The Dr. Hyman Show - Encore: Why Our Current Healthcare System Keeps Us Sick And How To Fix It

Episode Date: January 20, 2025

Heart disease, cancer, and stroke are the leading causes of death—and premature death at that—in the US. These diseases all have several risk factors in common, like smoking, physical inactivity, and poor diet, which policy often views simply as personal choices. We need to begin looking at disease prevention beyond individual decision-making. In this podcast, I talk with Dr. Anand Parekh, Senator Bill Frist, and Dr. Dariush Mozaffarian on the need for government policymakers to address disease prevention. Dr. Anand Parekh is the Bipartisan Policy Center’s chief medical advisor, providing clinical and public health expertise across the organization, particularly in the areas of aging, prevention, and global health. As a US Department of Health and Human Services deputy assistant secretary for health from 2008 to 2015, he developed and implemented national initiatives focused on prevention, wellness, and care management. He is the author of Prevention First: Policymaking for a Healthier America. Senator Bill Frist is a heart and lung transplant surgeon and former US Senate majority leader. He led passage of the 2003 Medicare Modernization Act and the historic PEPFAR HIV/AIDS legislation that has saved millions of lives worldwide. As the founder and director of the Vanderbilt Multi-Organ Transplant Center, he has performed over 150 heart and lung transplants, authored over 100 peer-reviewed medical articles, and published seven books. Dr. Dariush Mozaffarian is a cardiologist, Dean and Jean Mayer Professor at the Tufts Friedman School of Nutrition Science and Policy, and professor of medicine at Tufts Medical School. He has authored more than 400 scientific publications on dietary priorities for obesity, diabetes, and cardiovascular diseases and on evidence-based policy approaches to reduce these burdens in the US and globally. He has served in numerous advisory roles, including for the US and Canadian governments.⁣⁣ ⁣ View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal This episode is brought to you by BIOptimizers. Head to Bioptimizers.com/Hyman and use code HYMAN10 to save 10%.

I know how frustrating it can be to struggle with sleep. Tossing and turning, feeling like your mind just won't shut off, and waking up more tired than when you went to bed. It's exhausting, both physically and mentally. Sleep is so foundational to your health, but so many of us suffer from poor sleep. I've been there myself and I know how much it can affect your mood, energy, metabolism, and even brain function. That's why I'm so impressed with Sleep Breakthrough by Bioptimizers. This formula takes a holistic route, helping you fall asleep, stay asleep, and wake up feeling truly refreshed, without that dreaded hangover feeling. Sleep breakthroughs carefully selected ingredients work together to support every stage of your sleep cycle.

Magnesium, vitamin B6, and zinc help relax your body, regulate sleep patterns, and support deeper pair. Amino acids like glycine, taurine, and L-theanine promote calm, lower stress, and enhance restorative sleep. Magnolia bark extract helps reduce cortisol and quiet a racing mind so you can drift off peacefully and wake up refreshed. Together these ingredients create a synergistic formula designed to optimize your body's natural rhythms and deliver deep restorative sleep. If you're ready to transform your sleep head over to bioptimizers.com sash hymen and get 10% off today with promo code Hyman 10. It's not just about feeling rested

It's about giving your body the deep restoration it needs to feel and function at its best Coming up on this episode of the doctor's pharmacy We have a three point six trillion dollar health care system and frankly can't make as much money On prevention as you can on treatment. So the can't make as much money on prevention as you can on treatment. So the incentives are not as much there. Hey everyone, it's Dr. Mark. One of the most important tools I have for helping my patients optimize their health

is testing and that is why I love what Rupa Health is doing. Functional medicine testing can require placing orders with lots of different labs and it can kind of get really complicated for doctors and their patients to easily access results and keep track of everything. But Rupa Health has totally streamlined that process. Looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables can help us find the most effective path to health and healing. I'm really excited about that now and I can finally take advantage of these tests

without the hassle of the confusion of going through so many multiple labs. Rupa Health is a place for functional medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. It's 90% faster, letting you simplify the process of getting you the functional

tests that you need and giving you more time to focus on your patients. This is really a much needed option in the functional medicine space and it means better service for you and your patients. You can check it out with a free live demo, with a Q&A or create an account at rupehealth.com. That's rupehealth.com. One of today's episode sponsors is ButcherBox and I'm always being asked, how do I get enough high quality protein in my diet and where do I find it? With all the conventionally raised animal products flooding the supermarket, it can be hard to find meat that actually supports your health goals instead of taking you further

from them because of the use of antibiotics and hormones and a really gross unnatural inflammatory diet that they feed the animals. And that's why I love grass-fed ground beef from ButcherBox. Ground beef is probably the easiest protein out there that can be worked into any type of dish. I just love how quickly it can help make a healthy meal. And when you go with grass-fed, you're getting a source of omega-3s,

vitamins and minerals too, and maybe even a lot of phytonutrients. And with ButcherBox, I get 100% grass-fed and grass-finished beef delivered right to my doorstep, no matter which state I have to be in. They also offer free-range organic chicken, wild cod, alaspen, and salmon, which are part of my weekly meals. Two, grass-fed ground beef is the first protein I recommend for people who are trying to get more comfortable in the kitchen because you can just throw it in a pan with some sea salt,

herbs, and spices and make a great meal. One of my favorites is sautéing it with lots of fresh garlic, onions, peppers, cumin, chili powder, oregano, and Tosino-Ribetta greens for a super easy homemade taco salad. Just talking about this makes me hungry. If you've been looking for a way to get more high quality protein in your own diet, be sure to check out the grass-fed beef from ButcherBox, along with all the other humanely raised antibiotic and hormone-free meats. They make eating well easy, delicious, and accessible.

This holiday, ButcherBox is proud to give new members two pounds of ground beef in your first box plus $10 off. To receive this offer, go to butcherbox.com four-size pharmacy, F-A-R-M-A-C-Y. That's butcherbox.com four-size pharmacy to receive two pounds of ground beef plus $10 off. Now let's get back to this week's episode of The Doctors' Pharmacy.

Hi, this is Lauren Fian, one of the producers of The Doctors' Pharmacy podcast. The U.S. is home to the best hospitals, most highly trained doctors, and people come from all over the world to get medical treatment here. Yet we're lagging behind almost every other country in health metrics, including life expectancy and infant mortality. That's because we're not being set up for success. The policies and systems we rely on for health care aren't supporting prevention, education and accessibility for all our communities. In today's episode, we feature three conversations from the doctor's pharmacy on why public policy is a key component of disease prevention. Dr. Hyman speaks with Dr. Anad Parikh on the challenge to get policymakers to appreciate

prevention, with former Senator Bill Frist on the importance of grassroots bipartisan efforts to generate change, and with Dr. Dariush Mazafarian on the need for government policies and why we can't solely rely on big food to change. Let's jump in. We all agree that prevention is important, but why has it not been that policymakers sort of elevated the, why haven't they elevated this issue to the top? And came up with a couple of reasons that I'd be happy to share. I think the first is, and you touched on this, a lot of policymakers are just reactive in

general and prevention requires a proactive approach. And the reason they're reactive is whether is whether you're an executive branch or you're a member of Congress, there are oftentimes so many emergencies, either real or imagined or crises or political controversies that oftentimes you spend a lot of time reacting. Putting out the fire. Absolutely. As opposed to thinking about proactive policies to improve health. And then, you know, prevention oftentimes takes time as well.

