If you lived in Macon, Georgia, and were lucky enough to survive a heart attack, you’d probably end up in the Acute Recovery Unit of the Navicent Health Heart Center. It’s “a national leader in state-of-the-art cardiovascular care,” according to their website. And they offer “prevention, diagnosis, and treatment of cardiac disease.” Their board-certified cardiologists “are committed to providing the best possible care.”
And to celebrate your rehabilitation, perhaps your visiting family members would bring you a couple of meals from the on-site hospital restaurant. You could treat your recovering heart muscle and arteries to a Bacon, Egg, & Cheese McGriddle for breakfast; a Big Mac, large fries, and Coke for lunch; and Chicken McNuggets and a chocolate shake for dinner. That’s right – a McDonald’s is renting space in a medical center.
Until June 2019, that is. That’s when a long campaign by Physicians’ Committee for Responsible Medicine (PCRM) finally bore fruit. They convinced the medical center’s leaders not to renew the fast-food chain’s lease.
The Moral of the Story
There are a lot of morals to this story.
One is, yippie for progress and sanity! Three cheers to American College of Lifestyle Medicine Trailblazer Award Winner, Neal Barnard, MD, and the rest of the PCRM team for their persistence and political savvy. And hurray for the courage of the Navicent board of directors to cut off a lucrative revenue stream in favor of patient health!
Another moral is, too bad for the harried, often economically distressed patients, visitors, and staff who have come to rely on McDonald’s. Now, where can they eat cheaply and quickly?
A third moral is, to put it bluntly, what the heck was a McDonald’s doing in a medical center in the first place?
Can you imagine a liquor store housed in an alcohol abuse rehab center? How about a demolition derby track as part of an auto body shop? Or a gun shop located on the grounds of a trauma center?
The Irony of Fast Food in a Hospital
If you stop and think about it for even two seconds, you’ll see that the analogies are spot-on. The food served at McDonald’s causes, beyond a shadow of a doubt, the diseases and conditions the Navicent Health Heart Center is treating.
Yes, it’s comfort food at a tough time; but there’s no comfort in a second heart attack. No comfort in a continual downward spiral of health and vitality. No comfort in more and more time, money, and energy devoted to managing a decline into disability and premature death.
If you wanted to be really cynical about it, you could see the two branches of the operation as feeding each other. The hospital provides customers for McDonald’s, and McDonald’s, in turn, provides more customers for the hospital.
Of course, no cardiologist wants to see more heart disease. No hospital is rooting for the rising incidence of angina, myocardial infarction, a-fib, stroke, and congestive heart failure. It’s not a conscious conspiracy. Rather, the Navicent McDonald’s (and dozens of other fast-food restaurants in medical centers around the country) are a symptom of a profound blind spot in medical practice and education.
The blind spot, so obvious to those outside the profession, is that the food we eat is the number one determinant of human health.
Diet is the Leading Cause of Preventable Death
The recent report published in the journal, Lancet, affirms that poor diet is responsible for more deaths than any other risk factor in the world. The report concluded that an unhealthy diet is the biggest contributor to tens of millions of deaths worldwide. And high salt intake, low whole grains intake, and low fruit intake were leading risk factors. Linked as the root cause for heart disease, a number of cancers, and type 2 diabetes, dietary habits are finally taking center stage as an area of much-needed change.
Not that this is cutting-edge knowledge. Humans have known that food affects health long before epidemiological research, or science, or, most probably, language itself. The father of modern medicine, Hippocrates, was quoted as saying, 2,500 years ago, that food is the medicine that can sustain and restore health.
The Disappearance of Food as Medicine
Since then, science has generated a magnitude of studies on nutrition and health. (A Google search for scholarly articles on clinical nutrition research results in 3 million posts.) We have an evidence base beyond any reasonable doubt that nutrition is the cornerstone of health or disease, depending on what we put in our bodies. And yet, we’ve lost sight of food as a foundational element of medical knowledge. In a survey of medical schools in the US, barely a quarter of them met the minimum 25 required hours set by the National Academy of Sciences. As a profession, medicine is simply missing the mark.
To quote my dad and colleague, John Robbins, “A doctor who doesn’t know about food is like a firefighter who doesn’t know about water.” Yet most doctors graduate medical school with little or no training in the foundation of health.
