My dear Jeremy,
As you know it is imperative that we eliminate the financial deficit and that one key element of our strategy it to ensure that that we use public money as efficiently as possible. Since the election the Treasury has been conducting evaluations of the various government departments and agencies to determine how effectively they fulfil their role. As part of that we have been considering if they offer value for money.
I am sorry to have to tell you that the Department of Health (DoH)/NHS has come out of this extremely badly. In fact it was bottom of this particular league table by a big margin. Despite the enormous expenditure which never seems to be enough it is evident that the standard of public health is lower than it has been for years and continues to deteriorate. If things continue along the same lines it is predicted that the NHS faces a funding shortfall of £30 billion by 2020/21.
We have also discovered that many of the treatments and procedures are ineffective and inappropriate. In fact some of them do more harm than good. Diabetes was one area we examined in depth and, quite frankly, the results were absolutely appalling. I am sure you are aware that the costs of treatment are about £10Bn per annum of which about £1Bn is for drugs. On top of this we have the costs to the national economy because workers have to take time off because of illness. Despite this, all the prognostications from your people are that the number affected will continue to increase. Surely it must be obvious to you that your existing policies are not working and that it is imperative that a totally different strategy is needed? It has emerged that the definition of diabetes which underpins your Diabetes Prevention Programme is:
“a chronic condition where the body does not produce enough insulin to regulate blood glucose levels” (1).
While this is a reasonably accurate definition of Type 1 Diabetes (T1D) it is certainly totally inaccurate and misleading as far as Type 2 Diabetes (T2D) is concerned. Since T2D accounts for about 90% of all cases of diabetes the definition/cause is absolutely crucial. The fundamental cause of T2D is excessive sugars in the blood. Therefore the pancreas has to produce extra insulin to ensure that the blood sugars are kept under control. However this then causes insulin resistance (IR) which is responsible for widespread damage inside the body. One effect of the IR is to increase the requirement for insulin which places even more strain on the pancreas. Eventually the pancreas is unable to cope and it cannot produce enough insulin. Consequently the blood sugar can no longer be kept under control. This is full-blown T2D. The excess sugar causes even further damage which may result in blindness and amputation of limbs.
Is there no-one in the DoH who understands that the fundamental problem is too much insulin?
There is only one way to cope with T2D and that it is to stop the build-up of sugars in the body. So the habitual diet must be altered. This means that the intake of sugar and those foods which contain starch (which breaks down to glucose) must be restricted. We know from the studies of Professor Robert Lustig that sugar is especially dangerous. It is present in many soft drinks and in lots of “healthy” low fat foods. It seems to us that sugar consumption must be reduced. Ideally it should eliminated from diet, especially for those who cannot tolerate it. But that is not sufficient and many people will also have to reduce their consumption of the carbohydrate-containing foods such as bread, flour, rice and pasta. Therefore I find it unbelievable that NHS choice website has the following advice for those with T2D:
“The important thing in managing diabetes through your diet is to eat regularly and include starchy carbohydrates, such as pasta” (2). This is linked another section which has the following advice:
“Starchy foods are our main source of carbohydrate, and play an important role in a healthy diet.
Starchy foods such as potatoes, bread, cereals, rice and pasta should make up about a third of the food you eat, as shown by the eatwell plate” (3).
Surely you appreciate that this is only making things a lot worse? There is a sound body of research which demonstrates conclusively that people with T2D can cope with the disease and improve their health significantly by consuming a diet which is low in carbohydrates and high in healthy fats (LCHF) (4). Furthermore there are numerous case studies from individuals who have been extremely successful in overcoming T2D using this approach. Here are some examples (5, 6, 7). The last reference is to the outstanding work of Dr David Unwin, a GP in Southport who has had wonderful results. I am especially impressed by the fact that he has been able to save over £20,000 per years by prescribing less drugs. I do hope you watched the excellent TV programme “Doctor in the House” in which Dr Rangan Chatterjee spent some time with a family advising the members how they can improve their health (8). This showed precisely how the NHS is failing but also provides valuable insight which I am sure you will find helpful in devising completely new strategies.
In the light of what we have learned I have decided that sugar has to be controlled in the same way as alcohol and tobacco. It may take a little time to set up the necessary arrangements to do so. Ideally there should be total ban but I am realistic enough to understand that this would drive the trade underground. However I am convinced that a system of licensing is feasible. In the meantime I propose to introduce legislation which will prohibit the use of added sugar in all foods which are marketed to children. The implementation will be phased in over the next two years. In the meantime I expect you to cease the existing policies forthwith and develop new ones based on research and practice which are demonstrably successful.
