13

Understanding the System

The riskiest thing we can do is just maintain the status quo.

—BOB IGER

For the last few decades of my research career, I naïvely believed that just sharing the facts about the benefits of the WFPB diet would be enough to sway my colleagues, policy makers, journalists, and businesspeople. I had implicit faith in the evolutionary principle; I thought that once people knew the truth (and more important, experienced it for themselves), change would come naturally.

Looking back, my naïveté was immense. In that respect, I had no more ability to discern the plain truth than my reductionist colleagues. Despite example after example of human greed and fear of losing power, I still thought sharing the facts would be enough. That someday the weight of evidence would be so compelling, so overwhelming, that even the AND and the ACS (two organizations whose names, in my mind, mean essentially the same thing!) would bow to the truth and recognize plant-based nutrition as the cornerstone of a healthy life, a healthy society, and a healthy planet. Scientists would come together with a unified voice to advocate for a sane diet and social policies that would enable all people to partake of it. Journalists would spread the very good news and devote their talents to telling inspiring stories of change. Government officials would hastily abandon ill-conceived subsidies for deadly foods and create nutritional guidelines and programs that could reduce health-care costs by 70 to 90 percent in a few years. And industry leaders, as visionary entrepreneurs, would embrace plant-based nutrition as the foundation of their cafeterias and health insurance plans in order to maintain a competitive advantage in attracting, retaining, and profiting from the labor of healthy and happy employees.

Despite the overwhelming evidence that supports a plant-based diet, none of these things has happened. Plant-based nutrition is still marginalized and maligned as an approach to reducing disease rates, obesity, and skyrocketing health-care costs. Journalists still tout gene therapy as the road to redemption and ignore the benefits of eating more plants and less meat and processed food. Lobbyists representing dairy, meat, sugar, and other processed foodstuffs all but write government regulations and control the bulk of nutrition-related messaging. Our school lunch programs highlight the government’s lack of commitment to instilling healthy eating habits in our population. And some companies have responded to the crisis of health-care costs by cutting insurance coverage and outsourcing jobs rather than addressing its root cause.

What I’m describing here isn’t a vast, evil conspiracy designed to keep the truth of the plant-based diet from you. Many of the players I’ve criticized truly believe their own PR. Lots of cattle ranchers, dairy farmers, and high-fructose corn syrup manufacturers think they’re providing high-quality calories to a hungry world. Many scientists are just as confused as the general population about the big picture of nutrition and human health. Many journalists report the results of each reductionist study under the honest misconception that they’re describing a comprehensive reality rather than a thin, misleading, out-of-context slice. And many government officials, while privately acknowledging the immense benefits of a plant-based diet, think that promoting such an idea would be counterproductive to their political futures in the face of so much deep-pocketed industry opposition.

The problem is not that humans are broken or evil. It’s that the system is broken. I have spent my entire career in academia and professional research and, like most of my colleagues, I take pride in my institution’s gentility, objectivity, and democratic tradition. Indeed, I believed that I experienced these virtues on many occasions. But that was before I realized I was living in a cocoon, unaware of the subtle way in which financial interests inform every part of the scientific process and beyond.

The thing about systems is that they’re resilient. I’ve learned that the hard way, after spending years sharing the best scientific information with policy makers, businesspeople, and consumers and still not having much of an impact on the entire system. You can tweak all the details—you can correct the science all you want—but if the goal isn’t changed, the system will continue to produce the same outcomes it always has. The logical goal of a health-care system would be to deliver health. That’s the stated goal of ours, certainly. But that’s not its actual goal. To discover that goal, as with any other system, we have to observe what it does, not what it claims to do.

If the goal of our health-care system were health, then it would operate in a way that promotes health. It might look clumsy, sloppy, and slow, but the connections built into that system would favor methods and technologies and interventions that move us all inexorably in the direction of good health throughout our lives. Obviously, that’s not the case. The goal of our health system is not health; it’s profit for a few industries at the expense of the public good.

That’s right—profit is the goal at the center of our health-care system, and that skews everything.

A HYPOTHETICAL HEALTH-CARE SYSTEM

When I say “health-care system” here, I mean more than just doctors, nurses, hospitals, drugs, and surgical apparatus. I mean everything in our society that affects our health, from our agricultural policies, to school lunch programs, to pollution laws, to public education about nutrition, to funding priorities for scientific research, to seat belt enforcement, and so on. This may sound unimaginably complex and hard to manage and restructure, and on a piecemeal basis it is. But let’s imagine a hypothetical system in which the primary goal is better public health. In such a system, all these elements and policies would naturally tend to produce better health outcomes.

