Hiding in Plain View: Health through Nutrition in Medicine

Dr. Caldwell Esselstyn, a barely-retired, 84-year old cardiac surgeon who spent his career at the Cleveland Clinic, said that medicine is “on the cusp of what is truly a seismic revolution.” Dr. Neal Barnard, president of The Physicians Committee for Responsible Medicine, spoke to an audience of a thousand medical doctors, nurse practitioners, and a few people like me — poster children with widely-assumed incurable diseases, treating ourselves with the simplest medicine: nutrition. We were all attending the August 2018 International Conference for Nutrition in Medicine. Dr. Barnard opened by saying that we are on a “wave that hasn’t even begun to crest.” I believe it, if this crowd is any indication of the future.

So many courageous leaders in healthcare spoke at this conference, and not surprisingly, I learned a lot. For example, according to Dr. LaQuandra Nesbitt, director of the District of Columbia Department of Health, there is a greater than 20-year gap in life expectancy between different neighborhoods in Washington, DC. In other words, as she put it, one’s zip code has a greater impact on longevity than one’s genetic code. Here (NYT and food banks) and here (Jack Monroe) are two perspectives that help explain how this could be.

We cannot ethically let this continue, can we?

At lunch, I joined a table of 10 strangers, most of whom were medical doctors in some version of family practice. Listening to them during our short lunch, my opinion of these doctors changed from awe to pity. After all, according to U.S. News and World Report, not one of the top 10 medical schools in the U.S. had an acceptance rate above four percent in 2017. For example, Georgetown University medical school received more than 14,000 applications, but less than three percent of applicants were accepted. My lunch mates were the creme de la creme of achievers in our country and the world. I hardly felt worthy of sitting with them.

And yet, one after another, each doctor described grueling hours and administrative hell in their daily work lives. They were attending the conference for continuing medical education credits, but nothing about the actions of this lunch group — a small sample of the one thousand attendees — were perfunctory. They were all committed to the seismic revolution in health care anticipated by Dr. Esselstyn. Many were volunteering their time and self-funding cooking classes or information sessions after office hours for their patients. At the same time, they were all beaten down by the stress of 15-minute time slots in which to counsel patients about their options for advanced diseases, like diabetes: drugs, diet, or death. Time is up! Good luck!

One 40-year old doctor told me that her employer, a large medical facility, would reduce her annual income if she did not meet specific performance targets. I asked her to explain these targets; I only understood that the targets were administrative gobbledygook — nothing to contribute in any measurable way to her patients’ wellness. She said that she has nearly a million dollars in debt from medical school, was burnt out from the moment she finished medical school, and living with her mother to make ends meet.

We cannot ethically let this continue, either, can we?

Another doctor, Saray Stancic, a keynote speaker at the conference who also has MS, is asking these same questions. Her website explains that her focus is shedding light on the building body of scientific evidence supporting the importance of optimal nutrition and lifestyle in disease prevention. With the help of Kickstarter, she is producing a movie, Code Blue: Redefining the Practice of Medicine, to examine these issues.

As a patient, I have always assumed that doctors could change the tide of medical stupidity, and yet now it seems to me that many doctors are irretrievably stuck. Events like this conference gave us all hope that things will be better. With 86% of our three trillion healthcare system spent on chronic illnesses, we do not have a choice.

I spend much of my free time researching how the U.S. healthcare system can be fixed; day-dreaming about a day when my neurologist will not react angrily when I tell him that I have chosen diet over drugs as my strategy for wellness. According to a March 2018 article in The Hill, “…agricultural subsidies cost taxpayers about $20 billion a year: This includes a massive transfer of wealth from taxpayers to mostly large agribusinesses that are (or should be) fully capable of managing their business operations without this special treatment.” Those subsidies should be directed to health-promoting initiatives, including production of organic fruits and vegetables. Not juices and sugary snacks. Just plain old-fashioned apples, spinach, etc.

The science is so fricken overwhelming for the efficacy and cost savings of nutrition in wellness that I literally get tired of reading the same repetitive, albeit inspiring, medical outcomes. Maybe apples and spinach aren’t sexy enough to catch people’s attention. Hmmm, how can apples and spinach get sexier?

