If Canada's wrangling provincial and federal leaders were serious about securing the future of medicare, they would consider putting the next batch of money into prescriptions for food, not drugs.
Just swipe your health card through the cash register when you buy healing munchies and you'll save the health care system a bundle, food visionary Brewster Kneen proposed a decade ago.
And while this is way off the government's radar, the truth remains: any plan to sink the next health care mega-expenditure into drugs almost automatically means high-tech medical cures, not disease prevention, will continue to soak up the lion's share of health dollars.
We now have a hundred years of welfare-state history upholding the Iron Law of Leopard Spots, which states that institutions set up to produce energy cannot learn to conserve it, agencies set up to police criminals cannot learn crime prevention, departments set up to cart away waste cannot learn to treat it as a resource, and medical systems - including drug companies - set up to treat diseases cannot learn to promote health.
I'm not trying to be dismissive of the provincial leaders' probably doomed pharmacare bid. Drugs, after all, are an essential part of health care treatment, so logic requires that they should be accessible to all people, regardless of income. There is certainly no equity in the present system, which leaves one person in 10 with no drug coverage. Pharmaceuticals now account for over 16 cents of each taxpayer's health care dollar - still less than hospitals, which spend 30 cents of that dollar, but more than doctors, who cost less than 13 cents.
One of the biggest arguments for a publicly funded plan is made by Toronto emergency physician Joel Lexchin, who has long proposed controls on drug companies. He argues that a unified government scheme can strike hard bargains with pharmacists over dispensing fees and with companies over prices, and rely more on low-cost generics. That said, the problems with comprehensive government funding of pharmaceuticals are awesome.
To start with, there's no evidence that the rise in drug use has done anyone's health any good. There's not much more hard evidence on pharmaceutical weapons of mass healing than there was on Iraq's weapons of mass destruction. While governments won't spend a dime to prevent disease until supporters make a bulletproof case that the proposed preventive measure will do the trick, the burden of proof is much lower for pills that claim to cure.
A study by Steven Morgan and Donald Willison for the Canadian Institute for Health Research shows that there's not even a system for gathering evidence on the impact of drugs.
The lack of data collection is worrisome given estimates of what are called iatrogenic diseases - illnesses caused by improper medical treatment or drugs. In the U.S., where a paranoid and litigious culture ensures more careful tracking of such trends than in Canada, a 1998 report in the Journal of the American Medical Association linked drug-related injuries to 6 per cent of hospitalized patients. Before we cart more scarce taxpayer dollars up to the black hole, we should know what we're getting for our money.
Then there's the fact that government financing of drug plans creates knotty conflict-of-interest issues. It's a difficult cross-pressure when a government is expected to stand up for consumers and bargain with the same global corporations that can threaten to stop research and manufacturing here if they don't get the prices and patent protection they want.
Big Pharma is also linked to conglomerates that trade in GE seeds, another R&D opportunity much sought after by governments and universities, both likely to be involved in reviews of a company drug.
Drugs are about treatment, not cure, and certainly not health promotion. But medicine once linked treatment with prevention. When doctors take the Hippocratic Oath, they honour a founder of medicine who said, "Let foods be thy medicine." When doctors fill out an Rx, that's a reminder that recipes were what medieval European doctors prescribed. Today we talk about nutriceuticals and superfoods, foods that can compete with drugs in terms of their specific properties.
New and surprising evidence about commonplace foods comes out almost every day. In time for this summer's berry season, a report to the American Chemical Society by Dr. Agnes Rimando of the U.S. Department of Agriculture's Natural Products Utilization Research Center outlined the mechanisms allowing blueberries to lower cholesterol counts more efficiently than commercial drugs.
The same point was made more generally in 2001 by Dr. David Jenkins of Toronto's St. Michael's Hospital when he showed that volunteers fed a "primitive" diet of nuts, berries, roots and fruits saw their cholesterol levels drop 22 per cent in two weeks, much faster than on the popularly prescribed statin drugs.
This month, the Journal of Nutrition reports that sulforaphane in broccoli can disrupt the cell divisions that lead to breast cancer. The same compound was identified by Johns Hopkins researcher Jed Fahey as more efficient than commercial drugs in clearing up ulcers. This is a lifesaver for people in Africa, Asia and South America who can't afford drugs, Fahey said.
This suggests the reason why there's no trend toward food-based treatments in the medical system. Foods require no specialized degrees or prescriptions written in a dead language and confer no job monopoly on anyone. Worse still, foods are not made of scarce materials that can be patented by corporations. Why can't the health care system pick up the cost of local, fresh, nutrient-rich foods that have documented medical benefits?
The fact that leaders responsible for health policy talk about drugs instead of food is a chilling reminder of the chasm between political dogma on conventional medicine and the wellsprings of health.