Millions Die Due to Withheld Care: Our Modern Tuskegee Experiment

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IMAGINE WE FOUND THE CURE FOR HEART DISEASE OR DIABETES, but as a society chose to withhold that treatment from those who need it most. Would it be ethical to withhold effective treatments when the result is unnecessary suffering and death that costs our health care system hundreds of billions of dollars a year?

The answer is obvious, yet that is exactly what occurs today in America. We know the most effective treatments for some of the deadliest diseases of our time, but millions are denied access to them. In effect, we are conducting a large experiment on our population without their consent. This happened in America once before. It is a dark stain on our scientific history that most of us would rather forget. It was the Tuskegee experiment.

Tuskegee: Human Experimentation Without Consent

From 1932 to 1972 scientists from the US Public Health Service conducted the Tuskegee syphilis study on 399 African American sharecroppers from Tuskegee, Alabama without their consent. They withheld a known effective treatment for syphilis — namely penicillin — in order to observe what happened over time to those with untreated syphilis. Scientists wondered how the disease affected the body and mind, so they drew blood from these men and monitored their progress but did nothing to stop the progression of the illness even though they knew they could cure it and prevent horrid disability with a few simple shots of penicillin.

Right now we are in the midst of a similar experiment, but few know about it. The tragedy of this experiment happened in my own family. My stepfather, who had diabetes and heart disease, was a victim of our modern Tuskegee experiment. He ultimately died last year as a result, and cost our health care system $400,000 along the way. If he were simply provided the choice of a different treatment — a treatment that is proven to be more effective and cost less than medication and surgery — namely a program for sustainable and comprehensive lifestyle change, perhaps he would still be alive and our national debt would be reduced by $400,000.

Overwhelming evidence proves that the most effective prevention and treatment for chronic diseases such as heart disease and diabetes is what we eat, how much we exercise, how we handle stress, and our social connections.

My stepfather was diabetic. He had the best medical, pharmaceutical, and surgical care available. Nonetheless, he suffered from very poor health and functioning. He went to the emergency room with chest pain and was treated with a cardiac bypass operation, even though evidence has shown no reduced mortality for cardiac bypass or angioplasty in diabetics.(i) Not providing effective treatment is one thing, but providing harmful, costly, and ineffective treatment like this is unethical.

Physicians do what they know (often as a result of training in a medical educational system dominated by Big Pharma) and what is paid for by insurance. Having a cardiac bypass after experiencing chest pain isn’t the best treatment option for diabetics, but it is what is paid for by insurance. After the bypass post-operative infection of his sternum with MRSA (an antibiotic-resistant staph bacteria) lead to a month in the intensive care unit, plastic surgery to repair the chest defect, and “mini-strokes” following bypass surgery which led to memory loss or “pre-dementia”,(ii) and a protracted recovery from hospitalization requiring months of home care.

The surgery and subsequent medical therapy with blood pressure medication, cholesterol-lowering medication, and blood thinners did not enhance the quality of his health and life. In fact, he continued to be sedentary, craved sugars and refined carbohydrates, and rapidly declined physically and mentally.

My stepfather was not offered a treatment that exists today, would have cost less than 2 percent of the $400,000 his care cost, and would have likely created an infinitely enhanced quality of life. It should be our right to have access to proven treatments that provide better value for the individual and for the health care system. This shift must be made if we are going to significantly impact our chronic disease epidemic and the frightening convergence of the GDP and health care cost curves.

How is our modern Tuskegee experiment happening today? How did this happen to my stepfather? What treatment was he denied that may have saved his life? Let me explain.

Treatments We are Denied by Conventional Medicine

Overwhelming evidence proves that the most effective prevention and treatment for chronic diseases such as heart disease and diabetes is what we eat, how much we exercise, how we handle stress, and our social connections. These factors are often referred to collectively as “lifestyle medicine.” Environmental toxins are also known to play a role in these epidemics but are less modifiable.

