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Recent Second Opinion: Post-Election Predictions for Obamacare Improving the FDA's REMS Program Are Foreign Clinical Drug Trials Safe? FDA's Bad Ad Program Obesity and Public Health The Route to Reconciliation Conflict of Interest Analyzing the Healthcare Bills President Obama's Plan for Reform The Healthcare Reform Debate Priorities for the New FDA Commissioner PhRMA's New Marketing Code Personal Genetics Testing Where health care policy experts have their say Sources of Medical Research Funding Off-Labeling Marketing
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Second Opinion: May 5, 2010:
States and cities are considering myriad initiatives to combat obesity from junk food taxes to expanding access to fresh fruits and vegetables in low-income neighborhoods. First Lady Michelle Obama has even launched a high profile campaign to end childhood obesity, dubbed "Let's Move." For this edition of our Second Opinion forum we've asked policy experts how important they think obesity ranks as a public health issue and what they think are the most effective public or private responses given concerns about how America's growing waistline is affecting U.S. health care spending. This edition of our expert panel includes:
People claim that obesity is a menace to public health and public finance. It is only a public health issue because Medicare and Medicaid pick up about half of the annual $100+ billion bill for obesity-related illness. In addition, obesity is produced by a complex array of perverse incentives. These include subsidies that make highly-processed, unhealthy foods cheaper than they would otherwise be. They also include transportation subsidies that make driving more attractive than biking or walking. Policy makers are, unfortunately, taken with the idea that they can design a system of food production, transportation, and health care delivery that will solve the obesity problem. They ignore one of F.A. Hayek's most important insights: "The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design." The right path for policymakers is not to do more, but to do less: tax less, subsidize less, and plan less. Don't punish people for making good decisions, and don't subsidize people for making bad decisions. Art Carden is an Assistant Professor of Economics and Business at Rhodes College in Memphis , Tennessee . In addition, he is an Adjunct Fellow with the Independent Institute and a member of the Adjunct Faculty of the Ludwig von Mises Institute. This week, Carden discusses his research on how Wal-Mart's revolutionary product distribution system sharply lowers food prices facing consumers—and may also affect obesity rates in the U.S. * * *
Rational persons constantly trade off health for competing goods, such as pleasure, income, time, and alternative consumption possibilities. Intervention that considers such tradeoffs unworthy of consideration is paternalistic. This is recognized in such areas as highway safety—no one proposes to shut down highways in order to reduce traffic deaths or to force automobile manufacturers to equip their cars with engines that limit top speed to 25 miles per hour—but the principle that legitimizes trade-offs involving life and health is equally applicable to obesity. The point is not that governmental efforts to control obesity should be ruled out of bounds a priori, but that all relevant costs and benefits of such efforts should be considered. Tomas Philipson is the chairman of the Manhattan Institute's Project FDA, professor at the Harris School for Public Policy at the University of Chicago, former Bush Administration Senior Economic Advisor to the head of the Food and Drug Administration (FDA) during 2003-04, and Senior Economic Advisor to the head of the Centers for Medicare and Medicaid Services (CMS) in 2004-05, talks to Paul Howard about comparative effectiveness research. * * *
After an exhausting debate, Washington passed legislation extending health coverage to millions. But here's the problem (besides the price tag): there is perilously little evidence that Americans will be any healthier for the effort. Indeed, despite the incredible advances in medical science, Americans have become paradoxically less healthy in recent years. More than a third of the adult population is now obese—nearly triple the percentage from the 1960s. Yes, this is an issue of health (hospitalizations due to childhood obesity have gone up three fold between 1999 and 2005), but also fiscal health (in one study, almost 50% of the recent rise in Medicaid costs is attributed to obesity), and even national security (brigades worth of willing volunteers for Iraq and Afghanistan were turned away because of their poor physical conditioning). What's to be done? State and federal governments can get smart: let's stop subsidizing cheap sugar (with agricultural handouts) and junk food in our schools (with poorly conceived school lunch programs), and let's make it easier for employers to design health-insurance plans that reward wellness. But let's also remember that not everything requires a government response. Have a home-cooked meal with your family tonight. It's important. David Gratzer, a physician, is a senior fellow at the Manhattan Institute. His research interests include consumer-driven health care, Medicare and Medicaid, drug reimportation, and FDA reform. The late Milton Friedman, Nobel Laureate in Economics, wrote that Dr. Gratzer is "a natural-born economist." David Gratzer's most recent book, with Foreword by Milton Friedman, is The Cure: How Capitalism Can Save American Health Care (Encounter Books, October 2006). * * *
Obesity is a very pervasive public health problem that sends its tentacles out to all aspects of disease and prevention. First, it leads directly to our biggest killers—heart disease, cancer, strokes, diabetes. Second, it combines synergistically with other health risk factors—decreased exercise, sedentary lifestyle, poor diet, to accelerate the diseases I mention above. Third, it is a form of addiction. eating fats and sugar causes the brain to rely on these foodstuffs before making its own opiates (endorphins) as well as interfering with how dopamine is metabolized. Obesity is also genetically regulated, as susceptibility varies. Overall, there is no greater health problem in developed countries. Marc Siegel MD is an Associate Professor of Medicine and a Fellow in the Master Scholars Society at New York University School of Medicine, a columnist for the Los Angeles Times and a Fox News Medical Contributor. * * *
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