Sick Planet: Corporate Food and Medicine

by Stan Cox

Overview

Neoliberals often point to improvements in public health and nutrition as examples of globalisation's success, but this book argues that the corporate food and medicine industries are destroying environments and ruining living conditions across the world.

Scientist Stan Cox expertly draws out the strong link between Western big business and environmental destruction. This is a shocking account of the huge damage that drug manufacturers and large food corporations are inflicting on the health of people and crops worldwide. Companies discussed include Wal-Mart, GlaxoSmithKline, Tyson Foods and Monsanto. On issues ranging from the poisoning of water supplies in South Asia to natural gas depletion and how it threatens global food supplies, Cox shows how the demand for profits is always put above the public interest.

While individual efforts to "shop for a better world" and conserve energy are laudable, Cox explains that they need to be accompanied by an economic system that is grounded in ecological sustainability if we are to find a cure for our Sick Planet.

Product Details

ISBN-13:	9780745327402
Publisher:	Pluto Press
Publication date:	05/20/2008
Edition description:	New Edition
Pages:	224
Product dimensions:	5.32(w) x 8.46(h) x 0.60(d)

About the Author

Stan Cox is a senior scientist at The Land Institute in Salina, Kansas. He worked for the US Department of Agriculture from 1984 to 1996 and has a Ph.D. in plant genetics.

Read an Excerpt

CHAPTER 1

HEALTH CARE'S MALIGNANT GROWTH

In March 2006, a Lafayette, Louisiana cardiologist was indicted by federal prosecutors on 94 counts of fraud. Accused of performing unnecessary angioplasties, stent replacements, and other heart procedures, he was also hit with a civil suit by more than 300 patients who claimed they had been mined for profit. A year later, as the cardiologist still awaited trial, a research report in the New England Journal of Medicine showed that many, perhaps most, of the million or so legitimate angioplasty and stent procedures done every year in the United States probably give little or no lasting benefit.

On 23 January 2007, the Parker Hughes Cancer Center in Roseville, Minnesota filed for Chapter 11 bankruptcy. Its founder's state medical license had been revoked in 2006, three years after an investigative series by the Minneapolis Star Tribune revealed that the Center had been subjecting cancer patients to excessive testing and treatment. The paper accused Parker Hughes doctors of milking Medicare and private insurers by claiming that they could cure incurable malignancies and by having patients return as often as four times a week for unnecessary examinations and ineffective, often grueling, treatments. One surgeon who reviewed a typical case wrote to the state Medical Board that a patient's treatment had been extended "for profit, long after there was even the remotest chance for her obtaining any benefit from it."

Also in January 2007, the state of Illinois joined a lawsuit against twenty magnetic resonance imaging (MRI) operators in the Chicago area for allegedly paying kickbacks to doctors who helped keep their machines supplied with patients. Around the same time, federal prosecutors filed suit against a Florida radiologist for offering deals that could potentially net doctors or chiropractors as much as $30,000 per month in insurance payments so long as they referred enough patients for imaging procedures.

Medical scams lure countless trusting patients into unnecessary treatment each year, but renegade doctors and clinics didn't create America's epidemic of overtesting and overtreatment. More imaging machines are kept humming every year, more blood vials are kept filled, and more hospital beds are kept occupied by good old respectable market forces.

For example, perfectly legal businesses like HealthFair USA and Life Line Screening offer ultrasound screening of arteries in the neck, abdomen, and legs, with fees running in the hundreds of dollars, depending on the number of arteries checked. The services can be arranged through websites, mail solicitations, or toll-free numbers advertised on the radio, or they can be done on the spot at "screening fairs" conducted via mobile labs. Faced with the popularity of ultrasound testing, federal and state public health authorities have advised people without known risk factors to avoid subjecting themselves to such mass screening programs. False-positive results can turn healthy people into patients, subjecting them to further unneeded diagnostic procedures and possible treatment. Critics blame a host of other, more well-established tests, led by high-resolution mammography and the prostate-specific antigen test, for drawing throngs of healthy people into further, unneeded medical intervention.

"You can't live without it!" is one of advertising's oldest and most well-worn slogans, even though it's almost never literally true. But the medical profession intends to be taken literally when telling potential customers, "If you don't buy what we're selling, you run the risk of death or grave illness — and we can show you the evidence!" Nowhere, except maybe in the military-industrial complex, do business interests and life-and-death decisions intermingle as freely as they do in today's medical industry. And if there's any product that, to use another slogan of commerce, "sells itself," it's health care. That has helped it become America's premier growth industry, rising from 5 percent of the US economy in 1960 to 16 percent today.

"IF THEY BUILD IT, WE'LL FILL IT"

When the people and companies who do medical testing and diagnosis are connected to — or even the same as — those who do the treatment and surgery, the profitable opportunities multiply. Time magazine put it this way in a 2006 article on "The hospital wars": "Since physicians get paid through fee-for-service rather than, say, for curing their patients, their primary incentive is to do more stuff."

