14

Industry Exploitation and Control

I hope we shall crush in its birth the aristocracy of our monied corporations which dare already to challenge our government to a trial of strength, and to bid defiance to the laws of their country.

—THOMAS JEFFERSON

The wealthy and powerful industries that make up our health system have replaced its original goal—human health—with the pursuit of ever-increasing profits. Their money distorts research agendas, media reports on health issues, and government policies. And thanks to their skillful wielding of subtle power, they do so without leaving obvious evidence. My goal in this chapter is to make their fingerprints as visible as possible, especially when it comes to one of the main victims of industry control over how information is produced, distributed, and used: wholistic nutrition.

The medical, pharmaceutical, and supplement industries figured out long ago that a nation of healthy eaters would be disastrous to their profits. They make much more money ignoring and discrediting the evidence for WFPB than by embracing it. So let’s take a look at these three industries and how they maximize profits at the expense of human health.

THE MEDICAL INDUSTRY

The purpose of the medical establishment is to treat illness. Doctors go through many years of training to learn the best ways science knows to treat diseases. When we visit them as patients, we hope they will show us the best road to wellness. We trust them to know things we do not, and to hold only our best interests at heart. And so, when we are confronted with a life-threatening diagnosis, most of us take our doctor’s recommendations for things like aggressive surgery, radiation, and chemotherapy, even if we sometimes wonder if another path is possible.

The medical establishment has all but cornered the market on legitimacy. And in my experience and to my knowledge, the vast majority of doctors are accomplished professionals who sincerely seek the best for their patients and pursue that goal as best they can, based on their medical training and ongoing education. But as we’ve seen, that training is limited by the reductionist way we do science. And like any group that “knows best,” doctors can be blind to other options that might be more viable than their own skills and tools. Some of them, out of twin desires to cure and to remain blameless, use their power advantage to bully and silence skeptics who might want to explore wholistic methods of healing. As a result, even the bravest and most open-minded patients usually feel that drugs and surgery are their best bet.

Cancer and heart disease tend to reduce us to powerlessness in our relationship with the medical establishment. And too many doctors exploit the power difference to scare their patients into unblinking compliance while simultaneously and sincerely believing that they are serving their best interests. It’s been said more than once that doctors are the clergy for a secular age, holding the keys to life and death in their hands and brooking no heresy. Like traditional clergy, they use symbolism and ritual to represent and reinforce their power (think of the waiting room, the receptionist behind the glass divider, the endless paperwork you fill out while you glance at the aging magazines). Far from maddening us, these and other rituals serve to comfort vulnerable patients who deeply desire to trust their doctors’ opinions. At such moments the doctor–patient relationship is imbalanced, however unintentional this may be: one side desperate to save their life, the other perceived as capable of doing so. When the diagnosis is cancer, a doctor’s unintended exploitation of this emotional vulnerability can lead to poignant, even tragic results. And not coincidentally, the treatment pathways they insist upon are those that deliver the greatest profits to the medical industry and its partner, the pharmaceutical industry.

When people find out that I have spent my career searching for ways to prevent and possibly cure cancer, they naturally ask my opinion about particular diagnoses: family members, friends, even themselves. Of course, I emphasize that I’m not a licensed physician and can’t offer specific advice; their doctor has years of specialized education and training that I do not. But when faced with a diagnosis of cancer, many people persist. They ask, “What would you do if you or a family member were to receive a diagnosis of ‘the Big C’?” At best, I can only share my interpretation of the scientific evidence, often advising them to get a second opinion while simultaneously trying to help them respect the advice of their personal physician. In 2005, my very best friend, after scratching a mole on her thigh and leaving a small scab, decided to have it checked and removed if necessary, because cancer was not infrequent in her family.

When test results were completed in a few days, her doctor phoned her to come for a visit. Being somewhat apprehensive, she asked me to join her. When the doctor entered the examining room, his demeanor was serious. The diagnosis? Stage III advanced melanoma, the most serious kind of skin cancer. He advised quick attention and referred her to a team of a surgeon and oncologist. Devastated, she experienced the usual emotions that every cancer patient knows so well: an all-encompassing fear and dizzying disorientation.

