Food Over Medicine (20 page)

Even the way that adverse events are reported is manipulated by the drug companies and the FDA, in collusion with one another. You have an institutional conflict of interest with the FDA: the organization that approves drugs should not be regulating them in the marketplace. Why? Because in order to withdraw a drug, the FDA essentially has to admit that it was wrong to approve it. One step in the right direction, in addition to posting trials online in advance, would be requiring proof that the drug is not only better than nothing but also better than other drugs on the market. That way, we avoid the “me too” drugs that do no more than mimic other drugs. We should also split the FDA into two agencies—one that approves drugs and one that monitors safety. That way, the one that monitors safety in the marketplace might not be so inclined to allow a bad drug to stay on the market.

If you go back and look at the Merck debacle with Vioxx, you will find that for many, many years before that drug was taken off the market, the FDA knew, as did Merck, that the drug was seriously dangerous. The same thing is true for Accutane and Crestor. These are dangerous, terrible drugs; they shouldn’t be taken by anybody. Yet the government didn’t do anything about Vioxx until tens of thousands of people had died.
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The FDA is no less flawed when it comes to regulating supplements, functional foods, and fortified foods. The supplement and food industries have been able to influence decisions at the FDA for years. The FDA long ago succeeded, unintentionally, at getting public sentiment on the side of the supplement makers by using tactics that were so outrageous and over the top as to provoke a backlash. Before the Dietary Supplement Health and Education Act (DSHEA) of 1994 was passed, the FDA had done things like raid the office of a doctor who was making his own vitamin C formula. They used heavily armed Alcohol, Tobacco, Firearms and Explosives agents to hold people in the office at gunpoint as the agents confiscated the office records. That’s an example of a kind of governmental overreach that breeds contempt of government. DSHEA got the FDA off the back of the supplement industry and allowed the supplement manufacturers to make generalized, unsubstantiated claims about how a given supplement may support the function of a given organ. The FDA is now toothless in dealing with the supplement industry, and given the history of the FDA, we’re probably better off that way.

GM:
The FDA may be ineffective when it comes to doing things like pulling dangerous drugs off the market, but it can be remarkably effective and tenacious opposing nonconventional forms of treatment.

PP:
Oh exactly, exactly, because their real client is the drug companies. If you look at most of the decisions that the FDA makes, it’s acting in the interest of the drug companies. When Andrew von Eschenbach was head of the FDA, Avastin was approved for breast cancer treatment. It does not extend the life of breast cancer patients by a single day, but signing that order resulted in billions of dollars in sales for Genentech.
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That decision benefited Genentech, but it did not benefit most of the women who took the drug. And while people love to beat up the insurance companies over these issues, consider the plight of an insurance company that was forced to pay $90,000—that’s what Avastin costs the average patient annually—for a drug that does absolutely nothing at all, because the drug companies lobby Congress to force Medicare to pay for it. Once Medicare pays, then all the insurance companies have to pay. We like to beat up the insurance companies, but they’re being mandated to pay for a lot of ineffective treatment, yet still have to make a profit, make their shareholders happy, and pay for all these unnecessary diagnostic tests and annual visits to the doctors and on and on and on. So the whole system is screwed up and the FDA is a vital cog in that very screwed-up wheel.

GM:
Still, it’s the USDA, not the FDA, that comes up with the Food Pyramid, or the Happy Plate, or whatever it calls its recommendations now.

PP:
That’s correct—and in conjunction with the Department of Health and Human Services.

GM:
How did the USDA get involved in deciding what the healthiest diet should be? Why do we trust an agency that’s supposed to deal with farm issues to tell us what to eat?

PP:
We shouldn’t. The conflict of interest stares us in the face. Its recommendations are all about promoting certain sectors of agriculture, not about what the healthiest diet should be. The most blatant example of the corruption is the “checkoff” program.

GM:
Explain how that works.

PP:
With the dairy checkoff, for example, for every hundred pounds of milk that dairy producers sell, they are mandated to contribute fifteen cents to the program. That money is spent on marketing dairy products to the public, like the “Got Milk?” campaign. It’s also spent on direct marketing of dairy products to schools, on promoting the use of butter, on partnering with fast-food chains to offer more cheese in their pizzas or more milk in their coffees, and on research to create new and more devastating uses of dairy.

But it’s not only dairy. There’s also a pork and a beef checkoff program. Cattle producers pay a dollar a head. Let me read to you from a website funded by the beef checkoff program a little ditty called “Feel Good about Loving Beef”:

GM:
That’s very nice. Conservatives are always saying that government should get out of the way and let private businesses run things efficiently without bureaucratic interference. But the checkoff program seems to me a good example of government and business working in complete harmony on a disinformation campaign.

PP:
Yes. Working hand in hand to help make people sick and obese.

GM:
Does the FDA get involved in nutrition at all?

PP:
It gets involved only to the extent that it regulates, along with the Federal Trade Commission, the sale of supplements and the approval for structure/function claims that can be made about certain nutrients and the labeling of fortified functional foods. So we can thank the FDA, for example, for allowing cholesterol-lowering claims to be made for margarine products that are 100 percent fat because the companies fortify the margarine with beta sitosterol or plant sterols, which have been known to lower cholesterol.

GM:
You’re kidding me? In other words, you could take pork fat, inject a little bit of niacin in it, and make a cholesterol-lowering claim for that?