And when doctors have a stake in diagnostic facilities, they have both the motive and the means to "do more stuff." For example, increasing numbers of doctors have been investing in their own MRI scanners, at prices ranging from $600,000 to $2 million apiece. Doctors, hospitals, and diagnostic centers did half a billion scans in 2006 alone. Some authorities are looking at the 40 percent increase in use of MRIs and other imaging procedures in the US since 2000 and wondering how many of those tests have been ordered solely for profit.

Back in the 1960s, a California study showed that when physicians owned X-ray facilities, their patients ended up being X-rayed twice as often as patients whose physicians referred them to outside labs. Three decades and several technological leaps later, the federal Government Accountability Office (GAO) studied records of almost 20 million office visits and found that doctors who had their own imaging equipment used the techniques two to five times as often as doctors who didn't. Syracuse, New York has become what a 2004 New York Times article called the "unexpected epicenter for a high-tech medical arms race," with physicians throughout the city installing MRI machines in their offices; not unexpectedly, the number of scans shot up 23 percent in a single year.

If you divide the price of a typical MRI machine by the typical fee a doctor collects for a scan, the result suggests that the doctor's first 2,000 to 3,000 scans will pay back the purchase price. Once that's done, additional scans generate what one health economist called "almost pure profit." The proliferation of diagnostic equipment can have ripple effects that drive its use even higher. A recent review of the overuse of radiological testing concluded that "even in the absence of financial incentives, the mere availability of imaging technology in a nearby convenient location will lead to increased utilization." As can be seen from Table 1.1, excessive testing has become a fact of medical life in America.

That much superfluous testing is certain to result in a lot of unnecessary activity "downstream": more visits to doctors, more prescriptions written, more hospital admissions, more surgeries. One study found that if, say, 100 patients are each subjected to ten random diagnostic tests, around 40 of them will be "found" to have a problem that isn't really there. A nationwide study of medical records by researchers at Georgetown University found large numbers of unwarranted urine analyses ordered for patients between 1997 and 2002. Those tests would have led to as many as 28,000 unnecessary kidney biopsies, resulting in almost 1,500 cases of medical complications and thereby creating a new wave of patients with new problems.

Asked by CBS News to respond to the Georgetown study, Robert Schwartz of the Miami University medical school cogently summed up the potential results of excessive testing:

It happens all the time ... The patient has no symptoms and doesn't smoke, but he gets a routine chest X-ray. If there is a small shadow, doctors are obligated to look further. That X-ray becomes a CT scan. That may show a small little nodule. The next thing you know, the patient ends up with a cardiothoracic surgeon who wants a needle biopsy, or even an open biopsy ... In a lot of these cases, he comes up with nothing, a benign nodule or something.

Aggressive testing and treatment by a few for-profit medical facilities in a community can propel others in the same direction. The CEO of the four-year-old Green Clinic Surgery Hospital in Ruston, Louisiana told Time that competition from his clinic prompted a nearby regional hospital to respond with a "spending binge" that quickly ran the facility deep into debt, and into the arms of a new, for-profit owner. Meanwhile, the sprouting of physician-owned diagnostic and surgical centers across Wichita, Kansas has driven two big non-profit hospitals to invest in tens of millions of dollars' worth of new buildings and diagnostic equipment. Of that and other projects going on across the country, Time concluded, "If they build it, we'll fill it."

Business columnist Steven Pearlstein of the Washington Post has formulated what he calls "Pearlstein's First Law of Health Economics," which states that "if you pay doctors on the basis of how many procedures they do, and you leave it to doctors and their insured patients to decide how much health care they get, consumption of health services will rise to whatever level is necessary for doctors to earn as much as the lawyers who sue them."

Demand for more and more medical services is pumped up not only by excessive testing but also by a general "medicalization" of the human condition, as we'll see in the next chapter. Later chapters will examine ways in which other parts of the economy, led by agriculture and the huge industries that it feeds, is helping to create a nation of unhealthy people living in unhealthful environments — in other words, a permanent customer base for Big Medicine. And the health-care system has an unfortunate tendency to recycle its own customers: The National Academy of Sciences estimated in 2000 that so many people are sickened or injured by medical error that each year between 44,000 and 98,000 patients actually die as a result. Meanwhile, an estimated 4 percent of all hospital admissions are related to preventable problems caused by medication.

If you're looking for scapegoats on whom to pin blame for the excesses of American medicine, there's no shortage of targets: malpractice lawyers accused of pushing doctors into "defensive medicine"; a private insurance system that pays for needless treatments; Medicare, blamed for inviting seniors to extra helpings of health care they wouldn't otherwise have or even need; patients who, it's said, will accept any treatment as long as someone else is paying; or those few "bad apples" running scams.

There is some truth to each accusation: Public and private insurance, the legal system, and our medicalized culture all really do work alongside overactive diagnostic labs to help feed medicine's out-of-control growth. But those aren't root causes; rather, they're a few prominent mechanisms among many by which the health-care system manages to snatch one dollar out of every six that flow through the economy. They all work together in the same direction — toward malignant growth — and they meet very little resistance along the way.

