In a recent Wall Street Journal Opinion piece, published just before he fired the CDC Director, our HHS Secretary, Robert Kennedy Jr, argued that physicians should be taught about nutrition. He cited some very nice statistics about how little nutritional education physicians get. Poor diet kills 500,000 people a year, RFK Jr wrote. So, he argued, we should make sure doctors get more nutritional education.
Yikes! The good news is that he and the Trump administration recognize that poor diet (and inadequate exercise, but he didn’t say anything about the exercise piece) is associated with 500,000 preventable deaths. But the bad news is that RFK Jr’s fix can’t and won’t work.
What Bobby appears not to know is that doctors don’t control food choices – and that only 43 percent of the US adult population has or uses a primary care doctor or practice – the folks who might conceivably be able to influence food choices – anyway.
There is a huge industry devoted to producing food-like goop – potato chips, fast food, fruit juices and sugar-sweetened beverages – basically, anything that comes in a wrapper or a box – and another zillion dollar industry devoted to marketing that goop to all of us. Thousands of people spend their days figuring out how to package this junk in bright colors and set it up at eye level in the supermarket so you and I will buy it. And eat it. Which we do. Because we are wired to eat anything and everything put in front of us. And because the food profiteers are so good at putting terrible food in front of us, all the time.
Doctors can give patients advice, and though more nutritional education can’t hurt, almost all doctors already know the basics: we all eat too many calories, don’t get enough exercise, and that diets favoring fresh fruits and vegetables, low in fat, simple carbohydrates and sugar, are better for people. But doctors just don’t have much influence on what people actually do. Advertising, how we are wired to eat everything in front of us, supermarkets, fast food outlets, convenience stores, and emotional stress drive food choices, not doctors.
If Bobby were serious about preventing the preventable deaths that poor food choices impact, he’d start by taxing sugar-sweetened beverages, and by subsidizing the purchase of fresh fruits and vegetables, making sure that the healthy choice is the easiest and most affordable choice. And he’d make sure all Americans have a great primary care doctor and a great primary care practice with the resources they need to actively coach all their patients to better diets and more exercise, instead of just reminding people with a sentence or two once every year or so, which is all that primary care clinicians have the time to do today. Bobby controls Medicare and Medicaid. He could get Medicare and Medicaid to pay to train more primary care clinicians, and then he could get Medicare and Medicaid to pay those clinicians for intense coaching of their patients about diet and exercise, if he were serious about reducing the burden of chronic disease.
But opinion pieces like the one Bobby published appear to be more about distracting us from the real causes of chronic disease than they are a serious attempt to improve America’s health. Blame doctors for people’s food choices? Chaos about vaccines? Endless controversy around CDC? Huge cuts to Medicaid?
Deny, deflect, and diffuse. The more things appear to change, the more they stay the same.
It’s crazy we aren’t talking about how to actually make America healthy again, something we know how to do, by using incentives to make sure people eat well and by providing better primary care to everyone, so everyone has the coaching to eat right that we all need. Shame on us. Shame on Bobby. Shame on this administration, which is wasting its great opportunity to improve the public’s health.
We can and must do better than this.