After getting two second opinions on the tissue specimens to confirm the diagnosis, she then scheduled her surgery. The cancerous tissue was removed from her thigh, along with a biopsied sample of the sentinel node of a nearby lymph gland to see if it had metastasized. The sentinel node is the part of a lymph gland to which cancer is most likely to spread first; if the sentinel node shows evidence of cancer, it is generally assumed that cancer has spread into the larger lymph gland “basin.” Think of the sentinel node as the doorway to a room—in this case, the larger lymph gland basin. If melanoma cancer cells migrated to the sentinel gland, it is assumed they are also in the lymph gland basin, thus requiring its removal—a tactic akin to destroying a village in order to save it.

At about this same time, my friend met with her newly assigned oncologist to talk about her treatment options, depending on whether her new tests indicated lymph gland involvement. I did not accompany her on this visit, as she brought along her adult sons, but she told me afterword that the doctor told her of the treatment options patients generally consider, including chemo and radiation. She informed him that she did not want to undergo any of these treatments regardless what the biopsy results might indicate, and he seemed okay with this. She was to return in another few days after learning the biopsy results of the sentinel lymph gland. It was about this time that she learned that the results were positive: the sentinel node showed that the cancer had spread to the lymphatic system. Three pathologists confirmed the diagnosis.

Before we returned to the oncologist, I decided to inform myself more deeply about melanoma and its treatment. Among other things, this included a visit to a very open-minded and welcoming pathologist to see for myself the histologically diagnosed tissue (I had received training in histology and had done quite a lot of microscopic work in my laboratory research group).

I already had some familiarity with melanoma. About twelve years before, I had used a summary report of melanoma cases published in 1995¹ as recommended reading for my Cornell class on plant-based nutrition, because the summary showed a remarkable dietary effect on the rate of survival. This paper was significant not only because it was a relatively rare peer-reviewed report of a favorable effect of diet on a serious cancer, but also because the lead author had been a member of a distinguished science panel recommending how research results from alternative clinical databases should be interpreted and published. The report provided detailed evidence that a plant-based diet had considerable potential to inhibit the progression of melanoma, but it also mentioned a similar effect on other cancers. The patient cases in this study were provided with a diet of mostly whole, plant-based foods prescribed by the famous (or, if you prefer, infamous²) Gerson Institute in Tijuana, Mexico. Survival was remarkably increased, even for cancers initially diagnosed as stage III and IV.

I also familiarized myself with the not very pretty consequences of lymph gland removal. The literature suggested that removing a major lymph gland in the groin often resulted in loss of use of the leg for about a year or so, with lots of side effects and discomfort, to say nothing of the serious compromise of the body’s immune system. Indeed, the woman’s doctor had told her that she should plan on being “out of commission” for a year.

I also learned that, to compensate for the lost immune system activity when lymph glands are removed, doctors often prescribe interferon, a powerful immunotherapy medication. I therefore sought and found a very recent review on interferon and related treatments for melanoma stage II and III patients.³ It concluded that “at present there is no single therapy [including interferon] that prolongs overall survival in stage II and III melanoma.” Research on this topic is exceptionally complex, involving different interferon types, drug dosages and protocols, and stages of melanoma, as well as lots of discussion of response details. Let’s put it this way: it’s definitely not bedtime reading. I don’t see how someone without adequate background and experience—which includes most melanoma patients—could make sense of the research, let alone use it to advocate with an oncologist for a different treatment.

Probably one of the most interesting observations that came to our attention was found by my friend’s oldest son, who is neither a doctor nor a medical researcher. He located a peer-reviewed publication by a group of researchers in London who summarized the case histories of 146 melanoma patients. In case you think any of the science in this book is a bit advanced, here’s the title of that peer-reviewed article: “The Microanatomic Location of Metastatic Melanoma in Sentinel Lymph Nodes Predicts Nonsentinel Lymph Node Involvement.”⁴ Quite a mouthful!