Medical education focuses on pathology and treatment. That is, let’s look at what goes wrong with the human body, and the risks and benefits of the myriad ingenious interventions that research has produced and validated: Pills, procedures, and protocols.
What’s missing in this paradigm, of course, is human health prior to disease or injury. That is, the healthy functioning of the systems and organs of the body. What keeps us well? What can return us to health? Medical education ignores these questions, and so medical practice simply pretends they are irrelevant to its mission.
Meanwhile, healthcare leadership built a system in which fast food can colonize medical centers and shuttle their customers on a conveyer belt of chronic disease.
A Disconnect Between Symptoms and Cause
The modern disease epidemic has hit us faster than anyone might have imagined. It’s been a mere 29 years, for example, since we had the first signs that type 2 diabetes, known then as “adult-onset diabetes,” was affecting youth. Type 2 diabetes in children now accounts for between 15-45% of newly diagnosed diabetes cases each year.
If there were a vaccine protective against type 2 diabetes, every child in the United States would require it. But because the disease is a food-borne one, vectored by Big Macs and Whoppers and Baconators, we act as if prevention is impossible. This abdication of medical responsibility sentences our young people to shortened lives full of avoidable pain and suffering.
We have graduated healthcare providers with a gap in the foundation of their education. We have built an acute care system to handle the flood of after-effects (i.e. type 2 diabetes) and forgot that we had the means to turn off the faucet. So, here we are in 2019 with epidemic levels of obesity, heart disease, diabetes, depression, cancer, and a culture that fosters the continuation of our poor habits.
Meanwhile, we have patients whose lives are on the line, being told nothing about nutrition, by doctors who, despite all their best intentions, know nothing about nutrition.
Leading the Charge for Nutrition in Medical Education
While it might cause backlash from visitors, patients, and overworked and underpaid hospital staff, improving food options in hospitals is the right step forward. Now that we’ve tasted progress and victory, what’s next?
How can we stop fighting against medical institutions, but instead empower them to lead the way in making nutrition a key component of the modern medical toolbox?
One key lever is medical education. Like most academic institutions, medical schools teach to a test. Wager a guess on how many questions about nutrition are on the certification exam for physicians? Currently, out of a total question bank of about 12,000 questions, there are almost none.
If you’re a medical school looking to recruit the best students, how much energy are you going to put into teaching a topic that will not be evaluated by medical boards? Or that will not determine the careers and incomes of your graduates? Right again: almost none.
That’s why in 2019, the American College of Lifestyle Medicine (ACLM) and Food Revolution Network teamed up to create the Lifestyle Medicine Question Bank. The goal is to create 1,000 questions medical schools can use in categorical assessments and that the National Board of Medical Examiners can choose from to add to final exams. The idea: If nutrition is on the tests, professors will be motivated to make it a core part of the curriculum.
Redefining Healthy
When we generate focus on food as medicine, we will see more changes like McDonald’s moving out of our anchor institutions of health. The medical establishment will redefine healthy so that it means much more than the treatment of symptoms and remission of disease. Armed with knowledge of nutrition and lifestyle, we will be able to prevent and reverse the diseases that harm and kill too many of us. and that threatens the very economic system in which we all live.
In the future, perhaps the Navicent Medical Center’s state-of-the-art cardiovascular care unit will include dietitians, health coaches, and chefs, as well as board-certified cardiologists and nurses. And maybe the most common order placed at the hospital restaurant will be, “Kale salad with air-fried sweet potatoes and fresh fruit.”
How You Can Take Action
Here are three ways you can add your muscle to the movement to reform our healthcare system:
- Join the movement to change medical education. Donate to add a new question to the Lifestyle Medicine Question Bank at lmquestionbank.org. Each question costs $250. We need to raise $250,000 to change the future of medical education forever. Can you pitch in? Grants, stock donations, and major gifts of all kinds are welcome, too!
- Follow ACLM to learn more about change, resources, and all six pillars of Lifestyle Medicine – Facebook; Twitter; and Instagram.
- Get back to basics by eating more whole plant foods. There are abundant resources right on this website to help you do just that.
Each of us has a choice. We can be helpless patients or empowered leaders. We can be complicit in the status quo, or we can be everyday revolutionaries.
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Tell us in the comments:
- What is your experience with hospital food?
- Do you think medical education should focus more on nutrition and prevention?
Featured Image: iStock.com/AlessandroPhoto
