The New York Times, September 14, 2009, by Michael Pollan  —  To listen to President Obama’s speech last Wednesday night, or to just about anyone else in the health care debate, you would think that the biggest problem with health care in America is the system itself – perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed.

No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.

That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry.

According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet – there’s smoking, for instance – but many, if not most, of them are.

We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.

The American way of eating has become the elephant in the room in the debate over health care. The president has made a few notable allusions to it, and, by planting her vegetable garden on the South Lawn, Michelle Obama has tried to focus our attention on it. Just last month, Mr. Obama talked about putting a farmers’ market in front of the White House, and building new distribution networks to connect local farmers to public schools so that student lunches might offer more fresh produce and fewer Tater Tots. He’s even floated the idea of taxing soda.

But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet. To put it more bluntly, the government is putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup.

Why the disconnect? Probably because reforming the food system is politically even more difficult than reforming the health care system. At least in the health care battle, the administration can count some powerful corporate interests on its side – like the large segment of the Fortune 500 that has concluded the current system is unsustainable.

That is hardly the case when it comes to challenging agribusiness. Cheap food is going to be popular as long as the social and environmental costs of that food are charged to the future. There’s lots of money to be made selling fast food and then treating the diseases that fast food causes. One of the leading products of the American food industry has become patients for the American health care industry.

The market for prescription drugs and medical devices to manage Type 2 diabetes, which the Centers for Disease Control estimates will afflict one in three Americans born after 2000, is one of the brighter spots in the American economy. As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.

As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.

But these rules may well be about to change – and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook – and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.

The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.

When health insurers can no longer evade much of the cost of treating the collateral damage of the American diet, the movement to reform the food system – everything from farm policy to food marketing and school lunches – will acquire a powerful and wealthy ally, something it hasn’t really ever had before.

AGRIBUSINESS dominates the agriculture committees of Congress, and has swatted away most efforts at reform. But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill – which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind.

In the same way much of the health insurance industry threw its weight behind the campaign against smoking, we can expect it to support, and perhaps even help pay for, public education efforts like New York City’s bold new ad campaign against drinking soda. At the moment, a federal campaign to discourage the consumption of sweetened soft drinks is a political nonstarter, but few things could do more to slow the rise of Type 2 diabetes among adolescents than to reduce their soda consumption, which represents 15 percent of their caloric intake.

That’s why it’s easy to imagine the industry throwing its weight behind a soda tax. School lunch reform would become its cause, too, and in time the industry would come to see that the development of regional food systems, which make fresh produce more available and reduce dependence on heavily processed food from far away, could help prevent chronic disease and reduce their costs.

Recently a team of designers from M.I.T. and Columbia was asked by the foundation of the insurer UnitedHealthcare to develop an innovative systems approach to tackling childhood obesity in America. Their conclusion surprised the designers as much as their sponsor: they determined that promoting the concept of a “foodshed” – a diversified, regional food economy – could be the key to improving the American diet.

All of which suggests that passing a health care reform bill, no matter how ambitious, is only the first step in solving our health care crisis. To keep from bankrupting ourselves, we will then have to get to work on improving our health – which means going to work on the American way of eating.

But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course.

For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.

Michael Pollan, a contributing writer for The Times Magazine and a professor of journalism at the University of California, Berkeley, is the author of “In Defense of Food: An Eater’s Manifesto.”



Michael Pollan  is an American author, columnist, activist, and professor of journalism at the University of California, Berkeley.

In The Omnivore’s Dilemma, Pollan describes four basic ways in which human societies have obtained food: the current industrial system, the big organic operation, the local self-sufficient farm, and the hunter-gatherer. Pollan follows each of these processes from a group of plants photosynthesizing calories through a series of intermediate stages and ultimately to a meal. Along the way, he suggests that there is a fundamental tension between the logic of nature and the logic of human industry, that the way we eat represents our most profound engagement with the natural world, and that industrial eating obscures crucially important ecological relationships and connections. On December 10, 2006, The New York Times named The Omnivore’s Dilemma one of the five best nonfiction books of the year. The book appears on NovelTracker.com’s shortlist of non-fiction that reads as well as the best fiction. On May 8, 2007, the James Beard Foundation named The Omnivore’s Dilemma its 2007 winner for the best food writing. It was the book of focus for the University of Pennsylvania‘s Reading Project 2007. An excerpt of the book was published in Mother Jones.


Michael Pollan speaks to the Marin Academy community.

