Policy ideas for a healthier America - The Next #57

14 ideas to fix the chronic disease crisis

Hi there, and welcome to The Next - my take on health, wellness, and company building.

In the last few years I’ve founded 3 health brands (Kettle & Fire, Perfect Keto, Surely non-alc wine), which do tens of millions in revenue. I’m now working on Truemed, which allows health and wellness brands to accept HSA/FSA funds. Previously, I worked in tech and had no experience in CPG, DTC, or any other 3-letter industries.

If you missed past episodes, I recommend checking out The Great American Poisoning, my manifesto on what’s going on with our chronic disease crisis. Otherwise, let’s dive in! 

🆕 What’s new

Last week I was thrilled to see The Great American Poisoning come to the forefront of the national conversation. 

If you haven’t seen RFK’s speech where he pauses his campaign, it’s well worth watching. Specifically, it’s worth watching from about 24:52 where he discusses the chronic disease crisis. 

RFK lays out one of the best summations of the chronic disease crisis I’ve ever heard. Some data points that drive home the gravity of our current situation: 

• 25% of kids have prediabetes

• 45% of kids are obese or overweight

• 77% of young adults don’t qualify for the military due to health issues

• The richest American men live 15 years longer than the poorest men, almost entirely due to nutrition (source)

• Between 1973 and 2011, male sperm count has decreased more than 50% (OUP)

• Girls are hitting puberty 1-2 years sooner than they were 40 years ago (link)

• Cancer cases in people under 50, increased globally by a staggering 79% from 1990 -> 2019 (link)

All told, this healthcare burden costs the US $4.3 trillion per year, with 85%+ of that going towards managing - not curing - chronic conditions 

This a uniquely American problem. The childhood obesity rate in Japan is around 3%. We spend three times more per capita on health care than Italians, and live five years less. Our food and healthcare systems are fundamentally broken, creating the sickest generation of Americans we’ve ever seen (as I discussed in-depth in The Great American Poisoning). 

It is increasingly becoming clear that protecting kids by fighting corruption and regulatory capture is among the biggest issues in the country. If an incoming administration is to take the chronic disease crisis seriously, here are some of the key policy steps they should take:

1. Remove corporate interests from FDA and USDA guidelines. Today, Big Pharma funds 75% of the FDA’s drug division budget (1), and 95% of the USDA panel charged with updating nutrition guidelines had conflicts with food or pharma (2). This is how you get “research” finding Lucky Charms are healthier than ground beef (really).

   • There was also a hilarious moment last week where the FDA formally responded to RFK’s claim that 50% of the total FDA budget comes from pharma, noting that it was “only 47%”.
     

2. Eliminate the ability of Big Pharma to buy off the mainstream news. As of today, the US and New Zealand are the only countries that allow pharma to directly advertise to the public (and the US has only allowed this since 1997). When pharma accounts for 55% of the mainstream media’s budget, they effectively own the media. It’s how you get crazy things like a pharma-funded doctor saying obesity is genetic and kids should be on lifetime Ozempic injections (3), and no mainstream mentions of the many downsides (inflammation, gut issues, etc) that come with Ozempic. 

3. Remove conflicts of Interest at the NIH. Currently, there are no conflict-of-interest bans at the NIH, and 8,000 researchers have "major" conflicts (4). Until 2005, NIH researchers were allowed to accept direct stock options and consulting fees (which 40% of them) did (5). This is why 40x more money is spent on ways to "manage" cancer than to prevent it: prevention is far less profitable than treatment. 

   • We should also explicitly ban conflicts of interest in nutrition studies. 82% percent of independently funded studies show harm from sugar-sweetened beverages, but 93% of industry-sponsored studies said no harm. 

4. Prevent pharma from price-gouging the American people. Today, buying Ozempic in Germany costs 17x less than it costs for Medicare to buy the same drug (6). Medicare is the largest buyer of healthcare services in the world, yet under a 2003 law, it’s prohibited from negotiating prices with pharma companies. This leads to absurd schemes like pharma “charging” consumers $1000/mo for Ozempic, then giving them rebates to get the total cost closer to $200/mo. At the same time, Medicare (and thus the US taxpayer) pays the full $1000/mo. 