So you have to have that patience. And oftentimes the results are, at least from a public health perspective, are often invisible when things are working and health is being protected. And so I think the first reason is that the mindset of policymakers needs to shift from being reactive to proactive. The second reason is that the mindset of policymakers needs to shift from being reactive to proactive. The second reason is it could very well be that policymakers are just not as attuned

to the evidence base, whether it's lifestyle medicine, whether it's prevention, whether it's a social determinants of health. Understanding the evidence now that has been generated about the effects of all of these other modalities, I think is critical. And when you don't know the evidence, then you tend to think, well, that might be a slush fund. Those dollars in prevention might be a slush fund

and why should we support it? There are others then, as you said, who may think of prevention as, you're right, part of the nanny state. Prevention is about individual responsibility and the government shouldn't be involved. So I think those are a couple of reasons, but then I think it goes beyond that. Prevention and public health, they require resources.

And right now in this country, if you look at our national health expenditure accounts, only about 3% of our dollars go to public health. Only about 5% go to primary and secondary prevention. And so even though we're in a tight fiscal climate, we're always gonna be in a tight fiscal climate. Finding opportunities through our discretionary budgets or mandatory budgets, CBO doesn't always help with their tenure budget window

in terms of scoring. But- So just to clarify for people, the Congressional Budget Office is the watchdog that looks over the costs of things for the government, policies and laws. And, and they score policies based on their impact over a 10 year period, but the benefits of prevention might be over a 20 year period. So it seems like a cost center instead of a cost savings.

Absolutely. Absolutely. And I think that's a very important point. And I think, so there needs to be more focus on finding the will really, the political will to expand resources using our discretionary budgets as well as our mandatory budgets and through Medicare and Medicaid because that's really how we scale things. So I think that's also a critical point. I think Dr. Hyman, another reason why policymakers haven't gravitated towards prevention is,

we have a $3.6 trillion healthcare system and frankly, you can't make as much money on prevention as you can on treatment. So the incentives there in the system are not as much there. Now value-based healthcare- Not from the government, but from the people running healthcare.

Absolutely, now value-based healthcare transformation with the focus on payment based on outcomes as opposed to volume should change that over time, but that's gonna be a long haul. So we were still- And just to clarify for people, the way typically doctors get paid and hospitals get paid is like widgets.

The more stuff you do, the more you get paid, the more angioplasties you do, the more surgeries you do, the more colonoscopies you do, the more visits you do, the more money you make. That's right. And it doesn't care if the product is good or not. It's like, imagine, you know, paying for a car, but it didn't work. Like you're not paying for the outcome.

And so value-based care is a new way of thinking that's incentivizing healthcare systems and doctors to be accountable for the outcomes of their patient's health. So keeping them healthy. If now, if somebody bounces back to the hospital, the outcomes of their patient's health. So keeping them healthy. If now if somebody bounces back to the hospital, the hospital makes money. In the future, the hospital won't make money.

It'll be making money by keeping people out of the hospital. And that's a very different paradigm shift, but we're not quite there yet. Absolutely, absolutely. We're about a decade into this, but still the vast majority of healthcare payments are still currently paid based on the services provided and a fee per service.

So we're not quite there. And I think the last reason why this hasn't really gotten the attention of policymakers is really, I think if you look at the general public as well, we haven't galvanized the American public and whether that's they don't realize the power of prevention or or we haven't realized or the area or we haven't communicated to them the importance of sound policies to support the healthy choice right policymakers

need to help Americans make the healthy choice the easy choice and so I think galvanizing the public you know they're not a lot of lobbying firms or interest groups going to members every single day in the halls of Congress preaching the power of prevention. But you do need a grassroots movement. You do need the American public to say, hey, I'm doing everything I can every day for my family

to eat well, to exercise, to avoid substances, to stop smoking, to drink alcohol in moderation. I'm doing everything I can, but if there are not community supports, if there are not policy supports, if there aren't policy systems, environmental change helping me and my family, it's gonna be very, very difficult to do. And I think that's a critical message in this book.

I think it's pretty important because if you don't actually provide an environment that allows people to make easy, healthy choices, it's hard to do the right thing. And I think one of the biggest challenges in this conversation is the sort of dichotomy between the idea of personal responsibility and sort of the nanny state, the environment we live in,

how do we change the toxic environment? And I think most of the messaging from most of professional associations, much of our government policy, and certainly the food industry is that it's your fault, you're overweight, it's your fault, you're sick. It's a personal choice, just like smoking is a personal choice.

And they talk about moderation. There's no good and bad calories that, you know, a thousand calories of broccoli is the same as a thousand calories of soda. There's focus on exercise as the solution. There's focus about moderation. You know, it's really interesting. And it's a culture that's really focused

on personal responsibility, but it ignores the fact that you actually can't be personally responsible in a toxic environment. If you can't go in your neighborhood and buy a vegetable and you have to take two hours of buses for, you know, to buy a carrot, that's a problem, right? And if we don't address the environment we live in, we're not gonna be able to get people to make healthy choices.

I remember reading a study where they looked at people who were overweight and diabetic, who lived in very low socioeconomic neighborhoods. They moved to a slightly better neighborhood and their blood sugar went down and their weight went down without any other intervention, just giving them a better zip code. So basically the zip code we have is a bigger determinant than our genetic code when it

comes to our health. And we don't really seem to acknowledge that in our policies. We say it's all about choice. Prevention public health, it's too important to underfund this. And there needs to be bipartisan support to finance evidence-based prevention and public health interventions. So it could be community-based prevention programs. I talk about several things that we did at Health and Human Services from the Recovery Act back in 2009.

There are opportunities to finance the public health infrastructure, which is significantly underfunded in this country. The public health emergency fund, so significantly underfunded in this country. The public health emergency fund, so the next Ebola or the Zika we face, we're not waiting on Congress to fight for months at a time before their resources, but targeted investments to lift up prevention and public health. That has to be a national priority. And I think in terms of bipartisanship, how do you crack that nut?

And there was an important commission on evidence-based policymaking that Senator Patty Murray and former speaker Paul Ryan actually led a couple of years ago and talked about sort of the importance of evidence-based policymaking. In that same vein, there ought to be bipartisanship around what are those priorities in the prevention and public health space that we actually need to invest more in. Right. Because the truth is, you know, food industry and pharma are not investing in research around this. That's right. That's right. And that leads me to sort of the fifth point, which is we

need Dr. Hyman more research. I mean, we have evidence base right now, but we need more research into prevention. Now, the National Institutes on Health estimates that 19% of their budget every year goes to prevention. Now one could ask, is that the right number or not? I don't know. Another- Is that really true? 19% of the NIH budget goes to prevention?