Lifestyle medicine is not just about preventing chronic diseases but also about treating them. It is often more effective and less expensive than relying exclusively on drugs and surgery. Nearly all the major medical societies recently joined in publishing a review of the scientific evidence for lifestyle medicine both for the prevention and TREATMENT of chronic disease. That report is called the ACPM Lifestyle Initiative, and I encourage you to read it. It concluded there is strong evidence that a lifestyle-based approach to chronic disease often works better than medication or surgery and saves money.

Taken collectively, the evidence is actually overwhelming. Lifestyle intervention is often more effective in reducing cardiovascular disease, hypertension, heart failure, stroke, cancer, diabetes and all cause mortality than almost any other medical intervention.(iii) This data in conjunction with a number of extraordinary recent research papers that call into question the very foundations of our current approach — treating risk factors such as high blood pressure, high cholesterol, or high blood sugar to prevent heart disease and diabetes — forces us to rethink our whole approach to medicine. These studies showed that lowering blood pressure, blood sugar, and cholesterol in pre-diabetics with medication didn’t reduce the risk of heart attacks or death and created unnecessary side effects.(iv),(v),(vi),(vii)

We’re targeting the wrong things — we need to treat the cause, not the effects. High blood pressure, high cholesterol, and high blood sugar are NOT the cause of heart disease or diabetes. The real culprit is what we eat, how much we exercise, stress, and environmental toxins. Our lifestyle and environment influences the fundamental biological mechanisms that lead to disease: Changes in gene expression, which modulate inflammation, oxidative stress, and metabolic dysfunction. Treating risk factors is like blowing away the smoke while the fire rages on. Lifestyle medicine puts out the fire.

Unfortunately, insurance doesn’t usually pay for it. No one profits from lifestyle medicine, so it is not part of medical education or practice. It should be the foundation of our health care system, but doctors ignore it because doctors do what they get paid to do. They get paid to dispense medication and perform surgery. They also need to be paid to develop and conduct practice-based and community programs in sustainable lifestyle change, such as those pioneered by Dr. Dean Ornish.

The new health care bill provides for community based wellness initiatives like these, and that’s a step in the right direction. The National Council on Prevention, Health Promotion, and Public Health has begun to develop policies that will create a healthier nation. But what’s missing is insurance and Medicare reimbursement for treatments known to be effective for heart disease and diabetes-lifestyle-based therapies that are critical not just for prevention but also for the treatment and reversal of these modern epidemics. By not offering reimbursement for these treatments we have, in effect, begun the Tuskegee experiment of the 21st century.

The future of medical care must be to transform general lifestyle guidance — the mandates to eat a healthy diet and get regular exercise that many physicians try to provide to their patients — into individually-tailored lifestyle prescriptions for both the prevention and treatment of chronic diseases. The only way this is going to happen is if doctors are paid to do it. Lifestyle is often the best medicine when applied correctly, and it is the only thing that will end our modern Tuskegee experiment.

To your good health,

Mark Hyman, MD

References

(i) BARI 2D Study Group, Frye R.L., August P., Brooks M.M. et al. 2009. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 360(24): 2503-15.

(ii) Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators, Newman M.F., Kirchner J.L., Phillips-Bute B.,et al. 2001, Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 344(6): 395-402.

(iii) http://www.acpm.org

(iv) The ACCORD Study Group. 2010. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 362(17): 1575-1585.

(v) The NAVIGATOR Study Group. 2010. Effect of nateglinide on the incidence of diabetes and cardiovascular events. N Engl J Med. 362(16): 1463-1476.

(vi) The NAVIGATOR Study Group. 2010. Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med. 362(16): 1477-1490.

(vii) Ray K.K., Seshasai S.R., Wijesuriya S, et al. 2009. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: A meta-analysis of randomized controlled trials. Lancet. 373(9677): 1765-72.

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31 Responses to Millions Die Due to Withheld Care: Our Modern Tuskegee Experiment

  1. Maria Erdman December 2, 2010 at 6:19 am #

    Dear Dr. Hyman,

    I am a registered dietitian who works in an acute rehab setting. I couldn’t agree with you more, except that it will take more than for doctors to get paid to develop lifestyle guidance. We need to somehow transform our entire society to make healthful lifestyles the norm instead of something followed by “health nuts.” I believe that a good 75% of my patients would not be in the hospital if they led healthier lifestyles. In fact, the only patients that wouldn’t be helped are those that are recovering from falls and/or motor vehicle accidents, and often they have more complicated recoveries due to comorbities of being overweight or obese.