Here’s what the article reported: All 146 patients in the study, as with my friend, showed metastasis to the sentinel lymph node, a finding that is conventionally used to justify surgical removal of the neighboring lymph gland basin. Because all 146 patients in this study had melanoma cells in their sentinel nodes, their full lymph gland basins were surgically removed. But retrospective reexamination of their lymph gland specimens showed that only 20 percent actually had melanoma cells in the larger basin,⁵ suggesting that 80 percent of these patients did not have to suffer removal of their lymph glands. For 38 individuals in that 80 percent, metastasis was limited to only a single region of the sentinel node, the subcapsular region.

These study results were startling. I called the study’s lead researcher, Dr. Martin Cook, in London, and he emphatically affirmed the article’s report. You can imagine how excited we were about this powerful and esoteric finding, as my friend’s biopsy also showed that her metastasis also was limited to the subcapsular region. I gave copies of this publication to my friend’s surgeon and pathologist, neither of whom knew of this information, while saving a copy for the upcoming visit with the oncologist.

With this information in hand and having examined the tissue specimens myself, I accompanied my friend on her return visit to the oncologist when he expected her to tell him which treatment option she preferred and when she could start treatment—even though she had previously said she did not want to undergo the recommended treatments. Her decision was, of course, hers to make, although I also believed that treatment was ill-advised in her case. Removing the lymph gland made no sense and would only lead to serious side effects. In clinical trials, interferon had been shown to be ineffective and laden with side effects. Furthermore, the presence of melanoma cells only in the subcapsular region of her sentinel node indicated a good prognosis, especially if she adhered to a WFPB diet.

My friend’s oncologist did not know about my professional background in cancer research and, as far as I know, also did not know about my visit with the pathologist about Dr. Cook’s study. He simply knew that I was there to support his patient, and I tried just to listen. As far as the oncologist was concerned, the facts were simple. It was “advanced” melanoma, as confirmed by the diagnosis, and it had already metastasized to the sentinel node of the lymph gland. Therefore, the remaining lymph gland needed to be removed and treatment with interferon or its equivalent needed to begin. All of this was urgently needed, in his opinion, and his personal demeanor left no doubt what he expected her to say.

Following this recitation of the “cold, hard facts,” the doctor popped the question: “When will you be able to begin?”

My friend repeated what she had earlier said to him. “I am not going to do any of your suggested treatments.”

Visibly shocked and annoyed, the oncologist now knew that his polite demeanor during the first visit was not working. He blurted out, “If you don’t do this now, it’s going to be too late when you come back!” He clearly expected “too late” to come sooner rather than later.

This kind of pressure from a medically informed superior given to an emotionally vulnerable and uninformed patient concerned for her survival is not a level playing field. It undoubtedly leads to acceptance of the physician’s recommendation. Cancer patients intensely want to believe in their oncologist, whom they see as holding the key to their recovery.

Because of this reaction, I offered to share with him some of the literature that I had with me. Brusquely and rudely, he dismissed with a wave of his hand what he clearly considered to be nonsense. He had no interest in hearing anything but his own voice.

I can only imagine how many events like this occur in oncology offices across the country. Given the incidence of cancer in the United States, I’m guessing there are around 2,000 to 3,000 such events per day.⁶ In most of these visits, the patient and their friends and family are neither capable of nor interested in questioning their doctors’ opinions. I myself was taken aback by his certainty. I could not help but wonder: did I miss something? His behavior, laden with conviction and professional ignorance but also personal arrogance, was revealing—at least for me. He clearly had no interest in evidence suggesting anything other than “standard care” that favored traditional chemo treatments.

