Ed Markey Chairs Senate HELP Committee Hearing On Medicinal Access Through Food
On Tuesday, Sen. Ed Markey (D-MA) chaired a Senate Health Education Labor and Pensions Committee hearing on food and medical access.
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NewsTranscript
00:00:00Education and Labor and a Pension Subcommittee on Primary Health and Retirement Security
00:00:06will come to order.
00:00:08Thank you all for joining us today for the hearing, Feeding a Healthier America, Current
00:00:15Efforts and Potential Opportunities for Food is Medicine.
00:00:20Thank you to Ranking Member Marshall for partnering to bring together this very distinguished
00:00:26hearing.
00:00:27In 1941, President Franklin Delano Roosevelt convened his first White House Conference
00:00:33on Nutrition.
00:00:34At that conference, he stated that the food an individual eats fundamentally affects his
00:00:41strength, stamina, nervous condition, morale, and mental functioning.
00:00:47And today we would say the benefits flow to all in our society.
00:00:56Security played an essential role in the reforms of the New Deal and the Great Society.
00:01:02As we moved towards a more equitable and just society, access to food was and is essential.
00:01:09In 1946, Congress passed the National School Lunch Act to safeguard the health and well-being
00:01:16of our nation's children.
00:01:17In 1964, Congress created food stamps, now called SNAP, or the Supplemental Nutrition
00:01:24Assistance Program, to support improved levels of nutrition for low-income households.
00:01:30And in 1965, Congress passed the Older Americans Act, which would later include and support
00:01:36nutrition programs for seniors.
00:01:39Food programs were core to the New Deal and Great Society because basic food security
00:01:45as a source of nutrition, health, and basic necessity is a key component of building a
00:01:50more just society.
00:01:52And at each point in history, it is the fight for a healthier, more just society that played
00:01:58an integral role in improving access to nutritious, healthy foods.
00:02:03In the late 1960s, in Mound Bayou, Dr. Jack Geiger wrote prescriptions for malnourished
00:02:13children to get food from black-owned grocery stores in Mississippi and were paid for by
00:02:22the clinic's pharmacy.
00:02:24When the federal government pushed back on this, he said, the last time I checked my
00:02:29medical textbook, the specific therapy for malnutrition was, in fact, food.
00:02:36Civil rights leaders demanded an end to hunger as part of the Poor People's March on Washington
00:02:41in 1968.
00:02:43And in the late 1980s and early 1990s, in response to the HIV-AIDS epidemic, programs
00:02:49like Community Servings, represented here today, and others developed food as medicine
00:02:54programs to make sure that people living and dying from HIV-AIDS received care and support
00:03:01even when many were disowned by their own families.
00:03:06As David Waters said, Community Servings showed up for them and said, you're not alone.
00:03:12You're not alone.
00:03:13We're here for you.
00:03:15And we've made this beautiful meal for you.
00:03:19Food is medicine.
00:03:20An outgrowth of this movement for greater food security and healthier communities is
00:03:25a basic concept.
00:03:27It is the concept that the food that we eat impacts our overall health and well-being.
00:03:32Today, we see food is medicine in medically tailored meal programs that address an individual's
00:03:39medical diagnosis, symptoms, allergies, or medications.
00:03:44Produce prescription programs are allowing people to get financial support to buy produce
00:03:49to treat a health condition or risk.
00:03:53These programs are being integrated across hospitals and community health centers, Lowell
00:03:58Health Center in Massachusetts partners with Mill City Groves to ensure patients with chronic
00:04:04conditions can access healthy, locally sourced produce.
00:04:09East Boston Health Center is serving grocers, health care providers, and health care providers
00:04:19home to a blue one with diet-related diseases, and for people with limitations on activities
00:04:29of daily living, we could save $13 billion in the first year alone.
00:04:41By comparison, Ozempic costs about $1,000 a month.
00:04:50Medicare spending for Ozempic, Rubellsis, and Mugino reached $5.7 billion in 2022,
00:05:10up from $57 million.
00:05:27Cost savings promised by food is medicine, we need to feed programs by funding research
00:05:34and supporting community organizations like our local health centers and nonprofits who
00:05:39are running and developing these programs, and we need to make sure that there is no
00:05:43separation between our food systems and our health systems.
00:05:47Health providers must know they can prescribe food as medicine that their patients can access
00:05:54easily and affordably.
00:05:56But food as medicine is more than just cost savings.
00:05:59Food as medicine is a stop in the continuum of food justice to guarantee that from the
00:06:05farms to dinner tables, people can get the food they need to sustain themselves and their
00:06:12communities.
00:06:13What our planet can produce is as essential to our health as what our health systems can
00:06:18provide.
00:06:19With food as medicine, we can nourish a healthier America.
00:06:23So thank you all, all of our witnesses, and now I will turn to recognize the ranking member
00:06:29of the primary health subcommittee, Senator Marshall.
00:06:33Thank you, Chairman Markey, for convening this hearing on food as health.
00:06:37A special welcome to our panel, and we have rescheduled this once, so thanks for turning
00:06:43your schedules again around to come back and help us understand this issue a little bit
00:06:48more.
00:06:49I want to say a special thanks to the majority staff for all your help putting this together
00:06:53as well.
00:06:54I'm often asked, you know, most days I get asked, what can we do to drive the cost of
00:07:00health care down?
00:07:01What can we do to save Medicare?
00:07:03What can we do to impact maternal morbidity?
00:07:07What can we do to impact the diabetes epidemic that we're seeing, ADHD, cancer incidents,
00:07:13all those, what can we do to impact all of those?
00:07:17And I would make the case that sound nutrition is not just part of the answer, it is the
00:07:22answer to those dilemmas.
00:07:26Food isn't just medicine.
00:07:28Food is health.
00:07:30And I look forward to the testimonies today.
00:07:32I think the challenge before us is how do we turn these ideas, this concept, the research
00:07:36you've all done, how do we turn it into practical programs, policy from the federal government,
00:07:42but also how can we put wind beneath your wings as you all try to solve this problem
00:07:46at the local level?
00:07:47So welcome, everybody, and we look forward to your testimony.
00:07:52Thank you, Senator Marshall, very much, and now we're going to turn to our witnesses.
00:07:57Our first witness is Ms. Jean Terranova.
00:08:00So thank you for being here today.
00:08:03Ms. Terranova is the Senior Director of Policy and Research at Community Servings in Boston,
00:08:09an organization which provides medically tailored meals to individuals and families facing chronic
00:08:15illness or food insecurity.
00:08:17She currently serves as a principal investigator for two NIH studies examining the impact of
00:08:23community servings meals on health outcomes and quality of life for individuals with diabetes
00:08:30and food insecurity.
00:08:32And she also serves on the Policy Committee of the Food is Medicine Coalition and is a
00:08:37board member for the Aspen Institute's Food is Medicine initiative.
00:08:43So Ms. Terranova, thank you so much for being here.
00:08:45Whenever you feel comfortable, please begin.
00:08:49Thank you so much.
00:08:50Remarking Ranking Member Marshall and members of the subcommittee, thank you for the opportunity
00:08:55to testify in this hearing.
00:08:58My name is Jean Terranova.
00:09:00I'm Senior Director of Policy and Research for Community Servings.
00:09:04Our organization was founded in Boston in 1990 by a diverse coalition of activists,
00:09:10faith groups, and community organizations to provide home-delivered meals to individuals
00:09:15living with HIV and AIDS at the height of the crisis.
00:09:20We were founded based on a simple principle, although perhaps revolutionary at the time,
00:09:25that food is medicine and that we can drastically improve health simply by changing an individual's diet.
00:09:33In the last 34 years, community servings has grown from a neighborhood to a regional program
00:09:39serving medically tailored meals, MTMs, to thousands of people across Massachusetts and
00:09:45our neighboring states.
00:09:47We've grown to serve diverse populations experiencing critical illnesses like diabetes, cancer,
00:09:54and many others.
00:09:56Over our history, we've delivered over 13 million meals, including 1.1 million last year.