    So, how do we make these changes? What are you organizing to do this? I’d love to know.

    Thanks for your column.

    Maria Erdman, MS, RD, CDN

  2. Patricia December 2, 2010 at 6:36 am #

    Hello: I read the above article, “Millions Die Due to Withheld Care” after returning from an INFURIATING doctor’s appointment today. When I asked for guidance on lifestyle changes to positively effect the current medical problem, my doctor immediately treated me like an alien life form.

    For those of us not wanting to be hurt or killed by standard allopathic care practices today, and who cannot afford to pay out-of-pocket for heatlhcare practitioners that practice real healthcare, we have no options, but to go it alone and simply use allopathic care for access to the medical testing we need–providing us with information so that as laypersons, we can effect our own healthcare with the “best guesses” our lack of education and medical wisdom can provide. How ridiculous that we must be forced to do such things!

    This is truly an insane situation in America’s healthcare today. Many of us won’t make it. I’ve already lost one family member to these insane practices. It is possible that I will lose two more because I cannot access the professional guidance I need, I cannot be reimbursed for the very expensive supplements to effect cures.

    Why are we not all descending on Washington and demanding better? This healthcare industry is a disgrace. Clearly, it requires even more bodies be sacrificed at its altar before anyone can loosen these industries’ grip, a grip that is preventing over 350 million Americans from gaining access to the REAL HEALTHCARE it needs.

    Someone, somewhere has to take a leadership role on this now. Why can’t healthcare providers who tell the truth and who practice sane healthcare not band together to effect such change? It’s not enough to tell us what’s wrong. Someone, somewhere–has to make it happen. Don’t tell us that it is up to us to make it happen. I’ve tried. I do not have the power and influence to effect change–not alone. And since my own health is already deteriorating by what has happened to me, neither do I have the strength to fight this madness even if I wanted to. Please–what does it take to stop this? How many more people must we watch become injured or die before we say enough is enough?

  3. Rose December 2, 2010 at 7:02 am #

    You are correct, no one profits from lifestle changes and most americans were never taught proper nutrition and how to take care of thier bodies. We were taught that when you are sick you see and MD – who knows best – how to treat with modern drugs and surgery. These effects are often worse that the illness itself, but we look for a quick fix and assume the MD know how to treat and cure disease. The bottom line is the body is designed to heal itself but we need to be educated in how to help the body heal itself with food, exercise and stress control.

    With regards to the Tuskegee Study – The public has the right to know the results of this study. Syphilis is a life long, chronic illness with systemic manefestations. Anyone with this illness has funded the the medical community and big pharma in a very big way. Do antibiotics provide a cure or just a latency?

    Tuskegee study = bad medicine, “bad blood” and big pharma profits!

  4. Ron Matthews December 2, 2010 at 7:21 am #

    Good for you for bringing this situation to light, Dr. Hyman.

    I think you hit the nail on the head when you pointed out that “Physicians do what they know (often as a result of training in a medical educational system dominated by Big Pharma) and what is paid for by insurance.”

    Do you think we’re nearing a tipping point of public consciousness about the scam that is our modern medical system? I sure hope we are.

    Warm regards,

    Ron Matthews

  5. Deanna December 2, 2010 at 7:03 am #

    I was perplexed after reading the article on Dr. Hymans step-father’s diabetic demise….if you , as his step son, knew what would have cured or at the very least made his life more comfortable in his declining years and you stood aside while all this was taking place with his health care and did nothing ? I am not sure I understand . Father , son….Doctor , patient…where is the distinction? I dont want to appear callous about your loss but I just wanted to comment about the article you wrote and your profession as a Doctor and advocate of alternative medical treatments and specifically why none of your wisdoms were used to treat you step-father.

  6. Lee Anne December 2, 2010 at 8:46 am #

    If it was your stepfather, why DIDN’T he do the stuff you said? It does not seem a withholding of medical care as much as people deciding not to eat right and modern medicine doing what it can to overcome that.

