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
I’ve seen too many women die over the past few months. Women that had so much life left to live. Women that had virtually conquered the world and transformed lives. Women who were gone too soon. I took their deaths personally.
I was angry that I didn’t know about their cancers before they died. I was angered by their secrecy. I was angry at the disease that caused them to turn inward and remain invisible. Could they have been saved? I took it exceptionally hard because, just a few years ago, my own life was saved because of my sister.
February 2007, at the age of 35, my sister was diagnosed with breast cancer. She decided to visit the Emergency Room for a migraine headache and requested a mammogram due to a feeling she had. Not an actual physical feeling, but a gut feeling.
She almost dismissed that gnawing in her stomach and came close to chalking it up to her being somewhat of a “hypochondriac” but she pushed past her own internal judgment to ask the doctor to give her a mammogram. It was in her self-advocacy that she learned she had breast cancer.
My sister elected to have a mastectomy and began her journey to survivorship March of that year.
Too Close to Home
My sister’s diagnosis raised my awareness to the disease. I knew about cancer, as many of my aunts died of the deadly disease. However, this time, it was a little too close to home.
I shared my sister’s diagnosis with my doctor and she advised me, at 32 years of age, to get a baseline mammogram. I’m glad I did.
Three years later, in 2010, before my 35th birthday, I was diagnosed with breast cancer. Two years earlier I had a lumpectomy as a mass was discovered but it was benign. But it was due to that discovery that routine screenings began for me.
My routine mammogram in 2010 was one of the most difficult ones I had. The squeezing, pulling, and tugging of the technician to get a good picture was unpleasant. Waiting in a room for a few people to look at my results also caused great anxiety. The repeat exam caused great alarm. The letter in the mail carrying the news that I needed a biopsy was mortifying.
The fine needle aspiration and the diagnosis later sucked all the air out of my lungs. I was diagnosed with Stage 1 breast cancer…#worldstop!
My doctor advised me to have genetic counseling and it was through a blood draw and genetic testing that I learned I had the BRCA2 gene mutation. My doctor encouraged me to use that information to make an informed decision about my treatment. I decided to have a double-mastectomy.
There is a more technical term for it but essentially one breast was removed due to cancer and the other was removed as a preventive measure.
My Sister’s Keeper
The same BRCA2 gene mutation also increased my chances of having both breast and ovarian cancer so in 2011 I also had my ovaries removed. Everything had to go!
I am sharing this story because I want to save a sister. My sister did for me what I hope to do for you, and that is to encourage you to become an advocate for yourself and take charge of your health. I was diagnosed with cancer but not given a death sentence. I am still here, 7 years later, sharing my story with you because I want you to live, too.
Get tested. Early detection is the key.
Share your story. Let someone else know what steps you took for survival. Let them know your journey so that they too can become vigilant in their health.
Break the silence. It’s time to stop hiding.
Going Beyond Breast Cancer
I am pleased to announce that another sister of mine is breaking the silence related to a health issue experienced by thousands of women, infertility. The Rev. Dr. Stacey L. Edwards-Dunn is the founder and president of, Fertility for Colored Girls, NFP (FFCG).
FFCG has been around for roughly four years and has made its mission to be a resource, advocate, and fertility coach for men and women looking to create the families of their dreams.
FFCG has been bringing awareness to the issue of fertility among black and brown women across the nation. The organization has 7 chapters in 7 metropolitan areas and is looking to open 5 more chapters this year.
The fight to bring awareness to the most commonly diagnosed cancer among Black women is highlighted in September, but it’s a year-long battle.
That is why women like Ann-Marie Appiah have made it their mission to promote educate and promote early detection of the disease among women. “You shouldn’t wait until something bad has happened before you’re ready to fight,” Ann-Marie says. The founder of Painted Pink, an organization dedicated to increasing breast cancer awareness among millennials, shares a few tips for our readers below:
The earlier you receive an exam, the better.
Research shows that 25% of new breast cancer cases are among patients under 40, which is why early detection is so critical. In addition to performing monthly self-exams a few days after your menstrual cycle, Ann-Marie recommends that you also request a breast exam during your annual gynecological exam. “Do not leave that table until they have also done a breast exam,” she says.
Then, of course, there is the traditional mammogram, an x-ray exam used to screen for breast cancer. In many cases, medical professionals do not recommend that women begin receiving regular mammograms, until they are at least 40 years of age. However, having a history of breast cancer in your family may warrant the need for earlier testing. “If you do know that someone in your family has had breast cancer, you can call your insurance company to make sure that they code you correctly [in order to receive a referral for a mammogram,]” Ann-Marie says.
And, don’t worry. The Painted Pink founder recognizes that mammograms can be a bit painful for some women, but the pain is so worth it. “Would you rather have five seconds of your life in pain, or would you rather have to fight for your life?” she asks.
