Abstract
This paper critically examines the systemic factors underlying the chronic disease epidemic in the United States, with a focus on the pharmaceutical and ultra-processed food industries. By tracing the legacy of the 1910 Flexner Report, commissioned by John D. Rockefeller’s lawyer, and its enduring influence on medical education, the study highlights how profit-driven structures have shaped modern healthcare and nutrition policies. Drawing on leading medical professionals, including Robert Lustig, Jerold Mande, and Mark Hyman, and integrating insights from theological ethics, this analysis critiques the commodification of health and the exploitation of human vulnerability. Recommendations for reform aim to realign public health with justice, sustainability, and human flourishing.
Introduction
The epidemic of chronic diseases—such as obesity, type 2 diabetes, cardiovascular conditions, and metabolic syndrome—has reached unprecedented levels in the United States, affecting over 60% of adults and nearly 40% of children. The systemic contributors to this crisis extend far beyond individual choices, implicating structural and institutional factors such as the pharmaceutical and ultra-processed food industries. These industries profit directly from the widespread prevalence of chronic disease, often perpetuating it through the creation of addictive products and the medicalization of preventable conditions.
By revisiting the historical origins of these systems, particularly the 1910 Flexner Report, and examining their biomedical and ethical implications, this paper seeks to uncover the mechanisms by which corporate interests have entrenched themselves in public health policy and medical education. The integration of biomedical research, public health policy, and theological ethics offers a comprehensive framework for addressing this multifaceted crisis.
Historical Context: The Flexner Report and Rockefeller’s Influence
The 1910 Flexner Report, commissioned by the Carnegie Foundation and heavily influenced by John D. Rockefeller’s financial interests, fundamentally reshaped medical education in the United States. Authored by Abraham Flexner, the report aimed to elevate standards in medical training by promoting rigorous scientific curricula and eliminating substandard institutions.1 While the reforms it introduced improved the quality of medical education, they also entrenched a reductionist model that sidelined holistic and preventative approaches in favor of pharmacological interventions. 2
Rockefeller’s investments in petroleum-derived pharmaceuticals and his financial backing of institutions like Johns Hopkins Medical School ensured that medical education would align with the emerging pharmaceutical industry’s profit-driven priorities. This alignment institutionalized a framework in which diseases were treated primarily through pharmacological solutions rather than addressing underlying causes such as poor nutrition and lifestyle factors.3
This historical context is crucial for understanding the structural biases in contemporary healthcare, where pharmacological treatments are often prioritized over preventative measures.
The Role of Ultra-Processed Foods in Chronic Disease
The rise of ultra-processed foods in the mid-20th century exacerbated the chronic disease epidemic by introducing diets high in refined sugars, trans fats, and artificial additives.4 These foods, engineered for hyper-palatability and extended shelf life, are devoid of essential nutrients and disrupt metabolic homeostasis.5 Recent studies have demonstrated that ultra-processed food consumption is strongly associated with obesity, insulin resistance, systemic inflammation, and non-alcoholic fatty liver disease.6
Jerold Mande critiques the regulatory failures that allowed ultra-processed foods to dominate the American diet, emphasizing the role of corporate lobbying in shaping public health policies. These policies have prioritized the economic interests of food manufacturers over the health of the population.7
The deliberate engineering of foods to maximize addiction, combined with misleading marketing campaigns, has created a dietary environment that prioritizes corporate profit over public health.8 Lustig underscores this by highlighting parallels between the strategies of the tobacco and food industries, observing that the same mechanisms used to addict consumers to nicotine have been applied to sugar, salt, and fat.9
Medicalization and Industry Influence
The pharmaceutical industry has played a central role in the medicalization of lifestyle-induced conditions, such as type 2 diabetes, obesity, and stress-related disorders. This trend reflects a systemic preference for pharmacological interventions over preventative care or lifestyle modifications.10
Pharmaceutical companies, through strategic funding of academic research and marketing, have systematically framed chronic conditions as primarily pharmacological problems. For example, type 2 diabetes is often treated with long-term medication rather than comprehensive interventions targeting dietary and lifestyle changes.11
Mark Hyman critiques this dependency, arguing that it creates a cycle of chronic illness and pharmaceutical reliance that benefits industry stakeholders at the expense of patient well-being.12
Ethical and Theological Considerations
The commodification of health raises profound ethical and theological questions. From a theological perspective, the exploitation of human frailty for profit stands in direct opposition to the Christian understanding of health and healing.13 The body, viewed as a temple of the Holy Spirit (1 Corinthians 6:19–20), must be treated with care and dignity.