    Doctors prescribe lifestyle changes all the time. BUT, people do not follow it. If it were so easy there would be no fat doctors or doctors who smoke.

  7. Sharon Fraser December 2, 2010 at 10:56 am #

    Dr Hyman,

    As a Health Coach I support the message you convey in this article. I see the results in the patience I counsel about what they eat and how their quality of life and health improves with changes in diet and exercise. The question is how do we as a society move the insurance companies and government to fully support preventative medicine and reimburse patients’ and doctors like you for these services? As long as the drug companies continue the way they are it will be an uphill fight. But I have faith and firmly believe the tide is shifting and the population is waking up to reality of how toxic non organic food really is and that taking preventative measures is the best health care. The reality is the current medical protocols are not working. Thank you for your good work.

    Regards,
    Sharon Fraser
    Certified Health Coach

  8. Agni December 2, 2010 at 11:00 am #

    It’s interesting that you mention this.
    I’ve been doing reseach on the very subject.

    2 treatments for Atherosclerosis are pennies a day, clean the arteries are are avialble at most good pharmacies.

    Lecithin and vitamin K2

    The Lecitihin worked pretty good for me.
    and from my reading K2 will help with bone and tissue heatlh.

  9. Judi Flanders December 2, 2010 at 12:01 pm #

    My father died from meds given together that shouldn;t have and also diabetes drugs orinase and diabinase which was said to cause heart disease. My friend;s mother also died because of the same cause.
    I do my own research and do not take what a doctor says is the word of God. I have seen too much to rely on the Dr.’s word.

  10. chris December 2, 2010 at 11:46 am #

    You really nailed it Mark. Not much I can add other than well done. It will take lots more wakeup calls and calls to action but this is a classic piece. Thank you

  11. Amanda Spadazzi December 2, 2010 at 1:07 pm #

    I agree that lifestyle modification is the best way to prevent and treat diabetes. Are you saying that your father-in-law was not aware that eating a low carbohydrate, low animal fat high, vegetable diet and regular exercise would help him? Are you saying that our health care system kept him completely ignorant and if his doctor had informed him he’d still be alive? If he really truly was ignorant, why didn’t you tell him?

  12. Jane Zentz December 2, 2010 at 6:54 pm #

    I agree whole-heartedly with Dr. Hyman. I have been following Dr. Hyman for years, own all of his books and think he is so right on. He had a major impact in me getting my health back in order and what he says makes so much sense to me. Medical doctors are just that – they prescribe meds. My doctor didn’t want to listen to me when I didn’t want to start taking a statin drug – I tried 3 of them with side effects with each one & quit all of them, heard Dr. Hyman on the television, read his books & I no longer have the health problems I had 5 years ago. Thank you Dr. Hyman – to me you saved me from going down the ‘prescription road’ for the rest of my life. Now I am so much more healthy & educated in the maintenance of myself – I exercise daily & my diet has turned around for the better. Thanks Dr. Hyman – keep up the good work & the informative words.

  13. D R J December 3, 2010 at 12:51 am #

    Good Luck! The lap-dogs of Big Pharma and friends (and of Big everything else) have gotten themselves back in office and the first thing they want to do is un-do the Health Care legislation that did manage to get passed.

  14. wendy December 3, 2010 at 1:57 am #

    To my Endocrinologist’s amazement, I “reversed” my diabetes using the exact methods detailed above. To my Endocrinolgist’s AND my OBGYN’s amazement, I went on to maintain non-diabetic BGLs throughout a full term pregnancy at age 40.

    So my big question is…. how do we change the system?

    It makes me crazy that insurance will pay the costs associated with the insulin and cocktail of four medications my mother uses to try to (poorly, I might add) regulate her diabetes, but they won’t even consider covering or reimbursing a $99 annual gym membership fee.. or a similar outlay for home fitness equipment
    …and don’t even get me started on food.
    Insurance won’t cover testing my son for food intolerances (that we know he has) but they are happy to shell out $25 a MONTH forever to cover the cost of the Singulair he must take because we can’t quite nail down what all of the intolerances are without the costly out of pocket testing. Makes no sense to me….

