Newsletter #35: 🇺🇸 My health wishlist for the next Administration

Articles

Oct 29

With the election coming up next week, there are many things I want to see happen at the policy level to improve the health of Americans. Some of these points were outlined in an excellent article written by Robert F. Kennedy, Jr in the Wall Street Journal, and I’m paraphrasing many of those ideas below as well as sharing additional points I think are important for the next Administration to consider.

More than anything, I would like to see our future White House rally Americans to be healthy and fit. We need inspirational national leaders helping to inspire people to care about their health, the food they eat, and their fitness. We also need leaders who understand the relationship between human health and environmental health, which are inextricably linked. We cannot go on poisoning the earth without destroying our own health; we are one with nature.

Regardless of who gets elected, we need to move towards a healthy American population.

Here are a few specific areas I’d like to see our future White House take seriously in shaping American health policy:

1. Remove conflicts of interest and industry influence in the National School Lunch Program and serve children nutritious, real food in schools.

Did you know that public schools are the largest restaurant in the country, serving 7 BILLION meals a year? Our public schools have more locations than Starbucks, Subway and McDonald’s combined. And they serve our most important customers: our children. 30 million kids in our country rely on school food for 30%-100% of their calories. Unfortunately, there are huge conflicts in the school lunch program, and corruption has found it’s way in: Kids in New Yok were recently found to be served plastic and metal shards in their school lunches, leading to criminal imprisonment of the CEO of the Office of School Support Services. And just last year the USDA brokered a deal with ultra processed food manufacturer Kraft Heinz to get Lunchables into school cafeterias, which took effect in April of this year. Take a look at what is in Lunchables:

This food is not fit for American children

At the other extreme, there is an incredible non-profit, Eat Real, which is helping public schools become the “best restaurants in town,” serving organic, regenerative, real food to kids in a way that does not cost more for schools. They can certify and help a school transform its food program in two years or less. I want our future leaders to work with Eat Real to get real food to our kids in schools.

2. Investigate toxins in our food supply and restrict/ban those that are known to cause diseases in animals and humans.

The FDA allows around 4,000 chemicals in the American food supply, including known cancer-causing substances. By some reports, that number is up to 10,000. The U.S. allows 72 pesticides that Europe bans, and high levels of toxic pesticides are found in 93% of Americans' blood/urine samples. The EU bans thousands of the more than 80,000 chemicals that the US allows in food, agriculture, water, skincare, and other products. We should immediately investigate these standards with unbiased scientists. We also need to modernize the Generally Recognized As Safe (GRAS) FDA designation to take into account the cumulative health effects of the multiple chemicals that are in our food and products, rather than evaluating them in isolation.

3. Put warning labels on all foods known to cause disease, including most, if not all, ultra-processed foods.

Ultra-processed foods cause serious chronic disease and are highly addictive. Junk food causes more deaths globally than tobacco. We should move to put warning labels on every one of these products, akin to the Surgeon General warning for cigarettes. This type of policy has bi-partisan support and has recently been pushed by Senator Bernie Sanders (I-VT), among others.

4. Eliminate the ability of pharmaceutical companies to advertise directly to consumers on TV.

As of today, the U.S. and New Zealand are the only two developed countries that allow pharma to advertise directly to the public. The advertising isn’t just problematic in its own right: When pharma is the largest contributor to the mainstream media’s budget, they have a direct line to networks that can influence what messages are emphasized on the news and what is deemed “misinformation” or “truth.”

5. Prevent the pharmaceutical and process food industry from buying influence at the FDA and USDA.

Today, Big Pharma funds 75% of the FDA’s drug approval budget, and 95% of the USDA panel charged with updating nutrition guidelines had conflicts of interest with food or pharma. An egregious example was a massive paper funded by the NIH and done at Tufts that showed that Lucky Charms are “apparently” healthier than ground beef, and, unsurprisingly, the lead author - Dariush Mozaffarian - was funded by several ultra-processed food and pharmaceutical companies, including Barilla pasta and Danone (see here for details). This might be funny if the stated goal of the project were not to influence nutrition policy. If the NIH is spending taxpayer money on research, that research should be clean from conflicts of interest with ultra-processed food companies and Big Pharma.

6. Remove conflicts of Interest at the NIH.

There have been over 8,000 "significant" conflicts in NIH research with industry. America spends $4.5 trillion dollars per year on “healthcare,” but only ~2-4% of that amount on prevention, with 90% of the dollars on reactive treatment once people get sick. This doesn't make sense when nearly every leading cause of death in the US is a largely preventable chronic disease. Trillions could be saved (along with enormous suffering averted) through a research and spending focus on prevention.

7. Consider meaningful Value-Based Care models for healthcare.

When the Affordable Care Act (ACA) was passed, the Merit- Based Incentive Payment System (MIPS) was rolled out under the Quality Payment Program (QPP), which sounded good on paper. Under this new set of rules, a physician would receive substantial adjustments/increases to payments from Medicare if they met specific quality‑of‑care criteria. One would think that “quality” and “merit” in medicine would mean that the patient was actually getting better. But when I dug deep through the MIPS website to find the specific quality metrics for each specialty, I was shocked to see that these quality criteria were primarily based on whether doctors prescribed drugs regularly or did more interventions. Yes, a government incentive program focused less on actual patient outcomes (i.e., Did the patient get healthier?) and more on whether doctors prescribed long-term pharmaceuticals (ie, did the drug companies and health care providers get richer?). For instance, there are four quality metrics under the domain of “Effective Clinical Care” for asthma, and none references the improvement or resolution of asthma; rather, doctors report on metrics like “percentage of patients aged five through sixty-four years with a diagnosis of persistent asthma who were prescribed long-term control medication.” This is consistent across hundreds of metrics for a multitude of conditions. It is essentially a double-dip give-away program for the health care industry.

