Jeremy: One of the books that Mitch and I are reading is Metabolical by Robert Lustig, who is a UCSF professor of endocrinology. This is where I have become aware that people have to assume more agency regarding the food they consume.  However, that would mean going against the food and beverage industry–whose entire goal is processing food and beverages so that they sell.  Do you remember images in the underdeveloped nations of starving child who look protein malnourished. It was assumed that this lack of protein makes them swell.  Well, it turns out that they were eating certain kinds of grain that were not healthy. We have become our own undernourished nation, as Scott pointed out.  We are malnourished obese people.  And that is a big challenge. However, if we put our thinking caps on and take a kind of systematic approach to that issue, we might be of some help. I notice that gasoline is cheap in the transportation industry. The producers of gas don’t have to pay for all of the environmental costs associated with gasoline. I think we have a similar situation in the food and beverage industry.  The prices of many foods and beverages do not reflect the health care costs that they are putting on the system.  So, a big gulp should cost $17.90 rather than 35 cents because you are paying for all of the liver failure being induced by that drink.

Bill G:  Well, this taxing strategy certainly worked with cigarettes.  We have historical data that price elasticity works. So that cigarettes have become a very expensive habit.  Theoretically, you could do something similar with all of these toxic foods, and it is clearly demonstrated that all of this works in society to reduce consumption.

Mark: If I may [he shows an ad for Lucky Strike cigarettes ]  This an ad from the 1950s  “20,000 physicians say  that Lucky Strike cigarettes are less irritating because they are toasted.”

Bill B: I worked for a while on the terminal cancer ward of a Veterans Administration hospital. All of the veterans were blessed by the Camels cigarette company. They all had free packs of Camels by their bedside.  This was gratitude for their service to America.  I remember just being shocked by the fact that they are dying of cancer–and here Camels are being provided to them free of charge.

My son just took a job with a major advocacy group that focuses on plastics.  One of things he has mentioned is that we are now consuming a credit card worth of plastic each week.   Mm son is now going around the United States and elsewhere in the world, helping to promote policies that are similar to what Jeremy is proposing. If you are going to use plastics in your products, then you will have to charge more so that some of that money can go back to repairing the damage done by these plastics. So, the reparation model that Jeremy is talking about and that Bill G. talked about with regard to cigarettes needs to be applied in a number of places.  I wonder if consumption of plastics every week contributes to obesity What does it mean that we have all that stuff in our bodies? What is the impact?

Jeremy: Some of the plastics are themselves hormonal simulators. What is the company that is going to pay for the study regarding the health impact of plastics? That is part of our crippling challenge. The federal government used to pay for a lot of these projects through universities which had complete independent ability  to publish what they were doing. Most of the universities are now subsidized by corporations that buy the labs where the researchers are doing the studies.  So now the infiltration of business interests with research has become far more challenging than it was in the past. Furthermoe, it used to be that industries built their own labs and did their own research. Now they are doing it at Harvard and Yale. And are being published by the most famous  people. I think that the level of infiltration of business interests into the research realm is troubling.

In Family Medicine we pretty much have banned the pharmaceutical companies  from sending their pharmacy reps into our residencies. That is an example of an advocacy effort that has had a substantial impact. It could be replicated in other ways if we get creative about it.