I have been told very similar experiences by dozens if not hundreds of cancer patients who are seeking information on nutrition and cancer, cases in which the research supports a nutritional approach, yet for which doctors insist on invasive, dangerous, and expensive treatments with poor success rates. However, I got much more involved in this case because the patient was my wife, Karen. And I know this melanoma case is a sample size of one and I did not professionally document it. It’s anecdotal, period. But Karen opted to do nothing aside from continuing to eat only plant-based foods, has had no side effects, and eight years later is still in excellent health, now enjoying with me our fiftieth year of marriage. In fact, I feel that Karen’s diet not only helped her after her cancer diagnosis, but in the years preceding it. The mole on her legs had been there for many years, and probably should have been checked out earlier. It is highly likely that this mole was cancerous prior to our family’s conversion to a plant-based diet and that its progress was slowed or suspended, or perhaps even reversed, after this point. The results of the biopsy may even have showed the cancer retreating rather than spreading.

Looking back, this incident is representative of many similar stories that motivated me to write this book. Since I can’t accompany every patient to high-stakes meetings with medical professionals, I wanted to do something to level the playing field—to give vulnerable women and men a voice, and to allow them to believe they have a choice when it comes to aggressive and expensive medical treatments for serious conditions.

On one level, the interaction between Karen and her doctor is simply a story of an arrogant professional pressuring a vulnerable patient to do what he believes to be in her best interest. He knows what standard care is. She doesn’t. Period. However, when we take a step back and look at the fact that there are a few thousand of these interactions each day, we see the mark of a medical industry whose profits depend on doctors’ unquestioning belief and persuasiveness—if not their arrogance. Let’s take a minute and follow the money in this story. Where does it flow when the surgical/chemical approach is chosen over the nutritional approach, and who benefits?

First and most obvious, the more often chemotherapy and surgery and pharmaceuticals are prescribed to patients, the more money the entire industry takes in. Even if we were to assume that a chemical approach is equally as effective as a nutritional approach (though there is no proof of this), the medical industry benefits more from training and encouraging its members to choose the chemical solution. There’s a lot of money to be made in cancer treatment. That’s why drug and medical equipment companies dominate the advertising in medical journals. (That advertising explains why medical journals are loath to print results that call those industries’ practices and effectiveness into question, but we’ll look at trade journals more in chapter fifteen.)

Second, by passing referrals back and forth, the medical “old boys’ club” keeps its members rich and busy. Karen saw three different doctors during her diagnosis, and each new doctor meant a new co-pay for her and high costs for her insurance agency. It’s necessary to see so many doctors when going the chemical route, because each doctor is a specialist who focuses on a specific reductionist element of cancer. But the reason for their specialization has more to do with our misguided approach to disease than the best way of treating patients. It would only take one doctor to prescribe a WFPB diet and monitor the results—were this strategy ever used.

Also, the other doctors Karen was referred to were also very likely to back up her first doctor’s point of view. They shared a paradigm, thanks to standardized educational training that does not include wholistic nutrition, and likely even shared a social circle. You can bet Karen’s oncologists weren’t playing golf with nutritionists who advocate WFPB diets!

I know that many people believe that the kind of behavior I’ve described here is symptomatic of the entire medical profession, but I would counter that. I have met many brilliant doctors who are sincerely devoted to their patients. It is not doctors who are responsible for this environment of coercion and hostility to suggestions of alternatives; it is the system in which they are trained and expected to practice. The structure of the medical industry makes it very difficult for decent and caring doctors to act contrary to the industry’s selfish, profit-seeking, defensive attitude. Those who buck the system face not just ideological pressure, but ideological pressure backed up by the subtle power of money. In some cases, even their license to practice may be challenged.

THE PHARMACEUTICAL INDUSTRY

Our society embraces the sentimental notion promoted by Big Pharma that the pharmaceutical industry is a selfless group of scientists, motivated only by an intellectual hunger and desire to serve humankind, toiling away to discover the cure for cancer or diabetes or heart disease. That perception exists largely because Big Pharma is so skilled at pretending to be good while manipulating the public’s emotions. There are plenty of sincerely good people in Big Pharma, but the economic imperatives of the system override their efforts to do good.

Big Pharma is an industry, and its constituent members are businesses. Most of them are publicly traded or, in the case of the newer gene-therapy companies, privately funded by investors looking to get massive returns as quickly as possible. Their only fiduciary responsibility to their shareholders is to turn a profit.