5. Remove toxins from our food supply. The American food system is uniquely poisonous. We allow 150 pesticides that Europe bans, and high levels of these toxic pesticides are found in 93% of American’s blood/urine samples.
   A simple approach would be to adopt the same chemical regulatory approach as the EU. Today, the EU bans 80,000+ chemicals the US allows in our food, water, skincare, and other products. We should follow the EU’s model and do safety testing on new chemicals before they’re introduced to the food system, rather than ban chemicals decades after we have proof of harm (more here).

6. Increase patient choice with HSAs. Today’s healthcare robs Americans of choice. Patients are shuttled into a 1-size-fits-all program where insurers cover only certain treatments, with certain doctors, and under certain conditions. We should introduce consumer choice (both by exposing prices to consumers via companies like Superscript) and by making HSAs and FSAs key pillars of all healthcare policy. A good step would be to unlock universal HSAs for consumers. 

7. No soda on SNAP. Coca-Cola and other soda manufacturers make billions each year from SNAP recipients. 75% of all $115B in SNAP funds go towards processed foods, and 10% of all SNAP funding goes to soda. This is insane: we are incentivizing the poorest among us to eat processed foods and drink soda. This policy is a key reason why the poorest men die 15 years earlier than their wealthier counterparts: almost entirely due to food-based chronic illness (7).

   • Additionally, I’d suggest giving bonus dollars or allowing SNAP funds to be used at farmer’s markets and within local food systems, to support healthy local food economies.
     

8. School lunch reform - Today, eating school lunches is a risk factor for childhood obesity (8). School lunches are toxic, largely due to captured interests that push for Lunchables to be sold in school lunches (9) and who say pizza is a vegetable (due to the tomato sauce. Yes, a tomato is a fruit) (10). We need to reform these corrupt guidelines to focus on nutrient density from whole foods, and ban ultra-processed foods from school cafeterias. 

   • Additionally, school lunch programs should likely have a health feedback loop. If the kids in a given district fall below certain health metrics (obesity, BMI, whatever), then the school lunch program should be changed! With such a feedback loop, almost every school lunch program in the country would be forced to change today.
     

9. Support a transition to regenerative agriculture - Some studies estimate that if 25% of our agricultural lands transitioned to carbon-sequestering regenerative agriculture, the US would solve its carbon emissions issue.
   Beyond the climate impact, regenerative agriculture improves soil health, leading to more nutrient-dense plants and healthier animals (and hence, to healthier humans). Incentivizing farmers to transition from chemically-intensive forms of monocropping to regenerative agriculture would do wonders for the climate and the health of our food system.
   

10. Reform crop subsidies - Under today’s system of crop subsidies, planting corn/soy/wheat is heavily subsidized, with most subsidies going to large agricultural corporations and landowners. These subsidies make corn/soy/wheat artificially cheap, which is why they end up in everything in their most processed forms (soybean oil - which today accounts for nearly 20% of the average American’s caloric intake - and high fructose corn syrup to name a few) (11). Our subsidies program is so corrupt that the government subsidizes tobacco 4x more than vegetables.
    I wrote more about this topic here, but if there’s one thing I could change in today’s US system, it’s probably this. 

    • To the extent that anything is subsidized, subsidies should go towards maximally nutrient-dense foods grown in local food systems by smaller farmers.
      

11. Fix our water supply - Our water supply is in dire straits. Not only are there issues with water in places like Flint, MI, but at the national level our drinking water is riddled with PFAS, glyphosate, and many other toxins. A recent study found 95% of all tap water exceeded the limit for at least 1 carcinogen, and half of all water is contaminated with PFAS (12).
    Current EPA and drinking standards should be improved, as current federal limits are often 10-100x higher than scientifically established safe limits. For example, the acceptable level of glyphosate in tap water is 7000x higher than the current EU standard.
    