AN UNHEALTHY INDUSTRY

Debates about America's health-care crisis tend to focus on outrageous costs and the chronic lack of access for low-income and uninsured people to good-quality care. But flip that terrible problem over and you'll see its other face: a superabundance of medical services beckoning those patients who can afford them. As one observer put it, the system is suffering simultaneously from underuse and overuse.

Access to adequate health care as a right of all the planet's people is recognized in the United Nations' 1948 Universal Declaration of Human Rights and subsequent international agreements. The United States stands alone among the world's wealthy nations in having no national policy guaranteeing affordable medical care for all. If someday we do manage to ensure that all Americans get all necessary health services, it will finally put an end to our national shame. But while delivering universal medical care would make the system more humane, it wouldn't make it sustainable. If that new system is also required to support the kind of huge corporate structure that the current system supports, and if the quantity of care to which people are entitled is not limited by something other than their income, the industry's environmental impact will grow worse rather than better. Like any overheated industry, American heath care is anything but environmentally benign. It's frittering away resources and throwing off wastes like, as the saying goes, there's no tomorrow. An industry dedicated to health ought not be feeding the endless economic growth that threatens the biological systems on which human health depends. But it is.

Big Medicine is a voracious eater of resources, as anyone who's been inside a well-furnished doctor's office or hospital in recent years can attest. In 2006, the US medical industry had $22 billion worth of buildings under construction or renovation — the biggest boom in half a century, predicted to last through the following decade. And despite a few environmentally friendly construction projects in recent years, the current hospital-building frenzy is coming down with the heavy impact that any construction boom tends to have. A report in the trade magazine Health Facilities Management summarized a nationwide survey of the "red-hot construction market that's reshaping the face of health care delivery." It extolled trends toward larger, more soundproof patient rooms, fewer shared rooms, nurses' computers in every room, wireless infrastructure alongside extra cabling and conduit, and of course, more and bigger electric power plants. But read through the report's 2,700-plus words, and you'll find not a single mention of energy conservation or other environmental issues.

A hospital bed in America generates 8 to 45 pounds of waste every day, seven days a week. That includes office paper, food, IV bags, gauze, syringes, human body parts, drugs, toxic agents used in chemotherapy, heavy metals, radioactive wastes, and much more. A typical pound of hospital waste contains three times as much plastic as does a pound of household trash. Much of that plastic is polyvinyl chloride (PVC), which can leak toxic chemicals; without being aware of it, patients can be mainlining those toxins via intravenous drips. PVC can also emit highly carcinogenic dioxins when incinerated. Research is showing that many drugs, including chemotherapy agents, psychiatric drugs, anti-inflammatories and even caffeine, can pass, still in an active form, through bodies and into sewers and waterways. The sewer lines under hospitals and clinics are teeming with such compounds. Not all the drugs have passed through a kidney; unwanted or expired medications are often just dumped or flushed as well. Then there are "upstream" ecological costs; for example, the long, toxic history of a pair of latex or vinyl gloves that may be used for only a few seconds and discarded. Even way back in 1994, US hospitals were using 12 billion such gloves a year.

The federal Centers for Disease Control and Prevention (CDC) estimates that 2 million people per year contract infections in America's hospitals, and that about 90,000 die from those infections. As hospitals work to fend off the bacterial onslaught with disposable supplies and chemical disinfectants, autoclaving, and incineration, they chew up even more resources and spit out more wastes. By one estimate, "Treatment of the side effects of treatment accounts for about a third of all medical care." And these days, detection and prevention of disease can be at least as resource-intensive as treatment. CT scanners, PET scanners, MRIs, and good old-fashioned X-ray machines are being joined every year by an alphabetful of new, improved contraptions. Diagnostic devices require huge computational power, heavily braced walls, vibration-resistant floors and/or lead shielding, and a big power grid on which to suck.

Andrew Jameton is a philosopher, a section head at the University of Nebraska Medical Center (UNMC) in Omaha, and one of the few academics willing to tackle the question of how to shrink medicine's big ecological footprint by shrinking the medical industry itself. In his office he has a simple diagram illustrating the cycle he sees driving the industry's rapid growth: "Big Medicine -> Big Economy -> Death of Nature -> Poor Public Health -> Big Medicine." As he took me on a backstage tour of UNMC, Jameton likened the typical American hospital's environmental wallop to that of a combination 24-hour hotel, truck stop, restaurant chain, office building, university science department, shipping company, and big-box retailer. He argued that there's an ethical imperative to rein in a system whose headlong growth seems to be producing more profit and less health. "But if you try to talk about ecological limits in the medical professions," he told me, "it's not a welcome conversation."

(Continues…)

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Excerpted from "Sick Planet"
by .
Copyright © 2008 Stan Cox.
Excerpted by permission of Pluto Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Preface
1. Health care's malignant growth
2. Feeling OK? Are you sure?
3. Side effects may be severe
4. Swallowing the Earth whole
5. "Agroterrorists" can take a vacation
6. Down-to-a-trickle economics
7. Supernatural food
8. The world is your kitchen
9. Political impossibility vs. biological impossibility
Notes
Further Reading
Index