Since my training is in nutritional biochemistry, I often think of the world in terms of nutrient narratives. And the nutrient around which any healthy modern society is organized is information—in this case, information about health, a key product of science that individuals, governments, nonprofits, corporations, and the media consume. Figure 13-1 is a simplified diagram of how the nutrient information moves through the health-care system.

In an ideal society, the “information cycle” is driven by the goal of empowering people at all levels of society to enjoy healthy lives. That goal would drive the main input of the information cycle, questions that are significant to public health and worthy of research. Scientists would tackle these questions with great curiosity and enthusiasm, collaborating and competing to come up with the most creative, powerful, and valid study designs. Many different studies would be carried out, from the extremely reductionist to the extremely wholistic, which would generate more questions and some controversies. Eventually, a “weight of evidence” would accumulate, consisting of a model that would be tested by its ability to predict future health outcomes. It would not be “The Truth”—science never is—but it would be as close to it as a group of humans could get at that point.

This weight of evidence would then cycle into the rest of society. The media, both professional trade journals and public media organizations such as newspapers, would report it to the people, who would incorporate it into their individual lifestyle choices. Government would create public policy, based on the weight of evidence, designed to promote the general welfare. These two would be the chief sources of public health information. Industry’s role would be to create health-related goods and services based on this evidence, since those things that work best tend to sell best. Businesses would compete to innovate and market new products and services that would better serve public health, based on the evidence. And professional and fundraising organizations would base their philanthropy and marketing on promoting and leveraging the weight of evidence to serve their communities. The result would be improved health outcomes, which would then lead to the next set of significant questions by showing where health research still needs to be done, in a continuous and never-ending quest for the best health possible.

FIGURE 13-1. An ideal hypothetical health-care system

It would be nice if our world actually resembled this diagram. But unfortunately, this idealized picture of a society whose goal is better health for its members is a very far cry from the way our system really functions.

OUR ACTUAL HEALTH-CARE SYSTEM

Let’s take a look at reality—at the way the nutrient “information” actually moves through the health-care system, as in Figure 13-2. It’s not in service of producing greater health outcomes, but instead in service of profit.

When the goal of the information cycle becomes profit rather than health, everything about it becomes distorted. Science, the producer of information from the raw materials of curiosity and funding, creates a monoculture of reductionist research that serves profit, not health. The output of this research, a narrow range of evidence that precludes wholistic, simple, and powerful solutions, is then turned into myriad temporary and partial solutions that ultimately make things worse. Just as a diet of processed, nutritionally barren food cannot be metabolized for healthy functioning, a diet of processed, wisdom-barren information cannot be metabolized into wise, compassionate, or effective social policy.

FIGURE 13-2. Our actual health-care system

Here’s how the profit-distorted information cycle works. At the very top, the questions that are asked have more to do with the potential for profit than breakthroughs in human health. Why bother to think about something when you won’t get the funding to pursue your research? Why build a career on questions that no one will pay for you to investigate? So already the system is excluding questions about how to get more people to eat healthy food, in favor of questions about how to make pills and potions that can be patented and sold at high margins.

These questions comprise what we currently call “science.” All the labs and apparatus and test tubes and white coats are just a means to an end: answers to the questions science is called upon to answer. In contrast to a healthy information cycle, however, science in this case does not investigate the questions with the full range of study methodology available to it. Rather, it limits itself to highly reductionist experimental research designs, which are deemed the only appropriate means of gathering evidence. Not so coincidentally, those are the ones most suited to drug testing, and least suited to complex biology and behavior change. Of course, this systemic limitation produces a very narrow range of evidence, which is then reported and marketed as “the truth,” as opposed to what it really is: a very narrow sliver of experience reflecting an even narrower set of questions posed by people with a hidden agenda. This evidence has two main audiences: the media (owned by industry and/or funded by industry advertising) and those in government and private think tanks who determine the public health implications of the evidence and recommend policy to make use of it. But the way these two audiences receive and use this evidence is heavily mediated by industry.

Industry uses that narrow range of evidence—or at least what of that evidence the public seems to be responding to—to create new products (including goods and services) and to lobby the government to declare those products “the standard of care.” Procedures and pills so labeled are all but forced upon doctors and hospitals, who fear lawsuits should they deviate from these treatments. Industry feeds press releases to a largely uncritical media emphasizing only the evidence that supports use of their products. And industry further distorts the evidence by spinning it to the public in the form of advertising, where the occasional benefits are hyped and the considerable side effects are shown in small print or quickly mumbled.