19%. Now there was another study that I recently saw that if you look at the National Cancer Institute, only 5% of their budget goes to prevention. So whatever the number is, I would think that these are all sort of low. Well, that's just to find prevention because there's a mammogram prevention,

there's a colonoscopy for prevention. No, it's early detection. Yeah, yeah. True prevention is really dealing with the causes, the upstream causes that you talk about in your book. Right, right, right. And so I would argue, and I argue in the book, that there ought to be a much more focused research

emphasis on prevention that looks at, and not just sort of the biology of illnesses, but also the importance of behavioral change, as well as policy, as well as other areas. And so, and that will also actually help the Congressional Budget Office, irrespective of what happens with the 10-year budget window, the more research, the more evidence there

will help policymakers. So I think in all five of these areas, number one, leadership prioritizing prevention, number two, healthcare professionals focusing on prevention, not just management, number three, a parallel pathway for lifestyle interventions and evidence-based community prevention interventions, number four, public health resources,

and number five, research all of these They're all heavy lifts dr. Hummins, but but I think that I wouldn't be writing a book if these weren't These are absolutely important for policymakers on both sides of the aisle to understand the importance of these and I think if there's movement On the policy side the American public public will see this also as a way to support themselves as they try to make sort of the healthy choice. But the American public is clamoring for assistance. Behavioral change is difficult given the environment, which you have so beautifully described.

And I think the best way to counter that environment is through policy change and empowered Americans speaking up. Yeah, one of the things you mentioned in your book in addition to sort of these points is sort of targeting things that work, but aren't paid for. So digital health, for example. You mentioned Omada Health,

which I helped advise when they were starting out. Right, right. And I said to them, look, the diabetes prevention was a good start, but it's based on a little bit antiquated nutritional data about low-fat diets and high-carb diets for diabetics. But it worked because, and I met people who were in the program, and they said,

well, it worked because we came to groups because we had to write down everything we ate because we exercised together. And, you know. The group dynamics, yeah. Yeah, it wasn't so much the food, although it was healthier. Yeah, yeah.

It wasn't the healthiest. And there's been more sort of advanced versions of that that have developed that are digital, for example, Virta Health, you've probably heard about, where they literally take in poorly controlled, like pretty overweight, poorly controlled diabetics, 60%, 60% reversal. Now in traditional medicine, it's like zero.

It's zero, right? Unless you get a gastric bypass. And they had 60% reversal. They had 90% or more off of insulin or very low insulin doses. They had 12% weight loss, which is a massive amount. Weight loss studies get five.

Everybody's dancing around, happy, and excited for 5% weight loss. And they did it through a digital platform where they were coaches and support. There was remote monitoring for ketones, for weight, for blood sugar. And they published the data using a ketogenic intervention, which is the opposite of the DPP,

which is basically high fat. And yet this is not reimbursed. And it's the amount of savings for these patients is just astronomical. So how do we sort of get, cause this sort of goes back to the conversation we were having earlier about prevention and treatment. So prevention is important.

It's a population based intervention. And you know, not all the people you're gonna do the intervention on are gonna get the problem. And there's not everybody who gets a colonoscopy was gonna get colon cancer, right? But everybody who's already sick needs the intervention of lifestyle interventions. Because it's lifestyle is treatment,

not only as prevention. But that's not reimbursed. And yet it's probably the biggest bang for the buck in terms of our healthcare system. And how do we get our government to start to understand that? And maybe it's what you talked about is funding more research that proves the model. Right, right.

Well, I think it's all there, Bob, also having pathways. Again, as you said, there's no real pathway, Medicare, Medicaid don't really know what to do with a lot of these interventions that are not sort of the traditional sort of medical model. As you know, in 1965, when Medicare was first created, it was essentially paid for the treatment of disease using routine medical services. So it hasn't really caught up with today's day and age and what we know about the importance of lifestyle medicine, either with prevention or treatment. So I think some of this is research,

some of this are new pathways in the government, regulatory pathways, some of this is educating the public. It's really gonna take, I think, all of the above to sort of change the status quo, because there are a lot of opportunities out there that are not being realized. Hey everybody, it's Dr. Mark here. We all know how critical getting good quality sleep is to our overall wellbeing and optimizing

our health. But if your mattress is not holding up to its head of the bargain, getting a good night's sleep can be almost impossible. And that's where Ascension comes in. It's handmade in Canada. These organic, non-toxic, latex mattresses are packed with technology to promote sleep. And Ascension mattress is the perfect environment

for you to experience unmatched REM sleep and deep sleep and benefit from all the amazing outcomes quality sleep provides. Ascension certified organic performance mattresses feature brand new organic foam formulas to help you experience truly rejuvenating sleep. Plus, there are no springs or fiber batting to harbor dust mites and no proteins to cause latex allergies.

Ascension believes there's nothing more powerful than the body's own ability to heal itself physically and mentally and these performance mattresses are proven to help you do just that. In fact, I have one and I would not sleep on any other mattress. In fact, I even bought my daughter one so I can go have one when I go visit her in medical school. Essentia has made a special offer available to my doctor's pharmacy listeners. Right now, you can get an extra $100 off your mattress purchase on top of Essentia's Black Friday sale, the biggest sale of the year, which will also take 25% off plus get you two free

organic pillows, $330 value with your mattress purchase. This is really an amazing deal. So be sure to use the code Hymen in your cart. Learn more at myessentia.com forward slash drmark hyman. That's drmark hyman. That's m-y-e-s-s-e-n-t-i-a.com forward slash drmark hyman. D-r-m-a-r-k-h-y-m-n.

And now let's get back to this week's episode of The Doctors Pharmacy. Where would you start to try to chip away at the need to change the food system? I mean, you were involved in the one campaign that was driving the AIDS and poverty relief in Africa. And it was a massive campaign against all odds and it succeeded and you were shepherding that through and that was a massive campaign against all odds, and it succeeded, and you were shepherding that through,

and that was a huge achievement. We need a PEPFAR One campaign for the food system. We need a Manhattan Project for the food system. How would you go about, given all your experience and knowledge and your work at the Bipartisan Policy Center, laying that out in a way that was a doable strategy, a winnable win?

Yeah, well, I think, and remember, I did the 20 years in medicine, the 12 years in politics and policy, but for the last 12 years, I used the private sector. And the example of the food that I gave, the example that I gave to you really comes out of the importance of the private sector and investments that are made that are cutting edge that ultimately define policy. I also work from the policy end. So even though I'm no longer Majority Leader of the Senate, you mentioned it, I'm on the board

of the Robert Wood Johnson Foundation where we talk about the health of the community, the non-medical determinants of health being much more important than the health care. That the food and our behavior and where we live and how we live is much more important to build for us the heart transplant surgeon, you know, saving lives, doing dramatic things. That's where the drama isn't very important. Don't want to diminish it, but the sort of 60% of the impact is in the dimensions

that we're talking about. And that means we have to go to policy. People say, why did you leave medicine and go to the United States Senate? What drove you to do it? Did you lose your mind? Why would you do that? And I guess I did lose my mind. But one of the reasons is to be able to participate in the system that we're talking about.