Okay, so, big deal. Every company is trying to turn a profit, right? If Big Pharma makes money by selling drugs that help people live longer and with less pain, why shouldn’t they? We should celebrate their profitability, because this money returns to the system to fund the research and development (R&D) that creates new drugs and refines and improves old ones. That’s just Business 101, simple enough even for a professor of nutritional biochemistry to understand. Unfortunately, Big Pharma is exempt from Business 101, because of the ingenious and insidious way they get their customers (us) to generously (and unwittingly) pay most of their research bill well before we pay for our prescriptions.

Do you pay taxes? If so, you’re contributing to the research budget of the government’s lead health research agency, the NIH, whose research priorities are heavily slanted to benefit Big Pharma. Have you ever made a donation to a private research funding agency, such as the American Heart Association, the ACS, or the American Diabetes Association? If so, you’re directly funding research that frequently creates ineffective and often harmful drugs that are sold to the American people at a huge profit. And those profits go not to us, the real investors, but to the pharmaceutical companies that patent, manufacture, and market these products. We are paying twice for stuff that often does not work at best and at worst is killing us.

Big Pharma is not satisfied with this cozy arrangement, however. In a never-ending effort to increase their profits, they seek government protection from the free market even as they exploit it for all it’s worth. Talk about having your cake and eating it too! Here’s how it works (with a nod to Professor Donald Light of the University of Medicine and Dentistry of New Jersey and Professor Rebecca Warburton of the University of Victoria, Canada, whose recent work reveals some little-known and damning facts about Big Pharma’s Big Claims about its Big Expenses).⁷

In an online review of their various published findings, Light and Warburton concluded the following: Big Pharma justifies its expenses and gargantuan profits by claiming very high R&D costs to bring a new drug to the market. The most commonly cited figure is a staggering $1.32 billion per drug. That’s a lot of money when, according to independent review groups, 85 percent of new drugs are useless or no better than the drugs already available. But this $1.32 billion price tag turns out to be highly inflated by the drug companies. Light and Warburton say this is “to justify higher prices [in the marketplace and receive] more government protection from free-market competition and greater tax breaks.” An inflated estimate of costs helps them cry poverty and dupe the government into passing anticompetitive legislation and relieving them of their tax burden. After all, a financially strapped pharmaceutical industry would be a national disaster and a tragedy—imagine if the cancer breakthrough that’s just around the next corner never materialized because some drug company had to cut back on R&D.

After carefully evaluating and professionally publishing their findings, Light and Warburton say that “no one should trust any estimate” of drug development costs by Big Pharma. They found that these costs are far lower per typical drug, averaging only around $98 million for development (ranging from a low of $21 million to a high of $333 million) plus an uncertain amount for research. Research costs are almost impossible to estimate because it’s impossible to know what scientific research should be counted as leading to which drug product. And most basic research is done at government expense with “84% of the world’s funds for research [coming] from public or foundation sources,” according to a National Academy of Sciences and other official reports.

When independent and reliable sources of cost estimates are considered, Big Pharma is scamming the system—by a Big Bunch. First, they came up with this $1.32 billion figure by using only the costs of 22 percent of the most expensive drugs (new chemical entities that are developed in-house) and implying that this was an average for all drugs. Second, the costs they claim on randomized clinical trials appear excessive, with twice as many subjects per trial as the averages reported by the FDA and costs per subject that are six times higher than NIH figures; overall, Big Pharma’s trial costs are more than twelve times higher than independently reported averages. Third, their reported lengths of both trials and time it takes the FDA to review new drug applications for approval are significantly longer than those reported by the FDA.

The story gets worse! Big Pharma also inflates the interest rate they use to determine the cost of capital and ignores substantial tax savings related to R&D and their foreign tax havens. Those lost taxes, according to Light and Warburton, “might pay for nearly all pharmaceutical R&D costs.”⁸

In all, the total costs industry pays for the development of a new drug (including the amount they receive from government grants) approach only $70 million—not the $1.32 billion they claim. And the extra $0.02 billion added to the $1.30 billion is silly. All that tells us is Big Pharma is using the marketing trick of false specificity to get the public to believe they have performed a mathematically accurate estimate.