The evidence ends up filtered and distorted, and presented as broader and more meaningful than it is. Any information that contradicts expected narratives is downplayed or doubted. Intentionally or not, this makes it easier for industry to sell more things to us, be they drugs, procedures, nutraceuticals, supplements, expensive running shoe inserts, or diets in a bottle. The health advice we hear are all messages like, “You need dairy to get enough calcium so you don’t get osteoporosis,” and “If you have high cholesterol, you need to take statin drugs.”

With this information, advocacy groups—professional interest groups and fundraising organizations—galvanize public support and collect and contribute money to the activities of science. Because of the limitations of the science they rely on, their donations go to those who seek magic-bullet cures for their diseases of interest. Advocacy groups also influence public policy through PR and lobbying; what politician wants to be branded a “friend of cancer” by not going along with the wishes of the American Cancer Society?

What all this means is that, in the current system, we don’t have free choices; we have constrained choices. We’re just deciding between equally ineffective magic bullet “cures” that don’t work. We buy what is sold to us, enlist in the never-ending crusades against bad diseases, follow mainstream health advice (because to ignore it seems foolish and risky), and donate time, money, and energy to our favorite anti-disease society. All this in the name of achieving better health for ourselves and others, when all it produces is an endless cycle of ever greater confusion, disease, and untimely death while stuffing the wallets of those who control and manage this system. And when you look closely, you’ll see that we the consumers, by unquestioningly buying the products created by a profit-obsessed industry, are funding the whole mess. That’s why one of the most important things any of us can do is improve our own diet and health; we can “vote with our dollars” against this system by opting out. The less we buy, the less money industry can deploy to distort scientific research and government policy.

I need to emphasize that these negative outcomes are not the goal of the current system. They’re simply an unavoidable side effect of the primary goal: ever-increasing profits for the several industries whose activities constitute and maintain the system. As I said, this isn’t a story of nefarious individuals’ intentions; to the contrary, most of the people contributing to the current mess truly believe they’re doing good. They’re waging the war on cancer. They’re uncovering secrets of our genes. They’re putting what are presumably much-needed nutrients in pills and foods. They’re producing breakthroughs in surgical techniques. They’re lowering the cost of calories for the poor. They’re producing animal protein more efficiently. They’re reporting new findings to a public hungry for advice about how to be thinner and healthier. And yet these wonderful intentions end up in the service of more profit and more disease.

I also want to be clear that I’m not arguing against capitalism, free markets, or profits. It’s natural for all the elements in a system to do what they can to survive and thrive. In fact, that collective motivation is the basis for the stability and resilience of the entire system. Forests can last for eons (until people cut them down) not because all the organisms in the forest are unselfish and “nice” to each other, but because each is taking care of its own business in a way that contributes to the welfare of the other elements. But the goal of the system called “forest” is to achieve maximum biomass and biodiversity, so it rewards players who contribute to that end. Trees that drop their leaves are rewarded by the richness of decomposer life that turns those leaves into nutrients, which eventually make their way back into the trees. Birds that excrete nitrogen back into the soil are rewarded by a bumper crop of worms that live in the carpet of fallen leaves that grow from the birds’ nitrogen. And so on. The problem in the case of our health-care system is not the selfish behavior of the individual elements; instead, it’s which selfish behaviors are rewarded, and which are punished, by a system whose goal is profit rather than health. This problem is not inherent to the free market, but rather the result of a market manipulated by its most powerful participants, often through collusion with a government far removed from the people it is supposed to serve.

Systems naturally reinforce themselves; if they didn’t, they wouldn’t continue. Here, the operation of our health-care system generates powerful forces that reinforce the profit motive over the health motive. It generates equally powerful forces that keep the current system in place, allowing it to withstand all manner of scientific evidence that things could be done smarter, cheaper, and better. But systems do collapse when their resources can’t sustain their goals on an ongoing basis. Such is the case when the high costs of our disease-care system, both economic and health related, threaten to bring down our entire society.

In a system that seeks the public welfare over profits for a few, companies and individuals could still make plenty of money, just as oaks and hickories can still get mighty big in the forest. They would just do it in a fashion that can be sustained indefinitely, because the other elements of the system would flourish, too.

THE REDUCTIONIST PROFIT CONNECTION

Before we explain how the pursuit of profit affects the health-care system, it’s important to discuss the why. Why are reductionist science, medicine, and food so much more profitable than their wholistic counterparts? After all, isn’t good health better for an economy than bad health? Healthy people make more productive workers and more avid consumers of the good things in life. And shouldn’t we be measuring our economy by how well it contributes to everyone’s well-being?

