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By Matthew Rees

Food and Health Fact #182:

Replacing the pharmacy with "farmacy"

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Hippocrates, the ancient Greek physician who is credited with laying the early foundations of medicine, is best known for the Hippocratic Oath, which is supposed to guide the doctor-patient relationship (“first, do no harm”).

But Hippocrates said something else that gets much less attention: “Let food be thy medicine and medicine be thy food.”

It’s a timeless truth – but one that has been largely overlooked in U.S. health care. Standard medical treatments for chronic conditions are pills and procedures – many of which have high costs and low levels of effectiveness, while not doing anything to address the dietary patterns that underpin so many chronic conditions.

But what if the default option in U.S. health care was to follow the wisdom of Hippocrates and focus on treating and reversing disease by having doctors prescribing – and health insurers providing – healthy meals for their patients? That was the focus of a Senate subcommittee hearing held this week, chaired by Cory Booker, a Democrat from New Jersey and a leading voice in Congress on changing America’s toxic food culture.

The backdrop to medically tailored meals is the outsized role diet plays in driving disease, disability, and death. For example, 85 percent of all U.S. health-care spending is a byproduct of diet-related chronic diseases.

Just as food can cause disease, it can also reverse it. A recent example comes from a Cornell study that was published in 2020. The study involved 158 patients, and 61 percent of them reversed their type 2 diabetes after following a low-calorie diet and engaging in 150 minutes of exercise per week. And Dean Ornish, of UC San Francisco, has shown how lifestyle changes can reverse heart disease.

The essence of medically tailored meals is they are designed by dieticians to meet the dietary needs of the patients and then delivered to the homes of these patients – many of whom have limited mobility, which inhibits their ability to shop and cook.

The health effects of these meals are shown in a recent study conducted by the Friedman School at Tufts and published in the Journal of the American Medical Association. The study found that patients receiving medically tailored meals “experienced better disease management and had fewer hospitalizations, emergency department admissions, nursing home visits, and lower health care expenditures compared with similar control patients.”

When comparing individuals who have and have not received medically tailored meals, those receiving them had a 37-52 percent lower risk of hospitalization, a 16-31 percent reduction in monthly health care expenditures, and reduced net costs of approximately $2,500 per patient-year. (Another study, published in 2019, reached similar conclusions.)

Treatment that saves money and improves health – why isn’t it the default option for all U.S. health care? One reason is that doctors receive little to no training in nutrition, so they’re not equipped to prescribe food. Another obstacle is that neither Medicare nor Medicaid covers medically tailored meals. And as reimbursement goes, so goes U.S. health care.

There’s some progress underway: California has introduced a pilot program and the Rockefeller Foundation and the American Heart Association are planning to launch a national Food is Medicine Research Initiative next year.

That’s hopeful, but change is very slow in U.S. health care, which is going to mean millions of Americans will continue to be treated with pills and procedures when food could be just as effective – if not more so – and at much lower cost. (Think “farmacy” not “pharmacy.”) Where is Hippocrates when we need him?