And that is ultimately public policy matters. Today, a lot of people dismiss government, dismiss institutions, but at the end of the day, the public policy matters. And you've written about it. You know, we've talked about nutrition and agricultural policy, the bipartisan policy center always, which is a center in Washington, DC, bipartisan timeisan Tom dashland. I run the health component. We stay on the issues of supplemental nutrition on Agricultural policy we're on that because it does affect health care and the health the burdens of disease And the sort of quality of lives we're gonna live So it really starts from the private sector all the way up to the public sector. And you don't have to be a politician to participate in the public

sector. Yeah, you don't. And so the key things that have to get changed, and you write about them, for example, in the bipartisan policy work, you know, SNAP, food labels, you know, reforms to Medicare, reimbursement around food is medicine, which you're talking about. How challenging do you think it is to get some of these things done? Because for example with SNAP, you know, the leveraging nutrition was a great report that was put up by the Bipartisan Policy Center which outlined some of the things that need to be done like sort of limiting access to, for example, sugar sweetened beverages which the dietary

guidelines say we shouldn't eat but the SNAP benefits provide $7 billion a year for soda consumption. And so it's like schizophrenic. It's like the right hand doesn't know what the left hand of the government's doing. And there are people who are for it, there's people who are against it. For example, the hunger groups oppose any restrictions. And how do you thread that needle? Because I think it's such a, you know, it's such an important program, for example, for feeding the hungry and food insecurity, but it also has secondary negative consequences of actually increasing poor health in that community

and increasing the need for Medicaid and Medicare to pay for those patients who eat those foods, who get sick, you know, so it's really a, kind of a rabbit hole, you don't want to go down. It is, it is, and again, you've written so much about it, but the food stamp program of the 1960s, a program that you've written about, is mainly, can people afford the food,

and let's just get them food. Let's just get them calories and some protein, but let's get them calories. And then in the 70s, when I was coming through in medical school, first we're gonna say, well, that's not gonna be enough and we really need to start looking to sort of better nutrition. But it took another 15 years to a healthier food

and not just any food, but it took another 15 years really and the SNAP actually became SNAP, Supplemental Nutrition Program after I left the Senate. But the fact that nutrition was put in the title, that was good, but then it took another five or six years before the Senate. The fact that nutrition was put in the title, that was good. But then it took another five or six years before the people say, what does nutrition really mean? And I think the SNAP,

the bipartisan policy center report that you mentioned, basically said three things. Instead of taking the big policy issue and just arguing for it, it said, let's take three things. Number one, that food is medicine and healthy food has to be an objective of SNAP. That wasn't the objective back in the 60s. So do that number one. Number two sugary beverages. We know science, you've known for a long time, but for the last eight years we know there's probably the

number one killer out there today in terms when you look at metabolic disorder. That's just so prominent and I'm exaggerating a little bit and oversimplifying. But we made that number two. And then number three, in that just one report, and that one report goes to the 450 sort of policymakers out there of the United States Congress. We made the healthy reading in terms of fruits and vegetables and to lower making them both affordable but also in the SNAP program itself. So we focused on all that.

We took it. Now that's not because of that report, but obviously the Obama administration came in, made huge progress. We have, based on the science, and that's been evaluated, you know, the health, the metabolic conditions, were probably 40% healthier, some reports say, than we did with the old SNAP program. And now you have president Trump coming in trying to roll that back. And that rollback now, the only thing that's going to stop that again,

as you said, all the lobbying is out there against it is going to be the science. We're 40% healthier. We're 40% more productive at work. There's 40% less absenteeism. The GDP, the economy is growing, the jobs are being created and it's that sort of reasoning that ultimately we need to push through, continue to push through. And you again you've written this whole story but things like the bipartisan policy center and other foundations need to echo that directly into the policy centers. Struggling with sleep is exhausting both physically and mentally. I've been there lying awake for hours, my mind racing. That's why I'm so impressed with sleep is exhausting, both physically and mentally. I've been there, lying awake for hours, my mind racing.

That's why I'm so impressed with Sleep Breakthrough by Bioptimizers. This formula takes a holistic approach to help you fall asleep, stay asleep, and wake up refreshed, without any ingredients that might leave you feeling groggy the next day. Key ingredients like magnesium, vitamin B6, zinc, and calming compounds like glycine and magnolia bark work together to promote relaxation, lower stress, and calming compounds like glycine and magnolia bark work together to promote relaxation, lower stress, and optimize your sleep cycle. If you're ready to transform your sleep and health, give Sleep Breakthrough a try. Head to bioptimizers.com slash Hymen and get 10% off today with promo code HYMAN10.

Yeah, I think that's right. I mean, I think I'm always curious about policy ideas becoming in policy and then becoming implemented. And it seems like there's a lot of steps there that things can go wrong. How do you navigate that? Well that's hard to beat because it's a fragmented system. We have our executive branch which can sort of be out there or voice and can do a lot through regulations. We have our legislative branch where all the money is and People forget that and the House of Representatives is where all this sort of money starts

And therefore ultimately has to be translated But then even after the law is passed it goes back to the execution and those are different people The only thing I can say is it comes back in this region I'm talking to you now and you're talking to me and we've got, you know, hundreds of thousands of listeners, it comes back to the American people. And how educated, how knowledgeable they are that they can translate that up through their mayors, through their school boards, through their city boards, through the state. And ultimately it gets through the system itself. And that's why democracy is a tough, tough system of government to

implement and execute because it takes so long to get through it. But again, HIV-AIDS is a great example for our listeners to listen to because it was killing 3 million people a year, not 60,000 a year, 3 million people a year globally. Huge stigma around it, impossible to do. And by coming together, Democrats and Republicans in a global and appreciation of the global environment, just like nutrition is and metabolic disorder is a global issue, coming together over a period of two years, we were totally able to reverse what happened to that time the previous 20 years since the early 1980s had been set over in the corner and stigmatized and now there are 20 million people alive because of that legislation. So policy

can work so we got to stick with it. It reminds me of what Winston Churchill said which was democracy is the worst form of government except for all the others. And I think, you know, you're kind of a unicorn because you thread the needle between a heart surgeon, which is the sort of epitome of acute care, rescue medicine, and public health, which has been a large focus of your work. And particularly with the Robert Wood Johnson foundation. And like you said, you were there operating on the downstream consequences of all this stuff.

