Whole (40 page)

The only good is knowledge, the only evil is ignorance.

—
SOCRATES

O
ur federal government plays an important role in our health. It’s responsible for funding health research, approving drugs and treatments, determining nutritional recommendations for federal institutions and school lunch programs, and establishing rules for nutritional labeling, among many other things. In the United States, we are supposed to enjoy a government of the people, by the people, and for the people. This should translate to a government whose policies seek to maximize public health by finding, funding, and promoting the most effective means of prevention and treatment of disease. Unfortunately, that’s not the way things work.

I’m sad to say that in my experience around health policy and information, the people are getting the short end of the stick. We are being misled, with tragic consequences. The national debate on health-care reform wildly
misses the mark, with Democrats and Republicans alike arguing about who’s going to pay rather than about what would actually make people healthy. National nutrition policy panders to wealthy corporate interests rather than objective science. Governmental health agencies all but ignore nutrition as a factor in public and individual health. If someone asked you to create public health policy for which the goal was to mislead the maximum number of people in ways that would compromise their health while profiting the pharmaceutical, medical, and junk food industries, you couldn’t do much better than what’s currently in place. As my friend Howard Lyman, a former rancher and agriculture industry lobbyist, has said, “We have the best government that money can buy.”

Are the people who create these policies so out of touch that they don’t realize the effects are the opposite of their stated goals? Hardly. With unrestricted access to government officials at all levels, industry applies a mix of carrots and sticks to produce our government’s pro-disease, proreductionist treatment policies that make them rich and the rest of us sick.

Big Pharma, Big Insurance, and Big Medicine are among the biggest contributors to U.S. political candidates. According to the watchdog group
OpenSecrets.org
, health professionals (individual practitioners such as doctors, nurses, and nutritionists, plus large professional organizations such as the American Medical Association) ranked fourth in total giving to members of Congress in the 2011-2012 election cycle (almost $19 million), followed by the insurance industry at sixth (almost $15 million), and pharmaceuticals/health products at tenth (over $9 million).
¹
And that means they have significant leverage when it comes to guiding health policy: they can coordinate millions of dollars in donations for candidates whose policies they support, and can deploy additional millions to defeat candidates who don’t play ball. It was at an AMA convention that, in 2009, President Obama unveiled the public insurance option of his health-care reform plan.
²

None of these industries have anything to gain by a more efficient and effective health-care system. To the contrary; if every American adopted a WFPB diet tomorrow, these industries would be in big trouble. You could
argue that improving health care through nutrition and other lifestyle factors would even be “anti-growth,” making it practically anti-American. After all, when someone avoids the operating room because they adopted a healthy diet, they aren’t contributing to GDP. A diet of cheeseburgers, large fries, and Cokes is good for the economy when it’s purchased, but it’s even better when it leads to heart disease and a big hospital bill.

These industries can afford the best lobbyists, many of whom are hired for their connections as well as their persuasiveness. The “revolving door” between industries and the government agencies tasked with regulating them is spinning faster than ever.

Regulatory agencies routinely offer employment to industry lobbyists and so-called scientists who trade on their degrees to enhance their incomes. The departure of officials from government jobs for one in a related private-sector industry is common practice. In 2009, NIH director Dr. Elias Zerhouni resigned to take a position at Johns Hopkins University, according to a Johns Hopkins press release.
³
He lasted only four months in that position before joining French pharmaceutical company Sanofi as their new head of research and development
⁴
—a career move that was conveniently omitted from the NIH website, in contrast to those former directors whose subsequent careers involved a return to academia.

In 2010, Dr. Julie Gerberding, who headed the CDC from 2002 to 2009, found gainful employment at Merck Vaccines shortly after departing government service.
⁵
It’s a relationship that benefits Merck greatly, allowing it to capitalize on Dr. Gerberding’s contacts and influence in the federal government and the World Health Organization to help them sell more vaccines in the United States and around the world. But the career move also raises questions about impropriety. Certainly, at the very least, Dr. Gerberding’s push to vaccinate all Americans against the flu each year of her tenure at the CDC (earning her the nickname “Chicken Little” for her annual predictions of a flu pandemic that never materialized) must have endeared her to her future employer.

We don’t know; there isn’t any evidence Dr. Gerberding intentionally promoted a vaccination policy that would enrich her future employer. But if you’re a government official whose interest is in using vaccines as a primary strategy for controlling diseases like autism,
⁶
it must be hard to ignore the fact that your tenure is short and, if you play your cards right, a private sector job could be awaiting you at the end of it. Coupled with
health policies that look like they could have been written by pharmaceutical marketing departments, this built-in incentive to please industry should make us a little less trusting that government agencies are seeking our good above all else.