  15. Vance Fulkerson Sr. December 3, 2010 at 10:49 am #

    Dr. Hyman:
    THANK you for bringing the facts of functional medicine to the public. I for one have avoided any medication unless I feel it is absolutely necessary, and that most of our health issues are self induced either knowingly or unknowingly, the unknowingly being the air, water, food bourne chemicals and introduced hormones and other unnatural components in our food and water supply. I have difficulty in discussing these issues with other persons as most of them think that their medical care doctors know everything there is to know about curing illness. Your experience with your father is a good example of what I believe to be the over commercialization of our medical system. Thank you again for your great news letters.

    Best Regards

    Vance

  16. Mary December 3, 2010 at 12:09 pm #

    Thank you Dr. Hyman for speaking your mind!!!

  17. Anita Jackson December 3, 2010 at 6:36 pm #

    Loved the straightforward advice you gave in the article. I’m trying to follow it for my own care for Type 2 diabetes, hi cholesterol and blood pressure. I’ve gotten serious about losing weight responsible and am taking a number of supplements to help like: cinnamon, chromium/vanadium, ALA, AlCar, fish oil, garlic, natural vit E, garlic and Hawthorn in addition to my prescribed metformin and Amaryl. As a preventative option for aortic stenosis (diagnosed with) and placque build-up in the arteries, what do you think about chelation therapy? I understand that oral chelation is very slow and not as effective as intravenous but don’t know if calcium is as well removed by EDTA as heavy metals–which is all that most conventional Drs. will prescribe chelation for…

  18. Joan Moore December 4, 2010 at 2:17 am #

    I have several thoughts on this topic:
    –Doctors need to be trained in lifestyle medicine to dispense it. This needs to include living a healthy life themselves. No one should be able to become a doctor by working ridiculously long hours and eating junk food; candidates should have to demonstrate balanced lives: sufficient and regular sleep, healthy diet, strong social connections, etc. to graduate.
    –A lot of doctors who consider themselves professionals and scientists are hardly more than technicians. Their lack of scientific approach shows up when they are too quick to ridicule “anecdotal evidence”. They need to pay attention to what works.
    –There are many alternative remedies that would save the health care system a lot of money. One is that cataracts do not require expensive surgery. Inexpensive eye drops made at home will reverse the cataracts. Another is that ph balance can reverse cancer tumors into nonexixtence.. I have seen both of these in my own family.

    • Barbara Arnett October 14, 2012 at 4:41 pm #

      Please describe the easily made eyedrops for cataracts. Mine are just beginning, and I NEED my vision for my work.

      • Avatar of Dr. Hyman Nutrition Staff
        Dr. Hyman Nutrition Staff February 9, 2013 at 6:09 pm #

        HI Barbara,

        Thank you for your interest in Dr Hyman’s work. At this time, he is unable to provide personal advice.
        In order to provide you the proper care you need we hope you will seek the attention of a local qualified Functional Med practitioner soon. To locate a doctor near you who practices functional medicine like Dr. Hyman, go to http://www.functionalmedicine.org/practitioner_search.aspx?id=117 and scroll down to where it says “locate a practitioner” and enter your location. Progress accordingly from there. Thanks!

  19. Jean December 4, 2010 at 8:39 am #

    Dr. Hyman-
    You are right, of course, but you are preaching to the choir. It’s time for people like you and the Institute for Functional Medicine to speak out in the media and expose the pharmaceutical industry for the influence it exerts.
    A financial advisor once said to me that capitalism has not been good for health care. When financial gain is more important than what keeps a population healthy, this is certainly a revealing statement.
    Please speak out in the main stream media so a conversation can begin about the facts of how people are being influenced and manipulated as well as how viable functional medicine and alternative approaches are.
    Thanks.