Richard J. Mouw’s work emphasizes the responsibility of societal structures to uphold justice and promote human flourishing, particularly for the most vulnerable. This ethical imperative is undermined by industries that prioritize profit over public health.14
Jerold Mande calls for a shift in public health policy toward preventative care and equitable access to nutritious foods, framing this as both an ethical and public health necessity.15
Recommendations for Reform
To address the systemic drivers of the chronic disease epidemic, this paper proposes a series of reforms:
1. Medical Education Reform: Medical curricula must integrate nutrition, lifestyle medicine, and systems biology alongside pharmacology to prepare physicians to address root causes of chronic disease. 16
3. Policy Changes: Stricter regulations on ultra-processed foods, including clear labeling, taxation, and restrictions on marketing to children, are essential for curbing their consumption.17
4. Public Awareness Campaigns: Public education initiatives should empower individuals to make informed choices about their diets and lifestyles, emphasizing the links between nutrition, cellular health, and chronic disease prevention.18
5. Corporate Accountability: Require transparency in research funding and establish independent oversight to reduce conflicts of interest in public health policymaking.19
6. Theological Engagement: Faith communities must advocate for systemic reform, emphasizing stewardship of the body as sacred and championing justice for vulnerable populations disproportionately affected by these crises.20
Conclusion
The chronic disease epidemic in the United States reflects systemic failures rooted in the historical alignment of corporate interests with medical and nutritional policies. The legacy of the 1910 Flexner Report, coupled with the strategies of the pharmaceutical and ultra-processed food industries, has created a healthcare landscape that prioritizes treatment over prevention and profit over public health.
Integrating insights from biomedical science and theological ethics, this paper calls for a fundamental reevaluation of these systems. By reforming medical education, enacting robust food policies, and challenging the ethical foundations of healthcare and nutrition industries, we can move toward a model of health that prioritizes human flourishing over corporate profit.
Endnotes
1. Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, Bulletin Number Four (New York: Carnegie Foundation, 1910), 56–78.
2. John H. Knowles, Doing Better and Feeling Worse: Health in the United States (New York: W.W. Norton & Company, 1977), 112–130.
3. William G. Rothstein, American Medical Schools and the Practice of Medicine: A History (New York: Oxford University Press, 1987), 87–108.
4. Marion Nestle, Food Politics: How the Food Industry Influences Nutrition and Health, 2nd ed. (Berkeley: University of California Press, 2007), 154–176.
5. Robert H. Lustig, Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine (New York: Harper Wave, 2021), 89–102.
6. Barry M. Popkin, The World Is Fat: The Fads, Trends, Policies, and Products That Are Fattening the Human Race (New York: Avery, 2009), 201–214.
7. Jerold Mande, Preventing the Epidemic: A Public Health Perspective on Chronic Disease (New York: Oxford University Press, 2015), 67–89.
8. Robert H. Lustig, Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (New York: Plume, 2013), 112–138.
9. Michael Moss, Salt Sugar Fat: How the Food Giants Hooked Us (New York: Random House, 2013), 201–223.
10. Mark Hyman, The Blood Sugar Solution: The UltraHealthy Program for Losing Weight, Preventing Disease, and Feeling Great Now! (New York: Little, Brown Spark, 2012), 89–102.
11. Peter C. Gotzsche, Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare (London: Radcliffe Publishing, 2013), 78–105.