Reductionism goes hand in hand maximizing corporate profits because reductionism causes new problems as it solves existing ones. Each of those new problems, while costly for society as a whole, represents a further profit opportunity for some industry.

It’s also easier to market reductionist solutions than wholistic ones. Picture a continuum of potential solutions to any problem, with “magic” solutions on one side and “realistic” solutions on the other (as shown in Figure 13-3).

FIGURE 13-3. Magic versus realistic solutions to health issues

The magic solution, which is described as instant, easy, and foolproof, is much more appealing than a realistic solution that takes time, requires effort, and is complex to get right. You’ll notice that most consumer advertising tends to favor the magic over the realistic. From weight loss solutions and financial services, to cleaning supplies and beauty products, the closer the product is to magic, the easier it is to sell and the more appealing it is to buy. This can produce a profit windfall for the person owning the intellectual property on which the magic solution is based, and indeed, these simple reductionist solutions can be patented, and thus owned, where others cannot.

Reductionist solutions, because they are formulated to address only a limited spectrum of a problem, are much more easily described as magical than as wholistic solutions. Worried about getting a heart attack? Well, all you need to do is take a couple of omega-3 capsules a day. It takes just a few seconds, and it’s as easy as, well, popping a pill. Got diabetes? Hey, here’s an insulin injector pen with a digital timer on the cap so you never have to think about doses and timing—or improving your diet. Overweight? Drink an appetite-suppressant shake, or just get your stomach stapled so you literally can’t overeat or tolerate rich foods any more.

Magic solutions work by addressing symptoms rather than causes. Symptoms can be suppressed and managed quickly, while causes take greater effort, which often means more time to deal with. Temporarily addressing an isolated symptom is fairly simple. Causes are more complex, and require greater involvement by and responsibility from the person with the problem.

Now consider the wholistic solution to cardiovascular disease, diabetes, and extra weight: eat a WFPB diet. It works by eliminating the underlying cause, our bodies’ attempts to deal with a diet high in processed foods and animal products. And while the effect of WFPB may be as quick as or quicker than a pill, a shot, or surgery, it requires continual upkeep; the reductionist interventions take far less effort to implement. Changing one’s lifestyle can be challenging. It requires commitment and responsibility from the person making the change, and a willingness to be open to having new experiences and developing new habits and skills.

Our sound bite world, our hurry-up lifestyles, and our advertising-based economy all make the reductionist quick-fix a much easier sale than the long-haul, comprehensive, wholistic solution. That reductionist solutions create the need for additional products and services (drugs and other treatments to manage the side effects of the initial solution and to suppress other symptoms of the Standard American Diet, plus emergency surgeries when the initial solution fails) is an added benefit for industrial profiteers. And all that profit means the industries that make it have a lot of extra money to throw around to ensure they can make more of it in the future. In short, they have power.

SUBTLE POWER

When we think of people who abuse power, our minds go to Hollywood villains whose nefarious deeds keep entire populations cowed and craven: the banker Henry F. Potter in It’s a Wonderful Life, Darth Vader in Star Wars, Nurse Ratched in One Flew Over the Cuckoo’s Nest, among many others. These and other archetypal villains use violence, threats of violence, and cunning to create environments in which they benefit from power and grow it to near omnipotence. When someone uses these kinds of overt strategies, you notice. Money can be used this way, too, when you bribe a public official to look the other way as you break the law, or pay some thugs to frighten your opponents into silent submission. But there’s another kind of power that’s a lot less noticeable, which I call subtle power: power that operates so softly and effectively that its force and source are practically invisible.

By way of example, let’s look at why millions of American school children drink milk, rather than water, with their school lunches, something that nets the dairy industry two huge benefits: huge financial return and early education of young people about the alleged health value of consuming milk. Obviously, the dairy industry does not post armed sentries in each school to force the administration to purchase the milk, the food service workers to serve it, and the students to drink it. They don’t have to; the subtle influence they exert brings about even greater compliance than a heavy-handed use of power.

First, the dairy industry has spent a lot of money over the past sixty years lobbying the government to promote dairy as one of the cornerstones of good nutrition. When the current school administrators were children, they were indoctrinated in school that dairy was one of the “four basic food groups.” The money the dairy industry spends to buy political influence extends to financial support for governmental agricultural policies that drastically subsidize milk production. For schools to offer the school lunch program with its subsidized foods, they must offer milk as an option. Federal authorities don’t require children to actually drink the milk, but they don’t need to. Local school authorities do the job. They’ve been well coached to believe that milk is needed for strong bones and teeth. The dairy lobby has also succeeded in compelling the federal government to buy billions of gallons of milk for use in other federal programs, including prisons, VA hospitals, and the military. Talk about your captive audiences!

