Marcia Angell, former editor in chief of the New England Journal of Medicine, wrote a scathing critique of the infiltration of Big Pharma into medical research, education, and health and drug policy.3 Aside from the $30 billion a year spent on marketing pharmaceuticals to physicians (known as “continuing medical education”), Big Pharma has turned many academic researchers into hired hands. Though leaders from academic medical centers are provided grants to do research “contracted for” by Pharma, the research is often designed, executed, and ghostwritten by the funders. The conflict-of-interest statements of authors on research articles now often run several pages long. These authors not only receive grants but also sit on corporate advisory boards, receive large speaking fees, and enter into patent and royalty agreements with Pharma. It would appear that our evidence-based medicine isn’t based on very good evidence. We have the power to change that.
Here’s what you can do
- Fix perverse financial incentives in health care reimbursement. In New York City, a very successful diabetes prevention and treatment program was implemented. It resulted in fewer complications, hospitalizations, and amputations. But the program was stopped by the hospital because its revenue dropped. Cutting off a diabetic toe and receiving $6,000 from Medicare is better than being reimbursed $100 for a nutrition consult. The system profits from having more sick and fat patients.
- Support real health care reform. We need to change not only insurance regulation, but also the type of medicine we do (lifestyle and functional medicine) and how we deliver health care (in small groups, in communities, and in health care organizations). During the health reform process in Washington, DC, Dean Ornish, Michael Roizen, and I were asked what organization we represented. We replied simply that we didn’t represent anyone but the patients or anything but the science. They accepted it, but looked perplexed. No wonder. During health care reform, the pharmaceutical industry had three lobbyists for every member of Congress and spent over $600,000 a day to make sure their needs were represented in the legislation.
- Mandate nutrition and lifestyle medicine training in medical schools and residency programs. As we know, all of the major drivers of disease and health care costs are lifestyle-preventable factors. If these factors were addressed, we could eliminate 90 percent of the heart disease and diabetes. Yet only one in four medical schools has a nutrition course, and only 28 percent of schools meet the minimum 25 hours of nutrition education recommended by the National Academy of Sciences.4 Most of those nutrition hours address diseases of nutritional deficiency such as scurvy and rickets. If we were successful in reducing heart disease by half or reducing diabetes (along with its complications) by 80 percent, hospitals would go bankrupt, Pharma would see their profits plummet, and many physicians would be forced to start “institutes of lifestyle medicine,” not more heart surgery hospitals.
- Support and develop a modular scalable nutrition curriculum. If food is our most powerful medicine, then educating health care professionals about nutrition is essential. We must develop and provide funding to support a nutrition curriculum built for people in the health care industry. This will address the lack of supply of adequate experts. (We could scale existing programs such as those provided by the Institute for Functional Medicine.)
- Provide reimbursement for lifestyle treatment of chronic disease. Despite the support of nearly all the major medical societies who joined in publishing a review of the scientific evidence for lifestyle medicine, for the prevention and treatment of chronic disease, this approach is still not part of medical training or practice. We need to have lifestyle treatments like the one outlined in this book paid for if they are going to become a part of mainstream medical practice.
- Develop more funding for nutritional science. Congress should mandate greater funding for nutritional science, and examine and test innovative treatment models. Responsibility for dietary policy should be placed with an independent scientific group such as the Institute of Medicine instead of with the politically and corporately influenced U.S. Department of Agriculture. In the 1980s, they advised a low-fat diet food pyramid with at least 8–11 servings a day of bread, rice, pasta, and cereal, which coincided with the rapid increase in obesity and diabetes. It was lethal to mix politics and health recommendations.
- End irresponsible relationships between medicine and industry. Public health organizations such as the American Heart Association and the American Dietetic Association should avoid partnerships, endorsements, or financial ties with industry that compromises their independence and credibility. Coca-Cola sponsoring events at the American Dietetic Association, or the American Heart Association promoting sugary cereals as heart healthy because they have a few grains of whole wheat does not seem credible.