00:10:03And with our nationwide partners in the Food is Medicine Coalition, we've learned that
00:10:07nutrition plays a crucial role in the healthcare space.
00:10:11I want to thank the subcommittee for shining a light on this important issue.
00:10:16Since the 2022 White House Conference on Hunger, Nutrition, and Health, healthcare
00:10:21stakeholders have been paying closer attention to nutrition and specifically how nutrition
00:10:27can better be integrated into healthcare delivery.
00:10:31We have great experience with this in Massachusetts.
00:10:34Since 2020, our Medicaid program has provided reimbursement for nutrition services through
00:10:40an innovative model funded under an 1115 waiver.
00:10:45Community servings now maintains contracts with 12 of the 17 accountable care organizations
00:10:51participating in this program.
00:10:54We've been able to achieve this integration because our programs have been rigorously
00:10:59studied, including in a peer-reviewed 2019 study published in JAMA, which I've submitted
00:11:05with my written testimony.
00:11:07That study found, among other benefits, that MTMs helped achieve a 16% net savings on total
00:11:15healthcare spending due to decreased emergency room visits, hospital admissions, and emergency
00:11:21transportation services.
00:11:23And the net savings factors in the cost of the meals.
00:11:27The Aspen Institute has just released its updated Food is Medicine Action Plan, showing
00:11:32that there are many other studies demonstrating that MTMs can significantly reduce healthcare
00:11:38utilization and costs.
00:11:41Community-tailored meals are a simple concept but are complicated to implement.
00:11:45At community servings, our nutritionists evaluate each client individually for their health
00:11:51and dietary needs, their community access to food, and their ability to provide for
00:11:56themselves.
00:11:57The client is then assigned one or a combination of community-serving 16 meal plans to meet
00:12:04their food preferences and dietary requirements.
00:12:07We provide a week's worth of meals at a time, often for both the client and their family.
00:12:13In addition to the meals, the weekly delivery includes snacks of fresh fruit and yogurt
00:12:17and a quart of milk.
00:12:19We also provide nutritional education and counseling to those we serve so that they
00:12:23have the tools to continue on a healthy path once they've moved on.
00:12:28And the results are powerful.
00:12:30Chuck, a 66-year-old with diabetes and vascular issues, has lost over 50 pounds and avoided
00:12:36a foot amputation since receiving a cardiac diabetic diet from community servings.
00:12:43And Janet, a 60-year-old with an autoimmune disease and cancer, credits community servings
00:12:49with taking an intimidating burden off her plate by providing her with medically-tailored
00:12:55foods and allowing her to focus entirely on her other health needs.
00:13:00Our impact goes beyond the patients we serve.
00:13:03Food is medicine programs also benefit local food supply chains.
00:13:08Our local foods program intentionally sources as much food as we can from local providers,
00:13:13totaling over 50,000 pounds of local fish, fruit, and vegetables every year.
00:13:19We have made great strides in increasing access to integrated food with medicine, but more
00:13:24still can be done.
00:13:26Congress should increase research funding through the National Institutes of Health
00:13:30to explore the benefits of MTMs and should seek other avenues to integrate nutritional
00:13:35interventions into programs like Medicare.
00:13:39We thank Chairman Markey and Ranking Member Marshall for their brand new trio of bills
00:13:44that would task federal agencies with publishing nutrition best practices and to increase access
00:13:51to MTMs through community health centers.
00:13:54We also strongly support the bipartisan, bicameral MTM pilot bill led by Senator Booker
00:14:01and Ranking Member Marshall.
00:14:03We need to be increasing such connections between the healthcare system and the food
00:14:07system.
00:14:08Again, I thank the subcommittee for the opportunity to testify today and welcome any questions
00:14:14you may have.
00:14:16Thank you so much, Ms. Terranova.
00:14:18Next we're going to hear from Erin Martin, who is a gerontologist and serves as founder
00:14:24and director of FreshRx, a produce prescription program which collaborates with primary care
00:14:30clinics and local farmers to provide free nutritious produce to people living with diabetes.
00:14:37Ms. Martin serves as president of the Urban Ag Coalition and co-leads the Oklahoma Food
00:14:44is Medicine Policy Coalition.
00:14:46So we welcome you, Ms. Martin, whenever you feel ready, please begin.
00:14:52Chairman Markey, Ranking Member Marshall, members of the Help Committee, thank you for
00:14:56this opportunity to discuss the transformative power of the FreshRx Oklahoma program.
00:15:02My name is Erin Martin.
00:15:03I'm a gerontologist, the director of FreshRx Oklahoma, the co-lead of Oklahoma's Food is
00:15:10Medicine Policy Coalition, and a proud member of the National Produce Prescription Collaborative.
00:15:17I started working in long-term care when I was 15 years old.
00:15:21Since then, I have worked in all levels of long-term care, including HUD housing for
00:15:2662 and older, where I saw people on 15 to 32 prescription drugs per year.
00:15:32During that time, I attended the first and leading school of gerontology in the world
00:15:37at the University of Southern California.
00:15:40And in Italy with USC, I studied death and dying and began to study the blue zones where
00:15:45people die of something called old age on zero prescription drugs.
00:15:51I started to understand deeply the connection of food and health.
00:15:55When the pandemic hit, a physician from North Tulsa shared that his diabetic patients were
00:16:00compliant in their medications and their doctor's visits, but that their health was still declining.
00:16:06To try to address this, we co-founded FreshRx Oklahoma, a produce prescription program that
00:16:12launched in North Tulsa, a community with an eight-and-a-half-year, sometimes longer
00:16:17lifespan difference from South Tulsans, a community without a grocery store for 14 years,
00:16:24and a community with the highest mortality rates of diabetes in our county.
00:16:30Our program empowers individuals with type 2 diabetes by providing them with biweekly,
00:16:37fully-grown produce for 12 months, along with four to six cooking and nutrition classes
00:16:42per month and quarterly health metric checkpoints.
00:16:46Participants, or members as we call them, are either self-referred or referred from
00:16:52healthcare professionals at one of our 22 partnering primary care clinics.
00:16:58This also includes federally qualified health centers, PACE clinics, and clinics even serving
00:17:03the uninsured.
00:17:05Their partners utilize a prescription form to refer the patient and verify their diagnosis.
00:17:11From there, we enroll the member and they begin the program at the very next food distribution
00:17:16cycle where they receive a starter kit complete with cooking utensils, cookbooks, and more.
00:17:23This program has significantly shown success in reducing A1C levels and weight, enhancing
00:17:29both quality of life and reducing medical costs.
00:17:33With our first 300 patients, 80% have shown a reduction in their A1C level with an average
00:17:39reduction of 2.2 points.
00:17:42Our largest reduction we've seen went from a 13.6 to a 5.4 in less than six months.
00:17:49And our record weight loss was just hit at 116 pounds, fully reversing her type 2 diabetes
00:17:56and coming off of all of her medications.
00:18:00Many of our members report having had diabetes for over a decade, but experiencing improvements
00:18:06in just a matter of weeks in our program.
00:18:10I'm extremely proud of what FresherX has accomplished, but I'm also proud of my colleagues across
00:18:15the country who are leading other successful produce prescription efforts.
00:18:20There's many ways to provide these services, including prepaid debit cards that can be
00:18:24used in retail, farmer's market vouchers, and even online shopping models that work
00:18:30well for different communities.
00:18:34Programs must reflect the communities for which they serve, providing food that is culturally
00:18:39relevant and supporting dignity of choice.
00:18:44Our specific model supports local agriculture, stimulates local economies, and most importantly
00:18:50transforms lives through improved health.
00:18:53I'm pleased to share that since its beginning, FresherX has expanded into beyond North Tulsa
00:18:59to five rural cities with the Muscogee Creek Nation to serve their diabetic and pre-diabetic
00:19:05populations.
00:19:08Implementing food as medicine is a smart economic decision with an enormous return on investment.