12. Mark Hyman, The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First (New York: Scribner, 2008), 45–78.
13. Richard J. Mouw, When the Kings Come Marching In: Isaiah and the New Jerusalem (Grand Rapids, MI: Eerdmans, 2002), 56–78.
14. John Swinton, Raging with Compassion: Pastoral Responses to the Problem of Evil (Grand Rapids, MI: Eerdmans, 2007), 102–124.
15. Jerold Mande, Public Health Ethics and Equity (New York: Oxford University Press, 2011), 67–98.
16. T. Colin Campbell, Whole: Rethinking the Science of Nutrition (Dallas: BenBella Books, 2014), 156–178.
17. Dean Ornish, UnDo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (New York: Ballantine Books, 2019), 67–98.
18. Michael Greger, How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease (New York: Flatiron Books, 2015), 78–94.
19. David A. Kessler, The End of Overeating: Taking Control of the Insatiable American Appetite (New York: Rodale Books, 2009), 67–89.
20. Michael Pollan, In Defense of Food: An Eater’s Manifesto (New York: Penguin Press, 2008), 123–145.
Expanded Bibliography
Medicine and Public Health
1. Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, Bulletin Number Four (New York: Carnegie Foundation, 1910).
• This foundational text shaped modern medical education, emphasizing scientific rigor and clinical training. It critiques the lack of standardization in early medical schools while laying the groundwork for the dominance of reductionist medicine, sidelining holistic health practices.
2. Robert H. Lustig, Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine (New York: Harper Wave, 2021).
• A leading voice in the critique of the ultra-processed food industry, Lustig’s work synthesizes evidence from metabolic science to demonstrate how food systems exacerbate chronic diseases. This text bridges biochemical insights with systemic critiques of healthcare policies.
3. Marion Nestle, Food Politics: How the Food Industry Influences Nutrition and Health, 2nd ed. (Berkeley: University of California Press, 2007).
• Nestle provides a seminal analysis of how corporate lobbying and financial interests shape public health guidelines, resulting in dietary recommendations that fail to address the root causes of obesity and metabolic disorders.
4. Michael Moss, Salt Sugar Fat: How the Food Giants Hooked Us (New York: Random House, 2013).
• This investigative work exposes the strategies used by food corporations to engineer addiction to unhealthy diets, contributing to the epidemic of chronic diseases. Moss’s analysis underscores the ethical failures of prioritizing profit over public health.
5. Jerold Mande, Preventing the Epidemic: A Public Health Perspective on Chronic Disease (New York: Oxford University Press, 2015).
• Mande focuses on systemic barriers to effective prevention in public health, critiquing regulatory failures and proposing actionable reforms. His policy-driven approach is instrumental for addressing the structural determinants of health.
6. T. Colin Campbell and Thomas M. Campbell II, The China Study: The Most Comprehensive Study of Nutrition Ever Conducted (Dallas: BenBella Books, 2006).
• A landmark text in nutritional science, this study links plant-based diets to reductions in chronic disease risk. It challenges reductionist medical paradigms and highlights the importance of whole-food nutrition.
7. Dean Ornish, UnDo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases (New York: Ballantine Books, 2019).
• Ornish integrates scientific evidence on diet, exercise, and stress management, demonstrating how lifestyle medicine can prevent and even reverse chronic conditions. This work is a crucial counterpoint to pharmacological dependency.
8. David A. Kessler, The End of Overeating: Taking Control of the Insatiable American Appetite (New York: Rodale Books, 2009).
• Kessler’s exploration of the neurobiological drivers of overeating reveals how food corporations exploit the brain’s reward systems. His insights are critical for understanding the intersection of behavioral science and public health.
9. Michael Greger and Gene Stone, How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease (New York: Flatiron Books, 2015).
• This evidence-based guide synthesizes cutting-edge research on nutrition’s role in disease prevention. Greger advocates for dietary interventions over pharmaceutical treatments, aligning with functional medicine principles.
