Money, Politics, and Health Care: A Disease-Creation Economy – Part I

There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order.

—Niccolò Machiavelli, The Prince and The Discourses

Money in politics is making our nation sicker, threatening our national security, and ultimately destroying the very economic prosperity the “money in politics” seeks to achieve.

It is undermining our capacity to care for our citizens and is threatening our global economic competitiveness in invisible, insidious ways. However, the links, connections, and patterns that promote obesity and chronic disease are clear.

The economic and social impacts are evident. As health care consumes an increasingly large percentage of our federal budget, the negative impacts of money in politics have become too alarming too ignore and never more obvious than in this election cycle of 2012.

It may seem odd to suggest that lobbying, and in particular Citizen’s United the Supreme Court decision that personifies corporations and allows unlimited corporate campaign contributions through political action committees, threatens our nation’s health. But it does.

If money rules politics then our nation is not protected from disease-causing frankenfoods, including soda and processed foods, or from unrestricted marketing of the lowest quality, sugar-laden foods to our children.

When money rules politics our agricultural lands, soils, and aquifers are depleted through oil-dependent industrial farming supported by billions in federal subsidies.

Depleting Nature’s and Human Capital

We are depleting nature’s capital — capital that once destroyed cannot be reclaimed. One acre of arable land is lost to development every minute of every day. One pound of meat requires 2,000 gallons of water and produces 58 times more greenhouse gasses than one pound of potatoes.

It takes 7,000 pounds of grain to produce 1,000 pounds of meat. Irrigation is depleting our Ogallala Aquifer on the Great Plains 1.3 trillion gallons faster than it can be replenished by rainfall.

Three quarters of our fresh water (5 percent of all of the earth’s water) is used for agriculture, mostly to grow meat for human consumption.

If we all switched out one meat meal for one vegetarian meal each week, it would be the equivalent of taking half a million cars off of the road. Driving a Hummer and being a vegetarian produces less greenhouse gases than driving a Prius and eating factory farmed meat.

Yet when the USDA (United States Department of Agriculture) encouraged us to participate in “Meatless Mondays”, the National Cattleman’s Beef Association lobbied the government to retract their recommendation. And they did. Money in politics.

During health reform, I mentioned to Senator Harkin that all we wanted was for science to become policy. With a wry and somewhat sad smile he said, “That would be nice.”

Our energy policies support Orwellian “clean coal” that still discharges mercury, lead, and particulate matter into our air promoting heart disease, cancer, and more. Our politically handicapped Environmental Protection Agency allows environmental policies to permit untested chemicals and toxins to permeate our lives.

Should we worry when the average newborn has 287 known toxins in their umbilical cord blood that have been linked to neuro-developmental disorders such as attention deficit disorder and autism that now affect one in six of our nation’s children? What are the social and economic costs of that?

The reason we have these policies is not that they were encouraged and supported by citizens through a democratic process or grass roots movement. The policies are there for one reason – they were encouraged, shaped, lobbied for and even often ghostwritten by industries whose sole focus is profit not public welfare.

Money in Health Care: Perverse Incentives

If money rules politics, then the most profitable medical therapies, not the best treatments, are researched and implemented. If hospitals and doctors are paid for volume and piece work, they produce more visits and procedures but not better health.

If hospitals suddenly cut cardiac bypasses and angioplasties in half by implementing proven intensive lifestyle therapies they would go bankrupt. If Medicare refused to reimburse for cardiac bypasses or angioplasties proven to work in less than 5 percent of patients who receive them and instead reimbursed for intensive lifestyle treatment programs for those with heart disease and diabetes, health care costs, as estimated by the Cleveland Clinic, would be reduced by almost one trillion dollars over the next ten years. But since lifestyle treatment is not reimbursed it is not profitable, so it is not done.

At a recent medical innovation conference, I met with the head of Walgreen’s new Take Care Clinic and was impressed with their focus on education and service. But when I asked if they would implement a program that could be delivered through their clinics that could reduce prescription medication use by half, he was not interested. They want to appear to do the right thing, but they do not do it.

