November 2008

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Vol. 7, No. 11

John McDougall, MD

The First Imaginary Conversation between President-Elect Barack Obama and His Newly Appointed Surgeon General, John McDougall, MD

Date of 1st Meeting: November 30th, 2008

Barack Obama invites us to share our vision:
Write to him and include this letter.
(copy and paste the interview below into the submission form on Obama's website)

Obama: Welcome to the job. I want to be clear that I have appointed you because I need someone who has new ideas that will inspire change.  My one fear is that Congress will not confirm your appointment because many of the members represent interests of the food and drug industries—and you are well known to be a strong critic of both.

McDougall: I voted for you because I believe you are, foremost, interested in the welfare of people, not only Americans, but everybody. Being intelligent, articulate, and appearing unafraid also helped sway my vote.

The US Department of Health and Human Services says, “The Surgeon General serves as America's chief health educator by providing Americans the best scientific information available on how to improve their health and reduce the risk of illness and injury.” With two notable exceptions, which I will talk to you about later, the Surgeon General’s office has failed the American public. I am a general doctor; you should expect my interests to be solely focused on the welfare of people, not industry.

Obama: You will be perfect; the Surgeon General functions as the nation’s family doctor. I fully realize restoring health to America is fundamental to our success in all areas, including the economy and the two wars we are fighting. So where do we begin?

McDougall: The urgency to fix the broken health of this nation is as great as solving the housing and economic crises that you are facing. More than 80% of our health problems are from our food choices. After the age of 30, in our country, almost everyone is overweight, on medications and/or has risk factors, like high cholesterol and high blood pressure, which predict premature disability and death.  You have been asked to lead a nation of sick people, which compounds the difficulty of solving every one of your other problems.

Fortunately, there is one single big solution that will revitalize our citizens, cut food and health care costs, and reduce environmental pollution, overnight: reestablishing the natural human diet. If you will reflect for a moment on your life experiences you will quickly understand what I am talking about.

You lived for 4 years in Jakarta, Indonesia (1967 to 1971) and in 1988 you spent 5 weeks in Kenya.  Do you remember the diets of these people?

Obama: Rice was the staple food in the Indonesian diet. In Kenya they eat a ground corn flour mixed with water called ugali. They also eat lots of green vegetables, beans, breads, rice, and a little meat and milk.

McDougall:  I realize you were only a young boy then, but when you lived in Indonesia 98 percent of the calories people ate came from plant-food sources. Even today, the Kenyans ingest about 77% of their total daily calories from carbohydrates, primarily from starches.

The importance of starch as the natural human diet is resurging. Corn, beans, and squash—the three sisters of American Indian agriculture—will appear on the nation’s one dollar coin next year.  The United Nations has declared 2008 the International Year of the Potato in order to address global concerns, including hunger, poverty, and threats to the environment.

All large populations of trim, healthy people, throughout written human history, have obtained the bulk of their calories from grains, tubers, and legumes.  You have read history books about this and have witnessed this effect first hand in your extensive travels. 

Mr. Obama: Here Is a Partial List of Historical Examples of Starch-Based Diets

Barley – Middle East for 11,000 years

Corn – Central and South America for 7,000 years

Legumes – Americas, Asia, and Europe for 6,000 years

Millet – Africa for 6,000 years

Oats – Middle East for 11,000 years

Potatoes – South America (Andes) for 13,000 years

Sorghum – East Africa for 6,000 years

Sweet Potato – South America and Caribbean for 5,000 years

Rice – Asia for more than 10,000 years

Rye – Asia for 5000 years

Wheat – Near East for 10,000 years

Obama: I remember; everyone was trim, healthy, and hard working in Indonesia.  The same for Kenya, in fact their runners are legendary for their performance, endurance, and their unique ability to recover from strenuous exercise.  Today they dominate long distance running events.

McDougall: Over the past century there has been escalating abandonment of a starch-based diet in favor of one centered around low-carbohydrate meat and dairy foods.  Each and every time a population has made this change an epidemic of obesity, heart disease, diabetes, and cancer has followed.

You just finished 2 years of campaigning across America.  You must have noticed the condition of people, particularly those of African decent.  About four out of five African-American women are overweight or obese. One-third of blacks in America have hypertension accompanied by stroke, heart attack, and kidney failure. Black men have the highest rate of prostate cancer in the world.  Asian Americans, often in one generation, have also become Americanized in their diet and appearance.

People must learn to get the bulk of their calories from starches. Notice I did not say every patriotic American has to become a vegetarian or vegan—I am not pushing a religion, just a single big change in eating.

Obama: You are talking about a revolution.  I have promised our nation change on a historic scale.  But, this is unprecedented.

McDougall:  Twice before, Surgeons General have put people’s health before industrial profits. Luther Terry, MD, who was appointed by President Kennedy, served as Surgeon General from 1961 to 1965. Under his leadership, in 1964 the first Surgeon General's Report on Smoking and Health was released. Look what has happened over the past 4 decades.  In the late sixties, when I was a medical student, I saw doctors smoking while examining patients.  Today, smoking cigarettes is a social disgrace.