  20. Jody Berger December 5, 2010 at 2:22 pm #

    Thank you for this article. I agree with you wholeheartedly. There is just one small glitch. You write, “No one profits from lifestyle medicine.” If you mean no doctor, health insurance executive or pharmaceutical company director makes money by prescribing lifestyle medicine, that may be true. At the same time, everyone who practices lifestyle medicine–everyone takes care of how they eat, how they exercise and how they handle stress–profits from the choices they make.
    Jody

  21. Mary December 7, 2010 at 7:01 pm #

    Well written article. Happening all the time. Who doesn’t know someone where the medical model paid for by insurance companies, hasn’t failed them? My father died @ age 62 in 1985 after a horrendous “guinea pig” model of treatment.
    Our family certainly would like to have had his wisdom and humour gracing us for the last 25 years. Lifestyle changes were never part of the medical response equation.

  22. Harold "Dean" Gates December 8, 2010 at 11:04 pm #

    I have hypothroidism,, gout, hypertension, Diabetes II and have had two back surgeries plus a chemo-papain procedure. I am 6 FT. weigh 270 Lbs. How many pounds must I loose to not die young? I am 72 Yrs. old.

    • Avatar of Mark Hyman, MD
      Mark Hyman, MD May 26, 2011 at 12:26 am #

      Thank you, Harold, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.

      If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.

      Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.

      Wishing You the Best of Health!

  23. Amanda December 10, 2010 at 4:01 am #

    I agree with everything except for the last part.

    “The new health care bill provides for community based wellness initiatives like these, and that’s a step in the right direction. ” These are the same people who have chosen school lunch menus.

    The best person to be in control of the patient’s health, is the patient. Anytime you take the decision making away from the person who is most directly effected by its outcome, you are jeopardizing the integrity of the decision being made.

  24. Gail Gardner April 6, 2011 at 4:11 am #

    This travesty exists because people have handed over the responsibility for their own lives and health to others. The solution is to take it back and live a healthy life. The challenge to having that happen is that so many are so utterly brainwashed into believing that doctors know best, science is right, and insurance is a necessity that they are stuck in victim mode.

    IMHO if you want to live a long, health life avoid doctors, prescription medicine and insurance like the plague and make eating nutritional foods and reducing toxic exposure your priorities. That requires locating alternative sources of real food because almost everything in the grocery store IS truly bad for you. Healthy food is simple: if it comes in a package and was not created by God it isn’t food.

  25. Alice Galvin August 30, 2011 at 2:23 pm #

    Dr. Hyman,

    Thank you for continuing to work hard to spread the word about a healthy diet and lifestyle to treat disease. I work with Dr. Ornish and have seen the data first hand. Diet and lifestyle changes work amazingly well. Better than most medical treatments.

    Thanks!
    Alice Galvin, M.A., M.Sc.

  26. Lisa L August 30, 2011 at 3:32 pm #

    I’m a private practice registered dietitian. I think while some insurers pay for nutrition ed and counseling, many don’t (or like Medicare, only pay for limited conditions). While it’s so important for doctors to take nutrition & lifestyle changes seriously as effective treatment for many chronic diseases, I’d like to see the experts in nutrition get paid for this counseling. Until doctors are adequately trained in nutrition by our medical schools — which they are not– they should be actively referring to RD’s.

  27. Rodolfo Del Toro Colberg MD August 30, 2011 at 9:44 pm #

    As a practicing Ophthalmology, I watch as diabetic patients loose their vision.
    Prevention is the key, diet, physical activity, and as you describe, a lifestyle change.
    Unfortunably my personal experience is that most people want an easy cure, they don’t want to invest the time of energy required. We take better preventive care of our cars, than we do of our selfs.

  28. Deena Hubert HHP November 13, 2011 at 1:09 am #

    I am so annoyed that no one looks to the quality of our food. We can do lifestyle change only as far as the quality of the food. Our FDA is in bed with the giants who contaminate our food. People are told they need to make lifestyle changes in an impossible environment. Clean up the food supply. Read a study on obesity. They gave the mice MSG to make them fat then spend billions to figure out how to make them thin again. People have to stop and consider the pesticides herbacides genetics in our food our pharmacy MSG MFG fats how are feed animals are fed and cared for. It is not a generation of overeating
    lazy people. It’s a generation of people feed as cheaply as possible with the highest of profits. Perfu
    mes cosmetics cleaners. Quit using products with known or unknown carcinogenic products. Stand up and demand a clean environment and good health will follow.

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