Earlier blogs have discussed the pros and cons of drugs, but food is the most important thing any of us ingests and it seems foolish to not pay careful attention to what we choose to eat. In the past 12 years, three books have had a major influence on how I think about modern medicine: Marcia Angell's, The Truth about the Drug Companies, Michael Pollan's, Omnivore's Dilemma, the Robert Whitaker's Anatomy of an Epidemic. One might ask how books about pharmaceutical companies, industrial agriculture, and the long term effects of psychiatric medications might relate to one another and I will try to answer that in this blog.
As Whitaker notes, the discovery of the antibiotics changed medicine. It led to a hope that more effective drugs, "magic bullets," would be found for other diseases. I would argue that this optimism about our ability to solve and fix problems in medicine was part of a larger optimism that gripped western culture in the post World War II years. Agriculture changed dramatically. Chemicals that were used in explosives were found to be powerful fertilizers and this contributed to the development of industrial agriculture. In the US, policy favored the development of large farms and the entire nature of our agricultural system was transformed. Rather than have farms that grew a variety of crops and raised different kinds of livestock, farms became large and they focused on one product. Animals and produce became commodities.
Whitaker pointed out in Anatomy of an Epidemic, that when one gives a drug that alters the action of a neurotransmitter, the body has ways of adapting and adjusting. This tendency is known as homeostasis. He raises the concern that the body's homeostatic response to psychiatric medications may cause problems over time that may be worse than the condition they were meant to help. This plays out on a larger scale in nature. We are part of an ecosystem. If one perturbs one part, it has ripple effects on the entire system. Antibiotics may cure a particular infection in a particular individual. When an antibiotic is used over time, however, the organism the drug targets evolves and develops ways to survive exposure to the drug. Animals on industrial farms are overcrowded and this makes them sick. In order to keep them alive until they can be slaughtered, they are fed antibiotics. Pharmaceutical companies sell more drugs to farmers to use for livestock than they sell for use in humans. This practice may be contributing to the development of extremely dangerous strains of bacteria. Similarly, large monocultures of crops may develop sensitivity to parasites. Although pesticides might help to fight these infections, over time the parasites will develop resistance. In contrast, as Pollan describes in his book, farms that have multiple crops develop ecosystems that are healthier for the crops and livestock and eliminate the need to use pesticides and antibiotics. This is healthier for our environment and healthier for us.
As farmers became more effective at growing food, they needed to grow their markets. This led to the growth of the food processing business. If you go into a modern supermarket, there are food products - typically in the middle isles - that have been around for less than 50 years. These foods are mostly made of corn, an incredibly versatile and cheap food. High fructose corn syrup may not be an inherently dangerous food - or at least no more dangerous than cane sugar - but it is so cheap and abundant that food processors can pack high quantities into many products and there by increase not only their appeal to us (more on that in another blog) but also the amount of calories we are consuming with very little effort. This is likely a major contributor to the increase in obesity in our country. Obesity has been a major factor for the increase in a number of chronic illnesses such as diabetes and high blood pressure.
This has been an extremely profitable venture for food processors. The use of pharmaceuticals has been extremely profitable for the drug companies. This gives them enormous clout in the advertising and political worlds. We have a food and medical system that is geared towards making us sick and then treating those illnesses. In future blogs, I will write more about food and behavior and ways we can reverse some of the cultural trends that promote diet related illness.
Note: I did not put references in the blog but the ideas derive largely from the books cited above. Any flaws in the argument reflect on this author and not the authors of those books.
Anatomy of a Psychiatrist: Dr. Steingard chronicles how she is integrating information from Anatomy of an Epidemic into her community mental health practice. She also discusses changes in Vermont's mental health system and the influence of pharmaceutical advertising on clinical practice.