Pollan’s discussion of the industrial food chain is in large part a critique of modern agribusiness. According to the book, agribusiness has lost touch with the natural cycles of farming, wherein livestock and crops intertwine in mutually beneficial circles. Pollan’s critique of modern agribusiness focuses on what he calls the overuse of corn, for purposes ranging from fattening cattle to massive production of corn oil, high-fructose corn syrup, and other corn derivatives. He describes what he sees as the inefficiencies and other drawbacks of factory farming, assesses organic food production and what he thinks it is like to hunt and gather food. He blames those who set the rules – i.e., politicians in Washington, D.C., bureaucrats at the United States Department of Agriculture, Wall Street capitalists, and agricultural conglomerates like Archer Daniels Midland-for what he calls a destructive and precarious agricultural system that has wrought havoc upon the diet, nutrition, and well-being of Americans. Pollan finds hope in Joel Salatin‘s Polyface Farm in Virginia, which he sees as a model of sustainability in commercial farming. Pollan appears in the documentary film King Corn (2007).

In The Botany of Desire, Pollan explores the concept of co-evolution, specifically of humankind’s evolutionary relationship with four plants – apples, tulips, marijuana, and potatoes – from the dual perspectives of humans and the plants. He uses case examples that fit the archetype of four basic human desires, demonstrating how each of these botanical species are selectively grown, bred, and genetically engineered. The apple reflects the desire for sweetness, the tulip beauty, marijuana intoxication, and the potato control. Pollan then unravels the narrative of his own experience with each of the plants, which he then intertwines with a well-researched exploration into their social history. Each section presents a unique element of human domestication, or the “human bumblebee” as Pollan calls it. These range from the true story of Johnny Appleseed to Pollan’s first-hand research with sophisticated marijuana hybrids in Amsterdam, to the alarming and paradigm-shifting possibilities of genetically engineered potatoes.

Pollan speaking at TED in 2007

Pollan’s latest book, In Defense of Food: An Eater’s Manifesto, released on January 1, 2008, explores the relationship with what he terms nutritionism and the Western diet, with a focus on late 20th century food advice given by the science community. Pollan holds that consumption of fat and dietary cholesterol do not lead to a higher rate of coronary disease, and that the reductive analysis of food into nutrient components is a flawed paradigm. He questions the view that the point of eating is to promote health, pointing out that this attitude is not universal and that cultures that perceive food as having purposes of pleasure, identity, and sociality may end up with better health. He explains this seeming paradox by vetting then validating the notion that nutritionism and, therefore, the whole Western framework through which we intellectualize the value of food is more a religious and faddish devotion to the mythology of simple solutions than a convincing and reliable conclusion of incontrovertible scientific research. Pollan spends the rest of his book explicating his first three phrases: “Eat food. Not too much. Mostly plants.” He contends that most of what Americans now buy in supermarkets, fast food stores, and restaurants is not in fact food, and that a good practical tip would be to eat only those things that people of his grandmother’s generation would have recognized as food.

Pollan has contributed to Greater Good, a social psychology magazine published by the Greater Good Science Center at University of California, Berkeley. His article “Edible Ethics” discusses the intersection of ethical eating and social psychology.

In his 1998 book A Place of My Own: The Education of an Amateur Builder, Pollan methodically traced the design and construction of the out-building where he writes. The 2008 re-release of this book was re-titled A Place of My Own: The Architecture of Daydreams.

Pollan is a contributing writer for the New York Times Magazine, a former executive editor for Harper’s Magazine, and author of five books: In Defense of Food: An Eater’s Manifesto (2008) The Omnivore’s Dilemma: A Natural History of Four Meals (2006), The Botany of Desire: A Plant’s-Eye View of the World (2001), A Place of My Own (1997), and Second Nature A Gardener’s Education (1991).

His recent work has dealt with the practices of the meat industry, and he has written a number of articles on trends in American agriculture. He has received the Reuters World Conservation Union Global Awards in environmental journalism, the James Beard Foundation Awards for best magazine series in 2003, and the Genesis Award from the American Humane Association. His articles have been anthologized in Best American Science Writing (2004), Best American Essays (1990 and 2003), The Animals: Practicing Complexity (2006) and the Norton Book of Nature Writing (1990).

Sebelius: ‘Encouraging News’ Regarding Swine Flu Vaccine

Washington Post, September 15, 2009, by Rob Stein  —  The swine flu vaccine appears to work for adults with just one shot and within 10 days, a major boost to the widespread immunization campaign that officials are planning to protect people against the first influenza pandemic in 41 years, researchers reported.