00:19:15Our program success is a testament to the power of integrating a food as medicine approach
00:19:21with our healthcare framework and providing a regenerative, cost-effective solution to
00:19:27our nation's health crisis.
00:19:29The Senate Health Committee has an opportunity to integrate produce prescriptions across
00:19:33federal health programs.
00:19:36Doing so offers a promising pathway to not only manage and prevent chronic disease, but
00:19:41to save on healthcare spending and resurrect local economies.
00:19:46Again, thank you for considering the potential of food as medicine.
00:19:50I'm eager to answer any questions and discuss how we can expand these vital services to
00:19:55enhance health outcomes across our country.
00:19:58Okay.
00:19:59Well, Mr. Chairman, next I want to introduce Dr. Dariush Mozaffarian, who's the director
00:20:06of the Food as Medicine Institute at Tufts University located in Boston, Massachusetts.
00:20:11Dr. Mozaffarian is a cardiologist, a scientist, and globally recognized expert in nutrition,
00:20:17medicine, and public health.
00:20:19I've had the opportunity to work collaboratively with him since being a freshman in the House
00:20:24of Representatives, where we co-founded the Food as Medicine Working Program.
00:20:28As one of the leading experts on food as medicine, Dari was invited here today to share the vast
00:20:33contribution he's made in making food as medicine something we can apply successfully across
00:20:38our health system.
00:20:40Dari is also proof of the American dream.
00:20:42He's a child of immigrants.
00:20:44He couldn't get into Kansas State, so he went to Stanford University to get his bachelor's
00:20:48degree, an MD at Columbia University, and a doctorate in public health at Harvard University.
00:20:55Thank you for agreeing to testify and sharing your expertise with us.
00:20:58Dr. Mozaffarian.
00:20:59Well, Chairman Markey, Ranking Member Marshall, and distinguished committee members, thank
00:21:04you for the opportunity to share what I've learned and what I've seen from Americans
00:21:08across our great nation.
00:21:10As a heart doctor, I see firsthand people of all ages and backgrounds suffering from
00:21:15diet-related diseases.
00:21:17As a public health expert, I see the incredible challenges Americans face every day to obtain
00:21:22and eat nourishing food.
00:21:24And as a researcher, I study the science on how foods affect health, and I study the effect
00:21:29of policy changes to achieve well-being and health equity.
00:21:33Over the course of any given year, I see and speak with thousands of people, thousands
00:21:36of Americans, who know in their gut that our food is making them sick, and yet feel helpless
00:21:42to do anything about it.
00:21:43This inability to eat well is literally lethal.
00:21:47Poor nutrition is the top cause of death and disability in the United States.
00:21:51I should drop the mic there.
00:21:53Causing more harms than tobacco use, alcohol, opioids, physical inactivity, and air pollution.
00:22:00Each week, the food we eat is estimated to kill 10,000 Americans, cause 1,500 new cases
00:22:06of cancer, and cause 16,000 new cases of diabetes.
00:22:10Each week, these likely underestimate the full harms, given what we're now learning
00:22:14about the effects of our food on the gut microbiome, the brain, depression and mental
00:22:18health, child development, autoimmune diseases, immune function, and more.
00:22:23This is also driving societal discord.
00:22:26Each year, 40 million Americans, one in eight households, experience food insecurity, which
00:22:30is linked to worse nutrition, more diet-related disease, and greater healthcare spending.
00:22:35Americans with lower incomes in rural communities and from marginalized racial and ethnic groups
00:22:40are at highest risk.
00:22:41Our food is also an urgent matter of national security.
00:22:44Eight in 10 young Americans don't qualify for the military, and the leading medical
00:22:49disqualifier is overweight and obesity.
00:22:52Poor nutrition is crushing our economy, causing $1.1 trillion in economic losses every year
00:22:58from preventable healthcare spending and lost productivity.
00:23:01For diabetes alone, the US government alone spends nearly $200 billion each year on direct
00:23:07medical costs for a disease that is almost entirely preventable and treatable with better
00:23:11food.
00:23:12As detailed in my written testimony, the economic costs of diet-related diseases are also crushing
00:23:17US families, US businesses, the federal budget, and the national debt.
00:23:22The lack of attention to these harms of our food explains so much about the problems our
00:23:26country faces today.
00:23:28Tens of millions of sick Americans, hundreds of billions of dollars in preventable healthcare
00:23:33costs, suffering US businesses, exhausted state and federal budgets, and frankly, exhausted
00:23:39policymakers fighting over the shrinking remainder.
00:23:42Senators, if you want to do the things that you believe are important for the American
00:23:46people, you will never have the resources you need until we reduce healthcare spending,
00:23:51and this will not happen until we fix food.
00:23:54The nation state of diet-related disease is not okay.
00:23:57It's not normal, and we can fix it.
00:24:00Nutrition is the top cause of poor health, and yet historically has been ignored by the
00:24:04healthcare system.
00:24:05This is finally changing with food as medicine interventions.
00:24:08My written testimony describes the various types of food as medicine therapies you've
00:24:12heard from the preceding witnesses on these, their efficacy, and their cost equivalence
00:24:16or even cost savings compared to traditional medical treatments.
00:24:20As shown in many states and in private healthcare demonstration projects around the country,
00:24:24food as medicine can improve health and save money.
00:24:27There's almost nothing in healthcare that can do both of those things.
00:24:30Food as medicine programs can also support local farmers and regional food systems, serving
00:24:34as an economic engine for rural communities.
00:24:36With the current evidence in progress, the nation is at a tipping point to potentially
00:24:40accelerate food as medicine.
00:24:42Action is needed.
00:24:43Today, the vast majority of Americans cannot access these therapies, and more research
00:24:48and implementation are critical to assess which programs work best for which patients.
00:24:53My written testimony summarizes potential congressional actions in this area.
00:24:58For example, advancing food as medicine at community health centers, serving the most
00:25:02vulnerable Americans who will benefit, such as through S2840, introduced by Senators Sanders
00:25:07and Marshall.
00:25:08Advancing food as medicine in Medicare, such as through S2133, introduced by Senators Marshall,
00:25:13Cassidy, Booker, and Stabenow.
00:25:16Integrating food as medicine into the Older Americans Act, including produce prescriptions
00:25:20and medically tailored meals.
00:25:22Providing meaningful funding to NIH to launch Food as Medicine Centers of Excellence, a
00:25:26concept which has already received NIH clearance and is ready to go.
00:25:31And even utilizing report language to encourage food as medicine in Medicaid 1115 waivers,
00:25:36food as medicine pilots at CMMI, food and nutrition security screening and care referrals
00:25:41in the electronic medical record, and meaningful nutrition education for doctors, speaking
00:25:47to the national accreditation and licensing organizations that oversee U.S. medical education.
00:25:53Healthcare systems, payers, doctors, patients, public and private vendors, food retailers,
00:25:59pharmacies, advocacy and clinical groups, and even from our national polling, the American
00:26:03people all support food as medicine.
00:26:06It's time for congressional action to help bring food as medicine to the American people.
00:26:10Thank you for the opportunity to testify.
00:26:14Thank you, Dr. Mozaffarian.
00:26:16Next Mr. Chairman, I'd like to introduce James Carter Williams, the CEO and managing principal
00:26:22of iSelect Fund, a venture capital firm that invests in technology that bridges the gap
00:26:27between food health and ag tech.
00:26:30Mr. Williams has an extraordinary career, problem solving complex systems, an engineer
00:26:35by training, had a long stint in developing innovative cost-saving solutions for Boeing's
00:26:40technology planning process that brought the F-18 in under budget.
00:26:45He successfully invested in early-stage ventures in corporate research.
00:26:49He's now working to problem solve a more complex system, healthcare, with a unique mission
00:26:54centered on food as health.
00:26:56Our goal is to learn about the intersection of innovation and investment that will help
00:27:00combat the obesity and diabetic epidemic.
00:27:03He has an MBA from MIT Sloan School of Management and a BS in mechanical engineering from Rensselaer
00:27:10Polytechnic Institute.