Ann-Marie Appiah, founder of Painted Pink
A healthier lifestyle does make a difference.
There are several factors that can contribute to the development of breast cancer, but one factor that many medical professionals agree on is your lifestyle. Certain foods have been linked to the disease, so monitoring your intake of snacks that are loaded with sodium, caffeine, soy, and cholesterol may be your best bet.
You should also make it a priority to remain physically active. Some activities that Ann-Marie suggests is soul-cycling, hiking with girlfriends, or even yoga.
But, regardless of how you choose to maintain a healthier lifestyle, the bottom line is to start today while there’s still time. “A lot of the warriors who are fighting for their lives now talk about how they are cutting out the [unhealthy foods] now,” Ann-Marie says. “They are now saying, ‘Had I known what I know now, I would’ve done this a lot sooner.’”
Being diagnosed doesn’t mean it’s all over for you.
“Having cancer is nothing to be ashamed of, and it doesn’t indicate a death sentence,” Ann-Marie says. As if being diagnosed isn’t stressful enough, deciding on what to do next can be even more overwhelming. “The first thing you should do after being diagnosed, particularly for a woman of color, is to find a doctor that [you love],” Ann-Marie says. “It needs to be someone that you can almost consider as part of your extended family.”
The second step is to find someone to serve as your constant support throughout the entire process. It should be someone that you are able to be completely vulnerable with about what you are going through. “There are so many millennials who are sick, who aren’t letting people know, and aren’t taking the days off,” Ann-Marie says. “They are literally fighting for their lives at their desk or cubicle [for many reasons], and it’s really sad.”
Black women are often taught to be strong for others, but Ann-Marie says being diagnosed with Breast Cancer is one of the few times when you are allowed to get support from someone else for a change. “It’s all about your mindset,” she says.
There’s a seat for all of us at the table.
Perhaps you are someone who would love to participate in the fight against breast cancer but have no idea where to start. Well, Ann-Marie says sometimes it’s as simple as expressing interest and being supportive. “Solange [Knowles] has a new album that is about having ‘A Seat at the Table,’” the Painted Pink founder says. “Invite yourself to have a seat at the table.”
The bottom line is that you don’t have to be directly affected by breast cancer in order to promote awareness. It can be as simple as volunteering at a local clinic or participating in a fundraiser. “It’s all about loving yourself to the tenth degree and doing everything you can to support yourself and the people you love,” Ann Marie says.
Becoming a father is a major milestone in the life of a man, often shifting the way he thinks from being “me-focused” to “we focused.” But fatherhood can also shift how men perceive their health. Our research has found that fathers can view health not in terms of going to the doctor or eating vegetables but how they hold a job, provide for their family, protect and teach their children, and belong to a community or social network.
As founder and director of the Center for Research on Men’s Health at Vanderbilt University and as a postdoctoral fellow from Meharry Medical College, we study why men live shorter lives than women, male attitudes about fatherhood, how to help men engage in healthier behavior – as well as what can be done to reduce men’s risk of Type 2 diabetes and heart disease.
Work and health
Working with men to try to get them to be more physically active, eat healthier and maintain a healthy weight, we found that for many, their own physical and mental health is not high on their list of priorities. Men, we found, treat their bodies as tools to do a job. Health is not always important or something they pay much attention to until poor health gets in the way of their ability to go to work, have sex or do something else important to them. These roles and responsibilities are often the ways they define themselves as men and how others in their lives define their worth.
While many aspects of gender roles have changed, we have found that many men still recognize they are often defined as good or successful if they have paid employment that is enough to take care of their children and other responsibilities. Fathers generally aspire to be able to look after their children, spouse, partner or other loved ones. That may mean less sleep, longer hours at work and less free time for hobbies and exercise.
Wanting to be a great dad can motivate men to push themselves to work longer and harder than they may have thought possible, but these choices can come at a cost, particularly if they also are not making time to take care of themselves.
Rather than trying to restart these behaviors after taking a break from them for a number of years, studies have found that it is important to help men keep healthy behaviors a part of their lives as they age.
As men age, they may not make deliberate choices to engage in less healthy behavior, but they may just do so because their lives and environments make unhealthy choices easier than healthy ones. Policymakers have to think about how to make it easier to make healthy choices in men’s daily lives and to incorporate health into the time fathers spend with children and family or at work. Men don’t have equal access to healthy foods or the same opportunities to go to the doctor, be physically active or earn a living wage, and yet, if asked, they all want to be healthy and have a positive influence on their children and families.
Where does making time for their own mental and physical health fit into dads’ busy, stressful lives? We have found that it will be different for every father, but loved ones have to help them find a way. Based on our research, we believe that families, particularly women in men’s lives, can play an important role in encouraging fathers to eat healthier and take better care of their health.
