The 50-year Failure of American Health Care

America is getting sicker. It's time to look at root causes. It’s time for new leadership

Dr. Marty Makary has a powerful new book, BLIND SPOTS: When medicine gets it wrong and what it means for our health, that came out on Tuesday and instantly hit #2 bestselling book on Amazon. I loved the book and highly recommend it. In this piece, he discusses one of those blind spots of the modern medical establishment—America is getting sicker right before our eyes. We are going backwards. The statistics he cites are sobering, but true, and important for all of us to know as we re-examine our tired old approaches to America’s chronic disease epidemic. We need to address root causes. It’s a great piece, and a sample of what’s in his new book. Enjoy. 

– Vinay Prasad

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The last 50 years of American health care has been a failure. Half of our nation’s children are overweight or obese. Autism has increased 14% each year for the last 23 years. Pancreatic cancer rates have doubled in the last two decades as colorectal cancer increasingly strikes younger and younger people. Polycystic ovarian disease, causing pain and infertility, is epidemic, now afflicting one in eight women. Sperm counts are down by 50% compared to just 50 years ago. Auto-immune diseases have soared to now affect approximately one in five women. And peanut and other food allergies that were rare 50 years ago are now common and can be life-threatening. America is getting sicker. Yet no one in our health care system is asking why.

The medical establishment and insurance entities, including Medicare and Medicaid, don’t seem to be paying attention to our giant blind spots. They’re too busy billing and paying each other to zoom out and look at a macro level. The old guard has chalked up our chronic disease epidemic to “sedentary lifestyle and obesity.” But could it be that American children are not inherently lazy?

Could it be that adults have made them sick?

In the U.S., we’ve poisoned the food supply, engineered highly-addictive additives, and coated food with pesticides. Then as Americans get sicker, we medicate them. What are we doing? We now have the most overmedicated population in the history of the world. Two-thirds of Americans now take prescription medications, including 20% of children.

We need to stop and look around us.

Politicians put shiny objects in front of us, ignoring the core issues in health care. The latest decoy is Medicare’s ability to negotiate drug prices—a $6 billion savings in an expanding $4.5 trillion health care economy. We are missing the forest for the trees.

The best way to lower drug costs is to stop taking drugs we don’t need.

Emerging research is shedding light on where we need to turn our attention. Ultra-processed foods, which are stripped of fiber and chemically modified, function as sugar in the body, stimulating the pancreas to spike insulin levels. This result is widespread rates of obesity and diabetes, which now affect two-thirds of all American adults. Ultra-processed ingredients, chemical additives, and toxins we ingest also increase general body inflammation, a root cause of many inflammatory diseases. For example, seed oils from vegetables like corn and soybeans, are denatured and chemically-modified in production, causing our guts to react to them with an inflammatory response that is often dull and chronic. The result: Americans feel sick. But instead of our government studying the harms of food ingredients like seed oils, they subsidize them.

We also need to examine pesticides, some of which have hormone binding properties in the body. The last half century of carpet bombing our food supply with pesticides may explain why the U.S. has the lowest age of puberty (Africa, which rarely uses pesticides, has the highest).

The modern-day food supply is altering our gut’s microbiome, the bacteria lining the gastrointestinal tract involved in digestion, immunity, and mood regulation via the production of serotonin. If pesticides kill pests, just think what are they doing to the bacteria in our microbiome.

The overuse of medical interventions, such as cesarean sections and antibiotics, are also altering the microbiome. Last year, a study in the Journal of the American Medical Association Surgery observed that early-onset colon cancer was associated with being born by cesarean section, suggesting a central role of the microbiome in cancer. In addition, a 2021 Mayo Clinic study found that antibiotics given to a young child (known to alter the formation of the microbiome), was associated with higher rates of obesity, learning disabilities, attention deficit disorder, and celiac disease later in childhood. It’s no wonder that the increase in chronic diseases and cancers in the last half century parallels the advent of ultra-processed foods, pesticides, and the overuse of cesarean sections and antibiotics, all of which affect the microbiome. It’s no wonder that diseases like inflammatory bowel diseases that were once rare are now common.

Prescribing more medications is not the answer. We need a new approach.

For decades, the root causes of disease have been in the blind spots of modern medicine. We need to pivot our nation’s research priorities to examine our nation’s food supply. We need to talk about school lunch programs, not just putting every obese child on Ozempic. We need to discuss treating diabetes with cooking classes, not just insulin. And we need to study the environmental exposures that cause cancer, not just the chemo to treat it.

The National Institutes of Health has supported some excellent research—I’ve seen it. But when it comes to addressing the root causes of our growing chronic disease epidemic, they’ve put their head in the sand. Earlier this year NIH research concluded that Lucky Charms cereal is healthier than steak. The flawed research created today’s “food compass” guidance now informing school lunch programs and government food assistance programs.

If you want a peek into the NIH’s deeply flawed priorities, consider this. The $81 billion dollar agency has underfunded scientifically sound research on food and instead chose to fund projects like bat coronavirus research at the Wuhan Institute of Virology.

Health care needs new leaders. Our leaders have done a terrible thing to doctors—they’ve told doctors to put their heads down and focus on billing and coding in short visits with patients, as they measure their performance by a doctor’s throughput. We have not given doctors the time or resources to study the root causes of disease. As a result, one-third of doctors are burned out and doctors have the highest suicide rate of any profession. It's time we as a country allow doctors to address the underlying problems making people sick.

At no point in my 22-year career at Johns Hopkins treating pancreas cancer has anyone stopped to ask, “why has pancreas cancer increased in the last two decades?” Instead, the culture of medicine conditions us to focus on putting out fires after it's too late and chase NIH grants on small incremental experiments rather than big ideas. For emergency care, our health care system works like a whistle, but for the biggest health issues facing our country, we’re playing whack-a-mole. And losing.

The declining health of the U.S. population is the number one issue in America today. It results in the suffering of millions of children, fewer eligible military personnel (a national security risk), and a heavy financial cost burdening every family and business in America.

The last four years witnessed the largest decline in trust in the medical profession in American history. Trust in hospitals and doctors decreased from 70% to 40%, according to a JAMA study published last month. We can’t keep going down the same path. We need to turn our attention to look at the big topics in modern medicine’s blind spots. We need to do more than just treat sickness. We need to talk about health.

Marty Makary M.D., M.P.H. is a professor at the Johns Hopkins School of Medicine and New York Times bestselling author of the new book Blind Spots: When medicine gets it wrong and what it means for our health.