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Should Fast Food Restaurants Serve Cholesterol-Lowering Drugs With Meals?

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An editorial in the current issue of the American Journal of Cardiology proposes that fast food restaurants consider giving out a cholesterol-lowering statin drug with each meal, just as they give away little packets of ketchup. The authors are British, and those crazy Brits gave us "Monty Python's Flying Circus," so maybe these guys are just pulling our leg? If so, it's very deadpan humor indeed; there is no indication the editorial is a joke. But it ought to be!

The authors contend that fast food mainstays -- French fries, hamburgers, etc. -- deliver a variety of stressors to the cardiovascular system in the form of saturated fat, trans fat, salt and sugar. A robust literature indicates that statin drugs can mitigate this risk, and indeed can do so acutely. Thus the proposal: when you eat this food, take a pill to protect you from its harms.

In the widespread media coverage of this proposal, the only obvious objection raised is that there may be harms of fast food not fully addressed by a statin. (Maybe there should be a whole pill box on the condiment table, then?) Are we really supposed to be OK with this?

Food is the fuel that runs the human body. It is actually supposed to be GOOD for us! It is the construction material -- the ONLY construction material -- a child uses to grow his or her developing body. It is the source material for replacing the tens of millions of cells an adult body turns over daily. It is what we use to build our hormones, and replenish our neurotransmitters. Are we really supposed to be OK with food so bad for us that we need to take a pharmaceutical antidote along with it?

What appears to be missing entirely, both from the editorial, and from the media reactions to it, is any well-justified outrage. If the food we are talking about -- food widely sold to children as well as adults -- is actually bad enough for us that it warrants a pharmacotherapy chaser, should that even be legal, let alone acceptable to society?

Where is outrage at the idea that we should ignore the powerful influence of food choice on health, and then rely on the pharmaceutical industry to fix it? Where is the outrage that this proposal to combine drugs with dinner is blind to the fact that pregnant women eat this food; five-year-olds eat this food. Are they, too, supposed to get a statin drug?

Where is the outrage at a military-industrial establishment that profits from selling us food with the potential to make us sick, and profits further from selling us drugs to blunt the immediate risk of eating that food? This calls to mind the hospitals that house fast food restaurants, as if to say: "sure, you can super-size that -- the CCU is just upstairs!" Maybe we can extend the idea in this editorial just a bit, and reverse the scenario; maybe fast food franchises can set up angioplasty centers in a back room.

This would really be funny if it weren't so sad.

Yes, it is wrong to think a statin could undue the full range of potential harms from eating bad food. But it is wrong at a far more fundamental level to sanction the sale of so-called 'food' in the first place that is bad enough even to invite such a consideration. This is like letting children play in a park full of venomous snakes, and providing them syringes of anti-venom to administer in case of snake bite. How about we not have venomous snakes in children's parks to begin with?

Of course, in the context of a healthful diet, you could eat a fast food meal on rare occasion and suffer no meaningful harm. But then you wouldn't need a statin drug to defend against it, either! The very point of this editorial -- and it's a valid point -- is that enough fast food is consumed to constitute a meaningful threat to the health of the average customer.

That is true, but better living through pharmacotherapeutic self-defense is not the answer. Better food is the answer!

Respect for the significance of feeding our bodies is the answer. Recognizing that food can be 'fast,' and tasty, and convenient, and economical, and still good for us, is the answer. Learning to love food that loves us back, rather than loving foods that attack us so vigorously an immediate antidote is warranted, is the answer.

Food, well chosen, can do for health what no drug can do: build it from its very foundations. Food IS medicine, and the very best of medicine at that. As I have asserted many times before, diet pattern, along with physical activity pattern and avoidance of tobacco, is among the leading determinants of health outcomes. Feet, forks, and fingers are the master levers of medical destiny. Statins are highly effective drugs -- but they certainly do not make this list!

Folks, the notion that our society sanctions the peddling of food poisonous enough to warrant an anti-toxin on the condiment table is nothing with which we should be 'OK.' It is, in a word, an outrage. I am outraged.

I hope I'm not alone.

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