The head of health information technology from Partner’s Health Care, the Harvard group of hospitals, shared at a medical administrators meeting that the head of the Harvard health system rejected a proposal to connect two hospitals by a data line that would save 15 percent in labs costs by reducing redundant lab tests. They couldn’t afford a 15 percent reduction in lab billing.

Perverse economic incentives drive policy and medical decisions, they are not in the best interest of the patients, and certainly do not have better health outcomes. Violation of public trust, the sacred covenant between our elected leaders and our people, results from money in politics.

Whatever happened to government by the people, for the people and of the people? My friend, lawyer, and environmental advocate, Robert F. Kennedy, Jr., calls our political systems a “corporate cleptocracy.” “Communism,” he says, “is when the government runs business, and fascism is when business runs government.”

Our nation’s health and economy is close to entering an irrevocable downward spiral. It is difficult for most of us to grasp the immensity of the politically sanctioned economic forces at work that threaten our health. This quiet, dangerous set of forces in play in American society fuels the explosive and uncontrolled growth of disease in America.

Accounting for Sustainability: The True Cost of Money in Politics

The basic fact is that one third of our economy profits from making people sick and fat. The food industry sells products scientifically proven to kill more people than cigarettes, while our health care industry profits from providing more volume of care focused on medication and procedures, not better health.

Certain facts are clear. Lifestyle induced chronic disease is on the rise and accounts for nearly 80 percent of our health care costs. Nearly 70 percent of our population is overweight or obese.

Almost one in four teenagers have pre-diabetes or type 2 diabetes, up from only 9 percent in 2000 and almost zero in 1960. Most chronic disease is best prevented and even treated with lifestyle medicine and a systems approach to disease.

By 2042 one hundred percent of our federal budget will be needed to pay for Medicare and Medicaid. Today, 1 in 3 Medicare dollars is spent on type 2 diabetes. This is unsustainable.

The true cost of our food and agriculture, energy, education, and environmental policies on our health is not even measured in the equation. Our government subsidizes the production of low-cost high-fructose corn syrup and trans-fats from soybeans (used to make soda and French fries), but we don’t do an accurate cost accounting of the health, environmental, and energy impact of producing those crops in the way we do, or the health impact on the children and adults who consume those products.

Prince Charles gave a speech at the Future of Food conference at Georgetown University in 2011. He describes a new kind of cost accounting, “Accounting for Sustainability”, that expands our accounting processes to include the interconnected impact of financial, health, environmental, and social impact on long term “profits”.

Unless we do a true cost accounting for social, environmental, and health sustainability, I fear that simply addressing healthcare reform with the new Affordable Care Act, an effort that righted many wrongs in health care, but without addressing the systems-wide issues across all sectors of society that affect the health of our nation and healthcare costs, will fail.

Supporting Innovations to Create Health

Areas outside of the direct domain of healthcare such as intellectual property laws, for example, could encourage private industry to develop products and services that promote health and wellness rather than generate profit from sickness and obesity.

Education policies must support transformation of schools as incubators of health rather than disease. (How can we feed our children to prepare them for learning and thriving when so many school kitchens have only deep fat fryers and microwave ovens?)

Government agencies and departments with domains that impact health such as the Departments of Agriculture, Health and Human Services, Environmental Protection Agency, Transportation, Education, Defense, and the Centers for Medicare & Medicaid Services (CMS), etc, must be coordinated to create a culture of health and wellness.

I have no doubt that when applied properly the personalized systems-medicine approach based on functional medicine is a scalable model for medical practice, education, and research. It can dramatically improve outcomes while reducing costs, providing a real solution to our healthcare crisis which I have described in previous blogs.

Creating the incentives to build this approach and delivering it through integrated healthcare teams, to include health educators/coaches driven by the operating system of functional medicine, has to be part of the solution.

There is also an urgent need to mobilize the power of social networks and communities for peer-supported health programs utilizing health champions and community health workers who can help us cope with another growing problem: the serious deficit of general-practice doctors available to care for all the sick. If we in health care can’t cure the patient, perhaps the community can.

People helping people armed with the right information on how to create health can disrupt health care, improve outcomes, and reduce costs. This is how Saddleback Church got 15,000 people lose over 250,000 pounds in 10 months — with people helping people in community based programs like The Daniel Plan.

