Senator Marshall: Healthcare Spending Needs to Go Towards Preventing, Not Just Treating

Senator Marshall At Tufts Food is Medicine Institute & Food Tank Capitol Hill Briefing

Washington - U.S. Senator Roger Marshall, M.D. (R-Kansas), joined Dr. Dariush Mozaffarian at Tufts Food is Medicine Institute & Food Tank Capitol Hill Briefing to discuss the chronic disease epidemic in America, the importance of nutrition on the overall health of Americans, the research and legislation in process, and how making America healthy again is going to happen through a stronger focus on prevention rather than just treatment.

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On the importance of nutrition in fertility and pregnancy:

"Yeah, Dari, it's great to be with you, and you know, where do I start? We could talk about infertility, preconception, conception, miscarriages, the pregnancy, and the delivery - how important nutrition is for all of those. Infertility: I had a huge growing infertility practice, significantly impacted by the chronic disease epidemic. It's interesting now we're reading about GLP-1s, and they're worried that we're going to have a birth explosion, and they're citing that it's because probably one of the side effects of the GLP-1 is if you're on hormonal birth control pills, it decreases its effectiveness of it. But what I'm going to say is because when the women lose weight, they're going to start ovulating again, right? Or more often. So, I mean, the whole way through the pregnancy. One other just simple example - you think about importance of folic acid preconceptionally, that it decreases the risk of spina bifida, anencephaly, that type of thing as well. But it's got to be in their systems before they conceive, you know - it does no good after conception. So that's just one thing that we can measure. How many things are out there that you and I don't even know exist that are in just general nutrition to help have a healthy pregnancy?"

"You know, and by the way, in at least a third of the infertility it's the guy's fault. And you think how much nutrition would impact their sperm count. You know what your nutrition does to your nails, to your hair, your skin - things with really quick turnover. But sperm are one of those things as well that you're turning over a lot. So, I mean, the guy's got a responsibility here too in this."

On the chronic disease epidemic in America and bipartisan support for healthcare changes:

"Yeah, well, just to your point, when we got here to Congress 10 years ago, we wanted to do something in this space, and I told my staff, 'Go out and find me somebody that we can get bipartisan support on this. And by the way, make them as far left as you can because there'll be plenty of room between them and me.' And Congressman McGovern stepped up, and it is truly something we agree on. But I think it's the epidemic that we have: 70% of Americans have a chronic disease right now; the obesity rate has got to be more than that; 90% of the money we're spending in healthcare are for these seven chronic diseases right now. So, I think it's the right thing to do, and then also it's just the cost of healthcare. Everyone in this room understands: if you believe that balancing the federal budget is important to you, saving Medicare is important to you, we can't drug ourselves out of this. That we got to figure out a way to make America healthy again, and that'll decrease the spend on Medicare. Think about it - if we're spending 18% of our GDP on healthcare - if we spend $7 trillion a year up here, about 1.5% or 2% of that is on healthcare as well. So how do we save some of that money? That's to make people healthy again. Look at the health of our country. Some of my good friends across the aisle will look at me when they see how much money we're spending on healthcare, and they'll say, "Why can't you doctors bring down the cost of healthcare?" Well, it's because we're sick. Our incidence of chronic diseases and obesity is got to be between 2-7x of other developed countries right now, so we are utilizing these resources. And it's more than just that obesity leads to heart disease - I mean, I don't know what you think, but I think that Alzheimer's, there's going to be a component of inflammation from chronically high sugars. Hip replacements, knee replacements are happening 10 years younger now. Why? Because we're putting more stress on these joints."

On current legislation and the role of experts and Congressional staff:

"Shameless plug: if you throw that with our price tags bill forcing all the healthcare providers to show their prices, they save another $1,000 a month."

"Right. So, this week in committee, we passed a bill on ultra-processed foods: that we would put a label on it that it could be dangerous to your health. But I'm not sure what ultra-processed food means. And I think that defining what a definition is within ultra-processed foods, and then what's specifically in that is causing the inflammation? And I would just ask you, what do you think of ultra-processed food as kind of a definition? And this is what I've got to do: I'm going to go to the expert - Dari and Tufts are leading the world as far as I'm concerned on nutrition advice. And I know the CDC, NIH, HHS, and Secretary Kennedy are working on this definition as well. But I think that's just one example. I think we still haven't figured out what's in ultra-processed food - what's good, and what's bad?"

"Okay. Well, thank you for being here. Because I can't be an expert at everything, and just like a doctor, I wouldn't want to do your heart cath - I'm going to get a consultation as well. And I can't be an expert right now, but I need some help right now defining what ultra-processed food is. Again, every night in the paper, we're so confused - you find out, 'Oh, this is the problem. Coffee's good, coffee's bad. How many cups of coffee is good for you as well?' You know the story."

"And the other thing my mind jumps to are ingredients. What's generally recognized as safe? Some of those types of topics. To give me research to help me understand what is safe and isn't safe and then confirming things that have been sitting out there for 40 years that we need to go back - how do we start closing some of the loopholes that have existed on that as well? But I think there's a research component as well."

On focusing more healthcare funding on prevention and detection:

"Yeah, and another big part of the spending right now is on early detection as well - that I think that they're counting as early research on prevention and causes as well. Number one is I don't think we need a bigger bucket - I think $50 billion, I'm getting close, is probably enough money. And the last thing you want is Congress micromanaging it - so we give $7 billion to the Cancer Institute, we give $4 or $5 billion to Heart, and I think that within those areas they need to dedicate more money to what you're describing. And what percentage is it? Is it 4%? Is it 10%? Again, I think we need experts to come in. But all the focus right now is certainly on the treatment stage, so I'm all for more on this end as well to arm us. And one part of the research we need, Dari, is coaching. The big emphasis is education, but having delivered 5,000 babies, education doesn't work; coaching does. When you have a nurse coach coaching that person up, trying to help keep their sugars under control, keep their blood pressures under control. So, we need best practices when it comes to trying to implement these lifestyle changes."

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