Wives in particular often provide emotional support, offer advice, facilitate men going to the doctor and promote healthy behavior. Wives, daughters and other women in fathers’ lives are important sources of information about men’s health, and they often play a key role in helping fathers and other men better understand and cope with stress.
As we celebrate fathers, it is important to recognize that fathers, generally speaking, may not place health at the top of their priorities. Many fathers gladly sacrifice to see their children happy, safe and successful. The problem is that if fathers think only about these goals, their own health can often suffer.
In a former church parsonage in Grundy County, Tenn., Karen Wickham ladled out her lentil stew as people arrived for an evening health education class.
Wickham and her husband, Steve, are white-haired, semi-retired nurses who have dedicated the last years of their working lives to helping people with Type 2 diabetes control and even reverse the condition with diet and exercise.
Wendy Norris is in the group, and she has brought along her father and daughter. Since her diagnosis several years ago, Norris said, her doctor prescribed insulin shots and told her to watch what she ate.
She recalled thinking at the time, “Well, what does that mean?”
The Wickhams have set out to answer that question in Tennessee’s Grundy County, which ranks lowest on the scale of residents’ health. Grundy’s population of 13,000 has the shortest life expectancy in the state and an elevated rate of diabetes (16% of adults), which can eventually result in blindness, kidney failure or amputations.
Norris said trying to overhaul her diet by herself was confusing and difficult. And when things didn’t change, the doctor just kept increasing her dosage of insulin.
But then Norris lost her health insurance. The injectable insulin cost her hundreds of dollars a month — money she simply didn’t have.
“I felt like I was stuck having to take three or four shots a day [for] the rest of my life,” she said. She enrolled in one of the six-week seminars the Wickhams offer and is seeing results in how many shots she needs: “I’ve got it down to one already.”
With slide presentations, the Wickhams explain the difference between sucrose and glucose, and the science behind the fact that certain foods, like potatoes, spike blood sugar, while sweet potatoes don’t. They preach eating as much fiber as a stomach can stand, and dropping almost every kind of sweetened beverage.
Steve and Karen Wickham explain course materials to participants in their seminar on Type 2 diabetes in Grundy County, Tenn. The six-week seminar offers detailed instruction on the biology of diabetes, diet, and exercise — and provides plenty of individualized support.
And they demonstrate ways to burn all those calories. Steve even invented the “Beersheba Boogie” — after the Grundy town of Beersheba Springs — asking participants to raise their knees and pump their fists while marching in place.
All the workshop participants have to find a way to get active at home or in a rugged state park nearby because there’s no gym anywhere in the county. There’s not a proper grocery store anywhere nearby either, so healthy cooking can become a real chore.
These communitywide obstacles reveal why it can be a struggle for people to maintain their health in rural America. But the Wickhams are working to overcome those barriers.
During one education session, as participants shared their latest health stats, Steve called out: “Her blood sugar is going down! Give her a hand.”
If it sounds like a revival meeting, it kind of is. Steve and Karen Wickham say they are compelled in this work by their Christian faith as Seventh-day Adventists — a denomination known for a focus on health. They first moved to Grundy County to take care of ailing parents, and once settled in their scenic mountain retreat, they grew disturbed by the suffering they saw in their neighbors.
“I think God holds us responsible for living in the middle of this people and doing nothing,” Steve Wickham said.
Many people think of Type 2 diabetes as practically incurable, though it has long been known that the condition can be reversed with weight loss and exercise. But research shows people need lots of help to change their lifestyle, and they rarely get it.
“I had taken care of diabetic patients for so long, and I knew the progression,” Karen said. “If you truly want the people to get better, you have to treat it with lifestyle interventions.”
Those changes can be hard to start and even harder to maintain.
“Nobody, actually, will make all of the lifestyle changes that we recommend,” Steve said. “But if you’re making the kind of choices that lead you to a healthier lifestyle, then you get better.”
A More Hopeful Message
Along with their lifestyle counseling, the Wickhams always give a disclaimer, advising people to consult with their doctors. They also acknowledge that their seminars are not yet “evidence-based” or backed by peer-reviewed scientific literature.
“Doctors tell their patients, ‘You’ve got a lifelong condition. We know it’s going to steadily get worse.’ Then they turn around and their patients aren’t losing weight or doing exercise, but they’ve given them this utterly depressing message,” he said.
Taylor’s research finds that by losing 30 pounds or so, Type 2 diabetes can be reversed in the early stages.
Ultimately, Taylor hopes, better nutrition will become the preferred response to high blood sugar in the next decade.
“I think the main headwinds [against progress] are just conceptual ones — of scientists and doctors believing this is an irreversible condition because of what we’ve seen,” he said.
Even the American Diabetes Association has been changing its views. The advocacy group has a new position on reversal:
“If a patient wishes to aim for the remission of Type 2 diabetes, particularly within six years of diagnosis, evidence-based weight management programs are often successful.”