00:27:12Thank you, Carter, for being here, and the floor is yours.
00:27:16Thank you, Chairman Markley, Ranking Member Marshall, and distinguished members.
00:27:21It's my pleasure to appear before you today to reflect on the innovations reducing the
00:27:25healthcare cost of poor nutrition.
00:27:27My name is Carter Williams.
00:27:28I'm an engineer with a degree from Rensselaer and MIT.
00:27:32Over the last 35 years, I've focused on innovation and complex systems, spanning aerospace, energy,
00:27:40agriculture, and health.
00:27:42I served in senior roles in Boeing's Phantom Works and several successful startups.
00:27:47Since 2014, I have led iSELECT, a venture fund focused on the theme, food is health,
00:27:54investing in more than 70 ag tech and health tech startups.
00:27:59Over those 10 years, we have also met with more than 5,000 entrepreneurs, and this is
00:28:04what we have learned.
00:28:06The U.S. spends $1.7 trillion on food and $1.9 trillion on the healthcare cost of poor
00:28:12nutrition.
00:28:14Type 2 diabetes kills 283 Americans every day.
00:28:18Goldman Sachs has concluded that the U.S. GDP would grow 1% annually if we cured obesity.
00:28:25In 2000, the U.S. sequenced the human genome, launching companies with breakthroughs in
00:28:30immunotherapy and vaccines, reshaping treatments in healthcare.
00:28:36But we still have a problem that can be solved with similar thinking.
00:28:42For 350,000 years, humans were thin.
00:28:44In the last 50 years, we're fat and diabetic.
00:28:49Innovation is stepping in.
00:28:50In the near future, grocery stores will offer seamless access to a nutritional coach to
00:28:55get you better food through medically tailored meals or natural low-cost forms of ozempic.
00:29:02You eat what you enjoy, and what you enjoy is better and affordable.
00:29:06Your calorie intake is 25% less than your parents, 45% less from processed food.
00:29:12You lose weight and gain muscle mass.
00:29:15Regenerative vegetables, frozen or fresh, are tasty, nutrient-dense, and affordable.
00:29:20Beef managed on grasslands with virtual fences are net carbon positive, deliver balanced
00:29:25omega-3s and 6s, and reducing clogged arteries.
00:29:30Processed foods are sweet and tasty, but zero diabetic impact, made with healthy sugars
00:29:35from agricultural waste.
00:29:37Prebiotics fuel your gut microbiome.
00:29:40You sleep better, and you have less depression.
00:29:43Medical care is now functional medicine for stalling disease, easily accessed.
00:29:50Health data is part of the grocery store mobile apps.
00:29:53The app knows your genome, your blood work, your blood pressure, and the food you purchase.
00:30:00Integrated into your health insurance, reminding you of quality choices, everyone gets the
00:30:05standard of care.
00:30:07Comorbidities are a distant memory.
00:30:10Your health data is protected by the blockchain, anonymized, integrated into synthetic control
00:30:14arm models, comparing your genetics and health to peer groups, improving the work at FDA.
00:30:21Inspired by the original Human Genome Project, innovation is driven by the Human Microbiome
00:30:26Project, the Human Nutrition Project, the Soil Microbiome Project, all working to improve
00:30:33the quality of the data we use for our science.
00:30:36Not all crops are healthy.
00:30:38Their nutrients vary.
00:30:40In field spectroscopy, reveal the array of nutrients in meat, fish, vegetables, and grains
00:30:45to form a nutritional quality control, empowering farmers, ranchers, CPGs, and processors to
00:30:51optimize nutrient density and cost.
00:30:54Product labels are accurate and complete.
00:30:58Startups use AI to scan every journal and historical artifact to find natural solutions
00:31:02that improve health.
00:31:04Testing thousands of natural products against digital twin of human nutrition and billions
00:31:09of configurations and speeding the development of new technology, replacing an array of pharmaceuticals
00:31:15with quality nutrients.
00:31:18Farmers have transitioned to biologics that rebuild the soil microbiome, improving crop
00:31:22nutrient intake.
00:31:24Crops are robust against disease, drought, and weeds.
00:31:27UAVs use precision sprayers and lasers to reduce chemicals, improving farmer profits,
00:31:33increasing yield, and safer food.
00:31:36These technologies are all real.
00:31:38They all exist today.
00:31:40Some are controversial, some more affordable, but more than enough to reduce the healthcare
00:31:46costs of poor nutrition.
00:31:48American entrepreneurs in agriculture, food, and health, working with FDA, USDA, NIH, and
00:31:54other NGOs can solve this problem, lowering cost, improving sustainability, increasing
00:32:01longevity, and driving GDP growth.
00:32:04Thank you.
00:32:06Thank you very much.
00:32:08And now we'll turn to questions from the subcommittee.
00:32:13The Older American Act includes essential nutrition programs for older adults, including
00:32:19meals at congregate sites like senior centers or delivered to their homes.
00:32:25As a member of the working group to reauthorize this law, I remain committed to this sacred
00:32:30responsibility.
00:32:31Ms. Martin, can you elaborate on how food as medicine can be incorporated into the Older
00:32:37Americans Act?
00:32:39Yes, thank you.
00:32:42I think that these federally qualified health centers, rural health centers, and other congregate
00:32:48meal programs would be drastically enhanced and produce incredible health outcomes by
00:32:54being integrated in those systems.
00:32:57And can you discuss how pilot projects in the Older Americans Act could demonstrate
00:33:02the benefits of integrating medically tailored meals or prescription food programs for older
00:33:08Americans?
00:33:09Yes, and we see most of the people we serve actually are over 50 and experiencing these
00:33:16outcomes consistently.
00:33:19There is a federally qualified health center that has a diabetic program.
00:33:24They offer some food bank boxes, but we also get referrals because we really enhance that
00:33:29program from that federally qualified health center.
00:33:32So we believe that having it more integrated in that system would be way more beneficial
00:33:37for the older Americans.
00:33:38And this is such a great bipartisan issue.
00:33:41You're not often going to have the Democratic witness from Oklahoma and the Republican witness
00:33:45from Massachusetts.
00:33:46Wow.
00:33:47So the recombinant political DNA here shows that many things are possible.
00:33:51So Ms. Terranova, you have served as the principal investigator for two large scale NIH studies
00:33:58examining the impacts of community servings meals on health outcomes.
00:34:03Why is investment in NIH for research like this so important?
00:34:07Well, it's, thank you, Senator, it's really critical.
00:34:12Could you turn on your microphone, please?
00:34:13Thank you.
00:34:15Yeah, it's really critical because policy leaders are feeling that there is a gap in
00:34:21research and in particularly in communities such as rural communities.
00:34:28So you know, community servings, as you know, has published five peer reviewed journal articles
00:34:36on the impacts of medically tailored meals on health outcomes and healthcare costs.
00:34:41And there have been other studies that were also cited in the Aspen Institute's recently
00:34:47updated report on food as medicine.
00:34:50But there still do exist gaps, and in particular in multi-site settings, in rural settings,
00:34:56and for specific populations.
00:34:59And so investing in research for NIH is really critical to addressing these gaps.
00:35:05Okay, so Dr. Mozaffarian, what further research, in your opinion, needs to be done on this
00:35:12Yeah, I think there's a lot of questions.
00:35:16Like anything in medicine, right, we know enough to get going and do things now, but
00:35:19we also need more research.
00:35:20I really like the NIH concept of these food as medicine centers of excellence that's built
00:35:26on the cancer centers of excellence model about, you know, I think in the 1960s, the
00:35:31NIH launched these cancer centers of excellence.
00:35:34Maybe later, I'll have to check the date.
00:35:35But now almost every state has one, and these centers of excellence integrate patient care
00:35:39with research, with community outreach, and with education.
00:35:43I think having these hubs of knowledge generation in regions across the country would be really
00:35:49important.
00:35:50There's questions we need to ask.
00:35:51You know, what's the right dose?
00:35:53Is it $50?
00:35:54Is it $100?
00:35:55How important is sharing with the family?
