In Selling Sickness, authors Ray Moynihan and Alan Cassels explain that “there’s a lot of money to be made telling healthy people they’re sick.” The prologue to their book, published in 2005, paraphrases a candid interview with Merck’s former chief executive Henry Gadsen, originally published in Fortune more than thirty years ago. “Suggesting he’d rather Merck be more like chewing gum maker Wrigley’s, Gadsen said it had long been his dream to make drugs for healthy people. Because then, Merck would be able to ‘sell to everyone.’“ The case that the healthcare industry does not exist for the betterment of our health has also been well-argued by a number of experts from respected institutions, including Harvard and the New England Journal of Medicine, and so for the most part I’ve resisted making grand indictments of the healthcare industry and attacking its failure to keep us well. But it’s not just industry that’s to blame. This kind of corporate thinking trickles down from the boardroom into your local clinic, contaminating individual doctors—like yours.
While I was building my practice, my boss explained to me that to be “successful” I would need more chronic patients in my panel. He explained that putting people on blood pressure and other medications, which would need periodic monitoring, was key to building a busy practice. I understood that from his perspective keeping my patients healthy—and medication free—was bad for business. This entrepreneurial mentality is endemic in today’s healthcare model. But these days it’s gone beyond populating one’s own practice with as many unhealthy people as possible and doing little to improve their health. Now the name of the game is to push as many drugs as you can by whatever means you can get away with. When I interviewed with the Chief of Family Medicine at a large medical corporation on the West Coast, he explained that, since he was part of a team of people who arranged for pharmaceutical companies to issue cash grants, he was in a position to offer me a particularly enticing salary.
“What are the grants for?” I asked.
“We have a quality improvement program that tracks physician prescribing patterns. We call it ‘quality’ but it’s really about money.”
And that’s all it’s about. It works like this. In his organization, any patient with LDL cholesterol over 100 is put on a cholesterol-lowering medication. Any person with a blood pressure higher than 140/90 is put on a blood pressure medication. Any person with “low bone density” is put on a bone-remodeling inhibitor. And so on. The doctors who prescribe the most get big bonuses. Those who prescribe the least get fired. With a hint of incredulousness in his voice, he explained, “So far, every time we’ve asked for funding for our program, the drug companies give it to us.” If this is where healthcare is headed, then these hybrid physicians-executives will instinctively turn their gaze to our children and invent more creative methods to bulldoze an entire generation into the bottomless pit of chronic disease.
Merck CEO Henry Gadsen’s thirty-year-old dream was to make healthy people buy drugs they didn’t really need. But he was dreaming small. What I now see happening is more sinister and more profitable, and promises to have longer-lasting repercussions than merely creating diagnoses that lead to unnecessary prescriptions. What I see is a massive campaign of nutrition-related misinformation that has reordered our relationship with food and reprogrammed our physiologies. Industry has moved past selling sickness and learned how to create it. Whether by intent or simply fortuitous coincidence, today’s definition of a healthy diet enables corporations to sell us cheap, easily stored foods that will put more money in their pockets and more people in the hospital. By denying our bodies the foods of our ancestors and severing ourselves from our culinary traditions, we are changing our genes for the worse. Just as corporations have rewritten the genetic codes of fruit and vegetables to better suit their needs, they are now, in effect, doing the same thing to us.
But there’s one thing they’ve overlooked. Fruits and vegetables can’t fight back. We can.