And you're like, wait a minute, maybe we better figure out a way to not get these people on my operating table. And a lot of the work you're doing now in Nashville with Nashville health and the Robert Wood Johnson Foundation is focused on population health and how the social determinants, which are food and your housing and your economic opportunities, all the things that we don't think are that important, which may make up to 80% of the difference in your health and your actual health quality of life and productivity. What do you see is required for the government to sort of really shift to say, wait a minute,

we're focusing on the wrong end of the stick here. Yes, we need to maintain our best healthcare system in the world and the high quality of acute care medicine, but if we're really gonna solve the health disparities, the economic impact of chronic disease, the fact that six out of 10 Americans suffer from a chronic disease, four out of 10 have two, and in a few years, 83 million will have three

or more chronic diseases, and this will be metabolic health only being 12% of the population, 88 percent are not healthy. How do we start to shift our focus and share some of the work you're doing there because it's so important and it's such a different framework for how we solve these problems than just more access to care and better financing and better efficiencies. It's flipping the whole problem on its head. Yeah, it is. And I'll tell you what, just from a bit from the political standpoint, and again, it's nice to put politics aside, but politics are important in our democracy and where we are

today. But the language that we use is critical. And the study of language and the storytelling, if we want to move and establish movements, and for the HIV AIDS end of things, one of the things that we did was focus on young people and people like Jesse Helms, sort of an arch-conservative. They've written an article in the New York Times about how evil and immoral HIV AIDS is, and therefore we should not support any sort of helping people strike. That changed over about two or three months as we focused on things like a drug called

Nibirapine, which you know, and that for just 50 cents you can give that to somebody and that would reverse 10 million orphans out there to growing over time. And when Jesse Helms heard that, you know, there's a really sort of cost-effective way to protect babies and future babies and orphans and people, all of a sudden, he said he became our biggest advocate, and he pulled in a huge constituency constituency and evangelicals came on board, right people on the right, people from the left. Family planning, another huge global issue that I've been involved with, is an issue

that Republicans will turn to abortion issues and Democrats will turn to abortion issues and try to politicize it and always. But if you instead of you say family planning, you say that healthy timing and spacing of babies. But you just say that. All of a sudden people come to the room and I think we can do a better job. Instead of you know saying eat healthy or eat your vegetables at all, really do frame it. And I'll just close with saying what does speak and the Affordable Care Act came so unpopular because it focused just on access, which is important, but it didn't focus on

cost. It didn't focus on money. So the individual person, their prices were going up and they weren't getting any more benefits. So I think the more we can translate things into cost to effectiveness to well-being. And we know that a healthier, we know from my heart transplant, my heart transplants, they would do well long-term

if nutritionally and metabolically they were strong. So yeah, I did a heart transplant. I wanted to live 50 years and it came back to nutrition and a healthier lifestyle coming in. So I think if we do translate nutrition policy, not just good, bad, eat healthier, but translate it into a healthier person is a more productive person. And greater well-being means more productivity at work. It does mean a growing of economy. It means fewer absentee days. The economy growing, individual well-being increased, which translates into national

effects in their economy. And the Affordable Care Act, not if we don't miss it this time around, I think if we get the right language, and we do end up couching it into growth, personal growth, economic growth, productivity, that the case can be made, will be made, will be listened to. That's true. You know, and the thing that you talked about, the medically tailored meals is such a great example of an out of the box intervention that works better than anything else.

And you see that with the homeless population, providing them housing, literally paying for their apartments reduces health care costs dramatically. And it's actually an economic benefit. Or I was speaking to the former head of population health at Cleveland Clinic where I work, and he said, you know, if we provided housing and food for young mothers, we would dramatically reduce preterm births and neonatal costs,

which are literally in the billions and billions of dollars. And yet our healthcare system isn't set up to provide food or housing or any of the things that actually make the most difference. That's what's striking to me. Yeah, and I think the things that people listen to us, they say well again you're talking about Washington DC and policy and all that stuff and it's so far away, but it really isn't. When I left the Senate, the first thing I did is came back to Nashville, Tennessee where I grew up, Vanderbilt and family and all. And Nashville, ironically, it's sort of a Silicon Valley of health services.

All the hospital change, disease management change, psychiatric hospital change are based there on a per capita basis, much bigger than New York or Boston or Washington in terms of the reach. But ironically, in the Davidson County, where all these home offices are, the population health measures, and it could be metabolic disorders, diabetes, obesity, how long somebody lives, infant mortality, are higher there than other sort of brother-sister cities around the country of comparable size. And so we started a local initiative called Nashville Health, not appointed by the mayor or the governor.

Those are good, but they tend to go away when they go away. But a collaborative of 120 nonprofits, the academic institution, partnering with government, addressing these local issues. And because it's not healthcare, it's health. And as you said, 80% of that are things like food and housing and access to the internet. That's where our focus is. And we're making measurable change in the local community.

And I throw that out there because whoever's listening to us, they'll look around, do you have a collaborative like that? Addressing these issues at that ground level. And that's where this great movement can be of educating mayors and educating governors and educating Congress people starting in one's own community. That's true.

We were at a friend's house, Jimmy Haslam and his brother was the governor of Tennessee and we were chatting and he said, a third of our Tennessee budget is Medicaid, which is not only because of populations who are affected by these social determinants and desperate to find solutions. But I don't think they're hearing the right ideas. I don't think they're hearing the right information. And I think, you know, the fact that, you know, you're out there talking about this

and that there's these models like national health, I think hopefully will spur governors and mayors and others to actually start to act on this because this is where we have to move. I think in healthcare right now, there's this movement towards population health. Cleveland Clinic just stood up a new program called 4C, Cleveland Clinic Community Care, to try to actually act in this space and they started a Food is Medicine program. So you see these global leaders like Cleveland Clinic leaning into this space,

but I still find it's so incremental. And I am like, wait, you know, this is like, I feel like I've got a big truck full of water and I'm in the desert and there's on the other side of this glass wall, everybody's dying of thirst. and it's like, it's so not that hard. And yet, and we're just, it's so frustrating. So I think you're right. I think it's a grassroots efforts and on the local levels being focused on this.

And it's also educating policymakers. And that's really why, you know, I wrote my book Food Fix is why I started the Food Fix campaign to try to create a coordinated effort like you're talking about for the 2,000 people in Washington that actually need to be educated to understand these things. Because I don't believe there's anybody that wakes up in the morning and says, you know, I just want to keep people sick in America and I want to maintain the status quo. I mean, people, whether you're a big CEO of a food company or you're a politician, everybody wants better for themselves, for their families, for their country.

It's just that we don't have the roadmap to get there. And I think this is the kind of stuff that actually has to be at the forefront of whoever is in the next administration in the aftermath of COVID-19. Because just in terms of pandemic preparedness, how do we deal with even the next pandemic that's gonna come unless we make a more resilient healthcare system, a more resilient population? And I think you've worked so hard to do that.

So how would you, if you were president today, what would you be like leading the charge on to get us going in the right direction around this incredible burden of health disparities and chronic disease and social determinants. Yeah, it's a great question. First of all, I'd go back and- I would vote for you, actually.

I'm a Democrat, but I would vote for you. Well, you know, thank you, but you're not going to have the chance to. Come on. Why aren't the good people running? I just don't understand. You know, it is interesting that people say, how are you spending your time? And the first one, as you know, I do a podcast and that podcast is really interesting. It's called A Second Opinion, but I'm talking to people just like you are.

And it's really interesting. My particular podcast looks at this intersection of health and healing, the life that you and I live as physicians, intersected with policy, the sort of things we talk about today. And the third big bubble is innovation, the creativity innovation. So we bring people on, and not to be advertising it too much, but the interesting thing is that when we gravitate back to that intersection of policy, number one, number two, health and healing, number three, innovation.