10. Peter C. Gotzsche, Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare (London: Radcliffe Publishing, 2013).
• A bold critique of the pharmaceutical industry, Gotzsche exposes systemic corruption and conflicts of interest that undermine healthcare systems. His work is essential for addressing the ethical failures in modern medicine.
Theology and Ethics
11. Richard J. Mouw, When the Kings Come Marching In: Isaiah and the New Jerusalem (Grand Rapids, MI: Eerdmans, 2002).
• Mouw provides a theological framework for critiquing systemic injustice, emphasizing the prophetic call to uphold human dignity and equity. This text is critical for integrating theological ethics into public health reform.
12. John Swinton, Raging with Compassion: Pastoral Responses to the Problem of Evil (Grand Rapids, MI: Eerdmans, 2007).
• Swinton’s theological reflections on suffering and human vulnerability provide a robust ethical lens for critiquing the exploitation of individuals by profit-driven healthcare systems.
13. N.T. Wright, After You Believe: Why Christian Character Matters (New York: HarperOne, 2010).
• Wright emphasizes the formation of virtue and the pursuit of human flourishing, offering a theological counterpoint to the commodification of health. His work is essential for envisioning ethical healthcare systems.
14. Stanley Hauerwas, The Peaceable Kingdom: A Primer in Christian Ethics (Notre Dame, IN: University of Notre Dame Press, 1983).
• Hauerwas’s critique of societal systems that perpetuate harm is foundational for developing a Christian ethical response to public health crises. His emphasis on community and justice aligns with calls for systemic reform.
15. Lisa Sowle Cahill, Theological Bioethics: Participation, Justice, and Change (Washington, DC: Georgetown University Press, 2005).
• Cahill examines the intersection of theology and bioethics, addressing issues of equity and access in healthcare. Her work is pivotal for connecting theological principles with public health policy.
16. Pope Francis, Laudato Si’: On Care for Our Common Home (Vatican City: Libreria Editrice Vaticana, 2015).
• This encyclical critiques the environmental and social impacts of profit-driven systems, offering a theological vision for sustainable and equitable health practices.
17. James K.A. Smith, You Are What You Love: The Spiritual Power of Habit (Grand Rapids, MI: Brazos Press, 2016).
• Smith’s exploration of habit formation has implications for public health, emphasizing how cultural practices shape health behaviors and outcomes.
18. Dietrich Bonhoeffer, Ethics, trans. Neville Horton Smith (New York: Macmillan, 1955).
• Bonhoeffer’s reflections on ethical responsibility challenge systems that exploit human life for economic gain, providing a moral foundation for systemic critique.
19. Paul Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley: University of California Press, 2003).
• Farmer bridges public health and liberation theology, critiquing systemic inequities that perpetuate suffering. His work is indispensable for addressing the moral dimensions of healthcare reform.
20. Samuel Wells, Improvisation: The Drama of Christian Ethics (Grand Rapids, MI: Brazos Press, 2004).
• Wells’s emphasis on ethical improvisation provides a dynamic framework for addressing public health challenges, integrating theological insights with practical action.
Statistical and Interpretive Resources
21. World Health Organization (WHO), Global Status Report on Noncommunicable Diseases 2022 (Geneva: WHO, 2022).
• This report offers the latest global data on chronic diseases, highlighting the prevalence of preventable conditions and their systemic causes.
22. Centers for Disease Control and Prevention (CDC), National Diabetes Statistics Report 2023 (Atlanta: CDC, 2023).
• The CDC’s analysis provides a comprehensive overview of diabetes trends in the U.S., supporting arguments for preventative interventions.
23. Food and Agriculture Organization (FAO), The State of Food Security and Nutrition in the World 2023 (Rome: FAO, 2023).
• This resource contextualizes the global impact of food systems on health, emphasizing the need for sustainable reforms.
24. Harvard T.H. Chan School of Public Health, “The Nutrition Source: Processed Foods and Health Risks,” accessed November 2024, https://www.hsph.harvard.edu.
• This online resource synthesizes recent studies linking ultra-processed foods to chronic diseases, supporting evidence-based dietary recommendations.