In addition to the subtle muscle applied to our political apparatus, the dairy industry spends millions of dollars each year advertising the so-called health benefits of milk to consumers. The drumbeat has been going on for so long that we scarcely are aware that it’s paid, commercially-motivated advertising, not a public service announcement. Most of us just accept that milk is good for us. And the highly successful “Got Milk?” campaign used popular role models to convince our young people that milk makes you thin, rich, healthy, and sexy.

Dairy interests contribute generous sums of money to many health-related nonprofits as well, thereby influencing their highly effective public pronouncements about the benefits of dairy. These nonprofits have to scramble for funding, so there’s pressure not to upset large repeat donors. They also pay for academic activity that passes for “research,” producing studies that start by assuming milk’s benefits and then find increasingly creative and dishonest ways to “prove” those benefits. The mainstream media, to the extent that they are funded by “Got Milk?” and other dairy industry ads, conveniently ignores, underreports, and casts doubt upon the myriad studies that show that milk and other dairy products emphatically don’t “do a body good.” As newspapers and TV news struggle to stay afloat in the age of digital media, they also are susceptible to the dairy industry’s subtle pressure to favor its side of the story.

So those school administrators have every reason to buy lots of milk. It’s inexpensive (thanks to those government subsidies) and it’s easy to procure with minimal paperwork (because the federal government has made milk the default beverage). Thanks to health education and advertising, students expect it, parents demand it, and it sells; milk brings in profits that pay salaries, whereas water from the water fountain is free. Just in case students haven’t been brainwashed into viewing milk as a health food by thousands of images of celebrities with milk mustaches, the dairy industry “fortifies” school milk with sweeteners and appetizing chocolate and strawberry flavors to encourage children to drink up.

Similar subtle power operates everywhere: when people buy low-fat milk (because less fat is always healthier), reject the breakfast bagel in favor of two eggs and four slices of bacon (because carbs are bad for you), and choose their breakfast cereal based on its fortification with eleven vitamins and minerals (because it’s the best way to get the nutrients you need). These choices feel self-generated, but in fact are heavily influenced by millions of dollars of spending by the dairy, egg, pig, and processed foods industries, respectively.

This confluence of power, by the way, is also responsible for the phenomenon of vegetarians constantly having to answer the question, “Where do you get your protein?”—as if protein were something that exists in animal products alone. It’s also what gets us to agree to invasive medical procedures that earn the medical industry more money rather than improve our diets. Whenever you see large masses of people making what look like “free choices” against their best interests, you can bet that subtle power is at work in the background.

As you can see, money itself is a lever of subtle power. In a health-care system like ours, where profit is the ultimate goal, money is the most powerful force available, allowing those who have it to influence, almost invisibly, government policy, the media, popular culture, and the conversations that take place in the privacy of our own homes and minds.

Scientists are more likely to receive research funding and lucrative corporate contracts for research that can produce the next pill, supplement, superfood, or hospital treatment, so that research is more likely to get done. Media outlets are punished with the withdrawal of advertising for reporting unfavorably on advertisers’ products, making them less likely to do so; journalists know their salaries depend on that revenue. Politicians who pass legislation and write statutes favorable to certain kinds of commerce are rewarded with campaign donations from industry groups who benefit from these laws and statutes. Nowhere in this process can you see violence or even green-stained fingerprints. No one called up those scientists, journalists, and politicians and threatened them; no one blackmailed them or offered them a bribe to do something they didn’t want to. But behavior that supports the current paradigm is rewarded, and behavior that does not is disincentivized. These carrots and sticks are mostly silent, seldom pointed to, and never discussed.

This is how a system like ours—in which the goal of ever-increasing profits for the few is pursued at the expense of our health—can continue, even though that goal is not shared by the vast majority of people within it. Thanks to the rewards and punishments subtle power uses, people behave in ways they otherwise would not—ways that maintain the current system. The more industry profits increase, the more money is available to reward even more of the desired behavior. In other words, the money that is spent on subtle power achieves a return on investment that makes even more money available for the next round of subtle power. What we have is a vicious cycle that concentrates power more and more exclusively in the hands of those who already wield it.

If power corrupts and absolute power corrupts absolutely, then we should expect to see a lot of “legal” corruption in our health-care system. In the next chapter, we’ll pull back the curtain on some of that corruption and see how it keeps us from moving toward true and lasting health.

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