00:35:57You know, if the family's bigger, how much more food do you have to give?
00:36:02What should the duration of the program be?
00:36:03Some people may need this program for just a few weeks.
00:36:06Some people may need it for a few months.
00:36:08And like other things in medicine, some people may need it for their whole life, and we have
00:36:11to understand that.
00:36:13And then, so I think those are all really critical questions that need to be answered
00:36:17with better research.
00:36:19That could be done by NIH.
00:36:20It could be done by USDA.
00:36:21It could be done directly through CMMI and Medicaid.
00:36:25And, Dr. Mosfarian, how do you think cost savings in food is medicine programs relative
00:36:35to the growth of expensive medications like Ozempic that are used to treat diabetes and
00:36:40weight loss?
00:36:41Yeah, yeah.
00:36:42You know, one of the dirty secrets of health care is almost nothing saves money.
00:36:45If it did, we wouldn't have a $4.3 trillion health care system, and so blood pressure
00:36:50screening control, cancer screening control, cholesterol screening control, none of those
00:36:53things save money.
00:36:54They cost money.
00:36:55We get a good buy for the dollars we spend, but they cost money.
00:36:58Food is medicine is exciting because for the right patients, particularly very sick patients
00:37:02who receive medically tailored meals or produce prescriptions, the research suggests we might
00:37:06actually save money net of the program.
00:37:08So I think that's really exciting.
00:37:10I don't think they'll save money in every case.
00:37:12I think there'll be other cases where it'll be a good buy, just like, you know, giving
00:37:16a generic cholesterol-lowering drug is a good buy.
00:37:18So we shouldn't expect cost savings in every case.
00:37:21But I do think this is a really exciting area, and compared to GLP-1s, which Senator Sanders
00:37:27produced a report this week out of the health committee, that if half of Americans eligible
00:37:33for the drug went on the drug, we would double our national pharmacy spend on all prescription
00:37:37drugs combined.
00:37:39And so we just can't afford those drugs as effective as they are, and so we need to integrate
00:37:43nutrition and food is medicine and lifestyle together with GLP-1s to be able to mitigate
00:37:48that cost.
00:37:49Okay.
00:37:50Thank you.
00:37:51Senator Marshall.
00:37:52I'll defer to Senator Braun.
00:37:54Thank you, Mr. Chair and Ranking Member.
00:37:56I ran a company for 37 years prior to coming here, and I remember in 2008 how it got to
00:38:03a point where our health insurance premiums were going up to where we were lucky.
00:38:08It was only 5 to 10 percent.
00:38:10That was the line I'd get every year.
00:38:12It got to a point where I couldn't raise deductibles anymore, couldn't change underwriters any
00:38:17more often.
00:38:18I had to look at, and the insurance companies basically told me, they said, we are a system
00:38:23of expensive remediation, and we pay no attention to wellness and prevention.
00:38:29That sounded kind of philosophical, and then I dug into how that was going to work for
00:38:34me to lower costs and have healthier outcomes.
00:38:38Well, we did that all in one day.
00:38:41I took their advice, created healthcare consumers out of all my employees to where they watch
00:38:49what they eat.
00:38:51We give them every tool to do that.
00:38:54We have not had premium increases now in 16 years.
00:38:58A lot of it is watching what you eat, because the foods that are the worst for you generally
00:39:05get the most calories in them, and then you've got to work hard to shed the bare weight that
00:39:12you accumulate, and then you're not necessarily replacing it with good, wholesome foods.
00:39:18My question will start with Mr. Williams.
00:39:20I'd like each witness to give me your opinion.
00:39:23How did we get here?
00:39:25How much of it is a system of healthcare that they don't even give much study to nutrition?
00:39:33It is an expensive business of remediation, and then about our food supply production,
00:39:40which is more on processed foods as opposed to wholesome ones.
00:39:45I'd like to know who's more at fault when we really know that you should be eating better.
00:39:52Is it the healthcare industry that's not being voiceful enough, or is it big food processing
00:40:01that gives us generally many foods that just aren't nutritious for you?
00:40:05There's a lot in there.
00:40:07Yeah, there is.
00:40:08I think from an economic standpoint, it's notable that at the end of World War II, we
00:40:13said we don't like famine, and we've got to boost calorie production, and we set down
00:40:18the path of the Green Revolution, really, to stop worldwide famine.
00:40:22American innovation drove the cost down of those calories.
00:40:26Those calories tended to be, for various reasons, cheap, low-nutrition calories, and that sort
00:40:32of set this up.
00:40:33I think that same level of innovation with a different focus around nutrient density
00:40:38can change the food system itself, so that when you go to the grocery store, those kind
00:40:42of calories have been moved around a little bit.
00:40:44There's a lot more in there, but the basic food is moving to nutrient-dense, as Erin
00:40:50is working with when she uses regenerative crops.
00:40:53People like them better, they taste better, and they lead to an improvement.
00:40:58So the technology's moving in that direction.
00:41:01I think a challenge for healthcare is, over time, healthcare has been maybe more about
00:41:09healthcare, not about making people well.
00:41:13I think the movements by Dr. Hyman around areas like functional medicine, in terms of
00:41:18getting it before you get sick, are big shifts, and we're seeing that kind of new care delivery
00:41:23mechanism.
00:41:24It is unclear how to pay for it correctly, but when we take some of these solutions into
00:41:28the healthcare community, our entrepreneurs find it's very difficult to get them properly
00:41:33covered.
00:41:34You get into the morass of everything.
00:41:40So I want to agree with what Carter said about how we got here, and I would add the evidence
00:41:45that vitamin deficiency diseases were rampant in this country in the 1920s and 1930s, disease
00:41:50like pellagra and rickets and all these diseases.
00:41:52So in addition to the concern about getting enough calories for a booming world population,
00:41:57there was concern about vitamin deficiency diseases.
00:41:59So when you walk down the cereal aisle today and you see starchy, inexpensive calories
00:42:04from monocropped crops fortified with vitamins, that was a conscious creation of meeting the
00:42:09two scientific goals of the 20th century.
00:42:12There were no villains in that original goal.
00:42:14This was a very positive goal, and we did it.
00:42:16We probably prevented a billion people from starving, and we essentially eliminated vitamin
00:42:20deficiency diseases in most countries in the world.
00:42:23But we created unintentionally this hyper-processed, very monocropped food culture that has made
00:42:30us metabolically sick.
00:42:31And so it's that same mix of what got us here in the 20th century we can now use to go to
00:42:37the next phase, which is to combine government policy with private sector innovation with
00:42:41the best science.
00:42:43And we can do all that together and move forward.
00:42:44Before I run out of time, let's go down the line.
00:42:47Ms. Martin.
00:42:48Thank you.
00:42:49I think it's definitely a combination of both.
00:42:51I think having local and fresh food is really important, because when it's being shipped
00:42:55from long distances, it's prematurely picked and artificially ripened, and by the time
00:43:00it's in somebody's kitchen, it's very devoid of a lot of the nutrients.
00:43:04So having local food systems to support these food as medicine programs, I think, are vital.
00:43:10And then on the health care side, when we are enrolling these participants who, like
00:43:15I said, have had type 2 diabetes for a decade, we tell them that food, what all problems
00:43:22are you having?
00:43:23Oh, pain, depression, diabetes, all these other issues.
00:43:26You know, food could actually fix all that.
00:43:29And it's the first time that they're hearing about this.
00:43:33So a combination of both.
00:43:34Thank you.
00:43:38And Senator, I will just say, with respect to the medically tailored meal intervention,
00:43:44we have a dual focus that specifically address marginalized communities that, for people
00:43:50who experience both food insecurity and diet-related illness.
00:43:55And so we're not talking about people who are in a job who can prevent their disease
00:44:02through necessarily, through food.
00:44:06We are talking about people who have cancer, HIV, diabetes, very critical illnesses.
00:44:12The 5% of people who are accounting for 50% of health care costs.