PP:
Basically, yeah. You’ve come up with a viable business model.

GM:
But it doesn’t seem kosher.

PP:
And this constant bantering back and forth that goes on between the FDA and the food companies about fortifying foods by adding omega-3s to white bread, and the health claims that can be made for that nonsense, is unconscionable. If we want to reduce the incidence of coronary artery disease, for example, that means that we’ve got to, on the federal level, start giving people the right advice. Here’s why it’s not happening. If you give the people the right advice, it means you’re going to tell them to eat more of something, less of something, and none of something. Then you’re going to tick off manufacturers and agricultural groups, something the government is unwilling to do. So whose side is the government on? It’s willing to sacrifice tens of millions of people to horrible treatments, drugs, unnecessary procedures, and even deaths every year so that it doesn’t tick off the National Dairy Council? So that it doesn’t upset Kellogg’s? That’s who the federal government is working for, not us. It does not function in the interest of the public health.

GM:
Do you have a theory about whether the decision makers at the FDA—and for that matter the AND, the AMA, and so forth—believe that they’re doing the right thing? Do you think that they’re simply in the dark scientifically, but that they at least believe that the science is on their side? Or do you think that they know that what they’re promoting is untrue and evil and corrupt, but they’re just making a living?

PP:
I think some of both. First of all, health care professionals in general often do not have a very good understanding of how to read and interpret research. A common issue is reporting data in relative versus absolute terms. For example, patients are told that a 50 percent reduction in the recurrence of breast cancer results from taking tamoxifen. And boy, with those results, who wouldn’t take it, right? Then you discover the recurrence rate is 1.3 percent; with tamoxifen, recurrence is reduced to 0.68 percent, which is actually a 49 percent reduction, but the real or absolute benefit to the patient taking tamoxifen is one-half of 1 percent.
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Once someone looks at the side effects, nobody in her right mind would say, “Oh, I’m willing to endure all of this to reduce my risk of a recurrence of breast cancer by half a percent; it’s an insane trade-off.” So, part of it is well intentioned but poor science, combined with a mind-set that all the solutions to our problems must be drug related. They view their findings through that filter.

And then the other side of it is just pure money. We’re not going to tick off anybody who’s in a position to hurt us. The late Senator George McGovern learned that lesson long ago, and it’s had a chilling effect that’s lasted decades.

GM:
What happened to Senator McGovern?

PP:
Senator McGovern chaired a Senate committee that started looking into a shift from Americans being malnourished to Americans suffering from diseases of excess. And he had Ancel Keys testify in front of his committee. Keys had done the Seven Countries Study that helped establish the role of cholesterol in cardiovascular disease. As a result, Senator McGovern and his committee issued some dietary recommendations; you and I wouldn’t like them a whole lot, but they’re a whole lot better than the guidelines at the time. They discouraged overreliance on animal foods and processed foods. The food business—the agriculture groups—were incensed by this and got together, determined to take him out. Senator McGovern lost his bid for reelection in large part because of the enormous amounts of money that came from the cattlemen’s associations and the dairy industry and the agriculture groups that said this guy’s bad for business. So all the politicians looked around and said, “You know what, it’s not profitable to stand up to the agri-foods complex.”

GM:
In the end, the recommendations of the USDA and the FDA and the AND tend to get filtered through doctors, so let’s talk about medical doctors. They get how many hours, typically, of training in nutrition?

PP:
Tufts University is the best and those doctors get seventeen hours; that’s not seventeen credit hours; that’s seventeen classroom hours in nutrition. They’re the best in the country.

GM:
And the worst?

PP:
That would be about three-fourths of them, where the subject’s not even discussed at all. And in most of the rest, a cursory review of nutrition is about the best you can hope for. I’ve had current medical students tell me that when the subject of nutrition comes up, it’s dismissed as inconsequential. Their attitude is that patients can always be referred to a dietitian or whatever. There is absolutely no awareness—and this is true for all health care professionals. Nobody is taught that diet is the cause of the diseases we battle and nobody is taught that diet will reverse them. A doctor or a dietitian or a nurse practitioner or a physician assistant who goes to school is not taught that you can reverse early-stage multiple sclerosis with diet. They’re not taught that diet causes it and they’re not taught to reverse it. In fact, none of them are taught to reverse any condition. They’re taught to treat symptoms with drugs.

GM:
Now, we can assume that most med school students are highly intelligent.

PP:
Undoubtedly.

GM:
Is it possible that they could go to med school for four years and, even if they’re not taught anything about nutrition in med school, not see the relationship between, for example, diet and heart disease, and just focus on pharmaceutical and surgical interventions?

PP:
Well, even if they see the relationship, they need to be quiet about it. Friends of mine who are physicians advocating a low-fat, plant-based diet in their medical practice have children who have applied to medical school and mentioned in their essays their interest in helping patients regain and maintain their health with diet. Their applications were met with disinterest and in sometimes open hostility; in one instance, an applicant was instructed to sanitize his application of this information in order to be considered.

GM:
All the same, there are obviously many doctors who give advice about diet, even if they’ve had no formal training in the subject. I would think that most doctors who have patients with heart disease discuss with them whether hamburgers or cheeseburgers or hot dogs are a good idea. I mean, even the general public knows that cheeseburgers contribute to heart disease.