Just at that intersection there, it comes back to exactly what we're talking about. These non-medical determinants overall that will lower cost, improve outcomes, have greater wellbeing, productivity for the nation coming back. And then you end up starting with shelter and you start with housing and you start with access to access and consumption

of healthy foods and nutrition and then you gravitate back out to do that. You're one of the few scientists, physicians who've come to the insight that we can't just treat patients in the office and tell them what to eat, that we have to fix the food environment. That healthcare fix is not just about better care coordination or better efficiencies or improving payment systems or prevention in some vague way, but it has to do with changing the context in which we eat, the foods that we have access to and the policies that promote the consumption

of more and more of the bad stuff. And we're sort of incentivizing the wrong things. So one, how did you kind of have the aha? And two, let's talk about this because it seems like one and $5 is for healthcare and about 80% of that is for chronic disease and most of that is from diet. That if we go upstream, unless we go upstream, we're not gonna fix the problem.

Yeah, I just want to highlight and repeat what you said. One in $5 in the entire US economy is spent on healthcare. One in $4 in the entire federal budget is spent on Medicare and Medicaid. And that's projected to go up exponentially over the next 10 years. This is swallowing the economics of our country. It's swallowing our government budgets.

It's swallowing the economics of our country. It's swallowing our government budgets. It's swallowing competitiveness of business. It's pretty shocking if you think about food, how big of a part of our lives it is, how big of a part of the economy it is. I can't think of any other part of our economy, any other products that we interact with every day where safety is left up to the consumer. Imagine if you went to toy stores and- I love this analogy. You know, I mean, just imagine you went to toy stores

and everybody knew there was lots of toys that were unsafe for the kids. There were lots of toys that were okay, not, I mean, a little bit unsafe, but not fully safe. And there were some toys that were really safe. Or you walked into a building and, or you went to buy a house and some houses met earthquake standards and fire standards and electrical standards and plumbing standards. Others didn't at all,

not even close. And some houses were kind of in between, some things were met or other things were not met or teachers in schools. Some teachers, you know, were safe, you know, and were good for the teachers and others were known. Everyone knew the teachers were dangerous for the children in different ways. We would never leave it up to the individual family or the individual person to deal with that mess, right? We would say, this is outrageous, right? We want safe toys, safe cars, safe homes,

some minimum standards, right? And yet in food, it's the only system where we sort of say, well, it's up to the individual person. We need education, we need labeling, we need dietary guidelines. And we just need to leave it up to the person and just not do anything else. And I think, you know, again, that's to me,

kind of the craziest thing about our policy approach so far is that it's all up to the individual consumer. And so of course we need to keep choice and there's a range of foods that people should be able to choose from, but all of them should be reasonably safe. All of them. Well, the challenge with that is that the food industry has polluted the science with

studies that confound the truth, that challenge notions that they're unsafe. American Beverage Association funds studies that soda doesn't cause obesity and kind of muddies the waters. And so the argument is, well, who's going to be the, you know, the judge and determine whether or not this is safe or not safe, right? Some people think, well, Twinkie's fine if he eat it once a week, but maybe not. Well, yeah, I get asked about, you know, what my thoughts on the role of the food industry a lot. And it's like everything else. It's complicated. It's not straightforward. So first, I have to say that the food industry has followed and continues to follow a lot of the really

harmful and unwelcome playbook of tobacco where it's about deception, denial, attacking the scientists, hardball lobbying, softball, buying of influence, a lot of the same tactics. But I think at the end of the day, you know, the analogy to tobacco only goes so far. And many of those examples are actually around soda and big soda. There are still present for other foods, but it's really about big soda. But I think the analogy with the big with tobacco only goes so far for a few reasons. First, the food companies incredibly diverse and heterogeneous. There's thousands of companies with thousands of products compared to tobacco. You know, second, I think that with tobacco it's a companies incredibly diverse and heterogeneous. There's thousands of companies with thousands of products

compared to tobacco. You know, second, I think that with tobacco, it's a fight to the death. Whereas with food, we need the food industry. We need their scale, we need their expertise, we need their technology, we need their distribution systems. And when I say big food, I mean from agribusiness to large supermarkets, international supermarkets to restaurants to manufacturers.

People think of the manufacturers, but there's four pieces to big food. And I think, sure, and I think, you know, maybe most importantly we shouldn't forget is the food industry mostly for the last 50 years did what we as public health experts and scientists told them to do. And now in the last 20 years, it hasn't been that long

as we've really gotten to new science. We're saying, wait a minute, while you did what we asked you to do, slow down and change and refresh. And this is where the problem is that some food companies are slowly trying to do the right thing and trying to pick that up, mostly because they're being pushed

by their losses in sales. Some because they believe in doing the right thing. Others are fighting and, you know, digging in every step of the way. So there's a lot of heterogeneity, but I think what's interesting is that- You know, it's interesting, there was a guy who was at the Milken Conference

who was the head of a big food company. He was like, I feel like a frightened dinosaur. Yeah, yeah. All the people I speak to and have heard from, they see that the food revolution is coming. There's absolutely, the food in 10 years is not going to look like the food it does now. And so I think what keeps me up at night is not that there's not going to be change, there's going to be change, but that the change isn't going to be informed by evidence. And so, you

know, we need innovation in the food system, we need investment in the food system, but going from Doritos to Cool Ranch Doritos is not innovation. Going from gummy bears to non-GMO gummy bears is not innovation, right? We need real innovation. Making Oreo 90 calories instead of 100 calories.

Exactly. To cut six trillion calories out of the food supply. There's a major food company who wanted to reduce the calories in their ice creams, so they added air. Yeah. Right? So that per cup, there'd be fewer calories, right?

But adding air to food is not gonna improve its health. Right? So I think that, you know, that's the kind of thing that I worry about. All the calories are the same, sure. Yeah. Yeah, so we need to, but the public the public I think the biggest thing the public is Demanding from their food right now is trust

And big food is not trusted and that's a wake-up call and that's good that that's a wake-up call And so I think that we don't want to demonize the entire food industry There's there's a lot of folks trying to do the right thing a lot of graduates from our school at Tufts in the industry Trying to do their help to do the right thing. A lot of graduates from our school at Tufts in the industry trying to help them do the right thing. But we also wanna work with industry and also work against industry when we need to. Give them carrots, give them sticks, help them and sell healthier, more equitable,

more sustainable food. And I think that's happening. I think I've seen these big companies like Nestle and Pepsi just struggling to sort of reinvent themselves But it's tough because they've got you know, I mean I talked to the head of Nestle and he's like, yeah We have lean cuisine which is mostly carbs Because it's low fat and because we call it lean the FDA says we can't change the composition of it So we can't make it healthier even though we want to and I'm like, it's an 8 million dollar business