Big Pharma has been telling this kind of Big Lie for decades. When President Lyndon Johnson spoke to a group of Big Pharma executives in 1969, he bluntly told them that they knew well that NIH was doing their research and, further, that the public was footing the bill.

They reinvest these profits strategically, buying air time to keep broadcasting the Big Lie. The United States is one of only two countries on earth (New Zealand is the other) where drug companies are allowed to advertise directly to the consumer instead of just to physicians.⁹ Under the sway of advertisers, more and more of us are “asking our doctor about Viagra” and thousands of other brand-name drugs.

Big Pharma hasn’t forgotten to “educate” our physicians as well. According to a 2008 report, Big Pharma spends, as of 2004, an average of $61,000 per year, per each and every physician in the country, to promote its products. It also organizes a massive number of promotional meetings for doctors, wining and dining them and giving away vacations and computers and other wonderful perks. In 2004, the last year for which I could find data, there were 371,000 such meetings in the United States, or more than 1,000 meetings each day of the year. That works out to an average of twenty physician-fests a day in every state of the Union.¹⁰

In a nutshell, Big Pharma gets Big Subsidies from the taxpayer to fund their research and they pay far less in taxes than they owe. They also vigorously seek—through inflated R&D costs—tax breaks from unsuspecting taxpayers, and they are permitted to advertise directly to the consumer without effective control of what they say. Unsurprisingly, this lax attitude leads to a recent estimate that “of the 192 advertisements for 82 unique products [that were surveyed], only 15 fully adhered to all 20 FDA Prescription Drug Advertising Guidelines. In addition, 57.8% . . . did not quantify serious risks and 48.2% lacked verifiable references.”¹¹ Not only that, Big Pharma spends far more on this advertising than on R&D. In a 2008 report, they had, during the previous year, spent twice as much on promotion than on R&D.¹² Talk about misplaced priorities! Big Pharma’s “selfless” agenda is simple: sell, sell, sell, sell, and in their spare time, lobby the government for tax breaks and more subsidies.

The annual revenue for Big Pharma, $289 billion in 2010,¹³ exceeds the total national budgets of at least 80 percent of the countries in the world.¹⁴ Arguably, this might be acceptable if the outcome—or even the goal—were increased health. But as we’ve seen, this is emphatically not the case.

As bad as all of this is, Big Pharma has more up its sleeve. A significant problem with the pharmaceutical business model is that healthy people tend not to take drugs. Vitamins and minerals and herbs, yes. Pharmaceutical drugs, no. Big Pharma’s next step is therefore the development of preventive drugs that can be given out like candy to everyone at risk for common killers like heart disease, stroke, cancer, and diabetes—which, in our nutritionally ignorant country, is just about everyone.

One such troubling attempt at “prevention” is the proposal to develop a “polypill” to reduce the risk of cardiovascular disease (CVD).¹⁵ This polypill might include a few seemingly effective drugs like “3 blood pressure lowering drugs from different classes each at half doses, aspirin, a statin and folic acid.”¹⁶ The stated rationale for this pill is the need “[to reduce] the burden of cardiovascular diseases [by] strategies that are applied to entire or large segments of the population.”¹⁷ What a boondoggle for the pharmaceutical companies!

The pill would hypothetically benefit and therefore be recommended for “all individuals with an established CVD and all those over 55 years without CVD”¹⁸—an impressive number of people. This estimate is based on considerable speculation and, it appears, was obtained by adding up the effect of multiple individual interventions for sustained periods of time. However, the combined effects of two or more agents are almost never additive. And the side effects of combined drug therapy are almost impossible to know beforehand. Making the matter even more troubling is the credence given to this idea by prestigious national and international health agencies.¹⁹

In their defense of the proposed polypill, the pharmaceutical lobby states that “primary prevention should include multiple strategies: health policy and environmental changes, individual behavioral changes, and use of proven and safe drugs.”²⁰ They further claim that lifestyle interventions require behavioral modification—true—but then go on to say that such changes are too costly and “have only modest and unsustainable impact, and have failed to reduce CVD events when tested in large, long-term trials.”²¹ In other words, to echo a metaphor from chapter two, if an entire population suffers from headaches caused by hitting themselves over the head with hammers on a regular basis, it’s too expensive and not effective enough to teach them to stop. Instead, we should implement health policy and environmental changes, such as public service announcements reminding everyone to wear their helmets, and recommend that everyone take painkillers with every meal.