Preliminary data from an Australian study found that a single standard dose could produce an immune response in more than 96 percent of recipients, and U.S. studies indicate that the protection occurs within eight to 10 days, scientists reported. The vaccine also appeared safe.

The eagerly awaited findings mark the first results from a flurry of studies that scientists have been rushing to conduct to develop a swine flu vaccine. The findings indicate that plans to inoculate millions of Americans — the most ambitious vaccine campaign in U.S. history — and worldwide could occur much more quickly and require far less vaccine than officials had feared.

“This is good news,” said Anthony S. Fauci of the National Institutes of Health, which is leading the U.S. efforts to develop the vaccine. “This is very good news. If you needed two doses, that would be a major strain on vaccine supplies nationally and globally.”

In a statement released Friday, officials said U.S. studies found a 15-microgram dose of vaccine made by Sanofi Pasteur produced a protective immune response in 96 percent of adults aged 18 to 64 and in 56 percent of adults aged 65 and older. The same single dose of the CSL vaccine in the Australian study produced a protective immune response in 80 percent of adults aged 18 to 64 and in 60 percent of adults aged 65 and older. Officials said the differences may be due to “technical differences” in the preliminary data.

“This is very encouraging news,” said Health and Human Services Secretary Kathleen Sebelius as a briefing outlining the findings began, noting it means more Americans will be protected sooner than had been thought. “The vaccine we have purchased will go further and cover more people,” Sebelius said.

Results from additional studies will be needed to see whether children and other special groups need one or two doses, he added. Young children usually need two seasonal flu shots because they have not been exposed to the virus before.

The National Institutes of Health is conducting a series of studies testing the swine flu vaccine on 4,600 volunteers, including adults, children and pregnant women.

“We will hopefully get some information about kids from our trial in a couple of weeks,” Fauci said.

The results from CSL Ltd. in Australia will be published in the New England Journal of Medicine but were released online Thursday because of their urgency. The study involved a standard dose of 15 micrograms of vaccine and found that the vaccine produced a strong immune response in more than 96 percent of the subjects.

“The concern that people had was that because this was a new virus that this would require two doses for everyone. That would have created a problem of supply,” Fauci said. “This greatly alleviates the problem of supply.”

The findings also mean that adults will not have to return for a booster shot, which would have greatly complicated the already daunting vaccine effort.

The results were welcomed by officials at the World Health Organization, which has been particularly concerned about providing enough vaccine to poorer countries.

“If this is true, this is quite encouraging,” said Gregory Hartl, a WHO spokesman. “If you only need one shot instead of two, the vaccine will go twice as far. Twice as many people will be able to get the vaccine.”

The Australian findings were released with a second study from the University of Leicester. In that study, 175 British volunteers ages 18 to 50 received another version of the vaccine made by Novartis Corp. — either 7.5 or 15 micrograms of vaccine, along with a substance known as an adjuvant, which can boost a vaccine’s effectiveness. The study found that either dose produced adequate immune response within 14 days. Adjuvants have been used widely in Europe, which could extend the supplies even further. U.S. officials were considering approving an adjuvant in this country if supplies ran low.

The strong immune response was somewhat puzzling, Fauci said, especially given the results of a third paper, from the federal Centers for Disease Control and Prevention, that found exposure to the seasonal flu vaccine offered no protection against the swine flu.

“The responses you’re seeing suggest that somehow or other there has been some previous exposure to similar viruses or some vaccine that is responsible,” Fauci said.

The new virus, known as H1N1, emerged last spring in Mexico and quickly spread around the world, causing at least 2,837 deaths, including at least 556 in the United States so far and prompting the WHO to declare the first influenza pandemic since 1968.

The pandemic has sparked a flurry of emergency planning, including a rushed program to develop a vaccine. Because the virus is new, experts thought most people would need one shot followed by a booster several weeks later to produce sufficient protection.

Because the first batches of vaccine are not expected until mid-October, that meant the first Americans would not be protected until after the outbreak might have peaked.

The federal government has already spent $2 billion to buy 195 million doses of vaccine and plans to purchase enough to vaccinate every American if necessary.

Unlike the typical flu, the H1N1 virus has been affecting children and young adults much more often than the seasonal flu.

As a result, the top priority for vaccination will be everyone age 6 months to 24 years and people who care for children younger than 6. Pregnant women, health-care workers and adults ages 25 to 64 with health problems that put them at risk for complications are also being given high priority.

The results from the H1N1 vaccine trials came as top U.S. health officials urged Americans to get vaccinated against the seasonal flu.