00:44:18And so we're really in the business, I suppose, at Community Servings and within the Food
00:44:24as Medicine Coalition of addressing these illnesses as a treatment, as opposed to really
00:44:30a prevention.
00:44:31Thank you so much.
00:44:32I'll note that when we started producing food that had a lot of vitamins and kind of empty
00:44:38calories, that's when the health care industry really started to shoot up, which is now the
00:44:42biggest industry in our country, nearing 20% of our GDP.
00:44:46Thank you.
00:44:47Senator Smith, Senator from Minnesota.
00:44:52Thank you so much.
00:44:53Senator Markey and Senator Marshall, thanks to our panelists also for being here.
00:44:56This is super interesting.
00:44:58So you all are describing a health care system where costs are going up dramatically, at
00:45:03the same time that poor health is increasing.
00:45:07And food, which is arguably, has the biggest impact on good health and is the biggest cause
00:45:14of poor health, is sort of like knocking on the door of this system saying, let me in.
00:45:18Let me be, you know, I can be a part of the solution here.
00:45:23I think it's also true, and this is, I think you were alluding to this a little bit, Dr.
00:45:27Mozaffarian, that, you know, at the same time that this system is functioning so poorly,
00:45:32you have some big companies that are making a lot of money off of it, insurance companies,
00:45:39big food companies that are making a ton of money off of selling unhealthy food.
00:45:43So I think that that bears understanding as we try to figure out what to do here.
00:45:47There's so much that we could talk about, the research side of it, the side about developing
00:45:51products and therapies, and then the kind of the utilization side, the adoption piece
00:45:56of it.
00:45:57How do you get these products and therapies adopted?
00:46:00And so I want to actually focus on that a little bit as we think about what, you know,
00:46:04what we can do in Congress to support this.
00:46:08Maybe I'll start with Dr., with Ms. Terranova and Ms. Martin.
00:46:12Could you talk a little bit, just like hone in on one thing?
00:46:15I think we know that we can get, we're getting better adoption when you have medically tailored
00:46:22meals compared to a specialized dietary plan.
00:46:26I think I read that.
00:46:27I'm not sure if that's true, but could you just tell us if there's anything we can learn
00:46:30from those two products or therapies about how we can increase utilization or adoption
00:46:36by patients or consumers?
00:46:43I think, Senator, that it really gets to the question of what is a medically tailored meal
00:46:48and how are we defining it.
00:46:50And it's really important that there be uniformity and agreement around the standards and definitions.
00:46:58And the National Food is Medicine Coalition has just released an accreditation criteria
00:47:04and requirement that will, that standardizes what is this intervention.
00:47:10And it was developed by a committee of registered dietician nutritionists.
00:47:16And this is the model that has really been tested in the research that we've published.
00:47:21And so it's just very important that we all come to a consensus on what is a meal, how
00:47:28many meals a week, you know, what is the proportion.
00:47:31You're all talking the same language about what it is that you are prescribing or what
00:47:35the therapy, I'm using the kind of medical terms here, the therapies.
00:47:39Ms. Martin, would you, I mean, how do you see the issue of getting improved adoption
00:47:46or utilization for, say we've agreed on what the therapy should be?
00:47:51From the studies that I've read and how we've enacted this program is that I think the best
00:47:57results come from programs that are a hybrid model and having both education and food.
00:48:04And we really curate the food offerings that we provide.
00:48:09And so I think having these very well-defined programs and accredited education that they're
00:48:19going through, like just delivering food, yes, has impact, but really empowering people
00:48:25to have the knowledge to continue those behavioral changes.
00:48:28You know, in my home state of Minnesota, there are, we have many East African immigrants,
00:48:36we have many Latino people, we have many Hmong people, we have many Swedish people, everybody's
00:48:41cultures and food are quite different.
00:48:43How do you consider people's cultural preferences and their, you know, their culture broadly
00:48:48speaking as you think about what that medicine, what that food is that they're getting?
00:48:53That's a great question.
00:48:54So the majority of people that we serve are from the black community and indigenous.
00:49:00And we ask them what they would like.
00:49:03And no farmers at that time were growing collard greens.
00:49:06And so we commissioned the farmers to grow collard greens.
00:49:09And now we have more collard greens than we know what to do with.
00:49:12And so we're asking the people, and we also hire people from the community that reflect
00:49:17those that we serve.
00:49:19And we're asking for that input.
00:49:20We give a survey that says, what food do you like?
00:49:23What do you not like?
00:49:24So we look at kind of indigenous varieties of food.
00:49:26And we also look for growers that reflect that.
00:49:29So we have Hmong growers, black growers, integrated system, absolutely, yep, building a community.
00:49:35Right.
00:49:36Right.
00:49:37Mr. Williams, before I ever was a senator, I worked for General Mills, and I was a marketing
00:49:42person.
00:49:43And so as I'm thinking about you working on what you do from a venture capital perspective,
00:49:47a business perspective, how do you see this question of implementation, kind of utilization
00:49:53or uptake?
00:49:54I mean, in marketing language, you would be trying, you'd be talking about how you get
00:49:56trial.
00:49:57Yeah.
00:49:58So when you're dealing with an entrepreneur, you're trying to get customers to adopt the
00:50:03product.
00:50:04Right.
00:50:05And the main thing here is everybody wants to be healthier.
00:50:07And you really have to build a product that's so much better in a sense that people adopt
00:50:11it despite the friction.
00:50:13In many ways, what Erin's doing, she is doing that in the community.
00:50:17Most of the patients that she deals with had no idea that they could feel better if they
00:50:21ate better.
00:50:23It's a very basic thing.
00:50:24So from the standpoint of the way we see it, I would say that it's the people who will
00:50:29compete against General Mills introducing products that do meet the needs of consumers
00:50:36who want to be healthier, and that you're getting into that part of their psychology,
00:50:41and that they adopt it, and that General Mills follows in time.
00:50:45I will say that the Ozempic is driving processed food demand down by about 45% in certain patient
00:50:53populations.
00:50:54The cost of Ozempic is going down.
00:50:56So if that gets bigger, the General Mills of the world are going to be under a lot of
00:51:01challenge.
00:51:02And General Mills has been focused on sort of value engineering product to lower cost.
00:51:07They're going to start running into some challenges where they got to think differently about
00:51:10how they design the products.
00:51:12So they've got a lot of challenges on their face.
00:51:14Thank you, Mr. Chair.
00:51:15I've gone over my time.
00:51:16I appreciate it very much.
00:51:19Now we'll recognize, I'll just say that when I was a boy watching Superman, and all of
00:51:27a sudden, I'm told that if I can send three box tops from Frosted Flakes, this new product
00:51:34that they had, to Tony the Tiger, I would get a Superman t-shirt at home.
00:51:39And so we were moving from Corn Flakes, Cheerios, and Pep, to Frosted Flakes.
00:51:47I got a Superman t-shirt.
00:51:49So they knew what they were doing in marketing, for sure.
00:51:53And that t-shirt, by the way, completely shrunk in the first washing.
00:51:57So I learned about consumer ripoffs immediately.
00:52:02Senator Hickenlooper from Colorado.
00:52:04Great.
00:52:05Thank you, Mr. Chair.
00:52:06And thank all of you for being here.
00:52:09I appreciate your time and all your effort here.
00:52:13Community health centers have consistently led the way in a lot of the efforts around
00:52:17this.
00:52:18Colorado has a group of community health centers called Peak Vista Community Health Center.
00:52:27And they partner with Care and Share Food Bank.
00:52:30They serve 29 counties in Southern Colorado.
00:52:33It's almost half the size of the state.
00:52:37They've got a number of events where Care and Share will show up with a tractor trailer
00:52:42full of food.
00:52:45And they demolish it.
00:52:49These are things like back-to-school events or school physicals.
00:52:53Ms. Terranova, what role have you seen in terms of community health centers within food
00:53:00is medicine?
00:53:02How can we implement a model like that outside of, beyond community health centers?
00:53:09Community health centers really do play a vital role in both innovation, as well as
00:53:14in continuity of programs that exist.