The report²² they refer to that supposedly damns lifestyle change as low impact and unsustainable was a meta-analysis of thirty-nine studies that only represented a collection of independently acting interventions. The studies reviewed in this report intervened first with drugs (for hypertension, lower cholesterol, and high blood sugar), and then with meaningless and independently acting (but not necessarily additive) interventions to reduce body weight, decrease fat intake, get more exercise, and stop smoking. In other words, giving people drugs and encouraging them to lose weight, eat less fat, and walk around the block once a day didn’t miraculously make them healthy. That’s what they call “lifestyle change”? Is anyone surprised that this approach doesn’t work?

Big Pharma has used this collection of flawed studies as a straw man, claiming that “lifestyle change” doesn’t improve health outcomes. But the combination of drug interventions (which fail to show adequate long-term benefits) with vague statements to reduce body weight (by any means, healthy or not?) and lower fat intake (another reductionist result that can be accomplished not by meaningful dietary improvement but rather by eating processed “low fat” foods) by no means can be considered a “lifestyle change.” Lifestyle changes are wholistic, systemic, persistent, and comprehensive. A credible study of real lifestyle change to improve health would guide participants to transition to a WFPB diet, at a minimum. Yet most researchers in this field not only fail to acknowledge nutrition as a means to create and restore health, but also refuse even to become curious about its possibilities.

THE SUPPLEMENT AND NUTRACEUTICAL INDUSTRY

Dietary supplements (which include not only single-nutrient supplements, but also a wide variety of food and herbal extracts) are a huge business—at recent calculation, it totaled $60 billion here in the United States—and one that has everything to lose under a wholistic paradigm. After all, supplements, as with pharmaceuticals, are the products of reductionist science, in which individual nutrients are seen as independent actors, each doing “a thing” in isolation from everything else in the body and the environment. As we saw in Part I, the limited efficacy of supplements reflects the limited science that created them: nutrients outside of their natural food context do little good and sometimes do considerable harm.

This hasn’t stopped the supplement industry, though—and why should it, when there are so many studies to choose from and so much money to be made by choosing the ones, however faulty they may be, that support supplement use?

These days, the supplement industry has the process down to a “science.” New scientific research on single nutrients generalizes in a very superficial way about their ability to promote human health. Companies put these newly discovered “nutrients” into pills, organize public relations campaigns, and write marketing plans to encourage a confused public to buy. But it wasn’t always this way. The supplement industry rose from its modest origins to the multibillion-dollar behemoth it is today by exploiting relatively recent government policy toward deregulating the sale of certain health pills.

The nutrient supplement industry began in the 1930s, and for several decades had only modest growth. In the 1970s and early 1980s, however, it got a big boost, thanks to two events. First, in 1976, U.S. Senator William Proxmire and his colleagues succeeded in amending food and drug regulations to enable food companies to sell vitamins and minerals without a doctor’s prescription.²³ Previously, a prescription was required for any preparation containing more than 150 percent of a recommended daily allowance. Second, in 1982, the NAS published that highly publicized report on diet, cancer, and nutrition, which we’ve already discussed,²⁴ that the industry spun to lend scientific justification to their products. That report—coauthored by thirteen scientists (including myself) and two years in the making—talked about individual nutrients as they existed within whole foods such as cruciferous vegetables. Though we mentioned certain vitamins and minerals, we had no intention of encouraging a nutrient supplement industry, and we made this clear in our executive summary. Ignoring our conclusions, the industry audaciously claimed that we had said the opposite, as if they knew better than we did what we had said!