I get it. These are like big issues for them. But. And this is where, Mark, government has a key role, right? Because if you leave it up to every individual food company to try to fight the system, they're gonna go under. If they innovate and the other companies don't, they'll go under. So this is where government has really a role to play

to even out the playing field and help these food companies do the right thing. So let's talk about what those policies are because there's a lot of things you've written about and I wanna get into some of them. You talk about your best buy policy changes that are gonna be not one thing but a series of things that attack multiple sectors

where there's issues, whether it's policy schools, whether it's quality issues, whether it's labeling, whether it's research, all these things are needed in concert to actually shift the whole dynamic from what we have now. But one of the articles wrote was called the real cost of food. Can taxes and subsidies improve public health

in JAMA a few years ago? And one of the challenges that we sort of don't want a nanny state, but in essence, we are creating a nanny state in reverse because we're being a nanny to the big food companies by subsidizing commodities that are wheat, corn, and soy that are almost 60% of our calories and the people who consume the most of them are the sickest. Of course, we then fund food stamps which is predominantly I think 70 plus percent of it goes to junk food and seven billion almost ten

percent goes just to soda. So we've created a system where we're having price supports for the bad food but not for the good food. You talk about flipping that upside down. Well so you said a lot there. There's a lot of points there. So and you know just what's really interesting and again, sort of wonderful from a point of view of wanting to study this is that just like there's no single magic bullet to eating and nutrition science shows us that you can't just pick one piece of the diet and fix it and everything's fine.

The same is true for policy. There's gonna be no magic bullet. There's a range of solutions that are needed. I think that taxes and subsidies are pretty crucial and I'll talk about that in a minute, but I would go back to your comment about subsidies. There's been this sort of popular myth that's kind of urban legend that's spread through the media that somehow there's subsidies to commodities that's making the prices cheaper. And I just want to really say clearly that's totally false that that all US

Policy for commodities keeps the prices high the reason you know What farmer in the US wants their prices low right they all want their prices high and so sugar is a great example People say well their subsidies, you know and first most of the subsidies have turned to crop insurance Crop insurance gives farmers insurance so that if they have a really bad season because of drought or something, they don't go under. And so most subsidies now are actually crop insurance for those commodities, not direct cash subsidies.

That's still a form of a subsidy, but it's not direct. But corn is a great example. We actually keep the price of sugar high in this country because natural Brazilian sugar is much cheaper than corn syrup, much, much cheaper sugar from Brazilian farms than US corn farmers. I talked to the vice chair of Pepsi, he's like, Mark, I said, why do you use high fructose corn syrup in your drinks? He says, because the government makes it too cheap for us not to. Well, they make it cheaper than natural sugar by putting tariffs on the Brazilian cane sugar

to protect foreign farmers. Right. Right. So if he took away all the price supports, which actually keep the price high, foreign farmers would go out of business, but the market would be flooded with cheap sugar from other countries. So that's just one example of, of this kind of conventional notion. Somehow, I don't know.

You know, I don't know, Michael Paul and someone wrote about this and it's just entered the, the, But But doesn't allow for the production of more and more of the food. In other words, they pay for them to produce food even if they, for example, in bad soils or in ditches and then they fail and they pay for this money. I mean, I've heard all these stories. The great majority of commodity crops in our country aren't eaten by humans. So the great majority of commodity crops in our country aren't eaten by humans. So the great majority of commodity crops in our country go to livestock or go to energy. So I thought that's, I thought that's what Nixon's policies on

Earl butts were designed to do, which is to drive the prices of milk and meat down because they were consuming these commodity crops and he was worried about the prices going too high and not getting elected. And he got Earl butts to change the policies. I thought that's what the whole thing was about. I would have to go and look at that history. I don't know that history. I know about Earl Butts and his kind of, you know, green revolution, but the farm bill and kind of the subsidy approach has been oversimplified. There's

actually a lot of things in the newer farm bills to promote specialty crops that are called specialty crops like fruits and vegetables to start to promote them. A better approach would be to go to the retail level, right? A better approach would be to go directly to the consumer. And I think we should do that because right now the price we pay for foods doesn't reflect the true societal cost of the food and healthcare and loss productivity and suffering. All the externalities.

All the externalities. Even how we grow the food, how it affects soils and water and climate. Absolutely, and so it's really not a punitive or approach or a favoritism approach. It's just bringing true market prices to food, right? Food should reflect the true market cost and benefit to people. And so if we taxed most foods, most packaged and processed foods with a flat tax, 10%, 20%, 30%, whatever we could do, and then we used all of that money crucially, we used all of that money to heavily subsidize at the retail level, at the consumer purchase level, or

at the farm cost level if you invest in farmer training, new equipment, you know, other things, then you would use all that money to invest in and reduce the price of minimally processed healthy foods like fruits and vegetables and nuts and seeds and plant oils and fish and yogurt and things like that. You would turn the prices up, you know, upside down or at least more normal, right? Where you couldn't buy 36 ounce soda for 99 cents anymore. And you wouldn't have to pay 50 cents or 70 cents for an apple. You'd pay 25 cents, 20 cents for an apple. You'd pay a dollar for a serving of salmon, right?

And you'd pay a dollar 30 for soda instead. That would change all the incentives for farmers, for retailers, for restaurants, for manufacturers and for the consumer. And so, you know, what's happened over the last 40 years is the price of soda has gone down 40% and the price of fruits and vegetables have gone up 40%. Like, well, fruits and vegetables in season are still quite affordable. The USDA did a nice analysis of that.

So fruits and vegetables in season are quite affordable, but there's a lot of fruits and vegetables out of season now, and those of course are really expensive because they're getting shipped around the world. So that's another challenge. But I think that price is clearly one tool that the government needs to use to help address healthier food, and it sounds sort of pie in the sky like this will never happen, but there's now at least a dozen countries around the world that have passed soda taxes. Mexico has passed a junk food tax. Yeah, unfortunately none of that money is being used, to my knowledge, for subsidizing healthy foods and so that makes the taxes only regressive or in

terms of finances for the poor, although it's progressive for health for the poor, it's progressive for finances. We should use that, the revenue from those taxes to create incentives and systems for making healthy food less expensive while helping farmers. We don't want to just make the food less expensive by putting farmers out of business. So I think that price is just an absolutely crucial tool and we've learned from tobacco, for example, how important price is. So what are your best buy policies?

If you were willing to sort of be in charge for a little bit and could just do what you wanted. And so I think you're in North Korea, just make a decision and whatever you want to do. Yeah. Well, I, yeah, there's a lot of challenges in North Korea for sure. That maybe food wouldn't be the first thing I'd address, but it would be up there. So I think that there's probably six or seven categories of policies that I think are really crucial.

One is fiscal economic incentives. So like we talked about direct to consumer incentives or taxes, industry incentives, fiscal incentives, give them incentives for marketing and advertising and developing of healthy foods and give them disincentives for the opposite. No, but you shouldn't give them a tax break for spending billions of dollars advertising junk food to kids. Yeah, that's actually been proposed in Congress that hasn't gained steam or gotten out of committee,

but it's proposed to take away the tax breaks that companies now get for marketing junk food, right? Fiscal incentives through SNAP, the food stamps program. Fiscal incentives is one category. Two other categories are crucial, is to change the environments in schools and work sites. Kids spend much of their day in schools, adults spend much of their day at work sites.