00:53:19Community health centers are really key referral partners for our medically tailored home-delivered
00:53:25meal programs.
00:53:28And as you said, they can also offer pantry and programs right on site and are trusted
00:53:35advisors for the patients that they serve.
00:53:39So they can play really a critical role in maintaining and continuing these programs.
00:53:45Right.
00:53:46And I think it is amazing.
00:53:50And so I'm, I am a lifetime lover of sweet things.
00:53:56I was in the brewery business, brew pub business for a long time.
00:54:00So I've learned the hard way that moderation is the choice here in a lot of these things
00:54:05that genetically we, for various reasons, are inclined towards things that aren't necessarily
00:54:10good for us.
00:54:13I guess I was going to, we have a company in Colorado called Virta that actually provides
00:54:18coaches.
00:54:19It uses technology, keeps records, monitors glucose and other easily traceable biologic
00:54:28indicators, allows people to really, every day, be conscious of what they're eating and
00:54:34allows them to eat things in moderation.
00:54:37Maybe not as much as they did before, but at least in some cases, matches those epic.
00:54:43And without their supervision, I actually, you know, I got to the point where I was pre-diabetic
00:54:48a year ago.
00:54:49And so I basically almost quit sugar completely, as close as I could come, and dramatically
00:54:55reduced my alcohol consumption.
00:54:57I lost 10% of my body weight in the course of seven months.
00:55:00I thought I was sick.
00:55:02And yet that shows how much excess is there.
00:55:05In terms of how do we get this more accessible, and you raised the question or the example
00:55:11of Virta just because they engage people.
00:55:14People are coaching and they're, you know, they want to solve this issue for themselves.
00:55:20How do we get people to do something, assuming that we've got the resources, that isn't naturally
00:55:25their inclination?
00:55:26And obviously, the people that are very sick can resolve issues of pain and depression.
00:55:31I'm not worried about that.
00:55:33Those people that are going downhill, but consistently, but slowly.
00:55:37And I guess let's start down at the end with Mr. Williams and then Mr. Farian.
00:55:42I think things like Virta is, there are a lot of people in the medical community that
00:55:46don't even realize it works.
00:55:49So there is a bit of an education process of the medical community getting a better
00:55:55understanding that there are other interventions than putting somebody on a pill.
00:55:59Right.
00:56:00Then there's no drugs.
00:56:01Excuse me?
00:56:02I mean, Virta uses no pharmaceuticals at all.
00:56:04It's all just food and rearranging when you eat food and what food you eat and some level
00:56:09of moderation.
00:56:10Yeah.
00:56:11It's a multifaceted challenge, but I think that the one is the way doctors act.
00:56:18They need to learn more about these solutions.
00:56:21What we're saying here on the panel, there are doctors, I think, that really don't believe
00:56:25that these kind of solutions can step in.
00:56:27The second is, you'll see the first wave of things like this.
00:56:31Then you'll get a bandwagon effect.
00:56:34You know, the first one person started using a computer, nobody else used it.
00:56:38Then everybody else became more obvious.
00:56:40We haven't gotten to that bandwagon effect.
00:56:42When we get to that bandwagon effect, we're going to start seeing simpler versions of
00:56:46it.
00:56:47So we're on that pathway to it.
00:56:48I don't know if I can give you a trick to it, other than to recognize the Virta system
00:56:52does not scale to 200 million people.
00:56:56So we've got to move to that next level of better information exposure to everybody else
00:57:00that it's the art of the possible.
00:57:03And I'd add that the way I look at it, Willie Sutton, the bank robber from the 30s, he was
00:57:08arrested and they said, why do you rob banks?
00:57:10He said, that's where the money is.
00:57:12And so when I look at solutions to the food system, we've been driving towards cheaper
00:57:15calories, cheaper food.
00:57:16We need to flip that and reward farmers, producers, consumer packaged goods companies, retailers
00:57:22that are selling healthier food through dollars that are already spending, particularly dollars
00:57:26in health care.
00:57:27And so I have a vision that the food is medicine movement, which is built into health care,
00:57:31also then starts to shift the incentives for how we produce food from the ground up and
00:57:35really just creates a virtuous cycle instead of a negative vicious cycle so that ultimately
00:57:40Americans that aren't even in a food is medicine program, they have healthier choices at the
00:57:43grocery store.
00:57:44The cereals are better.
00:57:45The snack bars are better.
00:57:46We need processed and packaged food.
00:57:48We're not going to get rid of that, but we can make those healthier with better science
00:57:51and with investment.
00:57:52And so right now we're pouring money down into health care and taking money away from
00:57:58every other priority, including food.
00:57:59If we put some money into food, we can start to reverse that cycle and make food healthier
00:58:03for everyone.
00:58:04Yeah.
00:58:05Thank you.
00:58:08I think the health coaching aspect is great.
00:58:10Like you really, you really can get that referral from the doctor and then have someone hand
00:58:15hold them through that process.
00:58:17And that's what the doctors love that champion this program.
00:58:20They feel like this isn't, this isn't an extra shot or another pill.
00:58:24This is someone who will really walk through this with you.
00:58:26And so there's some great online shopping models for produce prescription, one called
00:58:30attain health.
00:58:32That's out of Kansas city and serving many states.
00:58:34And they have a health coach model on their platform.
00:58:39And that's pretty much all you need.
00:58:41And then you've, you've got it all fixed right there.
00:58:44Mr. Last word.
00:58:48Just last word to emphasize the importance of trusted relationships.
00:58:53And so those community health centers and organizations like ours have that trusted
00:58:59advisor, the registered dietitian, nutritionist, the other community members who really play
00:59:05such an important role in that coaching coaching is only as good as, you know, people will
00:59:11listen to it.
00:59:12So no, I should, I meant that was in my mind to say at the very beginning as a, as a framing
00:59:18element, but I appreciate that.
00:59:20You're exactly right.
00:59:21Mr. Chair.
00:59:22Yep.
00:59:23Thank you.
00:59:24And first, let me ask unanimous consent to enter into the record.
00:59:27Seven statements outlining stakeholder food is medicine priorities without objection.
00:59:33So ordered recognize Senator Marshall.
00:59:35Thank you, Mr. Chairman.
00:59:37Start with Mr. Williams.
00:59:38What obstacles exist that block us from harnessing personalized medicine today?
00:59:47I think that building on the last point, when we look at least from an entrepreneurial
00:59:52standpoint, the startups that we see, when you're a startup in this space, you have to
00:59:56make a decision whether you're going to be in the CMS lane or not.
01:00:00Okay.
01:00:01And if you're going to be in the CMS lane, then you got to comply with how it works.
01:00:05And there are things I know the entrepreneurs do that are not what they know is right for
01:00:10the patient, but is right because of the structure of how CMS works, not a criticism of CMS.
01:00:17It's really that they're there to deal with sick people, not proactive.
01:00:21So I think that the front end on CMS and also on FDA standpoint in terms of what is nutrition,
01:00:29their medical claims that we see in the new products that have more nutritional density
01:00:34that can't be made because when you go into FDA, it falls into a level of approvals that
01:00:39make it very difficult for an entrepreneur bringing new products to market to get through
01:00:44that buzzsaw.
01:00:45So I think both FDA and CMS and that front end, if we're expecting stuff to come from
01:00:50the innovators into this space, they need that pathway cleaned up a little bit or they
01:00:55got to go it alone and it's got to take longer.
01:00:58Okay.
01:00:59Ms. Martin, how would you handle the reimbursement part of this?
01:01:04What would you suggest that we should do to better reimburse for the food is medicine
01:01:09component?
01:01:11The reimbursement should absolutely be integrated into the healthcare model.
01:01:17There are about 14 states that are either pending or have already passed 1115 waivers
01:01:22that are implemented into state Medicaid and there's already Medicare and Medicare Advantage
01:01:28programs offering this as a reimbursable.
01:01:31I would think that it would need to be a preauthorization for at least a year and that would be paid
01:01:37up front to cover the food and the education.
