THE TWIN ELEPHANTS IN THE ROOM
IS AMERICAN HEALTHCARE REALLY SUSTAINABLE?
LOOK AT THE LATEST STUDY FROM BMJ AND YOU DECIDE
As I mentioned the other day, “Sustainable” has become one of the catchphrases of the 21st century. But what does it really mean — particularly in terms of healthcare? According to the huge drug company AbbVie it’s, “The adoption of people-centric innovative strategies that safeguard health of individuals and society by providing prevention and care adapted to evolving care needs today and tomorrow.” Because that was one of the biggest batches of touchy-feely mumbo jumbo I’ve ever heard in my life, let’s try again. Dartmouth-Hitchcock’s definition is much more vague. “A commitment to improving the lives of the people and communities we serve, for generations to come.” Both of these examples, as well as the next, ignore the elephants in the room — something we’ll discuss shortly.
Many companies see sustainability as “going Green” (whatever that really means as it pertains to healthcare). Mostly, they tout it as doing things like talking the local hospital board into switching to the newer energy-efficient light bulbs, or putting solar panels on the roof. For instance, in an article called Advancing Sustainability in Health Care, pharmaceutical giant Johnson & Johnson says of the research they commissioned on the subject………
“A study found that hospitals are placing greater emphasis on “green” products used both in patient care and throughout facilities, such as cleaning products and office supplies. More than half of respondents report their hospitals currently incorporate sustainability into purchasing decisions, and 80 percent expect that to be the case within two years. About eight in ten respondents said sustainable products help protect hospital staff and seven in ten said they make good financial sense; more than half said ‘green initiatives’ are an important factor for patients when choosing a hospital and that they help improve health outcomes.”
Sounds nice, but I would argue that this isn’t really “sustainability”. As I introduce you to the first elephant in the room — the one named “Fiscal Responsibility,” let me share my definition of sustainability as it relates to healthcare. Not only is it quite short, it’s also quite simple. Sustainability in healthcare is all about whether or not we as a nation can pay for it. Unfortunately, it’s become all too obvious that we can’t — a fact easily noted by browsing 2009’s GAO Report — Government Accountability Office (HERE). This report should scare the pants off every single taxpaying American (not to mention those who don’t pay taxes), because in it the authors admit outright that our nation is on a “fiscally unsustainable” trajectory.
Think about it for a moment. We are currently “officially” almost 20 trillion dollars in debt (HERE). But thanks to shady government accounting, our “Off Balance-Sheet” debt is universally believed to be at least an order of magnitude (10x) greater than that (HERE). And because “illions” all sound alike after awhile; in case you are not quite sure how a trillion differs from a billion, click the first link in this paragraph for an interesting one minute videographic on the subject.
Just one year after the aforementioned report was released, past chairman of ‘The Fed’, Alan Greenspan, wrote an article in a June 2010 issue of the Wall Street Journal comparing us to that bastion of European socialism; Greece. In it he stated, “Only politically toxic cuts or rationing of medical care, a marked rise in the eligible age for health and retirement benefits can close the deficit. If significant reforms are not undertaken, benefits under entitlement programs will exceed government income by over $40 trillion over the next 75 years.” Forget 75 years folks, it is happening in front of your very eyes — even as you read this post. The whole thing reminds me of one of my favorite scenes from one of my favorite movies — 1994’s hit comedy, Dumb & Dumber. Let me set the scene for you.
Two bumbling roommates (Lloyd Christmas played by Jim Carey, and Harry Dunn played by Jeff Daniels) end up traveling halfway across the country via the “Mutts Cutts” van and a vintage 1971 minibike, in order to return a briefcase to a woman that Lloyd had become smitten with while working as a chauffeur. While trying to find the woman (Mary Swanson played by Lauren Holly) in Vail, CO, they accidentally break open the briefcase, discovering it’s full of cash — millions upon millions of dollars in cash. As they are flat broke and freezing to death, they vow to sensibly and frugally spend only what they need to survive, promising each other they will pay back every penny as soon as they find the briefcase’s owner. Much of the second half of the movie focuses on the hijinks surrounding their outrageous spending spree. Playing Time: One Minute
Couple the fact that nearly one out of five dollars spent in this country is being spent on healthcare, with the fact that one out of three dollars being spent by our government is borrowed (or created out of thin air via printing presses or a keystroke on a bureaucrat’s computer), and you start to see just how unsustainable this problem really is —- a problem that can’t be solved with curly cue light bulbs, a backyard windmill, and super extra-biodegradable toilet paper. Which begs the question of whether or not anything could potentially be done to make American Healthcare truly ‘sustainable’?
