Signs of a health issue along I-75

Good afternoon, everyone.

The Weekly Packet will be getting back to regular sailing now that Nesiritide. The Rise and Fall of Scios has passed the final proofing and is on the way to the printer. Please look for the title as above on Amazon, or alternatively search by author: Roger M Mills, MD.

I have also been scrambling to get to a final draft of Clinical Management of Heart Failure, 3rd edition. The co-authors (Jim Young and Javed Butler) and I opted for starting the third edition with a clean slate. As a consequence, I have just made the long drive from our camp in Michigan’s Upper Peninsula to spend a day with Jim at the Cleveland Clinic. Which leads to what’s really on my mind.

On June 7th, JAMA ran an opinion piece titled “Lifespan Weighted Down by Diet” by David S. Ludwig, MD, PhD from the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital and Harvard Medical School. In response to the recent widely publicized observations of decreasing life expectancy among US counties in the Southeast and Midwest, Ludwig raises the hypothesis that technologic advances may no longer be sufficient to compensate for the adverse health effects of obesity.

He goes on to state, “Direct medical costs associated with obesity among noninstitutionalized adults have been estimated to have reached $190 billion annually in 2005, an amount that does not include losses from lower worker productivity.”

What does this have to do with driving the 495 (Mapquest) miles from Hulbert Lake to the Cleveland Clinic? Everything! With the exception of the very sparsely populated areas in northern Michigan, the trip is a visual festival of high-caloric density food. The woods and fields of the rural Midwest are blotted out by billboards for McDonald’s, Wendy’s, Kentucky Fried and scores of local places like Cops and Donuts (Clare, MI). And the drive thru lanes and parking lots for these places are packed. This observation prompted the following chain of thought.

First, I have read, learned, and written a lot about drug costs and their relationship to overall health care costs. Second, JAMA now publishes an expert from Harvard who tells us that the medical cost of obesity passed $190 billion a year a decade ago! Third, new data suggest that dietary composition may have an impact above and beyond caloric balance alone. Fourth, the fast-food industry is not about production and consumption of “high-quality proteins, fruits and vegetables, legumes, nuts, and other whole foods,” as a basic diet.

Where does this leave me? I cannot avoid the growing suspicion that some large players in the food industry are making profits by making us unhealthy, and driving the overall cost of health care up in the process. This seems at least an order of magnitude more villainous than making profits for discovering and developing new drugs to make us healthier.

One of the core values of writing the Packet was to use data to gain perspective on problems. Over the summer months, I’ll look for more data and a clearer perspective on these and other epidemiologic questions.