01:01:39Are you seeing it with any ACOs?
01:01:42I have not.
01:01:43Okay.
01:01:44All right.
01:01:45Dr. Mazzaferian, we got to talk about milk just for a second.
01:01:49I'm kind of the champion of whole milk up here.
01:01:51Can you just speak a little bit, have you done any research about whole milk, which
01:01:55by the way, tastes better and the kids actually drink it and we're going to have a whole new
01:01:59generation of boys and girls that develop osteopenia, osteoporosis at a much younger
01:02:04age.
01:02:05How do you feel about whole milk and what does your research show?
01:02:08One of the reasons I got into nutrition was in the 90s when I was doing my medical training,
01:02:12it was the height of the low-fat diet recommendations.
01:02:15When I read the science to educate myself as a doctor who wasn't receiving training
01:02:19on nutrition, the science in the 90s didn't support a low-fat diet.
01:02:24We were doing the best we could, but the policy was 10, 20 years behind the science.
01:02:31I knew right then that I had to really understand dietary fats.
01:02:35I've done a lot of research on dietary fats.
01:02:38Although most Americans don't realize this, the dietary guidelines have quietly dropped
01:02:42the focus on low total fat.
01:02:44There is no longer a focus on low total fat in the dietary guidelines, which is appropriate.
01:02:47There's still a focus on low saturated fat, which I think is misguided and not actually
01:02:51supported by the evidence.
01:02:53I hope the current dietary guidelines fixes that.
01:02:56What that does is make recommendations for low-fat or non-fat dairy.
01:03:01We've done research using observational studies, using biomarker studies, using meta-analysis,
01:03:06looking at a range of types of studies.
01:03:09There's no evidence that low-fat or non-fat dairy is healthier than whole-fat dairy.
01:03:13There's some evidence that whole-fat dairy may be healthier than non-fat dairy, even
01:03:17the other way.
01:03:18From my perspective, we don't have enough evidence to only recommend low-fat or non-fat
01:03:23dairy.
01:03:24We should be telling people to eat what they choose, and we need more science.
01:03:28I think the second point I would make is there's more interesting evidence about the type of
01:03:32dairy.
01:03:33Fermented dairy, like yogurt with probiotics or cheese, which is actually the top fermented
01:03:37food consumed in the U.S., may be particularly healthful.
01:03:40I think we need more research on fermented dairy foods.
01:03:43Yeah, and remind everybody that with the whole milk, you can absorb the fat-soluble vitamins
01:03:47A, D, E, and K.
01:03:49It just makes sense to me, especially for my pregnant mom, to let them have whole milk.
01:03:53Go back to Mr. Williams.
01:03:54Talk a little bit more about regenerative crops and nutrient-dense food.
01:04:00What does that mean to you?
01:04:01How do we get to them, and do they taste better?
01:04:05You can imagine that evolution says if something is more nutrient-dense, you would want it
01:04:11to taste better, so you remember to eat it 200,000 years ago.
01:04:16It's the case that taste and nutritional density tend to correlate with each other in crops.
01:04:21What we have found is that nutritional quality tends to come from the soil.
01:04:25If you enhance the soil microbiome, you tend to have more nutrients available, the more
01:04:30nutrient uptake.
01:04:31Farmers are learning a lot better how to balance both synthetic fertilizer and the microbiome,
01:04:39and shifting into a mindset where regenerative is working.
01:04:43Further, what Aaron has been seeing is that you can grow those crops in amongst existing
01:04:48agricultural products.
01:04:50So if someone is a 200,000-acre row crop farmer, can also put two or three acres and work around
01:04:56regenerative.
01:04:57Then that supply chain is more local.
01:04:59It can be done 10 months out of the year, and then directly supply rural areas with
01:05:04more nutrient-dense.
01:05:05Ultimately, that nutrition comes from the soil.
01:05:08Mr. Chairman, I just want to say again thank you for letting us have this hearing.
01:05:13You don't have to circle back to one of the statements you made that FDR was concerned
01:05:16about the malnutrition incidents in this country.
01:05:19I would postulate our incidence of malnutrition today is higher than it was in the 1940s.
01:05:24We have plenty of calories.
01:05:25That's not what I'm talking about.
01:05:27The nutrition quality of our diet has deteriorated for a lot of reasons.
01:05:31I wish I could wave my hand and fix this.
01:05:33This is something I've worked on for 30 years and still struggle to find that perfect place.
01:05:39Congratulations to the folks that are finding success doing and implementing.
01:05:43That's not easily done, so congratulations to you all.
01:05:47Thanks again to all of our participants today for your testimony.
01:05:52Thank you, Senator, very much.
01:05:55My father was actually a milkman.
01:05:57The one thing we got was whole milk, butternut margarine, ice cream.
01:06:03My wife is a physician, and she does say that one thing that my brothers and I don't have
01:06:08to worry about is osteoporosis.
01:06:10We were definitely fed the preventative medicine as children.
01:06:19If I may, Dr. Mozaffarian, when I was a boy growing up with Tufts University a mile from
01:06:27my house, we had Jean Maier writing a column in probably 200 newspapers every week on nutrition.
01:06:37He became the president of Tufts University.
01:06:40He died in 1993, but he was the world's leading nutritionist.
01:06:44To a certain extent, that's why you're there, because of the legacy of Jean Maier.
01:06:48Could you tell us, in the 30 years since Jean Maier passed, what would he learn today
01:06:56that he didn't know back then in 1993?
01:06:59What has the research developed that the greatest nutritionist in the world didn't know?
01:07:06I'm the Jean Maier professor at Tufts, and so it's quite a legacy.
01:07:10One of the reasons I actively try to bring science into action, which is what Jean Maier's
01:07:14legacy was.
01:07:15He was not an armchair academic.
01:07:19He fought at the Battle of Dunkirk as a French infantryman and helped the British escape
01:07:24across the Channel and then fought in the French underground and in North Africa.
01:07:29I think what has changed since Jean Maier passed is the unbelievable biologic complexity
01:07:36of how food affects our bodies.
01:07:39When Jean Maier was in his prime and training as an excellent scientist, we thought about
01:07:45macronutrients and vitamins and energy processing.
01:07:48That's how a lot of Americans still think about food.
01:07:50They look at the back of the package and look at the calories and the vitamins.
01:07:54Food is more than vitamins and calories.
01:07:56Food is biologic information.
01:07:58Everything we eat is biologic information that affects almost every cell in our body.
01:08:04Jean Maier would be amazed at how foods affect our gut microbiome, the fermentable fibers,
01:08:09the phytonutrients, the phenolics.
01:08:11He would be amazed at discoveries of things like epicatechin in apples or oleocanthal
01:08:16in extra virgin olive oil or EGCG in tea.
01:08:19These molecules that at nanomicrogram quantities have biologic effects.
01:08:27In the public literature, we've measured about 100,000 known compounds in food.
01:08:34There are startups like Bright Seed that I advise in California that have now documented
01:08:39two million previously unknown compounds in plant foods and their biologic effects.
01:08:45I think Jean Maier would be amazingly gratified and excited about this future where we really
01:08:50start to unpack all of these unbelievable biologic effects of food and how they can
01:08:54be our medicine and improve our health.
01:08:57That is so great.
01:08:59As a precursor to this hearing, back in 1986, I was able to include language in a bill with
01:09:07the support of Governor John Sununu, Republican of New Hampshire, and proud Tufts graduate
01:09:12into the bill, which then helped Jean Maier to build a new facility for research.
01:09:19So I think he'd be very gratified at the research that has now been conducted at the building
01:09:25that he recommended be constructed and that you are the Jean Maier professor advancing
01:09:30his science and helping us all to understand much better the impact which food has upon
01:09:36all of us and how ultimately food can be and should be medicine for every person on
01:09:42this planet.
01:09:43So I thank Senator Marshall for recommending this hearing and his staff and all of our
01:09:49great witnesses for all of your very, very helpful testimony here today.
01:09:54And with that, this hearing is adjourned.
01:09:57Thank you.