THE PHARMACEUTICAL INDUSTRY is staring into an abyss beyond a ‘patent cliff’ as prices for some well-known medications are set to plummet. To survive companies will develop new drugs to maintain revenue flows. But will these be worth the expense, or even be entirely safe? Can Big Pharma’s pursuit of profit be reconciled with the common good?

Ben Goldacre in Bad Pharma identifies the wide-ranging corruption at work in the industry from testing procedures to intensive lobbying with much inbetween.

That situation is complicated in Ireland where the sector has a significant presence. But the government cannot use this as an excuse for bad value – as Minister for Health James Reilly once intimated – or poor health outcomes. Devoting further resources to altering environmental factors, especially diets, will yield greater benefit.

Encouraging the over-use of drugs

Most doctors in this country have, unfortunately, developed in a system that encourages over-use of drugs, and only gradually is this shifting. Moreover, patients who present for examination expecting to be given a drug don’t take kindly to being told to take more exercise or reduce their sugar intake.

All drugs have side effects, sometimes fatal. Remarkably iatrogenic disease (caused by medical interventions including drugs) is the third largest cause of mortality in the US. Ireland is unlikely to be far behind.

Of course medications like antibiotics can be life-saving. I once developed an abscess while living in a Third World country and only antibiotics ended the agony of this life-threatening condition. But disease prevention is a more sensible and cheaper strategy.

Dietary Intervention

Spending the last 20 years of our lives in the grip of an expensive medical system can be tantamount to hell on earth. Prevention of chronic disease would bring immeasurable economic benefits, and increase happiness. The good news is that for most of us lifestyle changes, especially to diet, can dramatically increase our chances of maintaining health into old age.

Genetics are NOT the key determinant of health. Population studies begun 40 to 50 years ago show that when people migrate from one country to another, they acquire the cancer rate of the new country to which they have moved. Further, the obesity pandemic, the underlying cause of so many chronic conditions, is the product of Western lifestyle especially diet.

The present Irish diet is woefully short on fibre and most other nutrients that can be derived from plants and far too high in meat: we ate a staggering 106.3 kg of meat on average per person in 2002 (up from 55.5kg in 1961) much of it red and processed.

Becoming a vegetarian substantially lowers the risk of developing most chronic diseases and increases life expectancy according to a long-ranging Oxford study which adjusted for social class and smoking.

Above all refined sugar, described by Robert Lustig as ‘the Professor Moriarty’ of the obesity pandemic should be removed from our diets insofar as possible. This is a major challenge: in the United Sates of the 600,000 food items for sale 80 per cent are laced with sugar, and in Ireland we aren’t far behind.

Bioavailability

Human nutrition is a dynamic, highly complex exchange. It cannot be simplified as a static requirement for isolated nutrients. According to T. Colin Campbell: ‘there is almost no direct relationship between the amount of a nutrient consumed at a meal and the amount that actually reaches its main site of action in the body – what is called its bioavailability.’

Nutritious whole foods offer the best pathways for absorption. Yet a multi-billion dollar supplement industry attempts to delude us into thinking our health will be served by drawing nutrition from pills. In fact studies have shown how supplements including Vitamin E, Omega 3 and Beta-carotene may be dangerous.

Edible plants contain an array of healthy compounds that cannot effectively be bottled or rendered into tablet form. One study has shown that the vitamin C-like activity from 100 grams of whole apple was an astounding 263 times as potent as the same amount of the isolated chemical.

According to Jo Robinson in Eating on the Wild Side: ‘More than eight thousand different phytonutrients have been identified to date, and each plant produces several hundred of them. Many of these compounds function as potent antioxidants’. She adds: ‘The universal health advice to “eat more fruits and vegetables” is woefully out of date. We need good advice on which fruits and vegetables to eat.’

Bread of hell

One truly lamentable feature of present-day food is the degeneration in the quality of bread. ‘The staff of life’ has become the stuff of nightmares. It began with the medieval aristocratic fetish for white flour, a fashion that spread to the rising bourgeoisie who were wary of the tendency of bakers to adulterate brown bread.

Development of roller mills in the middle of the nineteenth century made white flour cheaper and whiter than ever before, allowing the poorer classes to participate in what Michael Pollan refers to as ‘a parable about the folly of human ingenuity’.

The production of white flour removes most of the wheat germ and bran which contain an array of nutrients that cannot adequately be restored through fortification. Pollan says: ‘Either there are synergies at work among these nutrients, or there is some x-factor in whole grains that scientists have yet to identify.’

The decline in the quality of bread is also linked to the post-WWII Green Revolution which emphasised high yield over nutritional quality. Modern dwarf wheat cultivars have a poor nutritional profile compared to older varieties and require synthetic inputs to grow.

As Steve Jones, the former wheat breeder for the state of Washington puts it ‘Wheat breeders are selecting against health.’ Probably for this reason many people are now intolerant to wheat and turn to alternative grains such as rye, spelt and khorasan.

The alternative

Worse still the Chorleywood Bread Process has turned most bread into indigestible stodge. Invented in 1961, and known as the ‘no-time method’ about 80 per cent of our bread is currently prepared using this method, which involves a super-quick fermentation. The slow maturation of dough is replaced by a few minutes of intense mechanical agitation in special high-speed mixers. This sounds miraculous, but solid fat is necessary to prevent the loaf collapsing and a far greater quantity of yeast is required than in traditional recipes.

The alternative is for more people, including children in schools, to learn the traditional sourdough preparation of wholegrain bread which synthesizes vitamin and protein compounds and makes allows us to absorb more of its nutrients.

The failure of our government to challenge Big Pharma and Big Food shows how effective lobbying by large corporations can be. It is left to concerned individuals, as part of civil society, to challenge a pathogenic status quo.

Frank Armstrong teaches an open access course in UCD on the Politics of Food.