Cue wildly successful Hollywood producer, James Cameron, and muscly 71-year old Arnold Schwarzenegger. Cameron’s next movie due in 2018, The Game Changers, is billed as “a shocking expose of the world’s most dangerous myth: that meat is necessary for protein, strength, and optimal health.” The movie follows elite special forces trainer and winner of The Ultimate Fighter, who traveled the world and “What I discovered was so revolutionary, with such profound implications for performance, health, and the future of the planet itself, that I had to share it with the world.”

I welcome the Hollywood sparkle, while recognizing the *army* of scientists, researchers, and other professionals pumping out mountains of data that said/says the same damn thing, starting decades ago.

I am also learning from unexpected places. Since 2017, my day job is as a project manager on a U.S. federal government contract funded by the United States Agency for International Development, supporting the President’s Emergency Plan for AIDS Relief (PEPFAR). It is the biggest contract ever awarded by USAID: $9.5 billion (yes, that’s a b). Big.

I was initially conflicted about the possibility of working on a project associated with Big Pharma, who royally pissed me off in my little MS corner of the world. My older sister, who has for my entire life never failed to tell me when I am being an idiot (for which I am grateful), became increasingly alarmed as I became more vocal about my mistrust of drug companies. One day after listening for the 100th time to my tirade against drug companies, she finally spoke up, saying “Drugs are not all bad! Childhood leukemia is no longer a deadly disease. The AIDS virus can be suppressed so that patients can live practically normal lives.” I could not argue with her.

From there, I began examining and questioning how my experience fit into the reality.  Was I totally wrong? No. Indeed, communicable diseases like AIDS and chronic diseases like MS are fundamentally different. But maybe I could borrow important lessons from AIDS to contribute to a better future for MS and other chronic illnesses. From the United Nations (UNAIDS) website, one can quickly see how clear goals can be a catalyst for action:

  • By 2020, 90% of all people living with HIV will know their HIV status. (There are currently 36.9 million people living with HIV. Just 75 percent know they are HIV positive. The rest do not.)
  • By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART). (Three out of five people are on ARTs.)
  • By 2020, 90% of all people receiving ARTs will have viral suppression. (Only 47% in 2018 have undetectable levels of HIV.)

When asked if AIDS is a chronic illness or a deadly disease, Warren (Buck) Buckingham III, responded that it depends on where you live. Hmmm, sounds like the words of Dr. Nesbitt regarding your zip code and gentic code for longevity.

By contrast, approximately 133 million Americans, representing more than 40% of the total population of this country have a chronic illness, according to the National Health Council, and that number is projected to grow to an estimated 157 million, with 81 million having multiple conditions. What will it take to wake up the beast of the American consumer?

So I accepted the assignment on the $9.5 billion AIDS project. To give it my best effort to prepare to join this team, I read two books recommended by a woman team leader, who works on this giant project and whose dedication to overcoming the AIDS epidemic mirrors my own passion for overcoming MS: And The Band Played On (by Randy Shiltz) and My Own Country: A Doctor’s Story (by Abraham Verghese). From MS, I understand the profit motive in illness, but I never fully understood the politics of illness until I read these books. You must read them to believe them.

In a nutshell, the U.S. government stalled far too long – decades – before it paid serious attention and dedicated sufficient resources to the AIDS epidemic. Many millions of people died horrible deaths, waiting for projects like this one.

Like AIDS in its early days, chronic illness today is not being taken seriously by the U.S. government. It was the same story with cigarette smoking, when doctors promoted it. As of July 2018, only 26 of 50 U.S. states have enacted statewide bans on smoking in all enclosed workplaces, including all bars and restaurants. Wake up, please.

Unlike AIDS, chronic illness is not as much of a mystery as drug companies would have us believe. In the 1980s, AIDS sparked an international race to identify the virus and develop drugs to suppress it. For chronic illness today, we already know a lot about the root cause of and how to prevent and reverse heart disease, diabetes, cancer, even some cases of MS, and so many other chronic illnesses. We also know that current agricultural and food policies, school lunch programs, subsidy programs, etc. establish perverse incentives and promote more chronic illness.

What we need is courageous public officials to regulate and legislate wellness into our food and education systems. I dream of a gigantic federally funded program — or even a coordinated national government initiative — to address the crippling problem of chronic illness in this country. In the meantime, there are a growing number of private groups, like The Physicians Committee for Responsible Medicine, The T. Colin Campbell Center for Nutrition Studies, etc etc etc; the list is long — churning out huge amounts of research so that, I believe, someday during my lifetime, we will look at today’s U.S. healthcare system as we now look at smoking. And we will ask: what took our government so long to wake up?

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