We must base any value-based care business model for healthcare on actual value: better outcomes over lower cost. We must not confuse a medicated patient with a good outcome. A healthy patient with well functioning cells is a good outcome. These two aren’t mutually exclusive, but they are not the same. If doctors were paid more (incentivized) for truly healthy patients, we would rapidly adopt a prevention approach in clinical practice (healthy eating, exercise, stress reduction), which is by far the cheapest way to get the best outcomes.

8. Incentives healthy food purchases on SNAP and other public assistance food programs.

Coca-Cola and other soda manufacturers make billions each year from SNAP recipients. 10% of all SNAP funding goes to sugary and artificially sweetened drinks, which drives obesity and diabetes. 70% of SNAP funding goes to processed foods. This is a terrible policy that is subsidizing harmful food that destroys the health of low-income Americans and costs American taxpayers trillions of dollars in subsequent health care and pharmaceutical costs.

9. Reform crop subsidies and create programs to rapidly increase the adoption of Regenerative Farming practices.

Current Farm Bill incentives make corn, soy, and wheat artificially cheap, so they end up in many processed forms. For example, soybean oil is now a top source of American calories, and high fructose corn syrup is ubiquitous. Our subsidies program is so backwards that we spend billions of dollars still subsidizing tobacco, yet barely spend any money subsidizing vegetables.

Less than 0.1% of budget goes towards “horticulture,” which is the part of the farm bill that covers fruits, vegetables, and nuts - the foods that actually make us healthy! While 6.7% go to commodity crops that turn to ultraprocessed foods.

It is very important to develop legislation to support the rapid adoption of Regenerative Farming. Studies have suggested that with current industrial farming practices, American soil will be unsuitable for growing food within 50 years. It will be fully destroyed by glyphosate and other pesticides and fertilizers and devoid of the nutrients needed to grow food.

Among the highly destructive practices of industrial farming: The seasonal plowing of fields releases massive amounts of hydrocarbons into the atmosphere. Mono-crop farming depletes the soil. Pesticides like Roundup poison crops, the soil, farmers, and consumers. Fertilizers spread fossil-fuel derived chemicals on the soil and crops. Industrial farming wastes huge amounts of water. Regenerative farming, on the other hand, does not over-aggressively till the soil, does not use toxic synthetic pesticides, uses locally produced compost for soil regeneration, conserves an estimated 25% more water than industrial farming, and is a massive net carbon sink. We should aim to convert at least 10% of the billion acres of American farmland to regenerative farming within 10 years to begin to produce clean and healthy food and save American farmland. This will require strong public policy support. Among the initiatives needed would be:

Research grants to study the food quality, soil regeneration, and environmental protection impacts of regenerative farming
Educational tools to teach regenerative farming and farm management
Research grants to develop AI tools to support regenerative farming
Financial vehicles and incentives to support the conversion of American Farmland from conventional to regenerative farming
Direct financial payments to regenerative farms based upon measured net carbon capture and water conservation

These policies, leading to healthier food, soil renewal, and environmental protection, are bi-partisan and should generate broad support.

In addition, regenerative farming has been demonstrated to be highly efficient and financially profitable. Combined with the trillions of dollars a year that healthier food may save in health care costs, these programs pay for themselves.

10. Break up the meatpacking monopolies and reform burdensome food regulations.

85% of the meatpacking industry is owned by four companies, 3 of which (National Beef, JBS, WH Group) are located in Brazil or China and have a long history of abuses and fraud. There is a huge burden to small farmers due to overregulation and centralization that hurts American freedom to buy local and sustainably-grown foods.

11. Require nutrition and functional medicine courses in medical schools.

Today, 80% of medical schools require zero nutrition classes, and the majority of the course load is in pharmacology and organ-specific physiology. Medical students are not learning about systems biology and functional medicine; instead, they are learning reactive sick-care. With 9 out of 10 leading killers of Americans being preventable metabolic conditions, any medical school that takes federal funding should be compelled to follow the science and teach doctors why Americans are getting sick (not just how to profit by managing disease).

12. Support preventative, alternative, and holistic approaches to health.

In the current system, researchers have little incentive to study generic, natural, and non-patentable drugs and therapies. Devote a portion of the NIH research budgets toward the alternative modalities that tens of millions of Americans use every day at their own expense.

13. Increase patient choice with Health Savings Accounts.

Today’s healthcare robs Americans of choice. HSAs are a bipartisan healthcare policy that saves Americans money and increases patient choice. They should be expanded so that people can choose how to spend their tax-advantaged dollars towards healthcare or prevention. Currently, the health insurance mandate locks people in to high priced plans with little to no flexibility on the type of care they receives, which leans towards reactive sick-care.

14. Prevent pharma from price-gouging the American people.

Today in Germany, Ozempic costs less than a tenth what it does in America! This is not the free market at work — it is the result of a rigged market and corporate-driven healthcare policies. While I think we need to focus much more energy on simply keeping Americans healthier, we also should not be extorting the American population with prices for life-saving drugs that are unreasonable.

15. Reform the National Childhood Vaccine Injury Act of 1986 and increase unbiased research on the safety of the cumulative effects of vaccines on the CDC vaccine schedule.

The 1986 bill “provides that no vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death.” It is unconscionable that any pharmaceutical company should have blanket legal immunity from harm they are causing to Americans for medications that are mandated by the government in order for kids to do basic activities (like attend school) in some states. There is growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children. This needs to be investigated.

Try to stay grounded and optimistic next week for a bright future - no matter who wins the election.

With good energy,

Dr. Casey

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