Ending Industry Influence in Science and Medicine

Even if we get everything else right in healthcare reform—such as payment reform, universal access, electronic records (currently conceived of as simply transferring the 19th- and early 20th-century medical records system to the computer rather than facilitation of a fundamentally new way to practice medicine based on whole-systems analysis), reduction of medical errors, and malpractice reform—none of our efforts will matter unless we address the true drivers of cost and chronic disease.

And among the biggest drivers of all are the complex, industry-driven government policies that promote obesity, disease, and agricultural and environmental degradation.

This is a national security issue that threatens our standing in the world. As President Obama stated, “Fixing healthcare is no longer only a moral imperative, but a fiscal imperative.”

But opponents will not go quietly into the night. As reported in The New York Times, there is an insidious presence of pharma and industry in medical education, research, and practice — a presence that prevents the best evidence on lifestyle medicine from becoming the standard of care.

Concern about this dynamic is what led Harvard medical students to petition for their right to an education free of pharma bias and to ask for limits on consulting and payments by pharma to faculty members (one of whom had 47 industry affiliations and many of whom received tens to hundreds of thousands of dollars in payments).

A recent JAMA review that examined the basis for clinical practice guidelines for evidence-based medicine (EBM) found that only 11 percent of guidelines are based on firm clinical evidence (level of evidence A); most are based on “expert” opinion (level of evidence C).

Of guidelines with good evidence (level A), only 19 percent are Class I recommendations (general agreement among experts that treatment is useful or effective.)

These clinical practice guidelines considered “best evidence” are heavily influenced by what we have done (driven by pharma), not what we should do (based on evidence for systems medicine.)

Medical device and pharma industries routinely pay consulting fees and payments to physicians who promote their products, often without evidence of benefit or for off-label uses.

Eli Lilly and Company (Indianapolis, Indiana) recently paid $1.4 billion to settle criminal charges that it illegally marketed Zyprexa, an anti-psychotic drug, and Pfizer (New York, New York) set aside $2.3 billion in fines for illegally marketing Bextra.

Dr. Peter Green, the world’s expert on gluten, found in a study of 10 million subscribers to CIGNA (Philadelphia, Pennsylvania) that correctly diagnosing celiac disease would result in a 30 percent reduction in healthcare costs by decreasing utilization (oral communication, March 2009), yet this is not advanced because there is no pharma marketing for testing or treatment of gluten intolerance, something that affects 3 to 10 million Americans, only 1 percent of whom are diagnosed.

The corruption of our political process by money has many unintended consequences, only a few of which are catalogued above. Money in politics has corrupted virtually all the systems and institutions upon which our collective health depends.

That’s why what we need now is nothing less than a revolution in the way our country thinks about health to include, as Prince Charles implores, “Accounting for Sustainability” – sustainability for our health, our environment, our communities, our economy, and our nation all of which are at risk today.

Certain ideas, while radical, seem obvious to me if we are to create real change and avert disaster. Horse-and-buggy makers gave way to the automobile, and eight-track manufacturers gave way to the iPod.

While some industries will fade, others that promote health and wellness will flourish. These are the changes that will shift our system from sick care to healthcare. A coordinated effort at the White House level is necessary to successfully create a culture of health and wellness and transform our healthcare system. That is the task of our next President.

Stay tuned for Part II of this discussion to find out what you can do to be part of the solution.

Please leave your thoughts by adding a comment below – but remember, we can’t offer personal medical advice online, so be sure to limit your comments to those about taking back our health!

To your good health,

Mark Hyman, MD

REFERENCES

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Wilson D. Harvard Medical School in ethics quandary. The New York Times. March 2, 2009. Available at: http://www.nytimes.com/2009/03/03/business/03medschool.html?scp=3&sq=harvard&st=Search. Accessed March 9, 2009.

Tricoci P, Allen JM, Kramer JM, Califf RM, Smith SC Jr. Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA. 2009;301(8):831-841.

Harris G. Crackdown on doctors who take kickbacks. The New York Times. March 3, 2009. Available at: http://www.nytimes.com/2009/03/04/health/policy/04doctors.html?_r=1&ref=health. Accessed March 9, 2009.

Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010 Sep;85(9):1537-42. Accessed March 9, 2009. Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010 Sep;85(9):1537-42.