Moving on to other areas we examined. It is obvious that the use of drugs is far too excessive and costly. I strongly suspect that Dr Unwin’s experience is just the tip of the iceberg and that many of the drugs currently in use have minimal benefit and once the adverse side-effects are factored in probably do more harm than good. In addition to savings in the treatment of diabetes, I find the case for statins lacks conviction. You probably saw the recent paper in BMJ Open which showed that the benefits of statins are just a few extra days of life (9). In view of the nasty side effects, I doubt if anyone would wish to be treated with them. Personally I know several members of my own family who have suffered from severe aches and pains before decided to stop the treatment. Consequently I have decided that we can no longer justify this expenditure.
This takes me to NICE, which relies heavily on people who are closely involved with the pharmaceutical industry. I am also aware of the many recent studies which have shown conclusively that we cannot rely on the drug companies to be responsible for the testing of their own products (10). Furthermore the vast majority of new drugs are not an improvement on those already available (11). We must cut down drastically on the use of drugs and where possible use those which are tried and tested rather than new ones which are usually horrendously over-priced. Accordingly I have decide to abolish NICE at the earliest opportunity. In its place I will establish a new organisation which will be totally independent. This body will be responsible for all testing and will be funded by a levy on the sales of drugs. It is my intention to re-invent our health services so that there is considerably less emphasis on the use of drugs and much more on identifying the fundamental causes. Essentially this will mean that the focus will have to be on lifestyle.
Which brings me to my final issue because nutrition will be fundamental to this new strategy. I have to tell you that I am appalled at the recommendations on Healthy Eating which the DoH has been promulgating. I realise that this is based on the advice of the Scientific Advisory Committee on Nutrition (SACN). I find that its performance has been abysmal. It took seven years to complete its report on carbohydrates yet the recommendations were fatally flawed as Zoe Harcombe has so effectively exposed (12). It is all far too complacent and cozy. In fact I am now convinced that this committee system is fundamentally flawed. It is much too easy for one forceful individual to get his/her ideas accepted and then the final report is regarded as gospel. In any case I find that these committees tend to be dominated by specialist scientists who lack the expertise in policy aspects. I have therefore decided that SACN and all other similar advisory committees will be disbanded immediately. In future we will scour the world for individuals with a proven track record who are genuinely independent of commercial interests. We will ask them to provide a report which will then be open to scrutiny and if necessary challenged. I believe this will provide us with the high quality advice which is essential if we are to get policies which are robust and effective.
I appreciate that my decisions will upset some of our “friends” in the food and pharmaceutical industries. As far as food is concerned, people will always have to eat so there will still be plenty of business. It is up to the food companies to make the necessary adaptations. This is nothing new because the food industry is in a constant state of flux. However I do envisage that the market for drugs will definitely be a fraction of what it is at the moment. But to be perfectly honest it is a pretty awful business as Peter Gøtzsche has explained in his excellent book (13).
Peter Rost is a whistle blower who used to be in a senior position with Pfizer and has described the industry as follows:
““It is scary how many similarities there are between this industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the side effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry …” (14)
I am resigned to the fact that we will just have to take a hit. On the other hand I have not the slightest doubt that this will be more than compensated by the fact that we will have a highly productive workforce and that we will be spending much less on the costs of health care. In addition the new policies which I am introducing will create a whole plethora of opportunities for new businesses, which will facilitate the improvement of personal health. The fundamental weakness with the existing set up is that the profitability of too many businesses is dependent on people remaining ill.
But there is a lot more to it than that. By making these innovative changes in policy we will be stimulating the development of new skills and starting new companies which have the potential for business in many other countries as they come to understand that our current health policies are no longer sustainable. I have total confidence that is the way we must go and I trust that I will have your enthusiastic support.
In the long run, I am convinced that it is essential to take initiatives like this in order to demonstrate that the Conservative Party is actively promoting the interest of the man in the street and even more important is seen to do so. As a consequence we will be able to gain positive support from millions of people who will not only vote for us but would be prepared to make small donations. This would mean that we would no longer have to rely on large contributions from a small number of individuals, which realistically cannot continue. It is becoming increasingly difficult to justify. In any case I am simply fed up to the back teeth with the necessity of having to lunch with those awful types who are stupid enough to spend up to £50,000 every year for the privilege (15).
With best wishes
- D W Light, J Lexchin & J J Darrow (2013) Journal of Law, Medicine and Ethics 14 (3) pp 590-610
- Peter Gøtzsche (2013). “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare” Radcliffe Publishing London