A similar change in our society should have followed The Surgeon General’s Report on Nutrition and Health issued under C. Everett Koop, MD in 1988. Unfortunately, this report didn’t have the desired effects; over the past 2 decades, obesity in America has risen from 10% to over 30% of our population.  The ultimate insult: McDonald’s and Burger King sell their products in hospitals. We are now two decades behind; we need a health revolution backed by our President.

Obama: Have you considered the effects on the meat, dairy, and processed food industries?

McDougall: I have about as much sympathy for the people in these industries as I do for those selling tobacco.  I have also considered the effect on the medical businesses. If this movement works as planned cardiologists and bypass surgeons will be temporarily standing in unemployment lines along with autoworkers.  However, under your leadership millions of new jobs will be created and the country will move forward. In order to carry out your dream for a green energy economy Americans must be competitively fit—we can no longer add $1500 to the price of each automobile to pay for the healthcare of the employees.  The benefits to individuals will be immediate; food costs will decrease from $14 a day to $3 a day per person on a starch-based diet. 

Obama:  As appointed (but unconfirmed) Surgeon General can you provide me with some specific steps to take?


1) Identify the livestock and processed food industries as the major cause of death and disability in the US.  This will be more difficult than it was for tobacco because in the case of smoking in 1964, half of the population were non-smokers and could see the insanity. Right now more than 99.9% of Americans cannot see past their own dinner plates—they have no idea there is a problem with their food choices. The education hurdles will be great, but not insurmountable.

I am asking for $217 million annually for this budget.  By no coincidence this figure represents the amount the dairy and beef industry spend annually—$175 million and $42 million, respectively—shamelessly promoting their products through our school systems, dietitians, doctors, the USDA, scientific journals, and every available form of media.  You may be asking how are we going to pay for this?

2) Levy a tax on health-damaging foods.  Cigarette taxes added by individual states are as high as $2.58 per pack.  Since there is too little time to wait for individual states to act, this legislation will immediately be brought to Congress, and become a federal tax. This tax will achieve two social objectives: to reduce the number of citizens making themselves sick and to raise government revenue. Annually, 28 billion pounds of beef and 9 billion pounds of cheese are consumed in the US.  Taxed at $1 per pound, this tax will leave a lot of money left over for other worthwhile programs.  How about dedicating $10 billion to rehabilitation live-in programs, modeled after the highly successful McDougall Program, for people with type-2 diabetes, heart disease, inflammatory arthritis, multiple sclerosis, GERD, IBS, obesity and other diseases caused by meat- and dairy-centered diets?

3) Place Product Warning Labels.  Just like those on tobacco products. Here are two examples:

4) Change to a starch-based diet for all government funded programs.  Three very needy groups come to mind: our military, schools, and food assistance programs.  Among our fighting forces 61% are overweight—it is unsafe to send these men and women into battle in such poor condition. Diet-induced childhood obesity and illness will be considered abuse, especially after adults know better.  Subsidizing foods that make people fat and sick doubly harms underprivileged Americans. In the near future food stamps and other assistance programs will not provide for the purchase of tobacco, alcohol, meat, dairy, or highly processed “junk” foods.

5) Educate doctors and dietitians about diet and how to take people off medications. The effects of food on health and disease, a subject almost entirely ignored in medical schools, need to be taught.  The food industry will be highly regulated when they finance research and banned entirely from educating dietitians. Relicensing exams will require all professionals to take courses in diet therapy and how to reduce and discontinue medications once used to treat diseases of over-nutrition.

6) Require all hospitals to serve healthful foods. In my parents’ day, free samples of cigarettes were distributed to patients, and I can remember hospital gift shops selling cigarettes.  Right now every hospital in the country serves to their patients the very foods that brought them there in the first place.  No longer will we miss the “teaching moments” that happen when people have a heart attack or a diabetic crisis.  All fast-food restaurants will be banned from hospitals.

7) Allow lawsuits to go forward against food industries. The Personal Responsibility in Food Consumption Act, also known as the “Cheeseburger Bill,” was twice passed by the House of Representatives, but fortunately not yet confirmed by the Senate. The aim of this bill is to protect producers and retailers of foods from being sued by customers who have become obese and sick by eating their products.  This legislation is being pursued by congressional representatives supporting the interests of industry; because of similar suits brought in the 1990s against tobacco corporations. 

Obama:  This is an ambitious plan. I like it.

McDougall: With the failing economy people may be forced to change to a starch-based diet, or starve.  However, a planned transition will be less painful, more likely to succeed, and a key ingredient in saving America. America can no longer afford to be sick. We must get this fixed now; we do not have a generation to wait. As your Surgeon General, I will be the nation’s family doctor.  Let’s plan another meeting soon.

Mr. Obama: Here are three Congressional actions needed for me to do my job:

First, the US Public Health Service (USPHS) must be converted into a fully independent agency that reports directly to the President, like the U.S. Environmental Protection Agency does now.  

Second, the Surgeon General, as the head of the USPHS, must be a lifetime appointment, like federal judges now have.  

Third, the Surgeon General must take over from Department of Agriculture (an organization representing the interests of the food industries) the responsibility of establishing and disseminating dietary advice to Americans.



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