There's a lot of ways, wellness programming, environmental standards, procurement policies, to make schools and work sites, places where you, and hospitals, places where you can, hospitals, you know, places where you can only really get healthy food, food that tastes good. And it's healthy and is good. Although our school lunch policy now doesn't exactly do that, right? Pizza's a vegetable and French fries are a vegetable. Well, the, the, the 2010 healthy hunger free kids act was actually a pretty enormous

advance and so school lunch is much, much better than it was before that. There are still holes, but it's actually probably one of the best policies, food policies we have nationally is the school lunch policy. 50% of schools, you know, you go in and get brand name food on different days. Monday is McDonald's day, Tuesday is Burger King, Wednesday it's Domino's. It's like, that's 50% of schools and 80% have contracts with soda companies. Well, soda is not allowed in public schools anymore. But all the sports drinks, which are extremely high in sugar. It's dominoes. It's like, that's 50% of schools and 80% have contracts with soda companies. Well, so does not allowed in public schools. But all the sports drinks, which are extremely high in sugar.

No, no. So does not allowed in schools, including sports drinks, uh, competitive foods. They're smart snack standards and they're not, they're pretty much out of the school. There's no sugar, sweetened beverages in schools. Yeah, that's pretty much a hundred percent. Juices is okay, but, but a sugar, sweetened beverages are out of schools with healthy hunger for

kids. Pretty landmark. There are again some holes, but it's pretty landmark. But more can be done, I agree. So I think schools, work sites, fiscal incentives, those are three categories. Healthcare reform, there's a lot to do in healthcare and that's a whole other podcast, but getting food in the electronic health record, the number one cause of health isn't tracked in the electronic health record.

That tells you everything, right? Right, right. That our health system. But you got to train the doctors and- Yeah, food and vegetable prescriptions, medical education, medically tailored meals, changing quality guidelines, changing reimbursement guidelines. There's a lot to do in healthcare reform. Research and innovation is-

But just before you jump on there, just to show you how powerful that is, what you just said, that if you get food prescriptions, the impact can be powerful. Why would the government want to pay for food? It seems like a waste of money, they feel like they have to eat anyway. But Geisinger did a study where they actually took very treatment resistant type two diabetics

who were poorly controlled, the most food insecure. They were costing an average of $248,000 a year, and they gave them $2,400 of food and some support, social support and help to use the food and learn what they're doing, and they reduced their cost to 48,000 and 80% cost reduction while improving dramatically the health of the people.

And so it's a no brainer, but you know, you can't get Medicare to cover a fruit and vegetable prescription. Well, so yeah, you're describing medically tailored meals and what you say is really crucial. About 5% of the population costs about 50% of health care. All the patients with really complex chronic diseases, you know, kidney disease, cancer, heart failure, AIDS,

a range of really severe conditions. And several interventional studies now have shown that if you actually give those people food, give them three meals a day, which costs about $20 a day, it's much, much cheaper. You save money because they don't go to the hospital, they don't get admitted, they don't go to the emergency room. And because of that, things are changing so quickly, you know, Mark, because of that, California has just launched a $6 million pilot

to do medically tailored meals in eight counties in California this year. And if it works and they see the same results, they're gonna extend it to all of California. So change is coming. Change is a coming. Change is a coming. Yeah, and so, you know, healthcare is a fourth bucket.

Another, a fifth bucket, which I think is crucial for policy is research and innovation. There's a lot we know, but there's so much left to learn. There's so much left to learn about how foods affect our brains, our microbiomes, the differences between different processing methods that we've talked about. I mean, we could go on and on and on. We don't focus on, you wrote that we spend

about a billion and a half on nutrition research and about 60 billion on all the drug and other research. So it's like... Yeah, the numbers are really telling that the federal government itself estimated that all of its nutrition research is about one and a half billion dollars a year. And that sounds like a lot. But again, all of the country's drug industry research, pharmaceutical research is about 60 billion a year. Advertising on candy in the US is about 5 billion a year compared to 1.5 billion on nutrition research. Advertising on candy is 5 billion a year and just purchasing of candy is 50 billion a year in the US.

And so, that 1.5 billion is just nothing compared to what the true issue is going on. I heard some scary thing. We spend more on animal pet care and food than we do on education for our kids. I have not seen that, but that really would be sad if that were true. It would be amazing. So we really need research and innovation. I think we need a new National Institute of Nutrition at the NIH. The NIH has a National Cancer Institute, a National Heart, Lung and

Blood Institute, all these institutes focus on diseases. We need a National Institute of Nutrition. It's the National Institute of Health. Food is the biggest challenge to health. Let's create a new National Institute of Nutrition. And again, that sounds impossible, but the National Cancer Institute was added to NIH, you know, not that long ago, because of just the concerted acts of a few people going to Congress and saying, hey, we need a war on cancer. We need a war on bad food and a victory for healthy food.

We need a National Institute of Nutrition. We need public-private partnerships and guard rails so industry can fund nutrition research. I think industry has a role to fund nutrition research, but we really have to figure out how to do that transparently and carefully and independently. It's tough. You got 40% of the Academy of Nutrition Dietetics,

which is our dietetic group in America, being funded by the food industry. It's a challenge. Again, the food industry- It's a hard, healthy cereal with seven teaspoons of sugar. You know, the food- That makes you want to quit the American Heart Association. It's challenging.

It's challenging. I mean, the food industry has expertise that we need and they also have negative influence that we don't need. And so how can we use the expertise and minimize the negative? So, and then I can think the last area, you know. Create transparency around all that. And have transparency around food in general.

And I think the last policy area we talked about economic incentives, schools, work sites, research and innovation, the healthcare system. The last area is sort of quality standards. There are some basic things the same way we have quality standards for toys or for cars, for houses. We need some minimum quality standards and the easiest places to start are additives. So we need quality standards and the easiest places to start are additives. So we need quality standards. Basically the government's saying you shouldn't have too much of these things in food. It's just

a minimum standard. We already have done that for trans fat. That's a huge win for the U.S. It took 50 years. Yeah, it took a long time, but we've done it. We need to do that for salt and for added sugar additives. And then we need marketing restrictions on marketing of unhealthy foods to young kids. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

Hey everybody, this is Dr. Hyman. Thanks for tuning into the Doctors Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I wanna tell you about something else I'm doing, which is called Mark's Picks.

It's my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays.

Nothing else, I promise. And all you do is go to drheimann.com forward slash picks to sign up. That's drheimann.com forward slash picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Just a reminder that this podcast

is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.

Fatigue, bloating, heartburn, stubborn fat, are you sick of feeling like crap? I'm Dr. Mark Hyman and I have a remedy that's helped thousands eliminate these frustrating symptoms and more almost overnight. It's called the 10-day detox and it can be seriously life-changing. On average, participants in this program report a 60% reduction in chronic symptoms in just 10 days. They have more energy, their blood sugar improves, junk food cravings disappear, their skin clears up and they lose stubborn fat.

And most importantly, they feel better than they have in years. All in just 10 days. If you're ready to feel your best again, go to DrHeiman.com forward slash detox. That's DrHeiman.com forward slash detox.