Dr. John Buse, chief of endocrinology at the University of North Carolina medical school, helped write the new position on reversal.
“We’ve known, literally since the 17th century, that diet is the key to managing diabetes,” he said.
But it’s hard to write a prescription for a lifestyle change.
“Doctors don’t have the time to do it well, so we have often used the sort of short shrift,” he said. “‘Eat less carbohydrates and walk every day’ … that has basically no impact.”
The Wickhams are doing their part to add to the scientific data, tracking the blood sugar of the participants in their program. And the anecdotal, short-term evidence they’ve gathered is resonating far beyond Grundy County. They’ve been traveling more and more lately.
Steve Wickham, who is a nurse, draws blood at the midpoint of his and wife Karen’s six-week diabetes seminar. The hemoglobin A1c levels measured by the lab test help patients monitor whether the diet and exercise changes they’re engaged in are making a difference in their blood sugar levels.
The couple just sold their retirement home so they can say “yes” to all the invitations they’ve received, mostly from Seventh-day Adventist groups, to present their program to other communities around the country.
Do you feel like nutritionists are always changing their minds? Do you want science-based information about diet but don’t know whom or what to believe?
If you’re nodding in agreement, you’re not alone: More than 80% of Americans are befuddled.
Yet it’s a lament that’s getting quite tiring – if you’re a nutrition scientist, that is. So much so that I refocused my career to shine scientific light on today’s critical food conversations, which have profound impacts on public health and the environment. My mantra: From farm to fork, what we eat matters.
Science says plants are better for you and our planet
Clean eating or keto? Paleo or gluten-free? Whole 30 or vegan? Forget fad diets, because science has the answers – there is far more agreement about diet and health than you may know. The scientific report from the 2015-2020 Dietary Guidelines for Americans, for example, concluded that a plant-based diet is best for human health and the environment alike. More than 75% of your meal should comprise vegetables, fruits and whole grains, and protein sources should include beans, peas, nuts, seeds and soy.
While it may sound like a fad, a “plant-based” diet has been studied for decades. Awareness escalated as it addresses two urgent public health challenges: the chronic disease epidemic and the climate change crisis. It’s a win-win for human health and the environment. Plant-based diets can be adapted to suit your taste preferences, traditions and cultures, as the Blue Zones, or regions of the world where people typically live longer than average and with fewer chronic diseases, indicate.
If science has the keys to a health-promoting, disease-preventing, planet-saving diet, why are people so confused? A closer look will arm you with the skills to sort fact from fiction.
One needn’t be a celebrity to hold sway, however. A list of the Top 100 influencers showed that most were bloggers or athletes with no expertise. (None were scientists.) These voices gain considerable traction on social media. Health Feedback, a network of scientists who review the accuracy of online content, conducted a study with the Credibility Coalition and found a minority of articles received a positive rating, with most “exaggerating the benefits and harms of various foods.”
Nonetheless, there are knowledge gaps: 57% of Americans have never seen the dietary illustration from the U.S. Department of Agriculture called MyPlate or know little about it, and 63% reported it was hard to recognize sustainable choices. Shoppers also claimed that identifying healthy food was difficult (11%) or moderate (61%). Unsurprising, perhaps, since 48% looked to crowded food packages for guidance: Some labels are meaningful while others are little more than marketing. (All natural, anyone?) Indeed, powerful food and agriculture lobbies still exert influence on dietary guidelines and obscure the science.
Through all of this, I believe the nutrition science community has tacitly contributed by failing to participate collectively in the public discourse. Nor have we adequately defended our discipline when attacked, whether by journalists, physicians or food writers.
Changing the conversation
Potent societal powers create a culture of nutrition confusion that not only obfuscate the truth about diet, they undermine science as a whole. Three steps will help eaters navigate this rocky terrain.
Begin by asking critical questions when digesting diet news. Does the writer have an advanced degree in nutrition, or does she or he have expertise in science journalism? Are there references to peer-reviewed studies or scientific organizations? Is the source credible? Are miracle cures or quick results promised? Are there expensive price tags for magic bullets? Does it sound like clickbait? Questioning the who-what-where-why-how is paramount.
Second, remember that what flits through our newsfeeds often comes via algorithms that enable news to careen through our echo chambers and elicit confirmation bias, factual or not. Offline, too, we are more likely to share beliefs with friends and family, our tribe. Getting curious about what you eat and why it matters beyond your comfort zone is necessary: You may need to “unlearn what you have learned.”
Finally, try this on for size: Nutrition. Isn’t. Confusing. We all have cherished traditions and values – what we eat isn’t just about the science. (At least, I hope not.) But it is time to learn the fundamental food and nutrition facts that will inspire you to harness the power of food to promote health, prevent disease and protect the planet. Change is possible – and the truth is out there.