Why are the Amish so healthy? The Next #68

Also, the MAHA report and regulating pharma ads

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). 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

Recently the MAHA Report came out came out: the most substantial list of recommendations to improve the health of the country in maybe, well, ever?

One of the changes will put the US on the same footing as every other country in the world (minus New Zealand), and start enforcing existing requirements for pharma ad disclaimers.

How did we get here, and why is this an important step? That’s what I want to explore in this installment of Justin Is Mad At The Great American Poisoning.

Picture this: you're watching TV in 1996 and a pharmaceutical commercial comes on. At that time, pharma ads would contain maybe a brief mention of a drug name, but no flashy visuals of people dancing through meadows while a voice speed reads 17 different side effects.

That’s not the case today. Today, turn on any football game or primetime news network, and you can’t escape the barrage of drug ads promising everything from better sleep, strong bones, or stronger boners (sorry 😬).

In August 1997, FDA leadership released a boring technical guidance document about "Consumer-Directed Broadcast Advertisements." This document changed exactly what pharma companies had to disclose around side effects of their various therapeutics. Before this update, companies had to include what was called a "brief summary": a full page of fine print listing every possible side effect. Fitting that into a 30 second TV spot was essentially impossible, which kept drug ads off the airwaves.

The new guidance offered a clever workaround. Instead of cramming all that legal text into commercials, companies could satisfy FDA requirements by directing viewers to alternative sources: a toll-free phone number, a website, a print ad, or the classic "ask your doctor." Suddenly, pharmaceutical companies could create those dreamy commercials we all know today: happy people doing happy things while a gentle voice mentions that small, rare side effects may include "nausea, dizziness, thoughts of suicide, anal warts etc."

The pharmaceutical industry's response was immediate and dramatic. Television advertising spending literally doubled from $310 million to $664 million between 1997 and 1998. Total direct-to-consumer spending jumped from under $800 million in 1996 to $1.3 billion in 1998. By 1999, it hit $1.8 billion.

Over the next 28 years, as pharmaceutical advertising exploded from that initial $800 million (to over $6 billion/yr today), Americans got sicker. And not just a little bit, but much, much sicker.

Today, the most heavily advertised drug classes (statins, antidepressants, diabetes medications) saw dramatic prescription increases that coincided with peak advertising periods. Meanwhile, prescription drug spending reached $449.7 billion in 2023, representing 11.4% of total healthcare spending (compared to just 7% in the 1990s).

Newborns today are expected to spend 48 years of their lives (for women) and 37 years (for men) taking prescription medications. That's not normal, and not what you see in other countries.

Only two countries in the entire world allow direct-to-consumer pharmaceutical advertising: the United States and New Zealand. That's it. The European Union? Banned. Canada? Banned. Australia? Banned. Japan? Banned. The World Health Organization unanimously recommended against such advertising in 2007.

This is an important step towards breaking the hold that pharma has on our healthcare system. Today, pharma accounts for 27% of primetime news media ad spend! When one industry funds the media, they effectively own it: this is why we’ve seen crazy things like a pharma-funded doctor saying obesity is 100% genetic and kids should be on lifetime Ozempic injections (2), and no mainstream mentions of the many downsides (inflammation, gut issues, etc) that come with Ozempic. It’s also why you saw no coverage of vaccine injuries during COVID, even though such injuries were clearly occurring and tracked in the VAERS database.

So the next time you see one of those beautiful pharmaceutical commercials with people frolicking through fields while a voice lists potential side effects including "thoughts of suicide or death," remember: you're watching the continuation of a failed 28-year experiment. An experiment that has made pharmaceutical companies incredibly wealthy while making Americans sicker, and healthcare more expensive.

💪 Health stuff

What if I told you there's a population living within 50 miles of major American cities where cancer rates are 60% lower than the national average, childhood obesity rates are 4% (not the national rate of 36.5%), and asthma is virtually non-existent?

Let’s talk about the Amish!

The Amish are traditionalist Christians that live a simple, rural life. They live in rural farming communities (mostly in Ohio, Pennsylvania, and Indiana), eschew electricity and other technology, and occasionally discover snapchat filters. Oh, and they also happen to miss out on so much of the chronic disease burden plaguing everyday Americans!

The Amish are incredible, and represent a natural experiment of “what is the health impact of avoiding modern life?”. The answer, sadly, is quite a lot. Their chronic disease outcomes are dramatically better than the average American:

• Amish cancer rates are 40% lower than Ohio population rates, and 56% lower than national rates (1)

• Childhood obesity affects only 4% of Amish children (compared to 36.5% of the general population) (2), and adult obesity rates show similar differences (3)

• Type 2 diabetes occurs at 50% lower rates than non-Amish populations, despite the Amish consuming a high-calorie diet rich in animal products (not that I animal consumption contributes to diabetes, but jussayin) (4)

• Amish children experience almost no allergies: just 7.2% of Amish children test positive for common allergens, compared to over 50% of the general U.S. population (5)

• Asthma affects just 1-2% of Amish children, vs 8-10% nationally (6). In some Amish communities, asthma rates are documented at 0%

In addition, the Amish also have suicide rates 1/4th the national average (7), lower depression rates, and ADHD is nearly unheard of (8).