This fledgling industry was now on a roll. The Proxmire amendment opened up the market, while the NAS report provided, in supplement makers’ opinion, the scientific evidence to justify their products. What a combo! But an obstacle to growth remained: the industry couldn’t yet make specific health claims that rose to FDA standards to help sell their products. Critics were right to be concerned about hyped-up claims, as evidence of such misbehavior had already surfaced with their gross misrepresentation of our NAS report. In fact, the NAS appealed to the Federal Trade Commission (FTC) to investigate the matter and asked me to represent the NAS in the subsequent court proceedings, which continued for about three years. My job was to examine the evidence the industry submitted to support their claims. I testified that most of their evidence was bogus and the FTC court agreed.

Neither the NAS nor the FTC had found any evidence to support these emerging health claims. Yet the industry still found ways to open doors for business, gradually gaining more and more liberty to make claims of improved health. Despite what, in my opinion, were (and are) minor restrictions on the health claims they could make, they essentially found ways—subtly but nevertheless powerfully—to advertise the health benefits of nutrient supplements and to grow their industry. I am not as familiar with the stream of regulatory and legal decisions paving the way for this growth that occurred over the next several years, because I was more involved with my research than with political shenanigans. But I do know that the industry has continued to grow—as did the lawyers’ fees involved in ensuring the supplement industry had a friendly regulatory environment! Revenues climbed as more people succumbed to massive industry advertising and the belief that health could come from bottles of vitamin and mineral tablets.

The industry, now well established, received a further boost in 1994 with the passage of the Dietary Supplement Health and Education Act that amended the Federal Food, Drug, and Cosmetic Act. This amendment was designed to standardize specific supplement-labeling requirements, among other “housekeeping” chores, which gave supplements the appearance of scientific credibility and class. Most supplements and dietary ingredients could now be classified as food, a change the industry welcomed. By this point, the supplement industry had become as much a part of the American landscape as cars, churches, and apple pie. It had risen to become an elite class of food product, rather like dairy.

According to a 2008 report,²⁵ the variety of dietary supplement products has grown immensely over the last thirty years, all the way from the original alphabet vitamins (A, B complex, C, D, E) and minerals to prebiotics, probiotics, omega-3 fats, and various whole food concentrates. But almost all the health claims for these products rely on the same kind of short-sighted findings we debunked in Part II.

I’ve mentioned these statistics before, but they’re worth laying out, all together, one more time. Sixty-eight percent of American adults take dietary supplements, while 52 percent consider themselves “regular” users.²⁶ As of 2007, the U.S. supplement market was $25 to $30 billion per year, with $7.4 billion spent on vitamins alone. More recent estimates have placed the U.S. market at $60 billion. Worldwide total dietary supplement sales in 2007 totaled $187 billion. Yet, with the immense growth of this “health” product market, the only thing getting any healthier is the supplement industry’s bottom line.

BUSINESS AS USUAL

Many other books detail the ways in which corporate money has corrupted government and institutional policies, and not just when it comes to our health. I could write an entire book just on the examples I’ve seen personally, and I shared some of them in The China Study. As well, the three industries discussed here—the medical, pharmaceutical, and supplement industries—are not the only ones involved in our health system. The food industries, particularly the animal and junk food industries (which my son, Tom, and I examined in detail in The China Study), are also major players in the distortion of our health system, as we’ll see in exploring these effects throughout the rest of Part III. But these three industries benefit most directly from the reductionist health paradigm, and have done the most to promote and maintain it.

What I want you to take away from the examples I’ve included here is just how much money there is to be made by suppressing wholistic nutrition in favor of reductionist health solutions, and just how far industry will go in pursuit of a larger share of that profit. In our current health care system, these examples aren’t exceptions; they’re business as usual. What looks like industry contributions to our well-being are often pure profit plays, dressed up as health initiatives. And it’s to the many ways and places where industry encourages only those products, services, and beliefs that reliably generate corporate profits that we next turn—beginning with industry’s influence on science itself.