12. Break up the foreign-owned meatpacking monopolies - 85% of the meatpacking industry is owned by 4 companies, 3 of which (National Beef, JBS, WH Group) are located in Brazil or China and have a long history of abuses and outright fraud. JBS in particular has paid over $3B in fines in the last 20 years for (at various times) bribing inspectors to let them sell tainted meats to school cafeterias, creating unsafe working environments, price fixing, and lying about the amount of rainforest they clear-cut for their cattle herds. JBS in particular is the company that is most responsible for clear-cutting the Amazon for cattle (13). American companies should control the American meat supply!

    • Additionally, a national law similar to TX SB 691 should be passed that allows for the processing and slaughter of animals at small farms. For a healthier and more resilient food system, we need to decentralize the system and make sure that 85% of beef processing does not go through just 4 centralized companies.
      

13. Require nutrition classes and functional medicine in MD programs - Today, 80% of medical schools require zero nutrition classes. Practically zero MD programs take a holistic, functional approach to medicine that aims to treat root cause issues (ie lifestyle).
    

14. New presidential fitness standards - JFK wrote a letter in 1960, The Soft American, which called for a reworking of the Presidential Fitness Test to create new physical standards and expectations for our children to develop healthy bodies. It is time to issue a new standard and framework and encourage a new baseline for physical fitness for our children.

(shoutout to my Truemed co-founder Calley Means for inspiring a lot of these talking points, and Anthony Gustin, Jacob Peters, Johnny Bowman, Kevin Fishner, and others for additional thoughts). 

You all are a smart bunch. Please let me know if you have ideas for other policies a Healthy America coalition should adopt!  

😌 Dope stuff on the internet

Some of my favorite things since the last newsletter (note: I don’t get paid to recommend anything here):

• 📰  Article - This interview with Casey + Calley Means on the chronic disease crisis is well worth the listen. It’s one of the best summations of our current crisis, from two people who have deep knowledge of the problem.
  Additionally, this article is a good review of how cigarette companies used similar strategies to make processed foods highly addictive, leading to many of the major health issues we see today. 
  

• 📚 Book rec - I cannot recommend The Body Electric enough. I strongly suspect that bioelectricity will be a top area to watch in the coming years, as it has implications across cancer, limb regeneration, and practically all functions of the body. This book is an excellent intro to the topic.
  

• ⌚Cool product - Rather than just one product, a friend kindly put together a list of every product I’ve ever recommended! Enjoy, and let me know if there are product categories you’d like me to dig into. 
  

• 🎵 Music  - This is a killer (chill) set I’ve been rocking the last few weeks! 
  

• 🏀 Random - This study found that artificial light at night leads to cancer in humans, even after adjusting for many potential cofounders. I really think you’re doing yourself a favor if you mitigate artificial light at night, and buy yourself a decent pair of blue light blocking glasses (these are good, though open to suggestions for ones that look good and are effective!).
  

• 🔥Hot take - There’s no future path where Americans stay as sick as they are today yet healthcare costs go down. I don’t care what the cost of healthcare is: we can’t drug our way to health when the average person is sick. Fundamentally, it’s why I believe we have to (and will at some point) turn our energies towards making America health again. Hopefully sooner rather than later! 
  

• 🙋‍♂️ Ask - If you (or someone you know) is an employer or benefits broker, we'd love to chat about a new program we're piloting at Truemed to help you save on healthcare spend and improve employee satisfaction with their benefits. Just reply to this email and let me know! 

***

I’ve been fired up to see the chronic disease crisis getting national attention over the last two weeks. I legitimately believe this is the most important issue of our time: if ISIS were to put something in the water that gave 45% of American children diabetes or prediabetes, we’d be up in arms. But because the same thing happens due to regulatory capture and corruption of our food + healthcare systems, the problem continues. 

I’m hopeful we are on the cusp of changing this in the coming decades. And I’m always open to hearing from you all as to ways we can fix this problem faster. 

• Justin