Worth noting as well that the Amish do deal with increased genetic disease burdens, largely due to the fact that the 300k+ Amish in the US are all descendants of just 750 founders in the 1800s. And those few descendants basically only procreate with one another.

So, we have to ask the question: what is going on here?!?

There are a few things worth calling out. Firstly, the Amish are just flat out more active than your average American. Amish men average 18,425 steps per day (vs 7,605 for non-Amish men), and spend a lot of time farming manually. As (mostly) farmers, they’re also eating a more nutrient-rich, local, and seasonal diet by default: certainly more than your Standard American Diet that’s 55% ultraprocessed.

The Amish are also exposed to drastically fewer environmental toxins. They have no electricity, no estrogenic plastics, no polyester underwear, toxic cleaning detergent, fewer pesticides… the list goes on. Given our insane approach to chemical regulation, I’m sure this has a significant impact on the health differences we see.

The Amish also have far lower vaccination rates than the general population, and tighter social ties. In an era where the average American has something like 0.8 close friends, the Amish live in tight-knit communities and average 75 first cousins (!!) in their community 👫.

Consistently, we have been told that our record rates of chronic disease are high, and there’s nothing we can do about it. It’s just genetics, sorry to hear about your bad genetic draw!

If genetics were the primary driver of chronic disease, we'd expect similar rates of chronic disease regardless of lifestyle. But that's not what we see.

What we see with the Amish is a population living alongside us with dramatically different health outcomes. And - worth noting - they're not even trying to be healthy! There's no Amish CrossFit, no Amish biohacking, no Amish Huberman (though he’d look great with a longer beard). Just a different way of living that avoids many of the ills of modernity.

The Amish serve not as a model to emulate (I'm personally not giving up my light bulbs anytime soon), but as a compelling argument that health improvements are possible when your environment is health-promoting rather than health destructive.

😌 Dope stuff on the internet

Some of my favorite things since the last newsletter:

• 📰 Article - This essay on dating men in the Bay Area is one of the best things I’ve read this year. Her “categories of lost” resonated, as did her overall characterization of what’s going on with men in today’s world:

  • “We no longer have one tribal leader or religious clergy to tell us how a man should act; the unified messaging has vanished. A boy may receive one definition of manhood from his father, another from his teacher, another from his brother, another from Hollywood, and endless more on YouTube. And if the definition is murky, the path to achieving manhood is even more confused.

  • In modern America, a minority of boys are born swaddled in communities that actively guide them through the process of becoming a man. However, most of those communities are religious and conservative, adjectives that the Bay Area actively repels. You won’t find many of those men around here.”

  I really enjoyed this piece and think that of the many problems in society, fixing sex and dating dynamics are among the biggest challenges of our time.
  

• 📚 Book rec - I recently finished For Blood and Money, a book about the crazy world of biotech. I know nearly nothing about this industry and want t oget a better understanding of just how pharma works: the good, the bad (a lot of bad), and the ugly. It’s a thrilling read and very educational - can recommend!
  

• ⌚ Cool product - After 30 days of taking Toku (I’m an investor), a friend saw his LDL cholesterol go down 20 points, and his ApoB go from 108 -> 90. In 30 days!!
  I’m increasingly bullish on Toku as a pre-statin product or statin alternative. If you want to try it for 30-60 days, can use MARES25 to get 25% off.
  

• 🎵 Music - This set from Marsh is fantastic. If you’ve enjoyed his other sets, I think you’ll realy dig this one!
  

• 🏀 Random - I think we have a lot to learn from Singapore and their approach to health and healthcare. It’s honestly astounding that the US has the worth health outcomes and the most expensive healthcare system, and we don’t just look around and go “yup that seems like a good idea - let’s do that”. Alas, change is coming - I am hopeful!
  

• 🔥Hot take - I think we are in inning 1 of understanding how potentially bad many SSRIs are. This podcast hits on a lot of the dangers of SSRIs, and highlighted several things I didn’t know:

  • That suicide rates go up for folks on SSRIs (though of course there sampling bias here), and there are on-the-package warnings about violence and increased rates of suicidal thoughts

  • They are risky to take during pregnancy

  • Tapering off SSRIs is insanely hard, and can take many years!

  • SSRIs seemingly only work in 50-60% of people (compared to 30-40% with placebo), and we still don’t totally understand how they work (or why they have strange impacts on the body, like how fast wounds heal)

  • All of this is concerning given 28% of adult women are prescribed SSRIs at some point, and nearly 20% of women are on them today.

  • If you’re curious, Chris Masterjohn has been going deep on SSRIs. This is an area I want to better understand, and may write about in the future!
    

• 🙋‍♂️ Ask - Speaking of writing, I’d love to hear from you. I’m going to do a reader mailbag section where I answer in-depth some of the questions from this smart crew. Please reply to this email and share any questions or items you’d like me to dig into, and I’ll answer in a future newsletter version!

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That’s all I got this month! Get outside, kiss a loved one, drink your bone broth, and enjoy your brief stint this planet. And, if you have topics you’d like me to dig into, just reply and let me know!

• Justin