On the industry side, lobbyists do more than shake hands and buy drinks after golf. They also write and edit legislation and regulations for grateful, understaffed legislators and agency heads. Their job, for which industry richly rewards them, is to strike out any language that might jeopardize profits. And the politicians play ball to protect their own careers. This fact, while not publicized, is common knowledge in Congress and on K Street, where industry groups have their lobbying offices. I’ve met with many high-ranking government decision makers over the years. While they often acknowledge privately that my views on nutrition and health should be public policy, I have learned that the political system will punish any elected official who advocates serious diet and health reform. Corporate interests don’t just fund elections; they are willing and able to end political careers and derail progressive legislation as soon as they get a whiff of any move that might threaten their bottom line. And that means laws are enacted that further the interests of the wealthiest rather than the public good.

One of the hottest political debates of the past four years has been healthcare reform. There’s no question that our health-care system is seriously broken. But when you look at the evidence offered in public discourse, you begin to realize that virtually everyone is missing the point: the primary reason our very costly health-care system is broken is because it doesn’t deliver health, and seems to have little interest in doing so. We’re paying way too much money for way too little health. Every other problem is a symptom arising from that core truth.

In recent years, a virtual army of writers, scholars, politicians, and business leaders has offered opinions and proposed programs to solve the “health-care problem.” Liberals point to the large numbers of uninsured people and insist the burden be shared by those who can afford to do so. Conservatives seek to protect the “free market” in health care, not
realizing that this market is far from free. Sometimes the two sides find agreement, but such agreement is usually limited to how to streamline the delivery of health care.

For the most part, the debate over health care is focused on the supply side rather than the demand, with intense argument over who should pay the bill and not why the bill is so high.

We talk endlessly about shifting payment responsibilities among different groups—private sector or public sector, employer or employee—as if these programs are going to help control our country’s back-breaking health costs: about two and a half
trillion
dollars in 2009.
⁷
Limiting these discussions and programs to matters of financing is too narrow. These political machinations, which are often fanned with much publicity and media coverage (or should I say hot air?), may please politicians and special interest groups from time to time, but they do little to address the main question of why we are so sick and why we are so unable to fix our sickness.

These discussions are not completely without consequence, however. They do serve to divert attention away from the really important question of how health might be improved—a question that leads directly to nutrition, not drugs and hospitals. Through this misdirection, they allow the system to continue to serve the profit motive at the expense of our health.

One of the best-known schemes intended for control of costs of health care is the HMO (health maintenance organization) legislation introduced in the 1990s. While health-care cost inflation slightly slowed for a couple of years with the introduction of HMOs, this trend proved short lived. Health-care costs have resumed their steady upward climb, with no new plateau in sight.

The initial savings generated by tough negotiations with doctors and efficiencies of scale did nothing to address the real problem: too many of us get sick, and the medical and pharmaceutical industries do a terrible job of making us well. Controlling costs is not the same thing as controlling disease. The HMOs talked about so-called preventive medicine, but in such a superficial way that the message had virtually no impact. Their dietary recommendations, by and large, boil down to “eat more veggies, drink fewer sodas, and choose leaner cuts of meat.” That’s like telling smokers to cut back from four packs a day to three—definitely a step in the right direction, but woefully inadequate. And because it was so superficial and inadequate, the “eat slightly better” message was universally ignored.

HMOs aren’t the last word in cost-cutting. When money gets too tight, some private-sector employers eliminate health insurance programs, cut jobs, and close shops, or send their businesses and jobs outside of the country, where they are often legally able to ignore worker health and eliminate such coverage. The movement of much of the U.S. auto industry from Detroit to Mexico is a case in point. General Motors attributes at least $1,500 of the cost of every new car made in the United States to employee health-care premiums.
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Ultimately, if we keep feeding the health-care monster everything we’ve got, it may bring down our entire economy.

We talked a little about the ways our government forwards the cause of reductionist nutrition in
chapter five
, focusing on the government’s nutrient databases and RDIs. But their reductionist nature is only part of the story.
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RDI information printed on food packaging represents one of the most powerful, ubiquitous, and enduring ways the federal government tells people what to eat and what to avoid. As I noted in
chapter five
, RDIs are the ultimate in reductionist nutrition. Most packages list about a dozen nutrients, as if those were the only ones, or the only ones that count. The recommended amounts are also listed as percentages of daily value in grams. Last I checked, Americans weren’t experts on metric weights or percentages. As we’ve seen, nutrition is nearly impossible to measure so precisely. And manufacturers are good at adjusting serving sizes to reduce the scary numbers of fat, sugar, and sodium—sometimes to zero, even though the product may contain a fair amount. In short, RDIs do a wonderful job of confusing the American public by appearing to be scientific while diverting attention from the simple truths about which foods support our health and which degrade it.

To make a bad system worse, for the vast majority of the population, most RDIs are much higher than they need to be. The establishment of the RDI for a nutrient generally begins with an assessment of the minimum amount of that nutrient needed to serve some particular function in the body for a sample group of individuals. This amount is sometimes
referred to as the minimum daily requirement (MDR). For example, we might determine how much protein (measured as nitrogen) is needed to replenish the nitrogen lost by the sample group’s bodies each day. But because the resulting number represents only a very small sample of the whole population, the MDR is then adjusted upwards to ensure that the majority of the people (say, 98 percent) will meet their needs. This considerably higher number becomes the RDI.