In answer to this question, ‘there certainly is’. But we don’t seem to have the stomach for doing what has to be done, collectively or individually. In fact, we are moving 180 degrees in the wrong direction. Case in point; just two short weeks ago, the British Medical Journal released a study called Ultra-Processed Foods and Added Sugars in the US Diet: Evidence From a Nationally Representative Cross-Sectional Study. Using statistics that are a minimum of five years old (in other words, the problem has significantly worsened over the last half decade), Dr. Carlos A. Monteiro of the University of Sao Paulo, Brazil, came to some startling conclusions about our national love affair (ADDICTION would be a much better word) with “ultra-processed foods“.
“Ultra-processed foods comprised 58% of energy intake, and contributed 90% of the energy intake from added sugars. The content of added sugars in ultra-processed foods was eight-fold higher than in processed foods and five-fold higher than in unprocessed or minimally processed foods. 82% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars”
I already know what you are wondering, because I was wondering the very same thing…….. What are ultra-processed foods? It’s easy. Beyond what we typically think of when we think of processed foods, the author defined ultra-processed foods as “industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations.” In English, he’s not talking about things like home-baked items such as cakes, pies, cookies, pizza, or bread here. He is talking about commercially-prepared foods that beyond things like sugar and bleached flour, also contain fun ingredients like ASPARTAME, MSG, artificial flavors, artificial colors, and any number of others. The sorts of things you would probably not incorporate into a dish you were going to serve the in-laws. Please note that this doesn’t even begin to deal with the plethora of substances on food labels that you have no idea what they are because you can’t pronounce them.
Part of the reason that we are not turning this problem around has to do with the incredible amount of MISINFORMATION BEING PROMOTED CONCERNING NUTRITION. I can tell you from personal experience that much of what is being taught in our university systems concerning nutrition is flat out wrong. It was wrong back when I was learning it thirty years ago (HERE), and it’s wrong now (HERE’S SOME MORE). A recent article by Leah Samuel helps prove this point.
Writing about the study we just discussed in a recent edition of the medical ‘daily’ STAT (Deep Dive Into Diets Shows Just How Much Processed Food Americans Eat), she let the proverbial cat out of the bag. In her article she quoted Dr. Connie Weaver, a Professor of Nutrition Science at Indiana’s Purdue University as saying, “Just because a food is highly processed and sugary doesn’t necessarily mean it’s lacking in nutritional value. You can’t just rule out processed food, because you’ll end up malnourished. Given what Americans eat now, they are getting a lot of nutrients from processed food.” Gulp! Maybe Weaver was misquoted or taken out of context, but I doubt it. Honestly, with friends like that, who needs enemies? Although Americans are certainly getting a lot of calories from processed foods, this is the sort of misguided thinking that brought us any number of ‘food fiascoes,’ including the fifty year WAR ON FAT.
Sure, people are getting a lot of nutrients from processed foods — macro nutrients (fats, carbohydrates, and proteins). But as far as real nutrition — the micro-nutrients, vitamins, minerals, phytonutrients, and FIBER that only come from WHOLE FOODS…….. Are you joking me? Cheap, SYNTHETIC VITAMINS are just that; cheap, synthetic vitamins. We eat and eat, but are starving for REAL NUTRITION. LIVING THE HIGH CARB LIFESTYLE provides the classic example of overfed and undernourished.
Of the thousands of individuals looked at in Monteiro’s study, only twenty percent of the group who consumed the lowest amounts of ultra-processed foods managed to stay under the government’s recommendations of less than 10% of one’s total calories coming from added sugar. This is essentially the same thing that I showed you a year ago in a different study (HERE). In other words folks, the problem is not fixing itself. What does this mean for the future of sustainable healthcare? Do I even need to show you? Allow me to introduce you to our second elephant — the one named “Personal Responsibility”.
Those with any degree of intelligence and honesty can read the writing on the wall. I’m not sure there is a better example of a more unsustainable industry than medicine (BIG PHARMA included) as it is currently being practiced. In fact, “Big Oil” is more sustainable than the trajectory that healthcare is on. By definition, sustainability requires a significant amount of personal responsibility. It is impossible to argue that Americans — especially OUR YOUTH (or HERE) — are getting more responsible in any arena, let alone this one. This decrease of personal responsibility is at least partially the by-product of the last three or four generations growing up in an environment that does not require them to pay their own way (HERE). But there’s much more to it than that.
I showed you JUST A FEW DAYS AGO that healthcare has an incredible over-reliance on technology. This would be fine if said technology was cheap and actually worked. Unfortunately, it is expensive and rarely works as touted by industry (THESE POSTS BEAR THIS OUT REPEATEDLY). And because “Prevention” was mentioned in one of the earlier definitions of ‘sustainability,’ lets get it on record right now that Prevention is in no ways what we have been taught it is (HERE). Whether you are interested in getting healthy as a duty to your government (ha) or whether it’s just for you, YOU GO ABOUT IT THE SAME WAY.